Fetal Alcohol Spectrum Disorders Prevention Among American Indian-Alaskan Native Communities: Reaching Underserved Populations and Reducing Health Disparities

Background: Problems associated with alcohol misuse have contributed to a death rate of 48.7 out of 100,000 American Indians compared with 6.7 deaths out of 100,000 for the U.S. as a whole (Minnesota Department of Health, 2002). The incidence of Fetal Alcohol Spectrum Disorders (FASDs) among American Indian-Alaskan Native communities also gives evidence to the health disparity between groups in the U.S. The percentage of babies with FASDs diagnosed at birth per 10,000 births is Euro-Americans 0.9; Asians 0.3; Hispanics 0.8; African Americans 6.0; and American Indians 29.9 (CDCP, 2009). Clearly, the rate of FASDs among American Indians and Alaska Natives is considerably higher than the general population.

Program background:  An increase in effective, targeted, culture-specific health communication campaigns may have contributed to the reduction in the number of alcohol-related deaths among members of American Indian Nations and Alaskan Natives. Culture-specific and Nation-specific campaigns for FASDs may reduce health disparities generally and the cases of FASDs among American Indians and Native People of Alaska specifically. One such campaign is “Pregnancy is Sacred” developed by the U.S. Department of Health and Human Services’ Substance Abuse and Mental Health Services Administration (SAMHSA).

Evaluation Methods and Results: This study, conducted by a Cherokee woman who researches health and status of citizens of the Cherokee Nation, an alcohol health campaigns researcher, and a researcher of intercultural and transnational women’s issues, examines the role of health communication and marketing strategies to assess the effectiveness of FASDs campaigns targeted toward American Indian-Alaskan Native communities. The evaluation is a multi-method approach of content analysis of the “Pregnancy is Sacred” campaign and textual analysis of American Indian news media reports on alcohol misuse and FASDs. It draws upon our previous research analyzing doctor-patient interaction at a federally funded clinic between young white middle class physicians and Indian women which revealed cultural, class, and health disparities. It also draws on our previous research in program evaluation of alcohol misuse campaigns.

Conclusions: Studies of alcohol misuse and its outcomes including, but not limited to, FASD must be grounded in an understanding of the historical and ongoing socio-economic marginalization and cultural dislocation of American Indians. Historical understanding illuminates the long lasting effects of health disparities brought about by cultural, socioeconomic and systemic disempowerment and disenfranchisement. The most successful campaigns have the following in common: (1) using Native health and social support providers; (2) developing a vigorous culturally oriented media campaign; and (3) coordinating Indian communities in with outsider social and health organizations. These criteria are evident in the SAMHSA program which was developed in conjunction with Native American health experts.

Implications for research and/or practice: Researchers, health communication campaign developers, and health policy makers must be knowledgeable about American Indian and Alaskan Native identity, culture and history, and the diversity across all 562 Nations. References CDCP (2009). Tracking Fetal Alcohol Syndrome. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Retrieved from http://www.cdc.gov/ncbddd/fas/fassurv.htm Minnesota Department of Health (2002). Take a closer look: Drinking during pregnancy in Minnesota. Cambridge, MA: Policy Studies.