Not all Native American Veterans able to get adequate care

By Monica Brown, Tulalip News Writer

The U.S. Department of Veterans Affairs (VA) released a comprehensive report in September 2012, of American Indian and Alaska Native (AI/AN) veterans.  There are over 154,000 AI/AN veterans in the U.S. with over 6,000 in Washington state.

“American Indian and Alaska Native (AIAN) Veterans have played a vital role in the United States military for over two hundred years. Recognizing their long history of distinguished service, this report seeks to provide comprehensive statistics on this important cohort of Veterans through an examination of AIAN Active Duty, Reserve, and National Guard data together with demographic, socioeconomic, and health status statistics for AIAN Veteran, “states the U.S. dept of veteran affairs.

Native Americans serve in the U.S. Armed Forces at a higher rate per capita than any other ethnic group and have had more female servicemembers than any other group of servicemembers.  The report, titled “American Indian and Alaska Servicemembers and Veterans,” shows that  AI/AN alos have higher unemployment rates and aren’t recieving health care.

The Veterans Health Administration Office of rural Health states, “Native Veterans face many challenges to receiving adequate care. These challenges include long distances to care with few transportation resources and limited access to specialty care. Rural Native Veterans must sort out an often confusing mix of local and federal health care providers with overlapping and sometimes inconsistent coverage across Native, local, state, and federal levels. Frequently, Native practices in health and healing are not well-integrated into care they receive from clinics or hospitals. Finally, rural Native Veterans often are among the most impoverished with little access to training opportunities and few viable prospects for employment—all factors which are closely tied to poor health outcomes,”

US Census Bureau populations
US Census Bureau populations

Here are some statistics from the study:

The unemployment rate of AI/AN vets is 7.1%

The unemployment rate for vets of all other races is 4.9%

 

15.3% of AI/AN vets who do not have health insurance

6.3%of vets of all other races who do not have health insurance

 

36.4% AI/AN vets who suffer from one or more disability

26.2% of vets of all other races who suffer from one or more disability

 

18.9% AI/AN vets who have a service-connected disability rating

15.6% of vets of all other races who have a service-connected disability rating

 

 

Objections mount as FDA reviews genetically engineered salmon

Published: March 5, 2013

By ERIKA BOLSTAD — Anchorage Daily News

WASHINGTON — Every summer since 1979, Kim Hubert has fished for sockeye salmon in Alaska’s Bristol Bay. It’s a family business in tiny Togiak that has, from time to time, also employed his wife and three children.

Hubert and his 21-year-old daughter work the nets now. They’re small permit holders who may catch and sell thousands of salmon in their nets each year, depending on the success of the run.

“We’ve got a fish camp out there, we enjoy the people and the bay and the work,” said Hubert, 58, a retired schoolteacher who lives in Eagle River. “Some years we lose a few bucks, and some years we make a few.”

They and other fishermen have been casting a wary eye on Washington, where the Food and Drug Administration is considering whether AquaBounty, a Massachusetts-based company with a lab on Prince Edward Island in Canada and growing facilities in Panama, may sell genetically engineered salmon to consumers in the United States.

More than 33,000 fishermen, environmentalists, food safety advocates and others have written to the FDA with concerns about the agency’s preliminary findings. Among the worries is that the genetically engineered fish might escape and mix with wild salmon. The company says that’s unlikely, not only because the fish are sterile but also because of its production process.

But there’s a reason that Alaska bans salmon fish farms in the state, the Sitka Conservation Society, an environmental group in southeast Alaska, said in its letter to the FDA. They fear that the company will expand to the U.S., where the fish would be closer to native salmon populations.”

These farms pollute water with concentrated fish waste and feed, spread sea lice and ultimately lead to escapement and interbreeding,” the organization said. “If genetically modified salmon are permitted, it will be only a matter of time before they are muddling the pure wild population in Alaska.”

Mostly, though, fishermen in Alaska fear that the new, faster-growing farmed fish would threaten their livelihood eventually by flooding the market with cheap fish. They’re also pressing for the AquaBounty salmon to be labeled as genetically engineered because they think that their wild-caught, more expensive product is superior. They want no confusion in the marketplace.”

In some ways I felt threatened,” Hubert said. “The threat may not be immediate, but I think down the line there could be some repercussions. We’ve had a lot of issues with labeling, and the ability (of consumers) to choose and know where the fish come from: what kind of stocks, whether they’re farmed or wild fish.”

Aqua Bounty has applied for federal approval to commercially produce a growth-enhanced, transgenic Atlantic salmon (Salmo salar). At 18 months, the transgenic fish is clearly much larger than the same-age normal fish. But overall growth of the same generation of fish evens out by 36 months. (Image Credit: Aqua Bounty Technologies)
Aqua Bounty has applied for federal approval to commercially produce a growth-enhanced, transgenic Atlantic salmon (Salmo salar). At 18 months, the transgenic fish is clearly much larger than the same-age normal fish. But overall growth of the same generation of fish evens out by 36 months. (Image Credit: Aqua Bounty Technologies)

The AquaBounty fish are Atlantic salmon that have been genetically altered with growth genes from a Chinook salmon and a sea eel. That makes them grow faster than other farmed Atlantic salmon, although they don’t get any bigger than regular salmon.

The FDA issued a preliminary finding in late December that the fish, known as the AquAdvantage Salmon, is as safe as eating conventional Atlantic salmon and that there’s a reasonable certainty of no harm in consuming it. The agency also issued a draft environmental assessment that there’s little chance of environmental harm from farming the fish.

However, after pressure from Congress — especially from Alaska lawmakers — the FDA in February extended the public comment period on its findings by 60 days. People have until April 26 to weigh in, and after that the agency will decide whether to issue a final report or pursue a more comprehensive environmental impact statement.

AquaBounty executives aren’t currently granting interviews. The company’s last public statement came in mid-February, when the FDA announced that it would extend the comment period. AquaBounty Chief Executive Officer Ron Stotish said at the time that they weren’t pleased with the delay.

Some food safety advocates are pushing for the FDA to do a full environmental review. They’re also petitioning the agency to consider the AquaBounty fish as a food additive rather than as an animal drug. The FDA uses its animal drug process to consider the safety of all potential genetically modified animals sold as food.

That change would make the approval process more transparent, as well as focus on the safety of the salmon as food, said Patty Lovera, the assistant director of Food & Water Watch. It joined Consumers Union, which is the advocacy division of Consumer Reports, and the nonprofit Center for Food Safety to petition the FDA.”

We just think it’s really deficient on the food front,” Lovera said. “What do we really know about allergies? What do we know about nutrition profile? That stuff’s really sketchy in that application that they put in. And we’d like to see a lot more of that, considering you’re going to eat the whole thing.”

People and animals already consume plenty of genetically modified grains, which aren’t required to be labeled in the U.S. A ballot measure requiring such labeling failed recently in California.

But the fish are the first genetically engineered animals being considered for human consumption in the U.S., and the approval process is being closely watched in the biotech field.

There’s a huge market for heart-healthy fish: Salmon is the second most popular seafood consumed in the U.S., behind tuna. And an estimated 91 percent of the seafood consumed in this country is imported; about half of that is from aquaculture.

Even if the AquaBounty fish is approved, however, supermarkets won’t be flooded with genetically engineered fish anytime soon, said Gregory Jaffe, the director of biotechnology at the Washington-based Center for Science in the Public Interest, an advocacy organization. Jaffe was on the FDA advisory panel that reviewed the safety of the salmon in 2010 and found no cause for alarm.

AquaBounty would have to reapply to the FDA to expand operations.

“They talked about hundreds of tons of salmon a year. We import hundreds of thousands of tons of salmon a year,” Jaffe said. “So maybe it’ll be slightly easier to eat one of these salmon steaks than to win the lottery. But if someone wanted to find one of these salmon steaks out there to eat, it’s going to take a little effort.

“That hasn’t stopped lawmakers from Western states from fighting the FDA findings — or at a minimum, seeking a requirement that genetically engineered salmon be labeled. Consumer groups are making the same push.

“Any fish that is labeled as wild-caught, or Alaskan, might see some of its market actually go up,” said Michael Hansen, a senior scientist for Consumers Union. “Since this will not be labeled, people would not know whether the regular salmon they’re buying is engineered or not.

“In his mid-February statement, AquaBounty’s Stotish noted that no new facts had been introduced since the FDA’s findings late last year and that the company doesn’t think the additional comment period “materially affects our chances for approval.”

“There has been neither new information nor a clear legal or regulatory issue raised by the FDA since that time,” he said in the statement.

AquaBounty says in its press materials that it wants its fish to be labeled “Atlantic salmon.” The company says the nutritional and biological composition of its AquAdvantage Salmon is identical to Atlantic salmon, and therefore doesn’t require additional labeling based on its method of production.

The company notes that it supports voluntary branding by the farmers who grow its salmon, to identify what it calls “the environmentally friendly benefits of this product.”

An FDA spokeswoman, Theresa Eisenman, said a decision hadn’t yet been made regarding labeling AquAdvantage Salmon.

The FDA since 1992 has considered bioengineered foods to be no different from other foods “in any meaningful or uniform way.” The agency supports voluntary labeling that provides consumers with such information, however.

Email: ebolstad@mcclatchydc.com

 

Read more here: http://www.adn.com/2013/03/05/2812889/objections-mount-as-fda-considers.html#disqus_thread

Tongue stimulation can reverse serious ailments

By Jason Bittel, Slate.com

The human tongue is an extraordinary bit of flesh. It’s alternately squishy and tense, at times delicate and others powerful. It helps us taste, talk and tie cherry stems, all the while avoiding two interlocking rows of sharpened enamel that know only how to gnash.

Now, it seems the tongue may even serve as a gateway to the human brain, providing us with the opportunity to treat serious afflictions from multiple sclerosis to combat-induced brain injuries.

The tongue is a natural candidate for electrical stimulation, thanks in part to a high density of sensory receptors and the concentration of electrolytes found in saliva.

This has allowed researchers at the Tactile Communication and Neurorehabilitation Laboratory at the University of Wisconsin-Madison to develop a pattern of electrodes that can be placed on the tongue and attached to a control box.

All together, the system is called a Portable Neuromodulation Stimulator (PoNS).

Once hooked in, patients undergo 20-30 minutes of stimulation therapy, or CN-NiNM (cranial nerve non-invasive neuromodulation), matched to a regimen of physical, occupational and cognitive exercises specific to the ailment being treated. Each exercise corresponds with different patterns of tongue stimulation, which in turn coax the brain to form new neural pathways.

These pathways remain active even after the stimulation has been removed, meaning the therapy can have lasting effects.

After treatment with CN-NiNM, patients with multiple sclerosis have been shown to have a 50 percent improvement in postural balance, 55 percent improvement in walking ability, a 30 percent reduction in fatigue and 48 percent reduction in M.S. impact scores (a measure of physical and psychological impact of M.S. from the patient’s perspective).

Extraordinary numbers by any standard, but if you really want to understand the project’s impact, read about Kim Kozelichki ditching her hobbled limp for a healthy jog on the University of Nebraska’s Medical Center blog.

Best of all, researchers have reason to believe CN-NiNM can not only slow functional loss, but also restore previously lost functions. It’s this promise that has the U.S. Army Medical Research and Materiel Command interested.

In collaboration with the University of Wisconsin at Milwaukee and NeuroHabilitation Corporation, the Army hopes to harness this emerging technology to “restore lost physical and mental function” for both service members and civilians suffering from traumatic brain injury, stroke Parkinson’s and multiple sclerosis.

More information
www.unmc.edu/mmi/docs/TrainTheBrain.pdf

Acupuncture can ease allergies, study says

By Landon Hall, The Orange County Register

Heather Rice calls them “kitty cat whiskers”: one acupuncture needle inserted on each side of the nostrils, an acupuncture point known as Large Intestine 20.

The treatment helps alleviate symptoms of seasonal allergic rhinitis: runny nose, congestion, nasal drip and general misery, said Rice, a licensed acupuncturist at University of California-Irvine’s Susan Samueli Center for Integrative Medicine.

“One thing I notice almost immediately is that in just 30 minutes, they say, ‘Oh my God, I can actually breathe,'” Rice said. “I don’t want to say it’s 100 percent, but with at least eight out of 10 people, their noses will open up. They can breathe better, and they’re not as congested.”

The benefits Rice has observed are confirmed in a new study, although the benefit isn’t as pronounced as she has found in her day-to-day work. The paper, published last week in the journal Annals of Internal Medicine, followed 422 Germans who suffered from seasonal pollen allergies.

Over the course of eight weeks, the subjects were divided into three groups and given three treatments: acupuncture, together with the antihistamine cetirizine (marketed as Zyrtec); a “sham” acupuncture, along with the drug; and the drug only.

The group that had real acupuncture with the drug reported a slight improvement in their symptoms, a boost of 0.7 points on the Rhinitis Quality of Life Questionnaire, compared with the group that got no acupuncture; and a boost of 0.5 points compared with the group that received the fake acupuncture, which involved sticking them with needles in places that aren’t accepted treatment points.

“The improvements may not have been large enough to be noticeable or to make much of a difference to people,” the authors said in a summary of their paper.

This brings up the big question once again about acupuncture: Does it really work, or do people just convince themselves it works? And does it matter?

A large analysis of previous studies last year determined the effectiveness rate for real acupuncture was about 50 percent, and for sham acupuncture it was 43 percent.

“UCI’s been studying that as well,” Rice said. “They can’t say it’s not the placebo effect. That is an ongoing thing.”

The German study also found that the improvement from acupuncture had disappeared two months after the study ended. That doesn’t surprise Rice, who says further treatments are needed to keep up the therapeutic benefits.

“That’s kind of how acupuncture works with those kinds of things,” she said. “What I say is this: Would you rather be on antihistamines every day or come and get acupuncture once a week?”

State lawmaker backpedals on bike riders polluting air

By Jonathan Kaminsky, Associated Press

OLYMPIA — A Washington state lawmaker apologized Monday for asserting in an email last week that bicyclists pollute the air with their heavy breathing.

But while Republican Rep. Ed Orcutt of Kalama, the ranking minority member of the House Transportation Committee, said that his statement was “not a point worthy of even mentioning,” he didn’t retract his claim that cyclists contribute to climate change with their “increased heart rate and respiration.”

“What I was trying to say is bicyclists do have a lower footprint but not a zero footprint in relation to automobiles,” Orcutt said. “I didn’t close that thought out very well. It was poorly worded.”

Orcutt’s initial statement came in a response to an email sent to more than 30 state lawmakers from Dale Carlson, the owner of three South Sound-area bike stores. Carlson was upset about a proposal to create a $25 fee for all new bicycle purchases of $500 or more as part of a transportation revenue package.

Orcutt, a conservative who opposes most tax increases, told Carlson by email that cyclists should help pay for the upkeep and construction of roads.

In support of his view, he wrote that “the act of riding a bike results in greater emissions of carbon dioxide from the rider. Since CO2 is deemed to be a greenhouse gas and a pollutant, bicyclists are actually polluting when they ride.”

Carlson said he appreciated Orcutt’s subsequent apology, but said the lawmaker’s views “still seems way out there.”

“Cycling has so many positive attributes to society,” Carlson said. “It should be encouraged and not discouraged.”

Dr. Lonnie Thompson, a climatologist and glaciologist at The Ohio State University, called Orcutt’s line of reasoning “crazy.”

“We have to breathe whether we’re riding a bike or not,” said Thompson, who added that burning through a 12-gallon tank of gas releases 314 pounds of carbon dioxide into the air.

A 2011 study by the European Cycling Federation found that bicycle riding is not emission-free, but is more than 10 times less polluting than driving a car. That study took into account the manufacture of the raw materials of a bicycle and the increased food consumption that fuels the physical activity, but did not factor in increased rates of respiration.

Hookah lounge can’t allow indoor smoking

Judge rules in favor of Snohomish Health District
Snohomish County Health District
SNOHOMISH COUNTY, Wash. – Hookah lounges are just like bars, restaurants and other businesses when it comes to the state law that prohibits smoking indoors.
 
Washington’s Smoking in Public Places law, or SIPP, was passed by voters in 2005 and prohibits smoking in public places and places of employment.
 
On Feb. 26, following a two-day trial in Snohomish County Superior Court, downtown Everett’s Hideout Hookah Lounge, also known as the Wetmore Café, was ordered to comply with the law by prohibiting indoor smoking by its patrons. In addition, the court levied fines of $89,100 against the business owners for “intentionally and repeatedly” violating the law after numerous warnings and an official Health Officer’s Order from the Snohomish Health District, which brought the lawsuit. The fine was based on $100 per day per violation..
 
A hookah is a glass pipe filled with water that is used for smoking flavored tobacco, often by several people at once. Hookah is a growing trend that has the attention of public health because it attracts young people to a dangerous habit.
 
“Smoke is smoke,” testified Snohomish Health District Health Officer Dr. Gary Goldbaum. “Hookah tobacco may smell sweet and be cheaper than cigarettes, but it is no less harmful or addictive. Tobacco use is the single most preventable cause of death and disease in the United States.
 
“We are glad this ruling makes it clear that hookah is not a potential business opportunity – it’s an unhealthy behavior that people can choose to do in private, but they can’t expose other people to it,” Goldbaum said.
 
Health District staff made several initial visits to the Hideout Hookah Lounge in February 2012, shortly after the business opened as the first of its kind in Snohomish County. Staff attempted to educate the
owners about SIPP requirements such as prohibiting indoor smoking, smoking at least 25 feet from doors, windows and air intakes, and posting “no smoking” signs which were provided by the Health District. City of Everett police and the state Liquor Control Board were also involved in seeking to enforce the state’s no indoor smoking ban
 
The court determined that smoking in the Hideout Hookah Lounge resulted in smoke permeating adjoining public uses within the building, directly in violation of SIPP’s goal of protecting people from secondhand smoke. The ruling also established that charging a membership fee or providing a membership card does not make the Lounge a private club. In addition, since it was established that the Hideout Hookah Lounge is a public place and a for-profit business, employees need to be protected from secondhand smoke under the SIPP law. Workers are defined as employees under state law even if they “volunteer” for no pay.
 
Thirteen follow-up inspection visits and numerous letters and notices directing the business to stop allowing indoor smoking were issued by the Health District before it filed the lawsuit in June 2012.
 
“It’s important that we provide a level playing field for all businesses that comply with the law,” explained Snohomish Health District Tobacco Program and Healthy Communities specialist Ann-Gale Peterson.
 
Snohomish Health District officials continue to work with county and city staff to ensure that potential business owners and code enforcement officers understand that SIPP prohibits smoking in all public places and in places of employment. 
 
“Our goal is to educate and gain compliance with businesses through cooperation,” Peterson said. “We always hope to avoid court action and consider it a last resort when all other options for enforcement have failed,” she continued.
 
To report SIPP violations or learn more about local tobacco programs, call the Snohomish Health District Tobacco Resource Line at 425.339.5237. The state Tobacco Quit Line may be reached at 1.800.QUITNOW (800.784.8669).
 
Established in 1959, the Snohomish Health District works for a safer and healthier Snohomish County through disease prevention, health promotion, and protection from environmental threats. Find more information about the Health Board and the Health District at http://www.snohd.org.

Health secretary to step down after nearly 15 years at helm

Washington State Department of Health

Washington State Secretary of Health Mary Selecky has announced plans to retire from state service and return to her longtime home in Colville.

Selecky has served three governors since first being appointed “acting secretary” in October 1998. Her nearly 15 years as Washington’s secretary of health make her one of the longest serving state health leaders in the country. Selecky had been the administrator for the Northeast Tri County Health District in our state for nearly 20 years before taking the state job. She marks 38 years in public service this year.

“Public health affects every person in our state. I’m especially proud of the great progress we’ve made lowering smoking rates and getting more kids vaccinated. We’ll have a healthier future because of it,” said Secretary Selecky. “It has truly been an honor to serve the people of Washington and to work with such dedicated state, local, and tribal public health professionals.”

Under Selecky’s leadership, Washington’s adult smoking rate has dropped 30 percent, and youth smoking rates are down by half; childhood vaccination rates are the highest in years.

“Thanks to Mary, Washington is a healthier place to live and raise a family,” said Gov. Jay Inslee. “I thank her for her valuable service to the people of our state and wish her all the best as she returns to the beautiful town of Colville.”

Secretary Selecky has committed to continuing to lead the Department of Health until a successor is found.

New state plan focuses on health inequities

Washington State Department of Health

Good health is not shared equally in our state or the nation. Native American men in Washington die seven years before their white neighbors, and babies of black mothers are twice as likely to die before their first birthday compared to the babies of white mothers.

These are just two examples of health inequities faced by racial and ethnic minorities in our state. These so-called health disparities happen because different conditions and resources shape our health. Communities of color tend to have lower incomes and less education, for example. Lower income and less education lead to less access to health care, nutritious food, and safe and healthy environments. The unequal distribution of social and economic resources isn’t the only factor that contributes to health disparities – these inequities show up even when factors such as education and income are taken into account. The added stress of how society treats people of color also contributes to the many factors that lead to inequities in health.

For several years, the Governor’s Interagency Council on Health Disparities (a group of state agency leaders) has been working to address this issue. The council strives to make sure that programs and services offered through the state are culturally and racially appropriate, work to break down barriers, and improve the conditions facing our state’s many diverse ethnic and minority populations. You can learn more about the council’s work and its new top priorities on its website.

While some of the factors that influence health are out of the control of individual people, each of us can take important steps to be as healthy as we can be and to support the healthiness of the places we work, play, and live.

Salmonella outbreak is a serious reminder to handle and cook poultry properly

Washington State Department of Health

An outbreak of Salmonella illnesses linked to chicken in Washington and other states points out that all poultry products carry the risk of contamination. Thorough cooking and proper preparation and handling can make poultry safe to eat.

Since last June, at least 56 people in Washington got sick from a specific strain of bacteria known as Salmonella Heidelberg. The disease investigation linked that genetic pattern of Salmonella to Foster Farms plants in Washington and California. None of the Washington patients died; 15 were hospitalized.

Salmonella is a common cause of foodborne illness, accounting for 600-800 reported cases in Washington each year. Poultry is common among the many sources of Salmonella bacteria. Salmonella in raw chicken is not limited to any one brand. The U.S. Department of Agriculture allows the sale of raw poultry that contains Salmonella, so the bacteria may be in all brands. In most cases of Salmonella illness, a source is not identified.

Symptoms of Salmonella illness usually include diarrhea, fever and stomach cramps. The symptoms usually begin one to three days after exposure, and the illness usually lasts four to seven days.

Proper poultry handling, preparation, and cooking can help prevent foodborne illness. Raw poultry should be kept separate from other foods; it should always be thawed before cooking to avoid undercooking. Cook poultry to 165 degrees F. Always wash your hands after handling poultry and thoroughly clean utensils and surfaces after preparing poultry.

Oglala Sioux demand an end to illegal alcohol sales activity harming their people

Pine Ridge Liberation Day Event Turns Into Alcohol-Related Showdown in Whiteclay Nebraska, Says Alcohol Justice

PINE RIDGE, S.D., March 1, 2013 /PRNewswire-USNewswire/ — Alcohol Justice is reporting that a serious confrontation over illegal alcohol activity occurred last night on the border between Whiteclay Nebraska and the Pine Ridge Native American Reservation in South Dakota. 

“We have so many strong sober relatives that the only option is to continue to heal,” stated activist Olowan Martinez. “We no longer hide our spirituality, we no longer walk in shame of who we are. An escape from the slavery of alcohol is now occurring and soon the mind of the Oglala Lakota will also be liberated.”

Eyewitness reports state a Round Dance celebration for Liberation Day 2013 (in recognition of the 1973 Wounded Knee Occupation) turned into a showdown between Nebraska state troopers and Native Oglala Lakota activists working to end destructive alcohol use when Nebraska State troopers walked onto Pine Ridge sovereign land. They warned Bryan Brewer Sr. , Oglala Sioux Tribal President, that if he stepped into Nebraska he would be charged with trespassing.

A state trooper performed an alcohol Breathalyzer test on Whiteclay Nebraska Sheriff Terry Robbins due to his behavior and results were not made public. Over a hundred Oglala Lakota marched into the town of Whiteclay forcing the state troopers to withdraw from the area. Tribal President Bryan Brewer Sr. stated that “…on Friday March 1st, activists will return with five times as many people to shut down Whiteclay.”

25% of Pine Ridge Reservation youth suffer from Fetal Alcohol Spectrum Disorder.

2/3 of Pine Ridge Reservation adults suffer from alcoholism.

What:  Liberation Day 2013 Rally to end illegal alcohol activity in Whiteclay Nebraska

When:  Friday, March 1, 2013 

Where:  Border of Pine Ridge South Dakota and Whiteclay Nebraska

Who:  Representatives from:           

  • Oglala Lakota Nation
  • Deep Green Resistance
  • Community Supporters

Why: To stop the illegal alcohol activity at Whiteclay, Nebraska such as:      

  • Retailer participation in alcohol smuggling into the Pine Ridge Reservation
  • Trade of alcohol for sex
  • Loitering at the premises of alcohol retailers with open containers
  • The inability of Nebraska Liquor Commission to stop illegal retailer activity
  • Recent homicides and physical violence
  • Alcohol sales to minors                                                                  
  • Alcohol sales to intoxicated people

Source: PRNewswire