The epidemic of obesity in American Indian communities and the need for childhood obesity-prevention programs.

American Indians of all ages and both sexes have a high prevalence of obesity. The high prevalence of diabetes mellitus in American Indians shows the adverse effects that obesity has in these communities. Obesity has become a major health problem in American Indians only in the past 1-2 generations and is believed to be associated with the relative abundance of high-fat foods and the rapid change from active to sedentary lifestyles. Intervention studies are urgently needed in American Indian communities to develop and test effective strategies for weight reduction. The poor success rate of adult obesity treatment programs in the general population points to the need to develop prevention approaches aimed toward children. Because eating and physical activity practices are formed early in life and may be carried into adulthood, prevention programs that encourage increased physical activity and healthful eating habits targeted toward young people need to be developed and tested. To be most effective, interventions must be developed with full participation of the American Indian communities.

The constipation assessment scale for pregnancy.

OBJECTIVE: To determine the reliability and validity of the Constipation Assessment Scale (CAS) during pregnancy. DESIGN: Survey. SETTING: The assessment tool was administered first to a group of healthy women of childbearing age in a school of nursing and then to pregnant women in their physicians' offices. PARTICIPANTS: A nonrandom sample of 16 nonpregnant women of childbearing age and 30 women pregnant 28 weeks or longer, 15 of whom had low-risk pregnancies and 15 of whom had high-risk pregnancies. MAIN OUTCOME MEASURES: The test-retest reliability, content validity, and internal consistency of the CAS were determined. RESULTS: An expert panel review found a calculated percentage of agreement for content validity of .75 and a Cohen's kappa of .714. Test-retest reliability based on 16 nursing students yielded high positive correlations ranging from rH = .84 to rH = .92. Internal consistency of the CAS for pregnancy based on the 30 surveys indicated an alpha coefficient of .82. CONCLUSIONS: The CAS for pregnancy was found to be reliable and valid within the context of this study. Future studies designed to identify potential therapeutic interventions for constipation during pregnancy could use the CAS for pregnancy as a measurement instrument.

Nutritional concerns in American Indian and Alaska Native children: transitions and future directions.

The nutritional health of American Indian and Alaska Native children has changed dramatically over the past 30 years. The prevention and treatment of malnutrition (primarily undernutrition) was a major health issue until the mid to late 1970s. Now, a generation later, obesity in American Indian and Alaska Native children is a major health threat. In 1969, the National Institutes of Health sponsored a conference to review the nutritional status of North American Indian children and to set a national agenda to improve the nutritional health of Indian children. Subsequently, increased food availability; food assistance programs; and improved sanitation, transportation, and health care have eliminated undernutrition as a major health issue. However, the substantial reduction in undernutrition has been accompanied by a rapid increase in childhood obesity. The current epidemic of child and adult obesity and associated obesity-related morbidities, such as type 2 diabetes mellitus and other chronic diseases, has implications for the immediate and long-term health of young American Indians. This article reviews the current nutritional health of American Indian and Alaska Native children, the changes that have occurred the past 30 years, and the nutrition transition to increasing obesity and subsequent diabetes that is being seen in American Indians. Future directions to improve the health of American Indian and Alaska Native children are discussed, as is the urgent need for obesity prevention programs that are culturally oriented, family centered, and community- and school-based and that target healthful eating and physical activity beginning in childhood.

The role of the perinatal home care clinical nurse specialist.

The perinatal home care clinical nurse specialist (CNS) is a cost-effective expert with the education and clinical skills to function in an expanded practice role in home care. The benefits of employing a perinatal home care CNS, a sample job description, the roles involved, and a model for evaluation are presented.

Toward comprehensive obesity prevention programs in Native American communities.

Obesity is a particularly important challenge to the health status of Native Americans. This challenge is manifest in the increasing rates of non-insulin-dependent diabetes mellitus among Native Americans. Most studies of Native American infants, preschool children, schoolchildren, and adults have confirmed a high prevalence of overweight. Historical studies suggest that for many Native American communities the high rates of obesity are a relatively recent phenomenon. The specific reasons for the increase in obesity among Native Americans have not been determined, although it has been hypothesized that Native Americans have a genetic predisposition to overweight in a "westernized" environment of abundant food and decreased energy expenditure. Few detailed studies of diet or of physical activity levels of contemporary Native Americans have been published. Community-based interventions to modify diet and activity levels to prevent obesity in Native American communities are needed. Preliminary evidence from two formative school-based programs in the Southwest suggest that Native American communities are receptive to school-based interventions, and that such programs may be able to slow the rate of excess weight gain and to improve fitness in school children. Because of the cultural diversity among Native Americans, future studies should focus on collecting community- and region-specific data, and should emphasize the need for obesity prevention through culturally appropriate community- and school-based behavioral interventions.

Weight perceptions and weight control practices in American Indian and Alaska Native adolescents. A national survey.

OBJECTIVE: To assess weight perceptions and weight control practices among American Indian-Alaska Native adolescents. DESIGN: Survey. SETTING: Nonurban schools from eight Indian Health Service areas. PARTICIPANTS: A total of 13,454 seventh- through 12th-grade American Indian-Alaska Native youths. MAIN OUTCOME MEASURES: A revised version of the Adolescent Health Survey, a comprehensive, anonymous self-report questionnaire with eating- and body image-related questions. RESULTS: Forty-one percent of the adolescent girls reported feeling overweight, 50% were dissatisfied with their weight, and 44% worried about being overweight. Almost half (48%) had been on a weight-loss diet in the past year, with 27% reporting that they had self-induced vomiting at some time to try to lose weight. Eleven percent reported using diet pills. Girls who reported feeling overweight were more likely to engage in unhealthy weight control practices than were those who felt they were of normal weight or underweight. A larger proportion of boys were satisfied with their weight (68%), with 22% worrying about being overweight. However, compared with rural Minnesota youth, both American Indian girls and boys had greater dissatisfaction with body weight. CONCLUSIONS: Our study shows that American Indian youth, particularly girls, are dissatisfied with their weight and are worried about being overweight, and that unhealthy weight control practices are common. More attention needs to be placed on developing culturally appropriate weight management programs for Indian youths.

Clinical hypertension and its interaction with diabetes among American Indians and Alaska Natives. Estimated rates from ambulatory care data.

OBJECTIVE: To estimate the prevalence of clinical hypertension and describe the coexistence with diabetes in American Indian and Alaska Native communities. RESEARCH DESIGN AND METHODS: A cross-sectional study of outpatient visits for hypertension and diabetes over a 1-yr period (1 October 1986 to 30 September 1987) in IHS facilities was conducted. RESULTS: The 1987 estimated age-adjusted prevalence of diagnosed hypertension for this group was 10.9/100 for people > or = 15 yr of age. Thirty-seven percent of diabetic patients were diagnosed with hypertension. The relative risk of hypertension in the diabetic populations compared with the nondiabetic population varied from 4.7 to 7.7 among the different IHS areas. CONCLUSIONS: Despite high rates of diabetes and obesity, hypertension rates were relatively low among American Indians and Alaska Natives when compared with other ethnic groups in the U.S.

Prevalence of obesity in American Indians and Alaska Natives.

Obesity is an important risk factor for cardiovascular diseases and non-insulin-dependent diabetes, which are chronic diseases that afflict American Indians and Alaska Natives today. Because American Indians are not represented in most national health and nutrition surveys, there is a paucity of data on actual prevalence of obesity in American Indians. We estimated prevalence of overweight and obesity for American Indian adults, school-age children, and preschool children from existing data. The prevalence of obesity in adults was estimated from self-reported weights and heights obtained from a special survey of American Indians performed as part of the 1987 National Medical Expenditure Survey. Prevalence of obesity in American Indians was 13.7% for men and 16.5% for women, which was higher than the US rates of 9.1% and 8.2%, respectively. Obesity rates in American Indian adolescents and preschool children were higher than the respective rates for US all-races combined.

Marking adult mosquitoes using an aerially applied fluorescent pigment.

A water soluble, fluorescent pigment was aerially applied to caged Culex quinquefasciatus adults in a south Louisiana marshland pasture. Mosquitoes held in cages on 1 m stakes were greater than 90% marked. This number was significantly greater (P less than 0.01) than the number of marked mosquitoes held in cages that were placed in dense vegetation (greater than or equal to 0.5 m high) near the ground surface (70% marked). In a second aerial test with caged Aedes sollicitans in an open, grassy area of the marshland pasture, the pigment marked 100% of the adult mosquitoes held in cages 1 m above the ground and 98% of the caged mosquitoes on the ground surface. Greater than 96% of the adults collected from an emerging population of Ae. sollicitans within the test area were marked as well as 100% of wild caught deer fly adults, Chrysops flavidus complex, in the test area.