Emily Haozous - Academia.edu (original) (raw)

Papers by Emily Haozous

Misclassification of race in medical and mortality records has long been documented as an issue i... more Misclassification of race in medical and mortality records has long been documented as an issue in American Indian/Alaska Native data. Yet, little has been shared in a cohesive narrative which outlines why misclassification of American Indian/Alaska Native identity occurs. The purpose of this paper is to provide a summary of the current state of the science in racial misclassification among American Indians and Alaska Natives. We also provide a historical context on the importance of this problem and describe the ongoing political processes that both affect racial misclassification and contribute to the context of American Indian and Alaska Native identity.

Background: As breast cancer screening is critical to early detection and treatment, it is impera... more Background: As breast cancer screening is critical to early detection and treatment, it is imperative to furnish health care providers with effective educational materials for the populations they serve. To do so for Comanche American Indian women requires understanding the cultural constructs that influence the use of screening and treatment recommendations. Purpose: The purpose of this article is to describe the health–illness beliefs and barriers to breast health for a group of Comanche women. Design: This was a descriptive, qualitative study guided by the principles of community-based participatory research. Seven community health representatives serving Comanche women participated in a “Talking Circle,” an indigenous method of making decisions and conducting group process among American Indian people. Findings: Themes were Barriers to Information, Barriers to Screening, Economic Barriers, Barriers to Follow-up, and Protecting Our Women. Discussion/Conclusion: This study provide...

American Journal of Community Psychology

The Engage for Equity (E2) study is an intervention trial for community-academic research partner... more The Engage for Equity (E2) study is an intervention trial for community-academic research partnerships that seeks to improve partnering practices and health equity outcomes by providing community and academic partners with tools to enhance and advance power sharing and health equity. Twenty-five community/academic research teams completed a two-day training intervention where they were introduced to the CBPR Conceptual Model and corresponding applied tools to their partnerships. We report on team interviews conducted immediately after the training, where teams discussed opportunities and challenges using the CBPR Model as an implementation framework as they considered their own contexts, their partnering processes/practices, actions, and their desired outcomes. We applied Diffusion of Innovation theory to guide data collection and analysis; augmented by intent to use and collective reflection. Results pointed to the flexibility of the CBPR model, concrete use of tools (e.g., planning/evaluation), and broader use in inspiring collective reflection to improve partnering practices and inform equity values. As an implementation framework, the CBPR model incorporates collaborative processes and strategies to mitigate power differentials into key phases of implementation studies, adding factors central to health equity work, not existing in previous implementation frameworks.

Journal of Health Politics, Policy and Law

Context: American Indian Elders have a lower life expectancy than other aging populations in the ... more Context: American Indian Elders have a lower life expectancy than other aging populations in the United States, due to inequities in health and access to health care. To reduce such disparities, the 2010 Affordable Care Act included provisions to increase insurance enrollment among American Indians. While the Indian Health Service remains underfunded, increases in insured rates have had significant impacts among American Indians and their health care providers. Methods: From June 2016-March 2017, we conducted qualitative interviews with 96 American Indian Elders (age 55+) and 47 professionals (including health care providers, outreach workers, public-sector administrators, and tribal leaders) in two Southwestern states. Interviews focused on Elders’ experiences with health care and health insurance. Transcripts were analyzed iteratively using open and focused coding techniques. Findings: Although tribal health programs have benefitted from insurance payments, the complexities of sel...

Frontiers in Public Health

The COVID-19 pandemic has inequitably impacted Indigenous communities in the United States. In th... more The COVID-19 pandemic has inequitably impacted Indigenous communities in the United States. In this emergency state that highlighted existing inadequacies in US government and tribal public health infrastructures, many tribal nations contracted with commercial entities and other organization types to conduct rapid diagnostic and antibody testing, often based on proprietary technologies specific to the novel pathogen. They also partnered with public-private enterprises on clinical trials to further the development of vaccines. Indigenous people contributed biological samples for assessment and, in many cases, broadly consented for indefinite use for future genomics research. A concern is that the need for crisis aid may have placed Indigenous communities in a position to forego critical review of data use agreements by tribal research governances. In effect, tribal nations were placed in the unenviable position of trading short-term public health assistance for long-term, unrestricte...

Annals of Internal Medicine

Although racial and ethnic disparities in U.S. COVID-19 death rates are striking, focusing on COV... more Although racial and ethnic disparities in U.S. COVID-19 death rates are striking, focusing on COVID-19 deaths alone may underestimate the true effect of the pandemic on disparities. This study estimated excess deaths related and unrelated to COVID-19 in the United States from March to December 2020 by race/ethnicity, sex, age group, and cause.

American Indian and Alaska Native Mental Health Research

This paper examines the ethical issues underlying research with urban American Indians and Alaska... more This paper examines the ethical issues underlying research with urban American Indians and Alaska Natives (AI/ANs) through the lens of tribal sovereignty. There are 574 federally recognized tribes within the United States. Each of those tribes is recognized by the federal government as having sovereign status, an important political designation that ensures that decisions impacting tribal peoples must be made after consultation with those nations. Most AI/AN people live away from their designated tribal lands, yet their sovereign rights are frequently only recognized when living on tribal lands. These urban AI/ANs are still considered citizens of their sovereign nations, yet they lack the protections afforded to those who live on tribal lands, including protections surrounding research with their tribal communities. We explore the Belmont Report and related documents and demonstrate their inadequacy in considering the cultural and ethical concerns specific to protecting urban AI/ANs. We also provide several solutions to help guide future institutional policies regarding research with urban AI/ANs that honors Indigenous data sovereignty, including consultation, partnership with community advisory boards, employment of data use agreements, and ensuring informed consent.

SSM - Qualitative Research in Health

Clinical Journal of Oncology Nursing

American Indians and Alaska Natives (AIANs) have been documented as a population with high rates ... more American Indians and Alaska Natives (AIANs) have been documented as a population with high rates of cancer mortality in comparison to other racial and ethnic groups in the United States. During a time when other populations in the United States are experiencing improvements in cancer outcomes, cancer disparities in AIANs persist. The disparities in cancer outcomes in this diverse population can be attributed to a complex constellation of factors, which include access-to-care, economic, medical, and individual barriers, and mistrust and disenfranchisement.

Qualitative Health Research

Medication-assisted treatment (MAT) for opioid use disorder (OUD) is accessed half as often in ru... more Medication-assisted treatment (MAT) for opioid use disorder (OUD) is accessed half as often in rural versus urban areas in the United States. To better understand this disparity, we used a qualitative descriptive approach to explore the experiences of individuals with OUD seeking MAT in rural New Mexico. Guided interviews were conducted with 20 participants. The frameworks of critical social theory, intersectionality theory, and the brain opioid theory of social attachment were used to guide data analysis and interpretation. Thematic content analysis derived five major themes which identified novel barriers and facilitators to MAT success, including a perceived gender disparity in obtaining MAT, challenges in building a recovery-oriented support system, and the importance of navigating a new normal social identity. This deeper knowledge of the experiences and perspectives of rural individuals with OUD could serve to address the rural–urban MAT disparity, leading to enhanced recovery...

Journal of Clinical and Translational Research

Nursing Research

BACKGROUND Certain research principles, framed within an indigenous context, are helpful guidepos... more BACKGROUND Certain research principles, framed within an indigenous context, are helpful guideposts to practice ethical, relevant, and sensitive inquiries. It is essential to further adapt research approaches based on the unique geographical, sociopolitical, and cultural attributes of partnering tribal communities. These adaptations are largely shaped by trial and error. OBJECTIVES The purpose of this article is to offer the prospective novice nurse researcher lessons that we learned when entering Indian country to conduct research for the first time. As indigenous and nonindigenous researchers, we are not seeking to set down a methodology but rather offer a list of processes, environments, timelines, and barriers that we never learned in didactic, seminar, clinical, practicum, or any other academic setting. METHODS We organized a set of memories and thoughts through a series of semistructured iterative sessions specific to our first encounters as researchers in Indian country. We compiled our written responses and field notes from our dialogue, interpreted these data, and organized them into themes. We have reported what we felt would be the most surprising, frequent, or important information to note. RESULTS We identified three overarching themes in our collective experience: orientation and negotiation, situating ourselves and our work, and navigating our way. Subthemes included perceiving ourselves as outsiders, negotiating distance and time realities, relying on the goodness of gatekeepers, shaping research questions per community priorities, honing our cross-cultural and intercultural communication skills, discovering the many layers of tribal approval processes, and developing sensibilities and intuition. DISCUSSION Our previous experiences as novices leading research projects in Indian country have produced unique sensibilities that may serve to guide nurse researchers who seek to partner with tribal communities.

Research in Nursing & Health

With mounting pressure to move toward precision health care and implementation science, nurse res... more With mounting pressure to move toward precision health care and implementation science, nurse researchers are faced with the challenge of producing evidence that their interventions are applicable in real-world clinical settings. Pragmatic clinical trials are critically important to generate evidence that is relevant to clinical practice. Pragmatic designs closely replicate true-to-life settings thereby expediting research translation and improving health outcomes. The Sequential Multiple Assignment Randomized Trial (SMART) is a valuable a pragmatic trial design that is receiving greater attention in nursing. SMART designs can be used to provide relevant clinical evidence by comparative evaluation of two or more alternative interventions. The objectives of this article are to provide: (a) A description of the main considerations and key components of SMART designs, and (b) a summary of three different nursing studies using SMART designs. Information provided by pragmatic nursing trials using SMART designs, which more closely mirror clinical practice, will facilitate evidence-based clinical practice.

The Journals of Gerontology: Series B

Objectives Inequities in access to and utilization of health care greatly influence the health an... more Objectives Inequities in access to and utilization of health care greatly influence the health and quality of life of American Indian elders. This study explores the importance and perceived prevalence of factors affecting healthcare use within this population and assesses the changeability of these factors to produce a list of action items that are timely and relevant to improving healthcare access and utilization. Method Concept mapping was conducted with American Indian elders (n=65) and professional stakeholders (n=50), including tribal leaders, administrators of public-sector health systems, outreach workers, and healthcare providers. Data were analyzed using multidimensional scaling and cluster analyses. Results The final concept-map model comprised nine thematic clusters related to factors affecting elder health care: Difficulties Obtaining and Using Insurance; Insecurity from Lack of Knowledge; Limited Availability of Services; Scheduling Challenges; Provider Issues and Rela...

Nursing outlook, Jan 8, 2018

JAMA pediatrics, 2018

The United States has higher infant and youth mortality rates than other high-income countries, w... more The United States has higher infant and youth mortality rates than other high-income countries, with striking disparities by racial/ethnic group. Understanding changing trends by age and race/ethnicity for leading causes of death is imperative for focused intervention. To estimate trends in US infant and youth mortality rates from 1999 to 2015 by age group and race/ethnicity, identify leading causes of death, and compare mortality rates with Canada and England/Wales. This descriptive study analyzed death certificate data from the US National Center for Health Statistics, Statistics Canada, and the UK Office of National Statistics for all deaths among individuals younger than 25 years. The study took place from January 1, 1999, to December 31, 2015, and analyses started in September 2017. Race/ethnicity. Average annual percent changes in mortality rates from 1999 to 2015 and absolute rate change between 1999 to 2002 and 2012 to 2015 for each age group, race/ethnicity, and cause of de...

The Lancet. Public health, Aug 20, 2018

Although life expectancy has been projected to increase across high-income countries, gains for t... more Although life expectancy has been projected to increase across high-income countries, gains for the USA are anticipated to be among the smallest, and overall US death rates actually increased from 2014 to 2015, with divergence for specific US populations. Therefore, projecting future premature mortality is essential for clinical and public health service planning, curbing rapidly increasing causes of death, and sustaining progress in declining causes of death. We aimed to project premature mortality (here defined as deaths of individuals aged 25-64 years) trends through 2030, and to estimate the total number of projected deaths, the projected number of potential years of life lost due to premature mortality, and the effect of reducing projected accidental death rates by 2% per year. We obtained death certificate data for the US population aged 25-64 years for 1990-2015 from the US Centers for Disease Control and Prevention (CDC) National Center for Health Statistics. We obtained US ...