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Programs aim to reduce health disparities among Native Americans, Alaska Natives :

February 13, 2019

American Indians/Alaska Natives (AI/AN) experience many health disparities, including increased prevalence of chronic conditions such as obesity and a shorter life expectancy than all other U.S. races.

Pediatricians have developed innovative models to improve access to care and promote the health of AI/AN children. Following is a summary of several programs.

Pediatric emergency services

The Child Ready Program at the University of New Mexico developed regionalized pediatric emergency care and a virtual pediatric emergency network to prepare the entire community to respond to emergencies. There are 11 telehealth sites statewide, five of which are at Indian Health Services facilities. Sixty-four percent of the communities served are tribal communities.

A former tribal governor was hired to serve as a cultural liaison to approach tribal leaders about the project and help with communication and relationship-building.

According to program leader Robert E. Sapien, M.D., M.M.A., FAAP, it was important to listen to the community and keep an open mind. For example, participants defined their communities more broadly than project leaders. This led to a model with overlapping regions rather than a map of distinct geographic communities.

The project has conducted nearly 70 consultations, 44% of which involved Native American children. Three-quarters of the cases were treated locally, saving almost $2 million.

“The emotional comfort of staying in their communities can be immense,” Dr. Sapien said.

Stopping gestational diabetes

Gestational diabetes mellitus (GDM) is the most common complication of pregnancy, and obesity increases this risk.

AI/AN adolescents are nearly twice as likely as the general adolescent population to be affected by obesity, pregnancy and GDM, according to Kelly R. Moore, M.D., FAAP, who leads Stopping Gestational Diabetes in Daughters and Mothers, a program being conducted in New York, Oklahoma, New Mexico and Oregon. The online educational curriculum aims to raise awareness of GDM and promote weight management prior to pregnancy. It is based on the READY-Girls program. According to Dr. Moore, tailoring the materials to AI/AN girls and their mothers encouraged participation.

To support healthy choices, mothers and daughters build communication skills on sensitive topics such as weight and puberty. In the pilot phase, knowledge increased, and daughters demonstrated increased self-efficacy for healthy living and pregnancy planning.

“Women participants in our initial focus groups during Phase 1 wished they had known about GDM prior to their own diagnosis and shared that this simple step of increasing awareness would greatly benefit their communities,” Dr. Moore said.

Making homes healthier

Alaska Native children have high rates of respiratory infections and lung conditions, which are associated with poor indoor air quality.

Rosalyn Singleton, M.D., M.P.H., FAAP, led the Healthy Homes project, which provided education, improved ventilation and replaced leaky wood stoves. With these interventions, children with lung conditions had fewer symptoms, fewer health care visits for lung infections and missed fewer school days.

“Families in rural Alaska often have to choose between ventilating their homes and heating their homes due to the high cost of heating fuel,” Dr. Singleton said. Fuel costs $6 to $10 per gallon, and families can use 100 gallons in colder months.

Even small impacts can make a difference, she noted. “One family discovered that they could open or close passive vents on different sides of the home based on the direction of the wind to allow fresh air into their home and conserve some heat.”

When asked about lessons learned, Dr. Singleton replied, “Partnerships are essential. Without the assistance of the tribes, regional health corporations and regional housing authorities, we could not have succeeded.”

Collaborating with schools

Yolandra Gomez Toya, M.D., M.P.H., noticed that many of the children with learning disorders she saw at the Jimenez Pueblo Clinic in New Mexico were not optimally diagnosed or managed correctly. So she contacted the local school’s Family Support Team (FST), which uses a multidisciplinary approach to support students who are struggling academically.

Now, when a child is identified with a potential learning disorder, FST contacts Dr. Toya to conduct an evaluation. A meeting then is held with the child’s parents and teachers to discuss evaluation findings and the child’s home life, and develop a plan.

Dr. Toya recalled a young boy who was struggling academically. After an evaluation, a plan was developed that included low-dose medication, an early bedtime, options for breakfast and strategies to facilitate homework. His parents and teachers now report that he is happier, his grades are up and he’s reading at grade level.

“I think it is imperative that medical providers get out of the clinic and participate in at least one community-led endeavor,” said Dr. Toya, who estimates she spends about two hours a month working with the FST.

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