Publications by authors named "Kelly R Moore"

18 Publications

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Reducing risk for gestational diabetes among American Indian and Alaska Native teenagers: Tribal leaders' recommendations.

Int J Gynaecol Obstet 2021 Jul 31. Epub 2021 Jul 31.

Department of Health Promotion and Development, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA.

Objective: To elicit feedback from tribal leaders and American Indian/Alaska Native (AI/AN) health system administrators as a national stakeholder perspective to inform the development of a gestational diabetes mellitus (GDM) risk reduction and preconception counseling intervention for AI/AN teenagers at high risk for GDM.

Methods: A semi-structured focus group interview guide was developed by both principal investigators and qualitative methods experts. Using open-ended questions about the Reproductive-health Education and Awareness of Diabetes in Youth for Girls (READY-Girls) booklet and video clips, AI/AN health care system administrators and elected tribal leaders attending the 2015 National Indian Health Board Conference in Washington, DC, made recommendations on adaptation for an AI/AN audience. The focus group was recorded, transcribed verbatim, and analyzed by two researchers using an inductive coding technique with constant comparison method as supported by the grounded theory approach.

Results: Recommendations from the 12 participants included: (1) the best ways to communicate with AI/AN teenagers, (2) the importance of parental, family, and community education and engagement to support AI/AN teenagers in GDM risk reduction, and (3) building on traditional AI/AN cultural values and practices, while accommodating differences between tribes and regions.

Conclusion: Findings from this focus group were used to inform the iterative development of a GDM risk reduction and preconception counseling intervention for AI/AN teenagers.
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http://dx.doi.org/10.1002/ijgo.13849DOI Listing
July 2021

Facilitators and Barriers to Healthy Eating Among American Indian and Alaska Native Adults with Type 2 Diabetes: Stakeholder Perspectives.

Curr Dev Nutr 2021 Jun 14;5(15):22-31. Epub 2021 May 14.

The University of Colorado Anschutz Medical Campus, Colorado School of Public Health, Centers for American Indian and Alaska Native Health, Aurora, CO, USA.

Background: American Indian and Alaska Native (AI/AN) adults have a higher prevalence of type 2 diabetes (T2D) and related complications than non-AI/AN adults. As healthy eating is a cornerstone of diabetes self-management, nutrition education plays an important role in diabetes self-management education.

Objective: To understand stakeholder perspectives on facilitators and barriers to healthy eating for AI/AN adults with T2D in order to inform the cultural adaptation of an existing diabetes nutrition education curriculum.

Methods: Individual interviews were conducted with 9 national content experts in diabetes nutrition education (e.g. registered dietitians, diabetes educators, experts on AI/AN food insecurity) and 10 community-based key informants, including tribal health administrators, nutrition/diabetes educators, Native elders, and tribal leaders. Four focus groups were conducted with AI/AN adults with T2D ( = 29) and 4 focus groups were conducted with their family members ( = 22). Focus groups and community-based key informant interviews were conducted at 4 urban and reservation sites in the USA. Focus groups and interviews were recorded and transcribed verbatim. We employed the constant comparison method for data analysis and used Atlas.ti (Mac version 8.0) to digitalize the analytic process.

Results: Three key themes emerged. First, a diabetes nutrition education program for AI/ANs should accommodate diversity across AI/AN communities. Second, it is important to build on AI/AN strengths and facilitators to healthy eating (e.g. strong community and family support systems, traditional foods, and food acquisition and preparation practices). Third, it is important to address barriers to healthy eating (e.g. food insecurity, challenges to preparation of home-cooked meals, excessive access to processed and fast food, competing priorities and stressors, loss of access to traditional foods, and traditional food-acquisition practices and preparation) and provide resources and strategies for mitigating these barriers.

Conclusions: Findings were used to inform the cultural adaptation of a nutrition education program for AI/AN adults with T2D.
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http://dx.doi.org/10.1093/cdn/nzaa114DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8242492PMC
June 2021

An Approach to Selecting Single or Multiple Social Risk Factors for Clinic-Based Screening.

J Gen Intern Med 2021 Mar 29. Epub 2021 Mar 29.

Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA.

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http://dx.doi.org/10.1007/s11606-021-06740-6DOI Listing
March 2021

Opportunities, Challenges, and Strategies for Engaging Family in Diabetes and Hypertension Management: A Qualitative Study.

J Health Care Poor Underserved 2020 ;31(2):827-844

Family engagement may improve disease management, yet little is known about this topic as it relates to underrepresented minorities who receive care in low-resource primary care settings. This study aimed to explore family engagement in diabetes and hypertension management at an Urban Indian Health Organization to identify opportunities and challenges, and inform care strategies. We employed semi-structured interviews, genograms, eco-maps, and timelines, among 23 English- and Spanish-speaking American Indian and Latino adults with a dual diagnosis of type 2 diabetes and hypertension and 13 family members. Using thematic analysis, we found that family support is not always available, patients have difficulty sharing medical information, and family often live far away. Conversely, opportunities to leverage included a desire for increased engagement, motivation from the younger generation, prevention within the family, outreach to family members with the same conditions, and learning from elders and ancestors. Implications for programs, clinical care, and research are discussed.
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http://dx.doi.org/10.1353/hpu.2020.0063DOI Listing
January 2020

Identifying Relative Changes in Social Risk Factors: An Analytic Approach.

Med Care 2021 02;59(2):e9-e15

Institute for Health Research, Kaiser Permanente Colorado.

Background: Individuals often report concurrent social risk factors such as food insecurity, unstable housing, and transportation barriers. Comparing relative changes between pairs of social risk factors may identify those that are more resistant to change.

Objective: The objective of this study was to develop a method to describe relative changes in pairs of social risk factors.

Research Design: This was a prospective cohort study.

Subjects: Participants in a randomized controlled trial of hypertension care in an Urban Indian Health Organization.

Measures: We measured 7 social risk factors (housing, transportation, food, clothing, health care, utilities, and debts) at enrollment, 6, and 12 months among 295 participants in the trial. We hypothesized that pairwise comparisons could identify social risk factors that were less likely to change over time. We used conditional odds ratios (ORs) with 95% confidence intervals (CIs) to rank each pair.

Results: Food, clothing, health care, utilities, and debts had more changes between 0 and 6 months relative to housing (OR=2.3, 3.4, 4.7, 3.5, and 3.4, respectively; all 95% CI excluded 1.0). These same social risk factors also had more changes between baseline and 6 months relative to transportation (OR=2.8, 3.4, 4.9, 4.7, and 4.1, respectively; all 95% CI excluded 1.0). Changes in housing and transportation risk factors were comparable (OR=0.7, 95% CI: 0.4-1.4). Relative changes between 6 and 12 months were similar.

Conclusions: Housing and transportation exhibited fewer relative changes than other social risk factors and might be more resistant to change. Awareness of the relationships between social risk factors can help define priorities for intervention.
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http://dx.doi.org/10.1097/MLR.0000000000001441DOI Listing
February 2021

A randomized clinical trial of an interactive voice response and text message intervention for individuals with hypertension.

J Clin Hypertens (Greenwich) 2020 07 9;22(7):1228-1238. Epub 2020 Jun 9.

Kaiser Permanente Colorado, Institute for Health Research, Aurora, CO, USA.

Interactive voice response and text message (IVR-T) technology may improve hypertension control in under-resourced settings. We conducted a randomized clinical trial to determine whether an IVR-T intervention would improve blood pressure (BP), medication adherence and visit keeping among adults with hypertension from multiple racial and ethnic groups in primary care at an Urban Indian Health Organization in Albuquerque, New Mexico. Two hundred and ninety-five participants were randomly assigned to IVR-T (N = 148) or to usual care (N = 147). The IVR-T arm received reminders for clinic visits, messages to reschedule missed clinic visits, monthly medication refill reminders, weekly motivational messages, and a blood pressure cuff. The usual care arm received no messages. The primary outcome was change in systolic BP (SBP) between baseline and 12 months. Secondary outcomes included change in SBP between baseline and 6 months, change in diastolic BP (DBP) at 6 and 12 months, self-reported adherence at 6 months, and the proportion of missed primary care clinic appointments. The intervention did not affect SBP or DBP at 6 or 12 months. The 12-month change in SBP/DBP was 1.66/1.10 mm Hg in usual care and 0.23/1.34 mm Hg in the intervention group (P values = .57 and .88, respectively). Self-reported medication adherence improved comparably in both groups, and there was no difference in percentage of kept visits. Several features of study design, clinic operations, and data transfer were barriers to demonstrating effectiveness.
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http://dx.doi.org/10.1111/jch.13909DOI Listing
July 2020

Stopping Gestational Diabetes in American Indian and Alaska Native Girls: Nutrition as a Key Component to Gestational Diabetes Risk Reduction.

Curr Dev Nutr 2021 Jun 6;5(Suppl 4):13-21. Epub 2020 May 6.

University of Colorado Anschutz Medical Campus; Colorado School of Public Health, Centers for American Indian and Alaska Native Health, Aurora, CO, USA.

Background: American Indian and Alaska Native (AI/AN) women have a higher risk of gestational diabetes mellitus (GDM) and subsequent diagnosis of diabetes than do non-Hispanic White women. Healthy eating is key to weight management both prior to pregnancy and between pregnancies and can reduce the risk of developing GDM. Our research team developed an innovative preconception counseling and diabetes risk-reduction program, which includes nutrition and weight-management principles and is culturally tailored for adolescent AI/AN women. The program is entitled (SGDM).

Objective: The purpose of this article is to examine nutrition-related information collected as a part of the formative qualitative research conducted for the development of a preconception counseling and gestational diabetes risk-reduction program, SGDM.

Methods: This in-depth secondary analysis explored the original qualitative data from the needs assessment for SGDM program development. Participants included AI/AN women with a history of GDM ( = 5); AI/AN girls at risk of GDM ( = 14), and their mothers ( = 11), health care providers, and health administrators who care for AI/AN girls ( = 16); AI/AN elected leaders; and Indian health system administrators ( = 12). All focus groups and interviews were reanalyzed utilizing the following research question: "How do key stakeholders discuss food and/or nutrition in terms of gestational diabetes risk reduction for AI/AN adolescent girls?"

Results: Three primary nutrition themes emerged: ) AI/AN women were aware of healthy nutrition, healthy weight gainduring pregnancy, and healthy nutrition for people with type 2 diabetes, but these principles were not linked to reducing the risk of GDM; ) participants expressed the need for education on the role of nutrition and weight management in GDM risk reduction; ) participants shared challenges of healthful eating during and before pregnancy for AI/AN women.

Conclusions: These stakeholders' comments informed the development of the nutrition components of SGDM.
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http://dx.doi.org/10.1093/cdn/nzaa081DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8242493PMC
June 2021

Recommendations from an expert panel of health professionals regarding a gestational diabetes risk reduction intervention for American Indian/Alaska Native Teens.

Pediatr Diabetes 2020 05 21;21(3):415-421. Epub 2020 Feb 21.

Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado.

Background: American Indian/Alaska Native (AI/AN) adolescents are at higher risk for gestational diabetes (GDM), type 2 diabetes, and pregnancy complications than the general population.

Objective: To inform cultural adaptation of a validated evidence-based intervention (VEBI) originally designed to deliver preconception counseling and diabetes education to non-AI/AN teens with diabetes.

Design: Qualitative data were collected using focus group and individual interview methods with health care professionals and experts (n = 16) in AI/AN health, GDM, adolescent health, and/or mother-daughter communication. A semistructured discussion guide elicited responses about provision of care for AI/AN girls at risk for GDM, experience with successful programs for AI/AN teens, comfort of mother/daughter dyads in talking about diabetes and reproductive health and reactions to video clips and booklet selections from the VEBI. All interviews were recorded and transcribed verbatim, and data analysis included inductive coding and identification of emergent themes.

Results: Providers felt teens and their moms would be comfortable talking about the VEBI topics and that teens who did not feel comfortable talking to their mom would likely rely on another adult female. Participants suggested including: AI/AN images/motifs, education with a community focus, and avoiding directive language. Concerns included: socioeconomic issues that affect AI/AN people such as: food and housing insecurity, abuse, and historical trauma.

Conclusions: Perspectives from these participants have been used to guide the development of a culturally tailored GDM risk reduction program for AI/AN girls. This program will be available to health care providers who serve the AI/AN population.
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http://dx.doi.org/10.1111/pedi.12990DOI Listing
May 2020

Impact of targeted health promotion on cardiovascular knowledge among American Indians and Alaska Natives.

Health Educ Res 2013 Jun;28(3):437-49

Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA.

The National Heart, Lung, and Blood Institute developed the Honoring the Gift of Heart Health (HGHH) curriculum to promote cardiovascular knowledge and heart-healthy lifestyles among American Indians and Alaska Natives (AI/ANs). Using data from a small randomized trial designed to reduce diabetes and cardiovascular disease (CVD) risk among overweight/obese AI/ANs, we evaluated the impact of an adapted HGHH curriculum on cardiovascular knowledge. We also assessed whether the curriculum was effective across levels of health literacy (defined as the 'capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions'). We examined change in knowledge from baseline to 3 months for two groups: HGHH (N = 89) and control (N = 50). Compared with controls, HGHH participants showed significant improvement in heart attack knowledge and marginally significant improvement in stroke and general CVD knowledge. HGHH participants attending ≥1 class showed significantly greater improvement than controls on all three measures. Although HGHH participants with inadequate health literacy had worse heart attack and stroke knowledge at baseline and 3 months than did participants with adequate skills, the degree of improvement in knowledge did not differ by health literacy level. HGHH appears to improve cardiovascular knowledge among AI/ANs across health literacy levels.
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http://dx.doi.org/10.1093/her/cyt054DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3716215PMC
June 2013

Management of type 2 diabetes mellitus in children and adolescents.

Pediatrics 2013 Feb 28;131(2):e648-64. Epub 2013 Jan 28.

Objective: Over the last 3 decades, the prevalence of childhood obesity has increased dramatically in North America, ushering in a variety of health problems, including type 2 diabetes mellitus (T2DM), which previously was not typically seen until much later in life. This technical report describes, in detail, the procedures undertaken to develop the recommendations given in the accompanying clinical practice guideline, "Management of Type 2 Diabetes Mellitus in Children and Adolescents," and provides in-depth information about the rationale for the recommendations and the studies used to make the clinical practice guideline's recommendations.

Methods: A primary literature search was conducted relating to the treatment of T2DM in children and adolescents, and a secondary literature search was conducted relating to the screening and treatment of T2DM's comorbidities in children and adolescents. Inclusion criteria were prospectively and unanimously agreed on by members of the committee. An article was eligible for inclusion if it addressed treatment (primary search) or 1 of 4 comorbidities (secondary search) of T2DM, was published in 1990 or later, was written in English, and included an abstract. Only primary research inquiries were considered; review articles were considered if they included primary data or opinion. The research population had to constitute children and/or adolescents with an existing diagnosis of T2DM; studies of adult patients were considered if at least 10% of the study population was younger than 35 years. All retrieved titles, abstracts, and articles were reviewed by the consulting epidemiologist.

Results: Thousands of articles were retrieved and considered in both searches on the basis of the aforementioned criteria. From those, in the primary search, 199 abstracts were identified for possible inclusion, 58 of which were retained for systematic review. Five of these studies were classified as grade A studies, 1 as grade B, 20 as grade C, and 32 as grade D. Articles regarding treatment of T2DM selected for inclusion were divided into 4 major subcategories on the basis of type of treatment being discussed: (1) medical treatments (32 studies); (2) nonmedical treatments (9 studies); (3) provider behaviors (8 studies); and (4) social issues (9 studies). From the secondary search, an additional 336 abstracts relating to comorbidities were identified for possible inclusion, of which 26 were retained for systematic review. These articles included the following: 1 systematic review of literature regarding comorbidities of T2DM in adolescents; 5 expert opinions presenting global recommendations not based on evidence; 5 cohort studies reporting natural history of disease and comorbidities; 3 with specific attention to comorbidity patterns in specific ethnic groups (case-control, cohort, and clinical report using adult literature); 3 reporting an association between microalbuminuria and retinopathy (2 case-control, 1 cohort); 3 reporting the prevalence of nephropathy (cohort); 1 reporting peripheral vascular disease (case series); 2 discussing retinopathy (1 case-control, 1 position statement); and 3 addressing hyperlipidemia (American Heart Association position statement on cardiovascular risks; American Diabetes Association consensus statement; case series). A breakdown of grade of recommendation shows no grade A studies, 10 grade B studies, 6 grade C studies, and 10 grade D studies. With regard to screening and treatment recommendations for comorbidities, data in children are scarce, and the available literature is conflicting. Therapeutic recommendations for hypertension, dyslipidemia, retinopathy, microalbuminuria, and depression were summarized from expert guideline documents and are presented in detail in the guideline. The references are provided, but the committee did not independently assess the supporting evidence. Screening tools are provided in the Supplemental Information.
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http://dx.doi.org/10.1542/peds.2012-3496DOI Listing
February 2013

Management of newly diagnosed type 2 Diabetes Mellitus (T2DM) in children and adolescents.

Pediatrics 2013 Feb 28;131(2):364-82. Epub 2013 Jan 28.

Over the past 3 decades, the prevalence of childhood obesity has increased dramatically in North America, ushering in a variety of health problems, including type 2 diabetes mellitus (T2DM), which previously was not typically seen until much later in life. The rapid emergence of childhood T2DM poses challenges to many physicians who find themselves generally ill-equipped to treat adult diseases encountered in children. This clinical practice guideline was developed to provide evidence-based recommendations on managing 10- to 18-year-old patients in whom T2DM has been diagnosed. The American Academy of Pediatrics (AAP) convened a Subcommittee on Management of T2DM in Children and Adolescents with the support of the American Diabetes Association, the Pediatric Endocrine Society, the American Academy of Family Physicians, and the Academy of Nutrition and Dietetics (formerly the American Dietetic Association). These groups collaborated to develop an evidence report that served as a major source of information for these practice guideline recommendations. The guideline emphasizes the use of management modalities that have been shown to affect clinical outcomes in this pediatric population. Recommendations are made for situations in which either insulin or metformin is the preferred first-line treatment of children and adolescents with T2DM. The recommendations suggest integrating lifestyle modifications (ie, diet and exercise) in concert with medication rather than as an isolated initial treatment approach. Guidelines for frequency of monitoring hemoglobin A1c (HbA1c) and finger-stick blood glucose (BG) concentrations are presented. Decisions were made on the basis of a systematic grading of the quality of evidence and strength of recommendation. The clinical practice guideline underwent peer review before it was approved by the AAP. This clinical practice guideline is not intended to replace clinical judgment or establish a protocol for the care of all children with T2DM, and its recommendations may not provide the only appropriate approach to the management of children with T2DM. Providers should consult experts trained in the care of children and adolescents with T2DM when treatment goals are not met or when therapy with insulin is initiated. The AAP acknowledges that some primary care clinicians may not be confident of their ability to successfully treat T2DM in a child because of the child's age, coexisting conditions, and/or other concerns. At any point at which a clinician feels he or she is not adequately trained or is uncertain about treatment, a referral to a pediatric medical subspecialist should be made. If a diagnosis of T2DM is made by a pediatric medical subspecialist, the primary care clinician should develop a comanagement strategy with the subspecialist to ensure that the child continues to receive appropriate care consistent with a medical home model in which the pediatrician partners with parents to ensure that all health needs are met.
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http://dx.doi.org/10.1542/peds.2012-3494DOI Listing
February 2013

Extending the public health impact of screening for diabetes in high-risk populations: opportunities in American Indian communities.

J Public Health Manag Pract 2005 Nov-Dec;11(6):537-41

Chronic Disease Preventive and Health Promotion Bureau, Montana Department of Public Health and Human Services, Helena, Montana 59620, USA.

Objective: To assess trends in diabetes screening among American Indian adults and identify opportunities to extend blood glucose screening to those at risk for undiagnosed diabetes and prediabetes.

Methods: In 1999, 2001, and 2003, approximately 1,000 American Indian adults aged 18 years and older living on or near the seven reservations in Montana were interviewed through telephone surveys.

Results: Of respondents without diagnosed diabetes, the proportion who recalled blood glucose screening for diabetes within the past 3 years increased from 68 percent in 1999 to 78 percent in 2003. Between 1999 and 2003, screening increased among men (64%-75%), women (71%-80%), those aged 18-44 years (64%-72%), and those aged 45 years and older (76%-84%). Factors independently associated with screening included age more than 45 years, family history of diabetes, and a history of high cholesterol. Current smokers were less likely to report screening compared to nonsmokers. Gender, obesity, and a history of high blood pressure were not associated with screening.

Conclusions: Although self-reported diabetes screening increased over a 5-year period among Indians in Montana, additional groups who could benefit from screening include younger and obese individuals, and those with hypertension.
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http://dx.doi.org/10.1097/00124784-200511000-00010DOI Listing
March 2006

Diabetes in Montana's Indians: the epidemiology of diabetes in the Indians of the Northern Plains and Canada.

Curr Diab Rep 2004 Jun;4(3):224-9

Montana Department of Public Health and Human Services, Cogswell Building, C-317, PO Box 202951, Helena, MT 59620-2951, USA.

The prevalence of diabetes is two- to threefold higher in American Indians in Montana compared with the non-Indian population. High rates of diabetes have also been described in Canadian aboriginal populations closely related to the tribes in Montana. Diabetes in pregnancy has increased among Indian mothers and high-birth-weight babies are increasingly likely to be born to Indian mothers with diabetes in pregnancy. Over 70% of the incident cases of diabetes in youth less than 20 years of age on the reservations have the clinical characteristics of type 2 diabetes. Cardiovascular disease mortality rates are high among Indians in Montana, and the prevalence of smoking in the Indian populations of Montana and the neighboring tribes in Canada is remarkably high. Indians in Montana are more likely than non-Indians of similar age to believe that diabetes is preventable and to recall advice about diabetes risk.
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http://dx.doi.org/10.1007/s11892-004-0028-2DOI Listing
June 2004

Three-year prevalence and incidence of diabetes among American Indian youth in Montana and Wyoming, 1999 to 2001.

J Pediatr 2003 Sep;143(3):368-71

Billings Area Indian Health Service, Billings, Montana, USA.

Objectives: To estimate the prevalence and incidence of type 2 diabetes among American Indian youth.

Study Design: Medical records were reviewed annually for all patients with diabetes who were <20 years of age at 6 Indian Health Service facilities in Montana and Wyoming. All cases < or =5 years of age or weight per age < or =10th percentile at diagnosis or with islet cell antibodies were considered as probable type 1. Among the remaining cases, probable type 2 diabetes was defined when a child had one or more of the following characteristics: weight per age > or =95th percentile or acanthosis nigricans at diagnosis, elevated C-peptide or insulin, family history of type 2 diabetes; treatment with oral agents with or without insulin or no hypoglycemic therapy after 1 year of follow-up.

Results: From 1999 to 2001, 53% of prevalent cases and 70% of incident cases were categorized as probable type 2 diabetes. The average annual prevalence of probable type 1 and type 2 diabetes was 0.7 and 1.3 per 1000. The average annual incidence rates for probable type 1, and type 2 diabetes were 5.8, 23.3 per 100,000.

Conclusions: The incidence of probable type 2 diabetes was approximately 4 times higher than type 1 diabetes among American Indian youth in Montana and Wyoming
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http://dx.doi.org/10.1067/S0022-3476(03)00295-6DOI Listing
September 2003

Physical violence, intimate partner violence, and emotional abuse among adult American Indian men and women in Montana.

Prev Med 2003 Oct;37(4):297-303

Montana Department of Public Health and Human Services, Cogswell Building, C-317, PO Box 202951, Helena, MT 59620-2951, USA.

Background: Little is known about the experience of American Indian communities relative to physical violence (PV), intimate partner violence (IPV), and emotional abuse.

Methods: A random sample of adult American Indians living on or near the seven Montana reservations were interviewed through an adapted Behavioral Risk Factor Surveillance System telephone survey in 2001 (N = 1,006). Victimization from physical violence was defined as PV or sexual assault committed by any person. Respondents who reported experiencing PV and who reported that the perpetrator was a current or former spouse, boyfriend, girlfriend, or date were categorized as experiencing IPV. Emotional abuse was defined as fear for one's safety or being controlled by another individual.

Results: Nine, one, and twelve percent of men reported experiencing PV, IPV, and emotional abuse in the past year, respectively. Five percent of women reported PV in the past year, 3% reported IPV, and 18% reported emotional abuse. Men who reported PV in the past year were more likely to be younger and report more days of physical and mental health problems in the past month. Women reporting PV in the past year were more likely to be younger and have more days with mental health problems in the past month. Few men (7%) or women (12%) reported ever being assessed for PV or safety.

Conclusions: Recent PV, IPV, and emotional abuse are prevalent for both American Indian men and women. Strategies to increase screening for PV and effective interventions for violence are needed.
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http://dx.doi.org/10.1016/s0091-7435(03)00136-1DOI Listing
October 2003

Smoking cessation and prevention: an urgent public health priority for American Indians in the Northern Plains.

Public Health Rep 2002 May-Jun;117(3):281-90

Montana Department of Public Health and Human Services, Cogswell Building C-317, PO Box 202951, Helena, MT 59620, USA.

Objective: The purpose of this study was to compare the prevalence of cigarette smoking and smoking cessation among American Indians living on or near Montana's seven reservations to those of non-Indians living in the same geographic region.

Methods: Data for Montana Behavioral Risk Factor Surveillance System (BRFSS) respondents (n = 1,722) were compared to data from a BRFSS survey of American Indians living on or near Montana's seven reservations in 1999 (n = 1,000). Respondents were asked about smoking and smoking cessation as well as cardiovascular disease (CVD) and selected risk factors. Quit ratios were calculated for both groups.

Results: American Indians were more likely to report current smoking (38%) than non-Indians (19%; p < 0.001). Thirty-seven percent of Indian respondents with CVD risk factors reported current smoking, compared with 17% of non- Indians with CVD risk factors. However, there was no significant difference in reported smoking rates between Indians (21%) and non-Indians (27%) with a history of CVD. Indian smokers were more likely to report quitting for one or more days in the past year (67%), compared with non-Indians (43%). Quit ratios were significantly lower among Indians (43%) than among non-Indians (65%).

Conclusions: High smoking rates in Indians, particularly among those with other CVD risk factors, demonstrate an urgent need for culturally sensitive smoking cessation interventions among Northern Plains Indians and highlight the need for the Surgeon General's focus on smoking in minority populations.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1497434PMC
http://dx.doi.org/10.1093/phr/117.3.281DOI Listing
December 2002

Accuracy of race coding on American Indian death certificates, Montana 1996-1998.

Public Health Rep 2002 Jan-Feb;117(1):44-9

Montana Department of Public Health and Human Services, Helena, Montana 59620, USA.

Objectives: The purpose of this study was to describe the consistency of coding of American Indians on Montana death certificates and to identify the characteristics of American Indians in Montana associated with consistent classification on death certificates.

Methods: The Billings Area Indian Health Service (IHS) patient registration file was linked with Montana Department of Health and Human Services death certificate files for 1996-1998.

Results: A total of 769 Montana residents who had died in 1996-1998 were matched to the IHS registration file. Of these decedents, 696 (91%) were consistently classified as American Indian on the death certificate. Seventy-two (99%) of the 73 decedents not classified as Indian were classified as white. American Indians living in counties on or near the seven Montana reservations were more likely to be consistently classified than Indians living in other counties (95% vs. 70%); those with less than 12 years of education (93% vs. 88%) were more likely to be consistently classified than those with 12 or more years of education. Decedents whose cause of death was suicide were less likely than those with other causes of death to be consistently classified (72% vs. 95%). In contrast, a higher percentage of those with an alcohol-related cause of death than of those with other causes of death were consistently classified, although this difference was not statistically significant.

Conclusions: The mortality rates for Montana American Indians are underestimated overall, and are differentially under- and overestimated for selected conditions.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1497410PMC
http://dx.doi.org/10.1093/phr/117.1.44DOI Listing
November 2002

Regional variation in cardiovascular disease risk factors among American Indians and Alaska Natives with diabetes.

Diabetes Care 2002 Feb;25(2):279-83

Bemidji Area Indian Health Service Diabetes Program, Room 115 Federal Building, 522 Minnesota Ave., Bemidji, MN 56601, USA.

Objective: To compare by region risk factors for cardiovascular disease among American Indian populations with diabetes.

Research Design And Methods: Trained providers from 185 federal, urban, and tribally operated facilities reviewed the records from systematic random samples of the patients included in the local diabetes registries in the 1998 Indian Health Service (IHS) Diabetes Care and Outcomes Audit. Selected measures of cardiovascular risk were aggregated by region and adjusted to calculate regional rates for patients <45 years of age (n = 2,595) and those aged > or =45 years (n = 8,294).

Results: Among the younger group of patients with diabetes, the rates of elevated HbA(1c) (> or =9%) and tobacco use varied significantly among regions. High rates of obesity (78%) and elevated HbA(1c) (56%) were found in the Southwest. High rates of tobacco use (55%) but the lowest rates of elevated HbA(1c) (27%) were found in Alaska. Among patients aged > or =45 years, all measures including rates of proteinuria, cholesterol > or =200 mg/dl, and mean blood pressure > or =130/85 varied significantly among all regions. Tobacco use was highest in the Great Lakes (44%) and Great Plains (42%) regions and lowest in the Southwest (14%) and Colorado Plateau (8%) regions. Proteinuria was found most frequently in the Southwest (35%), Colorado Plateau (30%), and Pacific regions (35%). Older individuals with diabetes were more likely than younger individuals to have proteinuria and blood pressure > or =130/85.

Conclusions: American Indians and Alaska Natives with diabetes carry a large burden of potentially modifiable cardiovascular risk factors, but there is significant regional variation.
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http://dx.doi.org/10.2337/diacare.25.2.279DOI Listing
February 2002
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