PreparedNationalby COVID-19 Resiliency Network (NCRN) AMERICAN INDIAN AND ALASKA NATIVE AUDIENCE PROFILE NATIONAL COVID-19 RESILIENCY NETWORK
10 States with the highest AIAN population:1 + Alaska + Oklahoma + New Mexico + South Dakota + Montana + North Dakota + Arizona + Wyoming + Oregon + Washington TABLE OF CONTENTS Click sections to access topics of interest. Profile COVID-19SummaryImpact on American Indians and Alaska Natives COVID-19 Perceptions Trusted Sources and Influencers Health Behavior and Information Seeking Considerations for Messaging Proven GeographicStrategiesData Education and Economic Implications Tribal ReferencesMediaCulturalEconomiesValuesHabits NCRN American Indian and Alaska NativePage 2
American Indians and Alaska Natives trust their primary care physicians, pediatricians, and nurse practitioners as well as other healthcare providers. For this audience, trusted spokespersons include Dr. Anthony Fauci (National Institute of Allergy and Infectious Diseases [NIAID]); Dr. Sanjay Gupta, CNN’s chief medical correspondent; and Dr. Anne Zink, chief medical officer of the Alaska Department of Health and Social Services. The majority of American Indians and Alaska Natives prefer to receive COVID-19 testing and vaccine information via social media and the web, with visuals (e.g., infographics) and data that highlight the impact to local and regional communities, tribes, and families.
1%
9.6M
In the United States, American Indians and Alaska Natives (AIAN) make up 2.9% of the population.1 Across the country, this population has been disproportionately affected by COVID-19. Historically, economic challenges and social conditions have caused this group to experience a poorer health status when compared to other Americans. In addition, many American Indians and Alaska Natives are employed outside the home and work in close proximity to others, further increasing their risk of becoming exposed and transmitting COVID-19.
American Indians and Alaska Natives make up 2.9% of the nation’s total population.1
Protecting their families and returning to a sense of normalcy are key motivators for getting vaccinated among members of this population. In fact, American Indians and Alaska Natives are getting vaccinated at a higher rate compared to other racial/ethnic groups.2 Despite being eligible for and having access to COVID-19 vaccines, some American Indians and Alaska Natives are apprehensive about getting vaccinated because of their distrust of the government—a result of historical trauma—and their perception that the vaccines were created and tested very quickly.
Profile Summary
American Indians and Alaska Natives make up 1.1% (5,080) of COVID-19 deaths.3
1.1%
One percent of COVID-19 diagnoses (205,537) are among American Indians and Alaska Natives.3
American Indian and Alaska Native populations have been disproportionately affected by COVID-19. Although only 2.9%1 of people in the United States identify as American Indian or Alaska Native, the collective group has an infection rate that is more than 3.5 times higher4 than that of non-Hispanic whites, and they are more than 4 times5 more likely to be hospitalized as a result of COVID-19. As of October 2021, American Indians and Alaska Natives represent 1%3 of COVID-19 cases in the United States. Additionally, this population generally has higher rates of mortality at younger ages than non-Hispanic whites.6
COVID-19 Impact on American Indians and Alaska Natives
Due to limited access to overall resources and transportation, as well as the existence of unique geographic characteristics in the state, many remote communities in Alaska face challenges in accessing COVID-19 testing and vaccination sites. In addition, American Indians and Alaska Natives have been exposed to COVID-19 infected persons at a high rate, in part because many people in this population are essential workers. According to a report from the Urban Institute, more than half (51%) of American Indian and Alaska Native workers hold essential and nonessential jobs that must be done on-site in close proximity to others.9 The report also states that American Indians and Alaska Natives have a greater risk of transmitting the virus at home because they live in multigenerational households and work outside the home.
TABLE OF CONTENTS Click sections to access topics of interest. Profile COVID-19SummaryImpact on American Indians and Alaska Natives COVID-19 Perceptions Trusted Sources and Influencers Health Behavior and Information Seeking Considerations for Messaging Proven GeographicStrategiesData Education and Economic Implications Tribal ReferencesMediaCulturalEconomiesValuesHabits NCRN American Indian and Alaska NativePage 3 NCRN American Indian and Alaska Native Page 3
Since colonization, American Indians and Alaska Natives have experienced a poor health status, low life expectancy, and disproportionate disease burden. According to the Indian Health Service (IHS), these health disparities exist because of generational trauma, inadequate education, disproportionate poverty, discrimination in the delivery of health services, limited access to culturally appropriate healthcare, and historical underfunding of IHS. 7,8
In focus groups conducted by the Morehouse School of Medicine with American Indians and Alaska Natives, participants noted that in addition to the physical impact of the pandemic, COVID-19 negatively affected their mental health. They experienced challenges and stress because they could not gather with family, friends, and the community for traditional ceremonies and cultural celebrations, especially ceremonies for loved ones when they passed away.10
+ Many feel that COVID-19 response efforts in some areas lack cultural competence.10
+ Despite having trust in science, some focus group participants indicated that they felt the development of the vaccines was rushed and did not allow for proper testing.10
TABLE OF CONTENTS Click sections to access topics of interest. Profile COVID-19SummaryImpact on American Indians and Alaska Natives COVID-19 Perceptions Trusted Sources and Influencers Health Behavior and Information Seeking Considerations for Messaging Proven GeographicStrategiesData Education and Economic Implications Tribal ReferencesMediaCulturalEconomiesValuesHabits NCRN American Indian and Alaska NativePage 4
+ Some American Indians and Alaska Natives distrust federal programs and agencies and, at times, medical approaches that are perceived to go against cultural beliefs or practices.10
+ Misleading information and vaccine hesitancy continue to have an impact on vaccination rates among American Indians and Alaska Natives.10
+ Focus group participants considered vaccines an effective way to protect Elders, children, and their community.10
+ One of the perceived benefits of the vaccine is the possibility of going back to “normalcy.”10
+ According to a survey conducted by the Urban Indian Health Institute, 75% of respondents indicated a willingness to get vaccinated, which is higher than that of the national population.11
COVID-19 Perceptions
+ Focus group participants were aware of the major impact of COVID-19 on their health, their family, and their community, as they reported having either personally experienced COVID-19 or having a relative or friend who tested positive or died. However, most focus group participants indicated they would get tested if they had to or only if they were feeling sick.10
+ Facebook. Although it is a significant source of misinformation and disinformation, Facebook is the preferred social media platform among focus group participants. Through this channel, they are able to share stories, read information, and exchange vaccination pictures.
+ Employers and faith-based organizations. Alaska Natives participating in the focus groups also identified employers and faith-based organizations as trusted sources, reporting that they partially rely on them for information related to COVID-19.
Trusted Sources and Influencers10
+ Indian Health Service. As the main federal healthcare provider and health promoter for American Indian and Alaska Native health, IHS strives to provide valuable information to the community. The IHS website contains statistics and community-related health news inviting readers to protect their community and help others get vaccinated against COVID-19.
+ Native organizations. The following organizations are considered reliable sources of information among American Indian and Alaska Native communities: Johns Hopkins Center for American Indian Health, Urban Indian Health Institute, National Congress of American Indians, National Indian Health Board, National Urban Indian Family Coalition, and National Council of Urban Indian Health.
+ Community health aides/practitioners and community health representatives. According to focus group respondents, Alaska Natives have relied on community health aides/practitioners (CHA/Ps) to provide quality care such as health promotion and prevention services—especially throughout the pandemic. The Community Health Aide program, which started over 40 years ago, is a network of over 500 CHA/Ps in more than 170 rural Alaska villages.12 The CHA/Ps are trained local villagers and function as part of a regional team that includes mid-level providers, physicians, regional hospitals, and the Alaska Native Medical Center. Together they provide assessments and critical and chronic medical care to remote Alaskan communities. CHA/Ps have become the backbone of primary rural care in Alaska.13 During the pandemic, CHA/Ps’ efforts have contributed to the success of vaccine rates.14 Similarly, community health representatives have become instrumental in providing healthcare, health promotion, and disease prevention services to tribal communities in the lower 48 states.15
+ Tribal leaders and Elders. Tribal leadership, culture, and traditions are essential, and for American Indians and Alaska Natives, Elders are highly respected and valued as keepers of wisdom and transmitters of cultural knowledge.16 They are recognized not just for their age but for their wisdom and teachings. As leaders within their communities, they are expected to be involved in decision-making.17
+ Healthcare providers. American Indians and Alaska Natives trust the advice and information coming from their healthcare providers, who are becoming a reliable source to motivate people to get vaccinated.18
+ Public figures and celebrities. Dr. Anthony Fauci, director of NIAID, as well as Dr. Sanjay Gupta, chief medical correspondent at CNN, and Dr. Anne Zink, chief medical officer at the Alaska Department of Health and Social Services, were noted as trusted spokespersons who provide clear and reliable information.
TABLE OF CONTENTS Click sections to access topics of interest. Profile COVID-19SummaryImpact on American Indians and Alaska Natives COVID-19 Perceptions Trusted Sources and Influencers Health Behavior and Information Seeking Considerations for Messaging Proven GeographicStrategiesData Education and Economic Implications Tribal ReferencesMediaCulturalEconomiesValuesHabits NCRN American Indian and Alaska NativePage 5 NCRN American Indian and Alaska Native Page 5
TABLE OF CONTENTS Click sections to access topics of interest. Profile COVID-19SummaryImpact on American Indians and Alaska Natives COVID-19 Perceptions Trusted Sources and Influencers Health Behavior and Information Seeking Considerations for Messaging Proven GeographicStrategiesData Education and Economic Implications Tribal ReferencesMediaCulturalEconomiesValuesHabits NCRN American Indian and Alaska NativePage 6
+ Tribal and government facilities. Fifty-five percent of American Indians and Alaska Natives rely on the federally funded IHS or Tribally operated clinics and hospitals for care.20
+ Traditional media. Due to lack of broadband access at standard speeds on Tribal reservations and in rural areas, national and local TV news as well as newspapers are considered reliable sources of information.19
+ Outreach programs. Some Tribal leaders have created call centers staffed with Native language speakers who can help with scheduling appointments, provide information, and connect callers with other members of their communities.19 Outreach has also been done through newsletters, radio announcements, social media, and mail. Tribes also collaborated with their schools and districts to leverage resources.
+ Social media. Personal stories and experiences posted on Facebook and Instagram by other Tribal members were largely considered to be trusted sources of COVID-19-related information.10
+ Youth technology habits. A nationwide survey conducted in 2016 with 675 American Indian and Alaska Native youth (ages 13–21) about their media technology use found that 78% reported having regular access to a smartphone and 46% had regular access to a computer.22 Over 62% of youth in this survey reported getting health information from the internet weekly or monthly, and 66% reported getting health information from social networking sites weekly or monthly.
+ Health insurance. In 2019, 51.9% of American Indians and Alaska Natives, alone or in combination, had private health insurance coverage. Additionally, 42.1% of American Indians and Alaska Natives relied on Medicaid or public health insurance coverage, and 14.9% had no health insurance coverage.21
+ Local hospitals or health centers. Focus group participants reported that the information provided by local hospitals and health centers is considered valuable and reliable.
Health Behavior and Information Seeking
Proven Strategies
• Provide educational resources that include information on vaccine side effects and offer tips to manage symptoms post-vaccination.
Considerations for Messaging
+ Acknowledgment of vaccination rate. Despite the challenges that American Indians and Alaska Natives face, they have the highest vaccination rate of any racial/ethnic group in the United States.24
• Address negative outcome expectations of the COVID-19 vaccine openly and transparently.
+ Community outreach. Engage Tribes, Native organizations, village leaders, and those who have a deep understanding of the communities’ needs, such as educational institutions and social or community service organizations. They play a significant role in the local community and are considered trusted sources of information.26
+ Trusted sources. Identify local health champions, so their personal stories can be shared to create a sense of trust.26
+ Endorsements. Including trusted national and local Native organizations, public health and healthcare organizations, as well as Tribal leaders, can help increase the effectiveness of the message. GeographicStrategiesData
+ Benefits of vaccine. Returning to normalcy—including gathering for traditional ceremonies and celebrations—and protecting one’s family, community, and culture were reasons cited for getting vaccinated.10
+ Distrust. Some American Indians and Alaska Natives distrust federal programs and agencies and, at times, medical approaches that are perceived to go against Tribal cultural beliefs or practices. This distrust stems from the generational effects of significant trauma caused by government policies and practices that explicitly or tacitly allowed the forced assimilation, sterilization, genocide, forced migration, and discrimination of American Indians and Alaska Natives.23
+ Health ramifications. All participants experienced COVID-19 themselves or reported having close friends, family members, or coworkers who tested positive for COVID-19.
+ Personalization. Messages should be personalized and convey stories that reflect local communities, speaking to the impact of COVID-19 on Tribes and families.
+ Tailored materials. Customize materials to reflect the population and provide detailed information, a call to action, and a contact person and credible source.25
+ Oral storytelling. For American Indians and Alaska Natives, storytelling is a way of sharing their history from one generation to the next. Delivering messages through storytelling can be effective.20
+ Language diversity. Include Native languages and cultural references (based on geographic region) in consultation with Tribal members (leaders and Elders).
the U.S. government. Position vaccines and testing as approaches that complement each other to protect the population’s health.
• Increase confidence in the safety of the COVID-19 vaccine through data reporting to dispel misinformation.
TABLE OF CONTENTS Click sections to access topics of interest. Profile COVID-19SummaryImpact on American Indians and Alaska Natives COVID-19 Perceptions Trusted Sources and Influencers Health Behavior and Information Seeking Considerations for Messaging Proven
+ Collective impact. Focus group participants consistently indicated that the COVID-19 pandemic has significantly impacted them and their families’ mental, spiritual, and emotional health; the community overall; and their ability to gather for traditional ceremonies.
Education and Economic Implications Tribal ReferencesMediaCulturalEconomiesValuesHabits NCRN American Indian and Alaska NativePage 7 NCRN American Indian and Alaska Native Page 7
+ Science focus. Elevate, embrace, and emphasize the science. Vaccine hesitancy is still present due to the rapid development of the vaccine, as well as the fear of potential long-term side effects and historical distrust of
The 11 cultures can be described by their geographical locations:
+ About 71% of American Indians and Alaska Natives live in cities.28
+ In 2019, 26.7% of American Indians and Alaska Natives spoke a language other than English at home.21
Cherokee Navajo Choctaw Sioux Chippewa Apache Blackfeet Iroquois Pueblo
AccordingWashingtontotheU.S.
• The southeast part of Alaska is home to the Eyak, Tlingit, Haida, and Tsimshian peoples.
• Southwest Alaska is home to the Yup’ik and Cup’ik peoples.
The largest Alaska Native Tribes31 according to the number of self-identified members, are:
Eskimo Tlingit-Haida Alaska Athabascan Aleut
Census Bureau, between 2010 and 2020, the multiple-race American Indian and Alaska Native population (those who reported being American Indian and Alaska Native in combination with one or more other races) increased by more than 50% in all but two states.1 Tennessee, South Carolina, and Kentucky experienced the most rapid growth in this population, with a more than 200% increase in each state.1 In all but three states, the multiple-race proportion of the American Indian and Alaska Native alone-or-in-combination population increased from 2010 to 2020.
• South-central Alaska and the Aleutian Islands are the home of the Alutiiq (Sugpiaq) and Unangax peoples.
+ Overall, 9.6 million people, or 2.9% of all people in the United States, identify as American Indian or Alaska Native, either alone or in combination with one or more races.1 From 2010 to 2020, the population grew by 85.2%. Those who reported being American Indian and Alaska Native alone in 2020 totaled 3.7 million, an increase of 27.1% from 2010 to 2020.1 Finally, the multiple-race American Indian and Alaska Native population (those who reported being American Indian and Alaska Native in combination with one or more other races) grew by 159.5% between 2010 and 2020 to reach 5.9%.1 The multiple-race American Indian and Alaska Native population, as well as both the alone and alone-or-in-combination populations, all grew at a faster rate than the total U.S. population, which increased by 7.4 % from 2010 to 2020.27
• Alaska’s interior is home to the Athabascan peoples.
• The north and northwest parts of Alaska are home to the Inupiaq and St. Lawrence Island Yupik.
Although they have adapted to the modern world, Alaska Natives maintain many of their ancestral traditions, including their traditional subsistence lifestyle of hunting, fishing, and gathering food.32
Nearly 7 out of every 10 American Indians and Alaska Natives—2.8 million—live in or near cities,29 not on or near reservations—a popular misconception.28 Regardless of location, many members of the population want to preserve their unique cultures and values.
American Indians and Alaska Natives are members of the original Indigenous peoples of North America.
Arizona
+ Fifty percent or more of American Indians and Alaska Natives are under 21.20
TABLE OF CONTENTS Click sections to access topics of interest. Profile COVID-19SummaryImpact on American Indians and Alaska Natives COVID-19 Perceptions Trusted Sources and Influencers Health Behavior and Information Seeking Considerations for Messaging Proven GeographicStrategiesData Education and Economic Implications Tribal ReferencesMediaCulturalEconomiesValuesHabits NCRN American Indian and Alaska NativePage 8
+ Only 55% of American Indians and Alaska Natives rely on the federally funded IHS or Tribally operated clinics and hospitals for care.
In 2020, the 10 states with the largest American Indian and Alaska Native populations were:1 Alaska Oklahoma New Mexico South Dakota Montana North Dakota Wyoming Oregon
According to the National Congress of American Indians, there are 574 federally recognized Tribes (also called Tribal nations, bands, pueblos, communities, native villages, and corporations in the United States).30 Approximately 229 of these ethnically, culturally, and linguistically diverse nations are located in Alaska; the other federally recognized Tribes are located in 35 other states.30
The largest American Indian Tribal groups,31 according to the number of self-identified members, are:
Alaska Natives make up many Tribes and 11 distinct cultures; and while they all may have diverse languages, ways of life, and histories, they share many core values.32
Geographic Data
Education and Economic Implications
• 7.6% of American Indians and Alaska Natives held an advanced graduate or professional degree.21
+ In 2019, 84.4% of American Indians and Alaska Natives had at least a high school diploma.
American Indians and Alaska Natives attend post-secondary education at a rate of 17%, in comparison to 60% among the total U.S. population.33 States where American Indian and Alaska Native students compose the largest percentages of the total student populations are Alaska (27%), Oklahoma (19%), Montana (11%), New Mexico (11%), and South Dakota (11%).34
+ In 2017, 459,158 American Indians and Alaska Natives owned their homes. This is less than 1% of all owner-occupied homes, compared to a rate of 63.8% for the total U.S. population.35
+ More than 50% of American Indians and Alaska Natives hold essential jobs that require working outside the home and in close proximity to others. This includes service occupations (25%); natural resources, construction, and maintenance (13%); production, transportation, and material moving (15%).36 These occupations increase the risk of transmitting COVID-19.
+ The percentage of American Indians and Alaska Natives living in poverty in 2019 was 20.3%.21
+ In 2019, the median household income for American Indians and Alaska Natives was $49,906, compared to $71,664 for non-Hispanic white households.21
• 20.8% of American Indians and Alaska Natives ages 25 and over had at least a bachelor’s degree.
TABLE OF CONTENTS Click sections to access topics of interest. Profile COVID-19SummaryImpact on American Indians and Alaska Natives COVID-19 Perceptions Trusted Sources and Influencers Health Behavior and Information Seeking Considerations for Messaging Proven GeographicStrategiesData Education and Economic Implications Tribal ReferencesMediaCulturalEconomiesValuesHabits NCRN American Indian and Alaska NativePage 9 NCRN American Indian and Alaska Native Page 9
Tribal Economies
+ American Indians value extended family networks and are often reared with a great social and affective emphasis on the collective.42
TABLE OF CONTENTS Click sections to access topics of interest. Profile COVID-19SummaryImpact on American Indians and Alaska Natives COVID-19 Perceptions Trusted Sources and Influencers Health Behavior and Information Seeking Considerations for Messaging Proven GeographicStrategiesData Education and Economic Implications Tribal ReferencesMediaCulturalEconomiesValuesHabits NCRN American Indian and Alaska NativePage 10
+ Characteristics of American Indian cultures include conformity and respect for authority figures (Elders, in particular), spirituality, expressive creativity, and holistic (mind, body, and spirit) belief systems.41,43
+ American Indian- and Alaska Native-owned businesses accounted for 12.9% of all jobs in Oklahoma (96,177 total jobs), and accounted for 27,300 jobs in Washington,
+ American Indians and Alaska Natives operated approximately 60,083 farms, comprising over 58.7 million acres of land, and conducted $3.33 billion in total sales, with $1.43 billion from crops and $2.11 billion from livestock and poultry.40
Cultural Values
41,700 jobs in Minnesota, and 12,840 jobs in Idaho. In Washington and Minnesota, businesses contributed $255 million and $539 million in goods and services, respectively.39
+ American Indian cultures value harmony with nature, endurance of suffering, and respect and noninterference toward others, making individuals and families facing challenges very reluctant to seek help.44
+ American Indian and Alaska Native businesses had an estimated buying power of $115 billion in 2018, larger than many countries, including Serbia, Panama, Uganda, and Costa Rica.37
+ The number of American Indian- and Alaska Nativeowned businesses totaled 24,433 in 2018. The businesses’ total worth of receipts was $33.7 billion.38
+ The following are 10 important values that Alaska Native cultures share: show respect to others; share what you have; know who you are, accept what life brings; have patience; live carefully; take care of others; honor your Elders; pray for guidance; and see connections.41
• Elders ages 50–54 showed the highest use of technology: 85.7% indicated having access to computers, 93% own a cellphone, 93% use email, and 78.6% use the internet to learn more about health than those in older age groups.
• 96% of American Indians own smartphones.
+ For much of the population, radio is the enduring medium that connects Tribal communities and citizens. Many American Indians still await the capacity to cross the “digital divide” (referring to the lack of access to the internet within their own homes and communities), and radio is the lifeblood of news and connection.47
+ Alaska Native Tribal members shared that their most trusted information sources include social media (e.g., Facebook), local radio stations (e.g., KAFC, KBLG), and national and local TV news (e.g., KTUU-TV, CNN, CBSN).10
Education and Economic Implications Tribal ReferencesMediaCulturalEconomiesValuesHabits NCRN American Indian and Alaska NativePage 11 NCRN American Indian and Alaska Native Page 11
• Alaska Natives also prefer digital channels (e.g., social media) to receive COVID-19 testing or vaccine information. GeographicStrategiesData
+ American Indians indicated using internet searches and social media (especially Facebook pages) to access information about COVID-19 testing or vaccination.10
+ Most American Indians prefer using social media channels (e.g., Instagram, Facebook, and TikTok) to receive COVID-19 testing or vaccine information.10
+ Forty-one percent of American Indians lag in internet-connected device adoption, making live TV and mobile devices critical gateways to content.46
+ A nationwide survey22 conducted in 2016 with 675 American Indian and Alaska Native youth (ages 13–21) about their media technology use found that 78% reported regular access to a smartphone, and 46% had regular access to a computer. Over 62% of young people in this survey reported getting health information from the internet weekly or monthly; and 66% reported getting health information from social networking sites weekly or monthly.
+ Of the more than 574 federally recognized American Indian Tribes in the United States, about 130 Tribes48 have a radio station on their Tribal land.
+ Younger American Indians (ages 18–34) increased their news consumption in 2020 by 41% compared to their consumption in 2019.46
TABLE OF CONTENTS Click sections to access topics of interest. Profile COVID-19SummaryImpact on American Indians and Alaska Natives COVID-19 Perceptions Trusted Sources and Influencers Health Behavior and Information Seeking Considerations for Messaging Proven
+ During the COVID-19 pandemic, organizations adapted to virtual program implementation and information dissemination.10
• Of all technology related questions, “Do you have a cellphone?” showed the highest usage across all age groups, with an average of about 88.5% of participants.
• Social media should be used for outreach, especially to the youth. Focus group participants mentioned that the most effective social media platform for Alaska Natives is Facebook.
+ American Indian Elders have a moderate to high utilization of technology:45
Media Habits
+ Trusted media sources for American Indians were mass media national and local TV news (e.g., CNN, KOTA TV [a South Dakota local news channel], Axios), and local newspapers (e.g., The Rapid City Journal).10 News apps such as Smart News were also trusted media sources for American Indians.
• There is a relationship between age and technology use. Elders over 55 presented the least amount of technology use compared to Elders ages 50–54.
+ Many American Indians rely on their local government’s communication channels, such as webpages and social media accounts, to get COVID-19 information.10
• Elders ages 75 and over used technology the least: 48.4% reported having computer access, 78.2% own a cellphone, 33.9% use email, and 17.1% use the internet to learn more about their health.
• American Indian influencers who own smartphones leverage social media to raise awareness of their culture and critical issues, and they do so on platforms such as TikTok.
18. COVID-19 Vaccines: Community Leaders Build Trust Among Native Americans. Blue Cross Blue Shield. March 11, 2021.
23. Impact of Unresolved Trauma on American Indian Health Equity. Harvard Medical School Blavatnik Institute Global Health and Science Medicine.
22. Stephens D, Peterson R, Singer M, et al. Recruiting and engaging American Indian and Alaska Native teens and young adults in a SMS help-seeking intervention: Lessons learned from the BRAVE Study. International Journal of Environmental Research and Public Health. December 2020.
37. Annual Business Survey Release Provides Data on Minority-Owned, Veteran-Owned and Women-Owned Businesses. U.S. Census Bureau. January 28, 2021.
13. Alaska’s Health Aide Model. Community Health Aide Program Alaska.
25. COVID-19 Vaccine Equity: Best Practices for Community and Faith-Based Organizations. Centers for Disease Control and Prevention.
38. Survey of Business Owners Facts: American Indian- and Alaska Native-Owned Businesses in the United States. Office of Advocacy, U.S. Small Business Administration. May 1, 2016.
44.
21. Profile: American Indian/Alaska Native. Office of Minority Health, U.S. Department of Health and Human Services.
39. Dean KD. The Economic Impact of Tribal Nations in Oklahoma, Fiscal Year 2017. Oklahoma Native Impact, Oklahoma City University. 2017 Census of Agriculture: United States Summary and State Data. Volume 1, Geographic Area Series, Part 51. April 2019. U.S. Department of Agriculture. Ethnogeriatrics: Cultural Values. Stanford School of Medicine. Accessed October 11, 2021. Jumper-Reeves L, Dustman PA, Harthun ML, et al. American Indians’ cultures: How CBPR illuminated inter-tribal cultural elements fundamental to an adaptation effort. Prev Sci. 2014;15(4):547–556. Cook-Lynn E. The power of horses and other stories. University of Arizona Press; Tucson, AZ: 2006. Duran BES. American Indian belief systems and traditional practices. The University of Oklahoma. April 11, 2002. Azure WB, Wheeler MJ, Gray JS, et al. Technology use among American Indian/Alaskan Native elders. August 2015.
40.
3. COVID Data Tracker: Demographic Trends of COVID-19 Cases and Deaths in the U.S. Reported to CDC. Centers for Disease Control and Prevention. Accessed October 1, 2021.
9. Dubay L, Aarons J, Brown S, Kenney GM. How risk of exposure to the coronavirus at work varies by race and ethnicity and how to protect the health and wellbeing of workers and their families. Urban Institute. December 2, 2020.
41.
19. The COVID-19 and Native American Community. Arizona Advisory Committee to the U.S. Commission on Civil Rights. April 2021.
12. Community Health Aide. Alaska Native Tribal Health Consortium.
33. Native American Students in Higher Education. PNPI. November 17, 2020.
4. Hatcher SM, Agnew-Brune C, Anderson M, et al. COVID-19 among American Indian and Alaska Native persons—23 states, January 31–July 3, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(34):1166–1169.
16. American Indian Leadership: Strengthening Native Communities and Organizations. First Nations Development Institute. 2013.
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14. MacArthur AR. Mekoryuk likely first Alaska community to reach 100% vaccination against COVID-19. Alaska Public Media. April 16, 2021.
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31. Status and Trends in the Education of American Indians and Alaska Natives: 2008. Table 1.3, Largest American Indian and Alaska Native tribes according to number of self-identified members, by race and tribal group: 2000. National Center for Education Statistics.
32. Alaska Native Peoples. Alaska Federation of Natives. Accessed October 11, 2021.
36. American Indians and Alaska Natives in the U.S. Labor Force. Monthly Labor Review. U.S. Bureau of Labor Statistics. November 2019.
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29. Invisible Tribes: Urban Indians and Their Health in a Changing World. Urban Indian Health Commission. 2007.
11. GlobalData Healthcare. American Indians, Alaska Natives have worse Covid-19 outcomes than whites, reflects disparities in other health measures. Clinical Trials Arena. February 11, 2021.
17. Whitewater S, Reinschmidt KM, Kahn C, Attakai A, Tuefel-Shone N. Flexible roles for American Indian elders in community-based participatory research. Prev Chronic Dis. 2016;13:150575.
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8. Warne D, Frizzell LB. American Indian health policy: Historical trends and contemporary issues. Am J Public Health. 2014;104(Suppl 3):S263–S267.
20. Culture Card. A Guide to Build Cultural Awareness: American Indian and Alaska Native. Substance Abuse and Mental Health Services Administration. January 2009.
26. The National Influenza Vaccination Disparities Partnership Resource Kit. Centers for Disease Control and Prevention. 2014.
34. Information on Native Students. National Indian Education Association. Accessed October 11, 2021.
6. Arrazola J, Masiello MM, Joshi S, et al. COVID-19 mortality among American Indian and Alaska Native persons—14 states, January–June 2020. MMWR Morb Mortal Wkly Rep. 2020;69(49):1853–1856
10. National COVID-19 Resiliency Network Reports on American Indian and Alaska Native Focus Groups. Morehouse School of Medicine.
27. 2020 Population and Housing State Data. U.S. Census Bureau. August 12, 2021.
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5. COVID Data Tracker Weekly Review: Interpretive Summary for October 1, 2021. Centers for Disease Control and Prevention. October 1, 2021.
35. Demographics. National Congress of American Indians. Accessed October 11, 2021. Retrieved from ncai.org/about-tribes/demographics.
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1. Race and Ethnicity in the United States: 2010 Census and 2020 Census. U.S. Census Bureau. August 12, 2021.
47. Oliff H. The impact of radio on Tribal communities. Partnership With Native Americans. February 20, 2018.
46. Invisible No More: The Rise of Native American Power in Media. Nielsen. November 20, 2020.
NCRN American Indian and Alaska Native Page 13
References (cont.)
48. Bredes M, Kurtzman L, Zayas M. Tribal broadcasting: Exploring the success of low power FM radio broadcasting within Native American communities. Accessed October 11, 2021.