Approximately 1.9 million people self-identified as AIAN in the 1990 Census. There are 554 federally recognized Indian tribes in the U.S.; the only group with a recognized political status with the United States government. These Tribes are recognized sovereign nations within the United States. AIAN are the only “minority” group which has direct government-to-government relations with the United States. The purpose of this review is to summarize the published literature on culturally competent HIV/AIDS prevention for AIAN. Because there was so little found on this subject, publications regarding cultural competence and related public health issues were also included. This review will be useful in the development of culturally competent interventions as well as data collection, policy development, programming and resource allocation for the prevention of HIV/AIDS and related public health areas.

This report details the findings from a series of focus groups on what young adults (ages 18-24) think is important to provide adolescents in sex education, sexuality education, and reproductive health. The results of the project will be used for curriculum planning. Key findings include: The average age when youth start dating was 12-13 or junior high school. The majority reported the onset of sexual activity before graduating from high school. The participants discussed one major factor that explained why Native youth did or did not use drugs or alcohol – their environment. Most participants could not recall any Native youth that did not use drugs or alcohol. Violence was witnessed or experienced by the majority of participants. Some of the participants believed that violence was a part of every relationship. Participants that had seen adolescent couples fighting all reported that it happened when youth were drinking alcohol. Having positive role models was an important protective factor. Youth with families that participated in family outings and supported youth in after school activities did not use drugs and alcohol and they earned better grades. Economic development is critical to a community’s health Urban Indians need support in raising their children and integrating into diverse communities The common reflection on their sex education experience was: It was largely inadequate- most had sex education (biology, sexual development) in the 3rd grade with a second course in high school. The curricula never covered attitudes, beliefs, and values, complete reproductive health, body image, or gender roles.

More than ever before, uninsured children in low-income families are eligible for low-cost health care coverage. But enrollment is lagging in California in both private-sector programs and public programs such as Healthy Families and Medi-Cal. The reason may be that low-income families whose earnings place them above the poverty line often struggle with the cost of unsubsidized health care coverage, to the point where many choose not to obtain coverage. That was the main conclusion drawn from focus groups designed to study the attitudes, perceptions, and opinions of low-income Californians about the value of health insurance for their children. On behalf of its Kaiser Permanente Cares for Kids initiative, Kaiser Permanente commissioned the study of Latino and non-Latino white parents with incomes between 200% and 275% of the federal income guidelines (family incomes ranging from $27,000 to $48,000 for a family of four in 1999). The goal of the study was to learn more about this population’s beliefs and values regarding children’s health care coverage, and to share those findings with policy makers, advocates and other interested parties.

On behalf of the Universal Coverage for California’s Children Coalition, Kaiser Permanente Cares for Kids (KPCK) asked the UCLA Center for Health Policy Research (the Center) to study the attitudes, perceptions, and opinions of Californians with incomes between 200% – 275% of the federal poverty level about the value of health insurance for their children. Focus groups were conducted with Latino and non-Latino white (white) adults living in Los Angeles who were married, with at least one parent working full- time for the year, and who were fluent in English. These populations were selected because they are the most likely to have uninsured children.

Asthma and Chronic Obstructive Pulmonary Disease (COPD) are among the 10 leading chronic conditions causing restricted activity. After chronic sinusitis, asthma is the most common cause of chronic illness in children. Methods are available to treat these respiratory diseases and promote respiratory health. Effective management of asthma comprises four major components: controlling exposure to factors that trigger asthma episodes, adequately managing asthma with medicine, monitoring the disease by using objective measures of lung function, and educating asthma patients to become partners in their own care. A literature search and annotated bibliography was conducted to identify culturally competent asthma prevention literature for AIAN.

Planning and financing long-term care services for American Indian and Alaska Native (AIAN) elders is a challenge. Institutional care (i.e. nursing homes) is not desired by most elders and has high costs for both the elders and tribal governments. In contrast, less expensive home care can provide enough assistance to keep most disabled elders in their own or their relatives’ homes, where they prefer to be. State Medicaid programs are one source of funding for home and community based long-term care services on reservations. We have compiled 20 guides that include a general overview of Medicaid in-home care programs as well as state-specific Medicaid home care details, such as services reimbursed by home and community based care programs and key contact information. These tool kits provide a road map for tribal health programs that are considering long-term care services, with a focus on personal care services for the elderly and disabled people that can be funded by Medicaid. The guides were developed on behalf of the Indian Health Services and with the assistance of numerous agency and state representatives. The tool kit provides information on a number of topics, including: Why Provide Medicaid Personal Care Services What Are Personal Care and other non-medical in-home services Medicaid Programs that Provide In-home Services How Personal Care and other in-home Services are Provided Tips for Developing a Plan for Delivering Medicaid Home Care Services

Background: More American Indians and Alaska Natives (AIAN) reside in California than any other single state in the United States; Los Angeles is home to the largest number of AIAN in the country. In 1997 the federal government initiated the State Children’s Health Insurance Program (SCHIP – called Healthy Families in CA). In 2000 federal regulations were amended to exempt AIAN children from any SCHIP cost sharing. Since the California waiver implementation date there has been no significant change in the rate of AIAN enrollment. Methods: This study examined the policy and implementation barriers for AIAN children to obtain Healthy Families coverage. The principal research methods focused on: (a) a review of administrative data; (b) the development of eligibility estimates of the AIAN population; and (c) key informant interviews with AIAN-health serving institutions, health care providers (including urban, rural, and non-Indian clinics), the Healthy Families administrative unit (MRMIB), Department of Health Services (DHS), and health insurance plans. Results: About 2,200 Healthy Family recipients are currently identified as AIAN, and we estimate that over 7,000 additional uninsured AIAN children in California are Healthy Families eligible. AIAN applicants using certified assistors are more likely to be approved for enrollment than those not using assistors, but one third of tho se using assistors are denied coverage. This research identified many barriers to AIAN enrollment including: diverse and inconsistent understandings of the waiver and eligibility requirements; insufficient training regarding the waiver; insufficient program awareness/outreach; and the additional application burden with requirement of tribal enrollment documentation. There will be a positive change in AIAN enrollment with parental eligibility and practical steps are presented that can be taken to improve the process/system. Conclusion: The California Legislature and MRMIB have made a series of program modifications that are designed to improve the coverage rate and total enrollment of Healthy Families. The AIAN population is a group with special implementation legislation that does not appear to have been reached adequately by those efforts; this research will assist policy makers in improving the coverage of AIAN children and families.

is report examines both the health and economic costs of commercial tobacco use and secondhand smoke inhalation in the American Indian and Alaska Native communities in California. The authors estimate the cost of smoking — in health care and lost productivity — totals nearly 800 million dollars a year. It provides detailed breakdowns of productivity losses, as well as costs per individual and by specific health condition, of commercial tobacco use. The authors also describe complicating factors, such as confusion over the role of traditional tobacco use or “sacred smoking,” and offers practical guidance and resources to tribes and American Indian communities seeking to implement tobacco-control and prevention activities in culturally-appropriate ways.

This report examines the health risks, health status and health services use of the American Indian/Alaska Native (AIAN) elders in California, home to one of the nation's largest populations of AIAN elderly. Specifically, this report uses the California Health Interview Survey (CHIS) to provide omnibus data on a range of issues, including demographics, obesity, alcohol and tobacco use, as well as cancer screening, mental health, health insurance and more. Assessing and understanding the disease burden among California AIAN elders will enable service providers, health advocates and policymakers to set priorities and allocate resources that will benefit the health and well being of this vulnerable population. Although national health status data exist on the AIAN population as a whole, there is a severe lack of state-level and sub-state level data focused on the health of AIAN elders. This report presents the first comprehensive population-level health data on California's Native Elders.

This report was funded by the California Wellness Foundation, the California Area Indian Health Service, the Mayo Clinic Spirit of Eagles and the UCLA Tribal Learning Community and Educational Exchange.