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1. Highlights of Division Specific Accomplishments/Activities

Outbreak Response for Prevention of Rocky Mountain Spotted Fever on Tribal Lands

(NCEZID/DVBD/RZB)

Rocky Mountain Spotted Fever (RMSF) is a serious and potentially fatal disease that emerged on 

Arizona tribal lands as early as 2003. Over 250 human cases and 18 deaths have been reported 

from tribal lands in Arizona since 2003. The incidence of RMSF in eastern Arizona is over 70 

times the national rate. The highest rates occur in children, and RMSF cases of all ages are ten 

times more likely to die in Arizona than in other parts of the country. Cases who recover from a 

severe infection may be permanently disabled. RMSF is a tickborne disease transmitted in 

Arizona by the brown dog tick (Rhipicephalus sanguineus), which thrives in areas where dog 

control is lacking. Unlike other U.S. ticks which may transmit RMSF (and are usually found in 

wooded areas), brown dog ticks are usually found in homes and yards and feed almost 

exclusively on dogs. Tribal lands in Arizona are the only known areas of the U.S. where 

epidemic transmission of RMSF from the brown dog tick is occurring, although the tick has also 

been linked to outbreaks in Mexico. Preventing RMSF and ticks bites is a very important goal 

for Arizona tribal communities, in order to save and improve the lives of tribal 

residents. Reducing ticks in the community directly translates to reduced RMSF cases in 

humans. During FY 2012, the Rickettsial Zoonoses Branch (OID/NCEZID) responded to 

requests for assistance from several tribes (Tohono O’odham Nation, Gila River Indian 

Community, Hopi Tribe, Navajo Nation, San Carlos Apache Tribe) related to RMSF assessment 

and prevention activities, as follows: 1) In November 2011, in response to the first human case of 

RMSF identified in a resident of the Tohono O’odham Nation, the tribe requested a CDC EpiAid #2012-011m to conduct a canine seroprevalence survey to identify RMSF risk throughout 

the reservation. The Epi-Aid identified widespread exposure among dogs on the reservation 

(overall rate 28.6%), and recommended broad prevention measures to control RMSF throughout 

the reservation. 2) In March 2012, in follow-up to a prior year’s Epi-Aid, Gila River Indian 

community requested assistance from the Rickettsial Zoonoses Branch to assess ongoing rates of 

canine seroprevalence on their reservation. This was not conducted as an Epi-Aid. Overall 

seropositivity was low (<5%), but evidence of recent RMSF transmission was noted, suggesting 

that additional prevention measures were needed to reduce human risk. 3) In June 2012, 

following the identification of a fatal RMSF in a Hopi tribal member who lived off-reservation, 

the Rickettsial Zoonoses Branch was invited to participate in Epi-Aid # 2012-047. This 

investigation identified the presence of RMSF exposure among reservation dogs (12.5%), but 

was not able to conclusively identify a source for the patient’s infection. 4) In July 2012, in 

response to concerns about RMSF on nearby tribal lands, the Navajo Nation requested assistance 

to evaluate its risk status through a systematic canine serosurvey spanning the reservation (EpiAid 2012-058); 16% of dogs were found to be positive. Funding – In kind (estimated $127,000 

in staff time, travel, supplies)

Rocky Mountain Spotted Fever (RMSF) Rodeo: A Demonstration Prevention Project on 

the San Carlos Apache Reservation, 2012 (NCEZID/DVBD/RZB, NCEH/DEEHS/EHSB)

The RMSF Rodeo was developed as a pilot demonstration project and carried out in a single 

community. The RMSF Rodeo was a collaborative project involving CDC/NCEZID, 

CDC/NCEH, IHS, USDA, the San Carlos Apache Tribe, the state of Arizona, and private donors 
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(Bayer, Petsmart Charities). The project received San Carlos Apache tribal approval in February 

2012. The tribe selected Peridot Heights (~600-home community) to receive the intervention, 

largely due to the high number of RMSF cases that had been reported from this community in 

recent years. Utilizing field teams composed of federal, state, and tribal staff members, the 

project delivered appropriately timed and integrated pet care and tick control techniques to every 

participating home in Peridot Heights., including the following key activities: 1) placing a new 

eight-month tick collar (the first such collar available in the U.S. and donated pre-marketing for 

the project by Bayer) on every dog; 2) treating every house in the project area once a month for 

four months with a tick-killing pesticide product; 3) creating a dog licensing and traditional 

collaring program to track dogs in the neighborhood; 4) providing free stakes and tethers to 

encourage owners to reduce pet dog roaming; 5) providing free spay-neuter services to promote 

dog population control. The project commenced in April 2012 and ran through August 2012, 

concluding with an evaluation of tick counts and knowledge in the RMSF Rodeo community, 

compared to parts of the reservation that received usual tribal RMSF prevention efforts. The 

project was highly successful, with 99% of eligible homes participating. Tick infestation counts 

dropped dramatically in the RMSF Rodeo neighborhood; at registration, only 66% of dogs were 

tick-free, but by August 2012, 99% of dogs were tick-free. In contrast, only 63% of dogs outside 

the RMSF Rodeo area had ticks during the August evaluation. Funding – In kind (Estimated 

$386,000 in staff time, travel, supplies, plus $78,000 in donated products/services)

2. Division Specific Activities

OFFICE OF THE DIRECTOR (OD) 

Office for State, Tribal, Local and Territorial Support (OSTLTS)

CDC/ATSDR Tribal Support (OSTLTS/OD)

CDC/ATSDR Tribal Support is the primary link between CDC, ATSDR, and tribal governments. 

CDC/ATSDR’s Tribal Support activities focus on fulfilling CDC's supportive role in ensuring 

that AI/AN communities receive public health services that keep them safe and healthy. The 

Associate Director for Tribal Support serves as CDC/ATSDR’s principal advisor to, and main 

liaison with, policy-level officials. The Tribal Support Unit also coordinates CDC programs and 

policies that benefit or affect AI/AN and serves as the subject matter expert on all CDC/ATSDR 

native efforts, including fulfillment of high-level speaking engagements, representing

CDC/ATSDR on interagency committees, OPDIV internal capacity building, tribal technical 

assistance, etc. Funding – No specific award for this activity

Secretary’s Intradepartmental Council on Native American Affairs (ICNAA) 

(OSTLTS/OD)

The Tribal Support Unit participated in, and provided administrative support to, ICNAA on 

behalf of CDC. Funding – $10,143

AI/AN Native Health Advisory Council (HRAC) (OSTLTS/OD)

The Tribal Support Unit provided funds to support HRAC activities, including meeting support 

and travel of tribal leaders. The HRAC provides input on research priorities. Funding – $16,700
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The American Indian, Alaska Native and Native Hawaiian Coalition (AIANNHC)

(OSTLTS/OD)

The Tribal Support Unit provided funds to support travel scholarships for native students to 

attend the annual meetings of the AIANNHC held in conjunction with the annual meeting of the 

American Public Health Association (APHA). Funding – $5,000

Tribal Winnable Battles Success Stories Compendium (OSTLTS/OD)

The Tribal Support Unit partnered with a consultant and NCCDPHP to develop tribal Winnable 

Battles success stories. One story resulted in the St. Regis Mohawk Tribe’s Centering Pregnancy 

Program receiving a national award from the National Indian Health Board for its work 

supporting and educating pregnant women. Project is ongoing. Funding – $25,000 through a 

cooperative agreement with the National Public Health Information Coalition

Tribal Grant Writing Trainings – University of Washington/Suquamish Tribe 

(OSTLTS/OD)

The Tribal Support Unit is partnering with the University of Washington School of Nursing and 

the Suquamish Tribe (Washington) on the development of grant writing trainings targeting 

tribes. Funding – No specific award for this activity

Tribal and State Health Collaborative Roundtable (OSTLTS/OD)

Tribal and state meeting took place to identify best and promising practices and successful 

collaborative relationships. Discourse led to two primers on engagement. The roundtable 

included Centers for Medicare and Medicaid Services (CMS) and members of its Tribal 

Technical Advisory Group in addition to members of the CDC Tribal Advisory Committee 

(TAC). Funding – $150, 000

“Knowing Tribal Health” Primer (OSTLTS/OD)

The Tribal Support Unit partnered with Association of State and Territorial Health Officers 

(ASTHO) to develop the "Knowing Tribal Health" primer, which provides guidance to 

state/local health officials on successfully partnering with tribal governments. Funding – No 

specific award for this activity, work product from Tribal and State Health Collaborative 

Roundtable 

Capacity Building Assistance to Improve Health in Tribal Populations (OSTLTS/OD)

 Reducing Rates of Childhood Obesity in Alaska Native/American Indian 

Populations: The Tribal Support Unit awarded funds to the Southcentral Foundation

(SCF) to assist in reducing childhood obesity among Alaska Native and American Indian 

youth in Alaska. SCF’s capacity building assistance will support a breastfeeding 

education class for pregnant women; a support group for women after childbirth; 

lactation education courses and certification for three health educators; revisions to the 

InJoy curriculum so that it is culturally relevant and teaches breastfeeding basics; the 

Snuggle Time weekly support group, through which participants share their struggles and 

joys with one another, a behavioral health consultant, and a certified lactation educator; 

and the Physical Activity Club for Kids, an after-school program for overweight and 
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obese children, led by two Alaska Native clinical exercise specialists. Funding –

$300,000

 Strengthening the Capacity of Tribal Health Departments to Implement HIV 

Prevention: The Tribal Support Unit awarded a cooperative agreement to the National 

Native American AIDS Prevention Center (NNAAPC) for capacity building and 

technical assistance to five tribal health departments. Funding will support strengthening 

organizational infrastructure and programmatic skills, providing culturally responsive 

HIV counseling, testing, and referral services, and applying a link-to-care protocol based 

upon the Antiretroviral Treatment Access Studies model. Funded tribes include the 

Confederated Tribes of the Colville Reservation (Washington), Fort Peck Assiniboine 

and Sioux Tribes (Montana), Shoshone Bannock Tribes (Idaho), Standing Rock Sioux 

Tribe (North and South Dakota), and White Earth Reservation (Minnesota). NNAAPC 

also received a supplement from NCHHSTP for STD prevention in urban Indian 

populations in Denver, CO, and Billings, MT. Funding – $288,400 (additional $200,000 

supplement from NCHHSTP)

Accreditation Support Initiative (OSTLTS/DPHPI/HDSDB)

Accreditation support to prepare for national accreditation through the Public Health 

Accreditation Board (PHAB). Partners: The Association of State and Territorial Health Officials 

(ASTHO), the National Network of Public Health Institutes (NNPHI), and the National 

Association of County and City Health Officials (NACCHO). Tribal grantees:

 Yellowhawk Tribal Health Center (Oregon) – Yellowhawk Tribal Health Center 

completed a departmental strategic plan and integrated it into the Tribal Health 

Improvement Plan. They also evaluated public health laws and developed a guide to 

assist staff and providers in understanding their roles and responsibilities in enforcement.

 InterTribal Council of Arizona, Inc. – InterTribal Council of Arizona, Inc. increased 

awareness about public health accreditation and the application process among tribes in 

Arizona, Utah, and Nevada; developed a tribal-specific accreditation readiness tool for 

conducting a community health assessment; and increased opportunities for tribal public 

health systems in Arizona to communicate and coordinate public health accreditation. 

Total funding – $65,000 through a cooperative agreement with NACCHO

Comprehensive Legal Review - San Carlos Apache (OSTLTS/OD/PHLO)

The Public Health Law Office (PHLO) conducted a comprehensive legal review and provided 

resources to the San Carlos Apache Tribe on infectious disease issues. Funding – No specific 

award for this activity

Comprehensive Legal Review - Umatilla Nation (OSTLTS/OD/PHLO)

PHLO conducted a comprehensive legal review and provided guidance and suggestions on five 

legal issues—disease reporting, prescription drug monitoring, authority to be a mental health 

provider, child abuse and neglect reporting, and the legal doctrines applicable to limiting services 

offered in a mixed community to only tribe or nation members—to the Confederated Tribes of 

the Umatilla Indian Reservation. Funding – No specific award for this activity

Public Health Law and Science – A Seminar for Tribal Judges (OSTLTS/OD/PHLO)
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PHLO conducted a seminar about infectious diseases and the law for tribal judges in Arizona.

This seminar is part of a series of judicial training sessions funded by CDC’s Office of Public 

Health Preparedness and Response (OPHPR) and implemented by the University of Pittsburgh. 

Funding – $35,000 for seminar through cooperative agreement with ASTHO, sub-award to 

University of Pittsburgh

Legal Foundations for Traditional Hunting and Fishing Rights (OSTLTS/OD/PHLO)

PHLO provided direct technical assistance to Toiyabe Indian Health Project, Inc. (California) in 

the form of a memorandum on the legal theories behind Native American tribes and nations 

exercising their traditional hunting and fishing rights in off-reservation locations. Funding – No 

specific award for this activity

ASTHO: Leadership Focus Area-Tribal Organizations Capacity Building 

(OSTLTS/OD/PSB)

ASTHO, through subcontracts, supported tribal leadership capacity building by partnering with 

the National Indian Health Board (NIHB) and Northwest Portland Area Indian Health Board 

(NPAIHB). NIHB and NPAIHB provided national leadership and program activities that 

address the following CDC priorities: Tribal Epi Centers: Expanding collaboration among Tribal 

Epi Centers; Healthy People 2020: Identifying and monitoring data for tribal-related Healthy 

People 2020 Objectives; Accreditation: Activities related to supporting and launching a national 

accreditation program; Surveillance: Analyzing and disseminating tribal data; Tribal, Federal & 

State Relations: Cultivating collaborative relationships; and Winnable Battles: Coordination of 

tribal public health initiatives. Activities were carried out in FY 2012 with funds from FY 2011. 

Funding – $585,000 (FY 2011)

National Network of Public Health – Leadership to Provide Technical Assistance for the 

Tribal Public Health Institute Feasibility Study (OSTLTS/OD/PSB)

NNPHI will provide ongoing technical assistance to Red Star Innovations as it conducts the 

feasibility study to support the development of a Tribal Public Health Institute (TPHI). Red Star 

Innovations initiated the feasibility study in May 2012. Funding – $39,998

Public Health Foundation (PHF) – Core Capacity Building (OSTLTS/OD/PSB)

PHF explored how it can better develop, deliver, and disseminate existing program management 

(PM) and quality improvement (QI) products and services for use by tribal health departments. 

PHF adapted PM and QI resources to enhance their applicability within tribal health 

departments. Funding - $59,189

Public Health Foundation (PHF) – Minority Student Outreach Pilot Project

(OSTLTS/OD/PSB)

PHF’s project was to help increase the number of minority public health professionals working 

in STLT health departments. They have conducted research and learned about tribal health 

leadership and the unique challenges that must be addressed in order to best serve tribal 

communities. Funding - $25,631
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Association of State and Territorial Health Officials (ASTHO) – Development and 

Implementation of Native Diabetes Wellness Program Traditional Foods Project Technical 

Assistance Protocol (OSTLTS/OD/PSB)

This project addressed the following priorities: Increasing diabetes prevention behaviors through 

sustained community member access to local traditional healthy foods and physical activity; 

enhancing and improving community and environmental strategies to prevent diabetes through 

sustained access to opportunities for physical activity in culturally relevant ways and in safe 

areas; and integrating physical activity with accessing local traditional healthy foods. This work 

is integrated with all of the Native Diabetes Wellness Program’s efforts to address diabetesrelated health disparities in Indian Country. Funding – $200,000

Public Health Associate Program (PHAP) (OSTLTS/OD/FSO)

PHAP is a competitive, two-year, paid CDC fellowship. A PHAP associate is assigned to a state, 

tribal, local, or territorial public health agency and works alongside local public health 

professionals. After completing the program, PHAP graduates are qualified for future jobs with 

federal, state, tribal, local, and territorial public health agencies, and are uniquely prepared to 

pursue an advanced degree in public health. Three associates are currently working at host sites 

in Indian Country: Shoalwater Bay Tribal Health Department and Wellness Center in Tokeland, 

Washington; Eastern Band of Cherokee Indians Health and Medical Division in Cherokee, North 

Carolina; and California Tribal Epidemiology Center in Sacramento, California. Funding –

Direct assistance

OFFICE OF SURVEILLANCE, EPIDEMIOLOGY AND LABORATORY SERVICES 

(OSELS)

Epi-Aid in Alaska: Yukon-Kuskokwim Health Corporation (Epi-Aid 2012-080)

(OSELS/SEPDPO/DAS/EISB, NCEZID/DPEI/AIP)

Community-acquired methicillin-resistant Staphylococcus aureus and methicillin-sensitive S. 

aureus infections are common to Southwest Alaska and have been associated with traditional 

steam baths. There is little evidence about the knowledge, attitudes, and perceptions of skin 

infections in Alaska Native people in Southwest Alaska. This information will help guide urgent 

actions needed to reduce transmission. The Yukon-Kuskokwim Health Corporation will use this 

information to identify and tailor appropriate evidence-based interventions to reduce the spread 

of infection in the specific communities. Funding – No specific award for this activity

Epi-Aid in Arizona: San Carlos Apache Reservation (Epi-Aid 2012-066)

(OSELS/SEPDPO/DAS/EISB, NCEZID/DVBD/RZB)

The San Carlos Apache Tribe in eastern Arizona reported their first human cases of Rocky 

Mountain Spotted Fever (RMSF) in 2006, and cases have been reported every year since. RMSF 

has reached epidemic status on the reservation, and two fatal cases were reported in March 2012. 

In August 2012, the EIS conducted an Epi-Aid at the San Carlos Apache Reservation in Arizona 

to evaluate an RMSF prevention program. Funding – No specific award for this activity

Epi-Aid in Arizona, New Mexico, Colorado, and Utah: Navajo Nation (Epi-Aid 2012-058)

(OSELS/SEPDPO/DAS/EISB, NCEZID/DVBD/RZB)
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In June 2012, the EIS conducted an Epi-Aid in Arizona, New Mexico, Colorado, and Utah to 

assess the risk for RMSF among the Navajo Nation. Although human cases have not been 

previously reported from the Navajo reservation, a published report in 2010 described 

seroprevalence rates to spotted fever rickettsiae among dogs as >50% on the nearby Hopi 

reservation, suggesting possible human risk on the reservation. Funding – No specific award for 

this activity

Epi-Aid in South Dakota: Oglala Sioux and Cheyenne River Sioux Tribes (Epi-Aid 2012-

051) (OSELS/SEPDPO/DAS/EISB, NCHHSTP/DSTDP/ESB)

The rates of gonorrhea and chlamydia among American Indians in South Dakota are 

disproportionately high and steadily increasing. In June 2012, the EIS conducted an Epi-Aid with 

the Oglala Sioux and Cheyenne River Sioux Tribes in South Dakota to 1) characterize the 

increases in chlamydia and gonorrhea among American Indians with respect to demographics 

and geography; 2) determine if increases in cases could be attributed to increased screening, 

changes in test technology, or other factors; and 3) identify opportunities for prevention and 

control. Funding – No specific award for this activity

Epi-Aid in Arizona: Hopi Reservation (Epi-Aid 2012-047) (OSELS/SEPDPO/DAS/EISB,

NCEZID/DVBD/RZB)

In May 2012, the EIS conducted an Epi-Aid to assess the risk for RMSF on an Arizona Hopi 

reservation after a fatal case occurred in a Hopi tribal member. Funding – No specific award for 

this activity

Clinical Characteristics and Survival of HIV-Positive American Indians

(OSELS/SEPDPO/DAS/EFAB, NCHHSTP)

This project examined the medical records of 460 HIV-positive American Indians receiving care 

at an urban IHS facility that incorporates an HIV center of excellence to conduct a survival 

analysis and examine clinical outcomes amongst this cohort. Persons from a multitude of tribes 

are included in this study because patients from a very wide geographic area, encompassing 

many states, access care at the HIV center of excellence. American Indians living with HIV are 

seldom included in HIV/AIDS studies or clinical trials and little reported data is available on the 

clinical characteristics and course of illness in this population. Collaborators included: IHS, 

CDC, and the Arizona Department of Health Services. Funding – No specific award for this 

activity

OFFICE OF INFECTIOUS DISEASES (OID)

National Center for Emerging and Zoonotic Infectious Diseases (NCEZID)

CDC/IHS American Indian and Alaska Native Health Analyses Collaborations (NCEZID)

Ongoing epidemiologic/analytical collaborative projects with the IHS, Alaska Native Tribal 

Health Consortium (ANTHC), CDC Arctic Investigations Program (AIP), and other agencies 

and CDC divisions to detect and describe disease burden and health disparities for overall and 

specific infectious diseases among the American Indian and Alaska Native (AI/AN) population. 

Analyses provide information for developing prevention strategies, vaccination policies, and 
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reducing health disparities related to infectious diseases. Findings increase awareness of specific 

infectious diseases, and highlight disease, person, and geographic target areas to further 

investigate health disparities. For example, the identification of lower respiratory tract infections 

disparities among Alaska Native children led to more in-depth respiratory studies and 

educational efforts to reduce disease among young children in Alaska.

Infectious Diseases: 1) Analysis of overall and specific infectious disease hospitalizations 

among the AI/AN population using IHS data to provide recent infectious disease hospitalization 

rates, high-risk diseases and high-risks areas to focus further study and prevention measures for 

the reduction of infectious diseases in the AI/AN population. The findings were presented at the 

World Society of Pediatric Infectious Diseases Conference. 2) Analyzed the occurrence of 

overall and specific infectious disease hospitalizations among the Alaska Native (AN) population 

using IHS data. This analysis provides recent infectious disease hospitalization rates, high-risk 

diseases and high-risks areas to focus further study and prevention measures for the reduction of 

infectious diseases in AN communities. The findings were presented at the International 

Congress on Circumpolar Health and a paper will be published.

Molluscum Contagiosum: Case/control study was analyzed to describe the epidemiology and 

risk factors that contribute to the high incidence of molluscum contagiosum among children in 

two specific AI/AN communities. This work will help target outreach and education activities 

with the long term goal of reducing disease incidence in these communities. Presentation of a 

description of molluscum contagiosum cases in the communities was given at the Native Health 

Research Conference. Analysis and presentation of risk factors is in progress.

Prion disease: Ongoing analysis of mortality data for AI/ANs with prion disease as a cause of 

death. Current available data is used to determine the occurrence of the disease among this 

population, including in chronic wasting disease endemic areas.

IHS/NDI Linkage Project: Committee member, and investigator on studies analyzing deaths 

among AI/AN infants and infectious diseases among all AI/AN deaths. Design and analysis is 

proceeding for both studies. This studies use newly created death dataset with IHS AI/AN racecorrected data which allow for more accurate calculation of death rates among AI/ANs. Health 

disparities will be examined by comparing death rates for AI/ANs with those for non-Hispanic 

whites. These studies are slated for publication.

Lymphocytic choriomeningitis virus: Medical chart review was conducted on a subset of IHS 

patients diagnosed with Lymphocytic choriomeningitis virus (LCMV) to verify diagnosis and 

estimate incidence of this rodent-borne disease. The medical chart review found that LCMV was 

diagnosed very rarely, and is thought to occur infrequently in AI/AN populations. A paper was 

submitted for publication.

Dog bite injuries: Analysis of AI/AN hospitalizations and outpatient visits for dog bite injuries 

with focus on affect related to tick-borne diseases and rabies. Dog bites were found to be a 

significant public health threat among AI/AN children living in the Alaska, Southwest and 

Northern Plains West regions, which indicate that enhanced animal control and education efforts 

should reduce dog bit injuries and emerging infectious diseases. Paper was accepted for 

publication.

Tickborne diseases: 1) Analysis of RMSF among AI/ANs using IHS inpatient and outpatient 

visit data. The incidence and high risk areas for RMSF were determined. The findings were 

published. 2) Analysis of ehrlichiosis among AI/ANs using IHS inpatient and outpatient visit 
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data. In this first analysis of ehrlichiosis among AI/ANs, incidence was estimated to describe 

trends and high risk areas. The findings were published.

Neurologic diseases: 1) Analysis of Parkinson disease-associated IHS inpatient and outpatient 

patient-based data to describe prevalence among the AI/AN population. Published paper on the 

Parkinson disease and presentation of Parkinson disease given at the Annual American Academy 

of Neurology. 2) Analyzed ALS-associated IHS inpatient and outpatient patient-based data to 

describe occurrence of ALS among AI/ANs. Paper on ALS analysis is in press.

Respiratory diseases: 1) Collaborated on an analysis of lower respiratory tract infection 

hospitalizations among AI/AN children to describe risk factors. Paper was published. Also, 

specific findings regarding Alaska Native children were presented at the International Congress 

on Circumpolar Health, and an extended abstract will be published. 2) Assisted in analysis of 

bronchiectasis outpatient visits among AN children, along with analysis of data for indigenous 

children in Australia and New Zealand. Paper submitted for publication.

Gastroenteritis: Published analysis of the occurrence of gastroenteritis hospitalizations among 

AI/ANs prior to and after the introduction of the rotavirus vaccine to describe the effect of the 

vaccine on hospitalizations. The findings underscored the importance of rotavirus vaccine among 

this population. 

Consultation and requests for specific IHS inpatient/outpatient visit analysis for specific diseases 

are conducted as appropriate. Funding – $40,000 through IAA with IHS

Arctic Investigations Program (AIP) (NCEZID/DPEI/AIP)

AIP’s program mission is the prevention of infectious disease in people of the Arctic and 

subarctic, with particular emphasis on indigenous people’s health. AIP coordinates disease 

surveillance and operates one of only two Laboratory Response Network labs in Alaska.

Sanitation services and infectious disease risk in rural Alaska: AIP assessed increased 

infectious disease risk due to lack of in-home sanitation services. These studies have been used 

to advocate for increased funding for water and sanitations services in Alaska.

Response to emergence of replacement pneumococcal disease in Alaska Native infants: AIP 

supported introduction of a new pneumococcal vaccine, PCV 13, in southwest Alaska. Usage 

results clarified that it provides protection for up to 75% of serious pneumococcal illnesses. 

Since routine use of this vaccine began in 2010, rates of serious pneumococcal infections have 

decreased in rural Alaska Native children.

High rates of pediatric dental caries in Alaska Native children: Dental caries among Alaska 

Native children represent a substantial and long-standing health disparity. Results of an AIP 

investigation concluded that pediatric dental caries are approximately five times more common 

in the region than for the general US childhood population. CDC’s Division of Preparedness and 

Emerging Infections (DPEI), along with two Alaska Native tribal health organizations, is 

conducting a cost-effectiveness study of caries prevention strategies. AIP is also working to 

establish a caries surveillance system using electronic health records in collaboration with a 

tribal health organization in southwest Alaska.

Support for Alaska Native health research: AIP promotes research activities by tribal health 

organizations and supports Alaska Native/American Indian health researchers.

Responding to pandemic H1N1 influenza in AI/AN populations: AIP has been addressing the 

increased influenza mortality among AI/AN people by leading a five-state investigation into risk 
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factors for deaths. The study data have been collected and are undergoing analysis. Results to be 

released in 2013.

Skin and soft tissue infections in rural Alaska: In 2012, The Yukon Kuskokwim Health 

Corporation, a tribal health organization in southwest Alaska, requested CDC assistance through 

an Epi-Aid mechanism to improve prevention and control of skin and soft tissue infections 

caused by methicillin-resistant Staphylococcus aureus. AIP responded with a three-week field 

investigation in the villages with the highest rates of infection. An intervention plan will be 

developed and implemented in 2013.

Joint Alaska Immunization Committee: Quarterly meetings in Anchorage focused on 

harmonization of statewide immunization policy, vaccine handling procedures, data sharing, and 

education of immunization program staff and the public. Attendees included: ANTHC 

immunization program, State of Alaska Immunization Program, Public Health Nursing, and AIP 

(NCEZID).

Funding – $3.1 million

National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP)

Alaska Native Tribal Health Consortium (NCHHSTP/DVH)

These funds are used to improve efforts to prevent hepatitis A and B through vaccination in 

Alaska Natives and to study interventions to reduce mortality and morbidity from chronic 

hepatitis B and C in this population. Funding – $369,661 

Capacity Building Assistance (CBA) To Improve the Delivery and Effectiveness of Human 

Immunodeficiency Virus (HIV) Prevention Services for High Risk and Racial/Ethnic 

Minority Populations (NCHHSTP/DHAP)

 Colorado State University – Fort Collins – American Indian/Native American awardee,

Funding – $401,787

 The National Native American AIDS Prevention Center (NNAAPC), Funding –

$401,787

 Great Plains Tribal Chairmen's Health Board (Aberdeen Area Tribal Chairmen's Health 

Board), Funding – $351,938

Comprehensive HIV Prevention Programs for Health Departments (NCHHSTP/DHAP)

NCHHSTP indirectly funded American Indian/Alaska Native awardee through health 

departments. Funding – $2,549,980

Human Immunodeficiency Virus (HIV) Prevention Projects for Community-Based 

Organizations (NCHHSTP/DHAP)

Indigenous People’s Task Force, Funding – $306,306

OFFICE OF NONCOMMUNICABLE DISEASES, INJURY AND ENVIRONMENTAL 

HEALTH (ONDIEH)
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National Center for Environmental Health (NCEH)/Agency for Toxic Substances and 

Disease Registry (ATSDR)

Working Effectively with Tribal Governments Training Course (NCEH/ATSDR/OD/OTA)

Hosted a “Working Effectively with Tribal Governments” training course for employees on 

August 22-23, 2012. The purpose of the course was to provide an overview of American 

Indian/Alaska Native (AI/AN) history to provide context for the complex environmental public 

health (EPH) issues that tribes face in the present day. Funding – $9,000 through a cooperative 

agreement with APHA

National Tribal Environmental Health (NTEH) Think Tank (NCEH/ATSDR/OD/OTA)

The primary purpose is to 1) characterize the priority environmental public health (EPH) issues 

facing tribal communities, 2) determine which NCEH/ATSDR divisions and branches are best 

suited to address these issues, and 3) offer actionable recommendations for NCEH/ATSDR 

leadership on how best to collaborate and engage with tribes on the selected issues. Key partners 

include the Great Lakes Inter-Tribal Epidemiology Center; Navajo Epidemiology Center; Alaska 

Wilderness League; Great Lakes Inter-Tribal Epidemiology Center; Pechanga Band of Luiseno 

Indians; Shoshone Bannock Tribe; Oglala Sioux Tribe; Great Plains Tribal Chairmen’s Health 

Board; Menominee Nation; Ho-Chunk Nation; Navajo Nation; Tohono O’odham Nation; 

Woman is the First Environment Collaborative; Poarch Band of Creek Indians; Native American 

Health Center. Funding – $100,000 through a cooperative agreement with APHA

A Prospective Birth Cohort Study Involving Environmental Uranium Exposure in the 

Navajo Nation (ATSDR/DTHHS/EEB, NCEH/DLS/IRATB)

The purpose of this study is to evaluate environmental uranium exposure by recruiting Navajo 

mothers, assessing their uranium exposure at key developmental milestones, and following the 

children post-birth to assess any associations with birth defects or developmental 

delays. Extensive uranium mining and milling have occurred in the Navajo Nation during the last 

half century. While there have been many studies of environmental and occupational exposure 

to uranium and associated renal effects in the adult population, there have been very few studies 

of other adverse health effects. There is limited epidemiologic and toxicological information 

indicating that uranium may pose a risk to the developing fetus. Applied public health objectives 

of the study are to provide health education to help mitigate uranium exposure, to increase 

prenatal care utilization among Navajo mothers, and to deliver earlier assessment and referral for 

identified developmental delays. Funding – $2,000,000 through the University of New Mexico

National Center for Environmental Health (NCEH)

Bisphenol A and Speciated Biomonitoring in a Native American Community / Association 

of BPA, Arsenic levels, and Diabetes among persons living in the Cheyenne River Sioux 

Tribe (NCEH/DEHHE/HSB, NCEH/DLS/IRATB)

The goal of this study—conducted in collaboration with the Cheyenne River Sioux Tribe 

(CRST)—is to determine Bisphenol A (BPA) and speciated arsenic concentrations in a Native 

American population and potentially associated health effects. BPA and arsenic exposure may be 

associated with adverse health effects such as diabetes, hyperlipidemia and obesity. Genetics 
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may play a role in this association. Biomonitoring results of urine BPA and speciated arsenic 

levels were found to be similar to the NHANES US population. Further data analysis is 

underway for associations of biomonitoring results and diabetes status. The Division of 

Laboratory Sciences (DLS), Inorganic and Radiation Analytical Toxicology Branch (IRATB), 

Inorganic and Radiation Analytical Toxicology, Organic Analytical Toxicology, and Clinical 

Chemistry Laboratories provided supplies and conducted urine analysis for the study. Funding –

No specific award for this activity

Addressing Asthma from a Public Health Perspective, Washington State Asthma Program 

(NCEH/DEHHE/APRHB)

The Washington State Department of Health (WDOH) is collaborating with the Port Gamble 

S’Klallam Tribe to develop and test a model tribal asthma home visit program, which may then 

be replicated by other tribes around the state. This population experiences significant disparities 

in their overall burden of asthma and related risk factors. Asthma home visits, combining home 

environmental assessment, trigger reduction, and self-management education, are an evidencebased strategy for improving asthma health outcomes. They are also well suited to tribal health 

care delivery systems, which make extensive use of community health workers. The goals of this 

project are to reduce asthma-related health disparities in tribal communities, as measured by 

emergency department visits, hospitalizations, symptom days, and missed school/work; build 

skills and capacity within Washington tribes to address asthma; and develop an effective, 

replicable, and sustainable model for a tribal asthma home visit program. The tribal asthma home 

visit project has generated interest and spread to other tribes in Washington. Both the Suquamish 

and Lower Elwha Tribes have contacted WDOH about starting their own asthma home visit 

programs. Both tribes plan to integrate the visits into their current home visit programs. In March 

2011, WDOH staff provided a combination of asthma educator and master home 

environmentalist training to Suquamish staff. Funding – $98,920 through a cooperative 

agreement with WDOH

Addressing Asthma from a Public Health Perspective, Minnesota Asthma Program

(NCEH/DEHHE/APRHB)

This intervention is intended to ensure that American Indians with asthma, their families, and 

other caregivers are well-informed and engaged in appropriate asthma self-management,

including written asthma action plans and assessment of environmental triggers of asthma. 

RETA stands for “reducing environmental triggers of asthma,” and the program is referred to as 

Tribal-RETA (Reducing Environmental Triggers for Asthma). This project will occur in the 

White Earth Nation reservation. The Minnesota Department of Health program staff will work 

with White Earth Health Clinic staff to connect with public health nurses and environmental staff 

serving White Earth tribal members and will discuss potential partnerships to implement the 

Tribal RETA program. The evaluation of the Tribal-RETA interventions will determine whether 

it is feasible to expand the established asthma home visit program to elders with asthma. It will 

also determine the contribution of the Tribal-RETA program to improvements in asthma 

outcome measures for the tribal population. Funding – $108,330 (including $34,882 funded to 

the contractor for the project: White Earth Health Clinic) through a cooperative agreement with 

Minnesota Department of Health
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Nicotine Exposure and Metabolism in Alaska Native Adults Research Study

(NCEH/DLS/ERATB)

The Division of Laboratory Sciences (DLS) Emergency Response and Air Toxicants Branch 

provided in-kind laboratory analysis via agreement with the Alaska Native Medical Center 

(ANMC)/IHS on a cross-sectional study to generate information on nicotine and carcinogen 

exposure in underserved Alaska Natives. DLS completed chemical analysis of Alaskan iq’mik, a 

native smokeless tobacco mixture that combines tobacco and fungus/plant ash, and performed 

measurements in urine for cotinine (a nicotine byproduct). Select findings were published in FY 

2012. Funding – In kind, laboratory analysis through a grant with IHS

National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP)

National Breast and Cervical Cancer Early Detection Program (NBCCEDP)

(NCCDPHP/DCPC)

CDC's NBCCEDP provides access to breast and cervical cancer screening services to 

underserved women. Funded programs include: Arctic Slope Native Association, Funding –

$561,519; Cherokee Nation Health Service Group, Funding – $846,660; Cheyenne River Sioux 

Tribe, Funding – $409,708; Hopi Tribe, Funding: $516,917; Kaw Nation of Oklahoma, Funding 

– $369,358; Native American Rehabilitation Association, Funding – $488,163; Navajo Nation, 

Funding – $871,458; Poarch Band of Creek Indians, Funding – $86,150; South Puget Intertribal 

Planning Agency, Funding – $508,752; Southcentral Foundation, Funding – $1,339,709; 

Southeast Alaska Regional Health Consortium, Funding – $670,000; Yukon-Kuskokwim Health 

Corporation, Funding – $615,000

National Comprehensive Cancer Control Program (CCC) (NCCDPHP/DCPC)

CCC is a cost-effective approach that brings key stakeholders together to develop and implement 

population-based public health approaches to reduce the burden of cancer. Grantees are funded 

to develop and implement policy, systems-level or environmental changes aimed at preventing 

cancer, detecting cancers early when they are more treatable, increasing access to treatment, and 

improving the quality of life of cancer survivors. 

 The Northern Plains Comprehensive Cancer Control Program (NPCCCP) was established 

in July 2005. NPCCCP has initiated, facilitated, and assisted in several projects. It has

leveraged numerous partnerships at various governmental, university, medical, and local 

organizational levels and work continuously to foster these partnerships while identifying 

new ones. NPCCCP is currently in the planning stages for the revision of a Cancer Plan. 

NPCCCP works very closely with the Northern Plains Tribal Cancer Data Improvement 

Initiative and assists in conducting data collection, analysis, and surveillance activities. 

Funding – $342,810

 With the support of Fon du Lac (FDL) Wiidookaage Cancer Team members, FDL 

Human Services Department (HSD) staff, FDL Tribal Leadership, FDL community 

members, and several external cancer partners continued to expand implementation of the

Fond du Lac Band of Lake Superior Chippewa Wiidookaage Cancer Plan 2007-2012.

The program maintained contact and mutually beneficial interaction with the 39 cancer 

partners from tribal, local, state, and national cancer-related agencies and piloted the 

National American Cancer Society's revised "Circle of Life" program during fall 2010. 
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The revisions were based, in part, on Fond du Lac's model, "Circle of Life Plus," adding 

all screenable cancers, supportive resources information and cancer prevention 

information to the previously breast and cervical cancer-focused program. The new 

"Circle of Life" will be introduced nationwide in 2011 to interested tribal programs. Fond 

du Lac Band of Lake Superior Chippewa Wiidookaage Cancer Plan 2007-2012. Funding 

– $261,346

 Other funded programs include: Cherokee Nation Health Service Group, Funding –

$379,019; Alaska Native Tribal Health Consortium, Funding – $326,132; Northwest 

Portland Area Indian Health Board, Funding – $300,000; South Puget Intertribal 

Planning Agency, Funding – $275,000; Tohono O’odham Nation, Funding – $177,575

Colorectal Cancer Control Program (CRCCP) (NCCDPHP/DCPC)

The CRCCP's goal is to increase colorectal (colon) cancer screening rates among men and 

women aged 50 years and older from about 64% to 80% in the funded states by 2014. The 

program provides population-based approaches to increase colorectal cancer screening rates 

among the U.S. population 50 years of age and older through policy and health systems change, 

outreach, case management, and limited provision of direct screening services. Funded programs 

include: Arctic Slope Native Association Unlimited, Funding – $362,205; Alaska Native Tribal 

Health Consortium, Funding – $750,000; South Puget Intertribal Planning Agency, Funding –

$650,000; Southcentral Foundation, Funding – $740,520

Tribal BRFSS Project (NCCDPHP/DCPC)

The purpose of this Intra-Agency Agreement (IAA) is to support the Tribal BRFSS Project at 

Northwest Portland Area Indian Health Board (NPAIHB). The objective of this project is to 

provide tribal grantees of the National Comprehensive Cancer Control Program with accurate 

health behavior data that is not readily available through the state BRFSS for tribal communities 

so that programs can use these data to assess cancer risk factors for their population and monitor 

progress toward reaching cancer plan objectives. NPAIHB will be subcontracting with 

InterTribal Council of Arizona to support a Tribal BRFSS Project with the Tohono O’odham 

Nation. Funding – $280,000 through an IAA with IHS

Enhancing Cancer Prevention and Control Programs for American Indian/Alaskan Native 

Women (NCCDPHP/DCPC)

As part of Native American Cancer Research Corporation's (NACR) ongoing CDC grant, NACR 

is coordinating two regional meetings each grant year. NACR will be implementing and 

evaluating 10 Regional Planning Conferences/working meetings in collaboration with local 

public health professionals and organizations that actively work with American Indian or Alaska 

Native (AI/AN) organizations and communities. NACR will address gaps in AI/AN cultural 

awareness materials (including designing, developing, and distributing AI/AN culturally

appropriate public education and awareness materials). This includes one Native Wellness 

booklet annually and one case study annually. NACR will provide technical assistance related to 

cultural appropriateness and awareness, as approved by the CDC, to states' IHS, tribal, and urban 

programs, and others, on an as needed basis. Lastly, NACR will implement and evaluate cultural 

awareness trainings. Funding – $400,000
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EARLY ACT AI/AN Project -"Walking Together: Making A Path Toward Healing"

(NCCDPHP/DCPC)

The purpose of this IAA is to support the Phoenix Indian Medical Center Oncology Program in

identifying and describing the impediments to care faced physically, psychologically, and 

spiritually by young AI/AN women diagnosed with breast cancer under the age of 45, from their 

own viewpoints. Through focus groups, the patients’ understanding of the barriers they faced in 

getting care, as well as their viewpoints regarding services available or unavailable to them, will 

be studied. The information gathered will be used to develop recommendations for targeted 

interventions that will address common concerns in these patients’ breast cancer journeys. 

Funding – $112,347 through an IAA with IHS, Phoenix Indian Medical Center

Tribal Tobacco Control Program to Reduce Tobacco Use Among American Indians and 

Alaska Natives (NCCDPHP/OSH)

The Nez Pierce Tribal Commercial Tobacco Abuse Prevention Program implements evidencebased strategies to reduce tobacco abuse among tribal members. Program staff members partner 

with the Idaho Tobacco Control Program, Project Filter for training activities, developing 

culturally appropriate messaging, and strategies for encouraging tribal members to use the Quit 

Line and other cessation services. The Nez Perce Program has met several milestones, including 

establishing a tobacco control coalition with representation from the Tribal Community Health 

Center, Diabetes Program, Tribal Police, Tribal Housing Authority and the Nez Perce Tribal 

Executive Committee. In addition the program is educating several tribal agencies on the health 

benefits of strengthening and enforcing their existing smoke-free workplace policy. The program 

partnered with the school district to enforce their closed campus policy at the high school to 

discourage students from leaving campus to purchase and smoke cigarettes. Also, the program 

has implemented the American Indian Adult Tobacco Survey successfully. Funding – $200,000

Black Hills American Indian Health Center (NCCDPHP/OSH)

The Black Hills American Indian Health Center is collaborating with the Navajo Nation Division 

of Health and the Navajo Indian Health Service to modify the Navajo Nation Youth Risk and 

Resiliency Survey. The Center collaborates with the Navajo Epidemiology Center (Navajo 

Nation Division of Health) for program evaluation services. The Center specializes in supporting 

decision making on significant health and social issues by providing evaluation services, with a 

recent emphasis on tobacco prevention and control. Funding – $250,000

Cherokee Nation Tobacco Program (NCCDPHP/OSH)

Partners with schools, communities, worksites, and health care settings within the Cherokee 

Nation tribal jurisdictional area to implement policy, systems, and environment change. The 

program goal is to make Cherokee Nation citizens healthier by making the healthy choice the 

easy choice for all tribal citizens. The program partners with the Oklahoma State Health 

Department to administer the Youth Tobacco Survey in schools located inside of Cherokee 

Nation jurisdiction and provides technical assistance to 112 elementary, middle and high schools 

implementing 24/7 school tobacco-free policies in the 14-county Tribal Jurisdictional Service 

Area. It also collaborated with the tribal health care system to implement the clinical practice 

guidelines for tobacco dependency and document interventions on the electronic medical 

records, among other public health activities. Funding – $200,000
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Great Plains Tribal Chairmen's Health Board (NCCDPHP/OSH)

The Great Plains Tribal Chairmen's Health Board collaborates with 18 tribes located in four 

states to implement culturally appropriate interventions to reduce commercial tobacco use. The 

project conducted several public health surveys and established a broad-based community 

coalition to facilitate communications, information sharing, and action plan development in tribal 

communities, among other public health activities. Funding – $232,670

Inter-Tribal Council of Michigan (ITCM) (NCCDPHP/OSH)

The ITCM partners with seven Michigan tribes to reduce commercial tobacco use by building 

the capacity of the tribes to maintain a surveillance system, educate tribal members about the 

health impact of tobacco use, incorporate a physician reminder system in the existing medical 

assessments, implement the American Indian Adult Tobacco Survey, and strengthen and enforce 

existing smoke-free policies. The program, in collaboration with the Michigan Public Health 

Institute Evaluation team and the seven funded Michigan tribes, developed a tobacco control 

surveillance and monitoring system, among other public health activities. Funding – $232,670

Muscogee Creek Tobacco Program (NCCDPHP/OSH)

The Muscogee Creek Tobacco Program is focused on reducing commercial tobacco abuse 

among tribal members, engaging tribal elders, leaders, and communities in activities that will 

encourage tribal members who use tobacco products to quit, and collaborating with partners to 

eliminate youth access to tobacco products through various strategies. They have partnered with 

multiple state and local partners on their multi-dimensional activities. Funding – $250,000

National Network for Commercial Tobacco Use (NCCDPHP/OSH)

The National Network for Commercial Tobacco Abuse Prevention (National Native Network) 

Program is designed to build the capacity of tribal tobacco control programs. This goal is 

achieved by recruiting individuals and organizations to facilitate learning and information 

sharing across and within Indian Country. Funding – $400,000

SouthEast Alaska Regional Health Consortium (SEARHC) (NCCDPHP/OSH)

SEARHC is a non-profit, Native-administered health consortium that represents the health care 

needs of Tlingit, Haida, Tsimpshian and other Native and rural-dwelling people of Southeast 

Alaska. In collaboration with the State of Alaska Tobacco Prevention and Control Program, 

SEARHC brought forward a resolution in support of a statewide smoke-free workplace law at 

the 2011 Alaska Federation of Natives (AFN) Convention to support healthy lifestyle. The 

resolution was passed by delegates of the convention and solidifies tribal leader support for 

smoke-free workplaces. Funding – $250,000

Tanana Chiefs (NCCDPHP/OSH)

The grantee described sustained efforts to promote smoke-free facilities for the Tanana Chiefs 

Conference (TCC) in the spring of 2012. The patient and sustained work, as well as the strong 

example of statewide Alaska Federation of Natives tribal leaders who passed a resolution of 

support for statewide smoke-free workplaces, resulted in the TCC Full Board of Directors 
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supporting the TCC tobacco-free policy. This will provide a foundation for working with tribal 

leaders in the villages to promote health effects of smoke-free air. Funding – $250,000

Tribal Tobacco Control Program to Reduce Community Tobacco Use among American 

Indians and Alaska Natives (NCCDPHP/OSH)

The Nez Pierce Tribal Commercial Tobacco Abuse Prevention Program implements evidencebased strategies to reduce tobacco abuse among tribal members, including administering the 

American Indian Adult Tobacco Survey. The Nez Perce Program has met several milestones, 

employing partnership with various tribal departments on their public health approaches.

Funding – $200,000

WISEWOMAN (NCCDPHP/DHDSP)

Southcentral Foundation (SCF) provides services to AI/AN women at the Anchorage Native 

Medical Center and the Valley Native Primary Care Clinic. SCF was recognized by the 

American Public Health Association for making WISEWOMAN screening a standard of care for 

all women 40-64 years old presenting for their annual exam and/or a clinical breast exam.

Funding – $427,823

WISEWOMAN (NCCDPHP/DHDSP)

The Southeast Alaska Regional Health Consortium (SEARHC) provides services to AI/AN

women representing 18 tribes in Southeast Alaska. Funding – $581,427

Support for Maternal and Child Health Epidemiologist (NCCDPHP/DRH)

DRH provided support for a lead maternal and child health epidemiologist assigned to the 

Northwest Tribal Epidemiology Center. Epidemiologist provides consultation, technical 

assistance, surveillance, and analysis of epidemiologic information. Funding – $100,000 through 

NPAIHB

Partial support for Public Health Advisor (NCCDPHP/DRH)

DRH provided partial support for a public health advisor assigned to the IHS, Division of 

Epidemiology and Disease Prevention; working in maternal and child health, reproductive 

health, and STD prevention. Funding – $60,586 through IAA with IHS

Food is Good Medicine (NCCDPHP/DDT)

"Food is Good Medicine" offers a model that embraces traditional foodways, physical activity, 

and community empowerment. Featuring the local traditional staple food, tanoak acorn, the "Got 

Acorns" Campaign was developed and launched to promote the health benefits of traditional 

foods and foodways. Young adults participating in the Leadership Program were empowered to 

explore their identity, interview elders and youth significant in their lives, and create digital 

stories that will be shared at community events. Funding – $100,000 through United Indian 

Health Services

Tohono O'odham Food, Fitness & Wellness Initiative (NCCDPHP/DDT)

The Tohono O’odham Food, Fitness, and Wellness Initiative increases knowledge of and access 

to traditional foods, while engaging the Indian-Oasis Baboquivari Unified School District 
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(IOBUSD) and tribal legislation in policy change to improve school health environments. 

Through strengthened partnerships with IOBUSD and Head Start, traditional foods were offered 

in meals and snacks at least weekly during the school year (2010-2011). Trainings and 

educational workshops were offered to teachers and cooks. Y.O.U.T.H members continue to 

demonstrate leadership and innovative approaches to education, youth engagement, and other 

Tohono O’odham Community Action (TOCA) endeavors. Funding – $100,000

The Native Gardens Project: An Indigenous Permaculture Approach to the Prevention and 

Treatment of Diabetes (NCCDPHP/DDT)

By reclaiming cultural knowledge and traditions of companion gardening through their Native 

Gardens Project, the Standing Rock Sioux Tribe strives to prevent diabetes and contribute to a 

better quality of life for individuals and families living with diabetes. The Nutrition for the 

Elderly Program Advisory Council, the Standing Rock Special Diabetes Program, the state and 

county Extension Service, Sitting Bull College, and other partners support the Native Gardens’ 

efforts to make local foods from farms and family gardens available and accessible. In 

collaboration with the USDA Nutrition for the Elderly program, the program documented that 

60% of 3000 vouchers distributed to elders generated $9,000 in 2010, encouraging local, 

certified farmers to keep growing. Through 4-H and Boys and Girls Clubs, youth are engaged,

gathering berries and other wild edibles on hikes. Well-advertised “Winter” and “Summer” 

markets consistently operate, providing opportunities to preserve food and share stories through 

the cold months of winter. Funding – $100,000

Siletz Healthy Traditions Project (NCCDPHP/DDT)

The Confederated Tribes of Siletz Indians' (CTSI) “Siletz Healthy Traditional Project” promotes 

health and prevention of diabetes through traditional foods and sustainable ecological approaches 

in the Siletz Indian community, engaging the local communities in identifying and sharing 

healthy traditional ways of eating, physical activity, communicating healthy messages and 

supporting efforts for diabetes prevention and wellness. The program emphasizes traditional 

foods education, growing, harvesting, and preserving of locally grown/caught foods, engagement 

of community leadership to facilitate food behavior changes, and preserving wisdom through 

collection of traditional stories. Participation in the program is expected to increase as more 

tribal members learn about the Healthy Traditions project and what resources are available to 

them. The Steering Committee is currently working on developing healthy policies for CTSI and 

suggestions to be included in the 2015-2025 Comprehensive Plan. Funding – $100,000

WISEFAMILIES through Customary and Traditional Living (NCCDPHP/DDT)

WISEFamilies Traditional Foods program supports community-driven programs that help people 

adopt healthy lifestyles. The program builds on traditional ways of eating, being active, and 

communicating by storytelling. All activities are developed with the goal to prevent chronic 

illness. Prior to the CDC Traditional Knowledge program, tribal members have expressed 

concern that the “old ways” of gathering and preparing traditional foods were being lost. The 

Wrangell program has impacted 85% of Alaska Native families in the community and the media 

exposure has included near weekly newspaper articles and numerous stories on the local radio 

station. Members of the Local Community Advisory Board have commented on how 
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instrumental this program has been for invigorating the community’s awareness of traditional 

foods and the importance it plays in health and culture. Funding – $100,000 through SEARHC

Uniting To Create Traditional and Health Environments (NCCDPHP/DDT)

The Sault Ste. Marie (SSM) Tribe of Chippewa Indians, “Uniting To Create Traditional and 

Healthy Environments” Project serves seven county service units. Partnership and collaborations 

with other tribal programs and surrounding health services help the project organize, support,

and serve SSM Tribal members. The project has created a Healthy Traditions Advisory Council 

(HTAC), which will help the project to carry out traditional foods, social support and physical 

activities and/or events, such as berry picking camp, workshops, training master preservers, 

implementing garden projects, building a Hoop House, implementing the harvest feast 

celebration, involvement in the local farmer’s market, fitness promotion, policy change for 

healthier food fundraising event, and digital storytelling. Funding – $100,000

Wiconi Unki Tawapi - Healing Our Live (NCCDPHP/DDT)

The program focuses on educating Santee Sioux Nation tribal members on the importance of 

traditional healthy foods and physical activity/exercise by the use of traditional techniques and 

teaching traditional practices. This will be accomplished through a variety of activities such as

gardening, canning and pressure-cooking classes, diabetes classes, diabetes awareness activities 

(booths, health fairs), weight loss classes, and the Young Braves Program. Funding – $100,000

Traditional Living Challenge in Contemporary Times: Indigenous Knowledge for 

Community Wellness (NCCDPHP/DDT)

Salish Kootenai College is building on programming that focuses on physical activity in relation 

to traditional foods gathering efforts. The overall project activities are blending the ancestral 

wisdom of traditional foods and lifestyles with contemporary realities. Two major components 

regarding traditional foods will be utilized to support active healthy lifestyles and physical 

activities based on traditional activities with a focus on youth. First will be activities surrounding 

the permaculture of indigenous plants. Second will be continuation of the Ancestors’ Choice 

social marketing campaign to promote a healthy diet and lifestyle for the prevention of type 2 

diabetes. Funding – $100,000

Old Ways for Today's Health: Red Lake Traditional Foods Project (NCCDPHP/DDT)

Red Lake Nation’s Old Ways for Today’s Health: Red Lake Traditional Foods Project works to 

reinstate the consumption of a traditional healthy diet at the Red Lake Nation utilizing family 

and community gardens, traditional food gathering encampments such as fishing, berry picking, 

hunting, wild ricing and maple sugar gathering, and cooking camps. The project will collaborate 

with partners, including the tribal diabetes programs, Chemical Health, and community center 

boards to provide community education through media, demonstrations, and community 

participation. Through the traditional foods gathering activities, Red Lake Nation members have 

an increased opportunity to be physically active. The level of physical activity is dependent on 

the type of activities associated with gathering these foods. Deer hunting and buffalo canning has 

the lowest level of exertion of energy while berry picking and sugar bushing require a high level 

of physical energy for an extended period of time. With a total of 120 participants in activities 
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during the first six months of Year 2, there has clearly been an increase in community members 

being physically active. Funding – $100,000

Empowering Ramah Navajos to Eat Healthy (ERNEH) (NCCDPHP/DDT)

This Project provides materials, training and technical assistance to families to help them grow 

fresh vegetables in their own yards by using conventional in-ground gardens, developing raised 

bed gardens, or planting in commercially-viable garden boxes. The project also encourages 

physical activity and works to improve access to a greater variety of physical activities through 

community support. The project also provides technical assistance and training regarding food 

use, preservation, and selling excess produce. Finally, the book, "Traditional Navajo Foods & 

Cooking," will be updated, first published by the Ramah Navajo School Board in 1983. Fortyfive community members participating in the gardening project have increased access to healthy 

traditional food fully as a result of the efforts of the ERNEH Project; another fifty-nine have 

increased access partially as a result of project efforts. Sixty-seven Honor Walk participants have 

increased access to information about traditional food fully as a result of the ERNEH Project.

Funding – $100,000

Return to a Healthy Past (NCCDPHP/DDT)

“Return to a Healthy Past” (RTHP) has reintroduced traditional foods and physical activities in 

the Prairie Band of Potawatomi Nation to promote health and prevent diabetes, among other 

chronic conditions. Serving as a model for rural and urban communities, RTHP has established 

gardens, increasing production and access to traditional produce. Through partnerships with the 

Land Department, Tribal Council, local hunters and the Diabetes Prevention Program, a wider 

variety of indigenous produce and meats were offered in diabetes education courses, Elders’ 

Center and Language Department gatherings and the Fall Harvest Feast. Traditional forms of 

physical activity have been broadened through nature hikes, camping trips, and gardening 

activities. RTHP continues to engage tribal members of all ages who are at risk for or living with 

diabetes. Community members have increased access to traditional and other physical activities 

due to their exposure to this project’s activities, such as hiking to identify wild plants and 

traditional foods, including wild onions, milk weeds, etc., and individual/family gardens.

Funding – $100,000

Listen to the Elders Project (NCCDPHP/DDT)

The Nooksack Indian Tribe’s Listen to the Elders Project involves gardening and planting, 

distributing garden-related materials, increasing community knowledge, awareness and use of 

traditional foods, and increasing physical activities, such canoeing and hunting. Funding –

$100,000

Indian Health Care Resource Center of Tulsa: Strengthening Traditional Ties

(NCCDPHP/DDT)

The program encourages American Indian families to eat nutritious diets and adopt healthy 

active lifestyles. Families participate in school-based health, nutrition, and physical education 

programs, including summertime wellness camps and a theatrical production. The program also 

engages in policy advocacy, and educational programs that emphasize healthy lifestyle choices 

within the context of traditional cultural practices, such as expanding existing and creating new 
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neighborhood and school-based gardening projects. "Building Community" established 

gardening partnerships with two local elementary schools, summer camp programs featuring the 

Coordinated Approach To Child Health curriculum, and worked with state policy makers in 

Oklahoma on healthy food initiatives to address the problem of food deserts. Funding – $100,000

Aleut Diet Program (NCCDPHP/DDT)

The Aleut Diet Program includes sustainable hands-on activities focusing on the healthy 

preparation and utilization of local traditional foods. The purpose of these activities is to promote 

health and prevent type 2 diabetes in the Aleutian and Pribilof Islands Region of Alaska. The 

program focus is to improve the nutritional health of people in the region through increased 

awareness of the benefits of traditional foods and the important role these foods play in reducing 

rates of dietary-related diseases such as diabetes, obesity, cancer, heart disease, hypertension, 

and dental caries. The program also seeks to encourage increased consumption of traditional 

foods from the land and sea by all members of the community as part of a healthy diet. The 

activities of the program are centered on culturally relevant information dissemination and the 

development of written resources that speak to the nutritional benefits of traditional 

foods. Funding – $100,000 through the Aleutian Pribilof Islands Association

Catawba Lifestyle and Gardening Project (NCCDPHP/DDT)

The Catawba Cultural Preservation Project (CCPP) is increasing awareness and the use of 

traditional foods and food practices by supporting individual and community gardens, and 

increasing fruits, vegetables, beans, and herbs in tribal members’ diets by providing access to 

local gardens and a tribal farmer’s market. The tribe is adopting policies that include preferred 

ecological methods for gardens using traditional growing methods to encourage a new generation 

of environmental stewards to care for the reservation ecosystem. The tribe is increasing physical 

activity with gardening, fishing, and traditional dancing and drumming. Innovative partnerships 

between the tribal Senior Center, CCPP, the Catawba Tribal Offices, and a Master Gardener 

have yielded a successful community garden project that is increasing local access to fresh, 

locally grown, and in some cases traditional foods. Elevated box gardens have been constructed 

for the senior center that mitigates the effects of aging on being able to fully participate in 

gardening. Additionally, changes in local practice within the Children’s Programs are becoming 

a precursor to policy change. Emphasis is on elimination of sugar-sweetened beverages, 

incorporation of fresh, locally-grown produce into lunch menus, and healthy snack alternatives 

are the focus of changes enacted thus far. Funding – $100,000

 

Cherokee Nation - Health Nation (NCCDPHP/DDT)

The “Cherokee Nation – Health Nation” project incorporates a variety of activities, including

community and school gardens, traditional foods gathering trips, traditional Cherokee foods 

cultivation, gathering, preparation, and preservation, traditional Cherokee foods education, and 

incorporation of the traditional Cherokee games Stickball and marbles into community and 

school activities. Over 55,000 members of the Cherokee Nation and their families benefited from 

the initiative’s focus on nutrition, fitness, personal responsibility, and a renewed awareness of 

their shared heritage. Youth activities focused on summer camp activities, organized sports and 

traditional games. Adult fitness activities were year-round and centered on recreation center 

classes, league sports walking clubs, and community races. Traditional games such as stickball 
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and marbles saw an exponential increase from the year before. Nutrition classes, healthy cooking 

classes, community garden classes, and recipe exchanges (all with a focus on traditional 

Cherokee foods) were offered in all 14 of the counties within the Cherokee Nation jurisdiction.

Funding – $100,000

Healthy Roots for Health Futures (NCCDPHP/DDT)

Healthy Roots for Healthy Futures works to increase the availability and accessibility to healthy, 

local, traditional foods and traditional forms of physical activity. The availability and access to 

local, traditional, healthy foods have been increased through the creation of entrepreneurial 

training and gardening programs, revision of the School Wellness Policy, and development of a 

Farm to School system. Physical activity is promoted through gardening and trail use. 

Revitalization of trails reconnects communities to the traditional paths of their ancestors, while 

increasing options for physical activity. Funding – $100,000 through the Eastern Band of 

Cherokee Indians

Coordinated School Health (CSH) (NCCDPHP/DASH)

The Maine Department of Education is funded for HIV Prevention, CSH/Physical Activity, 

Nutrition, and Tobacco, and the Youth Risk Behavior Survey (YRBS). Maine’s three tribal 

schools were selected in a competitive process to participate as priority schools in the state’s 

coordinated school health program. All tribal schools participated in professional development 

tailored to their needs, mini-grants of $5,000 per school per year, and on-going technical 

assistance. All tribal schools completed CDC’s School Health Index and used the results to 

revise and improve their wellness policies. Every tribal school implemented new healthy eating 

and/or physical activity promotion initiatives. Highlights include new physical activity breaks 

during the academic day policies, recess before lunch policies, inclusion of students in school 

menu choice, before-school walking clubs and establishing school gardens and healthy cooking 

clubs. In addition, the Maine Indian Unified School Committee augmented their tobacco policy 

passed last year with implementation of an alternative to suspension tobacco cessation program. 

The tribal schools represent a small portion of students served with Maine's CSH program.

Funding – $369,557

Strategic Alliance for Health (NCCDPHP/DCH)

Sault Ste. Marie Strategic Alliance for Health Program builds community capacity to implement 

policy, systems, environmental, and organizational changes to address chronic diseases and their 

associated risk factors. Sault Ste. Marie's primary focus is on the Native American/tribal 

community, with an emphasis on leveraging partnerships between Sault Tribal partners and nontribal partners. Sault Ste. Marie utilizes culturally-specific approaches that promote physical 

activity and healthy eating, reduce tobacco use and exposure, and foster improved and increased 

access to quality healthcare to reduce complications from and incidence of cardiovascular 

disease, diabetes, and obesity. The Strategic Alliance for Health Action Institute, held in May 

2012 in Chicago, IL, provided an opportunity for states and Strategic Alliance for Health 

communities to come together to learn best practices on implementing policy, systems, and 

environmental change strategies. Sault Ste. Marie leaders met with NCCDPHP to discuss the 

initiative and other projects. In addition, a Sault Ste. Marie representative presented “Facilitating 

Adoption of a Smoke-Free Housing Policy for a Tribal Housing Authority Implementation 
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Guide” to the Action Institute participants. Five participants attended the meeting. Funding –

$400,000

Communities Putting Prevention to Work (CPPW) (NCCDPHP/DCH)

 The Great Lakes Inter-Tribal Council (Wisconsin) received almost $1 million to bring 

tobacco prevention and control activities to five tribes. Funding – $990,599 (two-year 

award)

 The Pueblo of Jemez Health and Human Services Department (New Mexico) received 

$859,101 to promote increased physical activity, encourage healthy food choices, and 

support the local growers market. Successes include district-wide wellness physical 

activity policy that requires children in the after-school programs be offered 45 minutes 

of physical activity on a daily basis and a snack that consists of fresh, unprocessed, 

organic food, such as fruits and vegetables, whole grains and legumes, raw nuts and 

seeds, or fresh sprouts. Since August 2010, approximately 27 students benefit daily from 

this policy. Funding – $859,101 (two-year award)

 The Cherokee Nation Health Service Group (Oklahoma) received $2,108,856 to fight 

obesity and tobacco use with farm-to-school programs, physical education, and tobacco 

cessation programs. Successes include launching the new community-based campaign, 

the Cherokee Challenge, to encourage individuals and families to eat healthy and exercise 

throughout the year. The campaign has impacted 109,843 members of the Cherokee 

Nation. A $1,000,000 supplement was also awarded for a mentorship component, 

enabling the Cherokee Nation Health Service Group to build capacity and mentor tribes 

and communities in schools, communities, worksites and health care settings to 

implement high-impact, population-wide strategies for obesity and tobacco. Funding –

$3,108,856 ($2,108,856 two-year award; $1,000,000 mentorship supplement).

 The annual meeting was a training to strengthen and expand agency capacity to achieve 

program goals to reduce obesity and tobacco use, network with peers, and accelerate 

successes by building peer-to-peer consultation. Participants included: Cherokee Nation 

representatives, CDC, contractors, and technical assistance providers. The Healthy 

Communities meeting increased knowledge of strategies and resources to assist in 

development and implementation that increase access to healthy food and physical 

activity, and reduce secondhand smoke exposure. The meeting was designed and 

facilitated by Cherokee Nation and participants included tribal leaders, tribal health 

administrators and program managers, allied health professionals, and health educators.

National Center on Birth Defects and Developmental Disabilities (NCBDDD)

Project CHOICES Pilot Implementation and Evaluation for American Indian and Alaska 

Native (AI/AN) Women (NCBDDD/DBDDD)

CDC’s CHOICES project is an effective behavioral approach for preventing alcohol-exposed 

pregnancy (AEP), targeting both alcohol use and effective contraception. In 2010, CDC and IHS 

entered into a three-year interagency agreement to adapt and implement CHOICES in American 

Indian communities. This project will reach out to American Indian women of reproductive age 

of the Oglala Sioux Tribe in South Dakota. Funding – $150,000 through an IAA with IHS
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Paralysis Resource Center (PRC) (NCBDDD/DHDD)

The mission of the PRC is to promote the health and well-being of people living with paralysis 

by providing comprehensive information, resources and referral services. The PRC's 

Multicultural Outreach Program, located at the University of New Mexico through the PRC –

UNM Cooperative Agreement, has expanded its activities on the Navajo Nation to target Native 

American communities throughout the country. Funding – $50,000 through the Christopher and 

Dana Reeve Foundation

Limb Loss Public Health Practice and Information Resource Center (NCBDDD/DHDD)

Development of culturally appropriate peer support programs for the Plains Indians tribal 

community focused on limb loss, enhancing quality of life for amputees and their families, 

improving patient care, and preventing limb loss. Funding – $5,000 through the Amputee 

Coalition

North Dakota Disability and Health Program (NCBDDD/DHDD)

The North Dakota Disability and Health Program collaborative and tribal focused activities (e.g. 

meetings, workshops, health education materials purchases for tribes). Funding – $15,175

through Minot State University

Montana Disability and Health Program (NCBDDD/DHDD)

Ongoing partnership and outreach efforts with Montana’s Tribes (e.g. disability activities, 

nutrition education and service delivery improvement in group homes serving adults with 

intellectual and developmental disabilities, and supporting Accessibility Ambassadors to 

improve access to community health centers and rural health). Funding – $30,000 through the 

Montana Department of Health

Alaska Disability and Health Program (NCBDDD/DHDD)

The Alaska Native Tribal Health Consortium (ANTHC) supports the State of Alaska, 

Department of Health and Social Services, Division of Public Health, Section of Women’s, 

Children’s, and Family Health (Title V). The collaboration is an opportunity to promote health, 

prevent chronic disease, improve emergency preparedness, and increase the quality of life among 

Alaskans with disabilities. Funding – No specific award for this activity

National Center for Injury Prevention and Control (NCIPC)

Colorado Injury Control Research Center (CICRC) (NCIPC/ERPO)

The CICRC is located in the Public Health Services (PHS) Region VIII. PHS Region VIII 

includes Colorado, Wyoming, Montana, South Dakota, Utah and North Dakota. In the region, 

24% of the population is American Indian. A seed project to enhance injury surveillance of 

traumatic injuries is managed by the University of North Dakota. This project collects data from 

American Indian individuals, in the Aberdeen Area, who have visited an IHS emergency room, 

were hospitalized, or died as the result of a traumatic injury. Funding – $216,000

Effective strategies to Reduce Motor Vehicle Injuries among AI/AN (NCIPC/DUIP)

This program is to design/tailor, implement and evaluate Native American community-based 

interventions with demonstrated effectiveness for preventing motor vehicle injuries within the 
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following areas: 1) strategies to reduce alcohol-impaired driving among high-risk groups; 2) 

strategies to increase safety belt use among low-use groups; and 3) strategies to increase the use 

of child safety seats among low-use groups. An overriding intent of this funding is to assist tribes 

in developing evidence-based effective strategies in programs, which take into consideration the 

unique culture of Native Americans. Funding was awarded to eight grantees at approximately 

$70,000 per grantee. The eight funded tribes are the Colorado River Indian Tribe, Southeast 

Alaska Regional Health Consortium, California Rural Indian Health Board, Sisseton-Wahpeton 

Oyate of the Lake Traverse Reservation, Rosebud Sioux Tribe, Caddo Nation of Oklahoma, 

Oglala Sioux Tribe Department of Public Safety, and Hopi Tribe through the Office of Health 

Services (AZ). The period of performance is September 2010 through September 2014. Funding 

– $560,000

Tribal Epidemiology Centers (TECs) Injury Meeting Support (NCIPC/DVP)

NCIPC participates in the TECs quarterly injury-related meetings sharing subject matter 

expertise. Funding – No specific award for this activity

3. Tribal Delegation Meetings

CDC/ATSDR will employ a process to ensure meaningful and timely input by CDC/ATSDR and 

Indian Tribes in the development of policies that have tribal implications. Upon identification of 

an event (policy, funding/budget development, and program services, functions, and activities) 

significantly affecting Indian Tribe(s), CDC/ATSDR or the impacted Indian Tribe(s) can initiate 

consultation regarding the event through communication methods as outlined in the HHS Tribal 

Consultation Policy.

Tohono O’odham Nation Consultation

During the 2012 Annual Tribal Budget and Policy Consultation, CDC/ATSDR (represented by 

the OSTLTS Director and the Associate Director for Tribal Support) met with a delegation from 

the Tohono O’odham Nation to discuss a number of local public health issues and CDC items.

4. Affordable Care Act Activities specific to Tribes

National Public Health Improvement Initiative (OSTLTS/DPHPI)

Continuation funding is being provided for the National Public Health Improvement Initiative 

(NPHII). Funding is supporting increased efficiencies of program and service operations, 

effectiveness of programs and services, and readiness for voluntary national accreditation by the 

Public Health Accreditation Board. The awardee’s action plan outlines planned activities and 

milestones that will be achieved with this funding. Total funding – $2,590,692

 Alaska Native Tribal Health Consortium (ANTHC) focused on developing an internal 

quality/performance improvement environment, formed a multi-sector, crossjurisdictional partnership coalition; disseminating and facilitating the use of public health 

data among regional tribal health organizations and communities; promoting the 

implementation of evidence-based strategies, polices, and laws; completing assessments 

using the National Public Health Performance Standards Program assessment tool and the 

Public Heath Accreditation Board (PHAB) self-assessment; and soliciting subject matter 
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experts in key areas to ensure the most recent information for public health practice is 

embodied in their assessment, analysis, and strategic planning process. ANTHC was able 

to decrease redundancies and increase efficiencies by simplifying and streamlining the 

pharmacy process access for Tobacco Cessation Program client information that is 

needed prior to dispensing tobacco cessation medication to clients. This project was 

included in a poster session at the 2011 APHA Annual Meeting and Exposition in 

Washington, D.C. They also implemented a new electronic health record system to 

ensure availability of reliable data needed to assess, implement, and evaluate process 

improvement efforts. Funding – $250,000

 The Mille Lacs Band of Ojibwe (MLBO) efforts focused on contracting with an outside 

software management agency and a well-respected Native American public health 

institution for epidemiology training; advancing accreditation process to improve overall 

care of its patients; accessing a software system to chart patients’ data and enable an ongoing dialogue between health professionals regarding patient care; contracting with Lac 

du Flambeau, a sister tribe, to learn methodologies for analyzing data and converting it to 

an epidemiology study; and researching and applying for alternative funding sources to 

sustain public health programs in the future. Funding – $247,032

 Montana Wyoming Tribal Leaders Council (MWTLC) efforts for this project focused on 

systematically increasing performance management capacity of tribal health departments 

and ensuring access to needed resources by using the National Public Health Performance 

Standards Program assessment to evaluate the quality and performance of its Tribal 

health department/Tribal partners' public health services and the Mobilizing for Action 

through Planning and Partnerships (MAPP) tool to encourage and implement strategic 

planning for tribal health departments. MWTLC is also building its tribal health 

departments’ capacity towards public health accreditation readiness. Funding – $250,000

 Navajo Nation (NN) efforts focused on continuing to build and strengthen its public 

health infrastructure by implementing key components of the NN Strategic Plan;

addressing identified deficiency areas in preparation for Public Health Accreditation 

Board accreditation; developing a NN-wide community health assessment; developing a 

quality improvement initiative to address the effectiveness of key services; developing 

cross-jurisdictional partnerships with at least one local health department in each of the 

three states (i.e., New Mexico, Arizona, and Utah) where Navajo residents are located; 

and identifying and implementing traditional healing best practices in behavioral health 

related to alcohol, HIV, or diabetes. Funding – $250,000

 Northwest Portland Area Indian Health Board (NPAIHB) focused on augmenting efforts 

to establish and implement a Northwest Tribal Public Health Accreditation Performance 

Management Office; hiring a biostatistician to expand efforts of the Performance 

Improvement Manager; supporting the creation of a framework for quality improvement 

(QI) education and outreach; implementing a technical assistance and outreach schedule 

based on assessment outcomes; continuing to serve as a resource and referral for 

Northwest tribes for QI trainings, resources, and tools; implementing a strategic plan for 

public health infrastructure development; implementing a strategic training initiative; and 

providing two QI trainings at the NPAIHB in Portland, Oregon for the 43 federally 

recognized tribes that are members of the board. Funding – $249,998
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 Gila River Indian Community efforts focused on consolidating three major entities that 

provide prevention and treatment health care services under a new health authority to 

improve the delivery of services and improve performance measures; developing an 

organizational structure to increase quality and accountability; establishing a roadmap for 

an integrated health care system; supporting a stable, well-trained workforce; and 

increasing efficiencies in both prevention and treatment. Funding – $250,000

 Cherokee Nation efforts focused on continuing to expand and improve the Nation’s 

current tribal public health infrastructure; working towards achieving accreditation for the 

Nation’s tribal public health system through the Public Health Accreditation Board 

(PHAB); implementing the Mobilizing for Action through Planning and Partnerships 

tools in efforts to plan and meet PHAB's accreditation prerequisites and standards; 

conducting assessments; developing a strategic plan; developing a Cherokee Nation 

Tribal Community Health Improvement Plan based on the Forces of Change Assessment, 

among other public health efforts. Cherokee Nation is on track to apply for and achieve 

PHAB accreditation by December 2012. Funding – $843,662

 Southeast Alaska Regional Health Consortium (SEARHC) efforts focused on increasing

its capacity to improve the effectiveness of its organizations, practices, partnerships, 

program resources, and systems; developing a consortium-wide emergency preparedness 

plan; and engaging with a lean management consulting company to improve referral 

process and knowledge regarding quality improvement tools. SEARHC did not apply for 

Year 3 funding. Funding – $250,000

Racial and Ethnic Approaches to Community Health (REACH) US (NCCDPHP/DCH)

Various subactivities. Total funding – $1,644,977

 Reduce the rate of infant mortality among American Indians on the Wind River Indian 

Reservation through community-based approaches that will serve as a model for other 

tribes and communities. The Northern Arapaho Tribe of the Wind River Indian 

Reservation (WRIR) Action Community (AC) Infant Mortality Prevention Program 

(IMPP) plans to reduce the rate of infant mortality among American Indians on the 

WRIR through community-based approaches. These approaches include increasing 

community awareness and commitment to eliminating infant mortality disparities through 

coordinated and multi-organizational action; increasing the number of Northern Arapaho 

and Eastern Shoshone women initiating early, and sustaining, prenatal care; ultimately 

achieving measurable improvements in infant mortality rates. This will be done through 

community organization, education, inter-agency coordination and partnership, systems 

development and modification, and increasing access to health services. For grant Year 5, 

an important aspect of the Community Action Plan (CAP) will be to convene and

organize all partners to consider how to sustain the momentum the IMPP has created 

around the healthy priority while expanding the breadth and the depth of their 

programmatic efforts. Funding – $398,807

 The Cherokee Choices Program of the Eastern Band of Cherokee Indians works to 

change social norms, engage formal and informal leaders, and engage communities to 

reduce the risk for type 2 diabetes and cardiovascular disease in rural western North 

Carolina. Funding – $415,390
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 The Choctaw Nation of Oklahoma (CNO) Action Community (AC) Lifetime Legacy 

Program (LLP) plans to decrease heart attack and stroke risk in the CNO population 

through education, awareness, and community-based active living and healthy eating 

policy and environmental change efforts. Their overarching goal reads: “There is a 

directive from the Great Law of the Six Nations Iroquois Confederacy that says, ‘In our 

every deliberation we must consider the impact of our decision on the next seven 

generations.’ This is especially pertinent when implementing a project such as this one. 

What is initiated now, with and through our community coalitions will, indeed, have an 

impact on the health of our people for generations. The overall goal of this project is to 

improve the health status of tribal members by providing education about CVD, healthy 

eating habits and exercise options. And by providing the community with healthy 

activities, policy change, education on healthier lifestyles, exposure to cooking healthy 

and environmental changes. As a result of this project many people within the tribe will 

be informed, in a positive way to promote and maintain healthier lifestyles. Our tribe is 

supportive of this effort, our community coalitions are supportive of the effort and our 

tribal agencies are supportive of the effort. We continue to move forward in creating 

healthier Native people.” Funding – $415,390

 For Year 5, Inter-Tribal Council of Michigan (ITCM) REACH will continue to 

implement community-based intervention activities to reduce cardiovascular and diabetes 

related disparities that are culturally tailored to each of the three original tribal 

communities, while providing overall technical assistance to the tribes and disseminating 

results of the culturally tailored interventions among consortium partners. The project 

addresses the social determinants of health using four key strategies: 1) consciousness 

raising, 2) community development, 3) health promotion, and 4) 

policy/systems/environmental change. This will be accomplished through refining 

Community Action Plans (CAP) and hosting technical assistance and information sharing 

meetings with partner programs, agencies, and tribal leadership. Although ITCM’s goals 

and objectives continue to encompass the entire socio-ecological model approach, the 

primary focus will be on policy, systems, and environmental changes in community, 

school, work place, and health care settings, and include policies to increase access to 

quality services, identifying resources for improving the built environment, and 

increasing translation and dissemination efforts. Funding – $415,390

Community Transformation Grants (CTG) (NCCDPHP/DCH)

Total funding – $2,910,502

 The Southeast Alaska Regional Health Consortium is receiving $499,588 to serve an 

estimated population of 72,000 within the state of Alaska. Work will focus on expanding 

efforts in tobacco-free living, active living and healthy eating, and quality clinical and 

other preventative services. Funding – $499,588

 The Great Lakes Inter-Tribal Council, Inc. is receiving a $499,982 planning award to 

build capacity to support healthy lifestyles among an estimated tribal population of over 

8,000 within the state of Wisconsin. Work will target tobacco-free living, active living 

and healthy eating, quality clinical and other preventive services, social and emotional 

wellness, and healthy and safe physical environments. Funding – $499,982
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 The Sault Ste. Marie Tribe of Chippewa Indians is receiving $500,000 to serve an 

estimated tribal population of over 176,000 within the state of Michigan. Work will target 

tobacco-free living, active living and healthy eating, quality clinical and other preventive 

services, and healthy and safe physical environments. Funding – $500,000

 The Toiyabe Indian Health Project is receiving a $500,000 planning award to build 

capacity to support healthy lifestyles among an estimated tribal population of 3,000 

within the state of California. Work will target tobacco-free living, active living and 

healthy eating, quality clinical and preventive services, social and emotional wellness, 

and healthy and safe physical environments. Funding – $500,000

 The Confederated Tribes of the Chehalis Reservation is receiving a $498,663 planning 

award to build capacity to support healthy lifestyles among an estimated tribal population 

of 1,500 within the state of Washington. Work will target tobacco-free living, active 

living and healthy eating, and quality clinical and other preventive services. Funding –

$498,663

 The Sophie Trettevick Indian Health Center is receiving a $218,929 planning award to 

build capacity to support healthy lifestyles among an estimated tribal population of 2,200 

within the state of Washington. Work will target tobacco-free living, active living and 

healthy eating, and quality clinical and other preventive service. Funding – $218,929

 The Yukon-Kushokwin Health Corporation is receiving a $193,340 planning award to 

build capacity to support healthy lifestyles among an estimated tribal population of 

25,000 within the state of Alaska. Work will focus on expanding efforts in tobacco-free 

living, active living and healthy eating, quality clinical and other preventive services, and 

healthy and safe physical environments. Funding – $193,340

 In December 2011, the CTG Action Institute was held to form networks, discuss 

opportunities and resources for Community Transformation Grants, learn how to design 

implementation plans, and learn how to implement and sustain the programs. 

5. Agency Tribal Advisory Committee

CDC/ATSDR held two formal Tribal Advisory Committee (TAC) meetings during FY 2012 

along with regularly scheduled conference calls. The TAC meeting was held January 31–

February 1, 2012 in Atlanta, Georgia and August 28 – 29, 2012 at the Mohegan Tribe in 

Uncasville, Connecticut. The Tribal Support Unit (OSTLTS/OD) collaborated with the TAC cochairs and membership to develop substantive agendas. TAC members provide an area report to 

inform and discuss public health issues affecting their tribe and other tribes in their area (based 

on the IHS areas), and CDC provides a progress report on actions taken in response to TAC 

recommendations. The meetings focused on resource allocations and budget priorities, healthcare 

reform, public health preparedness and emergency response, epidemiology and disease 

surveillance, chronic disease prevention, social determinants of health, and environmental public 

health in Indian Country. The summer meeting also involved site visits to the Mohegan and 

Mashantucket Pequot Tribes, allowing participants to learn about the history, culture, public 

health needs, and governance of those communities.

In 2012, the two Tribal Consultation Sessions were focused on CDC’s Winnable Battles and 

HHS priorities. Discussions regarding smoking; physical activity, obesity, and nutrition; teen 
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pregnancy; HIV/AIDS; healthcare-associated infections; and motor vehicle safety were held. 

Prescription drug abuse, Community Transformation Grants, environmental public health, and 

the Native Diabetes Wellness Initiative were also on the agenda and resulted in valuable 

exchange of information and discussion. CDC leadership listened to powerful tribal testimonies 

reflecting critical health needs present in many AI/AN communities and responded to specific 

questions asked by tribal leaders. Consultations have provided opportunities for meaningful 

dialogue between tribal leadership and CDC leadership, resulting in new initiatives, programs, 

and collaborations to address public health needs while maintaining CDC’s commitment to 

uphold the tenets of tribal Consultation and to have a positive impact on the health of AI/AN 

people.

6. Agency Tribal Consultation Policy

The CDC/ATSDR Tribal Consultation Policy was revised in 2012. This document establishes 

policy and guidance regarding consultation between the CDC/ATSDR and Indian Tribes.

 

CDC/ATSDR will honor the sovereignty of Indian Tribal governments, respect the inherent 

rights of Indian Tribal self-governance, continue to work on a government-to-government basis, 

and uphold the federal trust responsibility to Indian Tribes. 

The government-to-government relationship between the U.S. and Federally recognized Indian 

Tribes dictates that the principal focus for consultation by CDC is with Indian Tribes, 

individually or collectively. Consultation parties include:

 Indian Tribes represented by the Tribal President, Tribal Chair, or Tribal Governor, or an 

elected or appointed Tribal Leader, or their authorized representative(s)

 CDC Director, ATSDR Administrator, CDC Associate Director for Tribal Support, or 

their designee(s)

CDC/ATSDR may confer with and solicit advice and recommendations at times from Indian 

organizations. The government does not participate in government-to-government consultation 

with these entities; rather the government confers with these organizations in the interests of 

Indian Tribes and AIAN. Government-to-government consultation at CDC will occur as 

outlined in the HHS Tribal Consultation Policy. 
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AC Action Community

AEP Alcohol-exposed pregnancy

AFN Alaska Federation of Natives

AI/AN American Indian/Alaska Native

AIANNHC American Indian, Alaska Native and Native Hawaiian Coalition

AIDS Acquired Immunodeficiency Syndrome

AIP Arctic Investigations Program

ALS Amyotrophic lateral sclerosis

ANMC Alaska Native Medical Center

ANTHC Alaska Native Tribal Health Consortium 

APHA American Public Health Association

APRHB Air Pollution and Respiratory Health Branch

ASTHO Association of State and Territorial Health Officials

ATSDR Agency for Toxic Substances and Disease Registry

BPA Bisphenol A

BRFSS Behavioral Risk Factor Surveillance System

CAP Community Action Plan

CBA Capacity Building Assistance

CCC Comprehensive Cancer Control

CCPP Catawba Cultural Preservation Project

CDC Centers for Disease Control and Prevention

CICRC Colorado Injury Control Research Center

CMS Centers for Medicare and Medicaid Services
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CNO Choctaw Nation of Oklahoma

CPPW Communities Putting People to Work

CRCCP Colorectal Cancer Control Program

CRST Cheyenne River Sioux Tribe

CSH Coordinated School Health

CTG Community Transformation Grant

CTSI Confederated Tribes of Siletz Indians

CVD Cardiovascular Disease

DAS Division of Applied Sciences

DASH Division of Adolescent and School Health

DBDDD Division of Birth Defects and Developmental Disabilities

DCH Division of Community Health (Proposed)

DCPC Division of Cancer Prevention and Control

DDT Division of Diabetes Translation

DEEHS Division of Emergency and Environmental Health Services

DEHHE Division of Environmental Hazards and Health Effects

DHAP Division of HIV/AIDS Prevention

DHDD Division of Human Development and Disability

DHDSP Division of Heart Disease and Stroke Prevention

DLS Division of Laboratory Sciences

DPEI Division of Preparedness and Emerging Infections

DPHPI Division of Public Health Performance Improvement

DRH Division of Reproductive Health

DSTDP Division of STD Prevention
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DTHHS Division of Toxicology and Human Health Sciences

DUIP Division of Unintentional Injury Prevention

DVBD Division of Vector Borne Diseases

DVH Division of Viral Hepatitis

DVP Division of Violence Prevention

EEB Environmental Epidemiology Branch

EFAB EIS Field Assignments Branch

EHSB Environmental Health Services Branch

EIS Epidemic Intelligence Service

EISB Epidemic Intelligence Service Branch

EPA Environmental Protection Agency

EPH Environmental Public Health

ERNEH Empowering Ramah Navajos to Eat Healthy

ERPO Extramural Research Program Office

ESB Epidemiology and Statistics Branch

FDL Fond du Lac

FY Fiscal Year

HHS Department of Health and Human Services 

HIV Human Immunodeficiency Virus 

HRAC Health Research Advisory Council

HSB Health Studies Branch

HSD Human Services Department

HTAC Health Traditions Advisory Council

IAA Intra-Agency Agreement 
US Department of Health and Human Services 

Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry: 

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ICNAA Intradepartmental Council on Native American Affairs

IHS Indian Health Service 

IMPP Infant Mortality Prevention Program

IOBUSD Indian-Oasis Baboquivari Unified School District 

IRATB Inorganic and Radiation Analytical Toxicology Branch 

ITCM Inter-Tribal Council of Michigan

LCMV Lymphocytic choriomeningitis virus

LLP Lifetime Legacy Plan

MAPP Mobilizing for Action through Planning and Partnerships

MLBO Mille Lacs Band of Ojibwe

MWTLC Montana Wyoming Tribal Leaders Council

NACCHO National Association of City and County Health Officials

NACR Native American Cancer Research Corporation

NBCCEDP National Breast and Cervical Cancer Early Detection Program 

NCBDDD National Center on Birth Defects and Developmental Disabilities 

NCCCP National Comprehensive Cancer Control Program 

NCCDPHP National Center for Chronic Disease Prevention and Health Promotion 

NCEH National Center for Environmental Health 

NCEZID National Center for Emerging and Zoonotic Infectious Diseases 

NCHHSTP National Center for HIV, Hepatitis, STD and Tuberculosis Prevention 

NCIPC National Center for Injury Prevention and Control 

NCRCCP National Colorectal Cancer Control Program 

NHANES National Health and Nutrition Examination Survey 

NIHB National Indian Health Board 
US Department of Health and Human Services 

Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry: 

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NN Navajo Nation

NNAAPC National Native American AIDS Prevention Center

NNPHI National Network of Public Health Institutes

NPAIHB Northwest Portland Area Indian Health Board

NPCCCP Northern Plains Comprehensive Cancer Control Program

NPHII National Public Health Improvement Initiative

NTEH National Tribal Environmental Health

OD Office of the Director

OID Office of Infectious Diseases

ONDIEH Office of Noncommunicable Diseases, Injury and Environmental Health

OPDIV Operating Division (of HHS) 

OPHPR Office of Public Health Preparedness and Response

OSELS Office of Surveillance, Epidemiology and Laboratory Services

OSH Office on Smoking and Health

OSTLTS Office for State, Tribal, Local and Territorial Support

OTA Office of Tribal Affairs (NCEH/ATSDR)

PCV Pneumococcal Conjugate Vaccine 

PHAB Public Health Accreditation Board

PHAP Public Health Associate Program

PHF Public Health Foundation

PHLO Public Health Law Office

PHS Public Health Service

PM Program Management

PRC Paralysis Research Center
US Department of Health and Human Services 

Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry: 

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PSB Partnership Support Branch

QI Quality Improvement

REACH US Racial and Ethnic Approaches to Community Health

RETA Reducing Environmental Triggers for Asthma

RMSF Rocky Mountain Spotted Fever

RTHP Return to a Healthy Past

RZB Rickettsial Zoonoses Branch

SCF Southcentral Foundation 

SEARHC Southeast Alaska Regional Health Consortium

SEPDPO Scientific Education and Professional Development Program Office

SSM Sault Ste. Marie Tribe of Chippewa Indians

STD Sexually Transmitted Infection / Sexually Transmitted Disease

TAC Tribal Advisory Committee

TCC Tanana Chiefs Conference

TEC Tribal Epidemiology Center

TOCA Tohono O’odham Community Action

UNM University of New Mexico

USDA US Department of Agriculture

WDOH Washington State Department of Health

WISEWOMAN Well-Integrated Screening/Evaluation for Women across the Nation

WRIR Wind River Indian Reservation

Y.O.U.T.H. Young O’odham United Through Health (Y.O.U.T.H.)

YRBS Youth Risk Behavior Survey