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Jason Eyachabbe (foreground) from the Chickasaw Nation Dance Troupe takes part in the American Indian Honoring Ceremony at the OSU Center for Health Sciences.
Jason Eyachabbe (foreground) from the Chickasaw Nation Dance Troupe takes part in the American Indian Honoring Ceremony at the OSU Center for Health Sciences. A team from OSU College of Osteopathic Medicine at the Cherokee Nation and OU-TU School of Community Medicine studied how American Indian/Alaska Natives teens can be underrepresented in some CDC data. Their findings were recently published in the American Journal of Public Health

Joint research study found Native American teens underrepresented in CDC database

Monday, April 1, 2024

Media Contact: Sara Plummer | Communications Coordinator | 918-561-1282 |

A team from Oklahoma State University College of Osteopathic Medicine at the Cherokee Nation and the University of Oklahoma-University of Tulsa School of Community Medicine studied how teens who self-reported as American Indian/Alaska Natives were reclassified using data from the Centers for Disease Control and Prevention.

Ashton Glover Gatewood, a fourth-year medical student from OSU-COM at the Cherokee Nation, and Micah Hartwell, Ph.D., clinical assistant professor of psychiatry and behavioral sciences, worked with Amy Hendrix-Dicken, research assistant supervisor at the OU-TU School of Community Medicine’s Department of Pediatrics, on the study published in the American Journal of Public Health.

The team analyzed the CDC’s 2021 Youth Risk Behavior Surveillance System (YRBSS) data, which collects behaviors and demographics of high school students including self-reported race and ethnicity. The self-reported race data is then used to create a single variable called imputed race variable — which can limit the representation of Native Americans, the study found.

When self-reporting, the teens can classify themselves as one or more races. Of the 816 teens who self-reported as American Indian/Alaska Native (AI/AN) in the YRBSS, 145, or 17.7%, reported as AI/AN alone; 246, or 30.2%, reported as AI/AN alone with Hispanic or Latino background; and 425, or 52%, reported AI/AN in combination with one or more races.

But, the study found only 145 teens were computed as being AI/AN, representing only 13.4% of AI/AN teens in the YRBSS.

“There’s a huge issue with Native American populations being underrepresented in a lot of data — nationally representative data,” said Hartwell, who also works with the Office of Medical Student Research at OSU-COM at the Cherokee Nation campus in Tahlequah.

For Gatewood, who is a citizen of the Choctaw Nation of Oklahoma and has Chickasaw Nation ancestry, the subject of the study is personal. Her daughter came home from preschool one day and told her they learned that Native Americans were people who lived a long time ago, wore funny clothes and aren’t around anymore.

“I told her no, you’re Native American, you’re Choctaw and Chickasaw. We had this long conversation about it,” she said. “I think in Oklahoma we’re probably a little bit ahead of the curve, but I know a lot of the country and the world thinks that Indigenous people are this extinct or mythical thing that lived a long time ago or we hear about in stories. They forget that we’re alive and are people that live next door to them.” 

Hendrix-Dicken, who is also a citizen of the Cherokee Nation and Ph.D. candidate in OU-Tulsa’s Organizational and Community Leadership program, said racial misclassification can have real consequences because national data, like the YRBSS, compiled and published by the CDC is used by a lot of researchers across the U.S.

“These numbers can tie back to questions like what are the unique strengths and experiences  of this racial group? In relation to funding, where does the funding need to go? When we’re not thinking about identity in this complex way, we’re missing a huge piece of the puzzle which can lead to ineffective programs and interventions,” she said.

She added that when someone self-reports as American Indian/Alaska Native and White, and someone else self-reports as Black and Hispanic/Latino, they are both put into a multiracial category.

“Is a singular multiracial group the correct way to do it? The most recent census showed that AI/AN have the highest percentage of multiracial individuals,” Hendrix-Dicken said. “America overall is becoming more multiracial, it’s not just Indigenous people. So, we’re throwing more and more people into a catch-all category.”

All three researchers said they weren’t surprised by their findings, but it didn’t make it easier to digest the information.

“I think we’re seeing a lot of this socially and anecdotally, but to see the numbers makes it more tangible and more real. So, I wasn’t surprised, but I was disappointed,” Gatewood said, adding that misclassification of AI/AN individuals can mean less allocation of resources from the federal government that have treaties with sovereign nations.

The team analyzed the YRBSS because it was one of the few datasets that included the imputed race variable numbers and self-reported race numbers, meaning the team could more easily compare the two.

The researchers’ recommendations are that the CDC include self-reporting data in all their large national datasets and that other researchers who are utilizing YRBSS data should consider whether they are looking at those aggregated numbers that can misclassify race or the self-reporting numbers.

“People who use this data really need to conceptualize how they’re intending to use race and ethnicity within their studies,” Hartwell said. “Using the self-reported identity may be vastly more important to the social, behavioral and health outcomes that they’re investigating than the imputed race variable.”

For Hendrix-Dicken, there’s the macro and micro of what comes next now that their research is published.

“The macro is we need to start moving all of these bigger datasets to where we can look at self-identification because it is important. We need better representation of Indigenous voices in universities where they’re doing the research and places like the CDC,” she said. “On the micro level, I’ve been taking this and really starting to have conversations with people who are not Indigenous about how complex Indigenous identity is.”

Gatewood said it was significant that she and Hendrix-Dicken are both citizens of tribal nations and that their tribal identities were acknowledged in the publication of their study in the American Journal of Public Health.

“I think it makes it more powerful saying we are from this group, and this is how we would like to be identified and this is important to us,” she said. “I think Amy and I are really fortunate that we were able to participate in research studies like this and able to use our education and training to provide a voice to some of these issues. I think it’s really the first time in history that we’ve had people from our tribes that have been in a position to do that.”

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