Course Capstone : Annotated Bibliography

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MPH/530 Epidemiology Concepts And Public Health Diseases

Celedon, I., Telles, V., Dickerson, D., Johnson, C., Schweigman, K., West, A., & Soto, C. (2022). Exploring Culturally Based Treatment Options for Opioid Use Disorders Among American Indian and Alaska Native Adults in California.  Journal of studies on alcohol and drugs,  83(4), 613–620. https://doi.org/10.15288/jsad.2022.83.613

This article details a study of 163 American Indian and Alaska Native (AIAN) people, who have a history of opioid use disorder (OUD), and assess whether they prefer traditional or cultural healing treatment. The study includes 21 adult focus groups, eight recovery centers and 13 tribal and urban organizations in California. Participants expressed their concerns of the community being unaware of OUD being a disease, ways to help, and available treatments. Participants described the importance of having an inclusive community and shared their desires for treatment to be complimentary to their cultural practice such as healing ceremonies. Those who had received treatment through therapy and 12-step programs mentioned they could not fully heal until they received cultural healing. This article outlines how significant cultural understanding is. By gaining knowledge of the AI/AN traditions, mainstream medicine and programs can find ways to incorporate or suggest treatments that incorporate cultural traditions.

Joshi, S., Weiser, T., & Warren-Mears, V. (2018). Drug, Opioid-Involved, and Heroin-Involved Overdose Deaths Among American Indians and Alaska Natives - Washington, 1999-2015.  MMWR. Morbidity and mortality weekly report,  67(50), 1384–1387. https://doi.org/10.15585/mmwr.mm6750a2 This article outlines the disproportionate rate of death due to opioids for AI/AN people in Washington from 1999-2015. AI/AN people had (and still have) the largest mortality rate due to overdose, compared to any other race in the United States. The article details how AI/AN people were misclassified on their death certificates and therefore did not account for an accurate amount of people whose lives had succumbed to drug use. A recalculation was completed after death certificates were compared to birth certificates, which illustrated the CDC had underestimated the number of deaths for AI/AN by 40%. These findings demonstrate the importance of accurately classifying individuals to address public health crisis within communities by providing education, resources, funding, and accessible healthcare.

Qeadan, F., Madden, E. F., Mensah, N. A., Tingey, B., Herron, J., Hernandez-Vallant, A., Venner, K. L., English, K., & Dixit, A. (2022). Epidemiological trends in opioid-only and opioid/polysubstance-related death rates among American Indian/Alaska Native populations from 1999 to 2019: a retrospective longitudinal ecological study.  BMJ open,  12(5), e053686. https://doi.org/10.1136/bmjopen-2021-053686

This article provides comprehensive historical data on the increased number of deaths due to opioids over two decades (1999-2019) amongst AI/AN people. The study showed an increase in opioid-related mortality rates from 5.2 to 33.9 per 100,000 AI/AN people. More specifically, the increase for women rose from 3.9 to 26.1 and men from 6.5 to 42.1 per 100,000. The study takes a deeper dive and outlines the death trends of opioids combined with other substances such as alcohol, benzodiazepines, cocaine, and methamphetamine. AI/IN continue to have the largest number of opioid related deaths each year compared to any other race. This suggests a much greater public health issue. Why does AI/IN communities suffer significantly compared to other races? The article suggests this is due to historical trauma (colonization), racism, inaccessible treatment, and socioeconomic factors. To address the opioid crisis, public health officials need to focus on the underlying factors that can led to addiction. Treatment should include culturally sensitive methods, address social determinants of health, and discrimination.

Singh, G. K., Lee, H., Kim, L. H., & Williams, S. D. (2024). Social Determinants of Health Among American Indians and Alaska Natives and Tribal Communities: Comparison with Other Major Racial and Ethnic Groups in the United States, 1990-2022.  International journal of MCH and AIDS,  13, e010. https://doi.org/10.25259/IJMA_10_2024

This study describes the health disparities in AI/IN communities amongst other racial and ethnic groups from 1990-2002. The research presented shows AI/IN people have the lowest life expectancy and highest rates of mortality (premature, infant, and maternal). AI/IN communities experience mental illness, disability, unemployment, poverty, and limited education and access to healthcare at a disproportionate rate compared to other races. This is a major public health concern that needs to be addressed. There needs to be a stronger presence of healthcare within these communities. One idea is to incorporate telehealth and digital health literacy, however a gap would still remain as low-income communities have limited access to computers, laptops, electronics, and internet. This article suggests there should be a focus on increasing internet access to allow exposure and support of telehealth and other health information and services that create a digital divide.

Waugh, E., Ivanich, J., O'Keefe, V., Usher, J., Haroz, E., Goklish, N., Kastler, G., Nestadt, P., & Cwik, M. (2023). Understanding opioid use within a Southwestern American Indian Reservation Community: A qualitative study.  The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association,  39(1), 179–185. https://doi.org/10.1111/jrh.12662

This article offers insight of American Indian youth and young adults understanding of opioid use. It uses qualitative data and takes place on a Southwestern American Indian Reservation. It is important to note, the interviews were completed by tribal members who wished to gain a better understanding of opioids use and misuse. 18 individuals participated in in-depth interviews between August 2019 and March 2020. This study showed the participants lack knowledge surrounding opioids, they were unable to define an opioid and some made assumptions that sleeping pills, allergy medicine, and cough medicine would be considered as such. This study suggested that there needs to be more education surrounding opioid use, addiction, as well as why and how opioids would be prescribed. Educating family members to provide support would be beneficial as well. This study makes mention of the large number of AI/AN people who died every year from opioids and encourages studies be done in different regions as they may share similar lifestyles but are different. This study had a small sample size so it would not be beneficial to create a generalization based on this information, but it does create some insight.

Conclusion

This annotated bibliography discusses how opioids play a significant role in mortality

within American Indian and Alaskan Native communities. It describes AI/IN people as the largest communities who die from opioids and overdose, over decades, compared to any other race. It suggests that to address this public health crisis there needs to be advocacy and policies created that focus on socioeconomic factors, discrimination and other social determinants of health that can led to opioid use. Telehealth can help to create access to healthcare with additional focus on ensuring there is proper internet and computer access. When initiating treatment, it is important to include culturally centered treatment paired with traditional treatments.