The challenges of conducting research to improve the health of American Indians and Alaska Natives.

Research to improve the health of American Indians and Alaska Natives (AI/AN) is subject to many special challenges. To that end, the merits and barriers of health disparities research was a central discussion topic by the editorial advisory board members for this special issue when they met in the fall of 2006. This discussion reflected that the comparison of AI/AN and non-Hispanic white health issues has limited value when limited ability exists to control contextual differences. These differences include the AI/AN history, level of poverty, culture, living environment, and the ability to access quality health services. Therefore, the board agreed to give priority to research papers that focused on measures for improving AI/AN health. AI/AN are dispersed in large cities such as New York City and Los Angeles and in small cities like Anchorage and Tulsa. In addition, they live in relatively isolated tribal reservations and villages disproportionately located in the 30% of U.S. counties that are sparsely populated and located at a great distance or travel time from the closest significant service center or market (Fig. 1). Most AI/AN live west of the Mississippi River. The National Center for Frontier Communities has described the challenges of economic development in these areas. We included papers that demonstrate the diversity of AI/AN with respect to their place of residence, as well as critical health issues. We cannot adequately represent the geographic and other diversity of the federally recognized 562 tribes who live on reservations or in urban areas. Assisting AI/AN in developing their own public health interventions will require knowledge and sensitivity to a multitude of variations. Maternal and child health practice research among AI/ AN is plagued by low response rates that limit generalization of specific findings. Response rates are often available for the overall survey, but not for AI/AN. In this issue, low reported response rates included 51% for inner city youth in two Oklahoma cities, 54% overall in the National Survey of Child Health [1] and 63% among AI in the Pregnancy Risk Assessment Systems (PRAMS) [2]. The median AI/AN response rates for Behavioral Risk Factor Surveys declined from 63% in 1997 to 50% in 2000 [3]. Kim noted that the 2000 US Census had an overall response rate from AI of 67%, with only 8.5% of tribes having a response rate of 70% or higher [4]. On the positive side, Kim documented that non-response in PRAMS was chiefly due to inability to contact the desired respondent. Once contacted, AI/AN responded as often as non-Hispanic whites. Conducting valid research to improve the health of AI/ AN may require more resources than research on the general population. Methods to increase research validity may include oversampling, face-to-face (rather than telephone) interviews; large record-linkage studies; identifying county code of residence of birth mothers for local area analysis; and the engagement of communities and their leaders in developing health assessment and practice methods. Moreover, educational resources should be devoted to developing more AI/AN researchers who can lead in achieving relevant research to improve the health of AI/AN mothers and children. R. Rochat (&) Hubert Department of Global Health, Rollins School of Public Health, STE 768, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA e-mail: rrochat@sph.emory.edu 1 http://www.frontierus.org/geography.htm