Health-Related Behavioral Risk Factors and Obesity Among American Indians and Alaska Natives of the United States: Assessing Variations by Indian Health Service Region

Abstract

Introduction Health-related behavioral risk factors and obesity are linked to high risk for multiple chronic diseases. We examined the prevalence of these risk factors among American Indians and Alaska Natives (AI/ANs) compared with that of non-Hispanic Whites and across Indian Health Service (IHS) regions. Methods We used 2017 Behavioral Risk Factor Surveillance System data from participants in 50 states and the District of Columbia to assess 4 behavioral risk factors (current cigarette smoking, heavy drinking, binge drinking, and physical inactivity) and obesity. We analyzed disparities in these risk factors between AI/AN and non-Hispanic White participants, nationwide and by IHS region, by conducting log-linear regression analyses while controlling for potential confounders. Results Nationwide, crude prevalence of current smoking, physical inactivity, and obesity were significantly higher among AI/AN than non-Hispanic White participants. After adjustment for sociodemographic characteristics, AI/AN participants were 11% more likely to report current smoking ( P < .05) and 23% more likely to report obesity ( P < .001) than non-Hispanic White participants. These patterns persisted in most IHS regions with some exceptions. In the Southwest region, AI/AN participants were 39% less likely to report current smoking than non-Hispanic White participants ( P < .001). In the Pacific Coast region, compared with non-Hispanic White participants, AI/AN participants were 54% less likely to report heavy drinking ( P < .01) but 34% more likely to report physical inactivity ( P < .05). Across IHS regions, AI/AN participants residing in Alaska and the Northern Plains regions had the highest prevalence of current smoking and binge drinking, and those in the Southwest and Pacific Coast regions had the lowest prevalence of current smoking. AI/AN participants in the Southwest region had the lowest prevalence of physical inactivity, and those in the Southern Plains region had the highest prevalence of obesity. Conclusions The findings of this study support the importance of public health efforts to address and improve behavioral risk factors related to chronic disease in AI/AN people, both nationwide and among IHS regions, through culturally appropriate interventions.

Urgent versus elective surgical disparities among American Indian and Alaska Native patients

“…It is therefore plausible that a lack of access to a consistent medical home may cause AIAN patients to be present for urgent surgeries without documentation of previously diagnosed adverse comorbid health conditions, when they do in fact exist. AIAN patients have been demonstrated to have a higher incidence of comorbid conditions which would support our claim that patients in our study may be experiencing a lack of documentation of previously diagnosed conditions and a lack of a consistent medical home 10–12 …”

“…AIAN patients have been demonstrated to have a higher incidence of comorbid conditions which would support our claim that patients in our study may be experiencing a lack of documentation of previously diagnosed conditions and a lack of a consistent medical home. [10][11][12] With respect to this last potential inequity, it is likely that AIAN patients in Washington State suffer from disparate access to preventive care and a routine medical home. Broadly, Washington State's AIAN population suffers from a high rate of poverty, lower-than-average education level, and low access to nutritious foods.…”

The commercial determinants of Indigenous health and well-being: a systematic scoping review

“…18 19 Tobacco, alcohol and ultraprocessed foods are leading contributors to health inequities among Indigenous peoples worldwide. [20][21][22][23] In addition, the mining industry is often in direct conflict with the well-being of local Indigenous communities. 24 25 While some research has been undertaken to understand the social determinants, and more recently the cultural determinants, of Indigenous health, 14 26 27 the influence of commercial entities and activities on Indigenous health and well-being has not been well described.…”

“…This definition encapsulates the power of corporations to influence socioeconomic conditions, legislation, health policy and regulations and population consumption 18 19. Tobacco, alcohol and ultraprocessed foods are leading contributors to health inequities among Indigenous peoples worldwide 20–23. In addition, the mining industry is often in direct conflict with the well-being of local Indigenous communities 24 25…”