+-----------------------------------------------------------------------+
| **NARCH Researchers & Abstract Title/Summary**                        |
+-----------------------------------------------------------------------+
| **Northwest Portland Area Indian Health Board (NPAIHB)**              |
+-----------------------------------------------------------------------+
| **1. Authors:** \***Thomas M. Becker**, Joshua D. Jones, Luella J.    |
| Azule, Victoria Warren-Mears                                          |
|                                                                       |
| **Title: Fostering health-related research skills among AI/AN Health  |
| Professionals**                                                       |
|                                                                       |
| **Purpose:** Although substantial research has been directed toward   |
| understanding reasons for high disease rates and health disparities   |
| among 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/AN peoples to carry out effective research in AI/AN populations |
| should be a priority concern. **Methods:** We implemented several     |
| related training programs that will increase the research             |
| capabilities of AI/AN investigators to carry out well-designed,       |
| culturally sensitive studies within AI/AN populations and in other    |
| settings. Experienced epidemiologists, biostatisticians, ethicists,   |
| and laboratory-based researchers at the Northwest Portland Area       |
| Indian Health Board, Oregon Health & Science University and the       |
| University of Washington offered individually-tailored training       |
| programs for qualified AI/AN researchers at the pre-doctoral,         |
| post-doctoral, and undergraduate levels. The training programs        |
| 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. **Results:** During the past three years, our training   |
| programs have included 207 trainees, almost all of whom were AI/AN    |
| heritage. **Conclusions:** Through the development of qualified,      |
| independent AI/AN investigators, our efforts 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.                                         |
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| **Siletz Confederated Tribes**                                        |
+-----------------------------------------------------------------------+
| **2. Authors**: **\*Kelley Ellis**, Delina John, Claire Wood          |
|                                                                       |
| **Title: Affects of Acculturation on Substance Abuse among Siletz     |
| Tribal Members**                                                      |
|                                                                       |
| **Background:** Research among Native Americans in the Pacific        |
| Northwest has found that the "traditional worldview" increases        |
| resilience and decreases use of mood altering substances. The         |
| Confederated Tribes of Siletz Indians conducted a research study by   |
| administering a series of surveys to investigate and identify         |
| cultural attitudes, beliefs and substance use. **Methods:** The study |
| was conducted in two phases. In phase 1, 1000 adult Siletz tribal     |
| members were randomly selected from the rolls to receive a mailed out |
| survey. In phase 2 personal interviews were conducted with volunteer  |
| participants from phase 1. Both phases included surveys with tribal   |
| members self-reporting on demographics, cultural attitudes and        |
| beliefs, and substance abuse. **Results:** We received 108 completed  |
| phase 1 surveys. Of the 108 respondents 59% were women. Although 91%  |
| had a high school diploma or GED or higher education, 47% earned less |
| than \$20,000 annually. More men and women self identified as         |
| culturally contemporary rather than traditional. 69% of the           |
| respondents were in the normal range of alcohol consumption, 19% were |
| at risk, and 12% were potential alcoholics. Alcohol abuse appeared    |
| more frequently in the men; 65% of the at-risk or potential alcoholic |
| respondents were male. We interviewed 32 volunteers in phase 2, 59%   |
| were men. **Conclusions:** The results of the study indicate that     |
| traditional activities should be presented to youth as a preventative |
| measure. Self identified substance abusers are more likely within the |
| contemporary generation and therefore rehabilitation should focus on  |
| contemporary factors to assist in their recovery.                     |
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| **Southern Colorado/New Mexico NARCH -- Albuquerque Area Indian       |
| Health Board (AAIHB)**                                                |
+-----------------------------------------------------------------------+
| **3. Authors: \*Lorenda Belone**, Nina Wallerstein, Bonnie Duran,     |
| John Oetzel, Greg Tafoya, and Erica Rodriguez. Tribal Organizers:     |
| Jemez -- Harriet Yepa-Waquie, Anita Toya, & Willie Waquie; Ramah      |
| Navajo - Jennifer Henio, Yin-Mai Lee & Carolyn Finster                |
|                                                                       |
| **Title: Native American Family Intervention Project: Community Based |
| Participatory Research Process Involving A University and Two         |
| Southwest American Indian Tribes**                                    |
|                                                                       |
| **Purpose:** Utilizing a community based participatory research       |
| approach the University of New Mexico Masters in Public Health        |
| Program with Tribal research teams in the Pueblo of Jemez and Ramah   |
| Navajo to adapt, modify, and implement a Native American Family       |
| Intervention Project to reduce risky behaviors in third and fourth    |
| graders. **Method:** Four year process to adapt exiting culturally    |
| specific curriculum developed by the Anishinabe (Ojibwe) people       |
| called the "Bii-Zin-Da-De-Dah" or "Listening to Each Other"           |
| prevention program. Data from the Anishinabe curriculum has showed to |
| be successful with parents and children when there is an integration  |
| of cultural stories and traditions. First year-- establish advisory   |
| boards in each tribe and adapt curriculum through focus group         |
| discussions with elders, parents, youth and service providers; second |
| year- modify curriculum based on each tribe's specific cultural       |
| importance, develop a community action project for participating      |
| families to be involved in, and provide cameras to the youth to       |
| develop photo essays; third year-pilot curriculum in each tribe with  |
| ten families who have third or fourth graders; and fourth year-base   |
| on pilot, revise curriculum and prepare for full implementation in    |
| each tribe. **Results:** Completed first year of project, able to     |
| establish very active advisory boards and conducted monthly meetings  |
| which were held in each tribe's community. Conducted four Jemez focus |
| group discussions, trained advisory board members to facilitate the   |
| focus groups. Held fifth focus group with advisory board members to   |
| examine research process. **Conclusion:** Both tribes very much       |
| interested and excited in developing a culturally specific            |
| intervention.                                                         |
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+-----------------------------------------------------------------------+
| **NARCH Researchers & Abstract Title/Summary**                        |
+-----------------------------------------------------------------------+
| **(AAIHB)**                                                           |
+-----------------------------------------------------------------------+
| **4. Authors**[:]{.underline} **\*Lorenda Belone**, Nina Wallerstein, |
| Bonnie Duran, John Oetzel, & Audrey Solimon; San Felipe Partners:     |
| Bruce Garcia; Ramah Navajo Partners: Sara Adeky, Yin-May Lee, Carolyn |
| Finster, Elissa Caston, & Gracie Apachito; and AAIHB Partners:        |
| Marianna Kennedy, Henrietta Vigil, & Connie Garcia                    |
|                                                                       |
| **Title: Community and Cultural Capacity Assessment: A Participatory  |
| Research Process Between A University, Two Southwest American Indian  |
| Tribes, and An Intertribal Organizational Partner**                   |
|                                                                       |
| **Purpose:** Community profile surveys were developed to better       |
| understand community needs and strengths to support the community     |
| planning efforts in the Pueblo of San Felipe and Ramah Navajo to      |
| promote better health and well-being. The need for a single           |
| comprehensive community profile was voiced by each tribe for use      |
| every three to five years to assess community change to improve the   |
| health of their people and reduce high incidence of disease and other |
| health conditions. **Method:** A one to two year process was required |
| to develop a community profile instrument tailored to each tribe's    |
| specific needs, the process involved development of partnerships,     |
| capacity building, and promotion of interdependence. For Ramah Navajo |
| an additional year was required for the translation of the instrument |
| into the Navajo language and approval by the Navajo Nation IRB.       |
| **Results:** Findings from the community profile have proven to be    |
| very useful data for each tribe and has been used for strategic       |
| planning purposes and grant writing to improve services and health    |
| status. Results in San Felipe have been shared with the Tribal        |
| Council, and program directors. In Ramah, results have been shared    |
| with the Ramah Navajo School Board, program providers, community      |
| members, and the Navajo IRB. **Conclusion:** The community profile    |
| instrument has proven to be a powerful tool that is needed by Tribes  |
| who lack such resources. Based on the success with these two Tribes,  |
| interest has been generated by other New Mexico tribal communities    |
| who have requested that the survey be conducted in their communities. |
+-----------------------------------------------------------------------+
| **Great Lakes Inter-Tribal Health Council (GLITC)**                   |
+-----------------------------------------------------------------------+
| **5. Authors: \*Alexandra Adams**, SuAnne Vannatter, Ron Prince       |
|                                                                       |
| **Title: A Dual Approach to Obesity Prevention in American Indian     |
| Communities**                                                         |
|                                                                       |
| **Background:** Over the course of five years, tribal health and      |
| wellness personnel, school personnel, and University of Wisconsin     |
| researchers participating in the Great Lakes NARCH have worked        |
| together to investigate the status and contributing causes of         |
| overweight among young children in three tribes in Wisconsin. They    |
| found that by the time of primary school, 27% of children were        |
| overweight and an additional 19% were at risk for overweight. While   |
| no single factor or combination of factors could be found to underlie |
| the problem, surveys revealed: low recognition of the problem by      |
| parents, high levels of sugar intake among children, low vegetable    |
| intake among children, high levels of overweight among parents        |
| themselves, and the identification of significant barriers to         |
| maintaining a healthy lifestyle in the communities. **Methods:**      |
| After a series of planning meetings with key stake holders in the     |
| communities, a two-level approach to solving the problem was devised. |
| The first level, Healthy Children, Strong Families, is a family-based |
| home visitation mentoring program that will work with families of     |
| Head Start aged children to improve nutrition and physical activity.  |
| It is backed up by an environmental assessment and intervention       |
| process based in community advisory boards called Supportive          |
| Communities. **Results:** The Healthy Children, Strong Families       |
| intervention has hired and trained mentors and begun enrolling        |
| families in each community. The Supportive Communities process has    |
| begun by recruiting expert advisors from around the state and seeking |
| members for community advisory boards. **Conclusions:** Lifestyle     |
| behaviors leading to obesity and related long term illnesses have     |
| causes within the person, the family and the community. Addressing    |
| all levels of the problem promises the broadest success.              |
+-----------------------------------------------------------------------+
| **(GLITC)**                                                           |
+-----------------------------------------------------------------------+
| **6. Authors: \*Susan J. Roskopf, \*Brian J. Jackson**, Mary K.       |
| Madsen.                                                               |
|                                                                       |
| **Title: American Indian Science Scholars Program at the University   |
| of Wisconsin -- Milwaukee**                                           |
|                                                                       |
| **Background:** As part of the Student Development Component of the   |
| NARCH funding, the American Indian Science Scholars Program is a one  |
| week summer program providing American Indian high school students    |
| with hands on science and lab experiences intermixed with traditional |
| teachings. **Methods:** For the 2006 program, 15 students were hosted |
| at The University of Wisconsin -- Milwaukee from July 23-29. With     |
| three students from Arizona, three from Michigan and nine from        |
| Wisconsin, ages ranging from 15-20, there was a great representation  |
| and diversity among participants. The combination of scientific and   |
| cultural activities kept the students motivated, engaged and          |
| enthused. Scientific activities ranged from growing bacteria to blood |
| typing, extracting their own DNA to tracking the spread of disease,   |
| from hiking through the Cedarburg Bog to forensically analyzing a     |
| mock crime scene. Students went to the UWM planetarium, Milwaukee     |
| County Zoo, Milwaukee Public Museum, and Indian Community School. At  |
| ICS, students learned about traditional medicines, some participated  |
| in a sweat lodge, and many made their own dream catchers. Community   |
| activities included an evening of basketball, a trip to a local mall, |
| a water-ski show, and the week concluded with tailgating and a        |
| Brewers baseball game. **Results:** Students were introduced to a     |
| variety of scientific and cultural experiences, making a real and     |
| personal impact on each participant, opening their minds to a greater |
| array of future possibilities and endeavors. **Conclusions:** As      |
| their feedback reflects, participating in this program gave students  |
| an invaluable experience that has dramatically excited and motivated  |
| them for their futures.                                               |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| **NARCH Researchers & Abstract Title/Summary**                        |
+-----------------------------------------------------------------------+
| **Aberdeen Area Chairmen's Health Board (AACHB)**                     |
+-----------------------------------------------------------------------+
| **7. Authors:** \***Sylvia Lasley**, Ramona Zephier, Timothy Ryschon, |
| Connie Brushbreaker, Judi Erickson, Ron Valandra, and Jennifer        |
| Larsen.                                                               |
|                                                                       |
| **Title: Identifying Diabetes Risk in Native American Adolescents.**  |
|                                                                       |
| **Background:** Diabetes is more common in Native Americans than      |
| other ethnic groups. The incidence of diabetes is increasing faster   |
| in Native American adolescents than other age groups. Insulin         |
| resistance is known to precede diabetes, and lifestyle changes can    |
| improve future risk of diabetes in individuals with insulin           |
| resistance. Identifying risk is important to preventing diabetes.     |
| **Methods:** In collaboration with the Diabetes Prevention Program of |
| the Rosebud Sioux Tribe, we are screening Native American youth with  |
| oral glucose tolerance tests to 1) determine prevalence of diabetes   |
| and impaired glucose tolerance, 2) identify which factors best        |
| predict insulin resistance, including environmental factors such as   |
| life stresses, and 3) if cultural affiliation is associated with      |
| lower insulin resistance in Native American youth. **Results:** We    |
| have screened 47 youth, ages 5-18 (27M/20F). Mean body mass index     |
| (BMI) % for-age-and-sex is 75%, including 43% with BMI% \> 85%        |
| considered at risk for overweight and 17% with BMI% \>95%, considered |
| overweight, using CDC guidelines. Blood pressure is greater than      |
| 90%-for-age in 4%; 11% have acanthosis nigricans, 6% have             |
| triglycerides \>150 mg/dl; 8% have albuminuria; and 12% have an       |
| insulin resistance score (HOMA-IR) \>4. None have diabetes and only   |
| 2% have impaired glucose tolerance. Life events and other survey      |
| tools have not yet been analyzed. **Conclusions:** Potential risk     |
| factors will be analyzed for their ability to best predict risk for   |
| insulin resistance. The community is looking forward to hearing how   |
| these results might enhance current diabetes intervention efforts.    |
+-----------------------------------------------------------------------+
| **Southern California - Intertribal Health Council (IHC)**            |
+-----------------------------------------------------------------------+
| **8. Authors: \*Stephanie Brodine**, Mary Ann Jacobs, Donna Riley,    |
| Geneva Fitzsimmons, Lucy Cunningham, Laura B Moyer                    |
|                                                                       |
| **Title: Applying a community model for Native American success and   |
| retention in higher education**                                       |
|                                                                       |
| **Purpose:** The California NARCH Student Development Program (SDP)   |
| strives to recruit and retain NA students into science and health     |
| undergraduate and graduate programs and onto successful and           |
| influential research and academic careers. **Methods:** Similar to    |
| other underrepresented (URP) student mentoring programs, a 'pipeline' |
| approach with faculty mentoring, and academic assistance are core     |
| elements. Additional strategies include formation of a student        |
| development team (SDT) with a full time NA outreach coordinator and   |
| SDSU and Community College faculty. Our program levies existing NIH   |
| and NSF funded programs for CA-NARCH student recruitment;             |
| collaborates to infuse science and establish a recruitment pool       |
| within Native driven high school level programs; developed a CA-NARCH |
| specific undergraduate directed research program (CANDUR); and        |
| established a CA-NARCH office space with office hours based on        |
| student's need. A web-based tracking system has also been developed   |
| to allow rapid, flexible qualitative and quantitative input on        |
| particular students. Grassroots dissemination is ongoing through      |
| participation at tribal events and ceremonies, regular newsletter     |
| publications, etc. **Results:** During the 2 year planning/ pilot     |
| phase and the 1 year full implementation phase, 157 NA students have  |
| participated in the SDP, with 15 students placed in higher intensity  |
| programs (including CANDUR). A growing product of the SDP is          |
| strengthening the trust with the Tribal Board and Native communities  |
| through the perceived support and care of tribal adolescents and      |
| young adults. **Conclusions:** Because of greater obstacles and       |
| non-traditional education paths, NA focused programs and a holistic   |
| approach is needed to successfully recruit and retain NA students in  |
| higher education.                                                     |
+-----------------------------------------------------------------------+
| **(IHC)**                                                             |
+-----------------------------------------------------------------------+
| **9. Authors: Diane E. Weiner\*,** Christine R. Romero, Deborah       |
| Wingard.                                                              |
|                                                                       |
| **Title: \"I May Speak Out Because I have to Now\": California Indian |
| Cancer Survivor Self-Advocacy Approaches**                            |
|                                                                       |
| **Background**: American Indians interviewed in California about      |
| cancer behaviors state that they often wait until pain prevents the   |
| person from performing daily chores before seeking detection and      |
| treatment services (Weiner 1996-2003). Physical pain associated with  |
| cancer tended to be treated by clinicians or endured. Indians suffer  |
| from limited palliative care resources.                               |
|                                                                       |
| **Purpose of Study**: The California NARCH team investigated Native   |
| perspectives of pain management and palliative care with the goal of  |
| developing a culturally competent curriculum for lay and professional |
| health audiences. A crucial task was to assess the variables that     |
| impact perceptions about pain and palliative care. **Methods**: The   |
| communities included the rural, suburban, and urban communities of    |
| one county, whose Native population includes about 25,000 people. We  |
| conducted group interviews with three groups of lay people and one    |
| group of Community Health Workers and Public Health Outreach workers. |
| A total of 17 individuals participated. Additionally, ten cancer      |
| survivors or their companions were interviewed in-depth about cancer  |
| and palliative care. Data was assessed using methods based on         |
| grounded theory coding. **Results**: As part of this larger topic,    |
| participants often described the methods they or their companions     |
| used to attempt to alleviate pain and discomfort. Interactions with   |
| providers and family caregivers reveal distinct avenues used by       |
| survivors to maneuver health systems and attempt to attain            |
| empowerment. **Conclusion**: This projects outlines the ways          |
| individuals learn to become self-advocates. It also explicates the    |
| challenges to obtain care. Data can be applied to develop advocacy    |
| programs for Native cancer survivors, or survivors at large.          |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| **NARCH Researchers & Abstract Title/Summary**                        |
+-----------------------------------------------------------------------+
| **White Mountain Apache Tribes (WMAT)**                               |
+-----------------------------------------------------------------------+
| **10. Authors:** **Allison Barlow\*,** Mariddie Craig, N. Katy        |
| Aday\*, Francene Larzelere-Hinton, Elena Varipatis Baker, Kathleen    |
| Norton, Sheridee Susan, Danya Hinton, Britta Mullany, John Walkup     |
|                                                                       |
| **Title: Employing community-based participatory research (CBPR)      |
| methods to prevent youth suicide on the White Mountain Apache         |
| reservation**                                                         |
|                                                                       |
| **Background:** Since 1990, White Mountain Apache (WMA) tribal        |
| members have experienced rates of suicide among youth (\<25 years of  |
| age) up to 10 times the U.S. rate and 5 times the AI/AN rate. In      |
| 2001, the Tribe passed a resolution requiring mandatory reporting of  |
| all suicidal events (ideation, attempts) and completions. In 2005,    |
| the Tribe partnered with Johns Hopkins University to employ           |
| community-based participatory research (CBPR) methods to investigate  |
| risk factors and key determinants of suicidal behaviors, as well as   |
| treatment preferences and service utilization experiences of suicidal |
| Apache youth (10-19). **Methods:** The project (9/2005-8/2009) is     |
| unfolding in three stages, including: Stage I) a nine-month formative |
| research phase to enhance existing surveillance data collection       |
| methods and to design assessment tools for the study of suicidal      |
| youth; Stage II) a 12 to 18-month study of 75 youth who make serious  |
| attempts to understand suicide severity, potential risk factors,      |
| intervention opportunities, mental health treatment experiences and   |
| preferences. Apache paraprofessionals will be trained to complete all |
| assessments---including self-reports, interviews and chart reviews;   |
| and Stage III) a 24-month prevention intervention design and pilot    |
| phase, conducted in collaboration with community stakeholders and     |
| employing knowledge learned in Stages I and II. **Results:** Stage I  |
| has yielded data about age-related rates, methods, sex ratios and     |
| possible triggers. Community interpretations of data and ideas about  |
| risk and protective factors have informed the development of the      |
| assessment battery and interview guides for Stage II and will be      |
| described. **Conclusions:** This study will contribute new knowledge  |
| about conducting CBPR in the arena of mental health within AI tribes. |
| Results regarding strategies for preventing youth suicidal behavior   |
| may be generalizable to other indigenous population contexts          |
| throughout the US and the world.                                      |
+-----------------------------------------------------------------------+
| **(WMAT)**                                                            |
+-----------------------------------------------------------------------+
| **11. Authors: N. Katy Aday**, Francene Larzelere-Hinton, Allison     |
| Barlow, Britta Mullany, Elena Varipatis Baker, Kathleen Norton,       |
| Sheridee Susan, Danya Hinton, Mariddie Craig, John Walkup             |
|                                                                       |
| **Title: A community-wide suicide surveillance system to identify     |
| patterns of completions and attempts among the White Mountain Apache  |
| Tribe**                                                               |
|                                                                       |
| **Background:** Suicide is a leading mental health disparity among    |
| American Indian and Alaska Native (AI/AN) youth and young adults,     |
| with wide cross-tribal variance in rates. Since 1990, the White       |
| Mountain Apache Tribe (WMAT) has experienced rates of suicide         |
| completion among youth (\<25 years of age) 10 times greater than the  |
| U.S. rate and 5 times greater than the AI/AN rate. In 2001, the WMAT  |
| implemented a community-wide suicide surveillance system to collect   |
| data related to age, sex, location of act, methods and potential      |
| triggers for suicidal ideation, attempts and completion. **Methods:** |
| A common suicide registry form is used by all tribal agencies to      |
| report suicidal events to the NARCH Suicide Prevention Coalition.     |
| Data are entered on a weekly basis into an electronic database. As    |
| part of a suicide prevention study supported through NARCH,           |
| surveillance data from these suicide registry forms are being         |
| analyzed for trends related to suicide attempts and completions that  |
| occurred between January 2002 and June 2006. **Results:** Confirmed   |
| completions include: 7 in 2002; 4 in 2003; 3 in 2004; 6 in 2005; and  |
| 4 in the first six months of 2006. 84% of those who completed suicide |
| were male. The primary method (83%) for both male and female          |
| completions was hanging. In the most recent calendar year (2005),     |
| there were 388 confirmed suicidal events. Almost half (47%) of the    |
| attempts were among youth \<20 years old, of whom 50% were males.     |
| Data trends for all suicidal events from 2002-June 2006 are being     |
| analyzed and will be reported, including age, sex, methods, and       |
| potential trigger patterns. **Conclusions:** Preliminary results      |
| suggest youth ages 15-24 are at highest risk for completing suicide,  |
| while 10-19 year olds are at highest risk for suicidal attempts.      |
| Emerging patterns suggest the WMAT population is distinct from other  |
| AI and U.S. populations in terms of primary method among completers   |
| (hanging)and sex ratios of attempters (male: female ratio is \~1:1    |
| vs. 1:3 in other populations). The next phase of the NARCH suicide    |
| prevention effort will be to complete a more in-depth assessment of   |
| youth attempters identified via this registry. Findings will be       |
| applied to the design of evidence-based and community-based suicide   |
| prevention interventions.                                             |
+-----------------------------------------------------------------------+
|                                                                       |
+-----------------------------------------------------------------------+
| **12. Authors: \*Sandra J. Bliss**, Felicia Frizzell, Francene        |
| Larzalere-Hinton, Mariddie Craig, Jeanne Hoddinott, Mathuram          |
| Santosham, Katherine L. O'Brien.                                      |
|                                                                       |
| **Title: Pneumococcal Polysaccharide Vaccine Coverage and             |
| Effectiveness Among White Mountain Apache Adults**                    |
|                                                                       |
| **Purpose:** White Mountain Apache (WMA) adults have high rates of    |
| invasive pneumococcal disease (IPD); efforts to prevent invasive      |
| disease in this population are clearly needed. Pneumococcal           |
| polysaccharide vaccine (PS-23) is one such strategy, recommended for  |
| high risk-adults. This study was conducted to determine how           |
| widespread PS-23 is utilized and to determine its effectiveness among |
| WMA adults. **Methods:** A random subset of subjects was selected     |
| from all WMA adults with an indication for pneumococcal vaccination   |
| (determined using disease registries and ICD-9 codes from the IHS     |
| database). Computer records and paper charts were reviewed in 2004-5  |
| for evidence of PS-23 administration. To determine the effectiveness  |
| of PS-23 vaccination using an indirect cohort method, active          |
| surveillance of IPD cases was conducted, case vaccination histories   |
| taken, and isolates serotyped. **Results: ** Among 477 WMA adults     |
| with an indication for pneumococcal vaccination, 75% had received     |
| PS-23. Vaccination rates were highest among subjects with pulmonary   |
| disease (95%), diabetes (88%), and heart disease (81%), and lowest    |
| for those between the ages of 50-64 without a medical indication      |
| (38%). Within each medical indication category, subjects older than   |
| 65 were more likely to be vaccinated than younger subjects, though    |
| this was only statistically significant for those with heart disease  |
| or immunosuppression. Among those who were vaccinated, 56% were       |
| vaccinated within 12 months of their indication diagnosis. For those  |
| individuals who had not been vaccinated or were vaccinated more than  |
| 12 months after their indication was diagnosed, there were a mean of  |
| 14.5 missed opportunities for vaccination (i.e. medical visits); of   |
| these,79% were outpatient visits, and 14% were emergency room visits. |
| Of 90 episodes of IPD between 1991 and 2005 for which serotyping      |
| information was available, 77% were due to serotypes contained in     |
| PS-23. Comparing vaccinated and unvaccinated cases, PPV-23 was 69%    |
| effective in preventing serotype-specific IPD. **Conclusions:** Among |
| WMA adults, pneumococcal vaccination rates are high, and PS-23 is     |
| effective in preventing serotype-specific IPD. Efforts to extend      |
| vaccination to those between the ages of 50-64 without other risk     |
| factors should be pursued.                                            |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| **NARCH Researchers & Abstract Title/Summary**                        |
+-----------------------------------------------------------------------+
| **(WMAT)**                                                            |
+-----------------------------------------------------------------------+
| **13. Authors: \*Sandra J. Bliss**, Felicia Frizzell, Francene        |
| Larzalere-Hinton, Kathryn J. Eagle, Debra J. McGinty, Mathuram        |
| Santosham, Mariddie Craig, Katherine L. O'Brien.                      |
|                                                                       |
| **Title:** **Invasive Pneumococcal Disease (IPD) among White Mountain |
| Apache Adults: Clinical and Epidemiological Features**                |
|                                                                       |
| **Purpose:** White Mountain Apache adults have high rates of invasive |
| pneumococcal disease (IPD); the reasons for these high rates are      |
| unclear. This study was conducted to determine the disease spectrum   |
| and underlying risk factors of WMA adults with IPD. **Methods:**      |
| Active laboratory and population-based surveillance was conducted for |
| IPD among WMA adults. When cases were identified, clinical features   |
| of illness were ascertained, and demographic and medical risk factors |
| as well as vaccine history were documented by chart review.           |
| **Results: ** From 1991-2005, a total of 112 IPD cases occurred among |
| 106 WMA adults; 83.6% of cases had pneumonia. 59% of cases were male, |
| and the mean age was 43 years. 91% of cases had a previously          |
| identified risk factor for IPD; among these alcoholism (73%),         |
| cirrhosis (25%) and diabetes (19%) predominated. Alcoholics with IPD  |
| were more likely to be male (70%; p=0.000) and were younger (mean age |
| 39.6, p=0.000) than non-alcoholics with IPD. 34% of episodes required |
| intensive care, and 15% of IPD episodes were fatal. All deaths        |
| occurred among those with a previously identified risk factor for     |
| pneumococcal disease. By logistic regression, only age\>65 was        |
| associated with increased risk of death. Among those with an          |
| indication for pneumococcal vaccination, 35% were vaccinated prior to |
| the episode of IPD; vaccination rates were highest for those with     |
| renal failure (90%), diabetes (75%), and heart disease (70%) and      |
| lowest among alcoholics (27%). Among those with IPD a vaccine         |
| indication, prior vaccination did not impact the risk of death.       |
| **Conclusions:** Among WMA adults, invasive pneumococcal disease      |
| occurs at young ages, usually in the setting of pneumonia. Alcoholism |
| is the primary risk factor identified, and contributes to the young   |
| age and male predominance. While the majority of IPD cases occurred   |
| among those with a vaccine indication, most cases had not been        |
| vaccinated prior to their illness.                                    |
+-----------------------------------------------------------------------+
| **(WMAT)**                                                            |
+-----------------------------------------------------------------------+
| **14. Authors: \*Cathie M. Frazier, \*Felicia Y. Frizzell**, Kristen  |
| L. Speakman                                                           |
|                                                                       |
| **Title: White Mountain Apache Tribe /Johns Hopkins Bloomberg School  |
| of Public Health (WMAT/JHBSPH) NARCH Student and Faculty Development  |
| Training Project**                                                    |
|                                                                       |
| **Background:** Through a NARCH I award, WMAT/JHBSPH launched a       |
| student and faculty development program in which 93 Apache scholars   |
| and health leaders participated in graduate coursework and workshops  |
| aimed at designing interventions to target key health disparities and |
| to advance the skills of Apache scientist-researchers, enabling them  |
| to compete for future NIH opportunities. The NARCH III award builds   |
| upon this success.  **Methods:** The NARCH III training program has   |
| established a 5-stage research training initiative for Apache         |
| scholars, which includes: 1) semi-annual institute courses at JHBSPH; |
| 2) public health certificate; 3) research coordinator course; 4)      |
| graduate/doctoral level training; and 5) community outreach and       |
| education. **Results:** The WMAT/ JHBSPH NARCH has made progress in   |
| each of these five areas. Twenty students from the WMA Reservation    |
| participate in semi-annual public health institutes (160 over 4       |
| years). Five WMA tribal members per year are eligible to enroll in    |
| the certificate program (20 total). Three Hopkins NARCH staff enroll  |
| in an intensive Hopkins Research Coordinator Course each year (12     |
| total). Two full-time graduate scholars will be recruited and         |
| enrolled at JHBSPH (in July 2006, the first WMA tribal scholar began  |
| the JHBSPH MPH program). Community education programs are conducted   |
| monthly, and a summer internship program to encourage pre-college     |
| educational planning among high school students is held over a 4-week |
| period each summer in Whiteriver, AZ.  **Conclusions:** The           |
| WMAT/JHBSPH NARCH Training Program is an innovative initiative that   |
| demonstrates the impact of a well designed training program to        |
| develop a cadre of Apache researchers.                                |
+-----------------------------------------------------------------------+
| **Alaska Native Tribal Health Consortium (ANTHC)**                    |
+-----------------------------------------------------------------------+
| **15. Authors: \*Laurie J. Helzer,** Melissa Vallee, Kate M.          |
| Heitkamp, Stacy L. Anderson, John T. Bernert, Ruth A. Etzel           |
|                                                                       |
| **Title: Pilot Study of Methods to Measure Saliva Cotinine in Alaska  |
| Native Women During Pregnancy**                                       |
|                                                                       |
| **Purpose:** This pilot study tested two methods for measuring saliva |
| cotinine levels in pregnant Alaska Native women. **Methods**: The     |
| strategies for measuring cotinine levels in this cross-sectional      |
| study involved liquid chromatography tandem mass spectrometry         |
| (LC/MS/MS) and NicAlert immunoassay test strips. The latter saliva    |
| test strips are designed for on-the-spot evaluation of smoking        |
| status. The measures were evaluated to determine whether NicAlert     |
| results were comparable to the (LC/MS/MS). Participants also          |
| completed a questionnaire at the prenatal clinic at the Alaska Native |
| Medical Center to establish self-reported smoking status.             |
| **Results:** Seventy one pregnant Alaska Native women participated in |
| this pilot study. Eighteen women reported that they used tobacco      |
| products during pregnancy. Sixteen women reported that they had       |
| smoked within the last 7 days. Among the 68 women for whom LC/MS/MS   |
| results were available, the median cotinine concentration was 0.068   |
| ng/mL for non-smokers and 113.5 ng/mL for smokers. Among the 60 for   |
| whom NicAlert strip analyses were available, the median cotinine      |
| concentration was 4.85 ng/mL for non-smokers and 101.5 ng/mL for      |
| smokers. Pre-established cotinine levels of 10 ng/mL or greater using |
| LC/MS/MS and 15 or greater using NicAlert indicated an active smoking |
| status. Median cotinine in the women who reported smoking cigarettes  |
| in the last 7 days was 111.0 ng/mL by LC/MS/MS (n=15) and 93.8 ng/mL  |
| by NicAlert (n=12). All of the women who reported smoking in the last |
| 7 days were categorized as smokers by both the LC/MS/MS and the       |
| NicAlert tests. Reported tobacco use in the last 7 days was highly    |
| correlated with LC/MS/MS cotinine concentrations (r=0.79; p=0.01) and |
| with NicAlert cotinine concentrations (r= 0.79; p =0.01).             |
| **Conclusions:** The NicAlert analysis of saliva samples is a rapid   |
| and useful method for classification of smokers versus nonsmokers     |
| among pregnant Alaska Native women.                                   |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| **NARCH Researchers & Abstract Title/Summary**                        |
+-----------------------------------------------------------------------+
| **(ANTHC)**                                                           |
+-----------------------------------------------------------------------+
| **16. Authors:** Michael G. Bruce^1^, Brian J. McMahon^1,2^, Thomas   |
| W. Hennessy^1^, Alisa L. Reasonover^1^, Julie M. Morris,^1^ Dana L.   |
| Bruden,^1^ Frank Sacco^2^, Debby Hurlburt^1^, Helen Peters^1^, Jim    |
| Gove^1^, **\*Jim Williams^2^**, Alan Parkinson^1^                     |
|                                                                       |
| **Title: Reinfection after Successful Eradication of *Helicobacter    |
| pylori* in Alaska Natives**                                           |
|                                                                       |
| \(1\) Arctic Investigations Program, National Center for Infectious   |
| Diseases, Centers for Disease Control and Prevention, Anchorage,      |
| Alaska ; (2) The Alaska Native Medical Center, Anchorage, Alaska      |
| **Introduction:** *H. pylori* infection is common (75% antibody       |
| positive) among Alaska Natives, is a major cause of peptic ulcer      |
| disease, and may be associated with high gastric cancer rates. Scant  |
| information is available on the rates of reinfection after cure of    |
| *H. pylori* infection. The goal of this study is to determine rates   |
| of reinfection in 3 groups: urban Alaska Natives (Group1), rural      |
| Alaska Natives (Group2), and urban Alaska non-Natives (Group3)        |
| followed for two years. **Methods:** We enrolled adults diagnosed     |
| with *H. pylori* infection based on a positive urea breath test (UBT) |
| and one or more of the following: culture, CLO test or histology.     |
| After successful treatment, we test each patient for reinfection with |
| UBT at 4, 6, 12 and 24 months. At each visit, the participants are    |
| asked about medication use, illnesses and risk factors for            |
| reinfection. **Results:** At present, 236 persons have been enrolled  |
| in long-term follow-up (followed for 2 years or until they became     |
| reinfected). Among Groups 1, 2 and 3, the preliminary cumulative      |
| reinfection rates at 2 years are 14.5%, 24.8%, & 12.1%, respectively. |
| Among all 3 groups, 28% of *H. pylori* isolates demonstrated          |
| resistance to clarithromycin and 53% demonstrated resistance to       |
| metronidazole. **Conclusions:** Among all 3 groups, reinfection after |
| successful treatment for *H. pylori* occurred at rates higher than    |
| those reported for other US populations (\< 5% at 2 years). A high    |
| proportion of *H. pylori* isolates demonstrate resistance to the two  |
| key antibiotics used to treat this infection.                         |
+-----------------------------------------------------------------------+
| **(ANTHC)**                                                           |
+-----------------------------------------------------------------------+
| **17. Authors: Brian J. McMahon**, Josephine P. Simonetti, Kathy J.   |
| Hurlburt, Lisa R Bulkow, Mary M. Snowball, James L. Williams, Thomas  |
| W. Hennessy, Stephen E. Livingston                                    |
|                                                                       |
| **Title: A Prospective Study to Determine the Prevalence and          |
| Incidence of Serious Sequelae of Chronic Infection with Hepatitis B   |
| Virus in Alaska Natives**                                             |
|                                                                       |
| **Background:** High rates of hepatitis B virus (HBV) are found in    |
| Alaska Natives. Up to 25% of persons with HBV could develop           |
| hepatocellular carcinoma (HCC) and cirrhosis during their lifetime.   |
| **Purpose:** To follow Alaska Natives with HBV prospectively to       |
| determine risk factors for complications and identify persons who     |
| would benefit from antiviral therapy. **Methods:** Every 6 months,    |
| letters were sent to all hepatitis B carriers in their villages       |
| reminding them to have blood drawn. Sera were sent to the Alaska      |
| Native Medical Center in Anchorage, AK and tested for ALT, AST,       |
| HBeAg, and anti-HBe, HBV DNA using a Real-Time PCR assay, HBV         |
| genotype and Basal Core Promoter (BCP) mutations. Persons with        |
| elevated ALT, AST, and HBV DNA or AFP were sent to ANMC for           |
| evaluation. **Results:** From October 1, 2001 to August 31, 2005,     |
| 1112 carriers were enrolled. Five HBV genotypes were found in this    |
| population (A, Bj, C, D, and F). HCC in children and young adults was |
| associated with genotype F (p \< 0.001) and HBV vasculitis with       |
| genotype D (p = 0.014). One or more elevations of ALT or AST were     |
| found in 464 (42%) persons. In 18% the cause was due to hepatitis B   |
| and occurred more commonly in persons infected with Genotype C (p =   |
| 0.014) while in most, elevated ALT/AST levels were due to other       |
| causes (alcohol use, fatty liver, medications). **Conclusions:**      |
| Results from this population-based prospective study suggest that     |
| genotypes C and F appeared to be associated with more hepatitis B     |
| related complications than genotypes A, B and D.                      |
+-----------------------------------------------------------------------+
| **(ANTHC)**                                                           |
+-----------------------------------------------------------------------+
| > **18. Steve Livingston**, Josephine Simonetti, Lisa Bulkow, Chriss  |
| > Homan, Mary Snowball, Kathy Hurlburt, James Williams, Brian McMahon |
| >                                                                     |
| > **Title: The Relationship between Hepatitis B Virus (HBV) Genotype  |
| > and Hepatitis B e Antigen (HBeAg) Status in a Cohort of Alaska      |
| > Natives**                                                           |
| >                                                                     |
| > **Background**: In Alaska Natives (AN) with chronic HBV infection,  |
| > we have observed a 73% probability of clearing HBeAg within 10      |
| > years of the first positive hepatitis B surface antigen (HBsAg)     |
| > specimen. **Objective**: To investigate the relationship between    |
| > HBV genotype (GT) and HBeAg status in this cohort. **Methods**:     |
| > Followed 1536 AN with chronic HBV infection for 12.6 years          |
| > (median). Sera were tested biannually for HBeAg. Using stored sera, |
| > we tested for HBV GT in 1045 persons by direct sequencing of the S  |
| > gene and determined HBeAg status by GT on the initial HBsAg +       |
| > specimen and changes in HBeAg status by GT over time. **Results**:  |
| > Fewer persons with GT A and B were initially HBeAg+ (P\<.001).      |
| > Among persons initially HBeAg+, those with GT C were more likely to |
| > remain positive on subsequent visits than those with GT A and D     |
| > (P\<.001), who likewise were more likely to remain positive than    |
| > those with GT B and F (P\<.001). At time of last testing, more      |
| > persons with GT C, 71% (22/31), were still HBeAg positive compared  |
| > to those with GT A, B, D and F, 14% (4/28), 0% (0/5) , 41% (63/255) |
| > and 13% (14/109) respectively (P\<.001). Among those initially      |
| > HBeAg+, persons with GT C and F were more likely to revert to       |
| > HBeAg+ after clearing HBeAg than those with other GT (P\<.001). Of  |
| > persons initially HBeAg-, those with GT B, D and F were more likely |
| > to remain HBeAg- than GT A and C (P=.002). **Conclusions**:         |
| > Significant differences in HBeAg seroconversion and reversion back  |
| > to HBeAg positivity were observed between HBV GT among a            |
| > homogeneous population of AN. Persons with GT C were significantly  |
| > less likely to clear HBeAg and significantly more likely to have    |
| > reversions back to HBeAg positivity than those with other GT,       |
| > suggesting that HBV GT status may be of clinical importance.        |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| **NARCH Researchers & Abstract Title/Summary**                        |
+-----------------------------------------------------------------------+
| **(ANTHC)**                                                           |
+-----------------------------------------------------------------------+
| **19. Authors**: Rosalyn Singleton, **Tania Thomas\*,** Mary Jackson, |
| Mehran Mosley, Thomas Hennessy, Gregory Redding, and the              |
| International Collaboration of Bronchiectasis Network                 |
|                                                                       |
| **Title: MULTICENTRE BRONCHIECTASIS STUDY: A collaborative and        |
| international study of bronchiectasis in Indigenous children**        |
|                                                                       |
| **Background:** Bronchiectasis still contributes to the high burden   |
| of respiratory disease in Indigenous children worldwide. The risk     |
| factors associated with progression to bronchiectasis, the clinical   |
| course and optimal treatment are not known. The high rates of         |
| bronchiectasis among Indigenous populations in affluent countries     |
| resulted in the first collaborative international study (Aboriginal   |
| and Torres Strait Island, New Zealand Pacific Island and Maori and    |
| Alaskan Native people). The aims of the Observational study are to:   |
| (1) define the clinical course of chronic moist cough and             |
| bronchiectasis and (2) identify risk factors associated with          |
| progression to bronchiectasis. The Australians are also conducting an |
| Interventional study to evaluate maintenance azithromycin (30 mg/kg   |
| once a week) compared to placebo on the prevention of pulmonary       |
| exacerbations. **Methods**: The Observational study design is         |
| identical in the participating countries: a prospective cohort study  |
| (2005-2010) of Indigenous children aged 6 months to 8 years with      |
| bronchiectasis or chronic moist cough. Primary outcomes are: number   |
| and rate of pulmonary exacerbations. **Results:** The study has       |
| commenced in all sites; 41 children have been enrolled; we expect to  |
| identify 100-150 eligible children. In Alaska, 19/20 enrolled         |
| children have chronic moist cough with infiltrates. Participants have |
| high rates of nasopharyngeal carriage with pneumococcus, H.           |
| influenzae, and M. catarrhalis. **Conclusion:** This will be the      |
| first study to prospectively document the clinical course of chronic  |
| moist cough and bronchiectasis in Indigenous children. The Australian |
| clinical trial will provide urgently needed information about the     |
| potential benefits and harms of maintenance antibiotic treatment. The |
| project has the potential to improve health outcomes for children     |
| with bronchiectasis worldwide.                                        |
+-----------------------------------------------------------------------+
| **(ANTHC)**                                                           |
+-----------------------------------------------------------------------+
| **20. Authors:** Rosalyn J. Singleton, Jay C. Butler, Lisa R. Bulkow, |
| Debbie Hurlburt, Katherine O'Brien, **Tania Thomas\***                |
|                                                                       |
| **Title: Invasive Pneumococcal Disease Epidemiology and Effectiveness |
| for Pneumococcal Polysaccharide Vaccine in Alaska Native Adults.**    |
|                                                                       |
| **Background:** Alaska Natives have age-adjusted invasive             |
| pneumococcal disease rates 2-3-fold greater than non-Native Alaskans. |
| To characterize IPD epidemiology and PPV-23 effectiveness in AN       |
| adults, we reviewed all IPD cases reported through Alaska-wide,       |
| laboratory-based surveillance during 1986- 2000.  **Methods:**        |
| Sterile site isolates submitted through surveillance were serotyped.  |
| Medical and vaccine histories were collected for IPD cases by medical |
| record review. Vaccine effectiveness (VE) was estimated by comparing  |
| the proportion of cases caused by PPV-23 serotypes among vaccinated   |
| and unvaccinated persons (indirect cohort method). **Results:** 394   |
| cases (44.5 cases/100,000/year) occurred in 374 ANs aged 20-96 yrs    |
| (36.0% aged ≥55 yrs). Underlying conditions included heavy ethanol    |
| use (65.7%), smoking (60.8%), and COPD (25.0%). For 300 persons with  |
| a serotyped isolate from a first IPD episode, 97 (32.3%) had received |
| PPV-23 before onset. PPV-23 serotypes infected 87.6% of vaccinated    |
| and 96.6% of unvaccinated persons. Overall VE = 75% (95% confidence   |
| interval \[CI\]:27% to 91%) but declined with increasing age; for     |
| persons ≥55 years, VE = \<0 (95% CI: \<0% to 78%). VE = 80% (95% CI:  |
| 30% to 95%) for persons who used ethanol heavily, 80% (95% and 74%    |
| (95% CI:-238%, 100%) for those with chronic lung diseases.            |
| **Conclusions:** Alaska Native adults have rates IPD rates that are   |
| higher than non-Native Alaskans. Most cases of IPD occurred in adults |
| with conditions that are associated with increased risk of IPD in     |
| other populations. Many studies have established PPV-23 effectiveness |
| in adults. We were able to confirm PPV-23 effectiveness for           |
| preventing IPD in all AN adults, younger AN adults and those with     |
| certain underlying conditions, but not among ANs aged 55 years and    |
| older.                                                                |
+-----------------------------------------------------------------------+
|                                                                       |
+-----------------------------------------------------------------------+
| **(ANTHC)**                                                           |
+-----------------------------------------------------------------------+
| **21. \*Jaylene Z. Wheeler**, Lisa G. Dirks, Laurie Helzer, MPH,      |
| Stacey Anderson, MD, Ruth A. Etzel, MD, PhD                           |
|                                                                       |
| **Title: Pilot Study of Prenatal Alcohol Exposure Among Alaska Native |
| Infants: Acknowledging the History and the Local Expectations to      |
| Ensure Successful Project Implementation**                            |
|                                                                       |
| **Background:** While alcohol-related research can be beneficial to   |
| Alaska Native public health, both the study populations' local        |
| protocol for addressing community needs and their historical          |
| experience with research are important considerations for ensuring    |
| adequate project implementation. **Methods:** An analysis was         |
| completed on the Alaska Area Institutional Review Board's (AAIRB)     |
| review and approval process of Southcentral Foundation's Pilot Study  |
| of Prenatal Alcohol Exposure Among Alaska Native Infants ("pilot      |
| study"), a project funded by the Native American Research Centers for |
| Health (NARCH). The review focuses on AAIRB feedback regarding        |
| enhanced human subjects protection with special emphasis placed on    |
| how the suggestions shaped study operations, namely the informed      |
| consent and data analysis processes. In addition, a literature review |
| of tribal regulation of research within other indigenous communities  |
| was conducted to successfully engage the study population.            |
| **Results:** Although the AAIRB review and approval process for the   |
| pilot study was extensive and lengthy (\~13 months), both individual  |
| and community-focused human subjects protections were put in place.   |
| Based on AAIRB feedback, example modifications include: delivery of a |
| pre and post-test during the informed consent process and destruction |
| of the meconium sample once the analysis has been completed.          |
| **Conclusions:** Southcentral Foundation has the opportunity to       |
| strengthen its tribal research review process to better protect the   |
| Native people residing in its service area. Since previous            |
| alcohol-related studies often alienated Alaska Native communities,    |
| new research projects such as the alcohol pilot study has both the    |
| challenge and the opportunity to help encourage more collaboration in |
| this area.                                                            |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| **NARCH Researchers & Abstract Title/Summary**                        |
+-----------------------------------------------------------------------+
| **(ANTHC)**                                                           |
+-----------------------------------------------------------------------+
| # **22. Authors:** Kari J. Hamrick, **\*Jim Be                        |
| rner**, Parul Christian, Martina Lauterbach, Joseph Klejka, Cyd Hanns |
|                                                                       |
| # **Title: Tradi                                                      |
| tional food consumption patterns among pregnant Alaska Native women** |
|                                                                       |
| # **Purpose:** To describe the use of traditional foods by preg       |
| nant Alaska Native women. **Methods:** Interviewers administered food |
|  frequency questionnaires (FFQ) to 160 participants during the first  |
| prenatal visit. Consumption of traditional foods by season, concerns  |
| regarding safety of food and change of diet during pregnancy were eva |
| luated. In addition, 71 participants completed 3-day food diaries. ** |
| Results:** Participants reported consuming a wide variety of subsiste |
| nce foods. Native foods were ranked by total ounces per year, median  |
| ounces per year and frequency of intake (percent of respondents consu |
| ming each food). The most commonly eaten traditional foods included s |
| almon, caribou/reindeer and moose muscle, seal oil, white fish, seal  |
| muscle, wild birds and berries. Fifty-four participants (76%) reporte |
| d consuming traditional foods on the 3-day food diaries. Fifty-four p |
| ercent (53%) of respondents reported changing their diet since becomi |
| ng pregnant and 25% reported changing because of traditional beliefs. |
|  A total of 33 respondents (22%) indicated a concern regarding the sa |
| fety of traditional foods and 17 of those respondents reported changi |
| ng their diets as a result of those concerns. **Conclusion:** Subsist |
| ence foods continue to be an essential part of the diet for pregnant  |
| Alaska Native women in this study. Traditional beliefs play an import |
| ant role in food selection and consumption patterns during pregnancy. |
+-----------------------------------------------------------------------+
| **(ANTHC)**                                                           |
+-----------------------------------------------------------------------+
| **23.** **Authors: \*Jennifer S. Johnson**, Elizabeth D. Nobmann,     |
| Harriet V. Kuhnlein, Julien Naylor, Tim J. Gilbert, Anne P. Lanier.   |
|                                                                       |
| # **T                                                                 |
| itle: Alaska Native Dietary and Subsistence Food Assessment Projec**t |
|                                                                       |
| **Background**: Diet related chronic diseases including cancer,       |
| cardiovascular disease, and diabetes are increasing among Alaska      |
| Natives (AN). ANs who traditionally depended on subsistence foods now |
| also consume western foods. There is no nutritional monitoring system |
| in Alaska. **Methods:** Community residents were hired, trained to    |
| record diet information and recruit participants for the study. Up to |
| four 24 hour recalls were conducted over a one year period from each. |
| 874 dietary recalls were collected from 333 persons of both genders,  |
| age 13 to 88, from twelve villages in two areas of Alaska. Based on   |
| 24 hour recalls, a food frequency questionnaire that included the     |
| most commonly consumed foods was developed and validated.             |
| **Results:** Overall, 13% of the foods reported were Native foods;    |
| 81% of participants reported eating at least one Native food on at    |
| least one of their recalls. Compared with US Dietary Reference        |
| Intakes (DRI), it appears that intake is very low for calcium and     |
| fiber, but adequate for average intakes of vitamins A, C and folate   |
| and iron. Average daily fat intake was higher than the US (90 vs. 79  |
| g/day). Protein and carbohydrate intake exceed the DRI. Omega-3 fatty |
| acid intake from fish/sea mammals is many times higher than the       |
| general US intake. **Conclusions:** Native foods are an important     |
| part of the AN diet and contribute to the high consumption of         |
| protein, iron, and omega 3 fatty acids. Excess carbohydrates may be   |
| contributing to the rise in obesity and diabetes. Calcium and dietary |
| fiber intake are low, which may contribute to the increased incidence |
| of colon cancer.                                                      |
+-----------------------------------------------------------------------+
| **(ANTHC)**                                                           |
+-----------------------------------------------------------------------+
| **24. Authors: \*Calle A Gonzales**, James E Berner, Martina          |
| Lauterbach.                                                           |
|                                                                       |
| **Title: Prevalence of Disabilities and Mortality Among Alaska Native |
| Children**                                                            |
|                                                                       |
| **Purpose:** To describe and calculate disability and mortality rates |
| among Alaska Native children. **Methods:** A birth cohort of Alaska   |
| Native (AN) children born 1984-1988 and their deaths through December |
| 31, 1999 were identified through Bureau of Vital Statistics and       |
| infant mortality records. We analyzed ICD-9-CM codes identifying      |
| potentially disabling conditions in the cohort during this time. We   |
| reviewed electronic health summaries and medical charts to determine  |
| presence, type and severity of disability. **Results:** Among 12,567  |
| AN children, 411 died before Jan 1, 2000. The disability prevalence   |
| rate was 7% (885/12,567); the prevalence rate for a lifetime          |
| disability was 4% (507/12,567). 129 of these children had preventable |
| permanent disability. Of these preventable permanent disabilities     |
| etiologies included teratogens, unintentional injuries and            |
| infections. **Conclusions:** This is the first disability prevalence  |
| study in Native American children and will allow comparison of        |
| disability prevalence data with other pediatric populations.          |
| Implementing prevention strategies for those preventable permanent    |
| disabilities will improve the overall health of this population.      |
+-----------------------------------------------------------------------+