COVID-19 Severity Among American Indians and Alaska Natives in 16 States - January 1, 2020, to March 31, 2021

Objective: To compare rates and risk factors of severe COVID-19-related outcomes between American Indian/Alaska Native (AI/AN) and non-Hispanic White people (NHW). Methods: Aggregate Social Vulnerability Index (SVI), COVID-19-related risk factor, hospitalization, and mortality data were obtained from 16 states for January 1, 2020-March 31, 2021. Generalized estimating equation Poisson regression models calculated age-adjusted cumulative incidences, incidence ratios (IR), and 95% confidence intervals (CI) comparing AI/AN and NHW persons by age, sex, and county-level SVI status. Results: Race data were missing for 42.7% of COVID-19 cases, 24.7% of hospitalizations, and 10.1% of deaths. Risk of AI/AN COVID-19 mortality was 2.6 times that of NHW persons (IR 2.6, 95% CI: 1.7 – 3.4); risk of COVID-19-related hospitalization among AI/AN persons was 3.5 times that of NHW (IR: 3.5, 95% CI: 2.7 – 4.3). Severe COVID-19 outcomes were significantly higher for AI/AN persons compared to NHW persons across all age and sex groups. There was no statistically significant difference in COVID-19 outcomes by SVI status. Associations between severe COVID-19 outcomes and co-morbid risk factors were inconsistent. Conclusions: Results describe increased risk of severe COVID-19 outcomes for AI/AN persons compared to NHW persons despite quality issues in public health surveillance data. Data linkages and improved ascertainment reduce race/ethnicity misclassification and improve data quality. COVID-19-related health burdens among AI/AN persons warrant improved access for AI/AN communities to medical countermeasures and healthcare resources

Protective and risk factors for problem health behaviors among American Indian adolescents.

While the majority of American Indian adolescents do not suffer from significant risks to overall health status, a sizable number report high rates of health-compromising behaviors and risk factors. This study examined risk and protective factors for problem health behaviors (i.e., alcohol, drug, and tobacco use and sexual behaviors) among American Indian adolescents, as well as gender and grade-level group differences. Secondary analysis of data collected in 1993 from a national survey of 2,390 American Indian adolescents in grades 9 through 12 from the Western United States was undertaken to develop and replicate models of risk and protective factors for problem health behaviors. In addition, prevalence rates for these behaviors were identified and compared to national statistics. Selected prevalence rates include: 57% tried marijuana, 51% had sex, 50% smoke cigarettes, 25% got drunk one to five times in the past month, 21% use smokeless tobacco, and 20% tried amphetamines. School connection, social support, community mindedness, and a connection to culture/traditionality were protective in reducing the risk of engaging in problem health behaviors. Stressful life events, financial insecurity, non-intact household structure, and parental/important adult substance abuse increased the risk of engaging in problem health behaviors. Although prevalence rates of certain problem health behaviors among this sample were high, they were comparable to rates reported from nationally representative samples of adolescents. In addition, results revealed that several of the protective and risk factors varied by gender and grade-level group, including community mindedness, White culture, death/loss and other stressful life events, and non-intact household structure. Interventions that promote a greater connection to school and that offer resources to adolescents dealing with stressful life events may prevent teens from engaging in problem health behaviors. Additional implications for interventions and suggestions for future research are discussed.Ph.D.Health and Environmental SciencesPublic healthUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/130754/2/9811119.pd

Feasibility Assessment of the Service Delivery Model for Youth with Serious Emotional Disturbances (American Indian/Alaska Native Circle of Care Initiative)

In this component of the evaluation, the Circles of Care grantees assessed the feasibility of their model systems of care. The goal of the Feasibility Assessment was to assure that each model system of care was well designed with careful consideration of project goals, community resources and readiness, cultural competence and measurable outcomes