Native American Drug Use Surveillance, NIDA, NIH

Developing surveillance systems for NIDA’s Division of Epidemiology and Prevention Research.

Living in two worlds; listening to the National Library of Medicine's Native Voices exhibition of native people's concepts of health and illness, reminds us of the importance for better substance use research. Research like the development and performance of a model surveillance system of substance use among Native American Populations in the southwestern U.S. which Cygnus worked on for the National Institute on Drug Abuse (NIDA), Division of Epidemiology and Prevention Research (DESPR), National Institutes of Health (NIH). Our experts provided statistical analysis; process and impact evaluation; and research methodology design and data collection.

The study was to determine the feasibility of implementing a surveillance system either at the state or national level, and to evaluate the process and logistics of developing such a system, as well as to evaluate the level of available in-house data to support such an effort.

Research Description

Methodology and Study Design. Pima County, Arizona was selected as the population universe for this project because of locale, size of Native American population, and nearby Indian Health Service (IHS), HHS resources. Within this universe, legal, medical, substance abuse treatment, mental health treatment, and other data sources in the public, private, Tribal, and HIS domains were contacted to elicit participation. The surveillance period was six months. A census sampling strategy was used, For the most part, to survey records of Native Americans within each facility. In those instances where the number of Native American records exceeded 1,000 for the surveillance timeframe, varied sampling schemes were employed.

Tribal Negotiations and Facility Contacts. Two sets of meetings were held with the councils for Tribes in Pima County to obtain approval by the councils before the study could proceed. A total of 37 facilities consented to, and were appropriate for, participation in this study.

Instrument Development and Data Collection. All case records of Native Americans that were selected based upon the sampling schemes, were reviewed for mention of substance use and a data abstraction instrument was completed on all detected cases. Demographic, substance use, medical, and legal data were sought, collected, and coded for all substance use cases to the extent that this information was available at each facility.

Database Management, Statistical Analyses, and Report Writing. The data collection efforts were directed by Cygnus staff and once collected, the data were entered, checked, and cleaning procedures performed. The data were then analyzed by the research analyst and epidemiological staff, and the tabular and graphical formats were developed. A final report summarized the project, a synopsis of which was presented at a final meeting that included Tribal representatives.

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