Hello everyone,
Sorry for the delay in my posting. I am now an Ensign in the United States Navy, which takes up a significant amount of my time. However, I am going to try and maintain this blog because the health issues that plague Native American women and indigenous women all around the world are not disappearing anytime soon.
In fact, here are a few notable journal articles as of 2014. I have tried my best to summarize them in an easy to read manner and have attached their links if you would like to read the original.
Anything written in green represents my personal thoughts and areas of question that I hope you will help me learn about by adding your thoughts to the comments.
Native American Race, Use of Indian Health Service, and Breast and Lung Cancer Survival in Florida
- Background: There are major health disparities between Native Americans and the average US population. For example, the life expectancy of Native Americans (71.5 years) is shorter in comparison to whites (75.6 years).
- Goal of the study = to find a relationship between Native American race, use of the Indian Health Service, and survival time after cancer diagnosis.
- Participants studied included members of 2 federally recognized tribes in Florida: Miccosukee and Seminole
- Independent variables for testing included race (white, Native American, black, Pacific Islander, Asian, etc.) and medical bill payer at time of diagnosis (Medicaid, Medicare, IHS, private, etc.).
- The dependent variable being measured was time elapsed from diagnosis to date of death or last patient encounter.
- Major findings
- Breast cancer survival was found to be worse for Native American women than for white women (after adjusting for comorbidities, tumor characteristics, and treatment factors)
- Breast cancer survival was found to be worse for women using the Indian Health Service than for those using private insurance
- No difference in lung cancer survival was found between ethnicities or payers.
- Additionally, the study found that use of the Indian Health Service was not correlated with Native American race "for example, only 3 Native Americans reported receiving health care from IHS"
- This is kind of weird since the IHS is supposed to be specifically for Native Americans. Why would Native Americans not use the IHS or why might the interpretation of results make it look like Native Americans don't use the IHS?
- The study suggests -
- There may be a discrepancy in self-reporting race in mixed race peoples (i.e. people do not always report their entire cultural/ethnic composition).
- People may find it advantageous to list different race/ethnicities in different settings. Historically, it has been disadvantageous to claim more Native American blood due to the social pressures of racism, stereotyping, etc.
- For a good example, read Devon Abbott Mihesuah's book "Indigenous American Women." I recommend chapter 7 which is titled "Culturalism and Racism at the Cherokee Female Seminary."
- Not reporting one's ethnicity completely may demonstrate mistrust of the medical profession. How can we change this?
- We must correct classification of Native American race in health documentation for more accurate and valid research.
- This is hard to do when not all Native Americans are federally recognized and most tribes have differing qualifications for what constitutes membership. If the legal classification is fuzzy, then people are likely to be confused themselves.
- However, this is a valid point. How can we emphasize the medical benefits of claiming Native heritage inside and outside of reservations?
- Current cancer care may not be enough: "For example, some cancer care costs such as specialized imaging studies may not be provided by IHS, in part because of chronic program under funding by appropriations from Congress."
- The IHS requires greater funding. No surprise here really. We should still try to lobby for an increase in funding, but in the mean time maybe we need to find an answer by unifying tribal leadership and discussing the matter at this leadership level.
- Other factors that may affect survival rate include "mistrust of the medical community, patient-provider miscommunication, and access to care"
- Limitations of this research:
- This study may not reflect mortality of Native Americans outside of Florida as breast cancer mortality rates are variable across the United States.
- How can we increase this trust is a big question. Here is a good start for medical providers - Top Ten Things Teachers Should Never Do When Teaching Native Students
- This article may be for teachers but is also highly applicable to medical providers.
- What else can we do to better relations between medical providers and patients?
- Doctor's who come from the community?
- Require cultural sensitivity training (training that preferable comes directly from the tribe who is working with or partnered leadership with tribal leadership and medical clinic's psychology department leadership)?
- Lessen racism on all sides? White to Native, Native to White, mixed to Native, Native to mixed, all to all? How can we promote community and mutual learning despite color, culture, and background?
- In addition, there are varying factors affecting different tribes which may require further study.
Lee, D., Tannenbaum, S., Koru-Sengul, T., Miao, F., Zhao, W., & Byrne M. (2014). Native American Race, Use of Indian Health Service, and Breast and Lung Cancer Survival in Florida, 1996-2007.
Preventing Chronic Disease, 11, E35.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3945077/
Lessons Learned in Community Research Through The Native Proverbs 31 Health Project
- Background: Native women have higher rates of cardiovascular disease, hypertension, diabetes, and obesity compared to the average US population.
- Objective: This study aimed to create a community-based and culturally sensitive program to increase physical activity and decrease tobacco use through community wellness programs at a local church in North Carolina specifically using interpretations from Proverbs 31 chapter of the bible.
- Participants: Women and girls of the Lumbee tribe
- Outcome: "Churches were very receptive to the program. However, limitations included slow rise in attendance, scheduling conflicts for individuals and church calendars, and resistance to change in cultural traditions."
- A few trigger words here concern me including "resistance to cultural traditions." In earlier posts, we discussed the negative how the Christian church imposed its Victorian values, sometimes forcefully, upon Native Americans in the attempt to raise natives up from their "barbarian life styles." This idea that natives are lesser in culture or thought is obviously incorrect and antiquated; however, the insinuation still exists in racism today. I feel that this study may carry at twinkle of this looming insinuation by focusing too much on the church's support versus the tribe's support.
- It is difficult to evaluate this study because there is manipulation of variables in a controlled environment. It should be noted that the creators on the project evaluated themselves in this article which creates a conflict of interest.
- Limitations of the study included access to nutritional foods and low attendance.
- Overall, a good point to take away from the study is that for any program to be sustainable, the tribal community and its leadership must be greatly involved.
Kimes, C., Golden, S., Maynor, R., Spangler, J., & Bell, R. (2014) Lessons Learned in Community Research Through The Native Proverbs 31 Health Project.
Preventing Chronic Disease, 11.
http://www.cdc.gov/pcd/issues/2014/13_0256.htm .
Ovarian and Uterine Cancer Incidence and Mortality in American Indian and Alaska Native Women, United States, 1999-2009
- Background: Misclassification of American Indian/Alaska Native (AI/AN) women in addition to limited studies of long-term duration have inhibited research on ovarian and uterine cancer. For example, "approximately 42% of AI/AN descendants were classified as white on death certificates." Research shows that while incident rates of total cancer in AI/AN women are stable/decreasing, death rates have been increasing.
- Objective: To improve understanding of uterine and ovarian cancer incidence, stage at diagnosis, and mortality in AI/AN women relative to white women by minimizing the effect of racial misclassification. In addition, the study also aimed to examine geographic differences and trends in incidence and mortality of ovarian and uterine cancer.
- Patients: population based central cancer registries participating in the Centers for Disease Control and Prevention's national Program of Cancer Registries between 1999-2009
- To limit misclassification, patients had to provide proof of enrollment in a federally recognized tribe for the Indian Health Service which was used to confirm AI/AN ethnicity in the central cancer registries.
- The control group for comparison was non-Hispanic whites and the group of interest was limited to non-Hispanic AI/ANs
- This presents the problem of limiting research to only federally recognized tribes, but there are far more tribes that exist which are not federally recognized such as the Muwekma Ohlone tribe of San Francisco.
- Furthermore, each tribe has different standards for tribal enrollment which may or may not be based on blood quantum or simple ancestry. Some tribes also require dues to maintain tribal membership such as the Saint Regis Reservation of New York, which means that some individuals of AI/AN blood may simply chose to opt out of an ID stating federal recognition.
- Limiting this study to individuals who are federally recognized tribal members may allow for easier control of experimental variables but will be less applicable to the real situation.
- Locations studied were those included in the IHS's contract health service delivery area (CHSDA) which includes federally recognized tribal or off-reservation trust land.
- Thus, major native populations outside these lands were not included.
- The data is, therefore, less applicable to native women outside these areas.
- Major findings
- Ovarian and uterine cancer death rates in AI/AN women in contract health service delivery areas were similar to those of white women.
- There were observed differences in incidence rates and death rates for both ovarian and uterine cancer between AI/AN women of different IHS regions.
- AI/AN women in the Pacific Coast and Southern Plains region had higher uterine cancer death rates.
- In Alaska, the Southern Plains, and Southwest regions AI/AN women had higher ovarian cancer death rates than white women.
- In the Norther Plains, Southern Plains, Southwest, and Pacific Coast regions, uterine cancer death rates were higher in AI/AN women than in white women.
- In comparison to white women, AI/AN women had a higher rate and proportion of ovarian cancer cases diagnosed at later stages.
- AI/AN women in the Northeast region have the lowest ovarian cancer rates.
- Discussion
- Potential misclassification of race still exists
- geographic variations in cancer statistics may be due to environmental, social, and personal determinants of health that vary from region to region
- 2/3 reside in urban areas and migrate back and forth to their lands. Urban AI/AN residents are likely to differ from their rural counterparts in terms of poverty level, health care access, and other factors not contained in this study that may affect mortality trends.
- AI/AN women of Hispanic descent were not included in this study, which may have disproportionately excluded some tribal members residing in states along the US-Mexico border.
- Findings Consistent with other Studies
- However, regardless of geographic region, AI/AN women still have a higher prevalence of obesity and are less physically active than white women.
- Additionally, AI/AN women were still seen to have higher prevalence of cigarette smoking, diabetes, and rate of mortality due to diabetes than women in the average population.
- AI/AN women have a higher prevalence of hysterectomy in comparison to white women.
- If you had a chance to read my post about forced sterilizations of native women by the IHS in the 1960s/1970s, you may see this high rate of hysterectomy as a warning sign that should be explored further. Why would native women have a higher rate of hysterectomies than the average female population?
- Higher hysterectomy rates in AI/AN women decrease the risk for uterine cancer.
- Maybe this precautionary measure against uterine cancer is why the hysterectomy rate in AI/AN women is so high, but I am still curious.
- Food for Thought
- No large study has been done in AI/AN population for genetic testing for familial cancers.
- This means that there is no conclusive evidence to demonstrate that higher cancer rates are due to genetics. Other factors such as environment, cultural trauma, and lifestyle may also play a roll similar to how geographic region is demonstrated to play a significant role in this study.
Singh, S., Ryerson, B., Wu, M., & Kaur, J. (2014) Ovarian and Uterine Cancer Incidence and Mortality in American Indian and Alaska Native Women, United States, 1999-2009.
American Journal of Public Health, 104 (S3), 423-431.
http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2013.301781?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed
