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.

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.