User:Jjgotshwifty/sandbox

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Location:
Coos Bay, Oregon: https://en.wikipedia.org/wiki/Coos_Bay,_Oregon

Native American People in Oregon https://en.wikipedia.org/wiki/Native_American_peoples_of_Oregon

Indian Health Services: https://en.wikipedia.org/wiki/Indian_Health_Service

Contemporary Native American Issues in the US: https://en.wikipedia.org/wiki/Contemporary_Native_American_issues_in_the_United_States

Health:
1. The Politics of Native American Health Care and the Affordable Care Act https://libproxy.berkeley.edu/login?qurl=http%3a%2f%2fsearch.ebscohost.com%2flogin.aspx%3fdirect%3dtrue%26db%3drzh%26AN%3d113211233%26site%3deds-live

•	In "Contemporary Native American Issues in the US," I can evaluate how the Indian Health Services is underfunded and lacking support for Native Americans. It also provides the historical development of Native American health care o	“In "Contemporary Native American Issues in the US," I can evaluate how the Indian Health Services is underfunded and lacking support for Native Americans.” (47) •	I can write how ACA is potentially a way to help improve Native American health, but the author argues that ACA reforms are “potential supplements to an underfunded HIS” (41). I will reference this argument. •	I can write about the outcomes of ACA and how it will benefit Native health, but I’m not sure if it should stay in this article or in the ACA article with a Native American section.

2. Broken Promises: Evaluating the Native American Health Care System Chapter 2: Social and Cultural Barriers Limiting Native American Access to Health Care and Contributing to Health Disparities

o	This article specifically discusses the following Native American health disparities: diabetes, tuberculosis, mental health, unintentional injuries, major cardiovascular disease, pneumonia and influenza, cancer, infant mortality and maternal health rates. It also discusses progress in resolving such disparities, and the federal government’s role to help improve. o	To contribute to the first article, I can reference the author’s talk of racial and ethnic bias and discrimination, and socioeconomic status which serve as limiting factors to contributions to health disparities. o	This article also serves to strengthen points made about IHS, as it talks about the programs provided, as well as it's issues. o	To add to the section about improvements, I can reference the article’s points in legislative initiatives, but also point out issues in funding.

3. MENTAL HEALTH, HEALTH, AND SUBSTANCE ABUSE SERVICE NEEDS FOR THE NATIVE AMERICAN REHABILITATION ASSOCIATION NORTHWEST (NARA NW) IN THE PORTLAND, OREGON METROPOLITAN AREA. Portland-specific

o	This article will give statistical data that will prove that Native health disparities are relevant and present. It specifically targets Native communities in urban areas, which is an important distinction to bring to light, as many people probably assume that when people talk about Native American issues, they are most likely referring to Natives living on reservations. It reveals that these health issues are ongoing.

Area (Portland):
1. MENTAL HEALTH, HEALTH, AND SUBSTANCE ABUSE SERVICE NEEDS FOR THE NATIVE AMERICAN REHABILITATION ASSOCIATION NORTHWEST (NARA NW) IN THE PORTLAND, OREGON METROPOLITAN AREA. Since I will be working in a tribe in Oregon, this article will help me understand other health disparities, even though this area in Oregon isn’t specifically the location of my PE location. This article will reveal health service needs that I could write about on Wikipedia. The majority of posts are about issues that Native Americans face now (diabetes, alcoholism, etc.) but don’t really write about the services available, other than the Indian Health Services. I will have to be careful not to write specifically about the needs that Natives have, as that would turn the informative page into an opinion page. This article can show me in what areas Native health services are lacking, and if there’s anything I could do to help make sure that the community’s needs are met. Perhaps we could create a new program within the tribe to provide further assistance. o	This article talks about the mental health of Natives around Portland and their needs. Since it’s about Portland, I won’t be able to talk about Coos Bay specifically. o	Specifically, the article uses focus groups to determine each group’s health problems and their individual needs. The end result showed that the group’s needs assessment was consistent with other needs assessments from urban Native populations. A holistic system of care is needed. o	This article provides statistics, although taken from small focus groups, that prove to be in line with current assessments of Native health disparities, thus strengthening the validity and need for change. Their solution is access to programs for health care.

2. Community Health Center Utilization Following the 2008 Medicaid Expansion in Oregon: Implications for the Affordable Care Act

This article can be compared with the first article in the sector section: how Native Americans are affected by the Affordable Care Act vs. how communities in Oregon were affected. This could reveal the political disparities between the two groups. For my PE, it is important to see how one group may benefit more than another over the same program. If a program that’s supposed to benefit every citizen isn’t, it’s important to understand why in order to begin to create solutions.

o	This article focuses on Oregon as a whole, so I might not be able to contribute to Coos Bay as it is a small city and it probably won’t have any references to use. o	Since I have articles for Native Americans and the impact the ACA may have on health policies to improve their health, I’ve also found how the ACA has affected communities in Oregon. o	This article provides statistical data from 2008 from four study groups. It measured utilization patterns, where it “adds to the previous studies reporting that even short coverage gaps can have significant effects on access to care and utilization” (645). It found that utilization of primary care helped improve health and management of chronic conditions.

3. Research Article: Receipt of Preventive Services After Oregon’s Randomized Medicaid Experiment

o	This study provides statistical data to show how access to insurance will likely increase rates of preventative services. More access to health insurance will help decrease health disparities. With insurance, people are able to receive the right recommendations for preventative services. o	This article studied the same randomized study in Oregon, which will help strengthen the facts I provide on Wikipedia.

Together, perhaps I can compare the effects of ACA in general, and the effects of ACA to the Native population. If ACA works, then what is it about the IHS that is lacking? The Native American population has a specific program for them, yet more is potentially accomplished through the ACA.

Housing
1. Sustainable Construction in Indian Country Expanding Affordability With Modular Multifamily Infll Housing Portland-specific https://permanent.access.gpo.gov/gpo75975/CaseStudy_Naya_scinic.pdf

2. Federal Programs Providing Housing Assistance Specifically to Native Americans (pg 32) https://babel.hathitrust.org/cgi/pt?id=coo.31924074277348;view=1up;seq=36

Coos Bay, Oregon
Is everything in the article relevant to the article topic? Is there anything that distracted you?
 * Everything listed was relevant except for the "sister city" section. Choshi, Japan is Coos Bay, Oregon's sister city. There's only one sentence in that section.

What avenues do you find here for further learning that is relevant to your PE preparation?
 * I should learn about the history of Coos Bay. There isn't a lot of information listed.

Does the article appear balanced or neutral? Are there any claims, or frames, that appear heavily biased toward a particular position?
 * The history section only acknowledges Native Americans as part of Coos Bay's history prior to the 19th century, and the tribes only receive one sentence about them. Throughout the rest of history, the tribes seem to have disappeared.

Are there viewpoints that are overrepresented, or underrepresented?
 * There are no current tribes listed on the Coos Bay, Oregon page. The only mention of Native Americans are in the demographics and history. The page mentions places, sites, and buildings, but does not acknowledge the tribe's site. During the history section, the article seems biased towards an Anglo view on history. There are no references to the displacement of Native Americans, their "Trail of Tears," their recognition as a federal tribe, etc. Although this could be in the tribe's own Wiki article, it seems relevant since the history section mentions Anglo visitors, lynchings, and "the worse life taken from a fire in Oregon."

Check a few citations. Do the links work? Does the source support the claims in the article?
 * ''Cite #3 does not link to anything, just a general webpage. Therefore, it is not a great source to support the claim. When clicking on the link, the user shouldn't have to look for whatever the Wiki writer was citing as support; it should be readily available. There are a lot of cites that go to a website as a source, but Wikipedia said that those home sites are not a good reliable source (since it is considered a primary source).

Look for links to other Wikipedia articles. Can you think of more such links that are relevant and that you could add? ·Nelson Machine Works-Coos Bay Iron Works · Alonzo Tucker ·J.C. Tolman ·Coos Historical & Maritime Center ·Oregon Coast Music Festival ·Mingus Park ·Coos Bay City Council ·Bay Area Hospital ''
 * ''I could add a link to the Native American tribe, not just the individual tribes but a link to the confederated one. I could also make a link to:

Is each fact referenced with an appropriate, reliable reference? Where does the information come from? Are these neutral sources? If biased, is that bias noted?
 * No, a lot of reference sources are from primary sources, or they don't link to specifically what the author was referring to.

Check out the Talk page of the article. What kinds of conversations, if any, are going on behind the scenes about how to represent this topic? There are conversations about a book that references the city, adding the point in time when the city's name was changed, linking the Egyptian Theater when it reopens, and references.

How is the article rated? Is it a part of any WikiProjects? WikiProject Cities, a collaborative effort to improve the coverage of cities, towns and various other settlements on Wikipedia.''
 * '' WikiProject Oregon, a collaborative effort to improve the coverage of the U.S. state of Oregon on Wikipedia.

What about your learning in GPP so far is different from how Wikipedia discusses this topic?
 * In GPP, I'm learning about other entities other than the Anglo perspective of what's in the city. For example, there isn't much said about groups, communities, organizations, etc. in Coos Bay. The history is mainly about white people. 

Contemporary Native American Issues in the US
Is everything in the article relevant to the article topic? Is there anything that distracted you?
 * Everything listed so far is relevant.

What avenues do you find here for further learning that is relevant to your PE preparation?
 * Public health, but no listing on housing insecurity or education.

Does the article appear balanced or neutral? Are there any claims, or frames, that appear heavily biased toward a particular position?
 * The article seems to be biased towards the Native American perspective as well as appearing balanced/neutral. It references a producer "wanting to make the film historically accurate and unbiased." Different sections, however, emphasize that there is a desire to be respectful of the culture.

Are there viewpoints that are overrepresented, or underrepresented?
 * The sections don't really go in depth, but housing and education are missing. The solution section is particularly short (a mere paragraph long) and doesn't reference the Indian Health Services as one solution to combat public health.

Check a few citations. Do the links work? Does the source support the claims in the article?
 * Some citations listed last do not have a link. They seem to be published works, perhaps not available online.

Look for links to other Wikipedia articles. Can you think of more such links that are relevant and that you could add? Language immersion school stereotype A brief and true report of the new found land of Virginia television movie on Geronimo, Major Crimes Act National College Health Association National College Health Assessment
 * Add housing and education.

Is each fact referenced with an appropriate, reliable reference? Where does the information come from? Are these neutral sources? If biased, is that bias noted?
 * For the referenced used to combat Native American mascots, the references are inherently biased, favoring the abolition of those mascots as it is politically incorrect and culturally insensitive. Without a biased, the paper cannot be argumentative to reach its point. There aren't any papers that consider both sides (one against and one for—saying perhaps that the mascots empower Native Americans because using the Chiefs as a mascot means that they are very powerful or something).

Check out the Talk page of the article. What kinds of conversations, if any, are going on behind the scenes about how to represent this topic? external links and formatting an additional section: trauma
 * a part that focuses on suicide and obesity.

How is the article rated? Is it a part of any WikiProjects? " WikiProject Indigenous peoples of North America, a collaborative effort to improve the coverage of Native Americans, Indigenous peoples in Canada, and related indigenous peoples of North America on Wikipedia''
 * ''" WikiProject United States, a collaborative effort to improve the coverage of topics relating to the United States of America"

What about your learning in GPP so far is different from how Wikipedia discusses this topic?
 * I'm learning that there are more issues and that some people may not think about that side or have a biased toward a particular section. Since this is contemporary issues, I feel like ALL issues Native Americans face should be addressed, not just typical issues that are first thought of.

Summarizing and Synthesizing:
Issues with my research: A lot of articles are research papers that have suggestions of what this research entails. This means that it's the opinion of the author and not a proven, studied fact. Although the trend may show that this is a feasible conclusion, it would make this section more persuasive than factual. Maybe I can still use it, maybe not. Maybe I can only use the data and allow the reader to come to the conclusion.

Indian Health Services
The Indian Health Service (IHS) was established within the Public Health Service in 1955 in order to meet federal treaty obligations to provide health services to members of federally recognized American Indian and Alaska Native tribes. The IHS consists of three branches of service: the federally operated direct care system, inde- pendent tribally operated health care services, and urban Indian health care services.

A network of twelve regional offices oversee clinical operations for individual facilities and funds. As of 2010, the federally operated sites included twenty-eight hospitals and eighty-nine outpatient facilities.

Unfortunately, data are limited regarding the quality of health care for Native Americans7. The Indian Health Service (IHS) is a federal agency that provides health care services for a substantial proportion of the Native American population. Recent Congressional requirements for the IHS to measure and report clinical performance have prompted an increase in quality improvement efforts across the organization8, but data on the impact of these efforts are limited.

Quality improvement within the IHS may be hampered by a shortage of funding to provide needed health services and by limited availability of clinicians9, 10, 11. Little is known regarding the potential impact of limited resources on the quality of care for Native Americans. We conducted this study to analyze recent trends in the quality of care within the IHS and to assess the perceptions of primary care physicians regarding barriers to the delivery of high-quality care within this system.

Cite this article as: Sequist, T.D., Cullen, T., Bernard, K. et al. J GEN INTERN MED (2011) 26: 480. https://doi-org.libproxy.berkeley.edu/10.1007/s11606-010-1594-4 DOI https://doi-org.libproxy.berkeley.edu/10.1007/s11606-010-1594-4 Publisher Name Springer-Verlag Print ISSN 0884-8734 Online ISSN 1525-1497

https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2005.063230

Contemporary Native American Issues:
Possible Solutions:

'Affordable Care Act' In addition to the Indian Health Services, researchers have data suggesting that the Affordable Care Act supplements Native American healthcare. With the two services, tribes have greater flexibility in health care availability. Tribes have direct access to IHS funds, which can be administered via contracts and other arrangements made with providers. However, it alters trust relationships.

IHCIA does not guarantee a health care arrangement of the kind Americans have generally come to expect—namely, comprehensive inpatient and outpatient services available on the basis of need— a critical point when considering the IHS, which is often mistaken for a Native American health insurance program. According to the governor of the Pueblo of Tesuque Mark Mitchell, IHS does not cover everything that insurance does. It is not an entitlement program, unlike Medicare or Medicaid. The IHS is a series of direct health care services provided at IHS facilities. A key distinction between IHS health services and insurance concerns the policy framework and logic of budgeting that underpins them.

This produces a fundamentally different dynamic than that which drives programs such as Medicare or Medicaid, or especially private managed care plans. The IHS does what it can with the resources it is provided by Congress but is not obligated to provide the services required to meet the broader health needs of Native Americans in the pursuit of measurable outcomes.

Public Health: Native Americans show high mortality rates due to illnesses such as diabetes, mental health, and alcoholism at far higher rates than the rest of the population.

Alcoholism: Alcohol abuse is widespread in Native American communities. Native Americans use and abuse alcohol and other drugs at younger ages, and at higher rates, than that of all other ethnic groups. Consequently, their age-adjusted alcohol-related mortality rate is 5.3 times greater than 51 The Department of Health and Human Services, Substance Abuse and Mental Health Services Administration’s National Household Survey on Drug Abuse reported the following for 1997: 19.8 percent of Native Americans ages 12 and older reported using illegal drugs that year, compared with 11.9 percent for the total U.S. population. Native Americans had the highest prevalence rates of marijuana and cocaine use, in addition to the need for drug abuse treatment.

Consequences of Alcoholism Native Americans and Whites have the highest rates of Driving Under the Influence (DUI). A 2007 study conducted by the National Survey on Drug Use and Health (NSDUH) reports that 13.3% of Native Americans report past-year DUI.

Of 1660 people from seven Native American tribes, the lifetime prevalence of alcohol dependence ranged from 21%-56% for men and 17%-30% for women among all tribes. Physical and sexual abuse significantly increased the chances of alcohol dependence for men. Sexual abuse and boarding school attendance increased the odds of alcohol dependence among women. Native Americans, especially women, are at high risk for alcohol-related trauma, such as rape and assault.

Unintentional injuries due to Alcoholism: Unintentional injuries account for the third leading cause of death for Native Americans and the leading cause of death for Native Americans under 44 years old. Unintentional injuries include motor vehicle crashes, pedestrian-related motor vehicle crashes, drowning, and fire-related injuries. From 1985 to 1996, 1,484 Native American children died in motor vehicle crashes, which is twice the rate for white children.

National estimates of alcohol-related motor vehicle deaths show that Native Americans have a 250% higher death rate compared to the US population.

Diabetes: Native Americans have some of the highest rates of diabetes in the world, specifically Type 2 diabetes. Although mostly diagnosed in adults, children are increasingly being diagnosed with Type 2 diabetes as well. Type 2 diabetes may be manageable through healthy eating, exercising, oral medication, or insulin injections.

A study published in Environmental Health Perspectives found that the prevalence of diabetes found in Native Americans of the Mohawk Nation was 20.2% due to traces of pesticides in food sources, where elevated serum PCBs, DDE, and HBC were associated. Mirex did not have a connection.

Obesity

Obesity is a risk factor for diabetes, cardiovascular disease, and hypertension. There is an increased risk for adults, where Native Americans are 2.3 times more likely to be diagnosed with diabetes. Obesity is prevalent in Native American communities, as these communities are usually rural and do not have access to grocery markets. Instead, the nearest stores are gas-stations, carry-outs, and fast-food restaurants which carry more unhealthy, processed foods rather than produce.Stores selling produce and other healthy foods are typically 30 miles or more away from reservations.

Mental health:

Native Americans are at high risk for mental disorders. The most prevalent concerns due to mental health include substance abuse, suicide, depression, anxiety, and violence. High rates of homelessness, incarceration, alcohol and drug abuse, and stress and trauma in Native American communities might attribute to the risk. According to The Surgeon General's report, the U.S. mental health system is not equipped to meet the needs of Native Americans. Moreso, the budget constraints of the Indian Health Service allows only basic psychiatric emergency care.

Major cardiovascular disease:

Heart disease accounts for the number one cause of death among Native Americans, causing them to have twice the rate of cardiovascular disease than the US population. High rates of diabetes, high blood pressure, and risk factors (unhealthy eating and sedentary lifestyle) contribute to the increased risk of cardiovascular disease.

Cancer:

Studies have indicated that there is are fewer cases of cancer in Native Americans than other ethnic groups. However, cancer is prevalent in Native Alaskan women and Native American women as the leading and second leading cause of death, respectively. Death rates are 70% of that for whites, indicating that the ratio of death by cancer to new cancer cases is the highest for Native Americans compared to other ethnic groups. Women have been diagnosed with later-stage breast and cervical cancer. Native Indian and Alaska Native people are disproportionately prone to colon and lung cancer. In some communities, this is consistent with a high prevalence of risk factors such as smoking.

However, data collected from cancer cases are limited. Regardless, experts have suggested that Native Americans experience cancer differently than other ethnic groups. This can be due to genetic risk factors, late detection of cancer, poor compliance with recommended treatment, the presence of concomitant disease, and lack of timely access to diagnostic and/or treatment methods. According to researchers, addressing underlying risk factors and low screening rates by implementing aggressive screening programs can prevent cancer from forming in Native Indian and Alaska Native communities.

Prevention
Cancer prevention needs to address a high prevalence of underlying risk factors and low screening rates. American Indian and Alaska Na- tive people suffer a disproportionate burden of colon and lung cancer, consistent with a high prevalence of risk factors, such as smoking, in some communities.10 People in this group also present with later-stage breast and cervical cancer, indicating a need for more aggressive screening programs.10

Portland, Oregon:
A lot of my articles reference the randomized implementation of the 2008 Affordable Care Act. I could create a new sub-section titled "2008 Affordable Care Act Trial" or something, but this is a section that perhaps should be part of the ACA Wiki. The Affordable Care Act might have been throughout Oregon collectively. Unless I can find stats for Portland specifically, I will add it.

Update: Difficulty with finding Oregon-specific Native American research articles. Could I perhaps find stats on Oregon health as a whole? But then that's essentially the 2008 Affordable Care Act Test. If I were to compare that to the Native American benefit from the ACA, could I make those connections? How can I compare the Indian Health Services to Oregon people using ACA? Is it biased if I write on Wiki how IHS is lacking for Natives?

Air Pollutants
A research conducted from 1999-2000 collected air samples from five monitoring sites in Portland to analyze 43 hazardous air pollutants. Seventeen of these pollutants exceeded cancer risk levels from all five sites. Twenty out of the 43 were found to pose potential adverse human health risks.

Citation: B.N. Tam, C.M. Neumann, A human health assessment of hazardous air pollutants in Portland, OR, Journal of Environmental Management, Volume 73, Issue 2, 2004, Pages 131-145, ISSN 0301-4797, https://doi.org/10.1016/j.jenvman.2004.06.012. (http://www.sciencedirect.com/science/article/pii/S0301479704001434)

Cancer
One research about the Pacific Northwest Native Americans found that there were many misidentified rates of cancer between 1996-1997. This misclassification was due to a low Native American blood quantum, resulting in an over-reported amount of Native Americans diagnosed with cancer. Because the research took data from the Oregon State Cancer Registry, the Washington State Cancer Registry, and the Cancer Data Registry of Idaho to research tribes in the respected states, their findings show that cancer rates among tribes in the US are heterogeneous.

Historical Trauma
A focus group conducted by the University of Colorado at Denver and Health Sciences Center reported that participants who experienced historical trauma in Indian boarding schools indicated a need for assistance to address their suffered abuse. Non-Native providers seem to lack the understanding, and perhaps discount those experiences. Some participants suggested that service providers should offer traditional healing ceremonies.

Urban Native American mental health agencies have difficulty understanding the diversity of cultures, languages, and traditions; the unique legal status of AI/ANs as citizens of sovereign nations; and the impact of historical trauma of Native American patients.

Boarding School
Participants in a study who are survivors of American Indian mission schools reported that Native Americans were thought to be "dirty" people who needed to be treated with dichloro-diphenyl-trichloro-ethane (DDT), a pesticide used for insect control, before entering class each day. Accounts of DDT powder was applied to their hair occurred in the 1946 and 1957. Participants indicated a need for assistance to address their suffered abuse.

DDT was used during WWII as a pesticide for insect control, eliminating typhus in parts of Europe and controlling malaria and dengue fever. After DDT was made avaialble to the public for commercial use, birds, fish, inscencts, and humans were dying because of the chemicals. Many states tried regulating the chemical and eventually the Environmental Protection Agency placed a ban on DDT.

The Oregon Experiment
In 2008, Oregon initiated Medicaid to 10,000 of a randomized 90,000 low-income, uninsured adults to participate in what is now known as the Oregon Medicaid Health Experiment Oregon Medicaid health experiment. Within 4 study groups of one study, researchers observed that utilization of primary care services will increase, as more individuals will begin and continue to use medical care. Researchers concluded that investment in primary care could help attend and mitigate the health care needs of individuals.

Notes:
Use of "Investment in primary care could help attend and mitigate the health care needs of individuals" sounds persuasivey to me. Perhaps I can say, "Researchers suggest that investment in primary care could help attend..." but it still might sound like I am biased. Perhaps if I could find another article and write, "however, other researchers report the opposite..." and then say "only trial and error will show results." However, I doubt I'll find an article that refutes this claim. Perhaps I should omit the sentence entirely.

Possible sections this could go in:
Oregon, USA Medicaid Affordable Care Act

Suggestions
any photos I could include in the Wiki page?

Public Health
·Alcoholism, Consequences of Alcoholism, Unintentional Injuries due to Alcoholism

·Cancer

·Diabetes

·Major cardiovascular disease

·Mental Health

Historical Trauma
·Boarding School

Possible Programs to Improve Native Health Disparities
·Indian Health Service

·Affordable Care Act

·The Oregon Experiment

IHS areas
A network of twelve regional offices oversee clinical operations for individual facilities and funds. As of 2010, the federally operated sites included twenty-eight hospitals and eighty-nine outpatient facilities.