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Epidemiology and Population Health

American Indian Alaska Native (AIAN) adolescents and obesity: the influence of social determinants of health, mental health, and substance use

International Journal of Obesity volume 47, pages 297–305 (2023)Cite this article

Subjects

Abstract

Objective

To explore the prevalence of obesity among American Indian and Alaska Native (AIAN) adolescents aged 12–19 years in association with social determinants of health (SDOH), and mental health and substance use disorders.

Methods

Guided by the World Health Organization’s Social Determinants of Health Framework, we examined data from the Indian Health Service (IHS) Improving Health Care Delivery Data Project from Fiscal Year 2013, supplemented by county-level data from the U.S. Census and USDA. Our sample included 26,226 AIAN adolescents ages 12–19 years. We described obesity prevalence in relationship to SDOH and adolescents’ mental health and substance use disorder status. We then fit a multivariable logit generalized linear mixed model to estimate the relationships after adjusting for other individual and county level characteristics.

Results

We observed a prevalence of 32.5% for obesity, 13.8% for mental health disorders, and 5.5% for substance use disorders. Females had lower odds of obesity than males (OR = 0.76, p < 0.001), which decreased with age. Having Medicaid coverage (OR = 1.09, p < 0.01), residing in a county with lower education attainment (OR = 1.17, p < 0.05), and residing in a county with higher rates of poverty (OR = 1.51, p < 0.001) were each associated with higher odds of obesity. Residing in a county with high access to a grocery store (OR = 0.73, p < 0.001) and residing in a county with a higher proportion of AIANs (OR = 0.83, p < 0.01) were each associated with lower odds of obesity. Those with mental health disorders had higher odds of obesity (OR = 1.26, p < 0.001); substance use disorders were associated with decreased odds of obesity (OR = 0.73, p < 0.001).

Conclusions

Our findings inform future obesity prevention and treatment programs among AIAN youth; in particular, the need to consider mental health, substance use, and SDOH.

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Fig. 1: Study SDOH Conceptual Framework.

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Data availability

The data that support the findings of this study are available from the United States Agency Indian Health Services within the Department of Health and Human Services. Restrictions apply to the availability of the data, which are owned by the tribal nations involved and used under approval for this study. Data requests must be submitted to the IHS National Institutional Review Board (irb@ihs.org), and each of the tribal IRBs, tribal councils and tribal authorities involved with the Indian Health Service Data Project.

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Funding

The research reported in this publication was supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health under Award Numbers P30DK092923 (SMM) and R18DK114757 (JO and SMM). Funding for the development of the data infrastructure, utilized in the reported analyses, was supported by the Agency for Healthcare Research and Quality (290-2006-00020-I, TO #11, JO) and the Patient-Centered Outcomes Research Institute (AD-1304–6451, JO). Furthermore the lead author received partial support from CIHR and NIH R01-DA037176-01, The content of this report is solely the responsibility of the authors and does not necessarily represent the official views of these organizations. The data used in this secondary analysis stem from project, known as the Indian Health Service (IHS) Health Care Delivery Data Project. The data set includes information for many American Indian and Alaska Native communities. This work was conducted with the guidance and advice of IHS and Tribal health program colleagues, as well as members of the project’s Steering, Project Site, and Patient Committees. Members of Tribal and IHS institutional review boards, Tribal Councils, and Tribal Authorities educate us about the health concerns they have for their Tribal members and how they hope this project will inform their work. This project relies on their support and approval. The authors would also like to express their gratitude to Sara Mumby for her editorial assistance.

Author information

Authors and Affiliations

  1. Indigenous Wellness Research Institute, University of Washington, Seattle, WA, USA

    Michelle D. Johnson-Jennings

  2. Department of Health Systems, Management and Policy, Colorado School of Public Health, University of Colorado Denver, Denver, CO, USA

    Margaret Reid

  3. Department of Epidemiology and Biostatistics, University of California, Irvine, Irvine, CA, USA

    Luohua Jiang & Jenny Chang

  4. Department of Sociology, The University of British Columbia, Vancouver, BC, Canada

    Kimberly R. Huyser

  5. Centers for American Indian and Alaska Native Health, School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA

    Angela G. Brega, John F. Steine, Spero M. Manson & Joan O’Connell

  6. Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA

    John F. Steine

  7. Institute for Research and Education to Advance Community Health (IREACH), Department of Medical Education and Clinical Sciences, Washington State University, Seattle, WA, USA

    Amber L. Fyfe-Johnson

  8. Research Department, Southcentral Foundation, Anchorage, AK, USA

    Vanessa Hiratsuka

  9. Charles George Veterans Medical Center, Ashville, NC, USA

    Cheryl Conway

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Contributions

MDJJ: conceptualization, original draft preparation, investigation, methodology, investigation, writing—review and editing, project administration; MR: methodology, formal analysis, data curation/management, visualization, writing reviewing and editing; LJ: methodology, visualization, formal analysis, data curation/management, writing reviewing and editing; KRH: conceptualization, methodology, writing—review and editing; AGB: project administration, investigation, supervision, conceptualization, methodology, writing—reviewing and editing; JFS: supervision, conceptualization writing—reviewing and editing, project administration; SMM: conceptualization, supervision, validation, writing—reviewing and editing, funding acquisition, project administration; JC: data curation, writing—reviewing and editing; ALFJ: writing reviewing and editing; CC: writing reviewing and editing; JO: supervision, conceptualization, project administration, data curation, investigation, methodology, writing reviewing and editing.

Corresponding author

Correspondence to Michelle D. Johnson-Jennings.

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Johnson-Jennings, M.D., Reid, M., Jiang, L. et al. American Indian Alaska Native (AIAN) adolescents and obesity: the influence of social determinants of health, mental health, and substance use. Int J Obes 47, 297–305 (2023). https://doi.org/10.1038/s41366-022-01236-7

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