Reservation-Urban Comparison of Suicidal Ideation/Planning and Attempts in American Indian Youth.

BACKGROUND: Our aim was to identify sex- and location-specific risk factors for suicide ideation/planning and attempts among American Indian youth. METHODS: Biennial data for 6417 American Indian high school students attending reservation and urban schools were extracted from the Montana volunteer sample Youth Risk Behavior Survey data for pooled years 2003 to 2011. Logistic regression was used to identify sex- and school location-specific risk behaviors and psychosocial factors for past 12-month ideation/planning and past 12-month attempts. RESULTS: Contrary to our hypothesis, the prevalence of ideation/planning and attempts did not significantly differ between reservation/urban location; however, risk factors associated with suicidality did. Sadness/hopelessness was associated with both outcomes for all groups. However, violent victimization was associated with both outcomes only among girls. Lack of school safety was associated with attempts but not ideation/planning among all students. There were distinct differences in risk factors associated with both outcomes among boys. CONCLUSIONS: The results indicate differences and similarities in risk behaviors and psychosocial factors associated with suicidality by sex and reservation/urban setting. Implications include screening potentially at-risk students for depression, violent victimization, substance use, and school safety and use of the findings by tribal and school programs in designing prevention and intervention programs.

A comparison of risk factors associated with suicide ideation/attempts in American Indian and White youth in Montana.

We examined racial/ethnic and gender-specific associations between suicide ideation/attempts and risky behaviors, sadness/hopelessness, and victimization in Montana American Indian and White youth using 1999-2011 Youth Risk Behavior Survey data. Logistic regression was used to calculate odds ratios and 95% confidence intervals in stratified racial/ethnic-gender groups. The primary results of this study show that although the American Indian youth had more statistically significant suicidal thoughts and attempts than the White youth, they had fewer statistically significant predictors compared to the White youth. Sadness/hopelessness was the strongest, and the only statistically significant, predictor of suicide ideation/attempts common across all four groups. The unhealthy weight control cluster was a significant predictor for the White youth and the American Indian/Alaska Native girls; the alcohol/tobacco/marijuana cluster was a significant predictor for the American Indian boys only. Results show important differences across the groups and indicate directions for future research targeting prevention and intervention.

Who wants to quit? Characteristics of American Indian youth who seek smoking cessation intervention.

No group is more at-risk for tobacco-related health disparities than are American Indian youth. Little is known about their readiness to quit smoking and the extent to which cessation programs may require cultural tailoring related to recruitment, implementation, or content. This study identifies unique characteristics of American Indian teen smokers who enrolled in a school-based smoking cessation program, Not On Tobacco (called N-O-T). Using data from N-O-T intervention trials conducted in North Carolina between 2001 and 2004, the present study (a) describes the characteristics of American Indian participants (n = 91); (b) determines if basic demographics and smoking history affect intervention readiness; and (c) compares findings with non-Native participants (n = 138) enrolled in N-O-T within the same state. Upon enrollment, 80% of the sample reported that they planned to quit smoking in the next 1-6 months. We found significant differences between American Indian and non-Native youth on smoking history, with non-Natives smoking with greater intensity and frequency. Contrary to previous reports, American Indian youth in this study smoked with less intensity and were more ready to quit smoking than non-Native youth. Results reveal previously unreported characteristics of American Indian teen smokers. Study findings may advance the development of effective marketing, recruitment, and programming among American Indian teen smokers into cessation programs, particularly N-O-T, which is the only teen smoking cessation program which includes an adaptation specifically for American Indians.

Quit and reduction rates for a pilot study of the American Indian Not On Tobacco (N-O-T) program.

INTRODUCTION: American Indian youths smoke cigarettes at high rates, yet few smoking-cessation programs have been developed for them. The objective of this study, conducted during 2003 and 2004, was to determine the preliminary quit and reduction outcomes of the American Lung Association's newly adapted American Indian Not On Tobacco (N-O-T) program. METHODS: Seventy-four American Indian youths aged 14 to 19 years in North Carolina were enrolled in the American Indian N-O-T program or a brief 15-minute intervention. Quit and reduction rates were compared 3 months after baseline using compliant subsamples and intention-to-treat analyses. RESULTS: Among males in the American Indian N-O-T program, between 18% (intention-to-treat) and 29% (compliant subsample) quit smoking. Six males (28.6%) in the American Indian N-O-T program reported quitting smoking; one male (14.3%) in the brief intervention reported quitting. No females in either group quit smoking. More females in the American Indian N-O-T program reduced smoking than females in the brief intervention. CONCLUSION: These pilot results suggest that the American Indian N-O-T program offers a useful and feasible cessation option for American Indian youths in North Carolina. Program modifications are necessary to improve outcomes for American Indian females, and recruitment issues require in-depth study. Further study is warranted to determine program efficacy.

Enhanced external counterpulsation in patients with heart failure: a multicenter feasibility study.

To assess the feasibility of using enhanced external counterpulsation to treat patients with heart failure, 26 patients with stable heart failure (New York Heart Association classes II-III), with a left ventricular ejection fraction at or below 35%, and without fluid overload, were treated with enhanced external counterpulsation (1 hour daily, 5 days a week, to a total of 35 hours). Patients were followed for 6 months after completing the course of enhanced external counterpulsation. The primary parameter was safety as reflected by adverse events or by changes in laboratory parameters. Secondary end points included changes in exercise capacity and quality of life. There were no clinically significant problems associated with the administration of enhanced external counterpulsation. Significant improvements were seen in exercise capacity (peak oxygen uptake and exercise duration), and in quality of life assessments, at 1 week and 6 months after the course of enhanced external counterpulsation. This study suggests that enhanced external counterpulsation is safe and well tolerated in patients with stable heart failure, and that a randomized, controlled study of enhanced external counterpulsation in these patients is warranted.

Effects of enhanced external counterpulsation on stress radionuclide coronary perfusion and exercise capacity in chronic stable angina pectoris.

Enhanced external counterpulsation (EECP) is an effective noninvasive treatment for patients with coronary artery disease (CAD). EECP has been demonstrated to improve anginal class and time to ST-segment depression during exercise stress testing. This study assesses the efficacy of EECP in improving stress-induced myocardial ischemia using radionuclide perfusion treadmill stress tests (RPSTs). The international study group enrolled patients from 7 centers with chronic stable angina pectoris and a baseline ischemic pre-EECP RPST. Patients' demographic and clinical characteristics were recorded. A baseline pre-EECP maximal RPST was performed within 1 month before EECP treatment. The results were compared with a follow-up RPST performed within 6 months of completion of a 35-hour course of EECP. Four centers performed post-EECP RPST to the same level of exercise as pre-EECP, whereas 3 centers performed maximal RPST post-EECP. The study enrolled 175 patients (155 men and 20 women). Improvement in angina, defined by > or =1 Canadian Cardiovascular Society angina class change, was reported in 85% of patients. In the centers performing the same level of exercise, 81 of 97 patients (83%) had significant improvement in RPST perfusion images. Patients who underwent maximal RPST revealed improvement in exercise duration (6.61 +/- 1.88 pre-EECP vs 7.41 +/- 2.03 minutes post-EECP, p <0.0001); 42 of the 78 patients (54%) in this group showed significant improvement in RPST perfusion images. Thus, EECP was effective in improving stress myocardial perfusion in patients with chronic stable angina at both comparable (baseline) and at maximal exercise levels.