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Baltimore Highlands, MD, United States

Chambers R.A.,Johns Hopkins Center for American Indian Health | Rosenstock S.,Johns Hopkins Center for American Indian Health | Neault N.,Johns Hopkins Center for American Indian Health | Kenney A.,Johns Hopkins Center for American Indian Health | And 7 more authors.
Diabetes Educator | Year: 2015

Purpose: The purpose of this study was to test the feasibility of a family-based, home-visiting diabetes prevention/management intervention for American Indian (AI) youth with or at risk for type 2 diabetes. Methods: The Together on Diabetes program, developed through community-based participatory research, enrolled 255 AI youth (aged 10-19 years) with or at risk for type 2 diabetes and 223 support persons. Delivered by local AI paraprofessionals in 4 rural AI communities, the program included home-based lifestyle education and psychosocial support, facilitated referrals, and community-based healthy living activities. Changes in AI youth participants’ knowledge, behavior, psychosocial status, and physiological measurements were assessed over 12 months. Results: Over one-half (56.1%) of youth were boys. The median age was 13.2 years. At baseline, 68.0% of youth reported no physical activity in the past 3 days; median percentages of kilocalories from fat (36.18%) and sweets (13.67%) were higher than US Department of Agriculture recommendations. Nearly 40% of participants reported food insecurity in the past month; 17.1% screened positive for depression. Support persons were predominantly family members, few reported having home Internet access (38.6%), and the majority reported being long distances (>30 minutes) from food stores. Whereas support persons were primarily responsible (≥69%) for obtaining medical care for the youth, the youth had a greater role in behavioral outcomes, indicating joint diabetes prevention/management responsibility. Conclusions: Baseline results confirmed the need for family-based youth diabetes prevention interventions in rural AI communities and indicated that enrolling at-risk youth and family members is feasible and acceptable. © 2015, © 2015 The Author(s). Source


Millar E.V.,Johns Hopkins Center for American Indian Health | Pimenta F.C.,Centers for Disease Control and Prevention | Roundtree A.,Centers for Disease Control and Prevention | Jackson D.,Centers for Disease Control and Prevention | And 7 more authors.
Clinical Infectious Diseases | Year: 2010

Background. A second-generation 13-valent pneumococcal conjugate vaccine, PCV13, was recently licensed. Although PCV13 includes serotype 6A, the usefulness of that antigen may be limited by the emergence of a new serotype, 6C, which was identified among isolates initially characterized (Quellung reaction) as serotype 6A. The epidemiology of serotype 6C prior to and after 7-valent PCV (PCV7) introduction is incompletely understood. Methods. We analyzed conventionally serotyped 6A (CS6A) pneumococci from invasive disease case patients of all ages and carriage isolates from children and adults obtained in population-based studies among Navajo and White Mountain Apache communities during 1994-2009. Samples were tested by triplex polymerase chain reaction to resolve serotypes 6C and 6A. Results. A total of 74 invasive CS6A episodes occurred. All were retyped by polymerase chain reaction; 40 (54.1%) were serotype 6C. The mean annual incidence of serotype 6C invasive disease was 0.3 (95% confidence interval, 0.03-0.9), 0.7 (95% confidence interval, 0.2-1.3), and 1.5 (95% confidence interval, 1.0-2.1) cases per 100,000 population in the years prior to the PCV7 efficacy trial, during the time the PCV7 trial was conducted, and following PCV7 introduction and routine use, respectively (P = .01). In the routine vaccination era, 76% of invasive CS6As were serotype 6C; nearly all cases occurred in adults. The proportion of serotype 6C among CS6A carriage isolates increased from 42% to 61% to 94% in the prevaccine, early vaccine, and routine vaccination eras, respectively. Conclusion. In the PCV7 routine use era, virtually all serogroup 6 invasive pneumococcal disease and carriage strains among Navajo and White Mountain Apache communities are 6C. Monitoring and evaluation of this and other emerging serotypes among invasive disease and carriage isolates is warranted. © 2010 by the Infectious Diseases Society of America. All rights reserved. Source


Chambers R.,Johns Hopkins Center for American Indian Health | Tingey L.,Johns Hopkins Center for American Indian Health | Mullany B.,Johns Hopkins Center for American Indian Health | Parker S.,Johns Hopkins Center for American Indian Health | And 2 more authors.
AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV | Year: 2016

ABSTRACT: This paper examines decision-making around sexual behavior among reservation-based American Indian youth. Focus group discussions were conducted with youth ages 13–19 years old. Through these discussions, we explored youth’s knowledge, attitudes and behaviors related to sexual risk taking through the lens of the protection motivation theory to inform the adaptation of an evidence-based HIV prevention intervention. Findings suggest that condom use self-efficacy and HIV prevention knowledge is low, vulnerability to sexually transmitted infections is lacking and alcohol plays a significant role in sexual risk taking in this population. In addition, parental monitoring and peer influence may contribute to or protect against sexual risk taking. Results suggest that future HIV prevention interventions should be delivered to gender-specific peer groups, include a parental component, teach sexual health education and communication skills, integrate substance-use prevention, and work to remove stigma around obtaining and using condoms. © 2016 Informa UK Limited, trading as Taylor & Francis Group. Source


Tingey L.,Johns Hopkins Center for American Indian Health | Cwik M.F.,Johns Hopkins Center for American Indian Health | Rosenstock S.,Johns Hopkins Center for American Indian Health | Goklish N.,Johns Hopkins Center for American Indian Health | And 6 more authors.
American Journal of Drug and Alcohol Abuse | Year: 2016

Background: American Indian (AI) adolescents are disproportionately burdened by alcohol abuse and heavy binge use, often leading to problematic drinking in adulthood. However, many AI communities also have large proportions of adults who abstain from alcohol. Objective: To understand these concurrent and divergent patterns, we explored the relationship between risk and protective factors for heavy binge alcohol use among a reservation-based sample of AI adolescents. Methods: Factors at individual, peer, family, and cultural/community levels were examined using a cross-sectional case–control study design. Cases were adolescents with recent heavy binge alcohol use that resulted in necessary medical care. Controls had no lifetime history of heavy binge alcohol use. 68 cases and 55 controls were recruited from emergency health services visits. Participants were 50% male; average age 15.4 years old, range 10 to 19. Independent variables were explored using logistic regression; those statistically significant were combined into a larger multivariate model. Results: Exploratory analyses showed adolescents who were aggressive, impulsive, had deviant peers, poor family functioning or more people living at home were at greater risk for heavy binge alcohol use. Protective factors included attending school, family closeness, residential stability, social problem-solving skills, having traditional AI values and practices, and strong ethnic identity. Confirmatory analysis concluded that school attendance and residential stability reduce the probability of heavy binge alcohol use, even among those already at low risk. Conclusions: Findings deepen the understanding of AI adolescent heavy binge alcohol use and inform adolescent intervention development fostering trajectories to low-risk drinking and abstinence. © 2016 Taylor & Francis Source


Mullany B.,Johns Hopkins Center for American Indian Health | Neault N.,Johns Hopkins Center for American Indian Health | Tsingine D.,Johns Hopkins Center for American Indian Health | Powers J.,Johns Hopkins Center for American Indian Health | And 6 more authors.
Public Health Nutrition | Year: 2013

Objective To identify factors associated with food insecurity and household eating patterns among American-Indian families with young children. Design Cross-sectional survey among households with young children that were receiving emergency food services. We collected information on food insecurity levels, household eating patterns, experiences with commercial and community food sources and demographics, and used multivariate regression techniques to examine associations among these variables. Setting Four Southwestern American-Indian reservation communities. Subjects A total of 425 parents/caregivers of young children completed the survey. Results Twenty-nine per cent of children and 45 % of adults from households participating in the survey were classified as 'food insecure'. Larger household size was associated with increased food insecurity and worse eating patterns. Older respondents were more likely than younger respondents to have children with food insecurity (relative risk = 2·19, P < 0·001) and less likely to have healthy foods available at home (relative risk = 0·45, P < 0·01). Consumption of food from food banks, gas station/convenience stores or fast-food restaurants was not associated with food insecurity levels. Respondents with transportation barriers were 1·46 times more likely to be adult food insecure than respondents without transportation barriers (P < 0·001). High food costs were significantly associated with greater likelihoods of adult (relative risk = 1·47, P < 0·001) and child (relative risk = 1·65, P < 0·001) food insecurity. Conclusions Interventions for American-Indian communities must address challenges such as expense and limited transportation to accessing healthy food. Results indicate a need for services targeted to older caregivers and larger households. Implications for innovative approaches to promoting nutrition among American-Indian communities, including mobile groceries and community gardening programmes, are discussed. © The Authors 2012. Source

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