Health patterns for American Indians and Alaska Native children: evidence from a nationally representative sample

The objective of this research was to evaluate the risks and protections for selected child health outcomes, especially among American Indians and Alaska Natives (AI/ANs), in the United States, 1997-2003. These outcomes were asthma, three or more ear infections, health limitation, and injury and were selected because they were available in the selected data and because they are salient for the target population, AI/ANs. The methods employed a national data set, the National Health Interview Survey 1997-2003 (N=67,903) from which the child sample, adult sample, person, family, and injury files were drawn. Variables used to predict the selected outcomes were categorized as child characteristics, socioeconomic factors, and environmental factors (parental health behaviors). Both race-inclusive and race-specific logistic regression models were estimated to predict child health. As the unit of analysis, only children whose responding adult was a parent were included. Children of pregnant parents were excluded to preserve adult body mass index. Overall, the results indicated the child characteristics that affected the selected outcomes were race-ethnicity, sex, age, and birthweight. The socioeconomic factors that consistently presented risk were having one parent in the home and having government insurance. The parental health behaviors robust across the varied outcomes were parental smoking, parental weight status, parent self-rated health, and the accumulation of negative parental behaviors. Children from the AI/AN population were at significantly greater risk for asthma in the full model, with an odds ratio of 1.37 compared to non-Hispanic Whites, the reference group. The children classified as AI/AN also had an increased risk for recurrent ear infections; however these results were not significant. There were no significant differences in the odds of AI/ANs having a health limitation or an injury compared to the referent. In conclusion, American Indian and Alaska Native children were at greater risk for two of the selected health outcomes, asthma and recurrent ear infections, compared to non-Hispanic Whites. Small cell sizes prevented stable estimates in race-specific models for the target population.