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Felicia Schanche Hodge, Dr.PH

Felicia Schanche Hodge, Dr.PH. Center for American Indian Research & Education. American Indian/Alaskan Native Population. 1996 U.S. Bureau of Census Population Estimates. 2.3 million. 1996 IHS service population. 1.4 million. More than 550 Federally recognized tribes in the U.S.

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Felicia Schanche Hodge, Dr.PH

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  1. Felicia Schanche Hodge, Dr.PH Center for American Indian Research & Education

  2. American Indian/Alaskan Native Population 1996 U.S. Bureau of Census Population Estimates 2.3 million 1996 IHS service population 1.4 million More than 550 Federally recognized tribes in the U.S.

  3. American Indian/Alaskan Native Health Services IHS Service Area - 12 Area Offices Service area consists of counties on and near federal Indian reservations • 37 hospitals • 64 healthcenters • 5 school health centers • 50 health stations • 34 urban Indian health projects

  4. American Indian/Alaskan Native Health Services (cont.) Tribally operated health services • 12 hospitals • 116 health centers • 3 school health centers • 56 health stations • 167 Alaska village clinics

  5. • 50% or more reside in urban areas • Non - IHS eligible population falling through the cracks

  6. • hard to reach populations

  7. • acute  chronic

  8. Leading Causes of Death IHS Service Area 1991-1993 (Deaths per 100,000) • Diseases of the Heart 116.1 • Malignant neoplasms 80.6 • Accidents 78.0 • Diabetes Mellitus 25.0 • Chronic Liver disease • and cirrhosis 23.6 • Cerebrovascular diseases 23.3

  9. Leading Causes of Death IHS Service Area 1991-1993 (cont.) • Pneumonia and influenza 19.5 • Suicide 15.2 • Homicide and legal intervention 14.0 • Chronic obstructive pulmonary • diseases and allied conditions 12.8

  10. Causes of Death IHS Service Area 1991-1993 Compared to rates for the U.S. Population, death rates among American Indians are: 465% higher due to alcoholism (703%)* 425% higher due to tuberculosis (525%)* 184% higher due to accidents (282%)* 166% higher due to diabetes (248%)* 46% higher due to suicides ( 89%)* *excluding 3 areas with problems underreporting death rates for Indians

  11. • Culture • Public awareness • Missed opportunities • Recruitment strategies

  12. • Culture

  13. • fatalism • fear • white man’s disease • introduction of foreign matter

  14. • Public Awareness

  15. • Threat is on-going • Where to obtain health care • For yourself and your community

  16. Culturally Competent Outreach • Culturally sensitive programs • Utilize community resources • Educate via Indian way

  17. • Demographic Barriers - written materials inappropriate - not culturally appropriate

  18. • Social Barriers - caretakers - childhood disease

  19. • Institutional Barrier - lack of access - patient / provider communication

  20. • Missed Opportunities

  21. • at IHS clinics • at urban clinics • at health fairs

  22. Barriers to Care • Access to medical care • Transportation • Financial limitations • Cultural barriers

  23. CAIRE Projects Smoking Cessation Project • Data collected from a sample of 1,369 adult Northern California Indian male/female patients at 18 Indian health clinics

  24. CAIRE Projects Smoking Cessation Project (cont.) • Participants completed a self- administered questionnaire designed to assess smoking rates, patterns and attitudes as well as health status

  25. Ceremonial vs. Habitual Tobacco Use - Tobacco in • American Indian culture Smoking and American Indians • IHS statistics show 2 out of 5 deaths of Indians are • related to smoking • Estimated that nationwide 50% of American Indians • smoke and 41 % of Indian teens smoke

  26. Smoking and American Indians (cont.) • Combined chronic alcohol consumption and • tobacco use substantially increases the risk of • cancer • Women who smoke may be at a higher risk for • developing cervical cancer • Tobacco control policies

  27. CAIRE Projects Cervical Cancer Project • Data collected from a sample of 413 adult California Indian patients at 8 Indian health clinic sites • Participants completed a self-administered questionnaire designed to assess cancer screening, knowledge, attitudes and behavior and health status

  28. CAIRE Projects Nutrition Project • Data collected from a sample of 440 adult female heads of households at 8 Indian health clinic sites • Participants completed a self-reported questionnaire designed to assess patterns of dietary habits, nutrition KAB, and anthropometric measures

  29.  16 cutoff  28 cutoff CES-D Caseness Rates Original Study 19% 5% Smoking Cessation Study 42.3% 14.7% Cervical Cancer Study 43.0% 15.8% Nutrition Study 36.2% 13.6%

  30.  16  28 Depression: CES-D Scale Original Study (Radloff) Smoking Cessation Study Cervical Cancer Study Nutrition Study

  31. Recruitment Strategies • Identify gatekeepers • Utilize Community Health Representatives (CHRs) • Work from “Inside” not “Outside” • Utilize community resources

  32. Education Strategies • Talking Circles • Community newsletters • Community clinics • Fully explain participation • Answer all questions

  33. Communication Strategies • Body language • Organization of speech • Less direct / more generalized • Talk slower - pauses • Minimize complaints

  34. Barriers • Understand fears • Address concerns • Extend family needs • Money, childcare, transportation

  35. Cultural Considerations • Loss of body parts • Illness beliefs • Healing ceremonies

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