Prevalence and association of depressive symptoms with physical disability and long-term care use among older American Indians

Health officials have recently been sounding the alarm that depression will soon surpass many of the major medical conditions in causing disability among adults. Recent demographic and health trends are generating public health concern about depression. First, the prevalence of chronic conditions has dramatically increased over the last several generations. Second, depression often accompanies chronic conditions and can exacerbate physical health outcomes. Third, the recent entry of the baby-boomers into the older age bracket is spawning an substantive expansion of the older adult population in this country, an age group that disproportionately experiences greater number of chronic conditions, physical disabilities, and associated long-term care needs. These health trends are even greater among older American Indians. However, despite greater prevalence of morbidity, depression, and physical disability among older American Indians, very little is known about the relative impact of morbidity and depression on physical disability. Therefore, the first manuscript examines 1) the prevalence and correlates of depressive symptoms and 2) the relationship of depressive symptoms with chronic conditions and physical disability among older American Indians, using the Native Elder Care Study data. The presence of depressive symptoms in older adults have been implicated in the need for and use of greater medical care, greater number of caregiving hours received, and increased medical expenditures above and beyond the severity of chronic conditions or physical disability. No published studies have examined the difference in amount of long-term informal and formal care receipt between older American Indians with different levels of depressive symptoms. Therefore, the second manuscript examines the difference in amount of informal and formal long-term care receipt between older American Indians with different levels of depressive symptoms. Examining the contribution of depressive symptoms to physical disability and long-term care use among older adults is important because it is a preventable and treatable condition afflicting a substantive proportion of this population. As the number of older adults increases, long-term care will be in greater demand. However, it is unclear whether our long-term care system will be able to meet the growing demand. Thus, this research contributes to our understanding of the factors leading to greater physical disability and long-term care use

Direct and mediated effects of a social-emotional and character development program on adolescent substance use

Mitigating and preventing substance use among adolescents requires approaches that address the multitude of factors that influence this behavior. Such approaches must be tested, not only for evidence of empirical effectiveness, but also to determine the mechanisms by which they are successful. The aims of the present study were twofold: 1) To determine the effectiveness of a school-based social-emotional and character development (SECD) program, Positive Action (PA), in reducing substance use (SU) among a sample of U.S. youth living in a low-income, urban environment, and 2) to test one mechanism by which the program achieves its success. We used longitudinal mediation analysis to test the hypotheses that: 1) students attending PA intervention schools engage in significantly less SU than students attending control schools, 2) students attending PA intervention schools show significantly better change in SECD than students attending control schools, and 3) the effect of the PA intervention on SU is mediated by the change in SECD. Analyses revealed program effects on both SECD and SU, a relationship between SECD and SU, and the effects of PA on SU were completely mediated by changes in SECD. Future research directions and implications for schoolbased social-emotional and character development efforts and substance use prevention are addressed.peer-reviewe

Community as a source of health in three racial/ethnic communities in Oregon: a qualitative study

BACKGROUND: A 2011 report by the Oregon Health Authority and the Department of Human Services documented disparities in its Latino and American Indian populations on multiple individual-level health indicators. However, research is lacking on the social contexts in which Latinos and American Indians in Oregon live and how these environments influence the health of communities as a whole. To help fill this gap, this study sought to contextualize the social environments that influence the health of Latinos and American Indian residents in three Oregon communities. METHODS: Guided by an ecological framework, we conducted one-time semi-structured qualitative interviews with 26 study participants to identify the prominent health-related issues in the communities and to examine the factors that study participants perceived as enabling or inhibiting healthy lifestyles of community residents. We used a grounded theory approach to perform content and thematic analyses of the data. RESULTS: Study participants identified preventable chronic conditions, such as diabetes, obesity, and hypertension, as the most pressing health concerns in their communities. Results showed that traditional and cultural activities and strong family and community cohesion were viewed as facilitators of good community health. Poverty, safety concerns, insufficient community resources, and discrimination were perceived as barriers to community health. Three themes emerged from the thematic analyses: social connectedness is integral to health; trauma has an ongoing negative impact on health; and invisibility of residents in the community underlies poor health. CONCLUSIONS: This study’s findings provide insight to the social contexts which operate in the lives of some Latinos and American Indians in Oregon. While participants identified community-level factors as important to health, they focused more on the social connections of individuals to each other and the relationships that residents have with their communities at-large. Our findings may also help to explain how the intra- and inter-personal levels, the community/institutional level, and the macro level/public policy contexts can serve to influence health in these communities. For example, trauma and invisibility are not routinely examined in community health assessment and improvement planning activities; nonetheless, these factors appear to be at play affecting the health of residents.Keywords: American Indian, Latino, Migrant and seasonal farmworkers, Trauma, Community healt

Perceptions of the Environment and Health Among Members of the Confederated Tribes of the Umatilla Indian Reservation

Indigenous cultures perceive the natural environment as an essential link between traditional cultural practices, social connectedness, identity, and health. Many tribal communities face substantial health disparities related to exposure to environmental hazards. Our study used qualitative methods to better understand the Confederated Tribes of the Umatilla Indian Reservation (CTUIR) members’ perspectives about their environment and its connections with their health including views on environmental health hazards. Three 90-minute focus group sessions with a total of 27 participants were held to elicit opinions on meanings of health and how the environment interacts with health. A systematic text analysis was used to derive themes across focus groups. Participants expressed a holistic view of health that included environmental, physical, mental, spiritual, and social components. A healthy natural environment was identified as an essential component of a healthy individual and a healthy community. Participants also described many environmental health concerns including second-hand smoke, outdoor smoke, diesel exhaust, mold, pesticides, contaminated natural foods, and toxic wastes from the Hanford nuclear site and methamphetamine labs. Many believe the identified environmental hazards contribute to diseases in their community. The natural environment is an important resource to CTUIR members and plays an integral role in achieving and maintaining health. Knowledge about the values and concerns of the community are useful to the tribal and federal governments, health professionals, environmental health practitioners, and community members who seek to achieve sustainable and healthy rural Native communities

Unmet Assistance Need Among Older American Indians: The Native Elder Care Study

Purpose: We examined the prevalence and correlates of unmet assistance need with respect to activities of daily living (ADLs) and instrumental activities of daily living (IADLs) among older American Indians. Design and Methods: Data for our analyses were collected in 2006–2008 as part of the Native Elder Care Study, a cross-sectional study of community-dwelling American Indians aged ≥55 years. In-person interviewer-administered surveys were used to collect data on demographic characteristics, physical functioning, mental and physical health, personal assistance needs, and psychosocial resources. Results: Among those with an assistance need, 47.8% reported an unmet need with one or more ADLs or IADLs. Significant adjusted correlates of unmet assistance need included greater number of ADL and IADL difficulties and lower levels of social support. Implications: Initiatives and programs aimed at increasing social support and augmenting informal care networks can support efforts to meet American Indian adults’ personal assistance needs.Keywords: American Indians, Unmet assistance need, Functional disability, Social suppor

Food and housing insecurity and health status among U.S. adults with and without prior military service

Food and housing insecurity may contribute to poorer mental and physical health. It is unclear as to whether those with prior military service, compared to those without, are more vulnerable to these current stressors. The objective of this study was to use U.S. population-based data to determine whether prior military service moderates the association of food and housing insecurity with poor mental and physical health.We analyzed data from nine states administering the Social Context module from the 2011 and 2012 Behavioral Risk Factor Surveillance System. Multivariable logistic regression was used to examine the associations of housing and food insecurity with poor mental and physical health and potential modification by military service. Compared with those with a history of military service, those without had higher prevalence of food insecurity (23.1% versus 13.7%) and housing insecurity (36.0% versus 22.5%). Food insecurity was associated with poor mental and physical health (mental health: odds ratio (OR)=3.47, 95% confidence interval (CI)=[3.18–3.77]; physical health: OR=3.21, 95% CI=[2.92–3.53]). Similar associations were observed between housing insecurity and poor mental and physical health. Prior military service was significantly associated with poor physical health. Interaction terms of prior military service with food and housing were not statistically significant. Food and housing insecurity does not appear to differentially impact mental and physical health among those with and without military service. Keywords: Food and housing insecurity, Mental and physical health, Military servic