The strength of American Indian and Alaska Native (AI/AN) communities comes from generations of Indigenous traditions, language, culture, and knowledge. These strengths have been challenged by a complex set of systemic, structural, and social factors related to historical and intergenerational trauma that affects the health of AI/AN communities. Furthermore, AI/AN population health data often are inaccurate because of analytic coding practices that do not account for multiracial and ethnic AI/AN identification and inadequate because of statistical suppression. The 2023 national Youth Risk Behavior Survey included a supplemental sample of AI/AN high school students. Coding of race and ethnicity was inclusive of all AI/AN students, even if they also identified as another race or as Hispanic or Latino, providing comprehensive data on health behaviors and experiences among AI/AN high school students nationwide. Adult caretaker engagement and school connectedness and their association with 13 health behaviors and experiences were examined, including five types of current substance use, four indicators of emotional well-being and suicide risk, and four types of violence. Pairwise t-tests and adjusted prevalence ratios from logistic regression models identified significant associations between exposure and outcome variables. Among AI/AN students, having an adult who always tried to meet their basic needs, high parental monitoring, and high school connectedness were associated with lower prevalence of certain measures of substance use, poor emotional well-being and suicide risk, and violence. Compared with non-AI/AN students, the prevalence of current electronic vapor product use, current marijuana use, attempted suicide, and experience of sexual violence was higher among AI/AN students.This report presents the most comprehensive, up-to-date data on substance use, indicators of emotional well-being and suicide risk, and experiences with violence among AI/AN high school students nationwide. The findings suggest the importance of engaged household adults and school connectedness in promoting emotional well-being and preventing substance use, suicide-related behavior, and experiences of violence among AI/AN students. Understanding the historical context and incorporating Indigenous knowledge when developing interventions focused on AI/AN youths are critical to ensure such interventions are successful in improving AI/AN health and well-being.

American Indian and Alaska Native (AI/AN) communities draw strength from Tribal culture and traditional ways of life, but social determinants of health, such as poverty, racial discrimination, unemployment, poor housing, and inadequate access to health care, contribute to persistent health disparities.1-3 Despite their resilience, AI/AN communities have disproportionate rates of obesity, diabetes, and other chronic and infectious diseases, including influenza, pneumonia, and COVID-19.4-9 The public health infrastructure required to address these inequities, however, is under-resourced and underdeveloped.10-12 The COVID-19 pandemic compounded these long-standing health inequities, elevating the need to address gaps in the current public health infrastructure.13-21 | In national health initiatives, Healthy People 2030,22,23 Public Health 3.0,24 and the 10 Essential Public Health Services framework,25 strategies to address social determinants of health and health equity, are multifaceted and complex and require robust public health infrastructure. To address infrastructure needs in AI/AN communities, the Centers for Disease Control and Prevention (CDC) developed the Tribal Epidemiology Center Public Health Infrastructure (TECPHI) program, a 5-year investment (2017-2022) to address gaps in data and build public health capacity to promote health and prevent disease in AI/AN communities.26,27 The impetus for the TECPHI program came from recommendations from the CDC/Agency for Toxic Substances and Disease Registry Tribal Advisory Committee, which supports CDC’s government-to-government relationship with Tribes and allows for engagement with Tribal leaders on approaches to promote health in AI/AN communities.28

OBJECTIVE: The purpose of this study was to examine the risk of birth defects in relation to diabetes mellitus and the lack of use of periconceptional vitamins or supplements that contain folic acid. STUDY DESIGN: The National Birth Defects Prevention Study (1997-2004) is a multicenter, population-based case-control study of birth defects (14,721 cases and 5437 control infants). Cases were categorized into 18 types of heart defects and 26 noncardiac birth defects. We estimated odds ratios for independent and joint effects of preexisting diabetes mellitus and a lack of periconceptional use of vitamins or supplements that contain folic acid. RESULTS: The pattern of odds ratios suggested an increased risk of defects that are associated with diabetes mellitus in the absence vs the presence of the periconceptional use of vitamins or supplements that contain folic acid. CONCLUSION: The lack of periconceptional use of vitamins or supplements that contain folic acid may be associated with an excess risk for birth defects due to diabetes mellitus.

A simple serodiagnostic test based on the Mycobacterium leprae-specific phenolic glycolipid, PGL-I, for individuals with leprosy is nearly universally positive in leprosy patients with high bacillary loads, but cannot be used as a stand-alone diagnostic test for the entire spectrum of the disease process. For patients with early infection with no detectable acid fast bacilli in lesions or with low or no antibody titer to PGL-I as in those at the tuberculoid end of the disease spectrum, this diagnostic approach has limited usefulness. To identify additional M. leprae antigens that might enhance the serological detection of these individuals, we have examined the reactivity patterns of patient sera to PGL-I, lipoarabinomannan (LAM) and six recombinant M. leprae proteins (ML1877, ML0841, ML2028, ML2038, ML0380 and ML0050) by Western blot and ELISA. Overall, the responses to ML2028 (Ag85B) and ML2038 (bacterioferritin) were consistently high in both multibacillary and paucibacillary groups and weak or absent in endemic controls, while responses to other antigens showed considerable variability, from strongly positive to completely negative. This analysis has given a clearer understanding of some of the differences in the antibody responses, between individuals at opposite ends of the disease spectrum, as well as illustrating the heterogeneity of antibody responses towards protein, carbohydrate, and glycolipid antigens within a clinical group. Correlating these response patterns with a particular disease state would allow for a more critical assessment of the form of disease within the leprosy spectrum and could lead to better patient management.