The findings of this analysis of YRBS data are generally consistent with national (11
), regional (17
), and local (19
) data showing that AI/AN youth are at greater risk for many health problems than their non-AI/AN peers. This study fills a gap in the public health literature by providing nationally representative data of AI/AN, white, black, and Hispanic US high school students for various behaviors associated with the leading risks to health. For 7 of the 16 variables examined in this study, the prevalence among AI/AN high school students was higher than the prevalence among white high school students. The prevalence of all smoking and alcohol use variables was higher among AI/AN students than among black students, and the prevalence of all smoking variables and not attending physical education classes was higher among AI/AN students than among Hispanic students.
The causes of disparities in health outcomes are complex. Poor health outcomes are associated not only with engaging in health risk behaviors but also with poverty, unemployment, low education levels, and limited access to health care (26
), all of which are common to many AI/AN communities (6
). For example, an estimated 1 in 4 AI/AN adults lives in poverty compared with 1 in 11 white adults (5
), and an estimated 16% of AI/AN children have no health insurance compared with 6% of white children (6
The findings from this study suggest that public health action will be needed to reduce the prevalence of health risk behaviors among AI/AN students. There are more than 560 federally recognized AI/AN tribes in the United States (4
). The populations of these tribes range from fewer than 100 people to more than 750,000 people (20
), and each tribe has its own distinct traditions and cultural heritage (17
). Understanding the geographic, legal, and cultural context in which AI/AN people live is essential to addressing the elevated risk for many health problems found among AI/ANs: a one-size-fits-all approach would not be appropriate. Any school or community-based intervention should be conducted in partnership with AI/AN people to ensure that it is culturally relevant and includes development of the community capacity necessary to ensure the sustainability of the intervention (17
In addition to the importance of culturally relevant interventions, for some behaviors, differences in the prevalence among boys and girls should be considered. For example, AI/AN girls drank less milk than AI/AN boys, and understanding this difference is important for ensuring adequate calcium intake among girls. Likewise, more AI/AN girls than boys had insufficient vigorous physical activity and did not play on a sports team. In contrast, the prevalence of binge drinking, computer use, and obesity was higher among AI/AN boys than girls.
The public health goals for the nation set in Healthy People 2010
address, in part, health risk behaviors among youth (26
). The findings of this analysis of YRBS data show that AI/AN high school students (and students in other racial/ethnic groups) have not yet met all of the target rates set in the Healthy People 2010
goals (). For example, the 2010 goal for current cigarette use is 16%, but 33.7% of AI/AN students were current cigarette users. The prevalence among black students was 12.6%, lower than the Healthy People 2010
goal. The goal for binge drinking is 2.0%, but the prevalence of binge drinking among AI/AN students was 30.9% (nearly equivalent to the prevalence among white and Hispanic students). Similarly, the targets for vigorous physical activity (85% goal) and moderate physical activity (35% goal) have not been met, and rates among AI/AN students are 62.4% and 28.1%, respectively (ie, the inverses of insufficient vigorous and moderate physical activity reported in this study). A similar pattern is seen with other Healthy People 2010
goals for comparable risk behaviors measured in this study.
Selected Healthy People 2010 Objectives and Targets for Adolescents
The findings of this study should be considered in the context of some limitations. First, because of the small number of students who identified their race as AI/AN, multiple years of YRBS data were combined to produce meaningful estimates of the prevalence of health risk behaviors. As a result, these prevalence estimates do not reflect any changes in the prevalence of these factors that may have occurred during the study period. In addition, because of the small number of AI/AN students in this study (even after combining 5 survey years of data), the 95% confidence intervals around the prevalence estimates for AI/AN students are wide. Second, because the YRBS combines American Indian and Alaska Native into a single race category, it was not possible to produce separate prevalence estimates for each group, and the results of at least 1 study showed notable differences in the prevalence of some risk behaviors among Alaska Native youth compared with American Indian youth not living in Alaska (17
). Third, these data apply only to adolescents who attend high school and do not capture students who have dropped out of school. Nationwide, in 2007, of people aged 16 to 17 years, approximately 4% were not enrolled in a high school program and had not completed high school (30
); the dropout rate among AI/AN youth is higher than among white and black youth, though lower than among Hispanic youth (4
). Fourth, because the sampling frame did not include schools funded by the Bureau of Indian Education, the findings from this study are not generalizable to students served by those schools.
Assessment of the effectiveness of efforts to reduce or eliminate health disparities in the United States, a focus of Healthy People 2010
), requires ongoing analyses of high-quality surveillance data from minority populations. This analyses of YRBS data found that the prevalence of some health risk behaviors was significantly higher among AI/AN high school students than among high school students in other racial/ethnic groups, indicating that they are at higher risk for illness and premature death than students in other racial/ethnic groups. Public health efforts targeted to this population are essential to addressing these disparities.