**NARCH 2007 at NIH: ORAL PRESENTATIONS**

**1) Preventing Pneumococcal Spread with Pneumococcal Conjugate Vaccine:
The Long-term NP Study.**\*Eugene V. Millar, Stella Cly, Virginia
Crocker, Beverly Gorman, Lorenda Samuel, Roxanne Thompson, Raymond Reid,
Mariddie J. Craig, Mathuram Santosham, Katherine L. O'Brien

**Background:** Pneumococcus is a major cause of illness and death; this
bacterium is carried in the nasopharynx of otherwise healthy humans.
Carriage can lead to invasive disease. Routine use of pneumococcal
conjugate vaccine (PCV; Prevnar^TM^) has reduced carriage and invasive
disease due to vaccine serotypes. **Methods:** We are conducting a
longitudinal study among Navajo and White Mountain Apache families.
Nasopharyngeal swabs and saliva specimens are collected monthly over a
six-month period. Serum specimens are collected at the first and last
visits. **Results:** A total of 1085 individuals (443 adults, 639
children) from 301 households have been enrolled. A total of 5048 NP
specimens, 1482 serum and 4284 saliva specimens have been collected to
date. 2378 (47%) NP specimens have been processed; 869 (37%) were
positive for pneumococcus. Less than 2% of pneumococcal isolates were
serotypes included in the PCV. **Conclusion:** Routine PCV use among
Navajo and White Mountain Apache infants has significantly reduced
carriage of strains included in the vaccine and, through this,
significantly reduced pneumococcal disease among infants and children.
Continued disease prevention rests on understanding what strains are
emerging and being spread in the community.

**For further information:** Eugene V. Millar, PhD; Johns Hopkins Center
for American Indian Health, 621 North Washington Street, Baltimore, MD
21205; (410) 955-6931 \[P\], (410) 955-2010 \[F\], email
<emillar@jhsph.edu>

**2) Legal, Social, Educational, and Mental and Behavioral Health
Characteristics of New Mexico Native American Youth Detainees.** Tassy
Parker, \*Billie Kipp, Gayle Dine'Chacon, Rebecca Ballantine, Bernie
Teba.

**Background:** New Mexico has one of the largest and fastest growing
proportions of Native Americans in its youth population. While most NM
Native youth demonstrate tremendous resilience in the face of adverse
living conditions, it is the Native youth in the state's juvenile
justice system to which we devote our investigation. Our research
continues a prior study of incarcerated Native youth with a new
collaboration by the NM agency responsible for the well-being of minors
in its custody. Together we seek prevention, intervention, and policy
strategies to "reclaim" Native detainees by systematically identifying
potential risk factors. **Methods:** Chart reviews were conducted for
all identifiable Native Americans detained in two state-operated
facilities during 2006. Our variables of interest included:
demographics; incarceration history; family/individual history of
violence, mental illness, and substance use; and education
considerations. Descriptive statistics were used for data analysis.
**Results:** All reported having used substances, median age at first
use was 14 years old. 72% had a psychiatric/mental healthy history prior
to incarceration and 84% had a substance abuse diagnosis. 43% had been
diagnosed with a mood disorder (depression, dysthymia, anxiety, phobia),
9% had a diagnosis of Post Traumatic Stress Disorder (PTSD), 9% had a
learning disorder, 61% had been diagnosed as conduct disorder and/or
oppositional defiant disorder. Eleven percent had a diagnosis of
Attention Deficit Hyperactivity Disorder (ADHD). Twenty-seven percent
were on medications at time of commitment and 36% had mental health
services planned at time of discharge. Average of age incarceration was
16.5 years. Sixty percent reported a history of domestic violence.
Seventy-two percent reported a history of familial alcoholism. Fifty
percent reported a history of physical abuse. **Conclusions:**
Longitudinal study is needed to illuminate temporal relationships among
risk factors and to suggest surveillance strategies for
prevention/intervention. Our snapshot of Native detainees suggests a
need for health, social, and legal advocacy at multiple levels both
outside and inside the juvenile justice system for youth with the
identified characteristics. Health policy that mandates early screening,
treatment, and follow-up for mental health problems among high risk
Native children is needed to reduce or prevent out of home placement.

**For further information:** Tassy Parker, PhD, RN, Assistant Professor,
Co-Director, Mental and Behavioral Health, University of New Mexico
Health Sciences Center, Center for Native American Health, 1001 Medical
Arts NE, Albuquerque, NM 87102. (505)272-9873. <taparker@salud.unm.edu>.
This research was supported with resources provided by NARCH and the UNM
Center for Native American Health.

**NARCH 2007 at NIH: POSTER PRESENTATIONS**

**1)** **Population-Based Study of Alaska Native Persons with Autoimmune
Hepatitis: Clinical Presentation, Response to Treatment and Relapses.**
Kathy J. Hurlburt MD, Brian J. McMahon MD, Stephen E. Livingston MD,
James Gove RN, Henry Cagle BS, James L. Williams, ANP

**Background:** Studies have demonstrated a high prevalence of
autoimmune hepatitis (AIH) in Alaska Native persons (AN). Clinicians
have felt these patients showed a dramatic response to treatment with
rapid drops in transaminase levels after initiating therapy. The general
consensus of scientific opinion is that achievement of remission in
adults averages 6 months or more. We conducted a review of AN diagnosed
with AIH to determine clinical presentation, how rapidly patients
responded to treatment and the frequency of relapse after treatment was
initiated. **Methods:** A review of patient records was performed from a
statewide (Alaska) registry of AN diagnosed with AIH since 1981. All
persons included met the International Autoimmune Hepatitis Group
criteria for definite or probable AIH and excluded those with overlap
syndrome. Unlike the AASLD guidelines, which define remission as ALT and
AST less than twice the upper limit of normal, we defined remission as
ALT and AST less than 40. Standard treatment was initiated with
methylprednisone 32 mg/day or prednisone 40 mg/day and azathioprine
50-150 mg/day, with a slow tapering of the corticosteroid based on
treatment response. **Results:** Eighty patients (76 women, 4 men) met
the criteria for definite (68) or probable (12) AIH. The average age at
diagnosis was 51.2 years (range 15-78). Twenty-one (26%) presented with
symptoms of acute hepatitis; 4 were diagnosed incidentally with normal
liver function tests; 4 had mild symptoms (fatigue) with transaminase
elevation, and 51 had no reported symptoms but elevated transaminases.
Ten patients were not treated and 7 treated had inadequate follow-up. Of
the remaining 63, one (1.5%) has not achieved remission; time to achieve
normal transaminase levels was 3-6 months in 7 (11%), 1-2 months in 8
(13%), and less than one month in 47 (76%). In 70 treated patients,
relapses were documented in 20 (29%): 4 were noncompliant in taking
their medications, 7 had bone marrow suppression and had to stop
azathioprine, and 9 were unable to tolerate azathioprine or the dose
could not be raised above 50 mg/day due to neutropenia. **Conclusions:**
Alaska Native persons with AIH appeared to respond more rapidly to
treatment than other reported populations, as the majority normalized
their liver enzymes within one month or less of starting therapy. The
majority of those who relapsed received inadequate dosing of
azathioprine due to intolerance, noncompliance or bone marrow
suppression.

**2) Ethical and Cultural Implications of Specimen Banking Among Alaska
Native People: Preliminary Results from Two Pilot Focus Groups.**
\*Denise A. Dillard, Jennifer K. Brown, Ruth A. Etzel

**Purpose:** This study analyzes the application of a coding scheme to
two pilot focus groups conducted as part of a larger project that will
ascertain how Alaska Native people view specimen banks. **Methods**:
Atlas.ti qualitative software was used to analyze written transcripts
from 2 focus groups using a convenience sample of Alaska Native people
(n=15). A coding scheme was created using the ethical principles and
constructs in the Belmont Report. This coding scheme was modified and
adapted as it was applied to one focus group. Primary codes included
respect for persons, beneficence, and justice. Boundary between practice
and research was also a primary code. Secondary codes within respect for
persons included information, voluntariness, and comprehension. Benefits
and harms were secondary codes for beneficence while historical
discrimination and compromised position were within justice. Two raters
independently applied the final coding scheme to the second focus group
and assessed inter-rater reliability. **Results:** The focus group
participants ranged in age from 18 to over 65 years of age and
represented six different cultures among Alaska Native people. The
participants had differing levels of education and previous
participation in research. Respect for persons was the most frequently
used primary code. The quotes depicted a clear desire of Alaska Native
people to fully understand the purposes and applications of research
when considering participation in research. Beneficence was the second
most frequently coded primary theme. Participants considered immediate
and long-term harms and benefits to self and community. Historical
discrimination and injustices and a current sense of being in a
compromised position as a people were salient secondary themes within
justice. Inter-rater reliability statistics indicated areas in which the
coding scheme needed further development. **Conclusions:** The
principles and constructs of the Belmont report appear to be meaningful
general framework to capture what Alaska Native people think about
research using stored biological specimens.

**For Further information:** Denise A. Dillard, Ph.D., Researcher,
Southcentral Foundation, 4501 Diplomacy Drive, Anchorage, AK 99508,
907-729-8518, 907-729-5464, <ddillard@southcentralfoundation.com>.

**3) Tobacco Use and Secondhand Smoke Exposure in Pregnant Alaska Native
Women during the Third Trimester.** \*Luisa P. Machuca, Laurie J.
Helzer, Jaylene Z. Wheeler, Julia Smith, Ruth A. Etzel.

**Purpose:** To describe smoking behaviors, secondhand smoke exposure
and use of smokeless tobacco in Alaska Native women during the 3^rd^
trimester of pregnancy.

**Methods:** This study was conducted at the Women's Health Clinic at
the Alaska Native Medical Center among women living in Anchorage and the
Matanuska-Susitna Valley. This analysis included 60 pregnant women who
completed a third trimester visit, provided informed consent and
answered questionnaires about their tobacco use and exposure.
**Results:** Participants' average age was 24 years (range 16 to 39
years). Eighteen women (30%) reported never smoking. Twenty one women
(35%) reported smoking tobacco before pregnancy and in their first and
second trimester and were not smoking in the third trimester. Twenty one
women (35%) reported using tobacco during their third trimester; 19 of
these women smoked a cigarette within the last 7 days. Three women (5%)
reported smoking and chewing tobacco before pregnancy and during their
first and second trimester; one of these women reported smoking and
chewing regularly throughout her pregnancy. Twenty nine women (48%)
reported that they did not use tobacco but they were exposed to
secondhand smoke. Ten women (17%) reported that they neither used
tobacco nor were they exposed to secondhand smoke in their third
trimester. None of the women who were actively smoking during pregnancy
used medications for smoking cessation purposes. **Conclusions:** Fewer
women smoked during the third trimester than during the first and second
trimester. The majority of the women in the study who were non-smokers
were exposed to secondhand tobacco smoke. Continued efforts are needed
to assist pregnant women to stop smoking.

**For Further information:** Luisa P. Machuca, MS. Research Associate,
4501Diplomacy Drive, Anchorage, Alaska 99508. 907-729-5491,
907-729-5464. lmachuca@scf.cc

**4) White Mountain Apache Tribe /Johns Hopkins University (WMAT/JHU)
NARCH Student and Faculty Development Training Project. ** Cathie M.
Frazier, Francene Larzelere-Hinton, \*Olivia-Belen Sloan, Kristen L.
Speakman, Mariddie Craig.

**Background:** Through a NARCH I award, WMAT/JHU launched a student and
faculty development program in which 93 Apache scholars and health
leaders participated in graduate coursework and workshops to design
interventions to target key health disparities and to advance skills of
Apache scientist-researchers 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 Johns Hopkins; 2) Public Health Certificate Program; 3)
Research Coordinator Course; 4) Graduate/Doctoral level training; 5)
Community Outreach and Education. **Results:** The WMAT/JHU NARCH has
made progress in each of the 5 areas. Annually, twenty (20) students
from the WMA Tribe 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 (total =20). One Hopkins NARCH staff
will enroll in an intensive Hopkins Research Coordinator Course. Two
full time graduate scholars will be recruited and enrolled at JHBSPH; in
May 2007, the first WMA tribal member graduated with an MPH degree from
Johns Hopkins. Community education programs are conducted monthly and a
summer internship program to encourage pre-college educational planning
among high school students is conducted over a 4 week period each summer
in Whiteriver, AZ.  **Conclusions:** The WMAT/ JHU NARCH Training
Program is an innovative initiative that demonstrates the impact of a
well designed training program to develop a cadre of Apache researchers.

**For Further information:** Cathie Frazier, MS, MPH. Director, Training
and Scholarship Program, 621 North Washington Street, Baltimore
Maryland, 21205. 410-955-6931, 410-955-2010. cfrazier@jhsph.edu.

**5) Patterns of Youth Suicidal Behavior Among White Mountain Apache
Tribe, 2001-2006**

\*Allison Barlow, Britta Mullany, \*Novalene Goklish, Danya Hinton,
Francene Larzelere-Hinton, Elena Varipatis Baker, Kathleen Norton,
\*Mariddie Craig, John Walkup

**Background:** American Indians (AI) suffer the highest rates of youth
suicide (\<25 years old) of any group in the United States. A lack of
tribal-specific data regarding suicide remains a barrier to overcoming
this major AI health disparity. **Methods:** Data from a
tribally-mandated, suicide registry were validated and analyzed.
Participants included White Mountain Apache Reservation residents
identified by tribal registry to die by suicide or have attempted
suicide between 2001 and 2006. **Results:** From 2001-2006, 41 deaths by
suicide were reported; annualized rate: 45.5/100,000 (95% CI=32.7,
61.7).  61% of the deaths occurred among youth. The annual suicide rate
for 15-19 year olds was 107.8/100,000 (95% CI=53.8, 192.8) and for 20-24
year olds, 151.9/100,000 (95% CI=78.5, 265.2), compared with 7.3/100,000
and 12.0/100,000 for U.S. All Races, respectively.  Hanging was the
primary method (88%) for deaths. Over 66% of attempts were among youth;
3.5% of Apache youth attempted annually. Males-to-female ratios for
suicide were 5:1, and for attempts, \~1:1. Conflict with family or
partners, and death of a loved one were most cited reasons for
attempts.  **Conclusions:** Apache youth are more likely than other
AI/AN and U.S. populations to die by suicide and to choose hanging as a
primary means of suicide. Attempt rates are also higher than registry
studies reported among other North American youth. A current study is
underway with Apache youth who have attempted suicide to learn about
mental health status, risks, precipitants and treatment preferences.
Understanding distinct suicide characteristics within AI communities is
critical to successful prevention.

**For further information:** Allison Barlow, MPH, MA, Deputy Director,
Johns Hopkins Center for American Indian Health (JHCAIH), 621 North
Washington Street, Baltimore, MD 21205 (410) 955-6931, fax (410)
955-2010, email <abarlow@jhsph.edu>

**6) CANDUR Program Native American Student Involvement in NIAAA Funded
Tribal Community Based Research.** Dan Calac, Donna Riley, Roland
Moore**,** David Gilder, Geneva Lofton-Fitzsimmons, Sheliamarie Racicot,
Tony Luna**,** Lucy Cunningham, Jamie Wolf, Rosalie Flores, Jennifer
Roberts, Breanna Siva, Nadeana Nelson, \*Stephanie Brodine.

**Purpose:** The critical need for increased numbers of Native American
scientists and health professionals motivates the NARCH initiative. One
strategy of the CA-NARCH Student Development Team has been to develop
CANDUR, (CA-NARCH Directed Undergraduate Research Program), which
encourages opportunities for applied research experiences and long term
faculty-student mentoring relationships for Native American students.
Overcoming restricted student research stipend funding, placement of
CANDUR students in funded research assistant positions for an
NIAAA-funded study at Indian Health Council (IHC), "Preventing Underage
Drinking by Southwest California Indians," provides a model in which
both Native American students and research investigators can benefit.
**Methods:** Undergraduates were selected from the CA-NARCH cohort based
on major, career interests, and logistics. Selected participants were
then trained by the IHC community team in ethics, ethnographic methods;
and survey recruitment and administration procedures. **Results:** Three
NARCH undergraduates were selected in April 2007, and within six months
the CANDUR team recruited over 100 tribal youth for a screening
interview on knowledge and behaviors regarding alcohol use. Over 20
interviews were also conducted with influential community members. The
CANDUR students report highly positive experiences, including giving
back to their community; the investigators confirm the benefits of these
students as part of their research team; and community youth and parents
have been extremely receptive to the team\'s potentially sensitive
research. **Conclusions:** Placement of Native American undergraduate
students onto funded research studies for tribal community based
research expands research positions and is mutually beneficial to the
investigators, the NARCH students, and the community.

**For Further information:** Stephanie Brodine, MD. Director, CA-NARCH
Student Development Program. 5500 Campanile Drive, San Diego, CA 92182.
619-594-0383. <sbrodine@mail.sdsu.edu>

**7) The Native Health Database:** Patricia Bradley, MLS

**Background:** The University of New Mexico Health Sciences Library and
Informatics Center collaborated with the Indian Health Service and the
National Library of Medicine to develop the Native Health Databases. The
Native Health History Database contained over 3000 documents, entry
dates ranging from 1672-1966. The Native Health Research Database
contained bibliographic information and abstracts of over 5700
health-related articles and resource documents. The database entries
date from 1966 to the present. **Methods:** The Native Services
librarian regularly searches PubMed, CINAHL and other sources for
quality health-related documents to become part of the database. In
September 2007 the Native Health History and Native Health Research
Databases were merged to become the Native Health Database. **Results:**
A single high-quality source of information on Native Health searchable
by range of years, tribe, state, article title, author, institution, and
source. **Conclusion:** The Native Health Database is the premier source
for health-related information on American Indians, Alaska Natives,
Canadian First Nations, Metis and Inuit.

**For Further information:** Patricia Bradley, Native Services
Librarian, Health Sciences Library & Informatics Center, University of
New Mexico, Albuquerque NM 87131, 505-272-0664, <pbradley@salud.unm.edu>

**8) Mood Disorder Assessment Validation with Northern Plains Indians.**
Jacqueline S. Gray\*, Angilique Gillis.

**Background:** Many psychological tests for mood disorders are used
with American Indian behavioral health clients, however; very few have
been examined to see if they are valid, reliable, and culturally
appropriate for this population. This study examines the psychometrics
of common measures of depression, anxiety and substance use with
Northern Plains Indians (NPI). **Methods:** Six hundred male and female
adult, NPI will be recruited from IHS and tribal behavioral health
clinics to complete a series of assessments. The participants will be
recruited from three groups: 1) diagnosed depressed (by clinician), 2)
diagnosed anxious (by clinician), and 3) no mental health diagnosis
(control). Each group will consist of 100 male and 100 female
participants. Participants will receive \$10 in gift/gas cards and the
tribe will receive \$5/participant for compensation. Assessments include
depression, anxiety, hopelessness, rumination, culture, quality of life,
substance abuse, substance use, demographics, and the clinician's
diagnosis code. Analysis will include comparison between groups, those
use or non-use of substances within each group, and psychometric
measures of validity and reliability for each assessment, and factor
analysis to determine if the same symptoms relate to the diagnosis for
the general population. **Results:** The Aberdeen Area Tribal Chairs
Health Board passed a resolution supporting the research. The University
of North Dakota (UND) IRB and the Aberdeen Area IHS IRB have approved
the research contingent upon a resolution from each participating tribe
and a letter of support from each participating IHS Service Unit CEO.
**Conclusions:** The approval process is a lengthy, time, and labor
intensive process that increases significantly for each added level of
approval that is required.

**For Further information:** Jacqueline S. Gray, Ph.D. Assistant
Professor, Center for Rural Health, University of North Dakota, 501 N.
Columbia Rd, Stop 9037, Room 4909, Grand Forks, ND 58202-9037.
701-777-0582, 701-777-6779. <jgray@medicine.nodak.edu>

**9) Insulin resistance in Native American Youth.** Jennifer Larsen,
Sylvia Lasley, Dezaray Varland, Ramona Zephier, James Lane, Connie
Brushbreaker, Timothy Ryschon, Judi Erickson, Junfeng Sun, Fang Qiu, and
Ron Valandra, Department of Internal Medicine and College of Public
Health, University of Nebraska Medical Center, Omaha, NE with Rosebud
Tribe and Tribal Diabetes Prevention Program, Rosebud, South Dakota

**Background:** Diabetes is increasing among Native American adolescents
more than in any other group in the U.S. today although the reasons for
this have not been established. Identifying risk is important to
diabetes prevention. We have hypothesized that depression and/or other
life stresses may contribute to risk in Native American youth.
**Methods:** To determine prevalence of diabetes and impaired glucose
tolerance, we have screened 113 of planned 300 youth 5-12 years of age
using 2h OGTT, obtaining history (e.g., family history of diabetes,
birth weight, history of breast feeding), physical (height, weight,
abdominal circumference) and biochemical markers (fasting glucose,
insulin, lipids, hsCRP, and urine albumin/creatinine ratio). Adolescents
were also screened with survey tools (life events survey, CES-D,
historical grief, post-traumatic stress, school and school bus stress,
substance use/abuse). We will also evaluate cultural affiliation as a
possible ameliorating factor and follow those with insulin resistance to
determine rate of change over time. **Results:** The results from the
first 100 youth screened (55M/45F; mean age [+]{.underline}SEM= 10 ±
0.4y) showed mean BMI%-for-age-and-sex was 78% ± 2, with 55% over
85%BMI, and 29% over 95%BMI. Mean insulin resistance score (HOMA-IR) was
3[+]{.underline}0.3 with 27% above the threshold for significant insulin
resistance in adolescents. Insulin resistance increased with BMI% (5.9
[+]{.underline} 0.8 in with BMI\>95% vs 2.4 [+]{.underline} 0.2 with
BMI\<95%; P\<0.01), and age (5-12 vs 13-19y: p\<0.01) but not sex. No
new cases of diabetes have been found; but 5% have impaired fasting
glucose, impaired glucose tolerance, or both. Parameters associated with
insulin resistance (triglycerides, blood pressure, acanthosis nigricans,
urine albumin/creatinine) were higher in those with elevated BMI and
insulin resistance. Depression risk was evaluated in 13-18y youth with
CES-D (score=16-23 defined as possible risk of mild depression;
24-60=possible risk of severe depression). Mean CES-D was 16.6 ± 1.7
(n=36), 53% had normal scores, 47% [\>]{.underline}16, and 25% \>24.
There was a trend toward higher CES-D score in those with greater BMI
and HOMA-IR, although was not yet significant (P\>0.05). There was no
association between exercise frequency and BMI%-for-age-and-sex, to
date. Other stressors have not yet been analyzed. **Conclusions:** This
preliminary data suggests that in a cohort of Native American youth,
mean BMI%-for-age-and-sex is greater than the U.S. average, and insulin
resistance increases sharply with BMI\>95%. Lack of exercise alone has
not emerged as a primary cause for obesity or insulin resistance based
on this preliminary data. However, depression may be a contributing
factor for both obesity and insulin resistance, although more data is
needed. Whether other stressors may also contribute to risk has yet to
be determined. **For further information:** Jennifer Larsen, MD,
Department of Internal Medicine, 3020 Nebraska Medical Center, Omaha,
NE, 68198-3020, jlarsen@unmc.edu

**10) Determining the Methamphetamine Threat to Wisconsin Tribes.** John
A. Dellinger, Olivia Byron-Cooper, and Kristin Hill

**Background:** Methamphetamine abuse is a major concern for tribal
officials, and Wisconsin's Division of Criminal Investigation has been
working in collaboration with tribal enforcement officials to estimate
the impact of methamphetamine and other illegal drug use. **Methods:**
During the summer of 2007, tribal law enforcement, tribal health
directors and substance abuse counselors were briefly surveyed.
Participants were asked to rank community threats for six illegal
substances (heroin, marijuana, methampthetamine, cocaine, illegal use of
prescription drugs, and club drugs), then they were asked to assess the
increase/decrease of clandestine lab activity, methamphetamine use, and
the impact on their community. After viewing the IHS video for
Methamphetamine, the volunteers then repeated their assessments and
answered three additional questions designed to assist with substance
abuse outreach and services. **Results:** Thirty participants primarily
from the targeted impacted area of northwest Wisconsin completed the
survey and watched the video. Methamphetamine concern was elevated after
watching the video, however, marijuana use was viewed as the biggest
legal concern and illegal use of prescription drugs was the second
highest concern. Education was considered to be the best way to approach
substance abuse concerns and prevention and treatment funding was the
primary obstacle. **Conclusions:** The project will be repeated during
the summer of 2008 and expanded to include epidemiology review of tribal
health data and national survey results to provide a perspective of
Wisconsin versus other Bemidje region states compared to the western
tribal experiences.

**For Further Information:** John Dellinger, PhD, GLNARCH Project
Director, P.O. Box 9, Lac du Flambeau WI, 715- 588-1033

**11) Screening for Asthma Among Children in Northern Plains Tribal
Communities.** \*Teresa K. Rodehorst, Susan.L. Wilhelm, Mary.B. Stepans,
Romaine Tobacco, Francisco delaPaz.

**Purpose**: Asthma has been identified as the most prevalent chronic
illness of childhood. Currently there are no data on the proportion of
Northern Plains tribal children with asthma who are receiving the
recommended regimen of care. The purpose of this pilot study is to test
the feasibility and utility of conducting an asthma screening
program---using both questionnaires and spirometry---for AI/AN children
in two Northern Plains tribal communities. **Methods**: Focus group
talks with tribal members were utilized to determine how best to
implement the study in their tribal communities. Children between the
ages of 6-18 years of age who are AI/AN descent will be screened for
asthma using written and spirometric measures. Evaluations and follow-up
will be through health care providers in the tribal communities.
**Results:** Results of focus group discussions indicated community
members were open to having the screening completed, however there were
issues of concern related to: l) mistrust of researchers, 2) concern
about asthma, 3) trigger identification, 4) screening follow up, 5) help
for children, and 6) education of community members. Written and
spirometric screenings have occurred in both tribal communities and
initial data indicates that half of the children screened are at risk
for asthma. **Conclusions:** These results will be important for
identifying children at risk for and assessing effectiveness of such a
screening program. Future studies need to examine interventions directed
toward assisting these children to live as normal a life as possible.

**For further information:** T. Kim Rodehorst, Ph.D., R.N., AE-C.
Assistant Professor, University of Nebraska Medical Center, 4502 Avenue
I, Scottsbluff, NE 69361. 308-632-0420, [tkrodeho@unmc.edu]{.underline}

**12) Multicenter Bronchiectasis Study: a Collaborative International
Study of Bronchiectasis in Indigenous Children.** Rosalyn Singleton,
Mehran Mosley, Greg Redding, Lori Pruitt, Pat Barrett, Nicolette Nick,
Patricia Valery, Anne Chang,

**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. High rates of bronchiectasis among
indigenous populations has led to the first collaborative international
study (Aboriginal and Torres Strait Island, New Zealand Pacific Island,
Maori and Alaskan Native people). The aims of the Observational study
are to: (1) define the clinical course of chronic moist cough with or
without infiltrates, and bronchiectasis; (2) identify the 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
in the 3 participating countries is a prospective cohort study
(2005-2010) of indigenous children aged 6 months to 8 years with
bronchiectasis or chronic moist cough. Children receive standard
clinical care. A nasopharyngeal sample for bacterial colonization is
obtained yearly. Primary outcomes are: number and rate of pulmonary
exacerbations and progression of radiologic findings. **Results:** To
date 81 children have been enrolled (35 children in Alaska). Current
respiratory symptoms among Alaskan and Australian participants show
similar patterns of cough; however, Alaska participants are more likely
than others to report wheezing (92% vs 40%). Alaska participants have
high rates of nasopharyngeal carriage with *S. pneumoniae* (84%), *H.
influenzae* (88%), and *M. catarrhalis* (72%), or all three bacteria
(60%). **Conclusion:** This is the first study to prospectively document
the clinical course of chronic moist cough and bronchiectasis in
indigenous children and evaluate factors associated with progression of
disease. The clinical trial will provide critical information about the
benefits and risks of maintenance antibiotic treatment. The project has
the potential to improve health outcomes for children with
bronchiectasis worldwide.