to wait longer for organ transplants than white people. stroke stroke is the sixth-leading cause of death in the native american population. native americans are sixty percent more likely than white adults in the united states to have a stroke. native american women have double the rate of stroke of white women. about 3.6% of native american and alaska native men and women over 18 have a stroke. the stroke death rate of native americans and alaska natives is 14 percent greater than among all races. psychosocial problems suicide native americans face issues of depression and the highest rate suicide rate of any ethnic group in the united states. in 2009 suicide was the leading cause of death among native americans and native alaskans between the ages of 10 and 34. 75% of deaths among native americans and native alaskans over the age of 10 are due to unintentional injury, homicide, and suicide. suicide rates among native american youths are significantly higher than among white youths. the head of the ihs, mary l. smith, says that her agency is focusing on mental health issues in native american communities. because of numerous suicides among teens on the pine ridge indian reservation, it has been designated as a promise zone and the government is sending extra help. a british columbia study, published in 2007, reported an inverse correlation between indigenous youth suicide and use of their heritage language. language use is considered a cultural continuity factor, and it was more highly correlated to youth suicide than six other such cultural factors. those bands that had higher rates of indigenous language use had lower rates of suicide. since the late 20th century, numerous tribes have undertaken language revitalization programs in order to maintain their cultures. this study indicates such language use can also have positive effects on teens' mental health. the study recorded suicides among bands with higher use and those with lower use of indigenous languages. communities with lesser language knowledge estimated 96.59 suicides per 100,000 individuals; the bands with greater language knowledge estimated 13 suicides per 100,000 people. indigenous youths' mental health can be affected by the community's use of indigenous language. alcohol use disorder main article: alcohol and native americans another significant concern in native american health is alcohol use disorder. from 2006 to 2010, alcohol-attributed deaths accounted for 11.7 percent of all native american deaths, more than twice the rates of the general u.s. population. the median alcohol-attributed death rate for native americans (60.6 per 100,000) was twice as high as the rate for any other racial or ethnic group. alcohol use disorder is often approached using the disease model of addiction, with biological, neurological, genetic, and environmental sources of origin. this model has been challenged by research showing that native american behavior is frequently affected by trauma resulting from domestic violence, racial discrimination, poverty, homelessness, historical trauma, disenfranchised grief, and internalized oppression. statistically, the incidence of alcohol use disorder among survivors of trauma is significantly elevated, with survivors of physical, emotional and sexual abuse in childhood having the highest rates of alcohol use disorder. however, at least one recent study refutes the belief that native americans drink more than white americans. analysis of data from the national survey on drug use and health (nsduh) from 2009 to 2013 revealed that native americans compared to whites had lower or comparable rates across the range of alcohol measures examined. the survey included responses from 171,858 whites compared to 4,201 native americans. the majority (59.9%) of native americans abstained from drinking alcohol, whereas less than half (43.1%) of the white population surveyed abstained. approximately 14.5% of native americans were light/moderate-only drinkers, versus 32.7% of whites. native american and white binge drinking (5+ drinks on an occasion 1–4 days during the past month) estimates were similar: 17.3% and 16.7%, respectively. the two populations' heavy drinking (5+ drinks on an occasion 5+ days in the past month) estimates were also similar: 8.3% and 7.5%, respectively. nonetheless, native americans may be more vulnerable to higher risks associated with drinking because of lack of access to health care, safe housing and clean water. after colonial contact, white drunkenness was interpreted by whites as the misbehavior of an individual. native drunkenness was interpreted in terms of the inferiority of a race. what emerged was a set of beliefs known as "firewater myths" that misrepresented the history, nature, sources and potential solutions to native alcohol problems. these myths claim that: american indians have an inborn, insatiable appetite for alcohol. american indians are hypersensitive to alcohol (cannot "hold their liquor") and are inordinately vulnerable to addiction to alcohol. american indians are inordinately prone to violence when intoxicated. these very traits produced immediate, devastating effects when alcohol was introduced to native tribes via european contact. the solutions to alcohol problems in native communities lie in resources outside these communities. scientific literature has debunked many of these myths by documenting the wide variability of alcohol problems across and within native tribes and the very different response that certain individuals have to alcohol as opposed to others. the 2012–2013 national epidemiologic survey on alcohol and related conditions iii (nesarc-iii) found that 19.2% of native americans surveyed had had an alcohol use disorder during the previous twelve months, and 43.4% had had an alcohol use disorder at some time during their lives (compared to 14.0% and 32.6% of whites, respectively). this contrasts sharply with the 2015 national survey on drug use and health and national survey of substance abuse treatment services, which surveyed adolescents and adults receiving treatment and found that 9.7% of native americans surveyed had had an alcohol use disorder during the previous twelve months (compared to 6.1% of whites). an analysis of surveys conducted between 2002 and 2016 determined that 34.4% of native american adults used alcohol in 2016 (down from 44.7% in 2002). native american tribes with a higher level of traditional social integration and less pressure to modernize appear to have fewer alcohol-related problems. tribes in which social interactions and family structure are disrupted by modernization and acculturative stress (i.e. young people leaving the community to find work) have higher rates of alcohol use and misuse. native americans living in urban areas have higher rates of alcohol use than those living in rural areas or on reservations, and more native americans living on reservations (where cultural cohesion tends to be stronger) abstain altogether from alcohol. alaska natives who follow a more traditional lifestyle have reported greater happiness and less frequent alcohol use for coping with stress. hiv/aids hiv and aids are growing concerns for the native american population. the overall percentage of native americans diagnosed with either hiv or aids within the entire united states population is relatively small. native american aids cases make up approximately 0.5% of the nation's cases, while they account for about 1.5% of the total population. native americans and alaska natives rank third in the united states in the rate of new hiv infections. native americans, when counted with alaskan natives, have a 40% higher rate of aids than white individuals. also, native american and alaskan native women have double the rate of aids of white women. these statistics have multiple suggested causes: sexual behaviorsprevious studies of high rates of sexually transmitted diseases among native americans lead to the conclusion that the sexual tendencies of native americans lead to greater transmission illicit drug usethe use of illicit drugs is documented to be very high among native americans, and not only does the involvement of individuals with illicit drugs correlate with greater rates of sexually transmitted disease, but it can facilitate the spread of diseases socio-economic statusdue to the poverty and lower rates of education, the risk of getting aids or any other sexually transmitted disease can be increased indirectly or directly testing and data collectionnative americans may have limited access to testing for hiv/aids due to location away from certain health facilities; data collected on native american sexually transmitted diseases may be limited for this same reason as well as for under-reporting and the native american race being misclassified culture and traditionnative american culture is not always welcoming of open discussion of sexually transmitted diseases combating disease and epidemics many initiatives have been put in place to combat native american disease and improve the overall health of this demographic. one primary example of such initiative by the government is the indian health service which works "to assure that comprehensive, culturally acceptable personal and public health services are available and accessible to native american and alaska native people". there are many other governmental divisions and funding for health care programs relating to native american diseases, as well as a multitude of programs administered by tribes themselves. legislature healthcare for native americans were provided through the department of war (throughout the 1800s) until it became a focus of the office of indian affairs in the late 1800s. it again switched government agencies in the early 1950s, going under the supervision of the department of health, education, and welfare's public health service (phs). in 1955, the indian health service division was created, which still enacts the majority of native american specific healthcare. the snyder act of 1921 (23 u.s.c. 13) was one of the first formal legislative pieces to allow healthcare to be provided to native americans. in the 1970s, more legislation began passing to expand the healthcare access for native americans. diabetes programs eagle books are a book series produced by the cdc to inform native american children about healthy lifestyles to prevent diabetes. as diabetes is one of the utmost concerns of the native american population, many programs have been initiated to combat this disease. governmental programs one such initiative has been developed by the centers for disease control and prevention (cdc). termed the "native diabetes wellness program", this program began in 2004 with the vision of an "indian country free of the devastation of diabetes". to realize this vision, the program works with native american communities, governmental health institutions, other divisions of the cdc, and additional outside partners. together they develop health programs and community efforts to combat health inequalities and in turn prevent diabetes. the four main goals of the native diabetes wellness program are to promote general health in native communities (physical activity, traditional foods), spread narratives of traditional health and survival in all aspects of life, utilize and evaluate health programs and education, and promote productive interaction with the state and federal governments. funding for these efforts is provided by the balanced budget act of 1997, public law 105–33, and the indian health service. one successful aim of this program is the eagle books series, which are books using animals as characters to depict a healthy lifestyle that prevents diabetes, including embracing physical activity and healthy food. these books were written by georgia perez, who worked with the university of new mexico's native american diabetes project. other successful efforts include diabetes talking circles to address diabetes and share a healthy living message and education in schools. the native diabetes wellness program also has worked with tribes to establish food programs that support the "use of traditional foods and sustainable ecological approaches" to prevent diabetes. the indian health service has also worked to control the diabetes prevalence among native americans. the ihs national diabetes program was created in 1979 to combat the escalating diabetes epidemic. the current head of the ihs, mary l. smith, cherokee, took the position in march 2016 and had pledged to improve the ihs and focus on comprehensive health care for all the tribes and people covered by the department. a sector of the service is the division of diabetes treatment and prevention, which "is responsible for developing, documenting, and sustaining clinical and public health efforts to treat and prevent diabetes in native americans and alaska natives". this division contains the special diabetes program for indians, as created by 1997 congressional legislation. this program receives $150 million a year in order to work on "community-directed diabetes programs, demonstration projects, and strengthening the diabetes data infrastructure". the community-directed diabetes programs are programs designed specifically for native american community needs to intervene in order to prevent and treat diabetes. demonstration projects "use the latest scientific findings and demonstrate new approaches to address diabetes prevention and cardiovascular