ACF OPRE: American Indian-Alaska Native Head Start Research and Outcomes Assessment (AIAN)

HEALTH AND PHYSICAL WELL-BEING

Issues and Observations

American Indian and Alaska Native children face a number of health issues, often at rates disproportionate to the rest of the United States population. Studies have shown that AI-AN children have higher rates of speech disorders, lower respiratory tract infections, fetal alcohol syndrome, diabetes mellitus, and obesity. Early intervention programs and other medical services are sometimes underutilized by AI-AN families, possibly due to such factors as lack of access and equity (Sontag and Schacht, 1993). Observations regarding the health and physical well-being of AI-AN children include the following:

Many health disparities may be attributable to socioeconomic and environmental factors. For example, poverty, rather than race or genotype, is the major factor associated with fetal alcohol syndrome (FAS) (Abel, 1995). Populations characterized by lower socioeconomic status, including American Indians and African Americans, may have incidence rates as much as ten times higher than middle-to-upper socioeconomic status populations. Among Alaska Natives, the rate of FAS is estimated to be even higher (Egeland et al., 1998). Other risk factors—including smoking, poor nutrition, poor health, increased stress, and use of other drugs—may exacerbate the effects of heavy alcohol consumption, resulting in increased FAS (Abel, 2000; Abel, 1998; Abel, 1995; Abel et al., 2002; Cassano et al., 1990; Hingson et al., 1982; Kennedy, 1984; Kuzma and Sokol, 1982; Olsen et al., 1991; Polednak, 1991; Westphal, 2000).
AI-AN children have higher rates of hospitalization for respiratory illnesses such as wheezing illnesses (Liu et al., 2000), Haemophilus influenzae (Millar et al., 2000), hepatitis A (Welty et al., 1996), and middle respiratory tract infections such as bronchiolitis (Lowther et al., 2000). Use of vaccines, when available, and disease prevention programs have led to a reduction in diseases (Millar et al., 2000; Lowther et al., 2000).
AI-AN children may be prone to a greater incidence of speech disorders than the general population. In some children, speech disorders may result from recurrent otitis media with effusion (middle ear infections) and as such may be preventable. Research has found a link between OME and speech disorders in a sample of AI children in Head Start (McShane and Mitchell, 1979; Shriberg et al., 2000); children may also experience learning problems linked to middle ear infections, particularly with word recognition and spelling (Scaldwell and Frame, 1985).
AI-AN children have higher rates of obesity than other populations (Zephier et al., 1999), contributing to the development of diseases such as diabetes mellitus. Various studies assessing diet choices (Koehler et al., 2000) and developing interventions for young children, such as the Pathways obesity prevention program (Davis et al., 1999), seek to provide further understanding and reduction of obesity and obesity-related diseases.

Research Findings: Health and Physical Well-Being
Author	Sample, Measures, and Methods	Major Findings Reported by Author
Abel, 1995	A meta-analysis identified 29 quantitative studies on the incidence of FAS in the United States, Australia, and Western Europe. Sample sizes varied from 278 to 14,923 across the studies and totaled 97,576. The studies were of varying duration and were conducted from the mid-1970s to the early 1990s. Researchers examined the incidence of FAS worldwide, by country, by socioeconomic status, cultural group, and among heavy drinkers.	Poverty, rather than race or genotype, is the major factor associated with Fetal Alcohol Syndrome. Populations characterized by lower socioeconomic status, including African Americans and American Indians, may have incidence rates as much as ten times higher than middle/upper socioeconomic status populations. Socioeconomic risk factors associated with poverty—including smoking, poor nutrition, poor health, increased stress, and use of other drugs—probably exacerbate the effects of heavy alcohol consumption, resulting in FAS. The author notes that the absence of prospective studies of FAS among AI populations means that it is not possible to estimate with precision the incidence of FAS among American Indians.
Egeland, Perham-Hester, Gessner, Ingle, Berner, and Middaugh, 1998	Medical charts of 37,346 Native and 139,419 non-Natives were obtained from 16 sources in Alaska and reviewed to identify potential cases of FAS. A diagnosis of FAS was based on the presence of all the following in the medical history: FAS suspected or diagnosed by a physician, prenatal alcohol exposure or maternal alcohol abuse, characteristic facial features, growth deficiency, and central nervous system impairment.	Researchers estimated that five to seven Alaska Native children per 1,000 live births require follow-up evaluation for suspected FAS.
Liu, Stout, Sullivan, Solet, Shay, and Grossman, 2000	A retrospective analysis was conducted of asthma and bronchiolitis hospitalizations in Washington from 1987 through 1996. Out of a total of 23,500 AI-AN children aged 0 to 17 years who had IHS patient registration data files, 383 were identified with asthma. Patients were included in the sample if asthma or brochiolitis was the first listed diagnosis. AI-AN children were identified by linking state hospitalization data with IHS enrollment data.	AI-AN children have significantly higher rates of hospitalization for wheezing illnesses during the first year of life than children of other age groups and races. The disparity has increased significantly over time. Similar rates of hospitalizations were observed for AI-AN children over one year old and for all children over one year old.
Shriberg, Flipsen, and Thielke, 2000	The authors used retrospective analysis of case histories of children with early recurrent otitis media with effusion (OME) and analyzed speech samples to assess the risk for speech disorders with and without hearing loss. The study was conducted with 50 preschool-age AI children. Two subsamples were drawn: one had 28 AI children with histories of OME and no complicating factors (e.g., no referral for special education services) and another had 22 randomly selected AI children enrolled in Head Start. Speech samples were analyzed using a 10-item measure (nine items measured children’s articulation and the 10th reflected children’s status on the speech disorder classification system). Data were compared to 35 non-Indian children attending a Midwestern pediatric health clinic.	Some children in both the Indian and non-Indian samples had histories of OME. The study found that children with histories of OME had significantly less articulate speech than children who had not had OME. The authors found that the American Indian children were at increased risk of speech disorders, compared to non-Indian children. If recurrent middle ear disease can be prevented or reduced, the authors say the data suggest that speech disorders could be prevented.
Stout, Sullivan, Liu, and Grossman, 1999	To ascertain prevalence rates of asthma, the authors conducted an analysis of data for children ages 1 to 17 from the 1987 Survey of American Indians and Alaska Natives (n = 2,288) and the 1987 National Medical Expenditure Survey (n = 7,529). Data were collected through telephone and in-person interviews using the Health Status Questionnaire.	About 7 percent of AI children have asthma or wheezing, according to their parents’ reports. This compares to a rate of 8.4 percent among all children in the United States. The small AI sample size means that prevalence rates cannot be adjusted for income and place of residence (metropolitan vs. non-metropolitan). Although rates between the AI children and all U.S. children are not statistically different, the authors note that the study has several limitations (e.g., the AI sample lives in primarily rural areas and pooled estimates may obscure regional differences).
Stout, White, Redding, Morray, Martinez, and Gergen, 2001	The sample for this study included all 16th grade students in a town in Washington and two rural Alaska coastal village schools (n = 629). All three schools served predominantly AI or AN children. The students viewed a video illustrating signs and symptoms of asthma, then completed a written questionnaire (developed and validated by the International Study of Asthma and Allergy in Children group) about health care utilization and experiences with any asthma symptoms.	Children in the metropolitan sample were significantly more likely to report having asthma and having been diagnosed as having asthma, but there was no difference between the groups in the percentages of respondents who reported having visited a medical provider or emergency department for wheezing or breathing difficulties. No differences were found in the overall prevalence of asthma symptoms between the metropolitan and rural samples.
Tarrant and Gregory, 2001	Using an instrument developed for this study, researchers interviewed 28 mothers of young children in two First Nations communities in the Sioux Lookout Zone in Canada, to determine perceptions about childhood immunizations and factors that encourage their use. Interviews were audio taped and transcribed, then content analysis was conducted to determine patterns and themes.	The authors found that immunization uptake in young children within the sample was influenced by four main factors: (1) knowledge barriers (e.g., lack of knowledge about how vaccines work or what diseases they protect against); (2) the influence of others (e.g., community beliefs); (3) vaccine barriers (e.g., negative side effects); and (4) missed opportunities (e.g., a child cannot be vaccinated when ill). The authors conclude that within this sample of First Nations mothers, multiple strategies and messages to address cultural and knowledge barriers are needed to improve immunization uptake and health in young children.
Westphal, 2000	This study drew a random sample from the 1988 National Maternal Health and Infant Health Survey. Women who delivered a live-born infant in 1988 and lived off-reservation in areas of selected urban AI clinics in 21 states were eligible. Mail questionnaires were completed by 763 women (a response rate of 61 percent). Survey questions asked about alcohol use and demographic characteristics.	Almost half of the study sample reported alcohol use in the 12 months prior to their delivery, but 90 percent of those reduced alcohol use after learning they were pregnant. The median level of drinking for those who drank during pregnancy was one drink per month. Women with higher education levels and higher incomes were significantly more likely to consume some amount of alcohol after learning they were pregnant. Women who smoked were more than three times as likely to report drinking than non-smokers. Virtually all of the women (97 percent) received some prenatal care during pregnancy.

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