Although the majority of Native American students face health risks no greater than those faced by non-Indians, a “sizable minority’’ of them are particularly prone to suicidal tendencies, alcohol abuse, and other unhealthful behaviors, according to a survey published by the American Medical Association.
“This is the most devastated group of adolescents in the United States,’' said Michael D. Resnick, an epidemiologist and one of the authors of the report, at a press conference here last week.
The survey of 13,454 youths in grades 7 through 12 was conducted by a team of researchers under the direction of Robert W. Blum, a physician at the University of Minnesota Hospital in Minneapolis.
Their findings were published in last week’s issue of the Journal of the American Medical Association.
Responses to the survey came from Indian and Alaskan Native students attending schools in reservation communities served by the Indian Health Service.
In addition to Alaska, the survey contains responses from students who reside within the boundaries of I.H.S. service areas in South Dakota, New Mexico, Minnesota, Montana, Tennessee, and Arizona.
The researchers noted that because the survey was school-based and reflective of rural communities, it “cannot be regarded as statistically representative’’ of all Indian youths.
Nor, they said, could it represent all rural Indians, because it failed to include responses from chronically absent students and from those who had left school.
But, they added, “what is particularly important is that the underrepresentation of youths at highest risk suggests that the data are in fact conservative estimates of the prevalence of high-risk behaviors.’'
Suicide, Abuse Cited
The survey results, which were compared with responses to a similar survey of white rural teenagers in Minnesota, indicate that:
- Only 46 percent of the Indian students lived in two-parent homes, compared with 87 percent of the teenagers in the control group.
- Roughly 22 percent of Indian 12th-grade girls reported having been the victims of sexual abuse, compared with 19 percent of the white girls surveyed.
- Approximately 27 percent of Indian 12th graders reported drinking alcohol at least once a week. While this finding was not significantly different from the drinking behavior of white teenagers, the survey found that Indian students began drinking at a younger age.
- Among Indian students, nearly 22 percent of the female respondents and roughly 12 percent of the males reported attempting suicide. For students whose families had a history of suicide, that figure climbed to 30 percent. Those rates compare to figures of 10.3 percent of girls and 6.2 percent of boys in the white population.
- Almost one-fifth of the Indian students reported having been “knocked unconscious’’ by another person at least once.
The survey also indicates that many young, sexually active Indians fail to comprehend the use of contraceptives as “an investment in oneself for the future.’'
“For a significant minority of American Indian youth in the present study, there is no such sense of future,’' the authors note.
And, among the minority of Indian children who face severe health risks, fewer of them seem to take advantage of preventive health care than do their white peers.
“This discrepancy is all the more dramatic considering that health services are available without financial barriers on all the reservation communities surveyed,’' the researchers said.
Culture-Specific Remedies
The survey also found a consistent association between respondents who reported that they did poorly in school and those who displayed multiple physical, social, and psychological risk indicators.
“Poor school achievers were one-third as likely to have previously attempted suicide, and they were almost twice as likely to indicate that school officials do not care about them and that their family does not understand them,’' the researchers noted.
The researchers suggest that any efforts to improve conditions for the children most at risk should employ “culturally appropriate’’ strategies that build on the strengths of community identity and culture as well as on “the exuberance, inherent optimism, and resilience’’ of young people.
“‘Culturally appropriate’ not only refers to cultural considerations that emanate from Indian-white differences, but also variations in health concerns and health promotion strategies at the tribal level,’' they concluded.
In a related development, the House Interior and Insular Affairs Committee held a hearing last month on a measure that would authorize the Department of Health and Human Services to distribute $153 million in federal grants over eight years to tribal programs designed to combat fetal alcohol syndrome.
Native American leaders consider the syndrome, which leads to mental retardation and severe behavior and learning difficulties, a major problem in the Indian community. (See Education Week, Jan. 22, 1992.)
