NW NARCH Projects

Project 1:  Toddler Overweight and Tooth Decay Prevention Study (TOTS)

Njeri Karanja, PhD, RD, Principal Investigator, Kaiser Permanente CHR
Tam Lutz, MPH, MHA, Project Director/Jr. Investigator, NPAIHB, (Lummi)
Julia Putman, BA, Project Coordinator, NPAIHB
Ardith Tom Site Coordinator, (Lummi),
Lara Munden, BS, Site Coordinator, (Nez Perce)
Teresa Bache, AA, Site Coordinator, (Shoshone Bannock)
Paul Steele, Project Manager, Kaiser Permanente CHR

TOTS was an overweight/obesity prevention project targeting American Indian children 0-2 years of age.  The overall objectives of the TOTS project was to test whether community and family-based interventions could alter patterns of breastfeeding and sugared beverage consumption in Northwest American Indian communities, and whether such behavior changes can reduce childhood overweight and early childhood caries (ECC).  Five tribes partnered with NPAIHB and the Kaiser Center for Health Research (CHR) to implement TOTS.  Two tribes served as controls, and three tribes received interventions to promote breastfeeding and water as a beverage of choice and to reduce the consumption of sugared beverages.  All intervention tribes received community interventions, and two tribes received a family intervention in addition to the community intervention.  Community interventions target breastfeeding promotion and reduction of sugared beverage consumption coupled with promotion of water as a beverage.  The strategies used in these community interventions include raising awareness, delivering health education, changing behavior, improving public health practice and changing the environment.  Each tribe designed its own interventions within these targets and strategies.  Family interventions target behavior change within families.  Trained community health advocates delivered family interventions to individual families through counseling to reduce sugared beverage consumption and linkage to breastfeeding services.  A total of 201 families were enrolled in the study in the intervention tribes.  Baseline measurements of 151 children who will serve as controls to the intervention cohort have been collected in both the control and intervention communities.  The funding was extended one year to allow follow-up of children already recruited into the study until they are 2-3 years of age.  While the focus of intervention in the first 2 years of the project included breastfeeding, intervention in this continuation funding will focus on reduction of sugared beverage consumption to reflect the stage of development of the enrolled children and completing all measurements.

Tribes Served
Five northwest tribal communities participated in the study:  Nez Perce Tribe (ID), Lummi Nation (WA), Shoshone-Bannock Tribes (ID), Quinault Indian Nation (WA) and Makah Tribe (WA).

This project was completed on August 31, 2006.  The TOTS project is now in the process of analyzing data, submitting papers for publication and writing a final report.

Project 2: Improving Health Research Skills for AI/AN Students and Fellows

Thomas Becker, MD, PhD, NPAIHB, Principal Investigator
Joe Finkbonner, RPh, MHA, NPAIHB, Co-Investigator (Lummi)
Victoria Warren-Mears, PhD, NPAIHB, Project Director
William Lambert, PhD, OHSU, instructor, mentor
Jodi Lapidus, PhD, OHSU. instructor, mentor
Walter Hollow, MD, University of Washington, consultant (Assiniboine and Sioux)
Polly Olsen, BA, University of Washington, consultant, (Yakama)
Jennie Joe, PhD, MPH, University of Arizona, consultant (Navajo)
Mark Dignan, PhD, MPH, University of Kentucky
Esther Dunn, BA, OHSU, Program manager

The overall goal of this project will be to increase the number of well-trained AI/AN researchers who are capable of conducting biomedical, clinical behavioral, or population-based research in diverse settings.  We will build on our successful record of research career development implemented in the first cycle of NARCH funding.  We will plan and implement an innovative research training program and recruit AI/AN pre- and post-doctoral trainees as full-time fellows; recruit AI/AN health professionals and graduate-level students to NARCH projects and activities; and encourage undergraduate AI/AN students to consider biomedical, clinical behavioral, or population-based research careers through participation in our program.  Additionally, we will offer career development experiences to AI/AN researchers who work at the NPAIHB as investigators and project managers, and we will provide funds for research career development for scholars who were part of our earlier NARCH grant.  Further research career-related training will include students in the Northwest Indian College, and clinical residents in Family Practice at Seattle Indian Health Board.  We plan to increase trainee competencies by offering a mixture of formal courses in graduate programs, directed seminars and workshops, and mentored experiences.

Our proposal includes the following aims:

1. Recruit AI/AN post-doctoral students, graduate students, undergraduate students, and health profession students, using already established advertising strategies.

NW NARCH Opportunities
Predoctoral Fellowship Application
Postdoctoral Fellowship Application
Research Assistant Position Description
NPAIHB Employment
Summer Intern Application
Scholar

2. Match trainees with mentors and projects that are carried out by seasoned researchers at the NPAIHB, OHSU, UW, and other research institutions.
3. Through the partner academic institutions, offer MPH and PhD courses, course modules from ongoing training programs, and opportunities for trainees to complete advanced degrees.
4. Provide regularly scheduled seminars and workshops that will foster trainee research skills.
5. Provide AI/AN role models for the AI/AN research trainees.
6. Encourage and support trainee attendance at local, regional, and national scientific meetings.
7. Provide outreach support for graduate trainees in their submission of grants and manuscripts, including graduate trainees from our original NARCH grant.
8. Offer career development opportunities for pre-doctoral AI/AN researchers who are already employed at NPAIHB.
9. Develop and implement teleconferencing and internet-based science education for students in the Northwest Indian College, providing stimulus for AI/AN students to pursue health science majors at 4-year colleges.
10. Evaluate the success of the project and track the trainees as they progress in their careers, including trainees in our original NARCH grant.

Building on the success of our existing training programs for AI/AN students at NPAIHB, OHSU, and UW, we expect to meet our aims and further promote AI/AN researchers in careers that are responsive to AI/AN health concerns.  Thus, within the next decade, a larger cadre of AI/AN researchers will be well prepared to take a major role in research that will lead to reduction in health disparities among tribal groups.  In addition, the career development and training provided to existing NPAIHB researchers will further establish our NARCH as a regional resource center for tribal health issues.

Tribes Served
Summer Interns, pre-and post doctoral fellows and scholars were recruited from these tribes:  Navajo, Muscogee (Creek) Nation Chippewa-Cree, Gros Ventre, Alaska Native, Northern Cheyenne, Arikara, Mandan; Yupik Eskimo, Eastern Band; Cherokee, Choctaw, Three Affiliated Tribes, Northern Arapaho, and Lummi Nation

Project 3: Improving Health Research Skills for American Indian and Alaska Native Faculty

Thomas Becker, MD, PhD, Co-Investigator, NPAIHB
Joe Finkbonner RPh, MHA, Co-Investigator, NPAIHB, (Lummi),
Walt Hollow, MD, University of Washington, consultant, (Assiniboine and Sioux)
William Lambert, PhD, OHSU, mentor
Jodi Lapidus, PhD, OHSU, mentor
Mark Dignan, PhD, Evaluator, University of Kentucky

Although substantial research has been directed toward understanding reasons for high disease rates and health disparities among American Indian/Alaska Native (AI/AN) people, involvement by AI/AN researchers in most of these studies has been particularly infrequent. Because cultural factors are central to the design and implementation in many clinical, behavioral, or population-based studies, increasing the involvement of AI/ANs to carry out effective research in AI/AN populations should be a priority concern.
The program will increase the research capabilities of AI/AN faculty-level investigators to carry out well-designed investigations within AI/AN populations and in other settings.  Experienced epidemiologists, biostatisticians, ethicists, and laboratory-based researchers at the Northwest Portland Area Indian Health Board (NPAIHB), Oregon Health & Science University (OHSU) and the University of Washington (UW) will offer an individually-tailored training program for qualified AI/AN junior faculty.  The training program will introduce participants to various research strategies, measurement issues, study design considerations, data management, data analysis, preparation of grant applications, ethics of research, and manuscript preparation.  Tailored workshops offered at least twice per year and mentoring from seasoned researchers will form a key part of the training experience.  We will also provide research skill development workshops to clinical faculty affiliated with the Native American Center of Excellence at UW.  Evaluation of trainee progress will be centered upon knowledge and performance measures, including grant applications submitted and funded.
This project builds upon existing grant-funded training programs for AI/AN trainees at our academic partner institutions, and will further the career development of AI/AN researchers through capacity building and research skill development.  Through the development of qualified, independent AI/AN investigators, our effort may ultimately serve to reduce some of the many disparities in health that are observed among AI/AN groups, compared to U.S. whites nationwide, as well as reduce tribes’ distrust of research.

Tribes Served
Faculty trainees were recruited from the following tribes.  Ioway, Turtle Mountain Chippewa Cree, Puyallup, Lakota, Three Affiliated Tribes, Lummi, Choctaw and Cherokee

Project 4: Internet-assisted Diabetes care

Donna LaVallie, DO, MPH, Project Investigator, University of Washington, (Turtle Mountain Chippewa/Cree)
Harold I Goldberg, MD, Co-investigator, University of Washington
Sean Sullivan, PhD, co-investigator, University of Washington
Mary Mullen, Project Coordinator, University of Washington
John Preizler, Systems Analyst
Laura Samashima, NP, Nurse Practitioner, Case Manager, University of Washington

Diabetes is a growing public health problem among AI/AN nationwide, and innovative control strategies must be developed and tested to address this concern.  In this pilot study, we will assess the feasibility of implementing Web-based type 2 diabetes management among rural AI/ANs.  Our objectives are to demonstrate the efficacy and cost-effectiveness of internet-assisted type 2 diabetes co-management among rural AI/ANs, to develop general research guidelines for the application of cost-effectiveness analysis to this type of intervention, to determine health-related quality of life utility values associated with diabetes-related health states in rural AI/ANs, and to utilize the results from our studies to guide and inform decision makers in healthcare financing.  We propose to conduct a six month pre-test, post-test pilot in a rural AI/AN sample.  A University of Washington Diabetes Care Center nurse case manager will coordinate care for six rural AI/AN participants (patients) with the local mid-level provider/case manager.  Both providers of care will have access to the same Web-based diabetes module which is accessed through a secure “My UW” portal and consists of four related Web sites, including access for uploading blood glucose from home and entering nutrition and activity information in an online diary.  Participants will be provided with computers (and training as necessary) and Internet access.  Providers and patients will exchange e-mail in a secure closed system such that e-mail does not travel over the Internet.  The UW case manager will review all data and e-mail sent from home at least once weekly to ensure timely progress toward the “co-developed treatment goals, pre- and post-intervention outcomes that we will measure include:  hemoglobin A1c, self-efficacy, patient satisfaction, health related quality of life, and direct and indirect treatment costs.  We propose to identify barriers and enablers to the successful use of computers, the Internet and e-health applications through post intervention qualitative assessment.

Although this was a one-year pilot project, due to extra ordinary length of getting the necessary IRB approvals, this project was carried forward into year two

Funding for the above NARCH 3 Projects by the Indian Health Service and National Institutes of Health” four-year grant, which began in September 2005. Award Number: U26IHS300003

NARCH 4
The Summer Research Training Institute for American Indian and Alaska Native Health Professionals
Thomas Becker, MD, PhD, Principal Investigator, NPAIHB
Joe Finkbonner, RPh, MHA Co-Investigator, NPAIHB, (Lummi),
Jodi Lapidus, PhD, OHSU, Project Investigator
Luella Azule, BS, Project Coordinator, NPAIHB (Yakama Nation/Umatilla)
Walter Hollow, MD UW Consultant (Assinboine/Sioux)
William Lambert, PhD, OHSU, Instructor/consultant
Esther Dunn, BA, OHSU Program Manager
Keely Moriarty, BA, OHSU Research Assistant

The Northwest Portland Area Indian Health Board (NPAIHB) proposed to continue the Northwest Native American Research Center for Health (NW NARCH) in partnership with two premier health research institutions of the Northwest, Oregon Health Science University and the University of Washington School of Medicine.  Three premises for this NARCH 4 project.  First, despite longstanding efforts by tribal, federal, and state health care programs, the available data show substantial disparities in health for American Indians and Alaska Natives (AI/AN) compared to non-AI/ANs (Regional Differences in Indian Health, 1999).  Northwest tribal leaders fear their health status is getting worse instead of better; this fear unfortunately has been substantiated with diabetes surveillance data showing a doubling of prevalence over the past ten years.  Second, Indian communities distrust health research because of negative experiences with non-AI/AN researchers who did not respect tribal needs or sensitivities, even though carefully implemented health research has the potential to provide solutions to reduce, and ultimately eliminate, existing health disparities.  Third, health research done by highly skilled AI/ANs who are sensitive to the culture and specific concerns of Indian communities can bridge the gap between academia and community, though currently we lack the critical mass of AI/AN researchers necessary to accomplish this task.

This years Summer Research Training Institute for American Indian and Alaska Native Health Professions will be held in Portland OR at the Northwest Portland Area Indian Health Board from June 11-29, 2007.

Summer Research Training Institute Booklet
Registration form
Travel Scholarship

For more information contact:
Luella Azule
Northwest Portland Area Indian Health Board
527 SW Hall, Suite 300
Portland, OR 97201
503-228-4185 x 275
Fax 503-228-8182
E-mail
Or visit http://www.ohsu.edu/summer-institute

NARCH 4 Project activities are funded by the Indian Health Service and National Institutes of Health through year to year grant, which began in September 2006. Award Number: U26IHS300132A