American Indian and Alaska Native (AIAN) adults in California have worse access to healthcare, experience higher numbers of adverse childhood experiences, and are more likely to have suicidal thoughts and attempts compared with all adults in the state, according to a new study from the UCLA Center for Health Policy Research (CHPR).

The findings, which are based on data from the California Health Interview Survey (CHIS), are presented in three fact sheets that provide insights into how various factors affect the health of populations often underrepresented in public health data, the authors said.

“By looking at access to healthcare, suicidal thoughts and attempts, and adverse childhood experiences, we see how health inequities for many American Indians and Alaska Natives in California begin in childhood and continue throughout their lives,” said Alex Bates, CHIS senior data analyst and one of the authors of the research.

Significant gaps in healthcare access leave many Alaska Native and American Indian adults without consistent care

Data from the 2020–2024 CHIS showed that many AIAN adults in California have no usual source of healthcare and had no preventive care visits in the past year.

Nearly 1 in 7 AIAN adults (14%) did not have health insurance for all or part of the past year compared with 10% of all California adults. AIAN adults were also less likely to have a usual source of care, according to the healthcare access fact sheet. 

More than 1 in 5 AIAN adults (21%) delayed needed medical care in the past year compared with 18% of all California adults. AIAN adults were also more likely to delay filling a prescription in the past year, and 20% visited an emergency department in the past year compared with 17% of all adults in the state.

“The lack of readily available, culturally responsive healthcare has long been a challenge for American Indian and Alaska Native populations, which are often more geographically isolated in rural areas,” said Sue Babey, director of research at CHPR and a study author. “Seeing that 1 in 5 American Indian and Alaska Native adults visited an emergency department in the past year underscores the challenges they face accessing timely, routine, preventive care.”

Childhood trauma disproportionately affects AIAN communities

AIAN adults reported significantly more adverse childhood experiences (ACEs) than adults overall in California, according to the ACEs fact sheet, which was based on CHIS data from 2021–2024.

ACEs were sorted into two categories:

• Household distress: Includes mental illness in the household, substance use in the household, incarceration of a household member, and parental separation or divorce
• Abuse and violence: Includes witnessing intimate partner violence, or experiencing physical abuse, emotional abuse, and/or sexual abuse

Approximately 4 in 5 AIAN adults (80%) in the state reported experiencing at least one ACE, significantly more than the 67% of all California adults. Additionally, more than 1 in 3 AIAN adults (36%) experienced at least four ACEs, and more than 1 in 5 (22%) experienced at least five ACEs, roughly double the rates seen for all adults in California (20% and 11%, respectively).

Among all AIAN adults, 53% reported experiencing emotional abuse, the most common type of ACE, significantly more than the 39% of all California adults who reported the same.

The study showed that for each type of adverse childhood experience, rates among AIAN adults were higher than rates among all California adults.

“The higher prevalence of adverse childhood experiences in AIAN populations reflects not only individual experiences, but also the enduring impacts of historical trauma, systemic inequities, and disrupted cultural connections,” said Nicamer Tolentino, director of the California Tribal Epidemiology Center. “Continued research and investment in prevention, mental health services, and culturally grounded healing programs are critical to reducing childhood trauma and fostering resilience for future generations.”

Suicide-related challenges remain an urgent public health concern

While about 5% of California adults self-identify as American Indian or Alaska Native, representative data on suicidal thoughts and behaviors among AIAN adults are often lacking.

Overall, an estimated 1 in 11 AIAN adults (9%) in California had attempted suicide in their lifetime, nearly double the percentage for all adults (5%), according to the fact sheet about suicidal thoughts and attempts, which was based on 2020–2024 CHIS data.

The study also showed that nearly 1 in 4 AIAN adults (24%) in California had ever seriously thought about suicide, significantly higher than California adults overall (18%).

“These latest publications on healthcare access, adverse childhood experiences, and suicidal thoughts and attempts help address the lack of reliable, timely, and population-representative data about the health and well-being of American Indian and Alaska Native communities in California,” Bates said.

The new fact sheets are the second in a series of projects funded by the California Rural Indian Health Board, Inc. (CRIHB) California Tribal Epidemiology Center that examine the health of American Indian and Alaska Native populations in California. Antoinette Medina of CRIHB also served as a co-author. The first project focused on chronic disease and substance use.