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Objective: Suicide is a leading cause of death among American Indian/Alaska Native (AI/AN) young people aged 10-19 years in the United States, but data collection and reporting in this population are lacking. We examined results of an oversample project in New Mexico to determine the association between resiliency factors and suicide-related behaviors among AI/AN middle school students.Methods: We conducted analyses using data from the 2019 New Mexico Youth Risk and Resiliency Survey for students in grades 6 through 8. An oversampling method was used to increase the sample size of AI/AN students. We used logistic regression to determine the association between resiliency factors and suicide indicators among AI/AN students, stratified by sex.Results: Among female AI/AN students, community support had the strongest protective effect against having seriously thought about suicide (adjusted odds ratio [aOR] = 0.23; 95% CI, 0.14-0.38), while family support was significantly associated with the lowest odds of having made a suicide plan (aOR = 0.15; 95% CI, 0.08-0.28) and having attempted suicide (aOR = 0.21; 95% CI, 0.13-0.34) (P< .001 for all). Among male AI/AN students, school support had the strongest protective effect against all 3 outcomes: seriously thought about suicide (aOR = 0.34; 95% CI, 0.19-0.62; P< .001), having made a suicide plan (aOR = 0.19; 95% CI, 0.09-0.39; P< .001), and having attempted suicide (aOR = 0.27; 95% CI, 0.12-0.65; P= .003).Conclusions: Oversampling AI/AN young people can help accurately quantify and understand health risk behaviors and strengths of this population, leading to improved health and wellness. Family, community, and school-based support should be considered in interventions geared toward suicide prevention among AI/AN young people.

Objectives: Colorectal cancer (CRC) incidence and mortality are twice as high among Alaska Native people as among non-Hispanic White people in the United States; as such, colonoscopy is a recommended screening test for Alaska Native people. Adenoma detection rate (ADR) is measured in patients at average risk of CRC undergoing initial screening colonoscopy and reflects the prevalence of precancerous polyps in a screened population. We evaluated the ADR among Alaska Native people living in Interior Alaska.Methods: This project evaluated the ADR among Alaska Native and American Indian adults aged ≥40 years (N = 460) living in Interior Alaska, using a retrospective medical record review of patients referred for screening colonoscopy from February 1, 2018, through March 31, 2022. The main outcome measure was ADR, stratified by age and sex.Results: The ADR was 45.0% overall: 43.0% among women and 47.1% among men. Among patients aged ≥50 years, the ADR was 67.1%: 62.7% among women and 70.7% among men. Among patients aged 40-49 years, the ADR was 34.4%: 35.3% among women and 33.3% among men.Conclusions: Measured ADR was high among Alaska Native men and women aged ≥50 years in Interior Alaska and in all age groups that were screened. These findings have implications for which CRC screening methods, intervals, and age to begin screening are most appropriate for Alaska Native people, as well as the need for future research on the pathology, etiology, and natural history of CRC in this population.

Tribal Epidemiology Centers (TECs) are an essential and unique part of the public health system and an important part of federal efforts to improve the health status of American Indian and Alaska Native people. Pursuant to federal statute, TECs serve the 574 federally recognized Tribes (hereinafter, “Tribes”) and their members across the United States, as well as American Indian and Alaska Native people in general. The COVID-19 pandemic has highlighted the need for timely, complete, and accurate public health data, particularly for American Indian and Alaska Native communities and others who may have been disproportionately impacted by COVID-19. This article reviews the history and importance of TECs and federal statutes governing TECs’ ability to access and use protected health information for public health purposes. TECs and Tribes often encounter difficulty receiving public health data from state and federal agencies despite their designation as “public health authorities” under the Health Insurance Portability and Accountability Act and associated regulations. Limited access to this information hinders the statutory mission of TECs as well as Tribal monitoring of and response to public health threats such as SARS-CoV-2. Agency acknowledgment and compliance with current federal law regarding data sharing with TECs are essential to improve data access and the fragile public health of Tribal communities.

Objective: To better understand health experiences among Two Spirit and lesbian, gay, bisexual, transgender, and queer and questioning (LGBTQ+) American Indian/Alaska Native (AI/AN) people, we examined experiences with access to health care of 223 AI/AN Two Spirit and LGBTQ+ people.Methods: Participants of the Pride and Connectedness 2020 survey, conducted through the Northwest Portland Area Indian Health Board, were asked about barriers to seeking and accessing care through a 10-question scale. We compared cisgender and gender-diverse participant demographic and scale responses to explore potential differences based on gender identity using the Pearson χ2test of independence and ordinal logistic regression, respectively.Results: Both cisgender and gender-diverse participants experienced at least some difficulties accessing health care. Finances, lack of psychologists/other mental health support, and lack of psychological support groups for Two Spirit and LGBTQ+ communities were the top 3 barriers to care experienced by all participants (84%, 82%, and 80%, respectively). Compared with cisgender participants, gender-diverse participants were more likely to report difficulties accessing care for nearly all questions on the 10-question scale and nearly 3 times more likely to report fear of being mistreated within the health care system based on their gender identity (adjusted odds ratio = 2.9; 95% CI, 1.8-4.9; P< .001).Conclusions: Increased access to mental health services and improved health care provider training that focuses on culturally relevant and gender-affirming practices would benefit the health and well-being of AI/AN people who identify as Two Spirit and LGBTQ+.

Objectives: The Inter Tribal Council of Arizona, Inc (ITCA) Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides nutrition services for families by partnering with local vendors. In 2009, the US Department of Agriculture (USDA) instituted the WIC Vendor Cost Containment Final Rule, which required WIC programs to group vendors with similar characteristics. USDA issued guidance for evaluating and constructing vendor peer grouping systems in 2017. We constructed vendor peer groups using USDA recommended methods.Methods: We used ITCA WIC vendor and redemption data to construct composite variables for mean food basket cost as the outcome in linear models using the following predictors: business model, Supplemental Nutrition Assistance Program (SNAP) store type, WIC total sales, number of Universal Product Codes (UPCs) redeemed, number of cash registers, store square footage, rural–urban commuting area codes, 2010 Frontier and Remote (FAR) area codes, distance to the closest interstate in miles, and urban or nonurban location. We developed an ITCA WIC vendor peer group system.Results: We examined 146 ITCA WIC vendors. Final complete vendor peer groups for ITCA WIC in linear regression models included SNAP store type (P< .001), number of cash registers (P< .017), and FAR codes (P< .001). FAR codes were important, while other geography measures were not.Conclusions: Using vendor peer groups can improve cost containment measures and the integrity of WIC services. Other WIC programs can use FAR codes as a USDA-required geography measure for local vendor peer group evaluations.

Objective: Data were essential to public health decision-making during the COVID-19 pandemic, yet no single data source was adequate for Tribes in Montana and Wyoming. We outlined data access, availability, and limitations for COVID-19 pandemic surveillance response to improve future data exchange.Materials and Methods: The Rocky Mountain Tribal Epidemiology Center (RMTEC) used various data sources to deliver data on the number of COVID-19 cases, deaths, and vaccinations at local, state, and regional levels to inform Tribes in Montana and Wyoming. RMTEC reviewed state, federal, and public datasets and then attached a score to each dataset for completeness of demographic information, including race, geographic level, and refresh rate.Results: The RMTEC COVID-19 response team shared data weekly on the number of COVID-19 cases, deaths, and vaccinations distributed and the percentage of the population vaccinated with Tribal health departments in Montana and Wyoming. The Indian Health Service Epidemiology Data Mart dataset scored the highest (24 of 30), followed by datasets from Montana (18 of 30) and Wyoming (22 of 30). Publicly available datasets scored low largely due to data aggregation across larger geographic areas and lack of demographic variables.Practice Implications: The absence of data on race and ethnicity from publicly available data and lack of access to real-time data limited RMTEC’s ability to provide Tribal-specific updates on COVID-19 cases, deaths, and vaccinations to Tribal health departments. RMTEC should be fully funded to provide the necessary resources for data management and the capacity to respond to data requests from Tribal health departments and their programs to address current and future pandemics. Federal and state agencies should also be educated on Tribal Epidemiology Centers’ public health authority status to improve access to infectious disease data among those agencies.

Objectives: Black, Indigenous, and People of Color have borne a disproportionate incidence of COVID-19 cases in the United States. However, few studies have documented the completeness of race and ethnicity reporting in national COVID-19 surveillance data. The objective of this study was to describe the completeness of race and ethnicity ascertainment in person-level data received by the Centers for Disease Control and Prevention (CDC) through national COVID-19 case surveillance.Methods: We compared COVID-19 cases with “complete” (ie, per Office of Management and Budget 1997 revised criteria) data on race and ethnicity from CDC person-level surveillance data with CDC-reported aggregate counts of COVID-19 from April 5, 2020, through December 1, 2021, in aggregate and by state.Results: National person-level COVID-19 case surveillance data received by CDC during the study period included 18 881 379 COVID-19 cases with complete ascertainment of race and ethnicity, representing 39.4% of all cases reported to CDC in aggregate (N = 47 898 497). Five states (Georgia, Hawaii, Nebraska, New Jersey, and West Virginia) did not report any COVID-19 person-level cases with multiple racial identities to CDC.Conclusion: Our findings highlight a high degree of missing data on race and ethnicity in national COVID-19 case surveillance, enhancing our understanding of current challenges in using these data to understand the impact of COVID-19 on Black, Indigenous, and People of Color. Streamlining surveillance processes to decrease reporting incidence and align reporting requirements with an Office of Management and Budget–compliant collection of data on race and ethnicity would improve the completeness of data on race and ethnicity for national COVID-19 case surveillance.

In March 2020, a Tribal telehealth program—the Indian Country Extension for Community Health Outcomes (ECHO)—added emergency COVID-19 to its programming to support the pandemic response. A long-standing relationship with a network of Indian Health Service, Tribal, and urban Indian clinicians supported a rapid launch of the COVID-19 telehealth program. This nationwide service offered primary care clinicians and staff serving American Indian/Alaska Native people access to virtual learning opportunities, expert clinical recommendations, technical assistance, and capacity building. From March 12, 2020, through April 30, 2021, the program provided 85 clinical sessions in 12 months, with an average participation of 120 attendees per clinic (N = 11 710). Attendees could complete a voluntary evaluation form for each session via an online link. A total of 2595 forms were completed. Attendees came from 33 states and 206 unique locations, primarily from the Pacific Northwest (n = 931, 35.9%). Most pharmacists (78.1%), providers (ie, medical doctor, doctor of osteopathy, advanced practice nurse, physician assistant, or clinical nurse midwife; 70.8%), and nurses (59.6%) gave the sessions the highest rating of “very satisfied.” The highest proportion of attendees indicating that they planned a change in practice were pharmacists (68.0%), nurses, (64.1%), and providers (61.3%). Most attendees (93.1%) said that the COVID-19 sessions gave them a sense of social support. Lessons learned were that (1) a telehealth platform can be quickly retasked for emergency response with no further delays, (2) a telehealth network can be scaled up quickly with participation from preexisting relationships, and (3) the platform is flexible and adaptable to the needs of participants. An existing telehealth program can be a key part of timely, relevant, large-scale emergency readiness and response efforts.