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The Health Status of American Indians/Native

Americans in Massachusetts

Massachusetts Department of Public Health

Center for Health Information, Statistics, Research, and Evaluation

Division of Research and Epidemiology

November 2006

2 3

The Health Status of American Indians/Native

Americans in Massachusetts

Mitt Romney, Governor

Kerry Healey, Lieutenant Governor

Timothy R. Murphy, Secretary of Health and Human Services

Paul J. Cote, Jr., Commissioner of Public Health

Gerald F. O'Keefe, Director

Center for Health Information, Statistics, Research and Evaluation

Bruce Cohen, Director

Division of Research and Epidemiology

Massachusetts Department of Public Health

4

Acknowledgments

This report was prepared by Malena Orejuela Hood and James K. West, of the Division of Research and Epidemiology, Center for Health Information, Statistics, Research, and Evaluation. We wish to express our gratitude to the North American Indian Center of Boston and the Mashpee Wampanoag Tribal Council for the results from their Community Health Surveys in

2002, and to the women and men who participated in the surveys.

Special thanks go to: Bruce Cohen, Director, Division of Research and Epidemiology, Center for Health Information, Statistics, Research, and Evaluation, and Brunilda Torres, Director, Office of Multicultural Health, Center for Community Health, for their input in the development and review stages of this report. In addition, we extend our gratitude to Christine Judge, Research Specialist, Division of Public Health Practice, Harvard School of Public Health, who began this report while working at the Division of Research and Epidemiology, Center for Health Information, Statistics, Research, and Evaluation. We also like to thank the many people who contributed data for this report: Belinda J. Hanlon, Research & Evaluation Director, Department of Education; Susan Keyes, Senior Research Analyst, Health Survey Program, Center for Health Information, Statistics, Research, and Evaluation; Andrew Hanchett, Assistant Director, Office of Statistics and Evaluation, Bureau of Substance Abuse Services; and, Nidu Menon, Senior Epidemiologist, Chronic Disease Unit, Center for Community Health. The sections on Births and Mortality are based on data collected through the efforts of the Registry of Vital Records and Statistics staff. In addition, we wish to thank all reviewers of this document for their comprehensive and insightful reviews of this publication. To obtain additional copies of this report, contact:

Massachusetts Department of Public Health

Center for Health Information, Statistics, Research and Evaluation

250 Washington Street, 6th floor

Boston, MA 02108

This and other Department of Public Health publications can be downloaded from following website: http://www.mass.gov/dph/resep (Click on Population Health Statistics To obtain more information other Department of Public

Health data:

register for the Department's free, Internet-based public health information service, MassCHIP, via the website at: http://masschip.state.ma.us or call 888-MAS-CHIP (toll free in MA) or 617-624-5629. 5

Table of Contents

List of Tables........................................................................ EXECUTIVE SUMMARY ........................................................................ ..................................9

I. Massachusetts Census Data ........................................................................

...................17 A. Population........................................................................ B. Ethnicity ........................................................................ C. Tribal Enrollment........................................................................ D. Age........................................................................ D. Top Ten Cities and Towns ........................................................................ ...................................22 E. Income........................................................................ F. Education........................................................................ G. Poverty........................................................................ H. Housing ........................................................................ II. Behavioral Risk Factor Surveillance System Data, 2001-2005...................................29 III. Mashpee Wampanoag Community Health Survey, 2002 ...........................................33 IV. North American Indian Center of Boston Community Health Survey, 2002...........39 V. Birth Indicators, 1999-2004.............................................

VI. Mortality Indicators, 1994-2004........................................................................

............49 VII. Admissions to BSAS Substance Abuse Treatment Programs, 2001-2004.................53

VIII. Early Intervention Program Utilization, 2001-2003....................................................57

IX. Department of Education Data (DOE) ........................................................................

.61 A. Enrollment Data ........................................................................ B. Dropout Data........................................................................ C. Retention Data........................................................................

D. Competency Determination Data........................................................................

.........................63

E. Plans of High School Graduates........................................................................

...........................64

F. Youth Risk Behavior Survey........................................................................

................................64 SELF DESIGNATION OF RACE AND ETHNICITY...........................................................69 DATA SOURCES........................................................................ 6

List of Tables

Table 1. American Indian and Alaska Native, Massachusetts Population ...............................................18

Table 2. American Indian and Alaska Native by Hispanic Ethnicity.......................................................19

Table 3. American Indian and Alaska Native Tribes........................................................................

........20

Table 4. Median Age and Age Distribution of Native American Population: 2000................................21

Table 5. Top Ten Cities and Towns with Largest Populations of Native Americans: 2000 ...................22

Table 6. Cities and Towns with Highest Percentage of Native Americans: Census 2000 ......................22

Table 7. Cities and Towns with Highest Percentage of American Indians/Native Americans, Massachusetts: MRACE 2000........................................................................ 23

Table 8. Income Characteristics ........................................................................

Table 9. Educational Level

Massachusetts: 2000........................................................................ .............24 Table 10. Poverty Level........................................................................

Table 11. Housing Characteristics........................................................................

....................................25

Table 12. Behavioral Risk Factor Surveillance System Data...................................................................30

Table 13. Mashpee Wampanoag Community Health Survey...................................................................34

Table 14. North American Indian Center of Boston Community Health Survey.....................................40

Table 15. Selected Birth Indicators ........................................................................

..................................44

Table 16. Selected Birth Indicators by American Indian........................................................................

..45

Table 17. Number and Age-adjusted Death Rates

..........49

Table 18. Leading Causes of Death........................................................................

..................................50

Table 19. Admissions to BSAS Substance Abuse Treatment Programs..................................................53

Table 20. Admissions to BSAS Treatment Programs, Massachusetts: 2001-2004..................................54

Table 21. Admissions by Primary Drug of Choice........................................................................

...........54

Table 22. Early Intervention Program Utilization........................................................................

............57 Table 23. School Enrollment........................................................................

Table 24. School Dropout Rates........................................................................

Table 25. School Retention Rates........................................................................

.....................................62

Table 26. Percent of Students Attaining the Competency Determination: Class of 2005........................63

Table 27. Percentage of Graduates by Plans....................................................................

.........................64

Table 28. Youth Risk Behavior Survey Data ........................................................................

...................66 7

Introduction

The Health Status of American Indians/Native Americans 1 in Massachusetts is the first report ever by the Massachusetts Department of Public Health (MDPH) on the health status of American Indians in Massachusetts, and the first in the nation, comprehensive state report on American Indian health. With this report Massachusetts takes the lead in developing a comprehensive strategy for monitoring the health of all races in the Commonwealth. 2 There are between 15,000 to 30,000 American Indians living in Massachusetts. This population is comparable to the population of the city of Chelsea. American Indians in Massachusetts share a common heritage and face common health problems. We have attempted to give a snapshot of the health status of American Indians by examining data from multiple sources. This report presents outcomes of the major indicators of health for American Indians/Native Americans in Massachusetts. Indicators included in this report are the standard set that MDPH routinely monitors and reports. These data come from state data sources providing information on health status in Massachusetts such as births and deaths from the Registry of Vital Records and Statistics, admissions to substance abuse treatment programs, Early Intervention Program utilization, and, survey data from the Massachusetts Behavioral Risk Factor Surveillance System (BRFSS). In addition, this report includes data from the Mashpee Wampanoag Community Health Survey and the North American Indian Center of Boston Community Health Survey. The section on demographics uses data from the U.S. Census Bureau. This report also includes a section on data from the Massachusetts Department of Education on high school enrollment, school dropouts, school retention rates, attainment of competency determination, plans for high school graduates, and data from the Youth Risk Behavior Survey (YRBS). 1

Note that the Census Bureau race category for American Indian includes Alaska Native ("American Indian and Alaska

Native"). The single-race Alaska Native population of Massachusetts was 128 according to Census 2000. However, since the

datasets and surveys used in this publication did not report separately on Alaska Natives, we were unable to present data on this

group. 2

MDPH has previously published, Asian Births in Massachusetts 1996-1997, Hispanic Births in Massachusetts 1996 -1999, and

Births to Black Mothers in Massachusetts 1997-2000. 8 9

EXECUTIVE SUMMARY

10 11

Executive Summary

This is the first document published by the Massachusetts Department of Public Health (MDPH) that focuses on the health of American Indians residing in the state. There is no systematic surveillance of the health of American Indians by states or the U.S., so that we have no external data with which to compare our findings. Therefore, we don't know how the health status of American Indians in Massachusetts ranks among the states. The findings in this report provide a benchmark by which Massachusetts can track improvement in American Indian health.

According to the U.S. Census 2000:

The per capita income for American Indians in Massachusetts is 60% of the state per capita income. The proportion of American Indian families living below 100% of the poverty level is three times that of the state average. The proportion of American Indians who have less than a high school education is almost twice that of the state average. Poor education and poverty are associated with poorer health outcomes, and the findings for American Indians in Massachusetts are no exception. According to data from the Massachusetts Behavioral Risk Factor Survey, more than

29% of American Indians reported being in poor or fair health as compared with

about 13% for the state overall. According to Massachusetts birth data, the proportion of American Indian mothers who reported smoking during pregnancy is three times that of all mothers. American Indians have less access to health care than Massachusetts residents overall. For example, the proportion of American Indians who reported having no health insurance on the Behavioral Risk Factor Surveillance System was 2.3 times greater than that of the state as a whole, and the proportion of those who reported being unable to see a doctor due to cost was over twice that of Massachusetts overall. American Indian youth also experience poorer outcomes when compared with all Massachusetts high school students. The proportion of American Indian high school students who reported being involved in gangs is over three times that of all other students. American Indians were 32% less likely to go to a 4-year public college and almostquotesdbs_dbs17.pdfusesText_23

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