Women and Health Research Ethical and Legal Issues of Including Women in Clinical Studies: Volume 2: Workshop and Commissioned Papers (1994) / Chapter Skim
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19 Health Status of American Indian and Alaska Native Women
19 Health Status of American Indian and Alaska Native Women
Pages 192-215
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From page 192... ...
EIISTORICAL FACTORS In contrast to other ethnic minority groups now encompassed within the United States, American Indians and Alaska Natives are descendants of aboriginal peoples who had been in North America for several thousands of years prior to European contact. Archaeologists, physical anthropologists, linguists, and e~nchistorians continue to accumulate lmowledge about dates and paths of migrations, which are presumed to stretch hom the northeastern portions of Asia, across the Bering Straits, and into the "New World" ofthe Western Hemisphere.
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From page 193... ...
An epidemic of measles that occurred within the last quarter-century in a South American aboriginal group with no immunity provides a glimpse of deteriorating conditions that occurred in the wake of smallpox (and other) epidemics from the seventeenth to the nineteenth century.
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From page 194... ...
and infant mortality rate (55 percent of deaths occurred in the first year of life) were high, and the median age was 15 years.
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From page 195... ...
Paul, New York, and San Francisco, but job training and employment did not always materialize and many had to rely on public assistance. As a result of relocation, however, less than 50 percent of Indian people now reside on independently governed reservations (often in widely separated areas3, and there are about 300 autonomous groups in the United States.~0~3 In Alaska, 22 ethnic groups are dispersed in 250 villages, and some reside in or near major cities and towns.34 It would be exceedingly difficult to conduct a national survey of health status of American Indians and Alaska Natives.
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From page 196... ...
services. The predominant health problems among American Indians and Alaska Natives now stem from behavioral risk factors directly related to injuries and chronic diseases.20'' Since 1959, the Sanitation Facilities Construction Program of the IHS has improved housing as well as established safe water supplies and adequate waste disposal facilities.22 As might be expected, there are still unmet needs for a variety of interventions and health services for Native Americans both on and off of reservations.'9 Common problems for adults include lack of prenatal care, need for access to substance abuse or diabetes treatment, and excess deaths from cigarette smoking and alcohol abuse.23 Problems for adolescents include lack of access to substance abuse or other mental health treatment; deaths from suicide are especially disturbing.24~5~6 Cigarette Smoking Although cigarette smoking among Native Americans has received comparatively little attention, rates are higher than for whites.
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From page 197... ...
Highest rates were found in the Plains region, and a separate study of four Indian communities in Montana during 1987-1989 found current smoking rates of 54.5 percent for women and 50.7 percent for men. Smoking cessation programs for Indian women are important, since infant mortality attributed to maternal smoking includes both respiratory disease and sudden infant death syndrome (SIDS)
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From page 198... ...
However, gestational diabetes mellitus is widespread among Native American women and can lead to higher birthweight babies as well as to Type 2 diabetes in mothers.42 In a regional study of behavioral risk factors, about 25 to 35 percent of Native American women (and 25 to 30 percent of Native American men) were found to be overweight (body mass index higher than 27.3 in women and 27.8
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From page 199... ...
In 1989, one study reported that poor health status was linked to overweight and to poor body image among 65 percent of Indian youth. A follow-up study of 1,012 diabetic male and female Native Americans in Oklahoma examined mortality rates and causes of death.43 The cohort consisted of 379 men and 633 women diagnosed win non-insulin-dependent diabetes mellitus at baseline during the period 1972-1980.
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From page 200... ...
They also reported having sexual partners who resided both on and off reservations, which could facilitate transmission of HIV infection from urban to rural areas, and encourage spread of HIV into small communities. The IHS conducted an HIV seroprevalence survey for the period July 1, 1989, to June 30, 1991.49 Sources were 37,681 blood specimens obtained from persons being evaluated for STD, entering drug and alcohol treatment programs, or receiving prenatal care in the first or bird trimester.
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From page 201... ...
.52 A General Accounting Office (GAO3 investigation has examined allegations of genocide by the Bureau of Indian Affairs and the IHS. In a sample of four out of 12 IHS service areas, 3,406 Native American women were found to have been sterilized dunog 1973-1976.
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From page 202... ...
mortality are SIDS, congenital anomalies, respiratory distress syndrome, disorders related to short gestation and low birthweight, and pneumonia and influenza.9 It has been estimated that SIDS accounts for40 percent of postneonatal deaths and 25 percent of infant mortality in Native Americans.56 Infant mortality and neonatal death rates vary across the IHS service areas, with lowest rates in the southwestern states and highest in the northern plains and northwest states.9~57 Infant mortality and neonatal death rates in the Southwest were higher in the past, having improved in recent years, and reflect concerted efforts on the part of the IHS to improve outreach efforts to pregnant women.9~ 59 Special services are provided to young primigravida women,60 since in 1987, 19 percent of all low-birthweight Indian infants were born to mothers under age 20.9 Cancer, Cardiovascular Disease, and Tuberculosis A meta-analysis of cancer incidence rates in American Indians versus the general populations found reduced incidence of cancer at most sites. Decreased incidence was noted for colon, breast, and uterine cancer.
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From page 203... ...
Adequate screening, contact tracing, and treatment efforts by the IHS are being mobilized to attain this objective. Rising rates of cardiovascular disease among Native Americans are the focus of the "Strong Heart Study."64 Risk factor levels were examined for Indian people living in central Arizona, southwestern Oklahoma, and North and South Dakota.
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From page 204... ...
Hypertension was high in Oklahoma tribes and the Pima All groups had high rates of diabetes and of obesity, but rates were highest among the Punk Interestingly, more than 90 percent of Pima reported "full-blooded" heritage, in contrast to 73 percept ofthe Oldahoma tribes and less than half of the Sioux.65 Mental lIealth It is asserted that mental health problems, including depression, anxiety, suicide, and substance abuse, are greater among Native Americans.66 Contributing factors are said to include violent behaviors, including physical and sexual abuse. Although suicide rates vary by region and tribe, a recent analysis for the Southwest indicates suicide most frequently occurs among young unmarried males.67 There are no data available for rates of physical or sexual abuse.
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From page 205... ...
It should be noted, however, that American Indians and Alaska Natives have attracted disproportionate attention because of reputed excessive alcoholism. One observer stated: "Perks no other ethnic group has had more written about their Finking behavior than Native Americans." High rates of both heavy Inking and abstinence occur among American Indians.
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From page 206... ...
Although 36.1 percent of all men and 38.8 percent of all women reported having an alcoholic first-, second-, or third-degree relative, highest percentages were reported by Native Americans: 46.1 percent of men but 62.S percent of women. Biological Alcohol Susceptibility and Stereotyping Before European contact, few American Indians residing above the Rio Grande River made use of fermented beverages.
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From page 207... ...
Wolff found increased facial flushing in Cree Indians,87 and faster rates of alcohol metabolism occurred in Ojibwa Indians than in Chinese and Caucasian subjects.- No differences in alcohol metabolism were found in a study comparing American Indians and Caucasians,76 but decreased facial flushing occurred in Tarahumara Indians.89 Honda found lower levels of increased alcohol sensitivity in subjects from populations related to Asiatic gene pools, namely Eskimos, American Indians, Hawaiians, Indochinese, and persons of mixed Asian ancestry.77 Emerging interest in the genetics of alcoholism has again stimulated investigation of characteristics of Native Americans. Interest in the DRD2 dopamine receptor genotype prompted investigation among Cheyenne Indian men, since their frequency of the DRD2 marker allele is fourfold that of Caucasians.9S Other investigators are examining frequency of alcohol dehydrogenase alleles and family history of alcoholism in Indian men in Califomia.96 Additional studies by this research group focus on family history of alcoholism and administer a challenge dose of 75 mlikg ethanol to measure effects on heart rate and blood pressure.97 Yet another study examines BEG records of California Indian men with and without a family history of alcoholism in a drug-free state.98 Studies of Indian women are planned under similar experimental protocols.
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From page 208... ...
In addition, some groups of Native Americans have en excess concentration of infants affected by FAS or FAE. The need for contraception to reduce the high birthrate and its complications, the high infant mortality rate, and transmission of alcohol-induced insult to the fetus is apparent.
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From page 209... ...
Not only do shelters, hospitals, and substance abuse treatment centers need to be encouraged to collect data, compile statistics, and publish reports, but Native American women need to be brought into planning for education and prevention strategies that can most effectively deal with what anecdotal evidence shows to be a pressing health problem. Participation in research protocols can be influenced by the enthusiasm of the participants.
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From page 210... ...
Miller, and J Warren, "American Indian population recovery following smallpox epidemics," Am.
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From page 211... ...
M Bulterys, et al., "The expected impact of a smoking cessation program for pregnant women on infant mortality among Native Americans," Am.
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M Nakamura, et al., "Excess infant mortality in an American Indian population, 1940-1990," JAMA 266 (1991~: 2244-2248.
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V Howard, et al., "Risk factors for coronary heart disease in diabetic and nondiabetic Native Americans," Diabetes 41 (1992~: =11.
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J Leland, Native American alcohol use: A review of the literature," in From Tulapai to Tokay: A Bibliography of Alcohol Use and Abuse among Native Americans of North America, P
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C Garcia-Andrade, et al., "Response to alcohol in Native American men win and without a family history of alcoholism," in Proceedings of the Research Society on Alcoholism Annual Meeting.
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