PROBLEM/CONDITION: In 2022, homicide was the second leading cause of death for Hispanic and Latino persons aged 15-24 years in the United States, the third leading cause of death for those aged 25-34 years, and the fourth leading cause of death for those aged 1-14 years. The majority of homicides of females, including among Hispanic and Latino persons, occur in the context of intimate partner violence (IPV). This report summarizes data from CDC's National Violent Death Reporting System (NVDRS) on IPV-related homicides of Hispanic and Latino persons in the United States. PERIOD COVERED: 2003-2021. DESCRIPTION OF SYSTEM: NVDRS collects data regarding violent deaths in the United States and links three sources: death certificates, coroner or medical examiner reports, and law enforcement reports. IPV-related homicides include both intimate partner homicides (IPHs) by current or former partners and homicides of corollary victims (e.g., children, family members, and new partners). Findings describe victim and suspect sex, age group, and race and ethnicity; method of injury; type of location where the homicide occurred; precipitating circumstances (i.e., events that contributed to the homicide); and other selected characteristics. Deaths related to each other (e.g., an ex-partner kills the former partner and their new partner) are linked into a single incident. State participation in NVDRS has expanded over time, and the number of states participating has varied by year; data from all available years (2003-2021) and U.S. jurisdictions (49 states, Puerto Rico, and the District of Columbia) were used for this report. Of the 49 states that collect data, all except California and Texas collect data statewide; Puerto Rico and District of Columbia data are jurisdiction wide. Florida was excluded because the data did not meet the completeness threshold for circumstances. RESULTS: NVDRS collected data on 24,581 homicides of Hispanic and Latino persons, and data from all available years (2003-2021) and U.S. jurisdictions (49 states, Puerto Rico, and the District of Columbia) were examined. Among homicides with known circumstances (n = 17,737), a total of 2,444 were classified as IPV-related (13.8%). Nearly half of female homicides (n = 1,453; 48.2%) and 6.7% (n = 991) of male homicides were IPV-related; however, among all Hispanic and Latino homicides, most victims were male (n = 20,627; 83.9%). Among the 2,319 IPV-related homicides with known suspects, 85% (n = 1,205) of suspects were current or former partners for female victims, compared with 26.2% (n = 236) for male Hispanic and Latino victims. Approximately one fifth (71 of 359 [19.8%]) of female IPV-related homicide victims of childbearing age with known pregnancy status were pregnant or ≤1 year postpartum. Approximately 5% of IPV-related homicide victims were identified as Black Hispanic or Latino persons (males: n = 67; 6.8%; females: n = 64; 4.4%). A firearm was used in the majority of Hispanic and Latino IPV-related homicides (males: n = 676; 68.2%; females: n = 766; 52.7%). INTERPRETATION: This report provides a detailed summary of NVDRS data on IPV-related homicides of Hispanic and Latino persons in the United States during 2003-2021. This report found heterogeneity of characteristics and circumstances of Hispanic and Latino IPV-related homicides. Whereas most Hispanic and Latino homicide victims were male, nearly 60% of Hispanic and Latino IPHs and IPV-related homicide victims were female. Additional research is needed to better understand the relation between IPHs and IPV-related homicides and race (distinct from ethnicity) and pregnancy. PUBLIC HEALTH ACTION: NVDRS provides critical and ongoing data on IPV-related homicides of Hispanic and Latino persons in the United States that can be used to identify existing strategies and develop new early intervention strategies to prevent IPV and the escalation of IPV to IPH. Strategies that have demonstrated promise in reducing rates of IPH include expanded availability of low-income housing units; sanctuary policies that outline the relation between immigration enforcement and law officers; state laws prohibiting firearm access to those subject to domestic violence restraining orders; improvement of community relations with police to implement risk-based interventions; and comprehensive social, economic, medical, and legal safety nets to create pathways out of abusive relationships, including for pregnant women. Community, local, state, and Federal leaders can combine data on IPV-related deaths and the best available evidence-based programming and policy to create community-engaged solutions that reflect the experience of their Hispanic and Latino communities, including historical and societal factors that increase risk for violence.

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.

BACKGROUND: Missing and Murdered Indigenous People is a historic and contemporary issue that has gained national attention. In 2021, homicide was the eighth leading cause of death among American Indian/Alaska Native (AIAN) persons aged between 1 and 54 years old, and homicide is the sixth leading cause of death among all AIAN males aged 1-54 years old. AIM: These data will build knowledge around AIAN homicides and to identify circumstances that can aid in comprehensive Missing and Murdered Indigenous People prevention efforts. METHODS: AIAN homicide data came from Centers for Disease Control and Prevention's National Violent Death Reporting System, a state/jurisdiction-based surveillance system that collects detailed information about characteristics and circumstances of violent deaths. We examined data from 2003 to 2020 (all available years) from participating states/jurisdictions. We also assessed sociodemographic characteristics of victims and suspects, incident characteristics and differences across dichotomised urban/rural status. The study was conducted in 2022. RESULTS: The National Violent Death Reporting System provided data on 2959 AIAN homicides from 2003 to 2020 (54.2% urban and 45.8% rural). Significant differences based on the two locations included type of weapon used, the location of the injury, race of the primary suspect, the victim's relationship to the suspect and select circumstances precipitating the homicide including crimes precipitating the homicide and homicides stemming from intimate partner violence. OUTCOMES: These findings provide crucial information to strengthen public health efforts for prevention.

BACKGROUND: Violence is a serious public health concern disproportionately experienced by American Indian and Alaska Native (AIAN) people. While the burden and impact of violence may be explained by the presence of risk factors among this group, AIAN communities benefit from unique protective factors and universal strategies which may be tailored with tribal adaptations. We sought to identify and explore violence prevention strategies specific to AIAN populations. METHODS: A review was conducted to systematically identify violence prevention programs, policies, and practices implemented in AIAN communities. We searched nine electronic databases and relevant gray literature released between January 1980 and June 2018. We included intervention-focused records targeting at least one violence topic area (child abuse/neglect, elder abuse, intimate partner violence, sexual violence, youth violence, and suicide) in a majority (> 50%) AIAN population. RESULTS: A total of 5220 non-duplicate records were screened, yielding 318 full-text records. After applying exclusion criteria, 57 records describing 60 program, policy, or practice implementations of 43 unique interventions were identified. All six violence types were represented, although more than half (58%; n = 25/43) focused on suicide prevention. Among suicide prevention programs, the most common strategies were identifying and supporting people at risk (80%; n = 20), teaching coping and problem-solving skills (56%; n = 14), and promoting connectedness (48%; n = 12). Two-thirds of the implementations (67%; n = 40/60) were in fully (100%) AIAN communities. Programs were implemented across many settings, though schools were the most common (35%, n = 21/60) setting. Of the 60 total implementations, a majority (80%; n = 48) were new approaches developed by and for AIAN communities, while the remainder were AIAN adaptations of programs previously created for non-AIAN populations. Most implementations (60%; n = 36/60) provided some evaluation data although less than half (45%; n = 27/60) reported evaluation results. CONCLUSIONS: This review identified many violence prevention strategies specific to AIAN populations. While programs developed in one tribe may not be completely generalizable to others, shared tribal risk and protective factors suggest programs could be successful across diverse communities. Findings indicate there is a need to develop and evaluate violence prevention programs, policies and practices for AIAN populations.

As the first scientists on the American continents, American Indian and Alaska Native people followed various methodologies in the pursuit of knowledge to understand and respond to complex environmental situations.1 Examples include data necessary to guide access to safe food and medicine as well as community roles, kinship, travel, housing, and healing for the well-being of the community. These Tribal data have been transmitted through specific practices with strict protocols such as storytelling, songs, and ceremony. Colonialism and attempts to eradicate Tribal cultures have stolen or at the very least hidden most of the original Tribal data practices in all current public health systems.2 Current methodologies fail to accurately capture data on American Indian and Alaska Native populations, resulting in inaccurate and even harmful data outcomes. Efforts to improve public health data systems should begin with the reclamation of Tribal knowledge systems and the reconstruction of these systems to fit our modern context and Tribal data sovereignty, with intentionality toward future generations.

Violence against American Indian and Alaska Native (AIAN) women, children, two-spirit individuals,(1) men, and elders is a serious public health issue. Violence may result in death (homicide), and exposure to violence has lasting effects on the physical and mental health of individuals, including depression and anxiety, substance abuse, chronic and infectious diseases, and life opportunities, such as educational attainment and employment. All communities are affected by some form of violence, but some are at an increased risk because of intergenerational, structural, and social factors that influence the conditions in communities where people live, learn, work, and play. Using a violence prevention public health approach, we discuss the role public health can play in addressing and preventing the prevalence of missing or murdered indigenous persons (MMIP).(2) This paper is written as a public health primer and includes a selective overview of public health and Native public health research. It also includes case studies and Native experts' reflections and suggestions regarding the use of public health knowledge and theory, as well as Native knowledge and cultural practices to combat violence. An effective public health prevention approach is facilitated by complex, contextual knowledge of communities and people, including individual and community risk factors, as well as protective factors in strengthening Native communities and preventing MMIP. Public health promotes and protects the health of people and the communities where they live, learn, work, and play. To prevent violence, public health seeks to create safe, stable, and nurturing relationships and environments for all people. MMIP affects communities, families, and loved ones, and its victims may be women and girls, children, men, two-spirit individuals, and elders. Violence is defined as "the intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, that either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment, or deprivation."(3) Violence, including adverse childhood experiences (ACEs), has a lasting impact on health, spanning injury, disease outcomes, risk behaviors, maternal and child health, mental health problems, and death.(4) This paper serves as a public health primer to prevent MMIP. MMIP context is provided by weaving public health, research, and applied examples from AIAN experts, best practices in public health, and legal approaches using traditional wisdom and culture. Woven throughout the text, author perspectives are provided as applied examples to contextualize and complement the topics raised based on the individual experiences of several authors.

Objectives. To examine the impact of racial/ethnic coding strategies on the esti-mated prevalence of risk behaviors among American Indian/Alaska Native (AI/AN) high school students. Methods. Data from the national Youth Risk Behavior Survey (2017 and 2019) were analyzed (N=28,422). Racial/ethnic data were coded to identify “Multiracial/ ethnic AI/AN students” and “AI/AN alone students.” The prevalence of persistent feelings of sadness or hopelessness, suicidality, and violence victimization were compared across the coding schemes and with non-Hispanic White students. Results. Of students who self-identified as AI/AN, one in six (18%) were AI/AN alone. The prevalence of many health risk behaviors was significantly higher among AI/AN students than non-Hispanic/Latino White students. The precision of the risk behavior prevalence estimates, however, varied considerably. Conclusion. How racial/ethnic data were coded affected the precision of calculations of risk behavior prevalence among AI/AN students, who are often multiracial and of Hispanic/ Latino ethnicity. © Meharry Medical College.

PROBLEM/CONDITION: Homicide is a leading cause of death for American Indians/Alaska Natives (AI/ANs). Intimate partner violence (IPV) contributes to many homicides, particularly among AI/AN females. This report summarizes data from CDC's National Violent Death Reporting System (NVDRS) on AI/AN homicides. Results include victim and suspect sex, age group, and race/ethnicity; method of injury; type of location where the homicide occurred; precipitating circumstances (i.e., events that contributed to the homicide); and other selected characteristics. PERIOD COVERED: 2003-2018. DESCRIPTION OF SYSTEM: NVDRS collects data regarding violent deaths obtained from death certificates, coroner/medical examiner reports, and law enforcement reports and links related deaths (e.g., multiple homicides and homicide followed by suicide) into a single incident. This report includes data on AI/AN homicides that were collected from 34 states (Alabama, Alaska, Arizona, California, Colorado, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nebraska, Nevada, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Utah, Virginia, Washington, and Wisconsin) and the District of Columbia. RESULTS: NVDRS collected data on 2,226 homicides of AI/ANs in 34 states and the District of Columbia during 2003-2018. The age-adjusted AI/AN homicide rate was 8.0 per 100,000 population. The homicide rate was three times higher in AI/AN males than females (12.0 versus 3.9), and the median age of AI/AN victims was 32 years (interquartile range: 23-44 years). Approximately half of AI/AN homicide victims lived or were killed in metropolitan areas (48.2% and 52.7%, respectively). A firearm was used in nearly half (48.4%) of homicides and in a higher percentage of homicides of AI/AN males than females (51.5% versus 39.1%). More AI/AN females than males were killed in a house or apartment (61.8% versus 53.7%) or in their own home (47.7% versus 29.0%). Suspects were identified in 82.8% of AI/AN homicides. Most suspects were male (80.1%), and nearly one third (32.1%) of suspects were AI/ANs. For AI/AN male victims, the suspect was most often an acquaintance or friend (26.3%), a person known to the victim but the exact nature of the relationship was unclear (12.3%), or a relative (excluding intimate partners) (10.5%). For AI/AN female victims, the suspect was most often a current or former intimate partner (38.4%), an acquaintance or friend (11.5%), or a person known to the victim but the exact nature of the relationship was unclear (7.9%). A crime precipitated 24.6% of AI/AN homicides (i.e., the homicide occurred as the result of another serious crime). More AI/AN males were victims of homicides due to an argument or conflict than females (54.7% versus 37.3%), whereas more AI/AN females were victims of homicides due to IPV than males (45.0% versus 12.1%). For homicides related to IPV, 87.2% of AI/AN female victims were killed by a current or former intimate partner, whereas approximately half (51.5%) of AI/AN male victims were corollary victims (i.e., victims killed during an IPV-related incident who were not the intimate partners themselves). INTERPRETATION: This report provides a detailed summary of NVDRS data on AI/AN homicides during 2003-2018. Interpersonal conflict was a predominant circumstance, with nearly half of all AI/AN homicides precipitated by an argument and for female victims, 45.0% precipitated by IPV. PUBLIC HEALTH ACTION: NVDRS provides critical and ongoing data on AI/AN homicides that can be used to identify effective and early intervention strategies for preventing these deaths. When possible, violence prevention efforts should include community-developed, culturally relevant, and evidence-based strategies. These efforts should incorporate traditional native knowledge and solutions, implement and possibly adapt evidence-based IPV and other violence prevention strategies, and consider the influence of historical and larger societal factors that increase the likelihood of violence in AI/AN communities.

Native Hawaiian and Pacific Islander populations have been disproportionately affected by COVID-19 (1-3). Native Hawaiian, Pacific Islander, and Asian populations vary in language; cultural practices; and social, economic, and environmental experiences,(†) which can affect health outcomes (4).(§) However, data from these populations are often aggregated in analyses. Although data aggregation is often used as an approach to increase sample size and statistical power when analyzing data from smaller population groups, it can limit the understanding of disparities among diverse Native Hawaiian, Pacific Islander, and Asian subpopulations(¶) (4-7). To assess disparities in COVID-19 outcomes among Native Hawaiian, Pacific Islander, and Asian populations, a disaggregated, descriptive analysis, informed by recommendations from these communities,** was performed using race data from 21,005 COVID-19 cases and 449 COVID-19-associated deaths reported to the Hawaii State Department of Health (HDOH) during March 1, 2020-February 28, 2021.(††) In Hawaii, COVID-19 incidence and mortality rates per 100,000 population were 1,477 and 32, respectively during this period. In analyses with race categories that were not mutually exclusive, including persons of one race alone or in combination with one or more races, Pacific Islander persons, who account for 5% of Hawaii's population, represented 22% of COVID-19 cases and deaths (COVID-19 incidence of 7,070 and mortality rate of 150). Native Hawaiian persons experienced an incidence of 1,181 and a mortality rate of 15. Among subcategories of Asian populations, the highest incidences were experienced by Filipino persons (1,247) and Vietnamese persons (1,200). Disaggregating Native Hawaiian, Pacific Islander, and Asian race data can aid in identifying racial disparities among specific subpopulations and highlights the importance of partnering with communities to develop culturally responsive outreach teams(§§) and tailored public health interventions and vaccination campaigns to more effectively address health disparities.