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We examined the prevalence of obesity among American Indian and Alaska Native (AIAN) young adults and to investigate the association between key social determinants of health (SDOH) and higher body mass index (BMI). We used the Indian Health Service Improving Delivery Data Project from fiscal year 2013. It includes data for 20,698 AIAN young adults aged 18–24 years. We added county-level measures of SDOH from the USDA Food Environment Atlas and the Census as contextual variables. We conducted stratified logistic regressions to understand the relationship between these SDOH indicators and odds of obesity. Thirty-seven percent of our sample was identified as obese (i.e., BMI ≥30). Individuals who lived in counties with lower levels of educational attainment and higher levels of poverty had higher odds of obesity than those who lived in counties with higher education and lower poverty (p < 0.0001). Counties with higher poverty rates had less access to social and environmental resources than the lower poverty rate counties (p < 0.0001). Federal and state governments should increase access to education and economic development opportunities to positively impact health outcomes.

The frequency and intensity of extreme climatic events such as heatwaves are predicted to increase under continued climate change and rising atmospheric CO2. Degraded and fragmented ecosystems are at particular risk of being greatly impacted by such extreme events. The longleaf pine (LLP) savanna ecosystem, once the dominant ecosystem throughout the Southeast Coastal Plains of the United States, has been reduced to a small percentage of its pre‐colonization range. While the effect of heatwaves on grassland systems has been well explored, less focus has been given to the legacy effects of previous climatic events. Through a greenhouse experiment using Schizachyrium scoparium (little bluestem), a dominant understory grass species in LLP savanna ecosystems, we aimed to study the legacy effects of heatwaves (i.e., higher temperatures and lower precipitation and humidity) across multiple plant performance metrics and stress responses. S. scoparium had a negative response to an early heatwave, showing increased mortality, smaller maximum leaf length, fewer leaves, decreased specific leaf area (SLA), decreased leaf thickness, and reduced belowground net primary productivity (NPP) when compared to plants that did not experience a heatwave. S. scoparium individuals exposed to a late heatwave had fewer leaves, reduced SLA, and thinner leaves when compared to plants that did not experience a heatwave. While plants exposed to both an early and late heatwave experienced an increase in some stress responses as observed by increased catalase activity and plant mortality, they exhibited no change in other stress responses studied (e.g., maximum leaf length, relative growth rate, productivity, leaf thickness, peroxidase levels, or fuel load). Overall, our study revealed that S. scoparium may show neutral‐to‐positive legacy effects in response to multiple heatwaves. This indicates that LLP savanna ecosystems dominated by S. scoparium may display resistance to the predicted increased frequency of heatwaves in the southeastern United States, an important outcome for the heavily degraded and endangered ecosystem.

Background Dietary interventions are used for the treatment of hypertension. We evaluated the cost-efficacy of delivering boxes of healthy, culturally tailored foods and checks that can only be spent on produce in a Native American population. Methods We conducted a group randomized controlled trial from 2018 to 2020 with N  = 2 treatment counties and N  = 2 control counties and a total of N  = 160 Native American adults with baseline stage 1 or stage 2 hypertension. Participants in the intervention group received monthly boxes of food that adheres to the Dietary Approaches to Stop Hypertension diet as well as checks that could only be spent on produce for 6 months. We measured blood pressure and quality of life at baseline and at a 6-month follow-up in both intervention and control groups. We used ordered logistic regression to estimate the effect of treatment on probability of blood pressure improvements. We then conducted a cost-efficacy analysis. Results We found that treatment was effective in reducing blood pressure in women with stage 1 hypertension at baseline. Based on this finding, we also estimate that this intervention satisfies normative cost-effectiveness thresholds, even when lifetime treatment is needed to preserve the impact, so long as treatment is only continued in those who respond to treatment. Conclusions Direct delivery of healthy foods and checks that can only be spent on produce are a potentially cost-effective intervention for the management of hypertension among Native American women with stage 1 hypertension. Further research is needed to understand why we found an impact only for this group.

The most significant change in hunter-gatherer studies has been the shift from expecting hunter-gatherers to have similar properties wherever they are found to recognizing that hunter-gatherer adaptations should vary along many different dimensions. Although archaeologists approach research with different goals, there is remarkable convergence in our knowledge about hunter-gatherers past and present. The ethnographic record of recent hunter-gatherers reveals enormous variation along several dimensions. The specific combinations of characteristics displayed among hunter-gatherers are not infinitely variable but cluster as distinctive \"system states\" (following Binford, Constructing frames of reference: an analytical method for archaeological theory building using ethnographic and environmental data sets, 2001) that pattern with both environmental and demographic variables at a global scale. Frames of reference based on these generalizations have implications for what archaeologists should expect for hunter-gatherers in different environmental settings, and also for how they should change over time if regional population density generally increases. Recognizing that patterns of variation at the regional scale are different from those at the global scale, I propose a hierarchical strategy for developing expectations for variation among prehistoric hunter-gatherers that can both situate the research locale with respect to global patterns of variation and acknowledge important dimensions of variation in habitat structure that are likely to condition regional variation in hunter-gatherer mobility, subsistence, and social organization.

Objectives Home blood pressure monitoring (HBPM) is crucial for managing hypertension, but there is a potential trade-off between measurement accuracy and health/economic outcomes due to asymmetric costs associated with misclassifying an individual as having hypertension or not. We assessed whether adjustments to device readings that increased overall accuracy produced net health and economic benefits. Methods We analyzed data from N  =  89 Alaska Native individuals who used 2 HBPM devices and a standard aneroid sphygmomanometer. We modeled changes in expected costs associated with individuals being misclassified as hypertensive or not under 3 different models of adjusting HBPM device readings. Results The gains in accuracy produced by adjusting HBPM readings decreased the overall rate of hypertension misclassification but increased the rate of false-negative readings. Adjusting readings led to a net increase in expected health and economic costs. Discussion Ignoring asymmetric costs of misclassification can escalate overall costs and worsen uncontrolled hypertension. Home blood pressure monitoring algorithms must be cautiously designed, considering both false negatives and positives. Greater transparency in HBPM algorithms is needed for effective coordination among manufacturers, clinicians, and patients.

In March 2020, academic medical center (AMC) pharmacies were compelled to implement practice changes in response to the COVID-19 pandemic. These changes were described by survey data collected by the Clinical and Translational Science Awards (CTSA) program which were interpreted by a multi-institutional team of AMC pharmacists and physician investigators. The CTSA program surveyed 60 AMC pharmacy departments. The survey included event timing, impact on pharmacy services, and corrective actions taken. Almost all departments (98.4%) reported at least one disruption. Shortages of personal protective equipment (PPE) were common (91.5%) as were drug shortages (66.0%). To manage drug shortages, drug prioritization protocols were utilized, new drug supply vendors were identified (79.3%), and onsite compounding was initiated. PPE shortages were managed by incorporating the risk mitigation strategies recommended by FDA and others. Research pharmacists supported new clinical research initiatives at most institutions (84.0%), introduced use of virtual site visits, and shipped investigational drugs directly to patients. Some pharmacies formulated novel investigational products for clinical trial use. Those AMC pharmacies within networked health systems assisted partner rural and inner-city hospitals by sourcing commercial and investigational drugs to alleviate local disease outbreaks and shortages in underserved populations. Pharmacy-based vaccination practice was expanded to include a wider range of pediatric and adult vaccines. The COVID-19 pandemic radically altered hospital pharmacy practice. By adopting innovative methods and adapting to regulatory imperatives, pharmacies at CTSA sites played an extremely important role supporting continuity of care and collaborating on critical clinical research initiatives.

Objective To explore the prevalence of obesity among American Indian and Alaska Native (AIAN) adolescents aged 12–19 years in association with social determinants of health (SDOH), and mental health and substance use disorders. Methods Guided by the World Health Organization’s Social Determinants of Health Framework, we examined data from the Indian Health Service (IHS) Improving Health Care Delivery Data Project from Fiscal Year 2013, supplemented by county-level data from the U.S. Census and USDA. Our sample included 26,226 AIAN adolescents ages 12–19 years. We described obesity prevalence in relationship to SDOH and adolescents’ mental health and substance use disorder status. We then fit a multivariable logit generalized linear mixed model to estimate the relationships after adjusting for other individual and county level characteristics. Results We observed a prevalence of 32.5% for obesity, 13.8% for mental health disorders, and 5.5% for substance use disorders. Females had lower odds of obesity than males (OR = 0.76, p  < 0.001), which decreased with age. Having Medicaid coverage (OR = 1.09, p  < 0.01), residing in a county with lower education attainment (OR = 1.17, p  < 0.05), and residing in a county with higher rates of poverty (OR = 1.51, p  < 0.001) were each associated with higher odds of obesity. Residing in a county with high access to a grocery store (OR = 0.73, p  < 0.001) and residing in a county with a higher proportion of AIANs (OR = 0.83, p  < 0.01) were each associated with lower odds of obesity. Those with mental health disorders had higher odds of obesity (OR = 1.26, p  < 0.001); substance use disorders were associated with decreased odds of obesity (OR = 0.73, p  < 0.001). Conclusions Our findings inform future obesity prevention and treatment programs among AIAN youth; in particular, the need to consider mental health, substance use, and SDOH.

Outdoor time is positively associated with improved physical and mental health in adults. Little is known about the specific effects of outdoor time on health outcomes for parents and educators of preschool-aged children. Early childhood is a critical window for growth and development, as parental and educator stress negatively impacts young children; thus, it is of paramount importance to systematically support parents and educators during these developmental years. The objectives of this research were to use a cross-sectional natural experiment to (1) evaluate the association between outdoor time and physical and mental health in caregivers and educators who engage with preschool-aged children; (2) evaluate the association between income and physical and mental health in caregivers and educators who engage with preschool-aged children; and (3) identify benefits and barriers of outdoor time and the importance, availability, and accessibility of community resources for outdoor time. Participants were recruited from three stakeholder groups: preschool educators, parents of children attending an outdoor preschool, and parents of preschool-aged children in the local community. Participants completed a health needs assessment (n = 46) to assess demographics, mental and physical health outcomes, and benefits, barriers, and resources for outdoor time. Caregivers and educators in the higher income group (≥USD 70,000) were 41% (95% CI: 12%, 70%) more likely to report very good or excellent self-reported health. Mean anxiety, depression, and perceived stress were lower in the higher-income group. Caregivers and educators in the higher outdoor time group had lower body mass index (−5.5 kg/m2; 95% CI: −11.6, 0.7), and outdoor time appeared to be protective for general health independent of income. Thus, outdoor time may be a critical protective factor to enhance biological resilience for caregivers and educators, especially for those facing financial adversity.

A growing body of literature suggests that outdoor time is beneficial for physical and mental health in childhood. Profound disparities exist in access to outdoor spaces (and the health benefits thereof) for children in communities of color. The objectives of this research were to: (1) identify challenges and solutions to outdoor time for children; (2) assess the importance of outdoor time for children; and (3) evaluate results stratified by race/ethnicity. Using a convergent mixed methods approach, we conducted a thematic analysis from 14 focus groups (n = 50) with outdoor educators, parents with children attending outdoor preschools, and community members with children. In addition, 49 participants completed a survey to identify challenges and solutions, perceived importance, and culturally relevant perspectives of outdoor time. The main challenges identified for outdoor time were safety concerns, inclement weather, lack of access to outdoor spaces, and parent work schedules. The primary proposed solution was integrating outdoor time into the school day. Nearly all participants, independent of racial identity, reported that outdoor time improved physical and mental health. Overall outdoor time was lower in participants from communities of color (~8 h/week) compared to their White counterparts (~10 h/week). While 50% of people of color (POC) reported that outdoor time was an important cultural value, only 18% reported that people in their respective culture spent time outside. This work contributes to accumulating knowledge that unique barriers to outdoor time exist for communities of color, and the children that live, learn, and play in these communities. Increasing outdoor time in school settings offers a potential solution to reduce identified barriers and to promote health equity in childhood.

The current literature supports the positive relationship between time in nature and the improvement in children’s health and identifies early childhood education (ECE) settings as an avenue for intervention. Unfortunately, access to both outdoor time and ECE opportunities is lower in communities facing economic adversity. Efforts are needed to identify the best approaches to incorporate outdoor time in ECE settings, especially in communities facing socioeconomic adversity. The objectives of this research were to use a mixed methods approach to identify (1) barriers and solutions to the integration of outdoor time in ECE settings, (2) if outdoor time is a priority in ECE settings compared to other ECE priorities, and (3) how socioeconomic status influences ECE priorities and barriers for outdoor time, and health outcomes. Fourteen focus groups were conducted (n = 50) in the United States (US) with participants from three stakeholder groups: outdoor educators, parents of children attending outdoor preschool, and community members with children. Participants completed a survey (n = 49) to evaluate demographics, views on ECE and outdoor time, and health characteristics. Exploratory analyses of F as an effect modifier were conducted. The survey results showed that parents prioritized social and emotional learning and outdoor time when selecting an ECE setting for their child. The barriers identified include financial challenges and the limited availability of ECE programs. The solutions discussed included increased availability and financial support. Low income was correlated with higher rates of anxiety and increased outdoor time was a potential protective factor. These insights inform interventions to enhance outdoor time in ECE settings, with the goal of reducing disparities and promoting children’s overall health.