Healthcare-Seeking and Violence against American Indian and Alaska Native Women: Examining the Impact of the COVID-19 Pandemic

PROJECT SUMMARY/ABSTRACT In response to the Notice of Special Interest (NOT-OD-22-031) for "Research on the Health of Women of Understudied, Underrepresented, and Underreported (U3) Populations," we propose to apply resources from our parent R01 project to examine rates of injurious violence from hospital discharge data for American Indian/Alaska Native (AIAN) women residing on and off American Indian reservations; assess these rates within the context of the COVID-19 pandemic conditions; and utilize results of interviews with key Tribal leaders to interpret results in ways that are valid and useful for Tribal policymakers. With mounting reports of Missing and Murdered Indigenous Women, there is a profound need to expand the capacity of research on gender-based violence to account for the contexts, risks, and services underlying intimate partner violence, domestic violence, and sexual assault. The parent project uses Healthcare Cost and Utilization Project (HCUP) data to perform geospatial analyses across multiple states that are collocated with American Indian reservations populated with at least 2,000 residents. The proposed supplement will investigate injuries associated with gender-based violence specifically for AIAN women whose agency and needs have been historically and continually understudied, underrepresented, and underreported in research. Guided by research that has demonstrated the utility of the HCUP to address intimate partner violence and domestic violence among other groups of women, this supplemental study aligns with the priorities established by the Office of Research on Women's Health regarding disparities related to violence against Indigenous women. We adopt a multi-methods and intersectional approach to achieve the following aims: AIM 1: Assess the type and frequency of hospital discharge records coded for violence, such as assault and battery committed by intimate partners and unknown assailants, for AIAN women residing on versus off Tribal jurisdictions collocated with Arizona by using HCUP data from 2006-2019 (preceding the COVID-19 pandemic). AIM 2: Compare these reports of care-seeking within the scope of the COVID-19 pandemic conditions using HCUP data from 2020. AIM 3: Identify how Tribal community conditions and Tribal services may inform our understanding of the violence-related reporting and impacts of the COVID-19 pandemic control measures using interview data from key leaders. In doing so, this supplemental research addresses the call for creating culturally and contextually relevant evidence that considers the landscape of geographic and structural factors to primary and preventative care and centers the lived experiences of AIAN women to meet group- and population-level needs.