Native American Health

Stomach cancer is the third leading cause of cancer death globally. Rates for stomach cancer are 3-4 times higher among the Navajo Nation compared to the non-Hispanic white population in Arizona. Helicobacter pylori (H. pylori) plays a role in the healthy human gut, but it is also associated with multiple chronic diseases, including stomach cancer. A multi-year research program, conducted in partnership with Northern Arizona University through the Partnership for Native American Cancer Prevention, seeks to estimate the prevalence of H. pylori among Native Americans. The study in 2018 reported a 56.4% prevalence of H. pylori within participants from three Navajo chapters, with 72% of households having at least one infected person. This research program was expanded to continue the study through other regions of Navajo Nation. Together these studies will test hypotheses that the high H. pylori prevalence in Navajo communities correlates with environmental and behavioral factors as well as diagnostic delays and to determine the genotypes of H. pylori in Native Americans in Northern Arizona and antibiotic resistance to therapies.

Asthma prevalence among Navajo children is 2 times that of the general population and is fueled by disparities including poverty, environmental pollutants, and minimally accessible healthcare. This project on the Navajo Nation will address these disparities using a community-based intervention targeting healthcare providers, schools, parents, children, and community members. This project was funded by the National Heart, Lung, and Blood Institute of the National Institutes of Health. 

There are estimates of over 500,000 abandoned mines in the US, many with the potential to impact health and economies of local communities. Developing a successful model of capacity building related to spill response has great potential to be valuable not only to the Diné but to communities vulnerable to environmental problems throughout the world. The K’é bee da’ahiiniita: Strength Through the Diné (Navajo) Clan System team focused on creating transformational change in the relationship of the Diné to the US government and other entities by building tribal capacity through training of Diné tribal college students, environmental interns, and community health representatives. Before this project, a study funded by the National Institute of Environmental Health Sciences was done to assess the short-term exposure and risk perceptions of the Gold King Mine spill. This project received funding support from the Agenese Nelms Haury Program in Environment and Social Justice in the form of a Challenge Grant.  Researchers for this project spanned multiple colleges and communities. A list of collaborators that are not currently part of the College of Public Health has been provided below.  Janene Yazzie, To’Bee Nihi Dziil, Mae-Gilene Begay, Navajo Community Health Representatives, Perry Charley, Diné College, Jani Ingram, Northern Arizona University, Manley Begay, Northern Arizona University, Rebecca Clausen, Fort Lewis College, Nicolette Teufel-Shone, Northern Arizona University 

The overall goal of this project Cumulative Environmental Effects: Expanding Research with the Hopi Tribe is to use a community-based participatory research (CBPR) project is to collaborate with the Hopi Tribe investigating household exposures to inform policy decisions. Household exposures are major sources of environmental hazards encountered by many American Indian and Alaska Native (AI/AN) communities.  Household exposures include combustion by-products from heating and cooking, particulate from nearby mining and other land uses, and water and food contamination.  These exposures, and co-exposures such as unemployment and lower resilience, impact respiratory health and obesity among children and adults, and warrant evaluation of AI household exposures within a social ecological framework. The Hopi Tribe in Northern Arizona has identified several areas of concern, including the impact of burning coal and biomass in homes for heating and its potential impact on respiratory health. Other issues include concerns about arsenic and uranium species in drinking and surface water.  This application seeks to expand existing relationships to include Hopi officials in the Hopi Environmental Protection Office and university environmental scientists and health promotion experts. The project proposes to 1) Characterize magnitude of environmental exposures to particulate matter (PM), arsenic species, uranium and other contaminants from air, water, and food in selected households on Hopi tribal lands. 2) Evaluate how exposures are moderated by social determinants of health and social capital/community resilience, and 3) Expand Hopi capacity to address areas of environmental concern.  The effort will build additional capacity within the Hopi tribe to evaluate and mitigate propose mitigation for environmental hazards of concern to the tribe. The proposed joint project provides an opportunity to develop and strengthen a relationship built on trust between the Hopi tribe and university researchers and to increase the capacity of the Hopi Environmental Protection Office to monitor its air and water quality.  Anticipated results include modeling of cumulative exposures to arsenic and uranium species among Hopi residents and address environmental concerns of the tribe in terms of health inequities. The study will build Hopi capacity to conduct research of adverse exposures and develop informed tribal environmental and health policies for a sustainable future.

Problem Statement Effective public health preparedness and response (PHPR) requires a systems approach fully integrating all sector partners.  However, preparedness activities often take place in silos, resulting in ineffective multijurisdictional emergency responses.  Furthermore, although strengthening PHPR is a shared responsibility among federal, state, local, tribal, territorial, public and private organizations, integration of tribal public health partners is often lacking or far from ideal.  Tribal populations include individuals considered at-risk or vulnerable, including but not limited to persons with chronic diseases or disabilities, elderly community members, and residents of remote and isolated areas.  Supporting and sustaining an effective tribal and multijurisdictional response network will require determining which Preparedness and Emergency Response Research Center (PERRC) and Learning Center (PERLC) research, training, and technical assistance products can effectively be used, as well as how to adapt these products for effective tribal use.  Purpose This proposal will determine specific tribal and multijurisdictional PHPR needs, and adapt PERRC and PERLC products to meet these needs and support the transfer of PERRC and PERLC research outcomes and promising practices into the field.  These activities will provide validated models for improving health security nationally.  The proposed activities fall within Sub-project 3, as defined in the Centers for Disease Control and Prevention (CDC)/Association of Schools and Programs of Public Health (ASPPH) Request for Proposals (RFP).  The specific aims of our proposal are as follows: Aim 1a: Conduct a tribal needs assessment to validate existing knowledge, skills, and preparedness and response gaps. Aim 1b: Conduct a state and local needs assessment to validate existing collaboration gaps to bridge tribal partner intersections with state, local and territorial public health departments. Aim 2a: Provide targeted tribal evidence-based interventions using cultural frameworks for public health application to improve tribal readiness and capacity.  Aim 2b: Provide targeted state and local evidence-based interventions to improve the integration of tribal partners.  The needs assessments in Aims 1a and 1b will guide the selection of PERRC and PERLC products most appropriate to meet these needs.  These products will be adapted for tribal use in Aim 2a and Aim 2b for effectively integrating tribal populations into regional multijurisdictional response efforts.  The relation of the aims within a tribal and multijurisdictional response network is illustrated in Figure 1. The Mountain West Preparedness and Emergency Response Learning Center (MWPERLC) has extensive experience working collaboratively with tribal public health practitioners.  Given our proven ten year track record for successfully developing, initiating, implementing and evaluating innovative and sustainable tribal preparedness activities, we are well positioned to spearhead efforts for enhancing preparedness and the wellbeing of American Indian communities.  

The Center for Indigenous Environmental Health Research (CIEHR) is a Center of Excellence on Environmental Health Disparities Research supported by the National Institute of Health’s National Institute of Environmental Health Sciences and the Environmental Protection Agency. Learn more at https://ciehr.arizona.edu

More than four million people with asthma live outside of urban areas, and most are seen in primary care settings where their asthma is often inadequately managed, representing a significant gap in care. Rural health disparities for children with asthma include poverty, limited access to care, and environmental challenges including high levels of outdoor and indoor particulate exposure. The Asthma Toolkit program has translated evidence-based asthma care into both rural and urban primary care practices. Although this program has produced evidence of increased guidelines-concordant care, much room exists for improvement. We believe that by deploying Asthma Toolkit training in a larger program that includes community, school, and family engagement, quality of care and health outcomes can be improved for rural children with asthma. This project will bring together investigators from the University of Arizona and National Jewish Health to 1) engage three communities on the Navajo Nation to build a successful collaboration (U34); and 2) conduct a randomized pragmatic trial of a community rural pediatric asthma program (U01). During the initial empowerment phase, we will solidify relationships with community stakeholders including patients, parents, community leaders, hospital administrators, schools, and providers. A group of stakeholder advisors will be created to inform and guide the subsequent study.  In the second (U01) phase, we will employ a step wedge, randomized trial design to test the capacity of the Community Asthma Toolkit program to improve care and outcomes.  The provider component will include comprehensive training in evidence-based pediatric asthma care. The school component will work to improve capacity to identify pediatric asthma and facilitate communication between school, family, and provider. The hospital component will help provide structured communication between hospital clinicians and primary care providers to improve outpatient management and prevent unnecessary urgent care utilization. Finally, the air quality component will assess community and provider concerns about indoor and outdoor air quality and determine potential methods to measure and reduce environmental risks to children with asthma. The final trial will be modified in accord with stakeholder input during the engagement phase. We believe that the intervention could serve as a model for implementation of strategies to improve asthma care in rural children.

The goal of this project is to evaluate the role of Helicobacter pylori infection and gastric diseases in the southwestern United States to identify interventions to reduce disease. This private foundation-sponsored work has resulted manuscripts and multiple poster presentations, as well as numerous engaged students and faculty. In addition we are using this work as a springboard to apply for additional funding to investigate infectious causes of chronic diseases.

AIs suffer disproportionately from diabetes, substance abuse, unintentional injuries/motor vehicle accidents and suicides. Applying deficient approach to health challenges discourages AI students and communities and leaves AI populations conflicted about health research. CAIRs RTE Core will specifically address the need for a clear educational pathway to develop necessary research skills that address health disparities.

Collaborative Center with NAU and Dine College supporting 2 research projects, a community outreach component and education/training activities with Native communities and students. Advisory boards represent Indian Health Service, American Indian senior researchers at 5 different universities (nationally) and Arizona based tribal health departments.

Research: For this contract, I am conducting a process and outcome evaluation of Tucson Indian Center's Native Pride Project funded through the Indian Health Service. Native Pride is an 8 week program designed to increase protective factors, and decrease risk factors, for suicide and substance abuse among Native youth in the greater Tucson area. As lead evaluator, I coordinate all evaluation, data collection, and reporting activities.  Service: I attend biannual advisory committee meetings to disseminate results of the project to TIC staff, community members, and other key stakeholders. I have also developed presentations to disseminate results at regional and national Indian Health Serivice conferences. I also assist TIC with grant proposal development and submission to secure funding to continue Native Pride and other mental health related projects. Nancy Stroupe was a contributor on this project but has since left the University of Arizona.

This grant was funded by a K23 award from the National Institute on Alcohol Abuse and Alcoholism. The purpose was for Nicole Yuan to develop skills and expertise in the study of alcoholism and violence among Native Americans and other vulnerable populations with an emphasis on public health and community-based research methodologies. Dr. Yuan's career development plan included: 1) completion of the requirements for an MPH degree; 2) training in alcohol, genetic, and Native American health epidemiology and research methods; and 3) production of empirical papers, conference presentations, and grant proposals. Her primary sponsor and mentor was Dr. Mary P. Koss. Dr. Yuan's research plan consisted of three phases: 1) secondary analyses of data from the Ten Tribes Study; 2) pilot study with the tribes; and 3) research collaboration to develop a follow-up study with full participation from the tribes. After receiving a no-cost extension, the final end date was December 2011.

This center involves innovative and current models of research, service, and training within Arizona, and is part of a national network of Prevention Research Centers funded by the CDC. There is focused research in 4 border counties but the PRC community action board reflects statewide (including tribal) issues. This research project, Unidos: Linking Individuals’ to Social Determinant and Community Health Services will result in a model intervention to improve overall health and quality of life among predominantly Mexican-origin Latinos in Arizona. Principal Investigator: Scott CarvajalDeputy Director: Maia Ingram

AZCC/NAU partnership to address cancer disparities in American Indian Cancer Disparities in collaboration with Navajo, Hopi, and Tohono O'odham.

Partnership with Inter Tribal Council of Arizona and the Hopi Tribe to develop a training program for cancer navigation.  This ARRA funded project is a collaborative effort between the Inter Tribal Council of Arizona, the Hopi Tribe, and the University of Arizona to develop a patient navigator program in for breast and cervical cancer screening and follow-up tailored to southwestern American Indian populations.

This is CDC grant funded center develops and delivers core competency-based training designed for Tier II public health professionals that respond to the preparedness and response needs of state, local and tribal public health agencies.