Funded Projects

Below is the list of centers that are currently supported by IRINAH, organized by funding institute.

National Cancer Institute

Grant Number: 1R01CA247642-01
Project Title: Randomized Controlled Trial of the Stool DNA Test to Improve Colorectal Cancer Screening Among Alaska Native People
PI Name: Diana G. Redwood, PhD, MPH
PI Contact Info:
PD Name: Doria Rose
Institute: Alaska Native Tribal Health Consortium
RFA/PA: PAR-17-496
Project Start: 04/01/2020
Project End: 03/31/2025

Only 59% (29-73%) of Alaska Native people have been adequately screened for colorectal cancer (CRC), which could save lives, despite having the highest reported incidence of CRC in the world. A new at-home multi-target stool DNA screening test (MT-sDNA; Cologuard®) with high sensitivity for pre-cancerous polyps and CRC is now available. MT-sDNA has not been tested for feasibility or acceptability within the Alaska tribal health care delivery system, and it is unknown whether use of this new test will increase Alaska Native CRC screening rates. Our long-term goal is to improve screening and reduce CRC-attributable mortality. The objective of this application is to test the effectiveness of MT-sDNA for increasing CRC screening in Alaska Native communities using a mixed methods, community-based participatory research (CBPR) approach. The study will be conducted in collaboration with regional Tribal health organizations who are responsible for providing health care to geographically remote Alaska Native communities. This research has been requested by Tribal organizations. Although the proposed implementation strategy is evidence-informed and promising, it is novel in that MT-sDNA has not been evaluated in the tribal health setting or among rural/remote populations. Using the Social Ecological Model, our research will be multi-level, examining influence on patients, providers, and tribal health organizations (THOs). This research study will pursue two specific aims: (1) Identify patient-, provider-, and system-level factors associated with CRC screening preferences, uptake, and follow-up; and (2) test the effectiveness of graded intensity MT-sDNA intervention in the Alaska Native community setting. For the first aim, focus groups with Alaska Native people who are non- or inadequately adherent to CRC screening guidelines, and surveys and interviews with healthcare providers will be used to identify individual, interpersonal (provider), and health system factors for future intervention. For the second aim, a three-arm cluster randomized controlled trial (high intensity with patient navigation, medium intensity with mailed reminders, usual care) will provide evidence on the usefulness of MT-sDNA in remote tribal communities as well as the first data on MT-sDNA diagnostic follow up adherence rates in the Alaska Native population. This aim will also provide evidence on the usability of MT-sDNA in the Alaska setting by evaluating MT-sDNA sample quality and neoplastic yield, which will inform plans to scale-up the intervention model. This project is innovative because an effective strategy for achieving higher screening rates than current practice could lead to increased prevention or early detection of CRC cases among Alaska Native people. The proposed research is significant because it will address a health disparity of community concern. This research has the potential to sustainably improve public health by increasing CRC screening rates among a rural/remote tribal population as well as provide a model for other integrated health systems that provide care to high-risk or underserved populations in the U.S. and worldwide.

Grant Number: 1R01CA225439-01A1
Project Title: Tribally Engaged Approaches to Lung Screening (TEALS)
PI Name: Zsolt JNagykaldi, PhD
PI Contact Info: 405-271-2370,
PD Name: Pamela M Marcus, PhD
Institute: University of Oklahoma Health Sciences Center
RFA/PA: PAR-17-496
Project Start: 4/1/2019
Project End: 3/31/2024

Lung cancer is the leading cause of cancer mortality among American Indians and Alaska Natives (AI/AN), and AI/AN have worse lung cancer incidence rates, survival, and death compared to the general population. Because lung cancer screening (LCS) with low-dose computed tomography (LDCT) has been shown to reduce lung cancer mortality by roughly 20%, the United States Preventive Services Task Force now recommends LCS for men and women aged 55-80 years who meet specific eligibility criteria (grade-B evidence), and subsequently the Center for Medicare and Medicaid Services (CMS) opted to cover this test. However, the uptake of LCS implementation has been slow in most healthcare systems, and LCS implementation among AI/AN has never been studied. To address this knowledge and implementation gap, we prose the “Tribally Engaged Approaches to Lung Screening (TEALS)” study, which is a collaborative effort between the Choctaw Nation of Oklahoma, the Stephenson Cancer Center, and the University of Oklahoma Health Sciences Center that directly addresses the low uptake of LCS in tribal settings through the development of a theory-driven LCS implementation program within the Choctaw Nation Health Services Authority (CNHSA). Over the course of 5 years, TEALS will: 1) Conduct focus groups and semi-structured interviews with CNHSA patients, clinicians, and health administrators to elucidate individual- and system-level barriers and facilitators that affect the implementation of LCS; 2) Develop, and iteratively refine an LCS care coordination intervention that will identify eligible persons for LCS, help these patients navigate the screening process, and link them with smoking cessation services, when applicable; 3) Measure the impact of the TEALS intervention on the receipt of screening and a set of patient- and practice-level outcomes by conducting a cluster-randomized clinical trial of LCS implementation; and 4) Disseminate the TEALS program to other researchers and healthcare systems that serve AI/AN patients. TEALS will bridge the gap between evidence and clinical practice for LCS in a high- need, low-resource setting by intervening at the level of the healthcare system. System-level interventions for guideline implementation tend to be understudied compared to those evaluating individual-level, behavioral interventions. However, the careful development and evaluation of an LCS screening program at the level of the healthcare system would be critical to ensure that more patients can receive LCS when appropriate. Through TEALS, our research will create a critically needed platform from which future studies could be launched that will examine how to tailor the application of the LCS guideline to the individual preferences of AI/AN patients. TEALS will establish an effective LCS program in a tribal system and thus provide a direct benefit to the Choctaw Nation by increasing LCS participation. TEALS will serve as a blueprint for establishing a sustainable and accessible infrastructure for LCS in AI/AN and other community health systems. By increasing screening for early stage lung cancer, TEALS could ultimately reduce lung cancer mortality in AI/AN communities, many of which are in great need of effective strategies to reduce longstanding cancer disparities.

Grant Number: 1R21CA261078-01
Project Title: Development and Pilot Testing of a Culturally-Tailored Smartphone-Delivered Intervention for Commercial Smoking Cessation in American Indians
PI Name: Dana Carroll, PhD, MPH
PI Contact Info:
PD Name: Yvonne Prutzman
Institute: University of Minnesota
RFA/PA: PAR-17-464
Project Start: 09/01/2021
Project End: 08/31/2023

As many as two out of every three American Indian (AI) adults located in the Northern Plains region of the United States smoke commercial cigarettes. As a result, AIs in the Northern Plains experience rates of smoking-related cancers as high as three-fold greater than other races. AIs are only about half as likely to quit commercial smoking compared to other races. Poor access and engagement with existing cessation programs have been put forward as a main reason for low quitting in AI smokers. Our long-term goal is to develop cessation interventions for AI commercial smokers that are wide-reaching, engaging, and culturally appropriate. NCI’s QuitGuide is a publicly available smartphone app for smoking cessation that allows for immediate access to interactive treatment content, such as real-time guidance on how to navigate smoking triggers, and therefore has great potential for reaching and engaging AI smokers. However, QuitGuide does not include guidance on triggers unique to AI persons such as commercial cigarette use at pow wows nor does it address traditional tobacco, which is a spiritual practice common among AIs in the Northern Plains. The lack of content on traditional tobacco use is particularly problematic because of our team’s prior research showing that cultural references to traditional tobacco in commercial smoking cessation messages can improve self-efficacy to quit. Our present objective is to develop and pilot test a culturally tailored version of the QuitGuide in AI commercial smokers. Our hypothesis is that a culturally tailored QuitGuide will result in greater ratings of feasibility and acceptability in AI smokers versus the standard QuitGuide. The project builds on the Masonic Cancer Center’s and the American Indian Cancer Foundation’s research collaborations with AI communities. Our multidisciplinary team has expertise in AI tobacco use, smoking cessation, tailoring cancer prevention interventions to the AI culture, and smartphone app development. Our community partners represent a rurally located Tribe and an urban clinic serving AIs, both of which are located in the Northern Plains region of the United States. A community advisory board will oversee all activities, and we have an agreement to work with the same technology experts who created NCI’s QuitGuide app. Our first aim is to conduct in-depth interviews among AI smokers (n=40) and key-informants (n=10) to guide the cultural tailoring of the QuitGuide that will result in a tailored app prototype. Our second aim is to assess the preliminary feasibility and acceptability of the tailored app prototype using iterative testing among AI smokers (two groups of n=6; N=12) and to refine the app. Our third aim is to conduct a pilot randomized controlled trial to test the feasibility, acceptability, and preliminary efficacy of the tailored QuitGuide app (n=40) versus the standard QuitGuide app (n=40) among AI smokers. At the conclusion, we will have a blueprint to guide the development of a clinical trial intended to test the efficacy of a culturally tailored version of the QuitGuide smartphone app for AI smokers. Given that AIs in the Northern Plains experience some of the most extreme smoking disparities, this culturally tailored treatment approach could have a meaningful public health impact on the burden of tobacco-related cancers among AIs.

Grant Number: 1R01CA192967
Project Title: Enhancing Prevention Pathways Towards Tribal Colorectal Health
PI Name: Shiraz I. Mishra, MBBS, PhD
PI Contact Info: 505-925-6085,
PD Name: Erica Breslau, PhD, MPH 
Institute: University of New Mexico
RFA/PA: PAR-14-260
Project Start: 4/01/2016
Project End: 6/30/2023

American Indians/Alaska Natives (AI/ANs) experience significant health inequities and disparities in colorectal cancer (CRC) related incidence, mortality, stage at diagnosis, and survival. Recent reductions in CRC incidence and mortality rates and improvements in stage at diagnosis and survival rates in the general U.S. population have been attributed to routine screening with prompt removal of polyps, early detection, and timely and appropriate treatment. AI/ANs are significantly less likely than non-Hispanic Whites to receive timely and risk- and age-appropriate cancer screenings, including recommended CRC screening. The short-term goal is to test the efficacy of serially implemented interventions designed to enhance annual CRC screening using the fecal immunochemical test (FIT). Serial implementation refers to offering routine screening, irrespective of response to an earlier invitation, in concordance with national guidelines which recommend annual FIT testing between ages 50-75. The FIT is most appropriate because, based on consensus guidelines, it is an approved, high sensitivity fecal occult blood test that is offered annually and is available in Indian Health Service and tribal health facilities where resources to provide screening colonoscopy are limited. We will follow all positive FIT results with timely and appropriate diagnostic and treatment services. We address screening disparities through the testing of interventions designed to enhance annual CRC screening using the FIT among average- risk, on-reservation AIs aged 50-75 in the rural Southwest. The interventions are theory-informed, evidence- based, and graded in their intensity. The high intensity intervention will include navigated outreach, a mailed FIT kit, educational material, and follow-up reminders (Study Group 1). The medium intensity intervention will include a mailed FIT kit, educational material, and follow-up reminders (Study Group 2). The reference group (Study Group 3) will receive usual care (screening recommendation and a FIT kit at a clinic visit). We will use rigorous research methods to: (a) determine the efficacy of interventions to enhance annual CRC screening through completion of the FIT kit; (b) understand contextually relevant factors important for behavior change; (c) identify the most cost-effective strategies to enhance routine CRC screening; and (d) develop plans to inform sustainability and scalability. This is a collaborative effort between the University of New Mexico, the Albuquerque Area Indian Health Board (100% Indian-owned and operated), and six Pueblo Tribes in the rural Southwest. The research team has an extensive and successful history of conducting community based participatory cancer prevention research in collaboration with AI communities. Moreover, the research team recognizes the value of integrating a co-learning process and engaging in trust-based mutually beneficial research. Findings from this research could lead to an immediate increase in CRC screening and ultimately reduce the CRC disease burden among AIs experiencing cancer disparities and health inequities.

Grant Number: 1R01CA164533-01A1
Project Title: Community Intervention to Reduce Tobacco Use among Pregnant Alaska Native Women
PI Name: Christi A. Patten, PhD
PI Contact Info: 507-266-2577,
PD Name: Stephanie R Land, PhD
Institute: Mayo Clinic Rochester
RFA/PA: PAR-11-346
Project Start: 7/1/2013
Project End: 4/30/2018

Developing effective tobacco cessation interventions during pregnancy for American Indian and Alaska Native people is a national priority and will contribute to the U.S. public health objective of reducing tobacco- related health disparities. In the southwest region of Alaska where the proposed project will take place, 79% of Alaska Native women smoke cigarettes or use smokeless tobacco (ST) during pregnancy. In addition, pregnancy appears to be a high risk period for initiation of tobacco use, primarily ST, among women reporting no use of tobacco 3 months before pregnancy. Our pilot study suggested that an individual-based intervention delivered at the first prenatal visit had low reach to pregnant women and poor tobacco abstinence rates. Intervention efforts targeting the entire community, not only pregnant women, to address social norms about tobacco use may be more effective. Thus, we propose to evaluate the efficacy of a novel, multi-component, theory-based intervention for reducing tobacco use during pregnancy, incorporating both individually targeted and community level components delivered by female elders "Native Sisters." The intervention builds on effective community and individual-based approaches for tobacco cessation and lay health advisor approaches for cancer prevention among Native American women. As part of the intervention, a social marketing campaign including digital stories and other small media will be developed with community feedback. Individually targeted components will be six 30-40 minute telephone or home-based peer counseling sessions with pregnant women. This R01 project is submitted in response to PAR-11-346. It will be conducted in two phases. All aspects of the project will be guided by a community advisory committee. In Phase I, we will develop the social marketing components by obtaining qualitative feedback from pregnant women, family members and elders on message content and delivery channels. In Phase II, we will evaluate the intervention using a group- randomized design with village as the unit of assignment. Sixteen villages will be randomly assigned to receive the intervention or control condition (usual care), with > 20 women enrolled from each village. Enrollment will occur at the time of a positive pregnancy test which is the earliest point of prenatal care, enhancing the intervention's potential reach. Both tobacco users and non-users will be eligible because many start to use during pregnancy. Assessments will be completed by enrolled women through 6 months postpartum. We will evaluate the efficacy of the intervention compared with the control condition on the biochemically confirmed 7-day point prevalence tobacco use rate at week 36 gestation and at 6 months postpartum. We will also examine the effect of the intervention on proposed social cognitive-theory based mediators of change including perceived self-efficacy for non-tobacco use and anti-tobacco norms. Our long term objective is to determine effective interventions for Alaska Native women that will ultimately reduce the risk of tobacco-related maternal, fetal, and infant adverse health outcomes.

Grant Number: 1R01CA174481-01
Project Title: Web-based Smoking Cessation Program for Tribal College Students
PI Name: Won Choi, PhD, MPH
PI Contact Info: 913-588-4742,
PD Name: Stephanie R Land, PhD
Institute: University Of Kansas Medical Center
RFA/PA: PAR-11-346
Project Start: 4/1/2013
Project End: 3/31/2018

American Indian tribal college students have the highest smoking rates of any racial/ethnic group in the young adult population and also are disproportionately burdened by smoking-related morbidity and mortality. There are very few effective culturally-tailored smoking cessation programs for AI smokers. Our research group has worked with the American Indian community for the past 8 years to develop a culturally-tailored smoking cessation program (All Nations Breath of Life - ANBL), for AI adult smokers. All Nations Breath of Life was developed using the community-based participatory research approach and is an in-person group based program that incorporates cultural issues throughout the program. We have produced 30% cessation rates at 6-month follow-up with adult American Indian smokers from tribes and nations in the Midwest. Due to limited studies with the tribal college population, we have already conducted a cross-sectional internet-based survey to collect information on their smoking behaviors as well as other health behaviors. This research experience and strong collaboration with the AI community leaves us well poised to adapt the ANBL program for the tribal college smoking population. However, this current program needs substantial modifications to meet the unique needs of the tribal college student population. It recognizes the sacred role of tobacco among many American Indians and how culture affects smoking cessation among AIs, while still addressing recreational smoking. However, preliminary data from our recent studies indicate that the internet may be more favorable and appropriate delivery method for reaching this younger and more mobile tribal college population due to the web interactivity, immediacy of feedback, and wide reach and accessibility. This current proposal reflects a natural progression to addressing the significant problem of smoking among tribal college students using our successful methods. In this study, we will adapt and test a culturally tailored internet-based smoking cessation (I-ANBL) program based on ANBL, which was developed through CBPR methods. For the current proposal, we will conduct an individual randomized controlled trial (N=242) to test the effectiveness of an internet-based, culturally tailored smoking cessation program (I-ANBL) in a tribal college student population. Data will be collected at baseline, 3 months and 6 months using salivary cotinine, as well as comprehensive set of environmental and psychosocial measures. We hypothesize that AI tribal college students randomized to the culturally-tailored smoking cessation internet arm (I-ANBL) will have significantly higher continuous abstinence rates at 6 months than those receiving the heart healthy diet intervention (I-FV), focusing on increasing fruit and vegetable consumption. We will also examine the costs of delivering the tailored intervention program and potential mediators and moderators of the intervention-cessation relationship. Such a high-reach, low-cost strategy for promoting smoking cessation in this at-risk and underserved population could have great potential for adoption on a larger scale and thus help reduce existing health disparities.

National Heart, Lung and Blood Institute (NHLBI)

Grant Number: 1R01HL117729-01
Project Title: Tribal Health and Resilience in Vulnerable Environment (Thrive) Study
PI Name: Valarie J. Jernigan, DrPH, MPH
PI Contact Info: 918-660-3678,
PD Name: Barbara L. Wells, PhD
Institute: University Of Oklahoma Hlth Sciences Ctr
RFA/PA: PAR-11-346
Project Start: 8/15/2013
Project End: 5/31/2020

Food insecurity increases one's risk for obesity, diabetes, hypertension, and cancer (via its links to poor diet and nutrition), conditions highly prevalent among Native Americans in Oklahoma (obesity 42%, diabetes 15%, and hypertension 38%).1 Our pilot study shows that 3 times as many Natives in Oklahoma are food insecure as Whites (21.3% vs. 7.3% respectively).2 Yet few or no studies have assessed individual- and environmental-level correlates of food insecurity among Natives and none have developed interventions or broad-based educational materials within Oklahoma tribal nations.3,4 Aims and Methods: This study, led by a Native American Choctaw Investigator will, Aim #1: Assess correlates (sociodemographics, health behaviors, perceived food environment) and outcomes (dietary intake including vegetables and fruits, BMI, diabetes, and hypertension) of food insecurity in the Chickasaw and Choctaw nations in Oklahoma. A telephone survey will be administered to 500 Native American adults (18+) randomly sampled from tribal registries. Clinical measures will be validated for 200 of those surveyed using tribal clinic electronic healt records. Perceptions of food environments will be compared to objective store measures using GIS data. Aim #2: Design, implement, and evaluate a convenience store intervention to increase the availability and intake of vegetables and fruits among tribal members. Using a cluster-randomized design with 20 matched tribally owned convenience stores (5 cases and 5 controls in each tribe), we will implement evidence-based strategies (increased availability and variety, point of purchase information, reduced prices/coupons) to increase the sales and intake of vegetables and fruits among tribal members. Store-level changes will be measured by pre/post sales records and the Nutrition Environment Measures Survey; individual-level changes by two cross-sectional surveys, administered to 300 convenience store shoppers before and 300 shoppers after the intervention. Tribal members will use video voice,3 an action-oriented participatory media research method to collect qualitative and environmental data (e.g. types of foods/beverages sold and promoted in the convenience stores) to facilitate community planning and channel recommendations to policy makers. Aim #3: Create a multimedia manual, co-developed with tribal members, guiding tribes in food environment changes, and disseminated over a free and open source Website allowing for tribal user- created content. Innovation: Each of the 3 aims builds on our preliminary data and/or best practices, and leverages tribal resources and partnerships to enhance survey participation rates and convenience store "healthy makeovers." Significance and Impact: The knowledge from surveys on food insecurity correlates and health outcomes will inform the design of the convenience store intervention to increase availability of vegetables and fruits. The resulting multimedia manual will guide food environment changes among tribes nationally to address the critically high rates of obesity, diabetes, and hypertension within this population.

Grant Number: 1R01HL117736-01A1
Project Title: Technology Innovations for Supporting Health in Alaska Native People
PI Name: Judith J. Prochaska, PhD, MPH
PI Contact Info: 650-724-3608,
PD Name: Barbara L. Wells, PhD
Institute: Stanford University
RFA/PA: PAR-11-346
Project Start: 4/15/2014
Project End: 3/31/2020

the proposed research will evaluate the efficacy of two culturally tailored, technology-mediated disease prevention interventions for supporting change in multiple risk behaviors in rural Alaska Native (AN) men and women. Directly informed by the research team's fieldwork over the past 6 years in rural Alaska, continued community partnership with the tribes, and ethnographic research, the interventions will be tailored to AN health needs and values to target 5 of the American Heart Association's 7 Strategic Impact Goals for 2020. In a randomized controlled 2-group design, the trial will compare two active treatment conditions: Group 1 targets tobacco and physical activity; Group 2 targets control of hypertension and hypercholesterolemia (HTN-HCL) through medication adherence and nutritional changes. Both conditions utilize trans theoretical model-tailored, computerized interventions, delivered via telemedicine by Indigenous-focused counselors located in Anchorage reaching AN people in their rural home villages. Computerized intervention contacts occur at baseline, 3-, 6- and 12-months with final assessment at 18-months. Study design provides an equivalent contact time and technology comparison; facilitates individual-level randomization within communities, as all participants receive highly individualized counseling and intervention materials; and allows for comparison of traditional risk factor (HTN-HCL) versus risk behavior (tobacco/ physical activity) interventions. Participants (N=300) will be daily smokers with at least one additional cardiovascular disease risk factor (e.g., inactivity, overweight, HTN, HCL) or established vascular disease. The trial aims to reach AN people regardless of residential location or intention to change. The primary hypothesis is that Group 1 will achieve significantly greater biochemically- confirmed tobacco abstinence than Group 2 through 18-months follow-up and secondarily will significantly increase their physical activity. Secondary hypotheses are that Group 2 will achieve significantly greater control of HTN and HCL than Group 1 through (i) medication compliance and (ii) dietary change. Tertiary aims will: (a) compare the interventions on overall behavior change; (b) model cost-effectiveness and budgetary impact of each intervention; and (c) examine moderators/mediators of treatment outcome, including the trans-3'-hydroxycotinine to cotinine ratio, a noninvasive measure of nicotine metabolism rate. The proposal combines technology, pharmacology, behavioral science, and health economics for advancing the health of AN people who face significant health disparities with limited access to interventions given their isolated geographics.

Grant Number: 1R01HL122148-01
Project Title: Innovative Multigenerational Household Intervention to Reduce Stroke and CVD
PI Name: Lonnie A Nelson, PhD
PI Contact Info: 573-424-0888,
PD Name: Barbara L. Wells, PhD
Institute: Washington State University
RFA/PA: PAR-11-346
Project Start: 5/5/2014
Project End: 4/30/2018

American Indians (AIs) are experiencing an epidemic of stroke morbidity and mortality, with higher prevalence and incidence, younger age at onset, and poorer survival than other racial and ethnic groups. With a stroke incidence more than twice that of the general U.S. population, stroke in AIs is a public health problem of staggering scope. AIs also have disproportionate burdens of many risk factors for stroke, including hypertension, smoking, obesity, and diabetes. However, no rigorous, population-based studies of stroke prevention have included AIs. Tribes urgently need evidence-based methods for preventing stroke that minimize clinic visits and lab tests and use affordably measured endpoints. One such endpoint is a stroke risk score. We developed a 10-year stroke risk score for AIs using data from the Strong Heart Study, a large, population-based cohort of 4,549 AIs from 12 tribes in Arizona, Oklahoma, and the Dakotas. We propose to address the need for effective, affordable, and sustainable stroke prevention methods in participants in the Strong Heart Family Study. This study collected family-cluster data on cardiovascular disease risk factors from 3,800 AIs based on 94 randomly selected index participants from the Strong Heart Study. With our partners, we have designed the "Family Intervention in the Spirit of Motivational Interviewing" (FITSMI), a program delivered at the household level to encourage lifestyle changes that transform the home environment and reduce stroke risk for all residents. FITSMI uses a "talking circle" format in which facilitators guide participants to identify goals for change and create a tailored plan for sustainable implementation that may target smoking, exercise, diet, or medication adherence. FITSMI requires just 2 sessions (baseline and 1 month post-baseline), with text messaging used to boost long-term adherence. In a group-randomized trial design, we will recruit 360 households where Strong Heart Family Study members aged 45 and older reside. We will assign half to FITSMI and half to a control condition that receives educational brochures. All household residents e 11 years old will be eligible. Primary outcomes are household-level improvement in stroke risk score for adult's e 45 years old, and selected modifiable risk factors for all participants. Our Specific Aims are: 1) Determine the effectivenes of FITSMI in AIs e 45 years old to lower stroke risk scores from baseline to 1-year follow-up, with coronary heart disease risk scores evaluated as a secondary outcome; and 2) Determine the effectiveness of FITSMI to improve individual modifiable stroke risk factors (e.g., smoking, blood pressure) in all household members e 11 years old from baseline to 1-year follow-up. This effort is aligned with an Institute of Medicine report recommending a shift from provider- and clinic-centered healthcare to "care based on continuous healing relationships." FITSMI is designed to facilitate adoption of healthy lifestyles to prevent stroke and improve cardiovascular health. If proven effective, FITSMI has broad, multigenerational public health implications for prevention of stroke and cardiovascular disease in AI and non-AI populations.

National Institute on Alcohol Abuse and Alcoholism (NIAAA)

National Institute on Drug Abuse (NIDA)

Grant Number: 1R01DA056417-01A1
Project Title: A multiregional RCT of Parenting in 2 Worlds for Urban Indian Families
PI Name: Stephen Kulis
PI Contact Info:; 602-496-3333
PD Name: Aria Crump, ScD
Institute: Arizona State University
RFA/PA: PAR-20-238
Project Start: 06/01/2022
Project End: 04/30/2027

A large and rapidly growing majority of American Indian/Alaska Native (AI) families now reside in urban areas. Although they experience severe health disparities associated with substance abuse, risky sexual behavior, depression and suicide, few evidence-based prevention interventions address their distinctive needs. Family disruption, stresses due to migration and poverty, and cultural and social losses are often implicated in adverse health outcomes for urban AI families. By improving effective parenting skills and overall family functioning, culturally grounded parenting interventions enable parents to model and promote their children's well-being and reduce their children’s vulnerability to risk behaviors. The proposed study extends the project team's prior research on a culturally grounded parenting intervention for urban AIs, Parenting in 2 Worlds (P2W), which was co-developed with a coalition of urban Indian non-profit organizations, tested in three Arizona cities, and demonstrated efficacious. The research team joins two AI and two non-AI investigators, who together have extensive experience conducting collaborative research with AI populations in urban and tribal settings. This proposed multi-regional study will create new knowledge in four areas. First, the study will test P2W’s effectiveness beyond Arizona in improving parenting and family functioning, among a wider and more diverse group of urban AI communities located in cities spread across four regions: Northeast (Buffalo/Niagara), Midwest (St. Paul/Minneapolis), Mountain (Denver), and Southwest (Phoenix). Through the auspices of collaborating urban Indian center partners, the trial will recruit 720 families of AI youth age 12-17 (180 per city) and individually randomize them to receive P2W or an informational family health curriculum. Second, the study will test for moderators of the effectiveness of P2W, whether desired outcomes vary by the level of socioeconomic vulnerability, experiences of historical loss, or AI cultural identity of the parent participants. Third, the study will expand on the original Arizona trial to examine the adolescent’s reports on family functioning and an enlarged range of youth health behaviors potentially impacted by the P2W intervention, including mental health (depressive symptoms, suicidality) as well as substance use and risky sexual behaviors. Fourth, the study will test for mediation—whether positive changes in parenting and family functioning that result from P2W lead to changes in the youth health behaviors. This would be the first cross- site multiregional trial of a culturally grounded parenting intervention designed specifically for urban AIs. It will advance critical knowledge on community prevention interventions for an under-served group severely affected by health disparities, and establish whether urban Indian centers and their communities can readily employ P2W to strengthen urban AI families and promote the behavioral health of their youth. It will also provide a foundation for advancing knowledge on effective prevention interventions in urban AI communities that have different migration histories and tribal compositions.

Grant Number: 1R01DA053791-01
Project Title: Randomized Controlled Trial of Indigenous Recovery Planning for American Indians
PI Name: Monica Skewes, PhD
PI Contact Info: 406-994-3814,
PD Name: Julia Zur, PhD
Institute: Montana State University - Bozeman
RFA/PA: PAR-17-496
Project Start: 01/04/2021
Project End: 02/28/2026

Although there are high rates of abstinence among American Indians (AIs), there also is evidence of alcohol and drug use disorders disproportionately affecting Native communities. As a result of generations of systemic racism and historical trauma, AIs experience serious health disparities associated with substance use disorders (SUDs). Effective treatments for SUD are critically needed for improving health equity in AI communities, but there are few culturally grounded evidence-based interventions developed or tested with AIs. With this study, Randomized Controlled Trial of Indigenous Recovery Planning for American Indians, we aim to help fill this gap. Our research uses a community-based participatory research (CBPR) framework to test the efficacy of a culturally adapted relapse prevention intervention designed collaboratively by community partners from the Fort Peck Indian Reservation in northeastern Montana and research partners from Montana State University. Indigenous Recovery Planning (IRP) employs trained Fort Peck community members to deliver manualized intervention content culturally adapted from Relapse Prevention (RP), one of the most studied and efficacious treatments for SUD. Using data from 4 mixed-methods preliminary studies, we have worked closely with a community advisory board (CAB) to modify RP to focus on strengths, increase levels of protective factors, address culturally specific risk factors, and overcome barriers to engagement in treatment. We now will test the efficacy of IRP in a prospective randomized controlled trial with 150 tribal members with SUD using a waitlist control group, a design desired by the community partners. Using random assignment to IRP (immediate intervention; n = 75) or to a waitlist control group (delayed intervention; n = 75), we will test the effects of IRP on primary outcomes (percent days abstinent) and secondary outcomes (substance-related consequences, quality of life) assessed post-intervention. We also will examine maintenance of changes in treatment outcomes at 12-week post-intervention follow-up and examine hypothesized culturally specific mediators of treatment effects (AI identity, spirituality, communal mastery, grief and loss, distress from historical trauma, lateral violence, and racism) identified in our preliminary studies. Finally, we will conduct a process evaluation to examine the acceptability and sustainability of the intervention to ensure that IRP addresses barriers to evidence-based SUD interventions as designed. This research will fill an important gap in scientific knowledge regarding the efficacy and acceptability of culturally adapted evidence-based treatments tested in AI populations. This knowledge may be transferable to other communities with similar cultural values and barriers to treatment. By increasing access to efficacious treatment, this research has the potential to improve health outcomes and decrease SUD-related health disparities for underserved AI communities locally and nationally.

Grant Number: 1R01DA050521-01A1
Project Title: Discovering Our Story, to Develop the Chemawa Journey of Transformation
PI Name: Tessa Evans-Campbell, PhD
PI Contact Info:
PD Name: Aria Davis-Crump, ScD
Institute: University of Washington
RFA/PA: PAR-17-496
Project Start: 04/01/2021
Project End: 02/28/2026

Substance use and sexual health risk are increasingly prevalent, costly, and deadly fueling a synergistic epidemic in the United States that disproportionately affects American Indian and Alaska Native (AI/AN) communities. AI/AN youth are at the heart of the AI/AN health crisis. AI/AN youth are disproportionately affected by many of these historical, structural, social, and behavioral factors that contribute to significant health disparities including high alcohol, tobacco, opiate, and other drug (ATOD) use and sexual and reproductive health risks (SHR; ATOD-SHR). The overall mean age of tobacco use, alcohol use, and marijuana initiation for AI/AN is much younger (11.5 years) than the general population, with AI/AN youth having the highest prevalence of smoking and the earliest age of first use of ATOD. Alarmingly, more that 20% of Native high school students who used a prescription pain med without a prescription also used heroin in the past 30 days. Substance use is one of the most significant risk factors for unprotected sex and AI/AN youth have the earliest age of first sexual intercourse. AI/ANs under 25 years of age have three times the rate of chlamydia, gonorrhea, and syphilis compared to White youth. Taken together, these ATOD-SHR disparities underscore the urgent need for interventions that simultaneously target ATOD and SHR among AI teens. While there is a paucity of research addressing the ATOD-SHR prevention needs of AI/AN youth in general, there is even less information available on ATOD-SHR-related disparities for the nearly 1 out of 10 AI/AN youth attending the 183 tribal day or boarding schools nationwide. To address this crisis and the dearth of evidence-based programs for this population, the proposed study, prepared in response to PAR-17-496, involves a 5-year RO1 to test the preliminary efficacy of the Chemawa Journey of Transformation–Native Youth Health Leadership Program (CJOT) which is an adapted and expanded version of the Discovering Our Story intervention, a 2010 SAMSHA-identified best practice AI/AN strengths-based comprehensive substance use and health risk prevention and health leadership program for AI/AN youth. The CJOT emphasizes a holistic, positive youth approach that incorporates storytelling with traditional archetypes and responsibilities as both a process and metaphor for guiding AI/AN youth through behavioral change. The CJOT is a culturally centered experiential 8-week (10 sessions) school-based positive youth health leadership development intervention to prevent ATOD use and SHR among AI/AN youth (ages 13-16). The program involves a 2-month intervention (3 individual sessions plus 10 sessions) plus 5 booster sessions including digital storytelling training plus 1 community event (digital and oral storytelling premiere) that targets behavior change relative storytelling and a youth-led storytelling event.

Grant Number: 1R37DA047926-01
Project Title: Evaluation of an Optimized Intervention to Prevent Early Substance use Among American Indian Youth: Examination of Expanded Impacts on Youth and Parents
PI Name: Nancy Whitesell, PhD
PI Contact Info: 303-724-1456,
PD Name: Aria Davis-Crump, ScD
Institute: University Of Colorado Denver
RFA/PA: PAR-17-496
Project Start: 04/01/2019
Project End: 02/29/2024

The recent opioid crisis across the United States has drawn national attention and resulted in the allocation of significant federal resources to substance use treatment and prevention efforts. American Indian (AI) communities, however, have faced a substance use crisis of similar scope for many years, without the benefit of proportionate attention and resources. Disparities in substance use disorder impacting AI populations are well-documented, and the roots of these disparities can be traced to significantly higher adolescent substance use among AIs compared to other ethnic groups in the United States. AI youth report earlier initiation of substance use than their non-AI peers. National trends of escalating opioid use are evident among AI populations as well, and appear, in fact, to be even more pronounced, reflecting the overall pattern of disparities observed across substances, with AI youth reporting greater heroin and OxyContin use than youth from other racial and ethnic groups. The imperative remains strong to direct attention and resources to focus on early prevention efforts for AI youth. In response to this need, researchers at the Centers for American Indian and Alaska Native Health in the Colorado School of Public Health at the University of Colorado have recently completed an intensive community-engaged process to rigorously adapt the Strengthening Families Program for Parents and Youth 10-14 for the cultural context of a Northern Plains AI community, creating a program optimized for AI families, Thiwáhe Gluwáš'akapi (TG, sacred home in which family is made strong). The current study will test the effectiveness of TG for delaying the onset of substance use among young adolescents. Based on evidence that the original Strengthening Families program may impact risk behaviors beyond substance use, and in response to requests from participating families and community partners to help address suicide risk among their youth, the current study will also test the impact of TG on suicidal ideation among youth. In addition, in recognition of the potential for the TG program to have a reciprocal influence on the adults participating in the program with their children, capitalizing on parents' motivation to protect their youth and make concomitant positive changes in their own lives, the current study will examine effects on adult substance use as well. Examining effects on adult substance use is especially timely as the opioid epidemic rages in in this community, as around the country. In summary, this study will address three specific aims, testing effectiveness of the TG prevention program on three distinct sets of outcomes: (1) Substance use among youth: delaying the onset of use and reducing use among youth who initiated prior to program participation; (2) Suicide risk among youth: reducing suicidal ideation and other risk factors for suicide and increasing protective factors; and (3) Substance use among adults: reducing use among adults participating in the program with their children who report problematic levels of use at program entry.

Grant Number: 1R21DA053789-01
Project Title: Tribal Reservation Adolescent Connections Study
PI Name: Jerreed Ivanich, PhD
PI Contact Info:
PD Name: Kathy Etz, PhD
Institute: University of Colorado Denver
RFA/PA: PAR-17-464
Project Start: 04/15/2021
Project End: 03/31/2023

American Indian (AI) youth demonstrate early initiation of substance use and subsequently high rates of substance misuse. One factor contributing to ongoing risk for these youth is the relative lack of prevention strategies that leverage contextual and cultural strengths to optimize effectiveness and sustainability. Rich cultural and traditional practices, including collateral kinship networks, make interpersonal relationships particularly vital for AI youth, but these networks are largely untapped in prevention approaches. Research in other populations demonstrates the role of social networks in both risk and resilience, but data on AI social networks are sparse and data on how networks relate to risk for early substance use are virtually nonexistent. There are reasons to suspect that social network theories may require some adaptation for the culture and context of AI communities. To effectively inform interventions, we must first confirm which principles translate well and create new metrics where needed. This mixed-methods study will collect quantitative social network surveys and qualitative interviews with adolescents on a Northern Plains reservation to explore how these networks are structured and the principles under which they operate. Network characteristics will be examined in relation to substance use and related risk factors, most notably suicide and exposure to violence, to begin to understand how networks impact both risk and resilience. Network characteristics are likely to influence substance use, exposure to violence, and suicide risk in complex ways that are shared in both common and differential patterns. An explanatory sequential mixed method design (QUAN → Qual) will be used to accomplish two specific aims: Aim 1: Describe peer, kinship, and community social networks of AI adolescents. Hypothesis: Standard metrics of social networks will require modification to characterize social networks of AI adolescents; networks will have less homophily and more intergenerational and community relationships. Aim 2: Explore how social network characteristics predict risk and protective factors for substance use independently and in combination with violence and suicide. Hypothesis: Risk and protective characteristics of youth networks will be related in both common and unique ways to substance use, violence, and suicidality. This project will be led by a multidisciplinary team of early-stage Principal Investigators who are themselves American Indian and Alaska Native. These researchers have substantive expertise in substance use; exposure to violence and suicide among AIs; methodological expertise in community-engaged research with tribal communities; social network theory and analyses; and quantitative, qualitative, and mixed methods approaches. This project leadership team will be supported by a senior researcher with extensive experience in most of the areas relevant to this study and 18 years of experience conducting research with the reservation where the study will take place.

Grant Number: 1R21DA050518-01
Project Title: Assessing the Role of Culture in Reducing Recidivism Among Alaska Native and American Indian Women
PI Name: Katie Schultz, PhD
PI Contact Info: 734-647-6376,
PD Name: Kathy Etz, PhD
Institute: University of Michigan-Ann Arbor
RFA/PA: PAR-17-464
Project Start: 04/15/2020
Project End: 03/31/2022

Women are the fastest growing segment of the criminal justice population; Alaska Native and American Indian (AN/AI or Native) women are disproportionately represented within this growing population, and most arrests are alcohol or drug related. Although rates vary by region and tribe, Native women face significant substance use disorder (SUD) treatment needs, and nearly half of all treatment referrals originate in the criminal justice system. Trauma is an established antecedent to SUDs and justice-involvement, and 84% of AN/AI women have experienced intimate partner violence or sexual assault in their lifetime with 40% in the past year. Cultural beliefs and practices are protective in reducing substance misuse and healing from trauma among AN/AI women, yet little is known about the protective role of cultural beliefs and practices among justice involved AN/AI women and how those might be leveraged in an intervention to reduce recidivism. (Recidivism is broadly defined as the return to criminal behavior after a person has been convicted of a prior offense.) The goal of this study is to develop a culturally informed model by identifying modifiable risk and protective factors associated with lower recidivism among AN/AI women on probation or parole in Alaska. Women on probation or parole have greater access to alcohol and drugs than incarcerated women and are at elevated risk of interpersonal violence—both of which contribute to recidivism. Native women in Alaska are 19% of the population but are 28% of women under community supervision. Alcohol, opioids, and other drug use account for approximately one third of their criminal involvement. This study uses a convergent mixed methods design (QUAL + QUAN). Aim 1: Explore the role of substance misuse and interpersonal violence as risk factors for AN/AI women’s involvement in the justice system and identify the most salient cultural beliefs and practices that may influence factors related to recidivism through focus groups with AN/AI women on probation or parole (6 groups; N = 36). Aim 2: Identify modifiable factors associated with lower recidivism using administrative data and surveys with AN/AI women on probation or parole (N = 150) to investigate: 2a. associations between coping behaviors, cognitions, positive relationships, prosocial activities, and recidivism; 2b. the impact of substance misuse and interpersonal violence on recidivism; and 2c. the moderating effect of cultural beliefs and practices on these relationships. This study will be among the first to provide data on the influence of SUDs and interpersonal violence as primary risk factors for justice-involvement among AN/AI women and is the first to examine the role that AN/AI cultural beliefs and practices may play in the reduction of risk for recidivism among this population. Findings will inform development of a culturally responsive intervention to reduce recidivism among AN/AI women to be tested in a subsequent study.

Grant Number: 1R21DA047940-01
Project Title: Investigating Maternal Opioid Use, Neonatal Abstinence Syndrome and Response in NW Tribal Communities
PI Name: Tam Lutz, MPH, MHA
PI Contact Info:
PD Name: Keisher Highsmith, DrPH
Institute: Northwest Portland Area Indian Health Board
RFA/PA: PAR-17-464
Project Start: 08/01/2019
Project End: 07/31/2021

Medical and nonmedical use of prescription opioids has skyrocketed in the United States over the past two decades. The rise in opioid use during pregnancy marked disparities among American Indian/Alaskan Native (AI/AN) women and newborns. While there are evidence-based treatment strategies recommended for use during pregnancy and in the postnatal use period, use of these strategies is substantially lower in AI/AN across the United States. As sovereign nations, tribes are often responsible for policies, practices, and infrastructure improvements to address these problems. The Northwest (NW) Tribal Epidemiology Center (The EpiCenter) is tasked with responding to the data needs of the 43 NW Tribes, including opioid use, neonatal abstinence syndrome (NAS), and access and utilization of treatment related information. We initiate this proposal in response to these requests and needs of the tribes. We plan to perform an epidemiologic assessment to determine the magnitude and impact of maternal substance use during pregnancy and NAS among AIs in the NW. We will leverage ongoing and planned work in The EpiCenter to estimate race-corrected rates and trends of maternal substance use during pregnancy and NAS in hospital discharge data. We will also investigate opioid use and treatment in the NW as reported in Indian Health Service’s national data repository. We will complement these quantitative data with qualitative data to help us understand the environmental, social, and organizational structures, processes, and policies, as well as individual behaviors that influence access to, or use of, treatment in NW Tribes. This proposal will bring together epidemiologic and content experts as advisory board members to respond to the data and ensure that analyses and reports are useful to decision-makers in various capacities. Upon successful completion of the proposed study aims, we will be poised to implement and evaluate future tribal interventions and policies, which in the long term could reduce the effect of the opioid crisis in NW AI communities.

Grant Number: 5R01DA035143-05
Project Title: Intertribal Talking Circle for the Prevention of Substance Abuse in Native Youth
PI Name: John R. Lowe, PhD, RN
PI Contact Info: 850-644-5635,
PD Name: Aria Davis-Crump, ScD
Institute: Florida State University College of Nursing
RFA/PA: PAR-11-346
Project Start: 5/1/2014
Project End: 4/30/2020

Substance abuse among American Indians (AI) is a critical health disparity and accounts for many life- threatening and deadly problems such as accidents, chronic liver disease, cirrhosis, homicide, and suicide. The high rate of substance abuse found among AI adolescents is believed to be associated with a variety of environmental and historical factors. These include poverty, historical trauma, bi-cultural stress, and changing tribal and family roles. There are few evaluated programs addressing early adolescent AI substance abuse. Tribal communities must be actively engaged in program development and implementation to ensure cultural relevance and sustainability of prevention programs. This project proposes to evaluate an after-school substance abuse prevention intervention, the Intertribal Talking Circle (ITC), targeting 6th grade AI youth in three AI communities: Ojibwe/Chippewa in Minnesota, Choctaw in Oklahoma, and Lumbee in North Carolina. A community-based participatory research approach will be used to culturally and technologically adapt the ITC. A two-condition controlled study will evaluate the efficacy of the ITC to increase AI youth Native self- reliance while decreasing AI youth substance use involvement. An adult training program second level intervention study is also proposed to train tribal personnel from the three regional tribes on how to implement the Intertribal Talking Circle intervention as a tribl program beyond the study period. Effectiveness will be determined by a small partial cross-over randomized trial comparing ITC intervention to a Wait-List Control (WLC) condition. Process evaluations will focus on the future adoption and implementation of the ITC, and recommendations for sustainable adaptations. The project will also build AI capacity to address health disparities, as experienced Native investigators will mentor three Junior Native Investigators.

Grant Number: 1R01DA035111-01
Project Title: Culturally Grounded Early Substance use Prevention for American Indian Families
PI Name: Nancy R. Whitesell, PhD
PI Contact Info: 303-724-1456
PD Name: Aria Davis-Crump, ScD
Institute: University Of Colorado Denver
RFA/PA: PAR-11-346
Project Start: 6/15/2013
Project End: 6/30/2019

Problematic substance use is widespread in many American Indian communities, and early adolescence is a critical period for the development of subsequent substance problems. Efforts to prevent early substance abuse are ongoing on many reservations but often are not informed by scientific evidence of effectiveness - largely because such evidence is sorely lacking. We propose to partner with a reservation community with high rates of substance problems to adapt, implement, and rigorously evaluate a program designed to prevent early initiation of substance use and the myriad of problems that accompany early use. The identification of early substance use as a target and the selection of the particular intervention approach we propose have directly resulted from a longstanding university-tribal community relationship and, in particular, from community input within the context of two recent projects funded by NIDA (RC4DA029974, Whitesell & Beals, PIs; and R01DA027665, Whitesell, PI). A clear message arising out of both projects has been the need to engage families and culture in the prevention of early onset substance use. In this project, we will continue this partnership to translate a rigorously evaluated evidence-based practice for use with tribal families, adapting and anchoring it within a cultural practice arising from within the community. We will draw on the strengths of both university and community partners, implementing innovative intervention development methods within a community collaborative research and evaluation context. We will address three specific aims: 1. Develop a culturally grounded, family-based early substance use prevention intervention tailored to a Northern Plains American Indian Reservation. "Use an evidence-based practice approach to implement a proven program (Iowa Strengthening Families Program/ISFP) within a new context, working with community partners to translate ISFP for the local context, including deep and meaningful adaptations in how the curricular content is delivered. "Use a practice-based evidence approach to integrate a cultural curriculum (Seven Directions/SD) developed within the community into the ISFP curriculum, drawing on local knowledge of effective practices to further ground substance use prevention efforts within the cultural context. 2. Pilot the adapted Seven Directions for Stronger Families (SDSF) program to determine feasibility, refine details, and maximize fit within the community. 3. Use the principles of the Multiphase Optimization Strategy (MOST) for intervention evaluation and development, to determine the relative effect size of different intervention components and inform a final SDSF program that balances effectiveness and efficiency. 4. Set the stage for broad implementation of SDSF by the tribal health administration and a randomized controlled trial of the full intervention.

National Institute of Nursing Research (NINR)

National Institute of Environmental Health Sciences (NIEHS)

Grant Number: 1R21ES031553-01A1
Project Title: Aeroallergens, Air Pollution and Respiratory Health in the Chickasaw Nation A1
PI Name: Amanda Janitz, PhD, MPH, BSN
PI Contact Info:
PD Name: Claudia L. Thompson, PhD
Institute: University of Oklahoma Health Sciences Center
RFA/PA: PAR-17-464
Project Start: 05/01/2021
Project End: 04/30/2023

American Indians are disproportionately impacted by asthma. The Chickasaw Nation, located in southcentral Oklahoma, reports clinic visits for asthma as one of the top diagnoses, accounting for 7% of patients at Chickasaw Nation Department of Health. Due to the high patient burden for asthma in Chickasaw Nation, the Tribe has identified a need to better understand risk factors for asthma-related morbidity. The long-term goal of this research is to understand the impact of aeroallergens and anthropogenic air pollution on asthma morbidity in Chickasaw Nation and to investigate more efficient ways to monitor, control, and ultimately prevent asthma morbidity among this highly susceptible population. The Chickasaw Nation provides clinical and public health services for the majority of American Indians residing within their jurisdictional area in southcentral Oklahoma; thus, improving the health of the Tribe promotes the health of the overall community. This study provides a unique opportunity to evaluate the effect of ambient aeroallergens (pollen) and anthropogenic air pollution (particulate matter, ozone) on asthma-related morbidity using a novel device to measure the time and location of metered-dose inhaler (MDI) use in a rural, American Indian population. This in-depth study will allow researchers and the Tribe to: 1) evaluate the association of spatially and temporally resolved aeroallergens and anthropogenic pollutants with Global Positioning System (GPS)-enabled MDIs among Chickasaw Nation community members with asthma, and 2) compare the participants' perceived individual and neighborhood asthma triggers to the spatial and temporal data collected through the MDIs using sketch maps and interviews. We are partnering with Propeller Health to use GPS-enabled MDIs to measure asthma exacerbations, which will allow us to collect the exact time and location of the MDI actuation. We will evaluate whether the measured exposures are associated with MDI actuation using a time-series model accounting for lag times up to one week. At the end of the study, the participants will develop sketch maps that describe the perceived geographic locations of their asthma triggers. Our central hypothesis is that aeroallergen and air pollution levels in Chickasaw Nation interact synergistically to increase the prevalence of asthma-related morbidity. Longitudinal data on aeroallergens and asthma are sparse in American Indian populations and awareness of triggers will help improve asthma management in Chickasaw Nation. This study provides a unique opportunity to evaluate the effect of aeroallergens and anthropogenic air pollution on asthma morbidity using a novel device to measure the time, frequency, and location of MDI use in this population.

Grant Number: 5R01ES027793-02
Project Title: Promoting Smoke-free Homes in Lakota Communities.
PI Name: Patricia Nez Henderson, MD, MPH
PI Contact Info: 605-348-6100,
PD Name: Claudia L Thompson, PhD
Institute: Black Hills Center for American Indian Health
RFA/PA: PAR-14-260
Project Start: 09/15/2017
Project End: 07/31/2021

Secondhand smoke (SHS) is recognized as a class A carcinogen and has no safe level of exposure. Nonsmokers from the Cheyenne River Sioux Tribe, a Lakota tribe from South Dakota, disproportionately share the burden of SHS, especially in their homes. Our own recently completed research finds that 19% of Lakota non-smoking adults (including those on Cheyenne River) have cotinine levels (a metabolite of nicotine) >15 ng/ml, which are comparable to levels typically seen in active smokers. With smoking prevalence as high as 50% among this population, the consequences of SHS already manifest in this tribe, including high prevalence of childhood asthma and sudden infant death syndrome. Further complicating matters, the expanded use of commercial tobacco products for ceremonial and cultural practices is creating challenges not typically seen in non-American Indian communities. Therefore, eliminating SHS exposure in a culturally appropriate manner is a fundamental step in decreasing morbidity and mortality among Cheyenne River Sioux Tribe and other Northern Plains Tribes. Our primary study objective is to develop and test a culturally tailored intervention to encourage adoption of home smoking restrictions in Cheyenne River Sioux Tribal households where nonsmokers are present. We propose to conduct a randomized, controlled trial to test our culturally-tailored advocacy training both with and without urinary biomarker feedback. Biomarker feedback is an intervention method that can give personalized information, including levels of urinary or serum cotinine and/or tobacco-specific pro-carcinogen markers, back to individuals in order to characterize evidence of the negative sequelae of smoking in the household. Previous studies, including our pilot project, have focused on providing children's biomarker feedback back to decision-making smokers, but the evidence that this approach can promote in-home smoking restrictions is thus far mixed. This study appears to be the first to use biomarker feedback with adult nonsmokers for advocacy efforts. Our Specific Aims are to:

1) Assess knowledge, attitudes and beliefs about secondhand smoke exposure and perceived barriers to adoption of smoking restrictions in tribal member households on the Cheyenne River Sioux Tribe Reservation; 2) Augment, implement, and evaluate a nonsmokers’ urinary cotinine and carcinogen biomarker feedback intervention on the adoption of household smoking restrictions; and 3) Determine the effect of the intervention on health-related quality of life 6 months after implementation of the advocacy and biomarker feedback intervention.

National Institute on Minority Health and Health Disparities (NIMHD)

Grant Number: 5R01MD012761-03
Project Title: We are Here now - a Multi-level, Multi-component Sexual and Reproductive Health Intervention for American Indian Youth
Funding NIH Institute: National Institute on Minority Health and Health Disparities (NIMHD)
PI Name: Elizabeth Lynne Rink, PhD MSW
PI Contact info: 406-994-3833,
PD Name: Beda Jean-François, PhD
Institute: Montana State University - Bozeman
RFA/PA: PAR-14-260, Interventions for Health Promotion and Disease Prevention in Native American Populations (R01)
Project Start: 04/01/2018
Project End: 11/30/2022

American Indian (AI) communities in the United States (US) are disproportionately affected by sexual and reproductive health disparities, compared to other populations, placing current and future generations of AI societies in jeopardy. Our study, “Nen ŨnkUmbi/EdaHiYedo (N/E - “We are Here Now”)”, utilizes a culturally tailored ecological intervention in which the prevention of sexual-risk behaviors among AI youth that lead to STIs, HIV, HCV, and teen pregnancy are addressed. N/E takes place on the Fort Peck Reservation in northeastern Montana. N/E is a community-based participatory research sexual and reproductive health (SRH) intervention, constructed on Ecological Systems Theory. Based on Fort Peck tribal members' desire to implement a holistic SRH intervention for the tribes' youth, N/E includes: 1) A school-based SRH curriculum called Native Stand, designed to address individual-level factors that lead to risky behaviors; 2) a family-level curriculum called Native Voices, tailored to increase communication between adult family members and youth about SRH topics; 3) a cultural mentoring component at the community-level that pairs AI youth with adults and elders to discuss traditional AI beliefs and practices about SRH; and 4) a systems-level strategy to activate a multi-sectoral network of local youth servicing organizations to coordinate SRH services. The overarching aim of this proposal is to refine and tailor the components of N/E and evaluate its efficacy. N/E is a 5-year study involving 456 15- to 18-year-old AI youth and their parent/legal guardian. AIM 1 begins with a year of formative work to refine and tailor the components of N/E. Our community advisory board and the Fort Peck-based and MSU-based research team will design culturally appropriate adaptations for N/E's 4 levels. AIM 2 tests the efficacy of N/E using a cluster-randomized stepped-wedge design (SWD), in which the 5 high schools that Fort Peck youth attend are randomized into the intervention 1 at a time. N/E's primary outcome is increased condom use during sexual intercourse. Secondary outcomes are delayed onset of sexual intercourse, number of sex partners, frequency of sexual intercourse, pregnancy history, consistent use of birth control during sexual intercourse, and whether alcohol and/or other drugs are used during sexual intercourse. Tertiary outcomes are increased parent/legal guardian-child communication about SRH topics, increased understanding of cultural values related to traditional AI beliefs regarding SRH, and increased use of SRH services. Quantitative data collection includes: student surveys at baseline, 3, 9 and 12 months; parent/legal guardian surveys at baseline, 9 and 12 months. Qualitative data collection includes SRH service provider discussion groups at baseline and thereafter once a year over the 5-year study, with logs to track coordination and implementation at baseline and 3, 6, 9 and 12 months. AIM 3 will evaluate the fidelity and acceptability of N/E with focus groups, activity logs, and staff meeting notes and staff field notes.

National Institute of Mental Health

National Institute Of Dental & Craniofacial Research

Grant Number: 1U01DE027629-01A1
Project Title: Reducing Sugared Fruit Drinks in Alaska Native Children
Funding NIH Institute: University of Washington
PI Name: Donald Leslie Chi, DDS, PhD
PI Contact info: 206-616-4332,
PD Name: Darien Jerome Weatherspoon, DDS, MPH
Institute: University of Washington
RFA/PA: PAR-17-496
Project Start: 06/01/2019
Project End: 05/31/2022

Project Abstract Yup’ik children in Alaska’s YK Delta consume an average of 50 teaspoons of sugar each day, 16 times the American Heart Association’s recommended maximum. Most of this sugar is from fruit drinks like Tang and Kool-Aid consumed at home. Consequently, Yup’ik children experience tooth decay rates that are 16x the U.S. average and suffer from oral health inequalities compared to children from communities that are better off. Tooth decay is a multifactorial disease, but our pilot work shows sugared fruit drinks are the key risk factor. YK Delta communities have expressed a desire to target sugared fruit drinks that continue to harm their children. This study is a culmination of over 5 years of engaged research within YK Delta communities to co-develop a culturally-appropriate, feasible, and sustainable program to address persisting public health problems caused by sugared fruit drinks. We propose a 2-arm quasi-experimental behavioral trial in 3 small, isolated Alaska Native communities to test the hypothesis that Community Health Worker-led health education and self- efficacy training for caregivers will decrease child added sugar intake. We will introduce families to sugar-free water enhancers that will be made available through local stores. The Specific Aims are to: (1) Complete pre- intervention activities and finalize the intervention; (2) Implement the intervention and assess outcomes; and (3) Identify intervention improvement opportunities and disseminate findings. This application builds on previous R56 research by the study team and will for the first time seek to change sugared fruit drink intake in Alaska Native communities. 3 communities will be assigned to 1 of 2 arms based on the order communities were recruited into the study. In Communities A and B, 136 Yup’ik children ages 0-10 years will be recruited to test the 6-month culturally-adapted, 5-session intervention consisting of interactive health education and self- efficacy training delivered in-person by an indigenous Community Health Worker. In Community C, 56 children will be recruited to a comparison condition in which health education with the same culturally-adapted content is delivered by mail. Health education will address misinformation about sugared fruit drinks and promote sugar-free water enhancers. Self-efficacy training will empower caregivers to sustain behavior change over time. Local stores in all 3 communities will stock sugar-free water enhancers (Tang, Kool-Aid, and other popular flavors) as a tool to help shift children from sugared fruit drinks. The primary outcomes at the child level are sugared fruit drink intake (24-hour food recalls) and added sugar intake (validated, non-invasive biomarker) and will be measured at baseline and at 1, 3, 6, and 12 months. The Yukon Kuskokwim Health Corporation will maintain and disseminate the program if it works to address a critical problem facing 15,000+ Alaska Native children in the YK Delta. Moreover, it can be adapted to meet the needs of other populations with similar problems, including the millions of indigenous children in the Lower 48. PUBLIC HEALTH RELEVANCE Project Narrative Alaska Native and American Indian children suffer from high rates of tooth decay that lead to poor health, low quality of life, and broader problems like learning difficulties in school that have life-long consequences. In response to the Notice of Funding Opportunity (NOFO) calling for health promotion interventions focusing on Native American populations, the proposed study will target sugared fruit drinks that cause dental problems in children through a community- based program that builds on proven approaches that have not yet been implemented in Alaska Native communities. The proposed work addresses Healthy People 2020’s Nutrition and Weight Status Objective 17 (reduce added sugars), Oral Health Objective 1 (reduce the proportion of children with tooth decay), and Early and Middle Childhood Objective 1 (increase the proportion of children who are ready for school by ensuring healthy physical development); and NIDCR Strategic Goal 3 (apply rigorous multidisciplinary research to overcome dental disparities).

Last Updated
July 06, 2023