CDC/ATSDR TAC Meeting 

February 5–6, 2019—Summary 1 

CDC/ATSDR Tribal Advisory Committee Meeting and 

18th Biannual Tribal Consultation Session 

February 5, 8:00 am–5:30 pm and February 6, 8:00 am–4:45 pm

Global Communications Center

Building 19, Auditorium B3

CDC Headquarters, Atlanta, Georgia

The Centers for Disease Control and Prevention (CDC) and the Agency for Toxic Substances and Disease 

Registry (ATSDR) hosted their Tribal Advisory Committee (TAC) Meeting and 18th Biannual Tribal 

Consultation Session February 5–6, 2019. The meeting was open to the public. Nine members of the 

public attended the first day, and twelve attended the second day.

Table of Contents

CDC/ATSDR Tribal Advisory Committee Meeting and................................................................................................1

18th Biannual Tribal Consultation Session ..................................................................................................................1

Table of Contents .......................................................................................................................................................1

Tuesday February 5, 2019 ..........................................................................................................................................2

TAC Member Attendees.........................................................................................................................................2

CDC Attendees........................................................................................................................................................2

Non-Federal Attendees..........................................................................................................................................5

9:00AM–Opening Blessing, Welcome, and Introductions .....................................................................................5

9:15AM–TAC Business............................................................................................................................................5

10:00AM–Data Discussion on Racial Misclassification...........................................................................................6

12:30PM–Children’s Eagle Book Discussion and Consultation (Working Lunch) ...................................................8

2:00PM–Opioids, Adverse Childhood Experiences, and Suicide Prevention Updates and Listening Session........9

Wednesday, February 6, 2019................................................................................................................................. 11

9:00AM–Healthy Tribes, NCCDPHP Updates....................................................................................................... 11

10:00AM–CIO Senior Leadership Updates and Listening Session....................................................................... 12

11:00AM–CDC Director and ATSDR Administrator Updates and Listening Session............................................ 16

1:30PM–Commercial Smoking Cessation within Tribal Communities................................................................ 18

2:30PM–Supporting Indian Health Services’ Improvements in Healthcare Infection Prevention and Control.. 20

3:45PM–Tribal Testimony ................................................................................................................................... 21

4:45PM–Adjournment of CDC/ATSDR TAC Meeting........................................................................................... 21

Appendices.............................................................................................................................................................. 22

Appendix A: Acronym List.................................................................................................................................... 22

Appendix B: CDC/ATSDR TAC Roster................................................................................................................... 23

Appendix C: Oral and Written Statements.......................................................................................................... 25
CDC/ATSDR TAC Meeting 

February 5–6, 2019—Summary 2 

Tuesday February 5, 2019 

TAC Member Attendees 

Julie Deerinwater-Anderson

Cherokee Nation

Tribes-at-Large Authorized Representative

Councilwoman Lana M. McCovey

Yurok Tribe

California Area Delegate

Councilman Chester Antone

Tohono O’odham Nation

Tucson Area Delegate

Lisa Pivec

Cherokee Nation

Tribes-at-Large Authorized Representative

Rhonda Beaver

Muscogee (Creek) Nation

Oklahoma Area Authorized Representative 

Principle Chief Richard Sneed (TAC Co-Chair)

Eastern Band of Cherokee Indians

Tribes-at-Large Delegate

Vickie Bradley 

Eastern Band of Cherokee Indians

Tribes-at-Large Authorized Representative

Del Yazzie

Navajo Nation

Navajo Area Authorized Representative

Chairman Robert Flying Hawk 

Yankton Sioux Tribe

Great Plains Area Delegate

Absent

Affiliation/Tribal Area Name Title

Alaska Area Alicia L. Andrew President

Billings Area Byron Larson

Nashville Area Cheryl Andrews-Maltais Chairwoman

Bemidji Area Robert Two Bears (TAC Chair) Representative

CDC Attendees 

Romana Allison, MPH

Public Health Advisor/Analyst, Center for State, 

Tribal, Local, and Territorial Support (CSTLTS)

CAPT Larry Alonso, MSN

Nurse Officer, National Center for Chronic Disease 

Prevention and Health Promotion (NCCDPHP)

Robert “Bob” Anderson, PhD

Supervisor Statistician, National Center for Health 

Statistics (NCHS)

Danielle Arellano, MPH

Public Health Advisor, National Center for Injury 

Prevention and Control (NCIPC)

LCDR Naomi Aspaas, BSN, RN

Lead Public Health Advisor, Office of Tribal Affairs and 

Strategic Alliances (OTASA), CSTLS

Kelly L. Bishop, MA

Public Health Advisor, NCCDPHP

Michael Bruce, MD, MPH

Medical Epidemiologist, National Center for Emerging 

and Zoonotic Infectious Diseases (NCEZID)

Sharunda Buchanan, PhD, MS

Director, National Center for Environmental Health 

(NCEH)

CAPT Deron Burton, MD, JD, MPH CAPT Carmen Clelland, PharmD, MPA, MPH
CDC/ATSDR TAC Meeting 

February 5–6, 2019—Summary 3

Team Lead, National Center for HIV/AIDS, Viral 

Hepatitis, STD, and TB Prevention (NCHHSTP)

Director, OTASA, CSTLTS

CDR Alex Crosby, MD, MPH

Medical Epidemiologist, NCIPC

Valerie Daniel, MPH

Health Communications Specialist, NCIPC

Teresa Daub, MPH

Lead Public Health Advisor, CSTLTS

Jillian Doss-Walker, MPH

Public Health Advisor, National Center for 

Immunization and Respiratory Diseases (NCIRD)

Naomi Drexler, MPH

Epidemiologist, NCEZID

Stephanie Dulin, MBA

Senior Advisor, National Center on Birth Defects and 

Developmental Disabilities (NCBDDD)

Megan S. Early

Public Health Analyst, NCIPC

CAPT David Espey, MD

Medical Officer, NCCDPHP

CDR Mary “Molly” Evans, MD, MPH

Medical Officer, NCIPC

CAPT Ryan Fagan, MD, MPH

Medical Officer, NCEZID

Constance Franklin, MPA

Program Analyst, National Institute for Occupational 

Safety and Health (NIOSH)

Krystal Gayle, MPH

Public Health Advisor, OTASA, CSTLTS

Rebecca Gold, JD

Public Health Analyst, NCEZID

LT Kimberly Goodwin, MPH

Public Health Analyst, CSTLTS

Corinne Graffunder, DrPH, MPH

Health Scientist, NCCDPHP

Arlene Greenspan, DrPH, MPH, MS

Associate Director for Science, NCIPC

Wendy Heirendt, MPA

Lead Public Health Analyst, NCCDPHP

CAPT Thomas Hennessy, MD, MPH

Director of the Arctic Investigations Program, NCEZID

Wendy Holmes, MS

Senior Public Health Advisor, OTASA, CSTLTS

Heidi Holt, MPA

Public Health Advisor, NCCDPHP

Schell Hufstetler, PhD, MS

ORISE Fellow, NCCDPHP

LCDR Jason Hymer, REHS, MPH

Environmental Health Specialist, NCIPC

Robin Ikeda, MD, MPH

Deputy Director for Non-Infectious Diseases

Gilbert Kersh, PhD

Branch Chief for the Rickettsial Zoonoses Branch, 

NCEZID

Barbara Kitchens, MA

Public Health Analyst, Center for Preparedness and 

Response (CPR)

Laura Kollar, PhD, MA

Behavioral Scientist, NCIPC
CDC/ATSDR TAC Meeting 

February 5–6, 2019—Summary 4

Rachel Kossover-Smith, MPH, RD

Public Health Analyst, NCIPC

Rhea-Lanee Lansang Tran, MPH

Public Health Advisor, CSTLTS

Karina Lifschitz, MPH, MAIA

Public Health Analyst, CSTLTS 

Connie Lo

Public Health Fellow, Office of the Associate Director 

for Policy and Strategy (OADPS)

Stacey Mattison-Jenkins, MPH

Deputy Director for Division of Program and 

Partnership Services, CSTLTS

Heather McCann, MPH

ORISE Fellow, NCBDDD

Turcina McNeilly, MPH

Public Health Advisor, NCEH

Pamela Meyer, PhD, MSPH

Health Scientist, OTASA/CSTLTS

Beth Michel, MPH

Project Evaluator, NCCDPHP

Jessica Miller, MA

Public Health Advisor, OTASA, CSTLTS

Mitchell “Mitch” Morris

Acting Deputy Director for OTASA, CSTLTS

Emily Nethercott

Public Health Advisor, OTASA, CSTLTS

Dagny Olivares, MPA

Associate Director for Communication, CSTLTS

Matthew Olivares

Health Communication Specialist, NCIPC

Priyanka Oza

Public Health Advisor, OTASA, CSTLTS

Kathryn “Katie” Ports, PhD

Behavioral Scientist, Division of Violence Prevention

(DVP), NCIPC

Katherine “Katie” Pugh, MS

Environmental Health Scientist, Division of 

Community Health Investigations, ATSDR

Judith Qualters, PhD, MPH

Division Director, NCIPC

Jean Randolph, MPA

Nurse, CPR

Shannon Robinson Ahmed

Health Education Specialist, NCCDPHP

Delight Satter, MPH

Senior Health Scientist, OTASA, CSTLTS

Anne Schuchat, MD (RADM, USPHS, RET)

Principal Deputy Director

Gregory Smith, MPA

Tribal Liaison Officer, CPR

Daniel Sosin, MD, MPH

Deputy Director/Medical Officer, CPR

CAPT Gail M. Stennies, MD, MPH

Senior Advisor, CPR

Chris Stockmyer, MPH

Public Health Advisor, NCCDPHP

Craig Thomas, PhD, MS

Director for the Division of Population Health, 

NCCDPHP

Morgan Thomas, MFA

Health Communication Specialist, NCIPC

Celia Toles

Health Communication Specialist, CPR

CAPT Amy Valderrama, PhD

Epidemiologist, NCEZID
CDC/ATSDR TAC Meeting 

February 5–6, 2019—Summary 5

LT Jeffrey Walker, MPH

Public Health Advisor, CSTLTS

Alleen Weathers, Med, MPH

Public Health Advisor, OTASA, CSTLTS

Craig Wilkins

Senior Advisor, Office of Minority Health and Health 

Equity

Kelly Wilkinson

Health Marketing/Communication Specialist, CSTLTS

Stacey Willocks, MS

Behavioral Scientist, NCIPC

Andrea Young, PhD, MS

Associate Director for Science, CSTLTS

Non-Federal Attendees 

Robert (Bobby) Ahern Vivian García-López Rebecca Ledsky

Teresa Y. Brown Katie Grismala Caitlyn Lufty

Francys Crevier Carolyn Angus-Hornbuckle Pam Myers

Marisa Ervin Jamie Ishcomer CoCo Villaluz

Sherry Everett Jones Amy Lansley

9:00AM–Opening Blessing, Welcome, and Introductions 

• Councilman Chester Antone announced that he is filling in for Chairman Two Bears until Principal Chief 

Sneed is able to arrive later this afternoon. He led the opening blessing. 

• Captain Clelland welcomed everyone to the winter 2019 CDC/ATSDR TAC Meeting and announced that 

he will be acting on behalf of Dr. Montero, who was unable to attend. 

• Lieutenant Commander Aspaas conducted the roll call. A quorum was present to conduct necessary 

business.

9:15AM–TAC Business 

Facilitator

• Chester Antone (Tohono O’odham Nation) Councilman

TAC Business Opening

• The CDC/ATSDR TAC is Federal Advisory Committee Act (FACA) exempt.

• Councilman Antone read the FACA exemption language and the TAC members’ roles and 

responsibilities.

Changes to the Agenda

• Dr. Houry is unavailable for the NCIPC updates during the Centers, Institutes, and Offices (CIOs)

Leadership Discussion. Dr. Arlene Greenspan, NCIPC associate director for science, and Dr. Judy 

Qualters, division director for NCIPC’s Division of Analysis, Research and Practice Integration and the 

executive sponsor for the Injury Center Tribal Work Group, is filling in on Dr. Houry’s behalf. 

• The NCCDPHP is replacing the Elimination of Viral Hepatitis in Tribal Nations discussion originally 

scheduled for Wednesday, February 6. NCCDPHP will discuss the work they are currently doing in Indian 

Country. 

• Dr. Anne Schuchat, principal deputy director for CDC, will provide the CDC director and ATSDR 

administrator updates.

• TAC members seconded and unanimously approved the motion to approve the changes to the agenda. 
CDC/ATSDR TAC Meeting 

February 5–6, 2019—Summary 6

TAC Charter Review

• Current charter is more than three years old. 

• CDC received a revised charter draft about a week ago and is currently reviewing it to ensure it meets 

consultation requirements. 

Tribal Public Health Workgroup Discussion

• Captain Clelland opened a discussion on what the new Tribal Public Health Workgroup (TPHWG) should 

address under CDC’s new cooperative agreement (CoAg) with the National Indian Health Board (NIHB), 

and what types of subject matter experts should be included. One area of work suggested is to help 

support the TAC.

o Councilman Antone stated the TPHWG should be able to convene more often but that requires 

additional funding. To help inform and identify gaps, the TAC often requests research on specific 

areas.

o Vickie Bradley asked about opportunities for funding to develop a charter for the TPHWG. 

 CDC will reach out to partners to look into this opportunity. 

o Vickie Bradley proposed that CDC continue the TPHWG and for TAC input to help decide 

membership. This should be a priority agenda item for the TAC.

Location Recommendations for Summer TAC 2019

• Captain Clelland asked for location recommendations for the 2019 Summer TAC meeting. 

o Principle Chief Sneed made the invitation for the Eastern Band of Cherokee Indians to host the 

2019 Summer TAC in Cherokee, North Carolina.

 

10:00AM–Data Discussion on Racial Misclassification 

Presenters

• Jamie Ishcomer MPH, MSW, (Choctaw Nation of Oklahoma), Deputy Director, National Council of 

Urban Indian Health (NCUIH)

• Robert “Bob” Anderson, PhD, Branch Chief, NCHS, CDC

• Pamela Meyer, PhD, MSPH, Senior Epidemiologist, CSTLTS, CDC

Opening Remarks

• Some areas report that up to 60% of American Indian/Alaska Natives (AI/ANs) are misclassified.

• Working to use linkage data to find a systems level approach to improve misclassification. This is not 

necessarily specific to death certificates but burden of disease overall.

• Currently NCUIH is working to identify best practices in states to identify potential gaps, including 

licensing, training, and continuing education requirements to determine potential policy 

recommendations.

• There is a standard death certificate model; however, there are variations across each state. 

• The funeral director in each state is often providing the demographic information. The funeral directors

are supposed to get this information from an informant, such as a family member or acquaintance. 

o In total, there are 52 death certificate variations; this includes each state, the District of 

Columbia, and New York City. 

o This project includes a review of each of these variations to determine their consistency with the 

standard. This review will also look at the number of variations that have a space for tribal 

affiliation. 
CDC/ATSDR TAC Meeting 

February 5–6, 2019—Summary 7

TAC Questions and Discussion

Question from Jamie Ishcomer: Do TAC members understand the death certificate process? Do TAC members

have a role in the process?

Answers (input from multiple people): 

• (California Area) Identifying tribal members was easier in the past. We had a funeral director who had 

been there for years and knew everyone in the community. With a recent change in director, completing 

the forms correctly is now a problem. We provide funding for tribal members for burial. To receive this 

funding, a death certificate from the funeral home is required.

• (Tribes-at-Large) In North Carolina, the county instead of the state records death certificates. It becomes 

challenging to gather information across multiple county lines. We require tribes submit death 

certificates to us for our public health program.

• (Navajo Area) We have a data sharing agreement with states that border our nation. When tribes

request mortality data, they receive AI/AN race, but there is no mention of tribal affiliation. States are 

not aware of the importance for specific tribal affiliation information. It is important to gather tribal 

affiliation in order to know tribal-specific disease rates. 

Question from Jamie Ishcomer: How do we address barriers for AI/AN who live off reservations? Have tribal 

communities explored these barriers? The Indian Health Service (IHS) does not always capture the whole AI/AN 

population. What are your communities doing to move past only relying on IHS data?

Answers (input from multiple people): 

• (Tribes-at-Large) Oklahoma’s tribal public health workgroup has been discussing this issue with the state 

health department. Conducting linkages between IHS data and state data is not timely. What is CDC’s 

role and the state’s role in assisting the racial misclassification issue? 

o (Bob Anderson) CDC is working on training funeral directors to address the importance of 

accurately capturing race on death certificates. 

o (Pamela Meyer) OTASA is working to learn everyone’s processes to figure out who all the 

partners are and how states can play a larger role in addressing this issue. 

• (Tribes-at-Large) For our region, the National Association of Public Health Statistics is working with the 

United South and Eastern Tribes Tribal Epidemiology Center (TEC) on this.

• (Tucson Area) Tribes have a hesitancy to share data. In the Tucson area, the tribes do not work much 

with the state. They have their own tribal funeral home. For this specific region, there is an issue with 

classifying cause of death accurately. 

• (Oklahoma Area) Working with states to learn their best practices is not going to be effective. CDC needs 

to help fund and provide guidance to develop a sustainable system to allow tribes to build the 

infrastructure to obtain data themselves. Lack of data on affiliation is our issue.

Question from Jamie Ishcomer: In Montana, Northern Cheyenne shares paternity acknowledgement 

information with their state. What challenges have you encountered in sharing information with your states and 

would sharing enrollment data be a viable option?

Answers (input from multiple people): 

• (Tribes-at-Large) No, sharing would not be a viable option. Enrollment data is very privileged. 

• (Tucson Area) The challenge is determining affiliation as opposed to getting data directly. I propose that 

we look into this issue more. Can funeral director trainings with continuing education credits include the 

importance of marking tribal affiliation? If so, can tribes submit confirmation of this training to CDC?

o (Bob Anderson) Focusing on education works very well, but it would be difficult for a funeral 

director to determine affiliation without a database somewhere.
CDC/ATSDR TAC Meeting 

February 5–6, 2019—Summary 8

12:30PM–Children’s Eagle Book Discussion and Consultation (Working Lunch) 

Presenters

• Laura Kollar, PhD, Behavioral Scientist, DVP, NCIPC, CDC

• Katie Ports, PhD, Behavioral Scientist, DVP, NCIPC, CDC

• Morgan Thomas, MFA, Health Communication Specialist, DVP, NCIPC, CDC

• Marisa Ervin, BA, (Coquille Indian Tribe), Native Author and Illustrator

• Vivian García López, PhD LEd, (Pascua Yaqui Tribe)

• Rebecca Ledsky, MBA, BA, (Research Lead, FHI 360)

Opening Remarks

• The focus of this discussion will be to hear TAC member’s thoughts about these storylines and some 

book two story ideas, as well as on other issues concerning these books.

• CDC’s NCIPC is developing two books for AI/AN children in kindergarten through third grade, their 

parents, caregivers, and educators.

• The books aim to promote cultural protective factors and modeling bystander behavior to help achieve 

the overall goal to prevent injury and violence in Native communities. 

• Neither of the books will depict violence.

• Book 1 will focus on AI/AN cultural protective factors or tribal characteristics that buffer against risks for 

injury and violence. 

• Protective factors include positive social norms, and cultural protective factors include shared tribal 

language, ceremonies, traditional activities, and relationships with other tribal members, such as elders. 

• Book 2 will be a supportive bystander intervention story. 

• These books are tentatively scheduled to publish in late 2020.

TAC Questions and Discussion

Question from Moderator Vivian García López: What images do you associate with your own tribes or regions 

that may relate to or have meaning for the books’ topics?

Answers (Chairman Flying Hawk):

• The Missouri River comes to mind and the importance of that river.

Question from Moderator Vivian García López: What might help strengthen the message of first book’s 

storyline?

Answers (input from multiple people):

• Does the feather have to go back to the Earth in the first book? The feather should go instead with the 

wind. 

• Sometimes families themselves might change to protect the ones they love. That is, the change could be 

in the form of moving or staying away from certain family members. 

Question from Moderator Vivian García López: In what ways does this story reflect the supportive community 

cultural characteristics that exist in your own tribal community or region or other tribal communities?

Answers (input from multiple people): 

• Some tribes look at the earth in a different way. 

• Tribes have commonalities, but individually we all look at things differently. The commonalities should 

then be the focus. Commonalities include Indian Reorganization Act, constitutions, resilience, and 

historical trauma. 

• There should be more use of general terminology recognizable to all children. Some children do not 

know what an ocean looks like, but they do know the term water. Fishing and salmon may not be 

relatable. 
CDC/ATSDR TAC Meeting 

February 5–6, 2019—Summary 9

• Families may not be accessible for all children. Be cautious in using terms like grandma and grandpa, but 

say, “Someone that loves and supports me” instead. 

• Some commonalities can include health disparities. One such health disparity that some tribes have in 

common is diseases from ticks. For example, the story could include taking care of a dog and keeping 

your home clean and orderly so as not to attract bad things, that could include diseases such as Rocky 

Mountain Spotted Fever (RMSF). 

• The title Starry Lights is okay but “The Stars That Connect Us” may be a better title. 

• Need to change the title of Spirit Flight. The current title makes it seem like the children are going into 

the spirit world. 

• Will these books come with directions on how to use them? For example, “This is an example of how to 

deal with this situation.”

Question from Moderator Vivian García López: When it comes to the visuals of the two books, what else is 

important to keep in mind to make sure they are culturally appropriate and as relevant as possible across AI/AN

tribal communities?

Answers (input from multiple people):

• Mountains are good to show. 

• In general, daily living with people who look like us is important.

• One thing I did not see here is that we have a sense of community. We are always together helping each 

other—dinners, church, community meetings, and traditional gatherings with traditional foods. 

• In certain tribes, people cannot touch certain types of feathers. 

• It is important to watch out for “pan-Indianism,” which is something that could happen by propagating 

stereotyped images or by relying too much on commonalities. It might be a good idea to have notes on 

the sides that say, “This is a Cherokee tradition.”

• Another alternative to relying on commonalities is to add a discussion guide so tribes can tailor the book 

to their culture as it is used.

• Not all animals are common between tribes. For example, many tribal areas do not have bears, and not 

many have seen a bear before. The rabbit and owl are more common.

Comments on the five bystander intervention story ideas:

• (California Area) I like the first and fifth story idea. The fifth one is particularly relevant because a lot of 

kids experience trauma.

• (Navajo Area) I like the second and fifth story idea. They seemed the most relevant to Navajo and White 

Mountain Apache. Suicide prevention efforts are a priority in the southwest.

• (Great Plains Area) I like the fifth story idea. Reaching out to help each other in every stage of our lives is 

very important.

• (Tucson Area) I did not understand the message of the third one, but I like the second story idea. It is 

hard to seek help, and it can come across as demeaning to ask for help, but it is important to ask. 

2:00PM–Opioids, Adverse Childhood Experiences, and Suicide Prevention Updates and Listening 

Session 

Presenters

• Arlene Greenspan, DrPH, MPH, MS, Associate Director for Science, NCIPC, CDC

• Judith Qualters, PhD, MPH, Division Director, NCIPC, CDC

Opening Remarks

• The top three priorities at NCIPC are adverse childhood experiences (ACEs), suicide prevention, and 

opioids. 
CDC/ATSDR TAC Meeting 

February 5–6, 2019—Summary 10

• NCIPC projects in Indian Country (aside from the top three priorities) include motor vehicle crash 

prevention, intimate partner violence prevention, and falls prevention. 

TAC Questions and Discussion

Question from Councilwoman McCovey: How can we prevent post-traumatic stress disorder (PTSD) and drug 

abuse if they are co-occurring?

Answer (Dr. Qualters) For PTSD, there are potentially many causes. CDC understands that there is a relationship 

between ACEs, opioids, and suicide. ACEs for example can lead to longer-term mental health issues. So one of 

the areas we are looking at for primary prevention is to address children to reduce the risk of these issues later 

in life. 

Answer (Dr. Greenspan): There is a link between PTSD, suicide, opioids, and ACEs so it is important to provide 

resilience for kids and adults for primary prevention. CDC is working to focus efforts on children so the problems 

do not persist in adulthood. NCIPC works to develop funding announcements that are broad enough to allow for 

culturally appropriate approaches that can address a variety of challenges. We are also looking at these linkages 

to try to understand them in more detail to improve prevention strategies. 

Question from Dr. Greenspan: Are there particular injury prevention messages that resonate with your 

community to prevent ACEs?

Answer (Ms. Bradley): We are starting a new campaign on ACEs. We want to devise a system to conduct more 

tests on ACEs, but are unsure what to do with the data once they are collected. We need to educate the 

community more about ACEs and then identify potential protective mechanisms. For this campaign, we need 

assistance or effective community-based strategies on community-wide education campaigns. 

Question (Dr. Greenspan): We have begun to compile evidence-based strategies, and we do have a child-abuse 

technical package to provide more guidance on implementation of the evidence-based strategies. What are 

some of those evidence-based strategies that resonate in Indian Country, and what can we improve to make 

these messages more culturally sensitive?

Answer (Councilman Antone): Not all programs have tribal-specific projects. When we apply to them, we have 

to change our strategies to become competitive. Would there be assistance available for the tribes?

Response (Dr. Crosby): NCIPC developed technical packages to help communities learn more about 

implementing evidence-based strategies. These packages include a number of strategies to help communities 

learn more about the problem and the best program to address it.

Response (Dr. Qualters): NCIPC recently developed an implementation guide for communities. Other projects 

include suicide data and misclassification in the National Violent Death Reporting System.

Comment from Ms. Pivec: The different types of funding going to tribes for specific things hinders the bigger 

picture of creating public health infrastructure. We are doing a lot in the clinic setting, but we need to increase 

public health efforts.

Response (Dr. Qualters): We do have some funding opportunities directed toward strategic planning. We are 

encouraging partners to use strategic planning efforts to help manage and direct the other funding streams 

coming through. 

Question from NCIPC: Who are the key partners in Indian Country?

Answers (input from multiple people):

• Elders.

• We developed the Opioid Tribal Action Plan Coalition and brought in people from different sectors;

however, it was hard to manage multiple groups/projects. 

• It is difficult to recruit staff in tribal communities. 

Statements from NCIPC:
CDC/ATSDR TAC Meeting 

February 5–6, 2019—Summary 11

• There is a funding opportunity with a population size requirement going out to states, cities, and 

territories to address overdose data. 

• NCIPC is encouraging tribes to reach out to their state representatives and partners to ensure there are 

efforts going to tribes because of this funding. 

• There is a need for better data to use better interventions.

Wednesday, February 6, 2019 

9:00AM–Healthy Tribes, NCCDPHP Updates 

Presenters

• Craig Thomas, PhD, Director, Division of Population Health

• David Espey, MD, Director, Healthy Tribes

Overview of the Healthy Tribes Program

• In 2014, NCCDPHP took steps to work more cohesively and increase CDC’s investment in Indian Country.

• By fiscal year 2019, NCCDPHP will provide approximately $34.5 million to more than 100 tribes, tribal 

organizations, and TECs through three CoAgs: Good Health and Wellness in Indian Country (GHWIC), 

Tribal Epidemiology Center Public Health Infrastructure (TECPHI), and Tribal Practices for Wellness in 

Indian Country (TPWIC).

• GHWIC is a $76.5 million, five-year CoAg. 

o Our GHWIC partners include 12 individual tribes and 11 tribal organizations. 

o This CoAg will help tribal organizations support tribes in their arena in the form of sub-awards, 

evaluation support, training and leadership. 

o GHWIC is the largest investment to Indian Country from CDC to date. 

o The cornerstone strategy of GHWIC is promoting partnerships between all 23 grantees and 

partners. 

o This CoAg takes a more integrated approach to reduce obesity and tobacco use and to prevent 

and manage diabetes and cardiovascular disease.

o Within GHWIC, NCCDPHP emphasized policy, systems, and environmental approaches because 

they reach deeper into the community and last longer compared to behavioral change efforts.

o GHWIC also promotes community-clinical linkages between the services available in the 

community and those provided in the clinical setting to assure those at high risk for chronic 

disease are receiving the clinical preventive services they need. 

• TECPHI is a $42.5 million, five-year CoAg to strengthen the infrastructure of TECs and to increase their 

capacity to address regional public health priorities, including chronic disease prevention, to the tribes 

they serve. 

• TPWIC is a $15.5 million, three-year CoAg. 

o Input from CDC’s TAC suggest that AI/AN cultural and traditional teachings and practices are not 

widely understood or supported through financial and technical resources by federal agencies. 

o After convening three meetings with tribal leaders and cultural advisors, NCCDPHP identified 

seven strategies that strengthen connections to community, family, and culture to reduce risks 

for chronic disease in their communities.

o This CoAg provides funding to 21 individual tribes and 16 urban Indian organizations.

The PowerPoint presented by NCCDPHP is available upon request. Email tribalsupport@cdc.gov to request a 

copy of the presentation.
CDC/ATSDR TAC Meeting 

February 5–6, 2019—Summary 12

TAC Questions and Discussion

Question from Ms. Beaver: Can you explain the decision to fund the epidemiology centers instead of individual 

tribes? What about those tribes that do not have a relationship with their epidemiology center? Will you be 

conducting an evaluation on this CoAg to determine how effective it is to fund epidemiology centers?

Answer (Dr. Espey): The goal of this particular funding is to target a network of tribal organizations that serve a 

number of tribes. There will be an opportunity to apply for direct funding for tribes through our next round of 

funding for GHWIC. 

Answer (Dr. Thomas): When TECPHI is in its third or fourth year, it will be a good time to evaluate whether this 

was a good model for NCCDPHP and what we might like to do differently. We are currently in the second year of 

the grant. 

Question from Mr. Yazzie: How can tribes find more resources—specifically to do Tribal Behavioral Risk Factor 

Surveillance System (BRFSS)—and not just community health assessments or community health improvement 

plans? The cost burden currently is about $300,000 across five agencies or about $1.5 million to conduct a tribal 

BRFSS. 

Answer (Dr. Thomas): Now is a good time to start modernizing the BRFSS instrument. This would allow more 

opportunities for funding for tribes and tribal communities. Dr. Thomas made a request to discuss some lessons 

learned from tribal BRFSS at Navajo with Mr. Yazzie. 

Answer (Dr. Espey): TECPHI is another opportunity for epidemiology centers to apply for funding for tribal BRFSS 

projects. 

Question from Mr. Yazzie: State health departments do not always share data with tribes or epidemiology 

centers. Is it possible to include language in the notice of funding opportunity (NOFO) requiring states to share 

data with tribes and epidemiology centers?

Answer (Dr. Thomas): The NOFO for BRFSS will expire in 2020, so now is a good time to start incorporating new 

language. 

Question from Councilman Antone: Which regions in Indian Country experienced higher increases in homicide 

and is there a specific reason for this increase? It would be good to invest funding into the root causes of 

unintentional injuries and homicide so that we are responding proactively rather than reactively. We need 

guidance for setting up benchmarks so that we know we are moving towards the goals that we have defined.

Answer (Dr. Espey): Alaska and Southwest Areas. The reason for the increase could be a result of multiple 

factors, but factors like this increase in homicide are a part of our goal of TPWIC is addressing health through 

culture. We want to work to address these social determinants of health to improve some of these health 

conditions. 

 

10:00AM–CIO Senior Leadership Updates and Listening Session 

Presenters

• Captain Carmen Clelland, PharmD, MPA, MPH, Director, OTASA, CSTLTS, CDC (on behalf of Dr. José

Montero, CSTLTS Director)

• Captain Deron Burton, MD, JD, MPH, Associate Director for Health Equity, NCHHSTP, CDC

• Sharunda Buchanan, PhD, MS, Director, Division of Emergency and Environmental Health Services, 

NCEH/ATSDR

• Stephanie Dulin, MBA, Deputy Director, NCBDDD, CDC

• Captain Thomas Hennessey, MD, MPH, Director, Arctic Investigations Program, NCEZID, CDC

• Craig Thomas, PhD, Director, Division of Population Health, NCCDPHP, CDC

• Captain David Espey, MD, Director, Healthy Tribes, NCCDPHP, CDC

• Constance Franklin, MPA, Program Analyst, NIOSH, CDC
CDC/ATSDR TAC Meeting 

February 5–6, 2019—Summary 13

• Gregory Smith, MPA, Tribal Liaison Officer, Program Services Branch, Division of State and Local 

Readiness, CPR, CDC

CSTLTS

• CSTLTS has been working on a strategic plan to guide communication and decision making for the next 

3–5 years. The updated mission is “to improve community health outcomes by strengthening state, 

tribal, local, and territorial public health agencies.”

o The three goals of the strategic plan are to—

 Enhance public health system coordination and collaboration to advance public health 

priorities

 Fortify public health infrastructure and core capabilities of state, tribal, local, and 

territorial health departments

 Put public health systems science into action to achieve public health impact 

o Some examples of strategic objectives that support tribes include the following:

 Increase CDC engagement and collaboration with tribal elected leaders and tribal health 

officials

 Increase workforce capacity and competencies for improving AI/AN health

 Develop tools and guidance for responding to the social determinants of health

 Improve tribal resource strategies, systems, and performance

 Provide opportunities, resources, and tools to support and improve public health system 

response to emerging and emergency issues

• CSTLTS has recently started a new five-year CoAg to build capacity in Indian Country by providing direct 

funding to tribes and tribal-serving organizations. This is the Tribal Public Health Capacity Building and 

Quality Improvement Umbrella CoAg and will use a two-part strategy:

o Funding strategy 1 supports building capacities and capabilities and provided $550,000 to tribes 

and tribal-serving organizations in fiscal year 2018.

o Funding strategy 2 enables CIOs to make awards to funding strategy 1 recipients. This strategy 

provided $15,431,446 to tribes and tribal-serving organizations in fiscal year 2018. 

• Starting in fiscal year 2018, CSTLTS began funding national partnerships through a five-year CoAg. This 

CoAg provided $1,890,000 in funding to help strengthen the nation’s public health infrastructure by 

implementing activities to strengthen governmental and nongovernmental components of the public 

health system to ensure a competent, current, and connected public health system and to improve the 

delivery of essential public health services through capacity-building assistance. 

• The Public Health Associate Program (PHAP) is a two-year training program managed by CSTLTS. In fiscal 

year 2018, PHAP had 23 associates working in tribal host sites or in tribally focused assignments. This 

represents a total financial investment of $1.5 million to support tribes and tribal-related capacity 

building. 

NCHHSTP

• Division of Sexually Transmitted Diseases: The Community Approaches to STD Disparities project, 

currently in its second year, focuses on community engagement to promote wellness and sexual health 

in tribal communities. It works to establish partnerships, conduct needs assessments and local testing 

events, and apply primary interventions for teen sexual health. 

• Division of Adolescent and School Health (DASH): Youth Risk Behavior Survey (YRBS) monitors youth risk 

behaviors. CDC administers the YRBS nationally and directly funds states, tribes, and territories to 

conduct their own assessments independent of the national YRBS. CDC provides technical assistance to 

do this and allows awardees to keep their own data and modify the survey as needed. The Division of 

Adolescent and School Health can also provide technical assistance to tribal communities for conducting 

surveys and assessments so long as the population size is representative and substantial.
CDC/ATSDR TAC Meeting 

February 5–6, 2019—Summary 14

• Division of HIV/AIDs Prevention: Provides comprehensive HIV prevention for community organizations, 

including the Indigenous Peoples Task Force in Minnesota and the Native American Health Center in 

California.

• Division of Viral Hepatitis: From 2013 and 2018, a CoAg with the Alaska Native TEC, addressed Hepatitis 

A and Hepatitis B prevention via vaccination and interventions. The outcomes of this project helped 

develop publications and vaccine strategies. 

NCEH/ATSDR

• NCEH/ATSDR’s mission is to protect people’s health from environmental hazards that can be present in 

the air we breathe, the water we drink, and the world that sustains us by investigating the relationship 

between environmental factors and health, developing guidance, and building partnerships to support 

healthy decision making. 

• Phase One of our Tribal Drinking Water Program included training 24 professionals from 13 tribes and 

developing program improvement plans. 

• Phase Two of our Tribal Drinking Water Program included assistance in implementing the program 

improvement plans developed during first phase, creating an inventory of environmental health data 

sources, and designing an electronic platform for better management of data to prioritize program 

improvement needs.

• NCEH helped provide onsite consultation and technical assistance to the Cherokee Nation, Northern 

Cheyenne Tribe, and the Tuscarora Nation. 

• Per-and-Poly-fluoroalkyl Substances (PFAS) are contaminants that can pollute water systems. In 2018, 

NCEH/ATSDR conducted outreach and health assessments in Alaska to help address the PFAS problem.

• In collaboration with NIHB, NCEH/ATSDR is in the initial stages of planning a Tribal Environmental Health 

Summit for 2020.

NCBDDD

• This program works to advance CDC’s mission of preventing the leading causes of disease, disability, and 

death, while promoting the health of people of all ages.

• In fiscal year 2019, Congress appropriated an additional $10 million to NCBDDD to protect mothers and 

babies from emerging threats. 

• To implement surveillance for this project, CDC will support public health partners to prepare for and 

respond to emerging threats to mothers and babies. 

• CDC will provide a more accurate picture of infants and children affected by the Zika virus infection 

during pregnancy (up to age 2) included in CDC’s Zika Pregnancy and Infant Surveillance System. These

data will help inform the needs of and optimal care for children and families. 

• CDC will also pilot the innovative Zika surveillance system to monitor and respond to additional or 

emerging threats, including prenatal opioid exposure and related infections and their impact on mothers 

and babies.

• In fiscal year 2020, CDC will continue using Surveillance for Emerging Threats to Mothers and Babies as a 

key component of preparedness and rapid response activities for these populations. CDC will also focus 

on monitoring the impact of Zika, the opioid crisis, infectious diseases, and natural disasters affecting 

mothers and babies.

NCEZID

• Division of Vector-Borne Diseases: Currently working on RMSF control in Arizona. Funding recently 

announced targeting early diagnosis and better RMSF control.

• Division of High-Consequence Pathogens and Pathology: Dr. Hennessey discussed the capacity of their 

division to analyze data from the IHS Data Mart, which started with Hantavirus data in Arizona. This IHS 
CDC/ATSDR TAC Meeting 

February 5–6, 2019—Summary 15

data analysis capacity has since led to the publishing of about 60 papers. This service is available to tribal 

members and other centers.

• Division of Foodborne, Waterborne, and Environmental Diseases: Currently working on activities related 

to the early diagnosis and management of Valley Fever, as well as certain waterborne infectious 

diseases. An example of this would be the Great Lakes Restoration Initiative, which seeks to build 

capacity to better analyze these water systems.

NCCDPHP

• Division of Diabetes Translation

o The Division of Diabetes Translation currently has 38 tribes and tribal-affiliated organizations 

offering the National Diabetes Prevention Program (DPP) lifestyle change program and 

participating in the CDC recognition program.

o A pre-conference workshop at the upcoming Diabetes in Indian Country Conference (August 

2019) will focus on practical how-to’s and highlight lessons learned from tribes that have been 

successful in offering the National DPP lifestyle change program in their communities.

o In November 2018, the Division of Diabetes Translation released an announcement in the 

Federal Register for public comment related to the evaluation of their CoAg-funded programs 

that are working to support new program startups in underserved areas. 

• Division of Nutrition, Physical Activity, and Obesity (DPNAO): On May 6–10, 2019, DPNAO will 

acknowledge the 20th Anniversary of Racial and Ethnic Approaches to Community Health (REACH) 

during the National Training meeting in Atlanta, Georgia. 

• Division of Cancer Prevention and Control has about four CoAgs providing funding of approximately $10 

million. One of these CoAgs for breast and cervical cancer currently has thirteen recipients. Another for 

colorectal cancer has one recipient.

• Division of Heart Disease and Stroke Prevention (DHDSP)

o In fiscal year 2018, DHDSP funded two tribal organizations for Well Integrated Screening and 

Evaluation for Women Across the Nation (WISEWOMAN), which provides heart disease and 

stroke risk factor screenings and services that promote healthy behaviors.

o DHDSP funded tribes and tribal orgs through the current GHWIC and will continue to do so with 

enhanced community clinical linkages to support heart disease and stroke prevention in the 

next funding cycle for GHWIC beginning in fiscal year 2019.

• The Office on Smoking and Health (OSH)

o In fiscal year 2018, OSH funded the National Native Network through Inter-Tribal Council of 

Michigan, Inc., which serves as a public health resource to decrease commercial tobacco use and 

cancer health disparities among AI/AN. There are eight funded networks. 

o Every year as part of the Tips campaign, OSH invests funds for targeted media to enhance the 

reach of the campaign to AI/AN audiences. In 2018, examples of media channels containing Tips 

ads include on looped videos in health clinics serving this audience and on radio (Native Voice 

One), as well on digital and in print (Whispering Winds).

• Division of Oral Health

o Through a supplemental award within TECPHI, the Division of Oral Health provided fiscal year 

2018 funding to all 12 TECs to 1) assess infrastructure, capacity, gaps, and needs among selected 

tribes to conduct oral health surveillance and 2) develop capacity building and technical 

assistance resources for conducting oral health surveillance among selected tribes.

• Division of Population Health

o Announced an initiative for a new road map for tribal leaders to engage communities on 

Alzheimer, which coincides with their Healthy Brain Initiative. Tentative release date is spring 

2019.
CDC/ATSDR TAC Meeting 

February 5–6, 2019—Summary 16

o Collaborating with the Division of Heart Disease and Stroke Prevention to produce posters, 

flyers, videos, and newspaper articles on the management of blood pressure as a mechanism for 

preventing stroke. 

NIOSH

• NIOSH is announcing the “Building Bridges to Enhance the Safety of American Indian Workers”

conference for July 30–31. The goal of this conference is to meet and discuss tribal worker safety health 

and solutions. 

• NIOSH also currently has two recently released NOFOs (totaling about $6 million) on commercial fishing 

safety research and training.

CPR

• The Cherokee Nation received CDC’s FY 2019 CoAg for Emergency Response: Public Health Crisis 

Response because their application met the population size criteria. The next cycle for applications will 

begin at the end of 2019.

• CPR will post a NOFO for CDC’s Public Health Emergency Preparedness in the next few weeks, which will 

cover a period of performance from July 2019 through June 2024. Congress has stipulated that funding 

go mainly to state-level public health departments, so CDC has taken additional steps to strengthen 

state relationships with tribal nations to help ensure greater coordination for public health emergency 

preparedness. 

• CDC’s tribal support pilot program “Pathways to Preparedness” is mid-way through its first year. The 

focus of this program is to gather resources and engage with partners to help tribes prepare for public 

health emergencies. The program hopes to provide a toolkit of resources for AI/AN audiences.

• Currently, CPR is preparing to present its “Working Effectively with Tribal Public Health Emergency 

Management Programs and Tribal Governments” presentation and training program at two upcoming 

events. The first presentation will take place at the 10th Annual Native American Healthcare Conference 

held in Temecula, California, June 11–12, 2019. In addition, CPR will be presenting at the 6th Annual 

National Tribal Emergency Management Conference in Green Bay, Wisconsin, August 22–23, 2019. This 

conference will include representatives from the Northwest Tribal Emergency Management Council, the 

Montana Indian Nation Working Group, the Inter Tribal Council of Arizona, the Inter Tribal Long Term 

Recovery Foundation, and the National Joint Powers Alliance, now known as Sourcewell, Inc.

11:00AM–CDC Director and ATSDR Administrator Updates and Listening Session 

Presenter

• Anne Schuchat, MD, (RADM, USPHS, RET), Principal Deputy Director, CDC

Opening Remarks

• CDC understands the need for direct funding for tribes and tribal organizations. As a result, CDC 

provided nearly $65 million of direct funding to tribes and tribal organizations in fiscal year 2018.

• The diversity of tribes and tribal organizations means that one size does not fit all and as such, there is 

not always a capacity to apply for funds.

• CDC also understands that short-term or one-time funding opportunities will not necessarily lead to 

long-term results. GHWIC is a good example of a successful and sustainable program providing direct 

funding to Indian Country. GHWIC was innovative at the time of its release, but CDC hopes that the 

GHWIC model will continue to expand across all CIOs. 

Dr. Redfield’s Priorities

1. Health security and preparedness. The 2009 influenza pandemic in particular hit AI/AN communities and 

children especially hard. We need to ensure support for vulnerable communities in particular.
CDC/ATSDR TAC Meeting 

February 5–6, 2019—Summary 17

2. The opioid epidemic, referred to as “the epidemic of our time.” The social determinants of health 

underpin the epidemic itself. 

3. Eliminating disease. President Trump hopes to eliminate AIDs and the spread of HIV by 2030. A related 

epidemic is the hepatitis epidemic, and CDC recognizes the exemplary work that Cherokee has done to 

eliminate hepatitis C.

Foundational Capabilities of Public Health 

1. Data Analytics and Strengthening Data: AI/AN data needs to be more timely and actionable.

2. Workforce: PHAP is a model program for mobilizing the interests of younger generations and applying 

them in the areas of the greatest need.

3. Protecting Mothers and Babies: reducing the burden of maternal mortality has been a priority at CDC for 

years, as well as addressing emerging threats for babies like Zika. Too many women are still dying in 

childbirth.

TAC Questions and Discussion

Question from Councilman Antone: How is CDC coordinating to include tribal public health and traditional 

practices? 

Answer (Dr. Schuchat): The GHWIC program was CDC’s first formalized effort to support and improve health by 

building off cultural and traditional practices. This started when NCCDPHP was conducting listening sessions, 

developing funding, and sharing their experience with other CIOs. Most recently, NCIPC adopted that model to 

build their own opioid funding opportunities.

Question from Councilman Antone: I know that CDC is aware of the Tribal Behavioral Health Agenda from the 

Substance Abuse and Mental Health Services Administration (SAMHSA). How will CDC coordinate with SAMHSA 

and other federal agencies to implement it?

Answer (Dr. Schuchat): Working effectively across the federal government is important, especially in the 

government-to-government relationship. CDC is committed to coordinating with other agencies on the 

behavioral health effort. There is a behavioral health council that all of the federal agencies, including CDC 

participate in. CDC is looking for more opportunities to work more coordinated with other agencies. The way 

that CDC does funding sometimes makes it difficult to coordinate with other agencies. SAMHSA, for example, 

provides many block grants, whereas CDC funding can include more requirements. Accountability is important

to CDC, and it helps us with our commitment to ensure that we are making an impact. This also helps us gain 

congressional support to sustain and grow the resources that we get, because CDC puts a priority on being able 

to show results. The critical issue of importance for grants that CDC provides to tribes and tribal organizations is 

the sustainability lens. We want to support activities that have incremental improvements built for the long run. 

CDC grants try to work in a way that is sensitive and responsive.

Question from Ms. Pivec: The Cherokee Nation came up a lot as an example during the CIO leadership listening 

session; however, Cherokee does not have funding for public health infrastructure. The clean drinking water 

initiative was $10,000, BRFSS was $12,000, and the hepatitis funding was minimal and cost quite a bit “in-kind.”

The emergency management CoAg takes time as well. It is important for everyone to know that Cherokee 

participates in these small funding opportunities because we have the infrastructure to take these dollars, and 

the people who work on these projects wear multiple hats. There needs to be consistent public health 

infrastructure funding so that if a new priority comes along, the old priority does not completely fade away. CDC 

also needs to focus beyond TECs. What works in Oklahoma does not always work elsewhere. How can the bigger 

tribes in Oklahoma develop public health capacity and ensure that smaller tribes benefit from capacity-building

activities in Oklahoma?

Answer (Dr. Schuchat): Thank you for these comments. There is a common challenge to ensuring infrastructure 

to do this work. Many of these projects rely on the assumption that there is infrastructure already in place to 

execute them. Dr. Redfield has observed that CDC has neglected foundational infrastructure at the expense of 
CDC/ATSDR TAC Meeting 

February 5–6, 2019—Summary 18

individual projects. Because of this observation, there may be interest by policy makers in supporting 

infrastructure. 

Statement from Ms. Beaver: We recognize and respect relationships and would really appreciate a direct 

relationship with CDC. If we truly want to work together, we have to be able to have mutual respect for each 

other to move forward in addressing health disparities. As tribal nations, we want the help from CDC, and we 

need the direct relationship to do that. 

Response (Dr. Schuchat): Over the past few years, CDC has become more aware of the importance of a direct 

relationship with tribes. Ursula Bauer’s example at NCCDPHP was transformational for other leaders at CDC. It 

showed us at CDC that funding travel to Indian Country is very important and says a lot. It was because of her 

work that CDC was able to understand why our approach to grants funding tribes and tribal organizations 

needed to change. CDC does have restrictions on how we can operate, particularly when it comes to resources. 

However, the beginning does need to start with that relationship, trust, and understanding. 

Question from Mr. Yazzie: PHAP is a great program, but it does not provide us with workers who have a higher 

skillset. We have asked CDC during these consultations for Epidemic Intelligence Service (EIS) officers and we 

have the capacity to house an EIS officer because we have had two former officers here at Navajo Nation. We 

could also use career epidemiology field officers (CEFOs) at Navajo. Would it be possible to place staff in these 

programs in Indian Country? 

Answer (Dr. Schuchat): I am happy to follow up and look into this request. 

Question from Principle Chief Sneed: I want to echo Ms. Pivec’s and Ms. Beaver’s statements. The Eastern Band 

of Cherokee are in a similar situation as the Cherokee Nation of Oklahoma. We receive funding for specific 

projects, but we are able to apply only because we have some infrastructure in place. Is there a plan for building 

lasting infrastructure? Tribes cannot always step in to fund certain project expenses “in-kind.”

Answer (Dr. Schuchat): We are working to develop a plan for the workforce issue. In 2019, CDC will focus more 

on understanding the present and future scope of the public health workforce. We need to focus on the career 

ladder as a whole and provide more training for mid-career public health professionals. The issue of resources to 

support infrastructure and workforce gaps is a continual battle. It is sometimes easier to want to eliminate a 

disease rather than to build infrastructure to be flexible for whatever disease might occur. However, CDC’s focus 

on health security and preparedness and the public health data strategy both help address infrastructure needs 

and workforce gaps.

Statement from Councilman Antone: I would like to extend an invitation to Dr. Schuchat and Dr. Redfield to visit 

the Tohono O’odham Nation during the upcoming Secretary’s Tribal Advisory Council meeting. It is good to visit 

these areas and see how rural and hard to access Indian Country can be. 

Response (Dr. Schuchat): We will coordinate this with Captain Clelland’s office to ensure that one of us can visit 

during that time.

Question from Mr. Yazzie: When will CDC release the new GHWIC NOFO?

Answer (Dr. Espey): April 2019.

Question from Ms. Beaver: Is the IHS data tribal-specific?

Answer (Dr. Hennessey): No, it is regional.

1:30PM–Commercial Smoking Cessation within Tribal Communities 

Presenters

• Corinne Graffunder, DrPH, MPH, Director, OSH, NCCDPHP, CDC

• CoCo Villaluz, (Hidatsa [Three Affiliated Tribes], Assiniboine [Montana], and Chamorro [Guam]), Senior 

Community Development Manager, ClearWay MinnesotaSM
CDC/ATSDR TAC Meeting 

February 5–6, 2019—Summary 19

Opening Remarks

• CDC recognizes the importance of distinguishing between traditional and commercial tobacco use.

• CDC’s goal is to collaborate with tribal communities to promote cessation of commercial tobacco use.

• Tribal communities have a higher risk of experiencing tobacco-related illnesses, such as cancer, heart 

disease, diabetes, and stroke. 

• The good news is that estimates show the majority (55.6%) of AI/AN adult smokers want to quit 

smoking. 

• OSH launched the Reimagining Cessation initiative to gather, synthesize, and create recommendations 

for clear and contemporary vision for cessation support that takes advantage of research, practice, and 

lessons learned, and considers a range of contextual factors. 

• OSH seeks to build on its commitment to understanding the unique complex issues of commercial 

tobacco use among AI/ANs and developing effective quit strategies. 

• OSH’s overarching priority areas include increasing the—

o Quit attempts among people who use tobacco products

o Use and reach of evidence-based cessation interventions

TAC Questions and Discussion

Question from Dr. Graffunder: Given the burden of commercial tobacco use on AI/ANs, what do you see as the 

change needed in your communities? What strategy could tribal communities use to address commercial 

tobacco use?

Answer (Councilwoman McCovey): Vaping is a big issue for some tribes, especially in college areas. Parents may 

by unaware of what vaping is and how harmful and addicting it can be. There needs to be a campaign to discuss 

this and help older generations become more aware. 

Response from Dr. Graffunder: OSH would be happy to work with tribes to make resources available for 

education and training. There is no safe tobacco product for kids and any messaging or sharing conducted is 

helpful. OSH encourages tribes to make use and think about what policy levers are available for tribes to use to 

address tobacco control. One tribe started to incorporate no e-cigarette policies when they found out that 

people were starting to use other types of drugs in the JUUL cartridges. 

Question from Principle Chief Sneed: What is the efficacy of raising the smoking age for youth as well as raising 

taxes on commercial tobacco?

Answer (Dr. Graffunder): There is scientific evidence that raising the smoking age for youth helps curb initiation, 

but not cessation as much. Increasing the purchasing age from 18 to 21 is a powerful example of taking a stance

against youth tobacco use. Eighteen-year-olds are still in high school, and often their first exposure to tobacco is 

from friends at school. Taxes also help for both cessation and prevention of initiation because having fees for 

both buyers and sellers are excellent deterrents. Increasing prices is a greater motivator to quit. Marrying tax 

interventions with cessation techniques helps people who want to quit smoking feel more supported.

Question from Principle Chief Sneed: Are there any studies showing the long-term effects of e-cigarettes and 

vaping use?

Answer (Dr. Graffunder): Studies on e-cigarette and vaping use mostly document their impact on cardiovascular 

disease. Studies show that e-cigarettes and vaping release toxins that negatively affect cardiovascular health. 

This is still a relatively new issue and there is not currently too much long-term research for e-cigarettes/vaping. 

It is important to note that e-cigarettes are unregulated products, so no one really knows what is in them. The 

liquids are coming from places like India, China, etc. and do usually contain nicotine, which is most likely 

modified to increase its addictiveness. 

Question from Ms. Pivec: How can we present information to stakeholders and tribal governments that 

accurately describe the scope of the problem? We are able to present the facts, but since it is a sensitive issue, 
CDC/ATSDR TAC Meeting 

February 5–6, 2019—Summary 20

we would like to present it in a respectful and impactful way. In addition, has anyone tapped into tribal citizen 

groups or community coalitions to address this issue effectively?

Answer (Ms. Villaluz): Surveys really helped a lot in Minnesota. Election season was also a great time to bring 

these issues up. We need to send out the message of protecting our future generations. In Minnesota, we have 

engaged casino and facility management coalitions and we provided trainings for tribal governments. Often 

smokers and chewers are some of our strongest advocates for changing policies.

Answer (Dr. Graffunder): If you need assistance or studies showing the effectiveness of coalitions, resources to 

help quitters, etc., we are happy to help. Many know how harmful it is, and smokers always wish they never 

started. The majority of people, including smokers, are receptive to policy interventions and the support for 

solutions. 

Question from Ms. Pivec: Will there be more funding offered to tribes for commercial tobacco cessation?

Answer (Dr. Graffunder): OSH has contributed to the GHWIC program as our flagship investment to tribes. We 

have also made independent investments, but are always looking for ways to improve. This includes technical 

assistance with data analysis, providing resources, funding tribes to do their own data collection.

Question from Mr. Yazzie: Is the tobacco survey available to the public?

Answer (Dr. Graffunder): Yes, the link is in our briefing document 

(www.cdc.gov/tobacco/data_statistics/surveys/american_indian/index.htm). 

Question from Councilman Antone: When Arizona taxed cigarettes, there was a 24% reduction in use. Do you 

have any data on tobacco use in Arizona’s native communities? 

Answer (Dr. Graffunder): We will have to follow up on this. I know we have a program in Arizona that studies 

population-level data on tobacco cessation. The increase in price for cigarettes had reduced the number of 

people smoking in public spaces. 

Question from Ms. Beaver: What are the current partnerships with behavioral health programs? Muscogee 

Creek is trying to coordinate care for our citizens, and we do not want programs to have to do this work alone.

Answer (Dr. Graffunder): The National Native Network and the National Behavioral Health Association are some 

of the major partnerships we have. We can share with you the other partners in our network after the meeting. 

Treating the whole person, including their nicotine addiction, is important. 

2:30PM–Supporting Indian Health Services’ Improvements in Healthcare Infection Prevention and 

Control 

Presenters

• Captain Amy L. Valderrama, PhD, USPHS; Epidemiologist, NCEZID, CDC

• Captain Ryan Fagan, MD, MPH, USPHS; Medical Officer, NCEZID, CDC

Opening Remarks

• The Division of Healthcare Quality Promotion’s (DHQPs) mission is to protect patients, healthcare 

personnel, and to promote safety, quality, and value in healthcare delivery systems. 

• This division is multidisciplinary and crosscutting and provides a coordinated response with other offices 

and divisions.

• This presentation will help inform the TAC on the work that this division has been doing with IHS for the 

past year and a half and would like to learn about healthcare administration in Indian Country. 

• Collaboration with IHS began in 2016, when some hospitals were at risk for losing their Centers for 

Medicare and Medicaid Services certification. 

• In 2017, DHQP assisted IHS in developing a new general infection, prevention, and control training 

curriculum for IHS healthcare facility staff and support IHS Area-based training.
CDC/ATSDR TAC Meeting 

February 5–6, 2019—Summary 21

TAC Questions and Discussion

Question from Principle Chief Sneed: Are the trainings for IHS facilities and CDC TRAIN courses available for 638 

tribes?

Answer (Dr. Fagan): Yes, and we could think about creating trainings for 638 facilities in general.

Question from Councilman Antone: Healthcare-acquired infections were a priority in the previous 

administration. Has there been a decrease in those infections at IHS clinics? There are also many complaints 

about re-admittance to emergency rooms at IHS hospitals, before referral to a high-acuity hospital.

Answer (Dr. Fagan): We are aware that IHS hospitals conduct many referrals for high-acuity patients to other 

hospitals, and we do have evidence that surveillance of these infections works. Thank you for your suggestion, 

emergency department readmission rate is definitely a metric for us to consider.

The PowerPoint presented by DHQP is available upon request. Email tribalsupport@cdc.gov to request a copy of 

the presentation.

3:45PM–Tribal Testimony 

Presenters

• Councilman Chester Antone, Tohono O’odham Nation, Tucson Area

• Del Yazzie, Navajo Nation, Navajo Area

• Principle Chief Sneed, Eastern Band of Cherokee Indians, Tribes-at-Large

• Councilwoman Lana McCovey, Yurok Tribe, California Area

Testimony

• Councilman Chester Antone, Tohono O’odham Nation, Tucson Area—

o Reaffirmed the importance of the Tribal Public Health Framework. It is an important project 

because it is defining CDC’s roles and responsibilities of how it can contribute to behavioral 

health in its mission. It is an effort that is about three years old now. That is my first 

consideration for CDC to consider as a priority and move forward.

o Stated that one other priority is the Tribal Public Health Workgroup. The thought may be for 

NIHB to establish a policy that would guide this work and of course, the TAC would have to 

review this, but we need to look into the legal ramifications of this.

• Del Yazzie, Navajo Nation, Navajo Area—

o Thanked CDC for support.

o Acknowledged the work provided by the GHWIC and TECPHI.

o Requested EIS officers and higher skilled labor for Navajo Nation and Indian Country.

• Principle Chief Sneed, Eastern Band of Cherokee Indians, Tribes-at-Large

o Thanked CDC and presenters for sharing information. 

o Thanked NIHB for their tireless efforts.

• Councilwoman Lana McCovey, Yurok Tribe, California Area

o Stated there is a need to look at how to get both SAMHSA and CDC working together. 

o There needs to be more follow-up from the 2018 Summer TAC meeting in DC. 

Closing Remarks

• Captain Clelland, on behalf of the CDC, thanked everyone for participating.

4:45PM–Adjournment of CDC/ATSDR TAC Meeting 

 
CDC/ATSDR TAC Meeting 

February 5–6, 2019—Summary 22

Appendices 

Appendix A: Acronym List 

ACEs Adverse Childhood Experiences

AI/AN American Indian/Alaska Native

ATSDR Agency for Toxic Substances and Disease Registry

BRFSS Behavioral Risk Factor Surveillance System

CDC Centers for Disease Control and Prevention

CEFO Career Epidemiology Field Officers

CIO Centers, Institutes, and Offices

CoAg Cooperative Agreement

CPR Center for Preparedness and Response

CSTLTS Center for State, Tribal, Local, and Territorial Support 

DHDSP Division of Heart Disease and Stroke Prevention

DHQP Division of Healthcare Quality Promotion

DPNAO Division of Nutrition, Physical Activity, and Obesity

DPP Diabetes Prevention Program

DVP Division of Violence Prevention

EIS Epidemic Intelligence Service

FACA Federal Advisory Committee Act

GHWIC Good Health and Wellness in Indian Country

IHS Indian Health Service

NCBDDD National Center on Birth Defects and Developmental Disabilities

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/AIDS, Viral Hepatitis, STD, and TB Prevention

NCHS National Center for Health Statistics

NCIPC National Center for Injury Prevention and Control

NCIRD National Center for Immunization and Respiratory Diseases

NCUIH National Council of Urban Indian Health

NIHB National Indian Health Board

NIOSH National Institute for Occupational Safety and Health

NOFO Notice of Funding Opportunity

OADPS Office of the Associate Director for Policy and Strategy

OSH Office on Smoking and Health

OTASA Office of Tribal Affairs and Strategic Alliances

PFAS Per-and-Poly-fluoroalkyl Substances

PHAP Public Health Associate Program

PTSD Post-Traumatic Stress Disorder

REACH Racial and Ethnic Approaches to Community Health

RMSF Rocky Mountain Spotted Fever

SAMHSA Substance Abuse and Mental Health Services Administration

TAC Tribal Advisory Committee

TEC Tribal Epidemiology Center

TECPHI Tribal Epidemiology Center Public Health Infrastructure

TPHWG Tribal Public Health Workgroup

TPWIC Tribal Practices for Wellness in Indian Country

WISEWOMAN Well Integrated Screening and Evaluation for Women Across the Nation

YRBS Youth Risk Behavior Survey
CDC/ATSDR TAC Meeting 

February 5–6, 2019—Summary 23

Appendix B: CDC/ATSDR TAC Roster 

Area Office Delegate Authorized Representative 

(Designated by Delegate)

Alaska Area

Term Expires:

February 2021

Alicia L. Andrew

President, Karluk IRA Tribal 

Council

Native Village of Karluk

VACANT

Albuquerque Area VACANT VACANT

Bemidji Area

Term Expires:

August 2020

Robert TwoBears (TAC Chair)

Representative, Legislative 

District V

Ho-Chunk Nation of Wisconsin

Wally Apland 

Director of Finance, Department of 

Health

Ho-Chunk Nation of Wisconsin

Billings Area

Term Expires: 

February 2019

Byron Larson

Rocky Mountain Tribal Leaders 

Council 

Northern Cheyenne Nation

VACANT

California Area

Term Expires: 

February 2020

Lana M. McCovey

Council Member 

Yurok Tribe 

VACANT

Great Plains Area 

Term Expires:

August 2019

Robert Flying Hawk

Chairman 

Yankton Sioux Tribe 

VACANT

Nashville Area

Term Expires:

August 2019

Cheryl Andrews-Maltais

Chairwoman 

Wampanoag Tribe of Gay Head 

Aquinnah 

VACANT

Navajo Area

Term Expires:

August 2019

Jonathan Nez 

President 

Navajo Nation

Del Yazzie

Senior Epidemiologist, Navajo 

Epidemiology Center

Navajo Nation
CDC/ATSDR TAC Meeting 

February 5–6, 2019—Summary 24

 

Oklahoma Area

Term Expires:

February 2021

James R. Floyd

Principal Chief

Muscogee (Creek) Nation

Shawn Terry

Secretary of Health

Muscogee (Creek) Nation

Phoenix Area VACANT VACANT

Portland Area VACANT VACANT

Tucson Area

Term Expires:

August 2019

Chester Antone 

Councilman 

Tohono O'odham Nation

Sandra Ortega

Councilwoman 

Tohono O'odham Nation

Tribes-at-Large

Term Expires:

February 2019

Richard Sneed (TAC Co-Chair)

Principal Chief 

Eastern Band of Cherokee Indians 

VACANT

Tribes-at-Large

Term Expires:

August 2019

Bryan Warner

Tribal Councilor, District 6 

Cherokee Nation

Lisa Pivec

Senior Director of Public Health,

Cherokee Nation Health Serivces

Cherokee Nation

Tribes-at-Large VACANT VACANT

Tribes-at-Large VACANT VACANT
CDC/ATSDR TAC Meeting 

February 5–6, 2019—Summary 25

Appendix C: Oral and Written Statements 

To: CDC/ATSDR

From: Rhonda K Beaver, Muscogee (Creek) Nation, Oklahoma Representative

Date: February 6, 2019

Re: Tribal Testimony

On behalf of Oklahoma Area Tribes, the great Muscogee (Creek) Nation, and Principal Chief James R. Floyd, I 

bring greetings and appreciate the opportunity to share our recommendations. We serve over 370,000 

American Indians/Alaskan Natives in the Oklahoma Area. Oklahoma Area supports investments in Public Health, 

Health Promotion, and Tribal Sovereignty to care for our citizens and patients. 

• Preliminary grants to funding: We are thankful the CDC provides funding opportunities that help raise 

the health status of our citizens and patients. It is disheartening when funding announcements do not 

accurately relay the intent for full consideration. Most recently, the Tribal Public Health Capacity 

Building and Quality Improvement Umbrella Cooperative Agreement was advertised as a $50,000 a year 

grant, then, later explained that award of this opportunity was required to be connected to future 

funding opportunities. This presents several issues. First, many tribal nations review grant applications 

to determine whether they can feasible implement a program given the budget—for many health 

systems $50,000 would not cover appropriate salary, fringe, and indirect costs to implement a new 

program with qualified staff. So many tribal nations likely reviewed this opportunity and made a choice 

not to apply because the initial funding was not sufficient to institute a program. Second, the practice of 

making grants competitive is not one that tribes support nationwide. The federal government has a trust 

responsibility to provide adequate access and quality care. Additionally, creating additional 

administrative burdens, like secondary applications, makes it very difficult for smaller, less resourced 

tribes to take on a grant project without guarantee of additional federal support. All in all it is frustrating 

that the grant announcement was misleading and leaves the question, how can communication be 

improved to notify tribes that future funding is connected to future grants and is it possible to open the 

future funding for public health infrastructure to tribes who did not apply? Many tribes lack 

infrastructure and stable funding. Without access to this funding, it will not be possible to increase the 

infrastructure.

• Tribal Epidemiology Centers: Many funding opportunities from the CDC are available to Tribal 

Epidemiology Centers and it is at the determination of the TEC to distribute funding to tribes. Although, 

many tribes across the nation have a direct relationship with TECs, this is not always the case. This 

process does not reflect the government-to-government relationship we expect from all federal 

agencies. Each tribal nation should have to right to exercise tribal sovereignty over their patient and 

citizen data. In Oklahoma, the single TEC cannot be expected to act on behalf of or provide the services 

to meet each of the 39 American Indian Tribes’ needs. Opening funding streams to tribes empowers 

tribes to develop public health infrastructure for their own Tribes while respecting their sovereign 

status. Tribal Epidemiology Centers are viewed as a provider of services to Tribes as the customer; 

however, this is not the reality in every area. A core set of services, demonstration of capacity to deliver 

those services, and an evaluation of the services provided directly to Tribes should be a function of CDC. 

Tribal Epidemiology Centers vary greatly across the US and we do not suggest interruption of those 

areas in which they function appropriately but request greater accountability for TEC’s to ensure they 
CDC/ATSDR TAC Meeting 

February 5–6, 2019—Summary 26

are meeting the intent of the funding. Funding short term low funded projects to Tribes does not 

increase the capacity for Tribes to build public health infrastructure. Basic services such as direct 

technical assistance for surveillance are not available in the Oklahoma Area, instead Tribes in Oklahoma 

Area have to directly contact CDC or use their own dollars to contract with other providers. A potentially 

more effective funding strategy would be to directly fund the Tribes in Oklahoma Area and per Tribal 

Sovereignty allow Tribes to choose the technical assistance provider that is able to do the best job. If the 

Oklahoma Area TEC is the best provider then naturally Tribes will utilize them to conduct the services. 

Tribes building their own public health infrastructure should be trusted to make our own decisions 

regarding services to our People. 

o In the same manner, Emergency Preparedness funding is distributed to the States. The 

Muscogee (Creek) Nation has a full functioning Emergency Response Program which has 

assisted County and State efforts in water and flood rescues, person searches, and cleanup after 

ice, snow, and wind storms in and around our jurisdiction. Funding directly to this Tribal 

program allows our Tribes to strengthen their ability to act in a timely manner directly for our 

people while meeting their needs. 

• Racial Misclassification: Data drives funding and without data, many funding sources are not able to 

accurately define the need. Racial misclassification is one example that deters funding to Tribes; without 

proper racial classification and cause of deaths addressing the need through partnerships are a 

challenge. However, it is important to note Tribes are a sovereign nation and should be given the 

opportunity with funding to develop data linkages within our Nation from burial programs, social 

services, health systems, etc. Funding Tribes directly will allow Tribal Nations to develop culturally 

appropriate and respectful mechanisms to educate and accurately report mortality rates. States that 

work directly with Tribal Epidemiology Centers are not fully capturing data. It is up to the Tribes to 

develop and distinguish processes to develop data linkages within the Nations. Funding Tribal Vital 

Records programs is necessary to correct this issue.

In conclusion, the Oklahoma Area respectfully appreciates the opportunity to share these recommendations 

with CDC. The needs in Indian Country are great and we thank you for respecting the Sovereign status of our 

Tribal Nations. Mvto (Thank you).
CDC/ATSDR TAC Meeting 

February 5–6, 2019—Summary 27

February 6, 2019

CDC Tribal Advisory Committee Meeting – Navajo Nation Tribal Testimony

Thank you for CDC’s partnership and support in addressing our public health concerns and needs on the Navajo 

Nation. We appreciate the support for the following:

1. WORKFORCE: Public Health Associate Program (PHAP) – The Navajo Epidemiology Center (NEC) 

appreciates the PHAP Associate (Brittany Quy) assignment (2017-2019 class) to assist with infectious 

disease surveillance and prevention activities. NEC will be applying for more PHAP Associates for 2019-

2021 class.

2. TECHNICAL ASSISTANCE: Viral Special Pathogens Branch – The NEC appreciates the technical assistance 

provided addressing infectious diseases including Hantavirus and Rock Mountain Spotted Fever (RMSF). 

The NEC also appreciates the funding support (Rickett Benckiser donation via CDC Foundation) to 

implement a home-based rodent exclusion project (home patch-up and prevention education) focusing 

on reducing risk of Hantavirus exposure.

3. FUNDING: Good Health & Wellness in Indian Country – The NEC is using the funding support to focus 

on reducing rates of chronic diseases on the Navajo Nation (NN). The funding support has allowed NEC 

to conduct community health assessments on the NN (Tribal Behavioral Risk Factor Surveillance Survey) 

and develop community wellness plan toolkit.

4. FUNDING: Tribal Epidemiology Center Public Health Infrastructure – The NEC is using the funding 

support to develop an Indicator-Based Information System for Public Health (IBIS).

5. FUNDING: Injury Prevention – The NEC has established the Navajo Injury Prevention Coalition and is 

using the funding support to develop an injury atlas for NN looking at unintentional and intentional 

injury morbidity and mortality that describes magnitude, trends, and patterns of motor vehicle injuries, 

elderly falls, suicide, violence, substance abuse (including opioid) and traumatic brain injuries.

6. FUNDING: Tribal Public Health Capacity Building and Quality Improvement – The NEC appreciates the 

funding support to build public infrastructure and conduct infectious disease surveillance, prevention, 

and investigation activities.

7. FUNDING: Breast and Cervical Cancer Prevention – The Navajo Breast and Cervical Prevention Program 

appreciates the funding support to provide screening services for breast and cervical cancers. The 

program helps low-income, uninsured, and underinsured Navajo women gain access to breast and 

cervical cancer screening and diagnostic services.
CDC/ATSDR TAC Meeting 

February 5–6, 2019—Summary 28

8. FUNDING: Public Health Emergency Preparedness and Response – The Navajo Public Health Emergency 

Preparedness and Response Program is using the funding support to address public health emergency 

such as a natural disaster, act of terrorism, or disease outbreak in partnership with local, state and 

federal agencies.

9. NAVAJO NATION REQUESTS:

a. Explore ways for placement of Epidemic Intelligent Service (EIS) officers and Career 

Epidemiology Field Officer (CEFO) to be housed at NDOH/NEC to provide technical assistance 

and increase capacity for disease surveillance, disease outbreak, informatics, emergency 

preparedness, etc.

b. We urge CDC to continue and expand the groundbreaking work initiated by Dr. Ursula Bauer at 

the Director of the National Center for Chronic Disease Prevention and Health Promotion to 

advance the health and wellness of American Indian and Alaska Native populations nationwide. 

Specifically, these critical programs include:

i. Good Health & Wellness in Indian Country Program

ii. Tribal Epidemiology Center Public Health Infrastructure Program

iii. Tribal Practices for Wellness in Indian Country

These multiyear initiatives have led to the dissemination of sorely needed dollars directly to 

Indian Country to address critical tribal public health infrastructure needs and health priority 

areas such as diabetes, heart and kidney disease, stroke, and affiliated risk factors. Throughout 

her tenure at CDC, Dr. Bauer dedicated herself to visiting tribal communities, building 

relationships, and most important, listening to the needs and wishes of tribal leaders. She was 

committed to translating words into action, and kept her word by mobilizing funding throughout 

Indian Country to build a robust foundation of resources that will undoubtedly strengthen tribal 

public health infrastructure locally, regionally, and nationally. It is imperative that the CDC not 

only protect and ensure the continuity of these initiatives, but also look to them as models to 

guide resource dissemination from other CIOs to advance the health and wellness of Indian 

Country.

c. Funding for Injury Prevention – motor vehicle injury is the #1 cause of mortality on NN.

d. Funding for Colorectal Cancer Prevention and Screening for Early Detection – colorectal cancer 

is the #1 cause of cancer mortality on NN. 

e. Funding for Navajo Department of Health Public Health Accreditation.

f. Funding for Maternal and Child Health projects.

i. Tribal Pregnancy Risk Assessment Monitoring System (PRAMS) – to collect Navajospecific, population-based data on maternal attitudes and experiences before, during, 

and shortly after pregnancy.

ii. Birth Defects Surveillance – to examine whether known risk factors for birth defects 

explain the higher prevalence of selected birth defects among Navajo newborns.
CDC/ATSDR TAC Meeting 

February 5–6, 2019—Summary 29

g. Funding for Healthy Dine Nation Act (Unhealthy Food Tax) Evaluation Project – Conducting a 

review of the collection, distribution and implementation (including health impact) of HDNA is 

essential to make informed decisions about the future of the tax.

h. Funding for Navajo Behavioral Risk Factor Surveillance System Survey (Tribal BRFSS) – The 

survey was conducted on the NN for the first time and the need to continue the survey activities 

is imperative so that health trends over time can be established.

i. Direct funding for Public Health Emergency Preparedness.

j. Explore funding a NN tribal recycling project – reduce, reuse and recycle on NN.