Health conditions of American Indian/Alaskan Natives college students

Abstract

            American Indian/Alaska Natives comprise a small portion of the general college student population, but often have the poorest health and wellness, as well as the highest dropout rates compared to any other race or ethnicity. Despite the well-documented issues this group faces in higher education, they are often ignored in studies due to their status as the minority within the minority, comprising only 0.8% of all college students in the US. This study examines the differences in college students’ overall ratings of health across racial and ethnic groups, focusing specifically on the health and wellness of AI/AN students compared to their counterparts. This paper also investigates the physical health issues students experienced in the past 12 months and the health issues’ impact on their academic achievement. Results showed that AI/AN students reported the lowest overall health ratings and the most health issues in the past year.

Introduction

According to the United States Census Bureau, approximately 3 million people reported their sole race as American Indian/Alaska Native (AI/AN), and 2.3 million people reported their race as combined AI/AN and one or more other races (U.S. Census Bureau, 2011). These numbers indicate a shift from the census in 2000, where 2.5 million people reported their sole race as AI/AN and 4.1 million people reported their race as combined AI/AN and one or more other races (U.S. Census Bureau, 2011). 

Although these prevalence rates clearly show that AI/NA peoples constitute a significant population in the United States, American Indian/Alaska Natives make up only about 0.8 percent of all college students nationwide (O'Brien, 1992).  AI/ANs are the minority within the minority of the approximate 19 million college students in the United States (U.S. Department of Education, 2009). College dropout among AI/AN students throughout the United States are well-documented, however (Braxton, Brier & Steele, 2008; Patterson et al., In-press; Tinto, 1975; 1993). According to Brown and Robinson Kurpius (1997), 75 percent to 93 percent of AI/AN students drop out of college prior to degree completion, and this group, alarmingly, has consistently held the lead in having the highest dropout rates and lowest graduation rates among minorities in the United States (Benjamin, Chambers, & Reiterman, 1993; O’Brien, 1990; Kidwell, 1994; Ponterotto, 1990; Tierney, 1996; U.S. Department of Education, 2009). Research indicates that AI/AN students enter colleges and universities with poorer health and wellness issues than their counterparts, placing them at a greater risk of dropout.

Despite the research on the risks that AI/AN students face, they are the minority within the minority and, resultantly, their issues are often easily ignored and statistically considered unreliable and not significant (Pavel et al., 1998). In terms of succeeding in college, it is important for any student entering college to be healthy and have some level of perceived wellbeing. As a group AI/ANs are disproportionately affected with heart disease, cancer, chronic liver disease, and diabetes and disproportionately suffer from health inequities than any other group within the United States (Carter-Pokras & Baquet, 2002; Centers for Disease Control and Prevention, 2011; Commission on Social Determinants of Health, 2008; IHS, 2003 & 2012; Pan American Health Organization/World Health Organization, 1999; Wame, 2006).  American Indian/Alaska Native students who evaluate their health and wellness as fair or poor have higher rates of failing in high school compared to students who rated their health as good or excellent (Blum et al., 1992).

The purpose of the present paper is to explore differences in the overall ratings of physical health of college students self-identifying in differing racial/ethnic groups, as well in the types of physical issues experienced within the past 12 months.  The focus of these analyses was to compare AI/AN students with students in other racial/ethnic groups.  Since this is relatively new research territory that uses a very large and unique data set, the analyses presented here should be considered exploratory. As a result, no a priori hypotheses were tested.  Rather, a series of research questions was identified, and the data was used to answer these questions:

1.      How do AI/AN students compare to students in other racial/ethnic groups on ratings of general health?

2.      How many physical health issues have AI/NA students experienced in the past year compared to students in other racial/ethnic groups?

3.      Do the physical health issues experienced by AI/AN students in the past 12 months differ from those experienced by students in other racial/ethnic groups in the same time frame?

Since females are documented as more willing to report symptoms (Kroenke & Spitzer, 1998) and to seek treatment (Adamson et al., 2003), we have included gender as a control variable in each of our analyses.

Method

Data Source and Sample

The American College Health Association (ACHA) granted permission to use the data in the present study. These data were collected via four administrations of the National College Health Assessment (NCHA; Fall 2008, Spring 2009, Fall 2009, and Fall 2010), a bi-annual survey administered by ACHA since 2000.  A sample survey (ACHA, n.d.c), information about participation history (ACHA, n.d.b), and information concerning the reliability, validity, and generalizability of survey results (ACHA, n.d.a) are available from ACHA’s website (http://www.acha-ncha.org/overview.html).

The focus of the present analyses relates to comparisons of physical health concerns among students from different racial/ethnic backgrounds, with the primary comparison group being AI/AN Students; accordingly, these four administrations were selected to allow for a sufficient number of students in each group, making such group comparisons statistically feasible.  However, since only undergraduate students are of concern in these analyses, graduate student responses were removed from the data set.  The resulting sample contained 153,484 student records, 104,426 (68.0%) identifying as white, 9,066 (5.9%) identifying as Black, 9,941 (6.5%) identifying as Hispanic, 14,854 (9.7%) identifying as Asian or Pacific Islander, 2,125 (1.4%) identifying as American Indian, Alaskan Native, or Native Hawaiian, 5,075 (3.3%) identifying as Biracial or Multiracial, 3,903 (2.5%) identifying as other, and 4,094 (2.7%) unknown.   

Although the proportion of AI/AN students in the final sample is small, the proportion of AI/AN respondents in each survey administration ranged from 14.1% (Fall 2008) to 37.1% (Spring 2009).  The Fall 2009 and 2010 administrations had equivalent proportions of AI/AN participants (24.8% and 24.0%, respectively).  In order to justify pooling the four survey administrations to create a larger sample of AI/AN Students, it is important to examine the composition and characteristics of the AI/AN Students in each group.  Thus, across the four administrations, AI/AN Students were compared according to gender composition and overall health ratings in order to determine if these four separate groups of students could be considered comparable.  Since there were no significant differences across the four administrations on either variable – general health ratings (chi square = 14.17, p > .05) and gender (chi square = 12.02, p > .05) – data from the four administrations were combined for all analyses.

Some additional exclusions were made based on the racial/ethnic and gender identification items.  First, the students who responded “biracial or multiracial,” or “other,” and those who did not respond at all to the racial/ethnic identification item were excluded from all subsequent analyses (N = 13,012).  The students identifying as biracial and multiracial were excluded because, while there are certain gene patterns that may make certain groups more or less susceptible to illness and health issues, it is the culture that determines how people in these groups cope with health issues.  Since we do not know in what culture the students who identify as bi-racial or multiracial have been raised, we really have no idea how they should be expected to cope.

In addition, students who either did not respond to the gender identification question (N = 3,900) and those who indicated “transgendered” (N = 217) were also excluded.  The latter group was excluded because there were too few students who responded in this way, resulting in empty cells in the analyses.  The resulting sample size is 139,176 with the number of AI/AN Students in the final sample dropping to 2,098, a decrease of 27 students.

Measures

            Racial/Ethnic Identification.  This categorical variable was created based on students’ responses to the item, “How do you usually describe yourself?”  The choices are White, non-Hispanic; Black, non-Hispanic; Hispanic or Latino/a; Asian or Pacific Islander; American Indian, Alaskan Native, or Hawaiian; Biracial or Multiracial; and Other.  As mentioned above, cases were dropped from the analyses if this item was marked Biracial or Multiracial or Other and if there was no response. The group responding as American Indian, Alaskan Native, or Hawaiian are identified through out as AI/AN.

            Gender Identification.  This categorical variable was created based on students’ responses to the item, “What is your gender?”  As mentioned above, cases where there was no response to this item or where the response was Transgender were dropped from the analyses.

Overall Health Rating (OHR).  In order to create this variable, scores from the item, “How would you describe your general health?” were used.   This item uses a likert-type scale, where 1 indicates poor general health and 5 indicates excellent overall health.  

Past Year Physical Health Issues (PYPHI).  Over a series of four survey items, students were asked to indicate if they experienced certain categories of health issues over the past 12 months.  If they did not experience the health issue, they simply indicated that they did not experience it in the past 12 months. If they experienced the issue, they would indicate the degree to which it impacted their academic performance.  The categories of physical health issues addressed in these four items that are of interest to the present study are: allergies; cold/flu/sore throat; chronic health problem or serious illness (e.g., diabetes, asthma, cancer); chronic pain; injury (fracture, sprain, strain, cut); sexually transmitted disease/infection; sinus infection/ear infection/bronchitis/strep throat; and sleep difficulties.  In order to compute the total number of categories of physical health issues experienced in the past year, students were given a score of “1” for each category experienced, regardless of the degree to which it impacted academics.  Those who did not experience that category of health issue in the past year were given a score of “0”.  The final variable was created by summing the number of categories of physical health issues experienced in the past year, with scores ranging from 1 to 8.

Data Analysis Procedures

In order to answer the first two research questions, 2 Two-Way Analyses of Variance (ANOVA) were used.  In both analyses, the main effects of racial/ethnic identification and gender identification were tested, as well as the interaction of racial/ethnic and gender identification.  In the first ANOVA, the overall health rating served as the dependent variable, and the second used the total number of categories of physical health issues experienced in the past 12 months.  In order to follow up significant differences for the racial/ethnic main effect, planned contrasts were used, with the AI/AN student category as the comparison group (Anderson & Finn, 1996; Ott, 1993; Tabachnik & Fidell, 2007).  Bonferoni’s Inequality was used to determine the alpha level for each planned contrast (Anderson & Finn, 1996); with tests of significance being conducted for four planned contrasts (AI/AN students compared to students in each of the other race/ethnicity groups), the resulting p value must be less than 0.02 in order for the difference to be considered statistically significant.   Effect sizes for significant mean differences were computed using Cohen’s d (Cohen, 1988).

To address the final research question, a chi square analysis was performed for each physical health issue, separately for males and females, to determine if there were differences in the likelihood of reporting each illness by racial/ethnic identification within each gender.  The effect size for each significant chi square analyses was examined using Cramer’s Phi coefficient (Yatani, n.d.).

Results

            Table 1 shows each of the identification groups’ means and standard deviations for each of the dependent variables. Table 2 displays the percentages of students in each group who have experienced each category of physical health issue in the past 12 months.

Differences in Overall Health Ratings

            All three effects that are tested in the first ANOVA are statistically significant (See Table 3 for F-statistics and p values).  In terms of gender, males reported better overall general health than females (3.80 versus 3.58). This represents a mean difference of 0.26 standard deviation units, indicating a small effect size.   In terms of racial/ethnic identification, AI/AN students have the lowest overall average.  However, the results of the planned contrasts indicate that AI/AN students’ overall health ratings are significantly different from those students who identify as White (d = -0.19) and those who identify as Black (d = -0.06), both of which can be considered small effects.

The interaction term of racial/ethnic identification and gender identification is also statistically significant (F = 15.07, p < .001).  In order to aid interpretation of the interaction effect, the mean health ratings of each subgroup have been plotted in Figure 1. Females in all racial/ethnic groups report lower overall ratings of general health, but this difference between males and females is slightly larger for the traditionally underrepresented groups, Blacks, Hispanics, Asians, and AI/AN Students, as compared to White students.  In addition, AI/AN women have the lowest ratings of overall health as compared to any other group.

Differences in Total Number of Categories of Physical Health Issues Experienced

            For total number of categories of physical health issues reported in the past 12 months, there are significant effects for racial/ethnic identification, gender identification, and for the interaction of racial/ethnic group and gender  (See Table 4 for F-statistics and p values).  In terms of gender, females report more categories of physical health issues than males (2.11 versus 1.71), which can be considered a small effect (Cohen’s d = 0.24).  With regard to racial/ethnic differences in total number of health issues reported, the planned contrasts indicate that AI/AN students had significantly higher scores than students in all other groups.   The biggest differences, with medium effect sizes, are for AI/AN students and Black (d = 0.39), Hispanic (d = 0.34), and Asian students (d = 0.40).  There are actually very small differences between AI/AN students and those identifying as White (d = 0.12).

The interaction of race/ethnicity and gender is plotted in Figure 2.  Although females in each racial/ethnic group report significantly more physical health issues each year than males, the gender difference is larger for some groups than for others.  In fact, among AI/AN students, there is a much larger gender effect than among any of the other racial/ethnic groups, and AI/AN women have the highest number of reported physical health issues of any other group.

Differences in Categories of Physical Health Issues Experienced

            Table 2 shows the percentage of students reporting each physical health issue in the past 12 months by racial/ethnic group and by gender.  In order to examine differences among students in different race/ethnicity groups, chi square analyses were performed for each health issue separately for males and females.  To follow up difference among AI/AN students, an additional chi square was performed comparing AI/AN males to AI/AN females in terms of the incidence of each physical health issue.  Results are described by health issue below.

            Allergies.  Among women, there is a significant difference in the reported incidence of allergies among the five race/ethnicity groups (chi square = 43.72, p < 0.001), with the greatest incidence among AI/AN women (6.1%).  The effect size, as measured by Cramer’s Phi coefficient, is very small, however (0.02).  Among men, there is also a significant difference in the incidence of allergies (chi square = 40.51, p < 0.001).  The effect size for this difference is equally small (0.03), and the highest reported incidence is among Black males (5.6%).  AI/AN men and Asian men report allergies with equal frequency are second highest in terms incidence.  Among AI/AN students, there is no difference between men and women in the reported incidence of allergies (chi square = 1.43, p < 0.231).

Cold, flu, and sore throat.  AI/AN women are more likely to report cold, flu, and sore throat in the past 12 months as compared to women in the other race/ethnicity groups (25.6%; chi square = 354.09, Cramer’s Phi = 0.06).  AI/AN men also have the highest reported incidence of cold, flu, and sore throat, compared to men identifying as other races/ethnicities (16.9%; chi square = 32.04, Cramer’s Phi = 0.03).  Both of these effect sizes are considered small.  Among AI/AN students, women have a greater reported incidence of cold, flu, and sore throat (chi square = 19.69, Cramer’s Phi = 0.10).  This effect size is still considered small.

 Chronic health problem or serious illness.  Among women, AI/AN students have the highest reported incidence of chronic health problems or serious illnesses in the past 12 months, and the difference is statistically significant (9.0%; chi square = 103.20, p < 0.001; Cramer’s Phi = 0.03).  AI/AN men have the second highest reported incidence of chronic health problems or serious illnesses in the past 12 months (4.7%), second only to Black men (5.2%);  the differences among these groups are statistically significant (chi square = 31.65, p < 0.001) as well, which is a small effect size (Cramer’s Phi = 0.03).  AI/AN women are significantly more likely to report chronic health problems or illness (chi square = 11.98, p < 0.001; Cramer’s Phi = 0.08).

Chronic pain.  AI/AN women have the highest incidence of reported chronic pain as compared to women in other race/ethnic groups (6.8%; chi square = 52.79, p < 0.001; Cramer’s Phi = 0.02).  Race/ethnicity groups also differ significantly in the incidence of chronic pain for men (chi square = 51.93, p < 0.001; Cramer’s Phi = 0.03).  AI/AN men are second only to Black men with regard to the incidence of chronic pain (4.2% versus 5.6%).  Among AI/AN students, women are more likely to report chronic pain than men (6.8% versus 4.2%; chi square = 5.21, p < 0.05, Cramer’s Phi = 0.05)

Injury.  There are no significant differences between racial/ethnic groups in reported injury among women (chi square = 7.22, p < 0.13).  Among men, the reported incidence of injury does vary significantly in the racial/ethnic groups (chi square = 58.18, p < 0.001; Cramer’s Phi = 0.04).  Black men report the highest levels (6.9%), followed by AI/AN men (5.4%).  The incidence of physical injury in AI/AN men and women is equivalent (chi square = 2.52, p < 0.12).

Sexually transmitted disease/infection (STD/STI).  Among both men and women, AI/AN students are second highest with regard to the incidence of STD/STI.  Black men and women have the highest reported incidence (4.5% and 2.6%, respectively), followed by AI/AN men and women (3.3% and 2.4%, respectively).  The race/ethnicity difference is significant among both women (chi square =69.5, p < 0.001; Cramer’s Phi = 0.03) and men (chi square = 87.81, p < .001; Cramer’s Phi = 0.04).  AI/AN men and women do not differ significantly with regard to incidence of STD/STI (chi square = 1.57, p < 0.22).

Sinus infection/ear infection/strep throat.  As with cold, flu, and sore throat, AI/AN women are significantly more likely to report sinus/ear infection and/or strep throat (11.9%; chi square = 279.84, p < 0.001; Cramer’s Phi = 0.06).  AI/AN men also report the greatest incidence of sinus/ear infection and/or strep throat as compared to men in other race/ethnicity groups (6.6%; chi square = 42.93, p < 0.001; Cramer’s Phi = 0.03).  AI/AN women report this physical health issue to a significantly higher degree than AI/AN men, however (chi square = 13.75, p < 0.001; Cramer’s Phi = 0.08).

Sleep difficulties.  Among the race/ethnicity groups, AI/AN women have the highest incidence of sleep difficulties (29.8%; chi square = 128.42, p < 0.001; Cramer’s Phi = 0.04).  For men, there are significant differences among the five racial/ethnic groups (chi square = 26.29, p < 0.001; Cramer’s Phi = 0.02).  However, AI/AN men have an incidence of sleep difficulties comparable to men who identify as White, Hispanic, and Asian (all around 20.0%).  For Black men, the incidence is much lower (16.2%).  Among AI/AN students, women have a higher incidence of sleep difficulties compared to men (chi square = 19.73, p < .001; Cramer’s Phi = 0.10).

Discussion

            Regardless of gender identification, students who identify as AI/AN Students and Asians rate their overall physical health lowest, compared to students identifying with other racial/ethnic groups.  Those students who identify as white have the highest overall health ratings in comparison to all other groups.  Regardless of racial/ethnic identification, females report the lowest overall health ratings as compared to males.  However, within some racial/ethnic groups, the differences between males and females are greater than for other groups.  White and Asian males and females exhibit less of a difference in overall health ratings as compared to differences between males and females in all of the other racial/ethnic groups.

As with overall ratings of health, there were differences by racial/ethnic identification and by gender in the number of physical health issues experienced in the past year.  American Indian/Alaskan Native students reported the most health issues, compared to the other groups, and females reported more issues than males.  American Indian/Alaskan Native female students reported the greatest number of health issues as compared to all other groups. Results showed differences in the specific types of physical health differences experienced as well.  Both AI/AN men and women were more likely to experience cold, flu, and sore throat and sinus infection/ear infection/strep throat as compared to students in other groups.  American Indian/Alaskan women also had a significantly greater incidence of these acute infections, compared to AI/AN men. American Indian/Alaskan women also had the highest incidence of allergies, chronic health problems or serious illnesses, chronic pain, and sleep difficulties as compared to all other groups. 

Although the effect sizes for each of the differences were small, these differences do warrant further investigation.  From these data, it is unclear if AI/AN women truly experience more physical health issues or if they are merely more open to sharing them on a health survey.  If AI/AN students, especially women, are more likely to experience physical health issues, this susceptibility would likely have a negative impact on their ability to function in the college setting, an issue that should also be subjected to further investigation.

Conclusion

AI/AN students who enter college are coming from communities that have been disproportionately affected by chronic conditions such as heart disease, cancer, chronic liver disease, and diabetes within the United States (Carter-Pokras & Baquet, 2002; Centers for Disease Control and Prevention, 2011; Commission on Social Determinants of Health, 2008; IHS, 2003 & 2012; Pan American Health Organization/World Health Organization, 1999; Wame, 2006).  These young people’s health conditions are a reflection of their communities and, it seems, they enter college with these health issues.

To the best of our knowledge, no other study presents findings from a sample size in the range of these data.  While statistically significant scores were fairly certain due to the very large data set, effect sizes between groups were mostly low. AI/AN students are fairly comparable to students in other racial/ethnic groups on ratings of general health. Again, while there is statistical significance, effect sizes are small. American Indian/Alaskan Natives report about the same amount and have similar physical health issues in the past year compared to their count parts. With the current and persistent high rates of AI/AN college dropout, barriers to college success should continue to be evaluated. Without knowing the health reports of AI/AN students who dropped out of college, these findings provide little guidance toward understanding the connection between AI/AN student health and college success.

References

Adamson, J., Ben-Shlomo, Y., Chaturvedi, N., & Donovan, J. (2003).  Ethnicity, socio-economic position and gender – Do they affect reported health-care seeking behavior?  Social Science & Medicine, 57, 895-904.

American College Health Association (n.d.a) National College Health Assessment generalizability, reliability, and validity analysis.  Retrieved October 17, 2012, from http://www.acha-ncha.org/grvanalysis.html

American College Health Association (n.d.b) National College Health Assessment participation history.  Retrieved October 17, 2012, from http://www.acha-ncha.org/partic_history.html

American College Health Association (n.d.c) National College Health Assessment sample survey.  Retrieved October 17, 2012, from http://www.acha-ncha.org/sample_survey.html

Anderson, T. W., & Finn, J.D. (1996).  The new statistical analysis of data.  New York, NY:

            Springer.

Blum, R. W., Harmon, B., Harris, L., Bergeisen, L., & Resnick, M. D. (1992). American Indian-Alaska Native youth health. Journal of the American Medical Association, 267, 1637-1644.

Braxton, J. M., Brier, E. M., & Steele, S. L. (2008). Shaping retention from research to practice. Journal of College Student Retention, 9(3), 377-399.

Brown, L. L., & Robinson Kurpius, S. E. (1997). Psychosocial factors influencing academic persistence of American Indian college students. Journal of College Student Development, 38(1), 3-12.

Carter-Pokras, O., & Baquet, C. (2002). What is a health disparity? Public Health Reports, 117, 426-434.

Centers for Disease Control and Prevention. (2011). National diabetes fact, sheet: National estimates and general information on diabetes and prediabetes in the United States, 2011.

Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Lawrence Earlbaum Associates.

Commission on Social Determinants of Health. (2008). Closing the gap in a generation: Health equity through action on the social determinants of health. Geneva: World Health Organization.

Indian Health Services. (2003). Trends in Indian health, 2002-2003 edition. Washington, DC:  U.S. Government Printing Office.

Indian Health Services. (2012). Diabetes in American Indians and Alaska Natives: Facts at-a-glance. Retrieved November, 30 2012 from http://www.ihs.gov/MedicalPrograms/Diabetes/HomeDocs/Resources/FactSheets/2012/Fact_sheet_AIAN_508c.pdf

Kidwell, C. S. (1994). Higher education issues in Native American communities. In M. J. Justiz, R. Wilson, & L. J. Bjork (Eds.), Minorities in higher education (pp. 239-257). Phoenix, AZ: Oryx Press.

Kroenke, K., & Spitzer, R. L. (1998).  Gender differences in the reporting of physical and somatoform symptoms.  Psychosomatic Medicine, 60(2), 150-155.

O'Brien, E. M. (1990). A foot in each world: American Indians striving to succeed in higher education. Black Issues in Higher Education, 7, 27-31.

O'Brien, E. M. (1992). American Indians in higher education (Research Briefs 3). Washington, DC: American Council on Education, Division of Policy Analysis and Research.

Ott, R. L. (1993).  An introduction to statistical methods and data analysis.  Belmont, CA:

            Wadsworth, Inc.

Pan American Health Organization—World Health Organization (1999). Principles and basic concepts of equity in health. Retrieved October 3, 2012 from http://www.paho.org/english/hdp/hdd/pahowho.pdf

Patterson, D.A., Ahuna, K.H., Tinnesz, C.G., & VanZile-Tamsen, C. (In-press). Using self-regulated learning to increase Native American college retention. Journal of College Student Retention: Research, Theory & Practice.

Ponterotto, J. G. (1990). Racial/ethnic minority and women students in higher education: A status report. New Directions for Student Services, 52, 45-59.

Tabachnik, B. G., & Fidell, L. S. (2007).  Using multivariate statistics (5^th ed.).  New York, NY:

Pearson Education, Inc.

Tierney, W. G. (1996). The college experiences of Native Americans: A critical analysis. In C. Turner, M. Garcia, A. Nora, & L. I. Rendon (Eds.), Racial and ethnic diversity in higher education (pp. 302-311). Needham Heights, MA: Simon & Schuster.

Tinto, V. (1975). Dropout from higher education: A theoretical synthesis of recent research. Review of Educational Research, 45, 89-127.

Tinto, V. (1993). Leaving college: Rethinking the causes and cures of student attrition (2nd ed.). Chicago; University of Chicago Press.

U.S. Department of Education. (n.d.) Degrees conferred by racial and ethnic group. Retrieved October 8, 2012 from the Chronicle of Higher Education website, http://chronicle.com/article/Degrees-Conferred-by-Racial/48039/

Yatani, K. (n.d.).  Chi square test effect size. In Statistics for HCI research. Retrieved October 4, 2012 from http://yatani.jp/HCIstats/ChiSquare#ChiEffectSize.

Wame, D., (2006). Research and educational approaches to reducing health disparities among American Indian and Alaska natives. Journal of Transcultural Nursing, 17, 266-271. 

 Table 1

Means and Standard Deviations of Dependent Variables by Race/Ethnicity and Gender

Group	Overall Health Rating						Total Physical Health Issues
	Total		Male		Female		Total		Male		Female
	Mean	SD	Mean	SD	Mean	SD	Mean	SD	Mean	SD	Mean	SD
White	3.68	0.82	3.82	0.83	3.61	0.81	2.07	1.66	1.77	1.69	2.22	1.62
Black	3.59	0.90	3.84	0.88	3.48	0.89	1.57	1.80	4.41	1.99	1.64	1.71
Hispanic	3.58	0.88	3.78	0.87	3.48	0.87	1.70	1.66	1.53	1.75	1.79	1.60
Asian	3.54	0.87	3.67	0.88	3.47	0.86	1.63	1.54	1.46	1.62	1.73	1.49
Native	3.53	0.87	3.73	0.88	3.44	0.86	2.27	1.85	1.84	1.89	2.47	1.80

 

Table 2

Incidence of Physical Health Issues Past 12 Months by Race/Ethnicity and Gender

Physical Health Issue	Race/Ethnic Group	Overall	Gender
			Male	Female
Allergies	White	3.5	3.7	3.4
	Black	4.6	5.6	4.1
	Hispanic	3.8	4.2	3.7
	Asian	4.3	4.8	4.0
	Native American	5.7	4.8	6.1
Cold, Flu, Sore Throat	White	19.4	15.5	21.5
	Black	12.0	11.9	12.1
	Hispanic	16.6	13.8	18.1
	Asian	18.7	15.2	20.7
	Native American	22.9	16.9	25.6
Chronic Health Problem or Serious Illness	White	4.5	3.4	5.1
	Black	4.8	5.2	4.6
	Hispanic	4.2	3.5	4.6
	Asian	3.2	2.9	3.4
	Native American	7.6	4.7	9.0
Chronic Pain	White	3.7	3.3	3.9
	Black	4.9	5.6	4.6
	Hispanic	3.9	3.5	4.1
	Asian	3.0	2.7	3.1
	Native American	6.0	4.2	6.8
Injury (fracture, sprain, strain, cut)	White	3.5	4.0	3.2
	Black	4.5	6.9	3.2
	Hispanic	3.8	4.6	3.3
	Asian	3.2	3.8	2.9
	Native American	4.4	5.4	3.9
Sexually Transmitted Disease/Infection	White	1.6	2.0	1.4
	Black	3.2	4.5	2.6
	Hispanic	2.1	2.5	2.0
	Asian	1.5	1.7	1.4
	Native American	2.7	3.3	2.4

Table 2 continued

Categories of Physical Health Issues Experienced by Race/Ethnicity and Gender

Physical Health Issue	Race/Ethnic Group	Overall	Gender
			Male	Female
Sinus Infection/Ear Infection/Strep Throat	White	7.8	5.9	8.8
	Black	5.7	5.5	5.8
	Hispanic	6.3	5.2	6.8
	Asian	4.3	3.7	4.7
	Native American	10.2	6.6	11.9
Sleep Difficulties	White	21.4	20.4	21.9
	Black	17.0	16.2	17.3
	Hispanic	21.6	20.0	22.4
	Asian	20.8	20.0	21.3
	Native American	26.8	20.5	29.8

 

 

Table 3

Effects of Racial/Ethnic and Gender Identification on Overall Health Ratings

Source	df	Mean Square	F	p
Gender	1	503.03	727.92	.001
Race/Ethnicity	4	77.65	112.37	.001
Gender X Race/Ethnicity	4	15.07	21.81	.001
Error	136340	0.69
Total	136350

 

Table 4

Effects of Racial/Ethnic and Gender Identification on Total Physical Health Issues Experienced Past 12 Months

Source	df	Mean Square	F	p
Gender	1	963.93	354.21	.001
Race/Ethnicity	4	955.91	351.26	.001
Gender X Race/Ethnicity	4	58.67	21.56	.001
Error	136340	2.72
Total	136350

 

RETURN OF THE PASQUES

Below is the begining section of my newest novel. I have been writing novellas and short stories, but this story is working into a longer offering. I hope those who find it, enjoy this short begining section, Peace DAP

 

*The Beginning*

This story begins in a small, deep southern Alabama town where everyone says they know their neighbors, but in reality these folks keep mostly to themselves. The people who live here are relying on themselves and each other and expect their neighbors to do the same. In other words, it’s perfectly fine to receive help from neighbors, but if folks rely on the government for support, they are looked at differently. It is late summer and hot. The days can reach well over one hundred degrees with the nights providing some relief from cool winds blowing from the Appalachian Mountains in the north. The mostly brick homes were built after WWII by returning soldiers. The yards and houses have been maintained over the years by those who settled in long after the war.  

This story is about Mato Crow, who currently lives in this small and small-minded community. It follows his bewildering journey to find his birth mother who is believed to live out west. Although Mato has no recollection of his first year with his biological mother he understands why he was removed from her care. His mother, Nina Crow, a full-blooded Sioux from South Dakota was fifteen when she became pregnant.  She surrendered her son at the hospital and quickly returned to her people, trying to forget about him and move on with her young life. Mato knows he was adopted and that his biological mother is an American Indian. Other than that, he knows nothing of his past or people. His parents, the ones who adopted him, have raised him within their own cultural understandings, which is a typical white, Christian, southern upbringing.

   If sex, violence or tales of human misfortune bother you, this is a story to avoid. However, it seems unclear how anyone capable of reading this story could go through life without experiencing some kind of tragedy. Who is the eighteen-plus year old human who says they have not suffered some kind of harm in their life? All humans suffer, some more than others. If you have been blessed without any trauma in your life, then yes…you are a fortunate individual. Do not fret though, harm certainly awaits you. Harm is patient and unflappable. So, the issue is not if trouble will come into your life, what matters most, is how you respond when it does. There are some harm that happen to people that can alter their core – the very essence of who they are as human beings. No amount of therapy or time can heal some wounds.

Also, there are humans that, regardless what has happened throughout their life, they would not change one tiny episode, good or bad, for fear it would have altered where they are in their current life. They realize that any harm they suffered is a blessing. Tragedy can, in fact, improve a life. Unfortunately, harm’s impact is not known until it is experienced.

Mato will experience tragedy along his path. He will also be the cause of some hardships. Again, this story is not about exposing harm for harm’s sake, but to witness Mato’s story and his reactions to these events. It is an effort of trying to understand how life’s natural trials result in many different outcomes. Do not look away when devastation approaches during this story. Nor search for blame when it arrives. Blame should not be a concern and searching for it is a waste of energy.

Who is to blame when a tsunami causes a tragedy? It could not be a human that caused such a tragic event.  Is it god or some kind of greater power?    

If god or a higher power is to blame for a tsunami and that provides some self-comfort, then so be it. When human self-will is the result of suffering, does god play a role? An out-of-control self-will is just as devastating to humans as a giant tidal wave. Our reaction to tragedy is rooted within the context of whether that tragedy is viewed as the result of god’s will or human’s self-will.

For instance if a man drowns a child, our natural response has a clear path forward – hate the man and grieve the child. If a child drowns as the result of a tsunami, our response becomes more complex. The child is easily grieved, but our other emotional reaction – anger – gets no relief. Finding and applying blame to a harmful event is like applying medicine to an injury.

Mato’s story will provide no relief when disaster happens. Sometimes self-well and god’s will are not clear when tragic events happen. And when certain events happen in Mato’s story do not look for one or the other. It might be best, if assigning blame is needed, that is if you need to apply medicine to your own wounds, to consider both god and self-will’s influence. Can one will really exist without the other?  

Top ten things Native Americans can do to improve their health in 2014

1.       Stop smoking - please!

 

2.       Please stop drinking alcohol

3.       Stop eating fried bread, chicken, or for that matter fried everything

4.       Stop making excuses why you can't do something

5.       Attend a traditional ceremony (and take a child with you)

6.       Accept everyone for who they are (enrolled, not enrolled, non-language speaker, not in your tribe, etc. – especially if they are children)

7.       Start walking – everyday

8.       Enroll in an educational program

9.       Volunteer in your community

10.   Finally…If you are in a gang – get out; if you are in an unhealthy/violent relationship – get out and get help; if you live with people who are bad for your health – get out or kick them out; if you blame others for all of your poor decisions – stop it; if you are over thirty-years old and still blame your parent(s) for all of your problems – stop it; if you are over fifty and you have no close friends – maybe it is you!; and if you are the type of person who can find many reasons to disagree with these – hopefully you will discover you are most in need of them.

Peace, Happy New Year! DAP

Don’t Let Schooling Interfere With Your Education

Mark Twain said that. Don’t let schooling interfere with your education. The idea behind this quote seems simple. There is a difference between institutionalized schooling and becoming educated. Or maybe more specifically, institutionalized schooling can get in the way of becoming educated.

My grandpa said the same thing but differently. People cannot be fully educated until they can make something with their own hands. My grandpa was a farmer. He was not a college graduate. But he could repair any mechanical system like a tractor or car. He could also repair living systems too, like his animals. Or even a child’s broken heart.

He was both schooled and educated. Having children still in school, I worried about their education. School is good at schooling. Educating, on the other hand, is lacking in school. To be successful in school requires successful time management – be somewhere at a certain time; complete a task by a certain deadline, etc. There is a premium on timeliness in schools. I guess time management is important, but is it related to becoming educated?

Our small family spent a few days in the Ozarks on the lake. The rental house sat right on the water and there was a dock just out the back door for fishing and hanging out. It was a bit too cold for swimming. My oldest son spent a lot of his time on that dock fishing. It was his first time specifically fishing for catfish. Fishing for catfish requires a particular strategy.

He was taught about different hooks, baits and how to set up and watch his pole. Also, there is much learning about what to do after getting a bite, bringing the fish in, and handling it so he or the fish are not harmed or more harmed. He caught several catfish and a couple turtles. I feel comfortable to say that he was well educated during those days on that dock. And the educational processes were exciting to him. He wanted to learn. He was up early and out the door each morning, learning and becoming educated.

This was not school – this was education. Had this been designed and carried out by his school with a project wrapped around it – I suspect…it would have…well…sucked! School would have killed the creative process of education. Who explains this better is Ken Robinson. If interested, please watch his brief discussion in link below. http://www.ted.com/talks/ken_robinson_says_schools_kill_creativity.html

Mark twain also said something like…the person who does not read is equal to the person who cannot read.  If you are like me, picky about reading, please let me recommend an outstanding book. Or better yet, and outstanding writer -- Malcolm Gladwell. He has written Outliers, The Tipping Point, Blink, and his latest offering, David and Goliath. Any and all of those books are worth the investment. I have read every book he has written and just finishing David and Goliath. http://www.amazon.com/David-Goliath-Underdogs-Misfits-Battling/dp/0316204366

As with his other books, I am sad to be nearing its end. He is my kind of story teller and educator. If you are interested in underdogs and education, these are the books for you – especially David and Goliath.

You don’t have to still be in school to continue getting educated. As a matter of fact, school might be the worst place for an education.  Read. And go do or make something. That's educational!

 

Peace, DAP

Education: that which reveals to the wise, and conceals from the stupid, the vast limits of their knowledge.

In the first place, God made idiots. That was for practice. Then he made school boards.

Mark Twain

In Treatment. A Novella excerpt

Below is sample of a novella that is currently under review. It is about a recovering alcohol and drug addict, Daniel, who is the new resident manager at a treatment program. Daniel struggles with helping other addicted men as well as how he can stay clean and sober while helping others. It is a real-world story about addictions, dishonesty, healthy relationships, and self-improvement. Wherever their are people struggling with addiction, there are issues of sex, violence, and death. This story deals with all those issues. I hope you will consider reading the entire offering when it is published soon. Peace DAP

 

 

Willy and Daniel’s First Real Talk

            “Hey Daniel…can I come in?”

            “Sure Willy, come on in my friend.”

It was late in the evening. Daniel was sitting in Mike’s office, searching the web and reading the latest news online. Daniel had the run of the place in the evenings and on weekends so if the guys wanted to seek out advice, Daniel was the best person to talk with. Although Daniel and Willy had briefly talked during Daniel’s first couple of weeks, they never spent much time alone getting to know each other.

            “What do you think about our groups?” Willy asked as he sat down.

            “Well…I can say you were telling the truth when you said that Mike’s a ruthless mother fucker man!”

            “You got that right,” Willy nodded, “these men are no match for Mike.”

            “What is up with Larry?” Daniel asked, “I don’t trust him one bit.”

            “The reason you don’t trust him, Daniel, is because there is something not right with that man! I don’t trust him for some reason. Every time I’m in groups with him I get a bad feeling.” Willy said, pointing in the direction of the group room.

            “Are you trustworthy Willy?”

Willy smiled and chuckled under his breath.

            “I think I am trustworthy…more trustworthy than cock suckin’ reformatory raised Larry!” Willy replied. He rocked back and forth in his chair.

            “I wouldn’t brag about being better than Larry at something,” Daniel smiled.

            “You right man,” Willy said as his rocking came to a stop.

            “What’s your deal Willy? No one gets in here for being the type person you are trying to come across as.”

            “Damn, Daniel! What are you, Mike’s little brother?” Willy asked jokingly. He began rocking again. “You can’t just say that kind of shit to people, especially around here.”

Willy shook his head in disapproval.

            “I have changed man,” Willy said, “You not meetin’ the Willy that walked into this mutha fucka!”

Willy got a bit more dramatic now, lifting his hands as he spoke and rocked in his chair.

            Daniel said, “I got about two years clean now. I’ve changed, but not sure all the bad stuff is completely gone yet.”

This put Willy back at ease.

            “What recovery issues are you still working on here, Willy?”

            “Shit, man, a lot” Willy clapped his hands and laughed, “I’m still one angry, jealous bastard, especially when it comes to my baby’s mama, Tisa. That bitch drives me crazy, man.”

They both looked at each other, laughing. Relationships in this program are built on trust. Daniel knew not to get too close to Willy if he sensed that Willy was mostly full of shit. Although Daniel liked Willy right off the bat, he needed more information before he could put some faith in him.

            “Your girl’s name is Tisa. What’s your baby’s name?” Daniel asked.

            “Lavonda. She’s twelve now.”  

            “That’s good, Willy. You a good dad?”

            “I don’t know man…I use Lavonda for an excuse to see Tisa,” Willy admitted.

            “How did you get into First Step Willy?”

            “Man… I was all fucked up after being awake for a few days smoking crack and I was stalking Tisa. I sat out in front of her house for like six hours, man – drinkin’, and smokin’ that shit. Although she had already cut me out of her life, I wanted to know if she was seeing anyone else. I see her pull up with this black mutha fucka. I was out of my fuckin’ mind with rage, man. I had an old pistol…,” he started laughing as he spoke, “…I didn’t have any bullets in it cause I didn’t want to spend my drug money gettin ’em.”  

            “So what happened?” asked Daniel.

            “I jump out of the car and bounce over there like I am going to whip his black ass, and this mutha fucka goes about six foot five – two-fifty pounds!”

They were both laughing now. Willy waved his hand, trying to stop Daniel from laughing so he could tell the rest of the story.

            “Look…Look, man…here I am, five foot seven, built like JJ on Good Times and this big black bastard stands over me like King fuckin’ Kong.” Daniel covered his face with his hands and shook his head, laughing. Willy was standing next to him now, his hand on Daniel’s shoulders.

            “This ain’t no shit…man,” Willy said through waves of laughter.

            “My mind said, ‘You better run your ass back to that car and get the fuck away from this gorilla,’ but all that crack I smoked and all of my rage said, ‘Put that pistol in that mutha fucka’s face.”    

Daniel bent over in his chair, laughing and wiping away tears. He laughed and flung about harder each time Willy tried to get more serious.

“Crack make you do some fucked up things man.”

When Daniel laughed harder, Willy couldn’t help but join him. As the laughing and chuckling calmed down, Willy got quiet and stopped smiling.

            “I pistol whipped Tisa that night. That man didn’t want anything to do with me – he jumped in his car and took off. That rage all came out on her.”

The office fell silent as Daniel looked towards Willy. Daniel noticed him looking down, rocking side-to-side again. Willy continued in a low voice.

            “She’s down on the ground and I’m beating her with my gun and fists. I look up and I see my daughter standing behind the glass door yelling, beating on the door, screaming for me to stop beating her mama. If I had bullets, I would have killed her that night – right in front of our daughter, man. The only reason I stopped beating her was I was too tired, I was weak from being up for days not eating, only smoking that shit.”

            “You’re lucky no one died that night, man,” Daniel said.

            “Naw man…I ain’t lucky. No one is lucky in them situations. My daughter is scared of me still. Tisa won’t have nothing to do with me…and I have to force myself not to jump off the MLK.”

            “What do you mean, Willy?” Daniel asked.

            “Man I don’t know…whenever I get down, I walk the MLK Bridge.”

“Why would you do that, man?”

“Well…my father and older sister jumped off that bridge. All of their problems were gone after they jumped. When problems get too much for my family, that river heals us. It can handle problems better than we can. We let the river take us and our problems away.”

Willy continued talking at a steady pace, looking out the window, rocking. Daniel was still, watching and listening to Willy.

“After I pistol whipped Tisa, I drove to our bridge. It was about two in the morning. Only a few cars were on the road. I crossed that bridge ten times in my car. Illinois to St Louis and back again – over and over. There’s a parking stop on the Illinois side that I always use.

“Tisa and me had our first date on that fuckin’ bridge. We held hands, walked and talked. It was like introducing her to my family.”

Willy wiped away a tear running down his face and continues.

“That was one of the best nights of my life, my first date with Tisa on that damn bridge. I had a small bottle of liquor we were sharing as we walked. We smoked a little weed too. We were having a great time.”

“Did you tell her about your dad and sister?”

“Fuck no, man…that would have ruined our moment. Things were going too good and I thought she would run away from me if she found out about my family, or even me, too soon. I had to trick her into loving me first before I could talk about all that shit,” he said with a little chuckle.

“We get back to my car and we just start kissing and rubbing all over each other. I wanted her, man, and I could tell she would have probably let me do anything to her that night. I had to force myself to stop. She’s always had big soft tits and a fat ass, man. I grabbed them up that first night, but that was as far as it went. I did not want her to think I just wanted to fuck her in my car. I wanted it to be right, man…not like all them other street whores I usually ride with. I took her home after our first date on that bridge and did it correct, man. Walked her to the door and treated her respectable.

“What I did to her in front of her house with our little girl watching was not respectable, man. I kept seeing our little girl’s frightened face standing in that doorway, as I stood on that bridge. I talked to my daddy that night; I talk to him all the time when I walk the bridge, trying to figure out the exact spot where he jumped from. I wondered about all the problems in his life – what problems were pushing him over the rail – the rail that I was leaning on. I climbed over. I grasped the rail behind me. It was wet. I would stretch my arms out straight, looking down onto the water moving past. All my problems would soon vanish beneath that black river. As I was just ready to release, I was snatched up man.”

“Yeah…well thank god, man,” said Daniel.

“Somehow two fucking cops walked right up to me without me noticing them. They locked onto me. I was lifted over that rail, put on the ground, handcuffed, and rushed right down to Barnes Jewish’s psychiatric center, man. It took me a minute to realize what happened. I asked the cop who’s driving, ‘Hey man…you arresting me?’ he says, ‘Just relax, man, I’m taking you to see a doctor.’

“I spent some time there and ended up in this hell hole of a place. It’s changed my life though, man. That mutha fuckin’ Mike broke me down – he is no joke, man. This program is hard but if you are serious, it will change you, man. Some of these fuckers in here could care less about changing.”       

“Name them, Willy,” asked Daniel.

“Well…my opinion, the worst person here is that fuckin’ Larry.”

“Why you say that?”

“I don’t trust him, man. He never talks in group unless he is getting confronted about something. He’s a nasty, sweaty white racist mutha fucka, man!”

“Has he said something racist to you Willy?”

“He don’t say nothing to me, man…and when I try to say something to him, like something that’s been helpful for me, he treats me like I don’t even exist. He does that to all the black folks here. I try to be sympathetic because he has been raised by the state, in a system that’s racist, but man, that mutha fucka needs a big brick upside his head… sorry …I don’t mean that … my thinkin’ is still somewhat sick!”

They both began to laugh again.

“You alright, Daniel.”

“Thanks man…I enjoyed our talk and appreciate you sharing your story with me.”

“Do you think I’m fucked up, Daniel?”

“Shit man, we are all fucked up…we have to learn how to solve problems without alcohol, drugs, or walking that fuckin’ bridge, Willy!”

Willy laughed, reaching to shake Daniel’s hand.

“Damn, man…take it easy on a brotha.”

“Yeah, I’m gonna take it easy. I see you on the MLK, I’m gonna hit you upside the head with a big ass brick.”

They stood up laughing and hugged as they walked out of Mike’s office. They headed toward their rooms.

“Alright my brotha…I’ll see you tomorrow.” 

Silver Wolf meets the New York Times!

Below is the link to the recent NYT article. Peace DAP

http://www.nytimes.com/2013/05/12/us/professor-ex-addict-confronts-perils-american-indians-face.html?pagewanted=all&_r=0