IndianAlaska Native Epidemiological Profile Jennifer Kawatu RN MPH November 9 2011 wwwjsicom Background National Objective of IPP Infrastructure Epidemiological Profile of American IndianNative Alaskans ID: 426280
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American Indian/Alaska NativeEpidemiological Profile
Jennifer Kawatu, RN, MPHNovember 9, 2011
www.jsi.comSlide2
Background
National Objective of IPP Infrastructure:Epidemiological Profile of American Indian/Native Alaskans
4.5 X
Sources: For men and women, 15 and older, in US and outlying areas.
US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for HIV, STD and TB Prevention (NCHSTP), Division of STD/HIV Prevention, Sexually Transmitted Disease Morbidity for selected STDs by age, race/ethnicity and gender 1996-2009, CDC WONDER On-line Database, June 2011. Accessed at
http://wonder.cdc.gov/std-std-race-age.html on Oct 5, 2011 1:35:43 PM
National Chlamydia rates for men and women
2009
American
Indian / Alaska Native
White
Slide3
American Indians/Alaska Nativesin Region I
AI/AN make up less than 1% of population in Region I ( ~ 0.3%)560 Federally recognized tribes
Many others with state or no official recognitionAmerican Indians from all over the country live in Region I
Source: Census, 2010.Slide4
Green
=Densest AI/AN populations in rural areas
Region I AI/AN Population Density
Source: U.S. CensusSlide5
SocioeconomicsAI/AN more likely than Whites to:
Live in poverty Have lower median family incomesHave fewer years of educationBe YoungerSlide6
HistoryAI/AN population, has a distinct history with the federal government
Snyder Act of 1921 led to development of Indian Health Service (IHS) IHS serves almost 2 million members of the 564 federally recognized AI/AN tribes. IHS Direct CareTribally Managed ServicesTribal Services
Urban Indian Health ProgramsSlide7
AI/AN Health Care Management Systems by State
State
Funding Sources
Facilities
CTFederal and tribal
Federally funded Indian Health Service primary care facility; tribal insurances; tribal contract care services; tribally managed
MA
Federal (may also be some tribal funding)
Federally funded Indian Health Service primary care facility; tribal contract care services; tribally managed
ME
Federal, state, and private
Federally funded Indian Health Service primary care facilities that are tribally managed; tribal contract care services
NH
State and private funding
Non-profit education and prevention programs
RIFederal
Federally funded Indian Health Service primary care facility; tribal contract care services; tribally managedVT
NANASlide8
Cultural
Contracted with Medical Anthropologist with extensive experience working with native population in Northeast to conduct KIIBetween Feb-May, 2011 conducted 7 interviews with residents of all six statesPurpose of interviews to identify:
Barriers to carePerceptions and beliefs about
STI/Family planning care
Opportunities to partner with IPPSlide9
Cross Regional Messages from KIIs
Transportation challenges for rural and youth populationsFears of breached confidentiality may affect utilization choicesConcerns of perceived illness connected to stigma, socio-cultural prejudice, and racism may incline individuals to not identify as Natives among non-Natives.
Concerns about identity may alter the use of non-Native STD services. Both of these situations can and do skew associated statistics.Slide10
Cross Regional Messages from KIIs
Appropriate messaging must be culturally relevant and competent. Messengers gender and tribal specificConsider Message technology, methods of dissemination, and literacy levels.
More rural, older and northern populations tend to emphasize personal oral transmission of knowledge and information.Southern, as opposed to urban, communities may have greater access to education through smart phones and internet technologies. Slide11
AI/AN Served By Region I IPP(2005-2009)
Estimated Number of Female AI/AN 15-24
3467
Average number reached per year
84Estimated % of AI/AN Female 15-24 Population Reached
2%Slide12
Chlamydia Positivity among AI/AN
Age Breakdown by StatePercent Positive (Number)
Total Tested
24/25 and Younger**
5.5 (23)421
25/26 and Older
3.3 (4)
121
Total
5.0 (27)
542
Percent Positive for Chlamydia among AI/AN* IPP Females Region I
2005-2009
*Includes AI/AN only or AI/AN along with another raceSlide13
Region I Chlamydia Positivity Rates in Women 24/25 and Younger by Race (2005-2009) Slide14
ConclusionsAI/AN populations in Region I are small and very diverse groupAI/AN make up less than 1% of population in general, and less than 1% of population tested for Chlamydia
Reaching 2% of AI/AN in the under 24/25 age group – room to expandSlide15
Conclusions Cont.
If funds and personnel available
improve outreach to AI/AN:
Have additional conversations with tribal health contacts to elicit culturally specific message content.
Collaborate with tribal health leaders to disseminate messages using locally specific approaches. E.g. Project Red Talon in Oregon
Timelines should consider time to build relationships with AI/AN organizations
http://www.npaihb.org/epicenter/project/project_red_talon/Slide16
Conclusions Cont.
Non-Native facilities should actively train staff about perceived discrimination and its impact on Native clients. Media messages should address both genders and a variety of ages. Multi-generational audiences might encourage other participants to actively engage in education. Messages should “normalize” and de-stigmatize prevention and screening services and education.