FARGO (AP) - An advocate for American Indians wants to use a new study to push for better facilities and services in this city.

James Thomas, coordinator of the Native American Programs outreach program, said a survey by the Center for Rural Health at the University of North Dakota shows that Indians in Fargo have a higher incidence of diabetes than their rural counterparts and are less likely to have health insurance coverage.

American Indians who spend more than 90 days at a time off their reservation are considered urban American Indians and usually are not eligible for health services when they return to the reservation, Thomas said.

In most states, urban American Indians can get medical care at urban health centers funded by the Bureau of Indian Affairs. But no such center exists between Minneapolis and Billings, Mont.

"In Fargo, if they don't have health insurance or anything, then their access to health care becomes limited," said Mary Kay Herrmann, director of Fargo Cass Public Health.

Thomas and local health officials want to see an Indian health center established in Fargo. Thomas said the survey results support the need.

The UND survey, which was funded by the city and Fargo Cass Public Health, makes several recommendations to address poverty and health issues: more transitional housing, improved occupational training and educational outreach programs, better health promotion and smoking cessation efforts, and more screenings for cancer and mental health.

Thomas said money to achieve those goals is scarce. He plans to use the survey to apply for private foundation grants and to lobby the federal government for funding.

Native American Programs receives $64,000 annually from the United Way and $3,200 from the Federal Emergency Management Agency. The outreach program has outgrown its small house, Thomas said. The number of encounters with clients hit 4,075 last year, compared with 1,082 in 2001.

A nurse works eight hours a month at the house, and a graduate student from North Dakota State University is doing a family therapy internship there. Thomas said there is not room for many more workers.

"It's difficult because you can't start writing proposals and bringing in additional staff and programs when there's no facilities to house them," he said.