Disparities/Minority Health

Researchers examine link between trauma and alcohol problems as well as cardiovascular risk factors among American Indians

Growing evidence suggests a link between trauma and the development of alcohol disorders. American Indians experience more traumas and alcohol disorders than the general population. A recently published study found that 16 percent of American Indian adolescents and young adults have suffered from three or more traumas and 26 percent were diagnosed with alcohol use disorders. The same study linked exposure to severe trauma with alcohol use disorders among this group. A second study of older American Indians found that several risk factors for developing cardiovascular disease (CVD) increase as older American Indians age. Both studies were supported by the Agency for Healthcare Research and Quality (HS10854) and are summarized here.

Boyd-Ball, A.J., Manson, S.M., Noonan, C., and Beals, J. (2006, December). "Traumatic events and alcohol use disorders among American Indian adolescents and young adults." Journal of Traumatic Stress 19(6), pp. 937-947.

Researchers analyzed interviews with 432 American Indian adolescents and young adults between the ages of 15 and 24. The participants were enrolled tribal members living on or near two closely related Northern Plains Indian reservations. As part of a larger survey on mental health, interviewers asked the participants if they had experienced any of 16 types of traumatic events and about their use of alcohol.

The traumatic events were categorized as noninterpersonal trauma (disaster, life-threatening accidents); interpersonal trauma (combat, rape, sexual abuse, physical assault/ abuse); witnessed trauma (seeing violence perpetrated upon others or observing a serious accident or disaster that resulted in harm or death of others); hearing traumatic news about a close other (life-threatening illness, rape, suicide, of a family member or friend), and other trauma.

Over one-fourth (26 percent) of those interviewed were diagnosed with alcohol use disorders. Overall, 21 percent had experienced one severe traumatic event, 10 percent had experienced two, and 16 percent had experienced three or more. Young adults (aged 20-24) experienced more traumatic events than adolescents (aged 15-19), as did participants in both age groups who reported that their parents used alcohol while they were growing up.

The odds for alcohol use disorders increased from nearly twofold for one trauma to somewhat less than fourfold for three or more traumas compared with no trauma. These results held after adjusting for age, gender, and parental alcohol use, suggesting a dose-response effect of trauma on alcohol disorders among American Indians living on or near reservations.

Rhoades, D.A., Welty, T.K., Wang, W., and others (2007, January). "Aging and the prevalence of cardiovascular disease risk factors in older American Indians: The strong heart study." Journal of the American Geriatric Society 55, pp. 87-94.

Although mortality rates from CVD in the United States continue to decrease, rates are rising among Native American Indians and are now likely exceed those of the general population. Also, CVD is the leading cause of death in American Indians beginning at age 45 compared with age 65 for the U.S. general population. As older American Indians age, more of them develop hypertension, diabetes, and low levels of high density lipoprotein cholesterol (HDL-C), all risk factors for developing cardiovascular disease, according to this study.

The researchers examined the development of major CVD risk factors among a rural group of 4,549 American Indians aged 45 to 74 during initial examination in 1989 to 1991 and 8 years later. Their work was part of the Strong Heart Study of 13 predominantly poor tribes of American Indians. This aging group had decreased prevalence of smoking and no consistent changes in adverse HDL-C and low-density lipoprotein-cholesterol (LDL-C) profiles. However, the group had substantial increases in the prevalence of hypertension and diabetes, two of the most important CVD risk factors.

For example, prevalence of hypertension increased from 42.2 percent at the initial examination to 61.3 percent among men 8 years later and from 36.4 percent to 60.3 percent among women. The prevalence of hypertension in this group (aged 40-59) was comparable with the 65 percent hypertension rate among an older group (60 years and older) that participated in the National Health and Nutrition Examination Survey (NHANES).

Diabetes remained markedly and disproportionately high in this age group of Native American Indians. Prevalence increased from 41.4 to 47.4 percent among men and from 48.4 to 55.8 percent among women during the study period—three times higher than the 16.4 percent of people with diabetes among a similar age group in the 1994 NHANES. Men had a nonsignificant decrease in LDL-C and men and women initially had rapid increases in the prevalence of low HDL-C, which may have been affected by factors such as diabetes or insulin resistance that were also associated with this group.

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