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NCBI Bookshelf. Socioculturally distinctive groups exhibit differing behaviors associated with disease and health. Members of a group typically share beliefs about etiologies of diseases and what actions to take in response, or "explanatory models.
Decisions to use conventional medical, mental health, or substance abuse services also may be influenced by the general availability of such services, perceived barriers to treatment, actual access to resources and equity in services, or coercion. Individuals usually choose among several treatment options and evaluate the importance of various monetary and nonmonetary costs of treatment. Furthermore, a patient may not make an individual choice, but may follow family or community preferences, including use of alternative therapies offered by traditional healers. In contrast to other ethnic minority groups now encompassed within the United States, American Indians and Alaska Natives are descendants of aboriginal peoples who had been in North America for several thousands of years prior to European contact.
Archaeologists, physical anthropologists, linguists, and ethnohistorians continue to accumulate knowledge about dates and paths of migrations, which are pd to stretch from the northeastern portions of Asia, across the Bering Straits, and into the "New World" of the Western Hemisphere. Status as the "First Americans" is a matter of considerable pride, and, as indigenous peoples, American Indians and Alaska Natives point to the sophistication and complexity of their societies at the time of European contact.
Although some were nomadic hunters and gatherers living in groups of 30 toothers were members of more numerous tribal groups of sedentary agriculturalists who tilled fields of domesticated plant foods and had political structures that forged alliances between settlements. Still others were organized into larger and more socially complex groups, with massive ceremonial structures, elaborate artistic motifs, and extensive trade relationships with groups at distances of up to a thousand miles. All aboriginal societies had healers who aided the sick, and in such a context distinctions between religious practices and health practices, as understood by most white Americans, are a largely artificial dichotomy.
However, these traditional ministrations had little effect on the variety of diseases introduced by Europeans. Depopulation from morbidity and mortality also led to general social disorganization and breakdown in performance of social Indian woman needed 48 Orlando 48.
An epidemic of measles that occurred Indian woman needed 48 Orlando 48 the last quarter-century in a South American aboriginal group with no immunity provides a glimpse of deteriorating conditions that occurred in the wake of smallpox and other epidemics from the seventeenth to the nineteenth century. Caring for children, obtaining food, tending the sick, and attention to sanitary conditions were sufficiently disrupted to increase morbidity and mortality.
Native people recognized that diseases followed encroachment of Europeans, and most believed that epidemics were spread deliberately. For example, major smallpox epidemics occurred during the mid-nineteenth centuries, when "missionary barrels" containing clothing and blankets formerly used by persons infected by smallpox "fomites" were sent to needy and unsuspecting remnants of displaced tribes. Between and outbreaks of malaria decimated coastal native settlements from Vancouver southward to California and also those located in the Columbia River basin.
For example, forced assimilation is a highly sensitive issue. Between and25 to 35 percent of American Indian children were placed in institutions, foster care, or adoptive homes. Init was reported that 85 percent of Indian children in foster placements were in non-Indian homes. Passage of P. Placement in off-reservation boarding schools began in Boys were taught to be farmers, girls, to be domestic servants.
Use of native languages was discouraged, even during recreation and leisure; all pupils wore uniforms. Garments worn by girls were especially deed to deemphasize feminine characteristics and to protect chastity. No personal adornments were permitted, specifically native crafts and hairstyles.
Although young people rebelled against regimentation, these experiences permanently marked their perspectives on Indian-white relations. These affronts to Indian identity are still serious issues. More than two decades ago a landmark five-year demonstration project disclosed the impact of a comprehensive system of primary care services on a ly underserved remote American Indian community. Typically, matrilineal extended families of about 15 persons "outfits"comprising an older woman and her husband, their daughters and sons-in-law, and grandchildren, resided in a harsh environment in isolated, poorly ventilated, one-room wood and mud dwellings with dirt floors "hogans".
About 20 percent of income came from "welfare" sources, and there was a commodities distribution program. Indigenous curers, or medicine men, received respect and much traditional culture was preserved. Tuberculosis and other respiratory disorders were common. Rashes and fly-borne infectious diseases, such as enteric diseases and trachoma, were promoted by the lack of latrines and ubiquity of domesticated animals. Trauma and severe burns, typical in rural areas, were frequent.
Chronic diseases included congestive heart failure, gall bladder disease, and arthritis.
Man killed, woman injured in two-vehicle lake county crash
Thus, Navajos at Many Farms three decades ago exhibited a demographic profile now associated with Third World nations. The closest hospital was 55 miles away, one-half of births occurred at home, and hemorrhagic complication of pregnancy was one of the major health problems of women ages 15 to A handful of public health nurses gave smallpox immunizations in school clinics and otherwise cared for about 10, persons dispersed over 4, to 5, square miles.
Primary care physicians were introduced in Major acute microbial diseases observed during the five-year experiment were pneumonia, diarrhea, otitis media, measles, and impetigo. Only reduction of tuberculosis transmission, decreased incidence of otitis media, and increased referral Indian woman needed 48 Orlando 48 hospitalization were attributable to the experiment.
The pneumonia-diarrhea complex cause of about two-thirds of infant deaths and trachoma transmitted from child to child by unwashed hands, towels, and utensils remained serious health problems. Inin an effort to decrease unemployment and encourage immersion into the American mainstream, the Bureau of Indian Affairs, a federal agency, began the Urban Relocation Program to resettle Indians from geographically dispersed remote reservations.
Paul, New York, and San Francisco, but job training and employment did not always materialize and many had to rely on public assistance. As a result of relocation, however, less than 50 percent of Indian people now reside on independently governed reservations often in widely separated areasand there are about autonomous groups in the United States. It would be exceedingly difficult to conduct a national survey of health status of American Indians and Alaska Natives.
Appropriate authorities from each Indian woman needed 48 Orlando 48 entity, or "reservation," included in the sample would need to grant permission. Even if these obstacles were overcome, definitions of group membership would arise. Like ''minorities" or "ethnic groups," there is disagreement about criteria for inclusion. The Bureau of Indian Affairs counts individuals who meet legal definitions for registration on tribal rolls, usually quantified by fraction of "blood," with one-fourth to one-eighth minimum as typical.
In other instances, persons elect to be known as "Indian" for individual or social reasons, such as intermarriage. As a consequence, information about Indian health and mental health status is fragmented and uneven in quality. The predominant health problems among American Indians and Alaska Natives now stem from behavioral risk factors directly related to injuries and chronic diseases.
Although cigarette smoking among Native Americans has received comparatively little attention, rates are higher than for whites. Inpoor school achievement was linked to cigarette use among 31 percent of Indian youth. Rates for Indian women ranged between 0 and 2 percent.
There is considerable variation according to geographic region. In California in40 percent of all deaths of both sexes were attributable to cigarette smoking, in contrast to Highest rates Indian woman needed 48 Orlando 48 found in the Plains region, and a separate study of four Indian communities in Montana during — found current smoking rates of Smoking cessation programs for Indian women are important, since infant mortality attributed to maternal smoking includes both respiratory disease and sudden infant death syndrome SIDS.
Tobacco use also contributes to cardiovascular disease, malignant neoplasms, and cerebrovascular diseases. For cancer mortality, lung cancer is the leading cause of death for women in six out of twelve IHS areas, and exceeds the risk for women in the U. Reduction of tobacco smoking prevalence by 20 percent among American Indians is an objective of Healthy People Among ethnic groups in the United States, overweight and obesity occur most frequently in American Indians. Rates for American Indian men, Among Indian children and adolescents, For children four years old and under, An ethnographic study of daily dietary intake of Navajo women found 63 percent to be 20 percent overweight.
Diets were high in saturated fat and refined carbohydrates and low in fiber and vitamin A. Women who were younger and better educated, planted home gardens, read newspapers, had better housing, lived nearer food stores, and had spent more time off of the reservation had better diets. Another ethnographic study compared diets of obese and nonobese Hualapai women in Arizona.
Subjects were matched for age and percentage of Hualapai ancestry, and were similar in education, income, household composition, marital status, and employment history. Consumption of fat, fiber, and protein did not differ between obese and nonobese women, but obese women consumed more carbohydrates in the form of sweetened soft drinks and alcoholic beverages. High prevalence of obesity in American Indians is related to hypertension, diabetes, coronary artery disease, poor survival rates for breast cancer, increased rates of gallstones, and poor pregnancy outcome.
Diet and physical activity are important throughout the life cycle. Information available about the prevalence of diabetes mellitus Type 2 diabetes among Native Americans shows links with obesity, hypertension, anemia, and nutrient deficiencies. Both weight reduction and increased exercise are involved in treatment of this chronic disease, although many Indian people are found noncompliant with their treatment regimens. Major studies have focused on the complex interconnection among diet, obesity, diabetes, and pregnancy in Southwestern Indians, especially the Pima tribe.
Both genetic and environmental factors are implicated. Higher body mass index predicts risk for Type 2 diabetes, which is familial and associated with lower metabolism, and affects about one-half of the Pima people.
However, gestational diabetes mellitus is widespread among Native American women and can lead to higher birthweight babies as well as to Type 2 diabetes in mothers.