Urbanization among Indigenous peoples is growing globally. This has implications for the assertion of Indigenous rights in urban areas, as rights are largely tied to land bases that generally lie outside of urban areas. Through their impacts on the broader social determinants of health, the links between Indigenous rights and urbanization may be related to health. Focusing on a Canadian example, this study explores relationships between Indigenous rights and urbanization, and the ways in which they are implicated in the health of urban Indigenous peoples living in Toronto, Canada. In-depth interviews focused on conceptions of and access to Aboriginal rights in the city, and perceived links with health, were conduced with 36 Aboriginal people who had moved to Toronto from a rural/reserve area. Participants conceived of Aboriginal rights largely as the rights to specific services/benefits and to respect for Aboriginal cultures/identities. There was a widespread perception among participants that these rights are not respected in Canada, and that this is heightened when living in an urban area. Disrespect for Aboriginal rights was perceived to negatively impact health by way of social determinants of health (e.g., psychosocial health impacts of discrimination experienced in Toronto). The paper discusses the results in the context of policy implications and future areas of research.
Lack of access to care, funding limitations, cultural, and social barriers are challenges specific to tribal communities that have led to adverse cancer outcomes among American Indians/Alaska Natives (AI/AN). While the cancer navigator model has been shown to be effective in other underserved communities, it has not been widely implemented in Indian Country. We conducted in-depth interviews with 40 AI/AN patients at tribal clinics in Idaho and Oregon. We developed the survey instrument in partnership with community members to ensure a culturally appropriate semi-structured questionnaire. Questions explored barriers to accessing care, perceptions of the navigator program, satisfaction, and recommendations. AI/AN cancer patients reported physical, emotional, financial, and transportation barriers to care, but most did not feel there were any cultural barriers to receiving care. Navigator services most commonly used included decision making, referrals, transportation, scheduling appointments, and communication. Satisfaction with the program was high. Our study provides a template to develop a culturally appropriate survey instrument for use with an AI/AN population, which could be adapted for use with other indigenous patient populations. Although our sample was small, our qualitative analysis facilitated a deeper understanding of the barriers faced by this population and how a navigator program may best address them. The results reveal the strengths and weakness of this program, and provide baseline patient satisfaction numbers which will allow future patient navigator programs to better create evaluation benchmarks.
Cites: Cancer Epidemiol Biomarkers Prev. 2012 Oct;21(10):1673-81 PMID 23045542
Cites: MMWR Surveill Summ. 2004 Jun 4;53(3):1-108 PMID 15179359
American Indians and Alaska Natives (AIs/ANs) have some of the highest cancer-related mortality rates of all US racial and ethnic groups, but they are underrepresented in clinical trials. We sought to identify factors that influence willingness to participate in cancer clinical trials among AI/AN tribal college students, and to compare attitudes toward clinical trial participation among these students with attitudes among older AI/AN adults.
Questionnaire data from 489 AI/AN tribal college students were collected and analyzed along with previously collected data from 112 older AI/AN adults. We examined 10 factors that influenced participation in the tribal college sample, and using chi-square analysis and these 10 factors, we compared attitudes toward research participation among 3 groups defined by age: students younger than 40, students 40 and older, and nonstudent adults 40 and older.
About 80% of students were willing to participate if the study would lead to new treatments or help others with cancer in their community, the study doctor had experience treating AI/AN patients, and they received payment. Older nonstudent adults were less likely to participate on the basis of the doctor's expertise than were students (73% vs 84%, P = .007), or if the study was conducted 50 miles away (24% vs 41%, P= .001).
Finding high rates of willingness to participate is an important first step in increasing participation of AIs/ANs in clinical trials. More information is needed on whether these attitudes influence actual behavior when opportunities to participate become available.
Cites: J Cancer Educ. 2001 Summer;16(2):89-9211440069
Around the world, student populations are internationalizing and diversifying. The purpose of this study was to research culturally and linguistically diverse nursing students' experiences in Finland. The data were collected from 27 students in four polytechnics through focus group interviews. The findings highlight the importance of concreteness in theoretical instruction. In clinical settings, language barriers and negative attitudes towards students and their cultural background lead to social and professional isolation. The findings suggest that development of culturally sensitive pedagogy requires further investigation with strong research designs. Intensified language instruction for those who need it is essential. Strategies that increase cultural competence and promote appreciation of cultural diversity in health care settings should be developed.
This research involves the examination of drinking motives, alcohol consequences, and ethnic identity in a sample of Native and non-Native college student drinkers in Alaska. Although more Alaska Native students are abstinent from alcohol compared to any other ethnic group, Native students who do drink experience greater alcohol consequences and dependence symptoms. Therefore, we attempted to examine the influence of ethnic identity on alcohol consequences in a diverse sample of Native and non-Native students in Alaska. Findings showed that drinking motives, as measured by the Drinking Motives Questionnaire (social, coping, enhancement, and conformity), significantly predicted alcohol consequences after controlling for frequency of monthly binge drinking. In addition, after controlling for depression, binge drinking, and drinking motives, one aspect of ethnic identity (Affirmation, Belonging, and Commitment) was significantly negatively related to alcohol consequences, whereas another aspect of ethnic identity (Ethnic Identity Search) was not. Taken together, these findings suggest that interventions for college student alcohol misuse that target Native students should be culturally grounded and focused on enhancing the Affirmation, Belonging, and Commitment to one's ethnic heritage and should address drinking motives, especially drinking to cope, as a way to reduce alcohol related harm.
Suicide rates among American Indian and Alaska Native (AI/AN) young people are significantly higher than other ethnic groups in the United States. Not only are there great differences when comparing AI/AN rates and those of other Americans, some tribal groups have very low rates of suicide while other Native communities have much higher rates. Despite this obvious variability, there is little research to help understand the factors associated with these differences. The current study considers the correlates of suicidal behavior in one rural Alaska Native region that suffers disproportionately from suicide. The analysis describes suicide behavior between the years 2001-2009, and considers the characteristics associated with both suicide deaths and nonfatal suicidal behavior. In multivariate analyses we identified gender, method of suicide and history of previous attempt as significant predictors of fatal suicide behavior, similar to results obtained from analyses on the same community's data from the previous decade. This descriptive study can offer some insights to shape prevention efforts in this and other rural, tribal communities.
The objective of this study was to examine factors associated with HIV testing among Aboriginal peoples in Canada who live off-reserve. Data were drawn for individuals aged 15-44 from the Aboriginal Peoples Survey (2001), which represents a weighed sample of 520,493 Aboriginal men and women living off-reserve. Bivariable analysis and logistic regression were used to identify factors associated with individuals who had received an HIV test within the past year. In adjusted multivariable analysis, female gender, younger age, unemployment, contact with a family doctor or traditional healer within the past year, and "good" or "fair/poor" self-rated health increased the odds of HIV testing. Completion of high-school education, rural residency, and less frequent alcohol and cigarette consumption decreased the odds of HIV testing. A number of differences emerged when the sample was analyzed by gender, most notably females who self-reported "good" or "fair/poor" health status were more likely to have had an HIV test, yet males with comparable health status were less likely to have had an HIV test. Additionally, frequent alcohol consumption and less than high-school education was associated with an increased odds of HIV testing among males, but not females. Furthermore, while younger age was associated with an increased odds of having an HIV test in the overall model, this was particularly relevant for females aged 15-24. These outcomes provide evidence of the need for improved HIV testing strategies to reach greater numbers of Aboriginal peoples living off-reserve. They also echo the long-standing call for culturally appropriate HIV-related programming while drawing new attention to the importance of gender and age, two factors that are often generalized under the rubric of culturally relevant or appropriate program development.
Department of Psychiatry and Psychology and Behavioral Health Research Program, Mayo Clinic College of Medicine, 200 First Street Southwest, Charlton 6-273, Rochester, MN 55901, USA. firstname.lastname@example.org
BACKGROUND: Among Alaska Native women residing in the Yukon-Kuskokwim (Y-K) Delta region of Western Alaska, about 79% smoke cigarettes or use smokeless tobacco during pregnancy. Treatment methods developed and evaluated among Alaska Native pregnant tobacco users do not exist. This pilot study used a randomized two-group design to assess the feasibility and acceptability of a targeted cessation intervention for Alaska Native pregnant women. METHODS: Recruitment occurred over an 8-month period. Enrolled participants were randomly assigned to the control group (n = 18; brief face-to-face counseling at the first visit and written materials) or to the intervention group (n = 17) consisting of face-to-face counseling at the first visit, four telephone calls, a video highlighting personal stories, and a cessation guide. Interview-based assessments were conducted at baseline and follow-up during pregnancy (>or=60 days postrandomization). Feasibility was determined by the recruitment and retention rates. RESULTS: The participation rate was very low with only 12% of eligible women (35/293) enrolled. Among enrolled participants, the study retention rates were high in both the intervention (71%) and control (94%) groups. The biochemically confirmed abstinence rates at follow-up were 0% and 6% for the intervention and control groups, respectively. DISCUSSION: The low enrollment rate suggests that the program was not feasible or acceptable. Alternative approaches are needed to improve the reach and efficacy of cessation interventions for Alaska Native women.
Based on a sample of the Hannover registration office this project analyses the health and prevention behaviour of Russian- and Turkish-language migrants compared to natives. The project analysis revealed considerable differences, particularly concerning addiction behaviour and physical activities.