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Impact on American Indian or Alaskan Native (AIAN) Health Research
AIAN Health Data Needs
In December 1991, the grants program held an agenda-setting workshop to provide an opportunity for approximately 85 leading experts in minority health and minority health statistics to assist in setting research priorities that address the critical issues affecting current and future efforts to collect and analyze data on racial and ethnic minority populations. To assess the specific data needs and resources available on AIAN health, a grant was awarded to the American Indian Health Care Association (AIHCA). These efforts found that although there are other Federal efforts through the Indian Health Service (IHS) to improve AIAN health, the health status of these communities remain poor in comparison with the general population. Several factors affect the amount and quality of data available for planning the necessary public health programs. Misclassification of race on death certificates is common and greatly affects the accuracy of available data. The lack of resources and special outreach efforts to collect data from difficult-to-reach populations is another barrier. Existing NCHS and IHS data sets also need to be better utilized and made more available. Furthermore, more research needs to be done to distinguish between race, ethnicity, and other socioeconomic variables. Acculturation, participation in community events, beliefs and spirituality, and the seeking of traditional healers and cures are important in understanding the health status of AIAN communities.
Improving AIAN Health Statistics
Guided by the goals documented in "Setting a Research Agenda: Challenges for the Minority Health Statistics Grants Program" and "Enhancing Health Statistics for American Indian and Alaskan Native Communities: An Agenda for Action," the grants program has taken major steps in addressing the health data needs of AIANs. Its projects have made existing resources more useful and methods of collecting and analyzing data more accurate.
Analyzing existing data. Through the development of a minigrants program, a project with the Public Health Foundation (PHF) funded five State Centers for Health Statistics to analyze existing data and improve State data infrastructures. Utilizing the 18 health status indicators in Healthy People 2000 Objective 22.1, Michigan, North Carolina, and Rhode Island examined AIAN populations in their research.
Increasing access to existing data:
A
project with the University of Nebraska Medical Center developed a
database on access to care studies on rural minority populations,
including AIANs.
A
project with the University of North Carolina at Chapel Hill (UNC-CH) is
developing the Minority Health Research Catalog and the Minority Health
Database Catalog. The research catalog is the first annotated bibliography
of literature on studies, analyses, and methods for conducting research on
minority populations, and the database catalog is the most expansive
inventory of national and subnational data sets available for minority
health research. To maximize access to these catalogs, they are available
via the World Wide Web on the UNC-CH
Department of Biostatistics Home Page.
A project with the Northwest Portland Area Indian Health Board (NPAIHB)
combined IHS, State, and special national data on Indian communities to
create a more user-friendly database coordinated by Regional Epidemiology
centers.
Improving data sets for access to care studies. The University of Nebraska Medical Center compiled an annotated bibliography for its database and synthesized the information into composite summaries listing the issues addressed, the databases used, methodologies employed, and areas identified for further research.
Developing protocol to reduce racial misclassification. To access the prevalence of racial misclassification, the NPAIHB established a centralized tribal enrollment database and linked it with the Portland Area Indian Health Service patient registration file, State and other agencies' disease registries, the National Death Index, and other databases such as Medicare and Medicaid.
Developing methodologies to improve sampling frames/techniques:
A
project with the Western Consortium for Public Health developed the
sample-resample method for estimating the prevalence of health disorders
among minority populations. This sampling method is effective in working
with sparse and/or incomplete data.
Data
linkages accomplished by the NPAIHB project created a database containing
a more inclusive tribal registry.
Conducting analytic studies on race/ethnicity and socioeconomic status. The most recent grants awarded by NCHS, CDC will elaborate the impact of race, ethnicity, and socioeconomic status upon the health of minority populations.
Improving dissemination efforts:
The
AIHCA added a "Data Page" section to its newsletter, Native
Newsbriefs, and created a Data Needs Network of users and collectors of
AIAN data. To form the network, AIHCA contacts, suggestions from the
project's Advisory Council, word-of-mouth, and the "Data Page"
were utilized.
The
NPAIHB hosted a national conference, and the project's procedures and
results were drafted for use in other IHS areas.
Building Partnerships between Researchers and AIAN Communities
The grants program recognizes the need to build trust between researchers and the communities they study, and, the need to ensure that communities benefit from any research that is completed. Involving communities in all stages of the research process has become a priority of the program, including efforts to increase the pool of AIAN researchers. This goal is particularly important for research efforts on AIAN communities because of their long history with the U.S. Government.
Training and Educational Opportunities for Current and Future AIAN Researchers:
The
UNC-CH project also developed the Summer Public Health Research Institute
on Minority Health (SPHRI-MH) in order to allow current and future
researchers to explore innovative research strategies and methodologies
relevant to minority health research. NCHS, CDC provided scholarships for
minority graduate students to attend the institute.
NCHS,
CDC held two workshops to enhance the skills of researchers in minority
health statistics. In March 1994, "Research Issues to Address
Minority Health Data Needs" was held to build the proposal
development and writing skills of unfunded, but approved, applicants from
the FY 1992 competitive solicitation. In January 1995, a technical
assistance workshop was held to prepare potential applicants for future
grants program solicitations.
Community Participation in Research:
The
AIHCA project determined the data needs and resources available on AIAN
health by involving AIAN health care professionals who actively use this
data and understand the special problems faced by their communities. An
advisory committee of IHS, tribal, urban program, AIAN research agencies,
and community agency members, and, an AIAN Data Needs Network were formed
to guide this project. To solicit participation in the network, the
"Data Page" was added to the AIHCA newsletter.
The
NPAIHB hired tribal members as project personnel, and nonelectronic tribal
rolls were input into Epi-Info in collaboration with tribal staff.
The
University of Nebraska Medical Center project organized a workshop that
brought researchers and community leaders together to discuss problems and
needs in rural minority health research.
Projects Addressing AIAN Health Data Needs:
James Dimas, M.P.A., Public Health Foundation (PHF), "State Data Analysis: Year 2000 Health Status Indicators and Minority Health": Michigan Office of the State Registrar and Division of Health Statistics, $50,000; North Carolina Department of Environment, Health and Natural Resources, $50,000; Rhode Island Office of Health Statistics, $50,000 (FY 1992).
Lloyd Edwards, Ph.D., University of North Carolina at Chapel Hill (UNC-CH), "Assessment of Statistical Materials and Methods for Minority Health Research," $321,855 (FY 1993-94).
Ernest Hook, M.D., Western Consortium for Public Health, "Sample Resample Methods for Minority Statistics," $69,729 (FY 1992).
Keith Mueller, Ph.D., University of Nebraska Medical Center, "Improving Health Services Research Related to Rural Minorities," $115,251 (FY 1992).
Mary Suagee, American Indian Health Care Association, (AIHCA), "Promoting Healthy Traditions: Reaching Native Americans with the Year 2000 National Health Objectives," $50,000 (FY 1991).
Jonathan Reuell Sugarman, M.D., M.P.H., Northwest Portland Area Indian Health Board (NPAIHB), "Improving Health Data for Northwest American Indians," $129,295 (FY 1992).
This page last reviewed January 11, 2007
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