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Many American Indian nations, tribes, and bands are at an elevated risk for premature death from unintentional injury. Previous research has documented a relationship between alcohol-related injury and subsequent injury death among predominately urban samples. The presence or nature of such a relationship has not been documented among American Indians living in the northern plains. The purpose of this study was to identify and characterize any association between prior injury and/or alcohol use contacts with the Indian Health Service (IHS) and subsequent alcohol-related injury death that may suggest opportunities for mitigation. Death certificates of American Indians who died from injury (ICD-9-E 800-999) in a rural IHS area over 6 consecutive years were linked to IHS acute-care facility records and toxicology reports. Deaths and prior IHS contacts were stratified by alcohol use as a contributing factor. Of the 526 injury deaths involving American Indians in the IHS area studied, 411 (78%) were successfully linked to IHS records. One hundred fifty-two of these cases met the inclusion criteria, with an additional 98 cases identified as a comparison group. No differences in alcohol use at time of death between groups with and without prior health care contact (for injury or alcohol) could be determined (81% vs 73%). A significant relationship was found between previous visits for acute or chronic alcohol use and subsequent alcohol-related fatalities (P = .01). Based on these findings, injury-prevention activities in the population studied should be initiated at the time of any health-system contact in which alcohol use is identified. Intervention strategies should be developed that convey the immediate risk of death from injury in these patients.

The pathology of cardiac disease includes genetic, physical, biochemical, psychological, social, and environmental vectors. Factors contributing to suicide have been identified in these same areas. Survival from an acute cardiac event requires a systematized and multisectoral response. Communities that do not have systematized response capabilities to acute cardiac events have poorer survival outcomes. Suicide prevention and control may also be responsive to an integrated community response system. This paper examines the development of a community cardiac care model, explores potential parallels for a community suicide prevention and control model, and outlines a general systems theory framework for a suicide prevention and control system.

Objectives. To conduct an in-depth analysis of all suicides occurring in Alaska between September 1, 2003 and August 31, 2006, and to conduct follow-back interviews with key informants for select cases. Study design. Suicide data were gathered from the Alaska Bureau of Vital Statistics, law enforcement agencies and the Alaska medical examiner's office. Trained counsellors administered the 302 branching-question follow-back protocol during in-person interviews with key informants about the decedents. Methods. Suicide death certificates, medical examiner's reports and police files were analysed retrospectively. Key informants were contacted for confidential interviews about the decedents' life, especially regarding risk and protective factors. Results. There were 426 suicides during the 36-month study period. The suicide rate was 21.4/100,000. Males out-numbered females 4 to 1. The age-group of 20 to 29 had both the greatest number of suicides and the highest rate per 100,000 population. Alaska Natives had a suicide rate that was three times higher than the non-Native population. Follow-back interviews were conducted with 71 informants for 56 of the suicide decedents. Conclusions. This research adds significant information to our existing knowledge of suicide in Alaska, particularly as it affects the younger age groups among the Alaska Native population and the role of alcohol/drugs. [ABSTRACT FROM AUTHOR]