course material

1. UCB Causes of health problems among African and Indian Americans
Discussion
1) Compare and (2) contrast African American health and American Indian/Alaska Native
health for one health issue. (For example, you might discuss similar and differing causes,
challenges, and/or barriers to change.) (3) How would you use talking circle interventions
to work with a community experiencing this health problem? Health Among Black
Americans promoting 251 250 headed by a Black female (Conference of Mayors, 2004).
Veterans make up approxi- marely one-third of the male homeless popula- tion, with 56%
of these being Black or Latino (Department of Veteran Affairs, 2005). low-fat diet) results It
occurs more frequently in Blacks, pregnancy animal products, except dairy) no dairy
suggest that a was associated HEALTH AND DISEASE PATTERNS IN BLACK AMERICANS
Differences in health status of Blacks and Whites have been documented in the United
States as long as health data have been col- lected. These differences persist in spite of large
increases in life expectancy and improve- ments in the health status of the general popu-
lation (Thomas, 1992). vegetarian-type diet may be of gestational diabetes. CULTURAL
OVERVIEWS ated with obesity, primary prevention should Since the development of
diabetes is associ- particularly among Blacks, Native Americans, and Hispanic Americans
(CDC, 2011). inchide lifestyle changes in diet (a plant-based, Tonstad et al. (2011), reported
and increasing regular physical from a large cohort study of 97,000 Seventh activity (CDC-
OMH, 2005a; CDC, 2011). day Adventists across the United States and Gestational diabetes
is a form of glucose Canada, indicating that the Black Adventists intolerance diagnosed in
some women during (eating no animal products, including who reported they were vegan
vegetarians Hispanic/Latino Americans, and American Indians. It is also more common
among obese products), or lacto-ovo vegetarian (eating women and women with a family
history of with a decreased risk of diabetes. The authors that although Black women had the
second diabetes. Kim et al. (2012) found, however, a way to counteract the increased
diabetes highest rate of obesity among minority groups risk among Blacks. The Centers for
Disease in the United States, they had the lowest rate the development of diabetes is
associated with Control and Prevention agrees, stating since obesity, primary prevention
should include Cardiovascular Disease and Stroke diet) and increasing regular physical
activity lifestyle changes in diet (a plant-based, low-fat cause of death for Black Americans,
as they Cardiovascular diseases are the leading patient’s routine office visits to conduct food
Physicians should take advantage of their from heart disease declined annually for all ing

2. once a year. Health care and kidney exams and recommend eye screen- Americans from
1999 to 2005. Despite these gains, for Black Americans, the death rates for should teach
patients to make proper diabe. coronary heart disease and stroke were 155 tes
management a part of their daily lives. and 45 per 100,000, respectively, compared
Reducing high blood pressure among people with 113 and 26 per 100,000 for the total with
diabetes could prevent one third of dia- population. For Black Adventists who partici- betes-
related eye, kidney, and nerve diseases. pated in the Adventist Health Study-2 with a
Approximately 60% of diabetes-related blind- cular disease (CVD), mortality from CVD, trol
or by early detection and laser treatment. (CDC, 2011). pressure of 140/90 mmHg in
individuals aged 18 years or older. It is a significant compo- nent of the relative risk for
heart disease, stroke, and end-stage renal disease. The single most powerful determinant
for hypertension is ethnicity. High blood pressure is much more common among Blacks of
both genders than among the total population. A 2006 report showed that 27% of Black
males reported high blood pressure compared to 17% of White males and 15% of Hispanic
males. The rate for Black females has varied over the years, but is lower than that of Black
males (NCHS, 2011). Genetic and physiological differences alone are unlikely to explain race
differences in blood pressure. There are cultural variations in the relationship between age
and blood pressure levels (Williams, 1992). Cross- cultural studies indicate that blood
pressure within racial groups varies by geographical or social context. Williams (1992)
points out that blood pressure levels in West Africans are generally lower than those in U.S.
and Caribbean Blacks. When Black populations in Africa move from their original
communities to large urban centers, their blood pressure increases. Wilson et al. (2002)
also point out that certain psychosocial factors are related to hypertension among Black
men, e.g., racism, coping mechanisms for dealing with racism, substance abuse, and
depression. Livingstone and colleagues report that church affiliation was inversely related
to blood pressure among Black residents sampled in Maryland (Livingstone, Levine, &
Moore, ce for the entire U.S. population. Death rates Diabetes Diabetes was the sixth leading
cause of death in the year 2000. More than 17 mil- lion American have diabetes, and more
than 200,000 people die each year of related com- plications. Black Americans are twice as
likely to have type 2 diabetes as Whites of simi- lar age. Additionally, Blacks and American
Indians have higher rates of diabetes-related complications such as kidney disease and
amputations (Centers for Disease Control and Prevention, Office of Minority Health (CDC-
OMH), 2005a; CDC, 2011). The highest rates of type 2 diabetes are among Black women,
especially those who are overweight. Black women with diabetes are nearly seven times
more likely to die from ischemic heart disease than are Black women without diabetes (Will
& Casper, professionals years, the rates of cardiovas- follow-up of 12 ness could be avoided
with good glucose con- and hypertension were considerably lower than that of Blacks
nationally (Fraser, 2005), End-stage renal disease actually increased abnormally from 13.9
to 14.4 per 100,000 for the total population and 34 to 43 per 100,000 for Blacks (CDC, 2011;
National Center for Health Statistics, 2007). 1996). Among Black women 65 to 74 years of
age, one in four has diabetes. The predic- tion is that nearly 50% of Black females born after
the year 2000 will develop type 2 diabetes in their lifetime (USDHHS, 2001b). The MMWR
indicates that type 2 diabetes, usually an adult-onset disease, is increasingly being

3. diagnosed in children and adolescents, Half of all lower extremity amputations can be
prevented by properly caring for the feet and reducing risk factors such as high blood sugar,
cigarette smoking, and high blood pressure (CDC, 2011). Studies indicate that type 2
diabetes, usu- ally thought of as adult-onset diabetes , is increasingly being diagnosed in
children and adolescents, particularly Blacks, American Indians, and Hispanic/Latino
Americans (CDC 2005b; 2011) Pediatricians are alert to this problem, but sometimes
teenagers fall between the cracks in shifting providers. Hypertension. Hypertension kills 15
times as many Black males as White males in the 15-to 40-year age group and 7 times as
many Black females as White females in any age group. Hypertension is defined as
sustained blood 1991). A study of Blacks and Whites in North Carolina provides direct
evidence that social support is related to blood pressure among Blacks (CDC, 2010;
Williams, 1992). Health behaviors, such as excessive intake of alcohol, sodium, and dietary
fat, as well as inadequate physical activity, are also determinants of high blood pressure
(CDC, 2010; Williams, 1990b). Many of the preferred foods among Black CULTURAL
OVERVIEW 283 Younen reported to be type family members, an uaintance, or someone they
knew (American Indian Health Coumal JAN. 2009) Serious behavioral and smal problems,
leading to mures and early death, are well documented in the American Indian popula tion
Suicide rates are rising, and deaths due no homicide, acodents, and injuries continue ** one
of the leading causes of Indian mor tality High risk behaviors such as smoking, poor
nutrition, risky sexual practices and betes among Indians was sedentary lifestyles
contribute to scrious health conditions such as cancer, diabetes, nutritional diseases, and
cardiovascular diseases. A recent National Violence Against Women survey reports thar
Indian women are 24 times more likely to be assaulted and more than twice as likely to be
stalked as other women in the general population (USDHHS, 2010). This report notes that
one in three Indian women will be raped in their lifetime, and six in ten will be physically
assaulted. On some reserva- tions, the murder care for Indian women is ten times the
national average. Many (88%) of these types of crimes are committed by non- among
American Indians. Indians. Unfortunately, tribal governments lack any criminal jurisdiction
of non-Indians under U.S. law. According to the U.S. Census, 77% of the population currently
residing on Indian lands and reservations is non-Indian among youth aged 19 years and and
are reportedly over twice the national average (CDC. 2009; Wallace, Patel, Dellinger, 2003).
Other causes of death American Indians due to unintentional injuries ing, and fires (Wallace
et al., 2003). are reported to be suicide, homicide, drown. leading cause of death amongst
the American Type 2 diabetes is epidemic and is another Indian population. The mortality
rate of dia more than double the national average (IHS, 2011). Indians are also at a greater
risk for developing type 2 diabetes rather than 1 diabetes (American Diabetes Association
(ADA), 2012). According to the Office Minority Health, the age-adjusted percentages of
Indians 18 years and older diagnosed with diabetes was over 16% for both men and
women, nearly twice that of their white terparts (USDHHS, 2012c). The risk factors for type
2 diabetes include obesity, hyperten- sion, high cholesterol, and cigarette smoking
(USDHHS, 2012c), documented to be high Alcoholism among American Indians has great
concern with Indians for decades. The reached epidemic proportions and has been of
federal government reports that the Indian alcoholism and chronic liver disease mortality

4. were lurther found to have a lowered life Homelit id Diseuse of American Indian and Alaska
Native Populations in the United States years) (CDC, 2008a). expectancy due to alcohol
(36.3 vs. 29.6 Behavioral Impact on Health Status Currently, American Indians are dying
from chronic diseases that are largely attributed to environmental conditions and
behavioral patterns. Acculturation and assimilation have life styles and habits such as
smoking, alco contributed to the adoption of unhealthy hol consumption, and injuries and
accidents. illness, and increased social disruption. Behavioral influences have resulted in
poverty, The prevalence of smoking among American Indians is twice the rate of that
reported for the general population and has been for a number of years (Hodge & Nandy,
2011). Recent rates (CDC, 2008b) have indicated a exceeding any other racial or ethnic
group in national Indian smoking prevalence of 32.5%, the United States. Past studies have
shown that the prevalence of smoking is highest among American Indians in all regions
(Geishirt Cantrell, Hodge, Struthers, & DeCora, 2005; Hodge et al., 1995). Hodge and Nandy
(2011) have documented that prevalence remains high among Indian male and female
participants (44% and 37% respectively), particularly in the Western and Plains states. The
researchers also reported that American Indians began smoking earlier in age (14.7 years),
and cur- among the general population, the rate of decline in tobacen use has varied among
diverse sociodemographically defined groups, such as American Indians Hodge, 1995:
Hodge & Nandy, 2011). The historical importance of tobacco to American Indian culture is
multidimensional. The role of tobacco in religious and ceremonial practices has been
complicated by its economic importance for American Indian population. As a cash crop,
tobacco has provided eco- nomic security for American Indians for gen- erations. In the
traditional usage, tobacco is a gift of the earth. It is used as a spiritual com- municator and
as a cleansing agent. Tobacco is given as a gift to healers and often is used in healing
ceremonies. Tobacco also has become one of the few sources of economic stability in
otherwise poor rural reservation areas. Small vendors (e.g., smoke shops) are able to make
a living by selling tax-free tobacco products on Indian lands. The economic incentive in
areas where unemployment is high presents a bar- rier to smoking cessation and control;
how- ever, presently it is clear that smoking presents an undeniable health hazard for
Indians and non-Indians alike. OL coun- the 10 leading causes of death for AVAN, four are
alcohol related (IHS, 2011; USDHHS, more (U.S. Bureau of Census, 2010a). rates are greater
than that reported for all U.S. American Indians are twice as likely to die races (IHS, 2011;
USDHHS, 2012b). Out of as a result unintentional injuries as those in the general population
(CDC, 2009). Fatalities from motor vehicle accidents have remained 2012b). The mortality
rate from chronic liver as the leading causes of death for AIJANS disease is not solely
excused by the chronic ages 1 to 44 (CDC, 2009). Major risk factors use of alcohol; obesity
and hepatitis B and for motor vehicle fatalities included low use C are known to contribute
to this condition of seat belts, low child safety seat use, and (USDHHS, 2012b). In 2006, the
Indian alco- impaired driving due to alcohol (Department hol mortality was six times the
rate for all U.S. of Transportation [DOT], 2004; Le Tourneau, races combined (43.0 vs. 7.0
per 100,000) Crump, Bowling, Kuklinski, & Allen 2008; (IHS, 2011). Alcohol-attributed
mortality was Naimi et al., 2008). Preventable injury- responsible for over 11% of AIJAN
deaths related deaths from motor vehicle accidents, and the age-adjusted rate was twice the

5. U.S. pedestrian events, and suicide remain highest general population (CDC, 2008a). AI/ANS
Impact of Environmental Contamination on Health Status Health status is a function of a
variety of factors such as behavior, environment, hered- rent and former smokers were
statistically ity, and health services. Of these, environmen- likely to report suicide ideation
and to tal pollution is of potential irreversible harm be neglected and physically abused as
children that can threaten generations of American (Hodge & Nandy, 2011). Indians. Little
evaluation and scientific research has In the late 19th and early 20th centuries, been
conducted to examine successful smok- gold, timber, minerals, and water were mined, ing
cessation methods for American Indians. harvested, and harnessed in the West. Many Over
the past 25 years, there has been a Indian reservations were found to be rich in national
effort to decrease dependence on minerals and natural resources highly sought tobacco
products. Although public health by non-Indians (Harkin & Lewis, 2007). Little efforts
directed at reducing the prevalence thought was given to environmental conse- of smoking
have been somewhat successful quences, which resulted in extensive damage Trabal-Based
Participatory Research STUDIES 417 may indeed greatly explain the risky behaviors habits.
and identity issues among American Indians. ered into verified statistical measure rts were
screen- I health pre- uencies ncluded s, high. a physical and mental illness were found to
related to high-risk behaviors and unhealthy mfluence perceptions of risk, which may be
predictors of Wellness. Data showed that dictors of wellness were positive perceptions of
general health status and participation in American Indian cultural practices. Cultural
participating in American Indian practices, connectivity (i.e., speaking tribal language, and
feeling connected to community) was also associated with perceptions of wellness. Identity
and Sense of Belonging and Diverse tus were observed depending on experience Events.
Significant differences in wellness sta- of adverse events in childhood and adult- hood (i.e.,
neglect, physical abuse, and sexual abuse). Sense of belonging was found to be an important
concept that was related to con- nectedness: identify, language, participation in tribal
practices, and ceremonies. needs d by verse and and TALKING CIRCLE INTERVENTION The
talking circle was chosen as the medium to implement the intervention. This was a
curriculum for increasing knowledge on men- tal/physical health and support groups for
discussing the issues, barriers, and cultural constructs of wellness. Traditional stories were
used in the beginning of the group’s session (talking circle) to bring the group together and
to highlight the “mental health lesson of the day,” which was reinforced by the cur- riculum.
Following the implementation of the curriculum, the talking circle allowed the group to
engage in discussion and to provide group support. The talking circle process has been
described and demonstrated previously in a study among the Sioux and Winnebago tribes
(Hodge, Hodge, & Cantrell, 2008). The talking circle is a well-known method of intragroup
communication in many American Indian communities. Commonly composed of about 10 to
15 members, sitting in a circle, members meet to share or to obtain infor- mation. As they sit
in a circle, no one is the leader or is above another. The talking circle is intended to be
supportive, to impart educa- tion, and to entertain and to solve problems. Following the
opening session, our project intervention began with a story followed by ject ted Suicide
Ideation and Attempts. Data from in EC- ce the study support that sense of belonging has a
negative association with suicidal ideation and may buffer the development of depres- sive

6. symptoms. In addition, substance abusers (e.g., smokers) reported being neglected and
physically abused in childhood and adoles- cence and had poor wellness perceptions, poor
support networks, were depressed, and were more likely to report suicidal ideation.
Influence of Assimilation and Possible Identity Conflicts. The impact of historical trauma
may be evident in elevated suicide rates, depression, and substance abuse, among oth- ers.
In our study, those with risky behaviors also reported having less than 50% Indian blood
that raise issues of identity conflicts and assimilation. Historical trauma, described by Brave
Heart (2003), is the cumulative and the presentation of educational materials. A talking
stick is passed around the circle of participants to signify individual control of the floor.
While speaking, each participant has total control of the floor without fear of interruption.
Respectful attention is paid to all those who impart information or who speak within the
group. The talking circle format allows each group member to discuss his or her concerns,
responses or opinions regarding the topic within a supportive group. The project’s talking
circle collective emotional and psychological injury over the life span and across
generations, and