Tribal Advisory Committee (TAC) Summary Report February 9–10, 2016 

Department of Health and Human Services

Centers for Disease Control and Prevention

Agency for Toxic Substances and Disease Registry

Tribal Advisory Committee Meeting and 

14th Biannual Tribal Consultation Session

February 9–10, 2016

Atlanta, Georgia 

Summary Report

CDC/ATSDR Tribal Advisory Committee Meeting

February 9-10, 2016—Summary Report

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Tribal Advisory Committee (TAC) Summary Report February 9–10, 2016

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CDC/ATSDR Tribal Advisory Committee Meeting

February 9-10, 2016—Summary Report

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

(ATSDR) hosted the Tribal Advisory Committee (TAC) Meeting and 14th Biannual Tribal Consultation Session,

February 9–10, 2016, at CDC’s Roybal Campus, in Atlanta, Georgia. During the course of the two-day 

meeting, seven TAC members heard presentations from and held discussions with CDC and ATSDR staff, as 

well as presenters from the Substance Abuse and Mental Health Services Administration (SAMHSA), 

Administration for Children and Families (ACF), and the US Department of Justice (DOJ). Topics discussed 

during the TAC meeting included CDC’s budget, adverse childhood experiences (ACEs), electronic nicotine 

delivery systems (ENDS), and CDC’s Public Health Associate Program (PHAP). 

Members present for roll call: Alicia Reft (Alaska Area), Kristine Rhodes (Bemidji Area), Adam Geisler 

(California Area), Robert Flying Hawk (Great Plains Area), Jonathan Nez (Navajo Area), Lisa Pivec (Oklahoma 

Area), Delia M. Carlyle (Phoenix Area), Chester Antone (Tucson Area) [Quorum Met]

Members absent: Beau Mitchell (Billings Area), Herman Honanie, Darcy Morrow, Andy Joseph, Jr., and 

Leslie Sampson Sr. (Tribes-at-Large members)

Vacancies: Albuquerque Area, Nashville Area, and Portland Area

Action Items

CDC Budget 

• If funding is provided to CDC and other federal agencies for addressing Zika, the opportunity to provide 

direct funding to tribes will be a positive systems-level change in tribal-federal relations. CDC should 

look into issues related to domestic and foreign travelers; migration and border areas (as related to 

tribal lands); and Zika preparedness issues.

o Thomas Hennessy, director of CDC’s Arctic Investigations Program (AIP), within the National 

Center for Emerging and Zoonotic Diseases (NCEZID), agreed to take this message to Beth Bell, 

NCEZID’s director.

• Navajo Nation requests that CDC continue funding the Navajo Birth Cohort Study.

o Dr. Patrick Breysse, Director, National Center for Environmental Health (NCEH)/ATSDR, 

responded that NCEH/ATSDR is committed to continuing the study and is working to identify 

resources to continue support.

• Alaska Area noted a drop in CDC funding for colorectal cancer screening and requested future increased 

support for those Alaska programs. 

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

Ursula Bauer said NCCDPHP has a target of using 2% of its budget to support tribes (the 

percentage is in line with total tribal population), ensuring that some upcoming NCCDPHP 

funding opportunity announcements (FOAs) will have a funding strategy that sets aside some of 

the funding specifically for tribes. Also, NCCDPHP will look at the current budget to identify 

resources to specifically support colorectal cancer screening for tribes in fiscal year (FY) 2016. 

• The TAC states that CDC needs to focus funding around building public health infrastructure, like 

preparedness, in a consistent manner within Indian Country.

• The TAC suggests that every CDC center, institute, and office (CIO) should plan how to support tribes 

and implement those plans. 
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Adverse Childhood Experiences

• The TAC states that CDC should consider funding an “Essentials for Childhood” pilot in Indian Country 

(five state pilots are funded currently). 

Environmental Health Issues

• Navajo Nation requests that CDC raise awareness among other federal agencies, especially the US 

Environmental Protection Agency (EPA), of the need for a long-term study of the environmental and 

health effects of the Gold King Mine spill. CDC should also collaborate in the study.

• The TAC states that CDC should work with tribes to address climate change issues. 

o NCEH/ATSDR is reviewing what an environmental health initiative in Indian Country would look

like. Findings will be shared with the TAC.

o Thomas Hennessy (NCEZID) suggested connecting with the EPA, CDC, and the Alaska Native 

Tribal Health Consortium (ANTHC) to learn more about a supported network of local 

environmental observers, specifically in Alaska.

Infectious Disease Issues

• Navajo Nation requests that CDC be proactive about preventing another hantavirus outbreak. 

Hantavirus has caused one death this year. There is concern that high snow and rain levels could lead to 

increased vector distribution and another outbreak. 

Mental Health

• The TAC states that CDC address suicide and substance abuse by providing FOAs that allow for tribalspecific traditional approaches and interventions and increasing access to services to address substance 

abuse and mental health within tribal communities.

• CDC’s FOAs should allow for use of traditional healing and respect tribes’ right to practice those 

methods without disclosing what the practices entail.

Native Specimens

• Tribes requested updates and information about native specimens, such as 1) the effect of the US 

Department of Health and Human Services’ (HHS’s) new human subject policy on CDC’s upcoming 

Native specimens policy, especially in terms of consent, and 2) a timeline for CDC’s policy to be finished 

(including information about whether the policy will be a living document).

o Michael Shaw, associate director for Laboratory Sciences, Office of Infectious Diseases, said 

that there is no firm date for when the policy will be finalized; however, CDC is already 

implementing standard operating procedures specific to Native specimens. 

Health Policy

• John Auerbach, CDC’s associate director for policy (ADP) and acting director of the Office for State, 

Tribal, Local and Territorial Support (OSTLTS), said CDC is interested in exploring the public 

health/clinical intersection and reimbursement issues in Indian Country.
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Additional Recommendations

• The TAC requests more information about how CDC uses tribal testimony and TAC recommendations. 

The TAC requests increased communication about actions taken on its recommendations so members

can report back to the stakeholders who provided the testimony. CDC’s Tribal Support Unit (TSU) in 

OSTLTS reviews the audio recordings of each TAC meeting, identifies the issues and recommendations,

and shares them with appropriate CIOs for acknowledgement or response. TSU leaders are planning to 

meet with each CIO in 2016 and reiterate the issues, concerns, needs, and recommendations conveyed 

in previous TAC meetings and consultation sessions. 

Notable Highlights from Meeting Content

• SAMHSA awarded $20 million this year in tribal behavioral health grants.

• SAMHSA has been providing training for Project Venture, a tribal-specific intervention in 30 states that 

addresses historical trauma and high-risk behaviors. Tribes can apply for this training.

• The Attorney General’s AI/AN Children Exposed to Violence Advisory Committee published “Ending 

Violence So Children Can Thrive,” a report that includes information from country tribal leaders, 

practitioners, youths, and families from across the United States.

• Electronic Nicotine Delivery Systems are nationally unregulated and are not an FDA-approved quit aid.

Therefore, tribes have full authority to implement strategies that effectively reduce nicotine intake.

• The National Indian Health Board (NIHB) developed “Tribal Leaders’ Perspectives on Tribal 

Accreditation,” a 14-minute video that features elected tribal leaders and was designed to educate 

other tribal leaders about accreditation.

• CDC’s Public Health Associate Program is focusing on recruiting candidates who are interested in serving 

or are from an AI/AN tribe for two pilot projects: AI/AN Candidate Pilot Project and the AI/AN Host Site 

Pilot Project. The pilot projects are being implemented to increase public health workforce capacity 

serving tribal populations and to provide training opportunities to AI/AN college graduates who may 

return to serve tribal public health agencies.

• The Office for Public Health Preparedness and Response (OPHPR) wants to develop examples of existing 

and potential hazards in tribal communities and tribal success stories about addressing these hazards. 

This project will provide a baseline showing how well the tribal programs are doing and how they are 

funded.

• Ms. Georgia Moore (OSTLTS) stated tribes that see a FOA in the early planning stages are more than 

welcome to tell OSTLTS about their specific needs.

CDC/ATSDR Tribal Advisory Committee Meeting

Tuesday February 9, 2016

Welcome and Logistics

Councilman Chester Antone (TAC Chair/Tucson Area Delegate) opened the meeting with brief 

introductions. Chairman Robert Flying Hawk (Great Plains Area Delegate) provided the opening blessing. 

Captain (CAPT) Carmen Clelland, TSU’s associate director, introduced Dr. Ursula Bauer, director of 

NCCDPHP. Dr. Bauer, who served as the designated federal official (DFO), welcomed attendees. 
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Dr. Bauer greeted everyone on behalf of Dr. Tom Frieden, director of CDC and administrator for ATSDR. Dr.

Bauer conveyed that Dr. Judy Monroe, former OSTLTS director, left the agency to become chief executive 

officer for the CDC Foundation and that Mr. John Auerbach is now serving as acting director for OSTLTS. Dr. 

Bauer concluded her welcome, stating that she was delighted to serve as the DFO and thanked TAC 

members for attending the consultation session. 

CAPT Clelland announced that Business Committee Member Beau Mitchell, Chippewa Cree Tribe of the 

Rocky Boy Reservation, recently was elected to serve as the Billings Area Delegate. CAPT Clelland then 

thanked everyone who assisted with making the TAC meeting a success.

Ms. Annabelle Allison, deputy associate director for TSU, provided updates about CDC’s new travel system. 

She expressed TSU’s goal of receiving itineraries and travel in a timely manner. She asked TAC members to 

identify their travel preparers so TSU can contact the preparer directly to arrange travel. Ms. Allison

proposed that TSU staff host conference calls with TAC members’ travel preparers.

• The TAC members in attendance agreed with the proposal and a sign-up sheet was distributed 

to record their respective travel preparers’ contact information.

Councilman Antone reviewed roles and responsibilities of the TAC, which included 

• Identifying public health issues in Indian Country

• Providing guidance and consultation to CDC and ATSDR

• Disseminating information to local tribes

• Making a good faith effort to attend all meetings and conference calls 

Senior Leaders Roundtable Discussion

The Senior Leaders Roundtable Discussion began with introductions of all panel members. Those present

were 

• Rear Admiral (RADM) Robin Ikeda, CDC Deputy Director and Director, Office of

Noncommunicable Diseases, Injury and Environmental Health (ONDIEH) 

• John Auerbach, MBA, Associate Director for Policy and Acting Director, OSTLTS 

• Brad Myers, proxy for Katherine Lyon Daniels, Associate Director for Communication 

• Dr. Ursula Bauer, Director, NCCDPHP

• Dr. Patrick Breysse, Director, NCEH/ATSDR

• Stephanie Dulin, Deputy Director, National Center for Birth Defects and Developmental 

Disabilities (NCBDDD) 

• Dr. Debra Houry, Director, National Center for Injury Prevention and Control (NCIPC)

• RADM Jonathan Mermin, Director, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB 

Prevention (NCHHSTP) 

• RADM Stephen Redd, Director, OPHPR

• Brooke Tripp, proxy for CAPT Michael Iademarco, Director, Center for Surveillance, 

Epidemiology, and Laboratory Services (CSELS)

• CAPT Tom Hennessy, Director, Arctic Investigations Program, NCEZID (proxy for Dr. Beth Bell, 

Director, NCEZID)
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• Dr. Michael Shaw, Associate Director, Laboratory Sciences, Office of Infectious Diseases (OID)

Secretary Adam Geisler (California Area Delegate) shared his frustration of not being able to use his tribal 

identification card to gain entry into CDC’s building. Dr. Bauer responded that she will share this concern 

with the head of the security team. 

Vice Chairwoman Delia Carlyle (Phoenix Area Delegate) inquired about the status of tribal testimonies, their 

purpose, and how they are being used. CAPT Clelland stated that TSU maintains a repository of tribal 

testimonies, previous TAC meeting minutes, and area reports. The meeting minutes are uploaded to TSU’s

website and are accessible to CDC employees and the general public. CAPT Clelland explained that when 

TSU receives a data request about public health concerns for a particular tribe, staff members refer to the 

testimonies and area reports. CDC and ATSDR respond to the requests and recommendations provided in 

the tribal testimonies, via the “Responses to the Issues, Questions, Recommendations, and Requests” 

document. CAPT Clelland concluded with the example of the topic of ACEs. TSU found the need for a 

discussion about ACEs after reviewing the tribal testimonies provided during the Summer 2015 TAC 

Meeting. TSU then made a suggestion to the TAC to include an ACE panel discussion at this TAC meeting.

Vice President Jonathan Nez (TAC Co-Chair/Navajo Area Delegate) thanked everyone for attending and 

conveyed greetings on behalf of Navajo Nation President Russell Begaye. He highlighted the following from 

Navajo Nation:

• The death rate for unintentional injures is at the highest it has ever been. The need for resources 

for suicide prevention and surveillance remains.

• Navajo Nation is implementing a community-based suicide surveillance system. In an effort to

decrease the suicide rate, he and President Begaye are touring local communities and engaging 

with members to spread the message that there is joy in life. The tour, called “Building 

Communities,” is meant to begin conversations about how to solve the stigma of death and suicide. 

Navajo Nation would like to continue to partner with CDC, ATSDR, and SAMHSA to combat suicide.

• Emergency preparedness is an issue, especially in light of Zika. Navajo Nation wants to know how 

CDC plans to ensure that tribes are funded if President Barack Obama’s proposal for $1.9 billion in 

funding to combat Zika is approved.

• Navajo Nation requests additional funding for the Navajo Birth Cohort Study.

• Residents affected by the Gold King Mine spill into the Animas River are scared to use the water. 

The Navajo Nation would benefit from an immediate study and a long-term study, similar to the 

Navajo Birth Cohort Study, focusing on the Gold King Mine spill.

President Alicia Reft (Alaska Area Delegate) expressed her concern about several issues in her area:

diminished funding for colorectal cancer screening; increased opiate and heroin use during the past 10

years; abuse of prescription pain medication; and climate change and land erosion.

Dr. Bauer explained that NCCDPHP is addressing opioid addiction in Indian Country by drafting prescription 

guidelines for practitioners and clinics, since the issue lies in a patient being unable to access treatment 

during the time of addiction. Dr. Bauer also explained that NCCDPHP is collaborating with NCIPC and 

welcomes guidance from tribes. Regarding suicide, Dr. Bauer responded that NCCDPHP is working on this 

issue through an initiative for violence prevention. 
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Councilman Antone asked the senior leaders if there had been responses to the questions regarding 

suicide, the budget, President Obama’s funding request for Zika, the Gold King Mine spill, and injury 

prevention. 

Dr. Bauer stated that NCCDPHP has a funding announcement for its core violence and injury prevention 

program, which is open to tribes. She also thanked Vice President Nez for the tribe’s hospitality when she 

visited Navajo Nation in January. During that visit, CDC and ATSDR discussed water-related issues on the 

Navajo Reservation, including the Gold King Mine spill and uranium contamination. She stated that various 

CDC CIOs have been discussing ways to collaborate with the Navajo Nation to address their concerns about 

accessing safe and healthy drinking water. 

Ms. Lisa Pivec (Oklahoma Area Authorized Representative) shared that there is frustration at the lack of 

actionable items resulting from the TAC meetings. Tribal public health infrastructure does not exist. The 

funding Indian Country receives is allocated to direct care, with very few dollars going toward infrastructure 

development. Cherokee Nation is going through the public health department accreditation process, and 

she witnessed how tough it can be for tribes. Ms. Pivec asked how CDC and Indian Country can work 

together to put permanent infrastructure in place in a consistent manner. She concluded by stating that 

TAC members will meet in the evening to develop action items to present to CDC.

Mr. Auerbach stated that he would like to further discuss how tribes can take advantage of generating 

revenue through insurance and third-party reimbursements. He stated that the Office of the Associate 

Director for Policy (OADP) spent the past year exploring ways to maximize potential from those dollars to 

get an upstream approach. Ms. Pivec stated that they do third-party reimbursements, but it is hard to carve 

out dollars to exclusively target public health infrastructure. Mr. Auerbach replied that there are significant 

changes in the way that health care is reimbursed because there is a movement away from fee-for-service 

to value-based contracting. The latter method of reimbursement seems to offer some opportunities for 

greater creativity in what is being paid for and for greater flexibility. Mr. Auerbach concluded by offering 

CDC’s expertise, technical assistance, and support.

RADM Jonathan Mermin provided a success story about hepatitis C screening and treatment in Cherokee 

Nation. Cherokee Nation decided to test everyone and provide full treatment. He stated that other tribes 

are thinking about following Cherokee Nation’s approach. RADM Mermin stated the reason why this 

program is successful is the devotion to making it happen and the motivation to use clinical care services 

for the public’s benefit. 

Secretary Geisler asked about funding raised for the Zika virus and whether CDC would be able to provide 

insight about how to use some of the Zika funding for Indian Country. He explained that California Area 

tribes have smaller population sizes and land bases, despite California having the highest number of AI/ANs 

in the United States. The California Area tribes do not have a tax base like other states have for their public 

health departments. Ensuring public safety infrastructure takes priority.

RADM Stephen Redd stated that NCBDDD and NCEZID are drafting a budget for the proposed funding. He 

explained that the current plan is to use Zika funding for locations (Caribbean and Pacific Islands), where 

the virus is being transmitted currently, and for domestic locations, such as the southern states, where the 

vector mosquito lives.
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Secretary Geisler replied that when the TAC met a year ago, a conversation took place about what funding 

tribes are eligible for and that list has yet to be identified. Many tribes wanted to apply for federal funding, 

but they are still waiting to identify the exact programs for which tribes are eligible and can compete. He 

stated that tribes need funding for issues affecting their communities just as timely as the funding that is 

received for “exotic” emergencies, such as Ebola or Zika. For example, thousands of AI/ANs are dying from 

underage drinking and motor vehicle accidents, but funding is disappearing. He stated that tribes can 

address such issues with more direct funding for behavioral and mental health interventions. He concluded 

by asking how tribes can work with CDC to increase funds to develop additional capacities to improve tribal 

health. 

Dr. Bauer agreed with Secretary Geisler that “exotic” emergencies garner an immediate response but other 

issues, such as underage drinking, do not always garner the same response. In terms of the budget, she 

explained that the budget for NCCDPHP is $1.1 billion, and 2% of those dollars are allocated to Indian 

Country. Dr. Bauer acknowledged that the funds are not proportionate to the burden of health concerns in 

Indian Country, but NCCDPHP is committed to ensuring that at least 2% of its budget will go to programs 

addressing issues in Indian Country.

CAPT Thomas conveyed that since NCEZID is overseeing the Zika response, he will ask the center’s director, 

Dr. Beth P. Bell, if Zika funds can be used for tribal capacity building and will relay the answer to tribes. 

CAPT Hennessy directed the conversation toward President Reft’s earlier concern about climate change and 

erosion in Alaska. He informed the TAC about CDC’s cooperative agreement (CoAg) with ANTHC. The CoAg’s 

goal is to create a network of local environmental observers, funded through the EPA, meet regularly to 

look at climate change and the potential impacts on health. He explained that the group reviews

observations from tribal members and local environmental observers and then try to fit those observations 

with a capacity for response by linking them to health professionals or university people who can respond 

and provide resources. CAPT Hennessy concluded that he would be willing to provide more information to 

tribal members interested in joining the group. 

Councilman Antone mentioned that in terms of health care, tribes receive direct funding from Medicaid for 

the services that tribal clinics or tribal hospitals provide to patients. The services are paid for by the 

Affordable Care Act (ACA). Councilman Antone stated the funds used from the ACA to pay for these 

services is the third-party revenue coming into tribal hospitals and clinics. The funding is used to provide 

additional services, maintain accreditation, or fund field assignees. He requested that CDC consider

including tribes bordering Mexico, where people are more likely to cross on foot. He also requested direct 

funding be provided to tribes to address climate change issues. He explained that climate change has been 

a political issue in which tribes are not often considered. Most often, climate change is raised to a much 

higher level of awareness in remote areas, such as Alaska, but climate change affects cities during the 

summer as well. Councilman Antone mentioned a collaboration with the University of Arizona’s 

Department of Public Health Policy and Management. 

Councilman Antone shifted the conversation to inquire about an update on CDC’s Native Specimen policy. 

Dr. Shaw responded that a policy hasn’t been finalized. However, he assured Councilman Antone that the 

practice is in place. Dr. Shaw provided the example of polio virus contaminants. Now that polio has been 

eradicated, specimens have to be destroyed or transferred. Dr. Shaw explained that Native Specimens are 

being sequestered until tribes can be contacted. The laboratories are aware that AI/AN specimens have to 
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be identified and handled differently. Dr. Shaw concluded by stating that OID is working on getting a 

specific policy in place. He further explained that CDC’s current focus is on the specimens in its possession. 

Many of their specimens are anatomical specimens and infectious. Dr. Shaw assured Councilman Antone 

that CDC wants to honor tribal sovereignty, while safely disposing of infectious specimens.

Councilman Antone thanked Dr. Shaw for his response and mentioned that the National Institutes of Health 

is trying to draft a blanket policy for tribes. However, Councilman Antone vocalized the need for each tribe 

to be considered individually.

CAPT Hennessy added that CDC co-manages the Alaska Area specimen bank with ANTHC. The Native 

Specimen policy in Alaska was drafted, with consultation and guidance from tribal health leaders, prior to 

1994. The Alaska area specimen bank has been under the oversight of both the ANTHC Institutional Review 

Board (IRB) and CDC IRB. CDC renews the policy annually and can use this policy as a model for other 

settings. 

Secretary Geisler asked the timeline for the Native specimen policy to be finalized. Dr. Shaw responded by 

saying that he is unable to give an exact date, but he assured Secretary Geisler that the practices have been 

put in place and that CDC is closely monitoring the specimens. 

Speaking to CDC leaders, Ms. Kristine Rhodes (Bemidji Area Authorized Representative) stated that tribes 

have a federal obligation that does not reside in one particular agency. She invited CDC senior leaders to 

take the requests and recommendations from each TAC member and think about how they are maintaining 

federal trust responsibility. Ms. Rhodes said CDC can work more with the TAC to make progress. 

Councilman Antone went on to ask if each of CDC leaders could describe their specific role within Indian 

Country. 

Dr. Houry began by explaining that NCIPC has a field assignee working on AI/AN issues within the Indian 

Health Service (IHS). She also stated that the Technical Assistance and Training Portal is currently under 

evaluation to determine the program’s efficiency in directly assisting tribes. She stated that prescription 

drug overdose is the biggest growing problem. In terms of violence prevention, NCIPC has funded five state 

health departments. It has provided technical assistance to 30 unfunded states, and it is willing to provide 

the same support to tribes. Dr. Houry expressed NCIPC’s desire to work with the Good Health and Wellness

in Indian Country initiative to build assistance around suicide prevention, motor vehicle injuries, and 

prescription opioid abuse. NCIPC works with many tribal populations through their Rape Prevention 

Education Block Grant and has had many tribal site visits. Dr. Houry concluded by acknowledging that 

injuries and violence have a disproportionate burden on Indian Country.

Dr. Breysse explained that ATSDR supports the Navajo Birth Cohort Study and plans to continue funding it. 

ATSDR staff will attend a meeting, in early March, in Albuquerque, New Mexico, to discuss plans for pushing

the study forward. Dr. Breysse concluded by stating that NCEH/ATSDR is looking at more ways for 

involvement and would like to have a stronger focus on tribal environmental health initiatives. 

Ms. Stephanie Dulin indicated that NCBDDD’s key focus areas are funding interventions and providing 

technical assistance to prevent alcohol-induced pregnancies. During the past four years, NCBDDD has 

funded two training and technical assistance centers to work on screening and brief alcohol intervention 
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strategies with tribal partners. Currently, NCBDDD is revising the program implementation plan for the 

alcohol intervention program to sustain the initiative and increase funding. 

Next, RADM Ikeda explained that ONDIEH’s focus is to support the mission and priorities of CDC’s four noncommunicable disease centers: NCIPC, NCEH/ATSDR, NCBDDD, and NCCDPHP. Because ONDIEH is nonprogrammatic in nature, it does not have the funding to directly assist Indian Country. However, ONDIEH 

does get involved in pockets of activity to connect and leverage resources across agencies. 

Mr. Auerbach explained his dual-role as associate director for policy and as acting director for OSTLTS. In 

terms of policy, Mr. Auerbach explained that his office works on strengthening partnerships with the 

clinical and public sectors to support prevention and public health initiatives. He stated that OADP is 

invested in educating CDC about opportunities to work with medical programs and commercial payers. In 

terms of how this would benefit tribal communities, Mr. Auerbach stated that his office will explore 

opportunities for CDC and tribal communities to work together to incorporate these services with IHS and 

other organizations serving AI/AN communities. Mr. Auerbach explained that CDC, through the Six Ways to 

Spend Smarter for Healthier People Program, is working on the feasibility of paying for community health 

workers or team members in healthcare sites. 

Vice President Nez mentioned CDC’s response to a death in western Navajo Nation from hantavirus in 

1993. He explained that the death was associated with high levels of snow and rain fall in areas that hosted 

the deer mice, which are hantavirus carriers. He asked what CDC is doing to be proactive about an 

outbreak, as there may be one again because there had been high levels of snow and rain. Vice President 

Nez requested a written response from CDC to take back to Navajo Nation. 

Adverse Childhood Experiences Roundtable Discussion 

Dr. Melissa Merrick, lead scientist for the ACE study at CDC, explained that the ACE study was to 

demonstrate that early experiences of adversity affect health outcomes later in life. Today, much of the 

ongoing work has been moved under the ACF Office of Child Abuse and Neglect Prevention. ACE categories

collected in the study included abuse (physical, emotional, and sexual), neglect (physical and emotional), 

and various family challenges, such as an incarcerated parent. She explained that the original ACE study 

design did not capture other types of trauma known to affect health outcomes, like peer victimization, 

community violence, or historical trauma. 

The original Kaiser Permanente cohort was mostly white, higher socioeconomic status, and insured. Of this 

cohort, more than half had at least one adverse childhood event. Dr. Merrick noted that those respondents 

with an ACE score of one are 84% more likely to have additional adverse childhood experiences. When data 

were compared from the original cohort to the present behavioral risk surveys, the same types and grades 

of impacts on health outcomes were observed repeatedly. As the number of adversities increased, the risk 

to health outcomes also increased for more than 40 different health outcomes. Chronic disease outcomes 

were affected as a result, as well as life opportunities, including the ability to graduate high school or obtain 

a well-paying job. The risks continue across the life span and are even passed down through generations. 

She stated that NCIPC knows much about what contributes to abuse and neglect but knows very little about 

what actually protects against it, particularly the environmental components of protection. By 

environment, she clarified that she meant the physical environs of home, community, safety, security, and 

nurturance, as well as the contextual environments of sociopolitical influence. 
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Through the Essentials for Childhood initiative, five states (California, Colorado, Massachusetts, North 

Carolina, and Washington) are currently funded to raise awareness for the prevention of childhood abuse 

and neglect, coordinating with partners to align strategies that will provide safe, stable, and nurturing 

relationships and environments for children, and to use data to inform change. States are encouraged to 

develop partnerships in this work. Dr. Merrick stated that the program can provide states with the needed 

technical assistance required, but not the funding. She provided a list of resources, including the ACE web

page and a new website that will be launched in March 2016. (Note: The Injury Prevention & Control: 

Division of Violence Prevention new ACE’s webpage launched and is located at 

http://www.cdc.gov/violenceprevention/acestudy/index.html) Case studies will be available on the new 

website with information on how the data were used in various states to affect change. The Essentials for 

Children framework will be available there. There is also an ACE infographic located at:

http://vetoviolence.cdc.gov/apps/aces/index.html.

Dr. Merrick shared that the Robert Wood Johnson Foundation is currently funding two separate cohort 

studies in which the communities had engaged local tribes for the study. In addition, a coalition of seven 

midwestern tribes conducted an initial ACE study that received significantly higher ACE scores in these 

population sections. 

Dr. Larke N. Huang, Director, Office of Behavioral Health Equity, SAMHSA, introduced the agency, 

describing its mission to affect mental health, addiction, and HIV issues for populations across the country. 

Dr. Huang leads the Trauma and Justice Initiative, which integrates a trauma-informed approach 

throughout health, behavioral health, and other related systems to reduce the harmful effects on 

individuals, their families, and their communities. The initiative focuses on people in the criminal and 

juvenile justice systems. Trauma plays a central role in behavior and contributes to health and behavioral 

health. 

Dr. Huang stated that it is not simply a psychological issue, but also a cognitive and attachment issue with a 

real impact on psychophysiological functioning. For example, youths exposed to violence demonstrated 

increased levels of stress hormones similar to those in combat veterans. This creates altered sleep patterns,

a sense of grief/loss, mood-dysregulation, and irritability. Each of these, in turn, leads to poor health 

choices. The impacts of trauma are cumulative and affect the developing physiological system, leading to 

increased health risk behaviors like smoking, drinking alcohol, and over-eating, as well as substance abuse 

and early mortality. Impacts of trauma are observable at the molecular, clinical, and population levels. 

What manifests at the individual level also manifests at the community level. Community response to 

trauma influences individual response to trauma as well. From the previous discussion about the ACE study 

data, it is important to note that 51–90% of mental health clients report having exposure to a traumatic 

event, with highest rates among the adolescents and adults who have substance abuse issues. Additionally,

there is a connection between youths exposed to trauma and rates of incarceration within the juvenile 

justice system. In the large national survey data, there is a strong connection among the substance abusers 

with exposure to trauma—both individual (e.g., child abuse, sexual abuse) and large population-level 

trauma. When looking at these subsets and their physical health, the data show that there is an increase in 

associated chronic health conditions. This suggests trauma is leading to both mental and physical health 

impacts. To address this, SAMHSA is implementing an elevated focus on trauma and trauma-informed 
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approach throughout the health and behavioral health system, including better screening, assessment, and 

response in the primary care setting. 

SAMHSA has worked to develop trauma-specific clinical interventions for the mental health setting, with 

specific interventions for various forms of trauma in different ages across the lifespan. It has increased 

efforts to work with teachers and support staff to help identify which students may be experiencing trauma 

in their homes. SAMHSA also is working the criminal and juvenile justice systems to raise awareness and 

training on how these systems re-traumatize people with traumatic exposure histories. Training has been 

provided to several judges who are looking at ways to incorporate care for trauma exposure into their drug 

court and mental health court programs. 

SAMHSA defines trauma as “A particular event that is associated with a sense of experience that is 

physically and emotionally harmful or life threatening and has lasting effects of an individual’s or 

community’s functioning in terms of their mental, physical, social and spiritual well-being.” SAMHSA 

defines a trauma-informed approach as one that is more than a trauma screen, assessment, and 

intervention. A trauma-informed approach develops an organization or community culture around trauma 

response and resists re-traumatization. This allows them to recognize signs and symptoms of trauma and to 

learn how to respond. Dr. Huang expressed that SAMHSA has identified six key principles for a traumainformed approach. Two of these principles include understanding the physical, psychological, and 

emotional safety; and understanding the value of peer support. 

SAMHSA has several grant opportunities many tribes have been awarded grant funding to focus on trauma. 

This year, $20 million was awarded in tribal behavioral health grants. Through the National Child Traumatic 

Stress initiative, there is now a National Native Children’s Trauma Center that supports the development of 

trauma-based interventions for AI/AN children. For years, SAMHSA has been providing training for Project 

Venture, a tribal specific intervention in 30 states that addresses historical trauma and high-risk behaviors. 

Tribes can apply for this training. 

Ms. Carol Redding provided more detailed background about the beginnings of the ACE study stating it

began in San Diego, California, with Dr. Vincent Felitti of California’s Kaiser Permanente Preventative 

Medicine Department and a cohort of morbidly obese persons. The cohort had used a system in which they 

rapidly and successfully lost weight, but subsequently regained it. Dr. Felitti was attempting to identify why 

this had occurred. From the cohort, Dr. Felitti learned that many had suffered sexual assault as children and 

subsequently, obesity became a protective mechanism from sexual attention. 

Ms. Redding stated that these experiences damages not just individuals and families, but also communities

and economies. Participants in the study were 17,000 members of Kaiser Permanente in Southern 

California who voluntarily completed a routine health screening and a gender-specific questionnaire. Of the 

original study group, 54% were female, and 46% were male. Ms. Redding explained that the participants 

were likely to have been employed in good jobs and been well educated in order to have been enrolled in 

Kaiser Permanente coverage, and that the survey was done in the mid-1990s. Regarding AI/ANs, she stated 

that if any participated, they would be represented in the 1.9% “other” race category. The median age of 

study participants was 57 years. 
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Ms. Redding showed that, in the original cohort combing both genders, 12.5% of the respondents had an 

ACE score of more than four. Males demonstrated a higher incidence of physical neglect and physical abuse 

than females, but all other categories were very similar. When an ACE score of four or more is observed, 

health demonstrates a significant decline. 

Ms. Redding stated that ACEs find their way to the workplace, as it is difficult to function when one is 

haunted by post-traumatic stress disorder (PTSD), substance abuse issues, domestic violence, low selfesteem, and guilt. ACEs are associated with premature death. She recounted her personal experiences with 

cancer and pointed out that one is twice as likely to have cancer if their ACE score is four or more. 

Resilience can mitigate the risk that the ACE score creates, so a trauma-informed approach that fosters 

individual, organizational, and cultural resilience is key. 

Ms. Marilyn Zimmerman, Senior Tribal Policy Advisor, Office of Juvenile Justice and Delinquency 

Prevention, DOJ, started her presentation by asking how we can put the research into practice and 

incorporate the practice into policy. Historical trauma, a concept developed by Dr. Maria Yellow Horse 

Brave Heart of the Oglala Sioux, is unique to AI/AN communities and families. Ms. Zimmerman cited results 

from a study conducted in Virginia that looked at the attitudes of domestic violence in tribal versus nontribal women. For AI/AN women, a common response to domestic violence is to respond back violently. 

According to the study, white women stated that responding violently to domestic abuse was not an option 

for them. White women often thought the perpetrator was a psychotic, violent person and would 

internalize the reason for abuse. In contrast, AI/AN women externalize the reason for abuse, attributing 

reasons, such as drug addiction and unemployment, to the abusive behavior. White women would call 911 

at the mere threat of violence, whereas AI/AN women would not call 911 until after they were hurt. 

AI/AN families witness or experience domestic abuse in their homes and communities at much higher rates 

than the general population. Historical trauma brought on by events. Broken treaties, devastating federal 

assimilation policies, years of starvation, and loss of sovereign powers have had an impact of reservation 

life. Ms. Zimmerman explained that the definition of historical trauma is colonial in origin, and it 

accumulates over time. She went into detail about how AI/AN youths suffer from PTSD-like symptoms due 

to historical trauma, including boarding school trauma, which caused AI/AN youths to feel disengaged from 

their communities. When these youths returned to tribal communities, they felt ostracized because they 

did not know the culture or language. 

Ms. Zimmerman stated that she was a member of the Attorney General’s AI/AN Children Exposed to 

Violence Advisory Committee. The committee published a report that included information from country 

tribal leaders, practitioners, youths, and families from across the United States. Ms. Zimmerman stated that 

she is hoping to implement recommendations from the report in her new role at the DOJ. She stated that 

the committee often heard that tribal connection and cultural identity is important to AI/AN youths. Having 

a healthy cultural identity and access to the revitalization of their language can help youths establish a 

connection with their tribes. Ms. Zimmerman expressed that we are all here to acknowledge that we are all 

related and when one child is hurt, we are all hurt, and the opposite is true as well. 

President Reft commented how hard it is for the Alaska Area to connect youths to their AI/AN roots. There 

is a lack of elders to watch children in tribal communities. As a result, the Internet or television become the 

babysitter. 
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Ms. Zimmerman responded to President Reft’s concern for lack of supervision for tribal youths by citing 

results from a study by the University of Montana. The study observed suicidal youth behavior in one 

particular tribal community. Results indicated that often children were attempting suicide while a parent or 

caretaker was in the room. This observation proved a disconnection between the children and their parents

or caretakers. Ms. Zimmerman stated that the questions to ask are “How do we teach parents and 

caretakers to communicate in a supporting manner?” and “How does one say, ‘nice job,’ without 

patronizing them?” There is an issue of absentee parents in Indian Country due to socioeconomic factors,

such as parents having to work multiple jobs. However, Ms. Zimmerman pointed out that there are policies 

that can support families with such needs. She stated that using trauma-informed research can be 

beneficial in creating policies that can solve multiple issues in Indian Country. Ms. Zimmerman concluded 

by stating that by broadening our narrative and recognizing our vision for all children, we can implement 

policies that can result in healthy and supportive parents for the next generation. 

Vice President Nez conveyed that historically, when land is divided, it divides tribal communities. Issues 

such as grazing permits being reissued in Pinon, Arizona (a tribal community located in Navajo Nation),

resurfaces such discussions. Vice President Nez also brought up the discussion regarding the Indian Child 

Welfare Act (ICWA), which states that AI/AN children should have a choice of either staying with their 

parent(s) or being adopted by non-Native parents. Studies indicate, time and time again, that AI/AN

children are better off being raised within their respective tribal communities. He explained his 

disagreement with think tanks, such as the Gold Water Institute, that seem to believe otherwise. He 

concluded by stating that federal agencies and tribal communities should unite in support of ICWA. 

Secretary Geisler stated his tribe created a robust domestic violence program around sexual assault. He 

stated that this leads to a discussion of how to sensitively and effectively heal the process. He explained 

that funding is not the only solution; the way federal partners and tribes work together is key to a 

program’s influence. The root cause of epidemics in Indian Country needs to be evident, not only in 

anecdotal data, but actual data through studies that show a need for investments in addressing the issues. 

Secretary Geisler again asked why news-breaking topics, such as Ebola or Zika, receive abundant funding 

and root causes of epidemics in Indian Country do not, despite evidence of the need.

Ms. Pivec asked Ms. Redding if there was a difference in categories of violence that children witness. She 

explained that a lot of AI/AN families follow a joint-family structure, where individuals live with their uncles, 

cousins, and other family members. Often, violence is not directed toward children, but toward another 

family member, resulting in the child witnessing the act. 

Ms. Redding responded that the ACE score does not distinguish between witnessing violence and 

experiencing violence. However, children who witness violence are just as likely to develop PTSD as those 

who experience it directly. The ACE study has isolated the environment to the household, but a situation 

with violence could happen anywhere. Ms. Zimmerman added that normalizing the conversation goes a 

long way toward dispelling the stigma associated with child abuse. 

Dr. Merrick stated there is no data supporting that early diversity in a child’s life is deterministic for health. 

It is about boosting protective factors and positive policies at all levels of the social ecology. It is important 

to engage all members of society and to invest in early childhood. 
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Councilman Antone mentioned that the TAC will be presenting a tribal behavioral health agenda at the 

April 2016 NIHB Tribal Public Health Summit in Atlanta. The agenda is an attempt to change the way the 

federal government works with tribes. Councilman Antone mentioned that it is important for CDC to 

modify and contextualize language in their grants, which allows tribes flexibility to incorporate their 

traditional practices for mental and spiritual well-being. 

Lunch Break 

Electronic Nicotine Delivery Systems 

Dr. Brian King, deputy director for research and translation in NCCDPHP’s Office on Smoking and Health, 

gave an overview of electronic nicotine delivery systems (ENDS), stating that these products do not 

generate smoke or aerosol, but vapor. ENDS can be detrimental to health because the products can cause 

relapse among former smokers, diminish changes to quitting smoking, lead to individuals consuming 

conventional products, and potentially, cause lifetime addiction. Similar to regular cigarettes, ENDS can 

emit second-hand smoke to bystanders.

There has been an increase in advertising for ENDS in the past seven years; an estimated $115 million has

been used for advertising purposes. Currently, 3.7% of all US adults use at least one form of ENDS. The 

highest prevalence in terms of gender is found among men, and the highest prevalence in terms of 

ethnicity is found among non-Hispanic whites and non-Hispanic AI/ANs. There are high rates of ENDS use 

among youths. ENDS are the most commonly used tobacco products in the United States, followed by 

hookah and conventional cigarettes. A CDC study found that the number of youths who have never tried 

conventional cigarettes, but are using e-cigarettes, is rising in the United States; the number tripled 

between 2011 and 2013. 

Factors leading to youths smoking include exposure to advertisements with youth-resonating themes and 

youth-resonating flavors. Currently, flavored conventional cigarettes are banned from being sold in the 

United States, but flavored e-cigarettes are not. In addition to targeting youths, ENDS marketing companies 

target populations with mental health issues. Of cigarettes consumed in the United States, 40% are among 

individuals with mental health issues.

The aerosols in ENDS include heavy metals, nicotine, and volatile organic compounds. Nicotine poses 

unique dangers to the developing human brain; smoking harms brain development in adolescents. ENDS 

also can be modified to accommodate other psychoactive substances, such as marijuana. Marijuana in 

ENDS poses a particular safety concern because there is no smell when the user aerosolizes it.

Dr. King stated that public health practitioners have researched and know what works effectively to reduce 

tobacco use. He explained that a lot of the interventions used to reduce tobacco use also could be applied 

to ENDS. Policies could make it difficult for people to access and use tobacco products. Policy makers could 

make tobacco products more expensive and pass more smoke-free policies. Clinicians and public health 

practitioners could bridge the gap between addiction and access to care. 

In 2009, President Obama signed the Family Smoking and Prevention Tobacco Control Act that gave the 

FDA the authority to regulate tobacco. In 2014, as part of the Act, the FDA proposed to regulate ecigarettes as tobacco products. If Congress approves this, FDA can regulate the manufacture, marketing,
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and sale of ENDS. A key component of this law is that states and tribes have the authority to implement 

policies that they know work. 

Dr. King provided suggestions to decrease the effect of youth-oriented marketing. These include childproof 

packaging, prohibition of e-cigarettes to minors, and monitoring e-commerce around ENDS. Since aerosol is 

not a harmless vapor, clean air standards need to include “free of smoke” and “free of aerosol,” to fully 

protect the health of bystanders from exposure. Currently, six states (Oregon, Utah, North Dakota, 

Washington DC, New Jersey, and Hawaii) have included e-cigarettes as part of their smoke-free policies. 

Dr. King concluded his presentation by summarizing the following key takeaway points: 

• ENDS are nationally unregulated and are not an FDA-approved quit aid.

• Tribes have full authority to implement strategies that effectively reduce nicotine intake.

• Overall ENDS use is increasing rapidly. Among adults, they must quit smoking cigarettes completely 

if they are going to experience any benefits from these products. Limiting marketing or sales to kids 

is critical to decrease the likelihood of youths trying ENDS.

• Including comprehensive smoke-free laws protects everyone from the potential dangers of the 

ingredients from ENDS.

Tribal Support Unit 

TSU staff started by explaining their roles at TSU. 

As policy lead for TSU, Mr. Deon Peoples, Public Health Advisor, oversees TAC recruitment. He is in charge 

of handling requests that come from TAC members or HHS, such as quarterly and or yearly operative 

reports. Mr. Peoples also works in tandem with CAPT Clelland to support TSU’s mission to increase funding 

for tribes. 

Delight Satter, Senior Advisor, explained that her primary job is to listen to the Health Research Advisory 

Committee and leverage programs within CDC. These programs include infrastructure projects, tribal 

capacity building, and program improvement ideas. Ms. Satter concluded by stating that, over the course of 

her career, it has been her privilege and honor to partner with tribal communities. 

Ms. Alleen Weathers, Public Health Advisor, explained that one of her roles is within TSU is to extract the 

issues and recommendations raised by tribal leaders from TAC meeting transcripts and tribal testimonies. 

She works with the OSTLTS Policy Unit to assign, track, and review CDC and ATSDR’s responses concerning 

these issues. Ms. Weathers expressed that the importance of the issues and recommendations document is 

that it brings public and environmental health issues occurring in Indian Country to the forefront and helps 

guide CDC and ATSDR in addressing those issues in a timely manner. Ms. Weathers also created a 

document that provides an overview of the geography of federally recognized tribes, using information 

from the US Census Bureau to extract data on AI/AN communities. This document has been distributed to 

CIOs within CDC during FOA kick-off meetings. 

Dr. Nicolas Rankin, Public Health Advisor, works with internal and external partners to build relationships

that could help TSU carry out its mission. He explained his role in coordinating the ACE panel for this TAC 

meeting. Dr. Rankin stated that he first gained an understanding of ACEs and then constructed the panel for 

a successful conversation. Dr. Rankin gathered a diverse group of professionals to present.
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Priyanka Oza, Public Health Advisor, explained that her role at TSU consists of managing communications 

tasks, monitoring the TSU email box, and helping TSU strategize ways to bring more resources to tribes. Ms. 

Oza described her role in facilitating communication with key partners in Indian Country to provide 

technical assistance on gaining CDC resources to assist with issues that may affect their communities. Ms. 

Oza concluded by stating that she enjoys drafting messages and strategizing communications that further

TSU’s dynamic mission of supporting Indian Country. 

Ms. Annabelle Allison, deputy associate director for TSU, introduced a few programs in OSTLTS that TSU 

works with to provide assistance to tribes. Ms. Allison described the OSTLTS Public Health Associate 

Program (PHAP). She stated that this year, TSU facilitated a pilot project with tribes, to not only increase 

the number of AI/AN candidates who apply to and get into the PHAP program, but also to increase the 

number of host sites across the United States. To help associates prepare for their host sites, TSU gave a 

brief orientation to the incoming PHAP class on what it means to work with tribal communities. TSU will 

host follow-up meetings in May to gain feedback from associates working in tribal entities and to prepare 

for the next incoming PHAP class. Ms. Allison then explained the Public Health Law Program (PHLP), housed 

in OSTLTS, develops issue briefs, provides technical assistance on public health laws and tribal codes, and 

hosts trainings on public health law as it relates to various activities. 

TSU frequently receives data requests from HHS and Congress that are related to AI/AN populations. TSU 

works with Ms. Georgia Moore, associate director for policy in OSTLTS, on items such as the FY budgets. 

TSU works closely with the Program Planning and Communications Unit (PPCU) to clear informational

documents, such as fact sheets, materials for the TAC meeting binders, and briefing documents. Ms. Allison 

concluded by saying that it has been a privilege to work with the staff at TSU, and that the unit looks 

forward to getting involved in more opportunities and more collaborations to support tribal public health 

infrastructure. 

TSU works with the OSTLTS Partnership Support Unit on two CoAgs affecting Indian Country. The OSTLTS

Division of Public Health Performance Improvement (DPHPI) continues to guide tribal health departments 

through the accreditation process. It is working to educate them about the benefits of accreditation. Ms. 

Allison invited Mr. Robert Foley, Acting Director of Public Health Programs and Policy, NIHB, to provide 

successes about tribal public health departments going through the accreditation process. 

Mr. Foley stated that DPHPI awarded NIHB a small grant—$100,000 for year one and $150,000 for year 

two—to sub-grant to tribes working on accreditation requirements. NIHB completed the evaluation for the 

first year. Mr. Foley stated that they have evaluated across six different dimensions, which included the 

existence of the accreditation effort, for the five grantees. Some of the successes observed were payment 

of accreditation fees, preparation for applying for accreditation, completion of community health 

assessments, and completion of a strategic plan.

Ms. Pivec commented that Cherokee Nation’s health department was not an NIHB subgrantee, but that it 

has completed 95% of the accreditation requirments. Ms. Pivec explained that she works with some 

communities interested in accreditation as a framework or program improvement concept, but they are 

not at a readiness stage to begin the accreditation process. She mentioned that she often collaborates with 

Ms. Liza Corso, who works in DPHPI. Ms. Pivec stated that Ms. Corso has been a wonderful partner and that 

she presented several webinars for the Cherokee Nation’s health department. 
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Through the CoAg with CDC, NIHB developed a 10-minute video, featuring elected tribal leaders, designed 

to educate tribal leaders on accrediation. Though NIHB believes accreditation is important, it is a tribe’s 

decision to proceed with accreditation. Mr. Foley concluded by saying that there is value in accreditation,

above and beyond the application and finalization through the accreditation board.

Ms. Allison added that a lot of information is available to tribes on the OSTLTS website. For example, PHLP’s 

work with public health law codes can be found there. She also stated that DPHPI has a really helpful 

website with more information about accreditation and performance improvement. Ms. Allison concluded 

by encouraging everyone to visit the TSU website. 

Secretary Geisler requested having CDC/ATSDR senior leadership, TSU, and the TAC arrive a day or two 

prior to the Summer 2016 TAC meeting for a strategic planning session to outline the TAC’s strategic plan.

He also reiterated Councilman Antone’s request for a summary from each CIO about how it is working or 

could work with tribes. CAPT Clelland responded that TSU will consider Secretary Geisler’s request for TSU 

and CDC senior leaders to arrive early for the Summer TAC; however, travel funds are limited.

Councilman Antone asked if PHLP is aware of any tribal court decisions on major public health issues and 

how jurisdiction relates to public health off the reservation. 

Ms. Aila Hoss, Public Health Law Fellow, introduced herself as the lead researcher on tribal law and Indian 

law at PHLP. She explained that PHLP seeks to use law as a public health tool. During the past few years,

PHLP has created a robust, sustainable program that can work, not only on federal Indian law issues, but 

also jurisdictional issues. Ms. Hoss explained that one of the things PHLP finds incredibly important is for 

tribes to have inherent authority to promote public health and wellness in their communities. She 

explained that PHLP balances its portfolio to include Indian law issues involving jurisdictional issues, as well 

as tribal law issues. In terms of Councilman Antone’s question about tribal courts, Ms. Hoss explained that 

she did some research, based on the court opinions, about how public health issues are arising in tribal 

courts. For the most part, public health issues in tribal law include fewer infectious disease cases and more 

criminal jurisdiction and domestic violence issues. 

CAPT Clelland ended the session by stating that he has had the opportunity to work with supportive TAC 

members. He said it is his honor to work with CDC/ATSDR senior leaders and others in CDC/ATSDR community 

to address issues in Indian Country. 

Partnering with CDC to Build the Next Generation of Public Health Professionals 

The final presentation of the day was delivered by J.T. Theofilos, Public Health Advisor, PHAP. PHAP 

associates are placed in the field and expected to meet certain competencies that help advance public 

health initiatives at their host sites throughout their two years. Job duties include gathering data, 

community engagement, coalition building, and preparedness activities. The ideal PHAP candidate is a 

recent graduate or entry-level professional who is willing to re-locate and who thrives in a dynamic work 

environment. Mr. Theofilos detailed ways in which the program is looking to recruit and work with AI/AN 

populations. Associates carrying out their assignment at a tribal epidemiology center (TEC) or tribal health 

department will be involved in developing effective strategies for AI/AN communities. 
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PHAP is focusing on recruiting candidates that may have an interest in serving or are from an AI/AN tribe in 

the form of two pilot projects: AI/AN Candidate Pilot Project and the AI/AN Host Site Pilot Project. The main 

objectives of the projects are to identify AI/AN candidates who apply to the program and identify host sites 

that will provide an opportunity for associates to work in subject areas related to AI/AN populations. The

pilot projects are being implemented to increase public health workforce capacity serving tribal populations 

and to provide training opportunities to AI/AN college graduates who may return to serve tribal public 

health agencies. PHAP’s program team will look at the outcome of these pilot projects in July 2016, to 

determine if there is an increase in AI/AN applicants. PHAP’s ultimate goal is to have an ongoing system to 

recruit AI/AN candidates. PHAP encourages tribal entities to see if they have activities feasible for an 

entry-level public health professional. 

CDC/ATSDR Tribal Advisory Committee Meeting

Wednesday February 10, 2016

Welcome

Councilman Antone provided opening remarks and presented Dr. Monroe with a gift of appreciation for her 

work with tribes. 

CDC Office of the Director Updates

Dr. Bauer stated that she and Michael Iademarco, director of CSELS, are leading the search for the new 

OSTLTS director. In response to expressed desires by the TAC to meet some of the candidates, CDC is

discussing the use of video conferencing technology to accommodate the request. Dr. Bauer asked the TAC

members if they had any advice for CDC on qualities they would seek in a new OSTLTS director. 

Secretary Geisler stated that the committee would ideally prefer an AI/AN person in the position. Referring 

to the PHAP model, Secretary Geisler stated that there are some great guidelines as to how you could

search for possible candidates. He stated that the TAC would like someone who understands tribal 

sovereignty, the fiscal challenges that Indian Country faces, and is knowledgeable of historical trauma that 

continues to affect AI/ANs’ health. Whoever fills the seat needs to adapt an internal CDC and ATSDR policy 

about funding distribution to Indian country. Secretary Geisler expressed that to make sure tribes are 

funded directly, the TAC desires someone who is supportive. 

Ms. Rhodes added that tribes would appreciate an OSTLTS director who is willing to visit Indian Country and 

witness the realities AI/ANs face. Vice Chairman Carlyle concurred with Ms. Rhodes, stating that the 

willingness to come out and see the disparities is a desired quality in a director. Even though a director 

could not realistically visit every tribe, making more than a few visits to Indian Country would help to

develop a common understanding. 

Vice President Nez expressed that CDC could be a strong role model for other federal agencies on 

government-to-government relations. He stated that tribes and nations were not openly invited into the 

selection process for the IHS director. He stated that, ideally, an AI/AN is desired in the role but he 

recognized that there are many great non-AI/AN professionals with tribal health experience who could 

execute the requirements of the position effectively. He asked tribal leaders to keep this in mind. The 

position should be filled with someone who has the capacity to really listen to tribal leaders. He expressed 

that the opportunity to speak with and ask questions of the agency’s top two candidates would be desired.
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Councilman Antone concurred, saying that a director with strong familiarity of the inter-relationships 

among tribal, state, and federal governments would be ideal. Tribal leaders would value someone who can 

advocate for tribal issues and connect tribes to support organizations to address health and funding 

disparities. Councilman Antone also would like to see an AI/AN person in the position, but he expressed 

that any person who had the characteristics described would be good for Indian Country.

CDC Tribal Support Website Listening Session

Dagny Olivares, PPCU’s associate director, stated that PPCU wished to hear suggestions from tribal leaders 

about ways to enhance the OSTLTS and TSU websites. She highlighted key features, including

• Tribal Advisory Committee link: This is the place where information about the TAC can be found. 

Some things housed here are the executive order; reports and publications; and information about 

the TAC charter. 

• Training and career development opportunities: This section links to PHAP and other CDC and 

ATSDR training opportunities. There is also grant writing training for tribal applicants, as well as 

CDC-partnered trainings. 

• Health disparities link: The intention of this resource is to be a one-stop shop for information from 

CDC and other federal agencies to gain access to resources and opportunities. To accomplish this,

PPCU is partnering with other CIOs to collect the information.

Secretary Geisler stated that when one goes to the official CDC website, there is no easy way to navigate to 

tribal information; nothing steers an inexperienced user to TSU. He noted that on the main CDC page, there 

is a window reflecting African American History Month, and he wanted to make sure that Native 

Americans’ History Month is highlighted there during November. He stated that, when one clicks on 

“Funding Opportunities,” nothing appears, so an index would be appreciated. 

Councilman Antone reported that the only place for direct information on tribes is located on the IHS 

website. As a result, the website is a great tool for tribes. Collaboration about its content is desired,

particularly to cite issues happening in Indian Country. He suggested adding a director’s blog. He stated that 

links to the issues and recommendations documents from previous TAC meetings are not there. CAPT 

Clelland responded that several of the documents are undergoing clearance internally and will be posted to 

the TSU website in the near future.

CAPT Clelland stated that one of the things he has been looking at is how to make pages more engaging so 

that they capture attention. Currently, the only page that accomplishes engagement is the main TSU page. 

He referred to the main CDC page, showing the main topics by scrolling down. It would be valuable to have 

an update from the latest meeting and site visits to Indian Country and a video on AI/ANs. He expressed a 

desire to have an element on TSU’s main page that links to tribal programmatic information housed in 

other CIOs. CAPT Clelland suggested an RSS feed, highlighting hot topics, tribal activities, and/or history. He 

suggested adding a feature that would automatically display current FOAs. He suggested using the EPA’s 

website as a model, since it showcases interaction with communities and even has a children’s page. 

Vice Chairman Carlyle recommended adding TSU staff pictures and individual contact information to help 

build relationships and connect tribes to CDC.
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Councilman Antone added that in addition to the emails that CDC sends to tribal leaders about Vital Signs, 

emergency issues, and weekly updates, these items should be added to the website. Many times, tribal 

leaders do not have time to read a lot of the information CDC sends. 

Updates from Convening on Tribal Practices That Promote Health and Well-Being 

Dr. Bauer introduced the session by stating that through the TAC, CDC has heard that when tribes look at 

an FOA, they have noticed that tribes have not been eligible for some of the more robust funding. The TAC 

recommended convening a group of advisors to make recommendations about how CDC can change this,

so funding can be used to support tribal priorities and practices. 

The first convening was in Spokane, Washington, in August 2015, and focused on what the federal 

government is doing to understand the importance of tribal health practices. CDC heard from the attendees 

that these types of health and well-being activities have not been recognized or allowed as “evidencebased” public health interventions, although tribes have seen health improvement through these activities.

The group developed the overarching theme of connection to culture and connection to community to 

drive health and wellness and identified practices and activities related to culture and community. At the

second meeting in Chandler, Arizona, in December 2015, the group drafted language to describe these 

activities, and discussed how FOA language could be modified to include tribal health practices. The group 

categorized the activities into seven sub-themes:

• Family and community activities that connect to culture 

• Seasonal and cultural traditional practices 

• Social and cultural activities

• Intertribal and nongovernmental organization collaborations 

• Intergenerational learning opportunities

• Cultural teachings and practices about traditional health

• Traditional and contemporary physical activities that strengthen well-being

Councilman Antone expressed that tribes do not want CDC evaluating tribal practices, but instead fund 

tribes to use their tribal practices that have worked for their people. When CDC evaluates the impact of 

their funding in Indian Country, many times it is not as significant as it could be if tribal grantees had been 

allowed to use tribal health and well-being practices. Also, tribes have not applied for FOAs because the 

tribes would be restricted to a particular “evidence-based” intervention. Tribes note that many times the 

grant language seems to be more about evaluating the grant by the required activities than about creating 

beneficial outcomes for a specific health issue. This is critical because the environment determines human 

actions.

It was a challenge to properly summarize and group the multitude of tribal practices from all AI/AN tribes. 

However, the idea is to draft FOA language that will help tribes develop these tribal-specific, culturally

sensitive interventions. At the convenings, group members were adamant about the fact that tribal 

practices cannot be shared. However, the group realized that it is about tribes being able to use tribal 

practices to promote the well-being of their communities, not necessarily sharing these practices with 

other tribes or the federal government. The desired result is developing funding language that allows this 

to occur. 
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Chairman Flying Hawk expressed that the effort is going to help the “well-being of us all as people.” He 

appreciated the comments and the opportunity to develop culturally appropriate requirements and 

language. 

Councilman Antone opened the floor for TAC members to provide feedback on the seven sub-themes.

Vice President Nez explained that in prior generations many were raised with the Native language being 

their first learned language but that today’s youths are growing up differently. This can lead to segregation 

between generations; both can teach each other. Vice President Nez pointed out that youths are forgetting 

the importance of healthy foods and an active lifestyle. The elders ate less-processed foods, deriving 

sustenance from farm-raised animals and their cultivated plants. He stated that losing Native language is 

aiding in this disconnect.

Secretary Geisler said there are tribes that are trying to revitalize their cultures. As a result, there is a need 

for social investment. It all comes back to the health of tribal families and agreeing firmly with the 

foundational component of the enterprise. There are components to wellness that have been lost. He 

hopes that, as FOAs are being developed, those involved will bear in mind how broad they may need to be

to best address the needs in Indian Country. He asked about the prospective timeline implementing the 

drafted FOA language into the standard CDC’s FOA language.

Dr. Bauer responded that the beauty of tribal practices is that they contribute to the prevention of heart 

disease, suicides, and motor vehicle crashes. The challenge will be to convince CIOs and Congress of this. In 

terms of timing, the next step is vetting identified activities to stay true to the intent of the convenings. This 

will be done through mail, email, and video conferencing. A potential third convening around the Summer 

2016 TAC Meeting might be required to ensure the process is continuing in the right direction. Next steps 

will be to demonstrate that this will work in an FOA, then encourage other CIOs and other operating 

divisions within HHS to model that work. Therefore, she sees two possible timelines: 1) an opportunity in 

the President’s FY 2017 budget initiative, with a re-convening at the next TAC meeting when CDC and 

ATSDR know what funding they will receive, or 2) a forward look at the FY 2018 budget.

Vice Chairman Carlyle affirmed the sub-themes. She suggested including the ideas from young people, since 

many of them will be assisting their elders. Even though there have been setbacks, tribes are resilient and 

continue to progress. 

Ms. Rhodes replied that she appreciated the investment in this strategy. She added that there needs to be 

talk about sustainability and keeping AI/ANs engaged at all levels of the funding process, especially 

evaluation. Dr. Bauer responded that CDC is taking a different approach in grantee evaluation with Good 

Health and Wellness in Indian Country. 

Interactive Discussion with the TAC

OPHPR monitors the Public Health Emergency Preparedness (PHEP) CoAg that directly funds all states and 

eight territories. Often, tribal governments are not fully knowledgeable about state agreements due to lack 

of information sharing and communication between tribes and states. The states do fund local health 

departments and should also fund tribal public health preparedness programs. OPHPR encourages tribes to 

participate in state and local preparedness trainings and identify a tribal point of contact for their program. 

OPHPR wants to develop examples of existing and potential hazards in tribal communities and tribal

success stories on addressing these hazards. This will provide a baseline about how well the tribal programs 

are doing and how they are funded. 
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Mr. Todd Talbert, senior advisor to the director of state and local readiness in OPHPR, shared that OPHPR is 

currently working on a new FOA that will focus more on strategic planning. The following are prompts 

about which the OPHPR would like advice as it develops the FOA language:

• What is important to think about when developing a sustainable public health system? 

• How does preparedness strengthen public health capacity?

• As tribes work with their states, what are the tribes’ recommendations? What works? What are 

areas for opportunities to improve? What are priorities for tribes? 

• What works, as far as being able to provide input into the overall state applications and or local 

applications? 

Secretary Geisler asked if there would be changes in the Stafford Act to allow for direct funding to tribes for 

emergencies. He suggested that some of the metrics for compliance could be enhanced so that the states 

must show evidence that they are consulting with tribes. 

Mr. Talbert clarified that the PHEP CoAg supports building infrastructure; it is not an emergency response 

grant. With the declaration of a public health emergency, there is a public health fund, but it has not been 

funded by Congress. Even if funding becomes available, the focus should be on developing integrated 

systems.

Mr. Gregory Smith, tribal liaison officer with OPHPR, added that one of the big issues is that the PHEP does 

not directly fund the tribes. Eleven states work with tribal emergency preparedness programs but do not 

fund them directly. The Pandemic and All Hazards Preparedness Act of 2006 (Public Law No. 109-417)

specifies that the states have a right to work with tribes as states see fit. As a result, some states are not 

working with tribes at all. When he is in the field, he conducts training programs with basic information 

about how states could interact with tribes. He suggests that effort is needed to work more efficiently with 

tribal governments.

Secretary Geisler inquired about the timeline for edits to the language in the CoAg. Mr. Talbert responded 

that he would further discuss this with Ms. Allison to discover ways to establish a tribal-specific CoAg or a 

CoAg that strongly suggests that states engage in tribal consultation. 

Dr. Bauer shared that the Indian Healthcare Improvement Act of 2015 says CDC has to directly fund tribes 

for preparedness. TECs are one way to build that public health capacity throughout Indian Country. It is a 

nice nexus, as opposed to going through state or local health departments. CDC requests input from tribes 

to determine what language would be helpful for the potential revisions to CDC’s template for FOAs. Mr.

Smith volunteered to interact with Dr. Bauer and her associates on this effort. 

Vice Chairman Carlyle responded that it is great there is a movement toward enhancing the relationship 

between tribal and state governments regarding funding. In 2013, her tribe was awarded a CDC grant for 

emergency preparedness. The state, not CDC, imposed some regulations that jeopardized tribal 

sovereignty. At that time, the tribal council decided to find the money elsewhere because tribal sovereignty 

cannot be jeopardized. She expressed that it is good to know that there are possibly other ways to get 

funding that respects tribal sovereignty.
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CDC/ATSDR Tribal Advisory Committee Meeting

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CDC Tribal Budget Updates 

The proposed FY 2017 presidential budget has a line item of $15 million allocated for tribal initiatives; 

however, it is up to Congress to appropriate funds. Dr. Bauer stated that if the proposal becomes a reality,

CDC through NCCDPHP, will focus on the following: 

• Expand Good Health and Wellness in Indian Country CoAg to include focusing on mental health and 

wellness issues to help reduce the mental health disparities among AI/ANs

• Increase the number of Good Health and Wellness in Indian Country awardees

Ms. Moore explained that only a few budget proposal items are chosen by federal agencies each year to be 

put forward and the fact that Good Health and Wellness in Indian Country was chosen is very good news.

In order to convince Congress to approve the $15 million allocation, Secretary Geisler suggested including 

organizations, such as the National Congress of American Indians, to help advocate for congressional 

funding and policy issues. Tribal leaders need to be educated so they can effectively explain benefits to

funding tribal public health. 

Councilman Antone stated that the topic of appropriating sufficient funding to tribes can be a discussion 

topic at the HHS Policy and Budget Tribal Consultation in March 2016. Certain issues and topics require 

specific expertise from agencies, such as SAMHSA and NIH. Councilman Antone requested that copies of 

the language proposing an increase in CDC’s tribal budget be shared with the TAC members so they could 

better prepare and consider support via tribal resolutions. Dr. Bauer stated the language has been released,

and a fact sheet is available. If funding is approved, CDC would announce an FOA and then work with 

organizations, such as NIHB, Urban Indian Health Centers, and TECs, to disperse the announcement to 

Indian Country.

Ms. Moore said OSTLTS will keep the TAC informed about the budget approval as Congress moves forward. 

She also stated that February and March are crucial times for CDC and ATSDR to notify the tribes, states, 

localities, and territories what the agencies are proposing.

President Reft requested treatment for heroin use be included in the budget. 

Dr. Bauer responded that the president’s budget has allocated $80 million for prescription drug overdose; 

however, since CDC is a prevention agency, it cannot fund treatment. Deployment of any funds received for 

drug use would come from NCIPC. While there has been a $15 million “increase” for tribal public health 

work overall, there has been a $60 million reduction in NCCDPHP’s budget. NCCDPHP’s CoAgs coming up 

for renewal include 1) breast and cervical cancer program, 2) comprehensive cancer program, 3) state

public health actions, and 4) community health portfolio. The latter includes the Partnerships to Improve 

Community Health program, which used to be funded at $80 million but was cut in FY 2015 and has been 

supported by other funding. CDC does not anticipate seeing dollars for that program in FY 2017. CDC, 

through NCCDPHP, also funds tribes through the Racial and Ethnic Approaches to Community Health 

(REACH) grant. The president proposed a $30 million increase for REACH.

For cancer funding, $17 million has been proposed; however, there has been a decrease in funding for 

prostate cancer and colorectal cancer. Ms. Rhodes stated that colorectal cancer screening rates are very 

low in Indian Country and that funding for cancer screening is of high importance in AI/AN communities, 

especially across the Northern Plains and Alaska. Councilman Antone asked if a funding amount for 

colorectal cancer screenings could be added to the discretionary funding. Dr. Bauer explained that if there 
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is a line for an activity, like colorectal cancer screening, and that line is eliminated, then NCCDPHP will not 

have the funds to support that activity. She proposed that tribes or TECs could filter AI/AN data from state 

cancer registries to develop their own cancer registries. She encouraged the TAC to think differently about

how to procure services and not just contract services out. 

Information regarding the budget can be found at http://www.cdc.gov/budget/index.html. 

Dr. Debra Lubar, director for the Appropriation, Formulation, and Legislation Office, stated that CDC asked 

for a total increase of $200 million in FY 2017. Dr. Lubar listed a few areas where a request for increase in 

funding has been made for FY 2017. These areas include antibiotic resistance, Good Health and Wellness in 

Indian Country, gun-violence-prevention research, laboratory safety, noise-inducing hearing loss, polio 

eradication, and viral hepatitis. She explained that CDC has funding areas that are not part of the annual 

appropriation process referred to as mandatory funding. The mandatory programs include Medicaid and 

Medicare and the Vaccines for Children program.

President Obama proposed roughly $2 billion in supplemental funding for Zika. The following are projected 

funding allocations:

• HHS: $1.48 billion

• CDC: $828 million 

• Research and Diagnostic Development: $210 million 

• Emerging threat fund for HHS responses: $210 million 

• US Agency for International Development (USAID): $335 million 

• US Department of State: $41 million 

With any infectious disease spread, CDC’s goal is prevention, detection, and response. In Zika prevention,

CDC’s main objective is to reduce the risk of exposure in pregnant women and minimize other forms of 

transmission. For detection, CDC is trying to improve the Zika virus lab testing. The Zika response is focused 

on supporting those infected. 

Secretary Geisler commented that there should be an opportunity to see if the Zika funding can go directly 

to tribes. Referring to the map tracking areas of Aedes mosquito prevalence in the United States, many of 

those states, especially California and Arizona, have a sizeable AI/AN population. He asked how Indian 

Country can be a part of the Zika funding process. 

Dr. Lubar explained that because the current known route of transmission is not human-to-human, the risk 

of individuals propagating Zika is not the same as other infectious diseases that may be transmitted humanto-human. Dr. Lubar subsequently stated that the more people are infected with the virus, the more the 

mosquitoes have a chance to become infected. CDC has asked for global funds that would help build 

surveillance and vector control capabilities in parts of the world where Zika is spreading rapidly. Depending 

on the geography of the tribe, tribes may be eligible for different funding opportunities or other ways of 

working with the federal government. 

In 2015, a total of $35 million was allocated for grants and/or CoAgs to tribes. From this amount, 21 tribes 

were funded, and some received more than one grant. Approximately 32% of funding was through the 

Good Health and Wellness in Indian Country; 26% to focus on cancer screenings; and roughly 12% came 

from the Partnerships to Improve Community Health CoAg. Ms. Moore stated that if tribes see a FOA in the 

early stages of planning, they are more than welcome to articulate their needs to OSTLTS. Tribes are eligible 

for a lot of CDC’s bench research grants. They are encouraged to continue applying for those.
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Councilman Antone replied that, often times, tribes see grant applications as too much paperwork. He 

asked if there would be a way to streamline the process so tribes can submit one application rather than 

apply for five separate grants. Ms. Moore replied that ACF is doing a pilot where it has streamlined an 

application for one of its grant programs. CDC intends to learn from this pilot to see if it can incorporate 

this into FOAs. 

Tribal Testimonies

Alaska Area (President Alicia Reft)

Ms. Denise Dillard, research director for the South Central Foundation, provided the testimony on behalf of 

President Reft. The Alaska Area presented the following issues, questions, recommendations, and requests:

• CDC needs to continue funding for AIP, which provides support to different tribal health initiatives,

like specimen bank; and vaccines for hepatitis A and B, influenza, and human papillomavirus.

• Requests that CDC provide pediatric dental residents training on AI/AN specific issues.

• CDC should work with AI/AN communities to address issues regarding water contamination and 

sanitation. The availability of safe water has a behavioral health impact for AI/ANs because many 

cultural activities involve or depend on water. 

• The suicide rate for Anchorage, Alaska, is two-to-three times higher than that of the US population. 

Suicide rates among AI/AN youths remain equally as high. CDC should work with other federal 

agencies to provide more resources to combat the high rates of suicide. 

• In Alaska , alcohol poisoning and drug overdose, including opioids, is more than twice the national 

rate. 

• CDC should address the lack of treatment options for heroin abuse. 

• CDC should address the communication gaps and provide more information on the effect of ENDS. 

• CDC should provide resources to address the resurgence of TB, high obesity rates, and age-related 

issues among baby boomers. Programs for these issues need funding for sustainability.

• How are grants reviewed, and who sits on the grant review panel? 

• Do grant reviewers possess experience with unique issues in Indian Country, and how open are they 

to traditional practices for well-being? 

• Requests information and treatment data on vitamin D deficiency, as that is a large issue in Alaska. 

Bemidji Area (Ms. Kristine Rhodes)

Chairman Flying Hawk read a testimony on behalf of Ms. Rhodes. AI/AN communities residing in the 

Bemidji Area are excited to reintroduce culture, as they believe it will be the beginning of a healing process. 

AI/AN communities must re-claim their traditional and spiritual practices to thrive. The Bemidji Area 

presented the following issues, questions, recommendations, and requests:

• CDC should conduct ACE and ENDS surveillance among AI/ANs. 

• How is CDC working with TECs to support surveillance?

• CDC should tailor best practices to AI/ANs. AI/AN tribes often miss opportunities for effective 

solutions when they are not at the decision-making table. 

California Area (Secretary Adam Geisler)

The California Area presented the following issues, questions, recommendations, and requests:
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• CDC should fund cardiovascular disease prevention efforts, such as healthy diet and outdoor 

activity, for cardiovascular diseases in children. 

• CDC should provide resources and best strategies to address underage drinking to Indian Country.

• CDC should provide tribal communities with information on the influences and effects of illegal 

substance abuse.

• CDC needs to fund asthma awareness outreach. Many AI/AN parents do not always recognize signs 

and symptoms. 

• CDC should explore methods and conduct research to prevent adverse outcomes associated with 

the legalization of marijuana use and its potential impact in AI/AN communities. 

• CDC should increase funding for transportation, as motor vehicle accidents (unintentional injuries) 

are the leading cause of deaths in Indian Country. 

Navajo Area (Vice President Jonathan Nez) 

Navajo Nation is a recipient of the Good Health and Wellness in Indian Country CoAg. With the funding, it is 

trying to implement policies, such as taxing soft beverage products, to decrease the consumption of junk 

food. The Navajo Area presented the following issues, questions, recommendations, and requests:

• CDC needs to continue funding the Navajo Birth Cohort Study on uranium exposure.

• CDC needs to fund another study like the Navajo Birth Cohort Study, but about the Gold King Mine 

spill.

• Navajo Nation requests direct funding from CDC for cancer screenings. 

• Navajo Nation leaders are touring schools to promote suicide prevention. CDC should work with 

SAMHSA to fund an initiative like this and other suicide prevention programs in Indian Country.

• Navajo Nation is currently working on implementing policies to create a smoke-free environment. It 

would like more information on ENDS.

• Navajo Nation requests direct funding for public health emergency preparedness, viral hepatitis 

screenings, and STDs, and TB prevention. 

Phoenix Area (Vice Chairman Delia Carlyle)

The Phoenix Area presented the following issues, questions, recommendations, and requests:

• Unintentional injury is the third leading cause of death in the Phoenix Area. The TEC serving the 

Phoenix Area is currently helping 20 tribes develop their community health policies. However, it is 

running into the issue of finding tribal-specific data. CDC should work with TECs to help address the 

lack of tribal-specific data on public health issues, such as unintentional injuries.

• In 2015, the Phoenix Area identified priority areas with IHS, which included mental health and 

health education. CDC should reach out to IHS and determine how it can collaborate to better assist 

the Phoenix Area on these priority areas.

• From 2002 to 2011, there have been 205 cases of Rocky Mountain spotted fever, with 15 fatalities 

in two Phoenix Area tribes. In 2013, CDC awarded a five-year CoAg of $6 million to five 

southwestern tribes, but no funds have been allocated. 

• CDC needs to increase cancer funding. Approximately, 1,050 cancer cases have been detected in 

Vice Chairman Carlyle’s community. 

Tucson Area (Councilman Chester Antone)

The Tucson Area presented the following issues, questions, recommendations, and requests: 
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CDC/ATSDR Tribal Advisory Committee Meeting

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• CDC should define its role on oral health and provide resources for the Arizona American Indian 

Oral Health Initiative. 

• CDC and ATSDR need to assist the TAC in conducting work sessions to develop a strategic plan. 

• CDC should define its role in decreasing rates of suicide in Indian Country. This could include 

facilitating a convening focused on suicide prevention. 

• The Tucson Area requests a one-page summary, from every CIO and from ATSDR, containing an 

overview of the work from each and how it could benefit Indian Country.

• CDC needs to update the TAC on the Native Specimens draft. When will tribes be able to review the 

draft?

• What is the status for tribal public health department accreditation? 

• Who is the tribal liaison for the Strategic National Stockpile? What has been done to reach out to 

tribes?

Dr. Bauer concluded the Winter 2016 TAC session by thanking TAC members for traveling to Atlanta. 
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CDC/ATSDR Tribal Advisory Committee Meeting

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Participants

Tribal Advisory Committee Members

• Chester Antone (Tohono O’odham Nation): Councilman, Tohono O’odham Nation; Chair, Tribal 

Advisory Committee (TAC); Tucson Area Delegate

• Delia M. Carlyle (Akin Indian Community): Vice Chairman, Ak-Chin Indian Community; Chair; 

Phoenix Area Delegate 

• Robert Flying Hawk (Yankton Sioux Tribe): Chairman, Yankton Sioux Tribe; Great Plains Area 

Delegate

• Adam Geisler (La Jolla Band of Luiseño Indians): Secretary, La Jolla Band of Luiseño Indians; Chair; 

California Area Delegate

• Jonathan Nez (Navajo Nation): Vice President, Navajo Nation; Co-Chair, TAC; Navajo Area Delegate

• Lisa Pivec, MS (Cherokee Nation): Director, Community Health Promotion, Cherokee Nation; 

Oklahoma Area Authorized Representative

• Alicia Reft (Native Village of Karluk): President, Karluk IRA Tribal Council; Alaska Area Delegate

• Kristine Rhodes (Bad River Band of Lake Superior Tribe of Chippewa Indians): Executive Director, 

American Indian Cancer Foundation; Bemidji Area Authorized Representative

CDC and ATSDR Senior Leaders

• John Auerbach, MBA: Associate Director for Policy and Acting Director for Office for State, Tribal, 

Local and Territorial Support (OSTLTS), Centers for Disease Control and Prevention (CDC)

• Ursula Bauer, PhD, MPH: Director, National Center for Chronic Disease Prevention and Health 

Promotion (NCCDPHP), Centers for Disease Control and Prevention (CDC)

• Patrick Breysse, PhD, CIH: Director, National Center for Environmental Health (NCEH), Centers for 

Disease Control and Prevention (CDC)

• Stephanie Dulin, MBA: Deputy Director, National Center on Birth Defects and Developmental 

Disabilities (NCBDDD), Centers for Disease Control and Prevention (CDC)

• CAPT Thomas Hennessy, MD, MPH: US Public Health Service (USPHS); Director, Arctic 

Investigations Program (AIP), National Center for Emerging, Zoonotic, and Infectious Diseases 

(NCEZID), Centers for Disease Control and Prevention (CDC)RADM Robin Ikeda, MD, MPH: USPHS; 

CDC Deputy Director; Director, Office of Noncommunicable Diseases, Injury, and Environmental 

Health (ONDIEH), Centers for Disease Control and Prevention (CDC)

• RADM Jonathan Mermin: Director, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB 

Prevention (NCHHSTP), Centers for Disease Control and Prevention (CDC)

• Brad Myers, MPH: (proxy for Katherine Lyon Daniels, Associate Director for Communication

Services (DCS), Centers for Disease Control and Prevention (CDC)) 

• RADM Stephen Redd: Director, Office of Public Health Preparedness and Response (OPHPR), 

Centers for Disease Control and Prevention (CDC)

• Brooke Tripp, MPA: (proxy for CAPT Michael Iademarco, Director, Center for Surveillance, 

Epidemiology, and Laboratory Services (CSELS) , Centers for Disease Control and Prevention (CDC) )

Presenters/Discussants

• Annabelle Allison (Navajo Nation): Deputy Associate Director for Tribal Support (TSU), 

• Office for State, Tribal, Local and Territorial Support (OSTLTS), Centers for Disease Control and 

Prevention (CDC)
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CDC/ATSDR Tribal Advisory Committee Meeting

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• CAPT Carmen Clelland, PharmD, MPA (Cheyenne and Arapaho Tribes): Associate Director for Tribal 

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

and Prevention (CDC)

• Stacey Dandridge, PMP: Content Management Analyst and Business Analyst, Office for State, 

Tribal, Local and Territorial Support (OSTLTS), Centers for Disease Control and Prevention (CDC)

• Laura Harrington, PMP: Program Operations Manager and IT Project Manager, Office for State, 

Tribal, Local and Territorial Support (OSTLTS), Centers for Disease Control and Prevention (CDC)

• Larke Huang, PhD: Senior Advisor, Children, Youth and Families Lead, Trauma and Justice Strategic 

Initiative, Administrator’s Office of Policy Panning and Innovation, Office of Behavioral Health 

Equity, Substance Abuse and Mental Health Services Administration (SAMHSA)

• Brian King, PhD, MPH: CDC Deputy Director for Research Translation, Office on Smoking and 

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

for Disease Control and Prevention (CDC)

• Debra Lubar, PhD: Senior Advisor to the Appropriations, Legislation, and Formulation Office, Office 

of the Chief Operating Officer, Centers for Disease Control and Prevention (CDC)

• Melissa Merrick, PhD: Behavioral Health Scientist, Division of Violence Prevention, National Center 

for Injury Prevention and Control (NCIPC), Centers for Disease Control and Prevention (CDC)

• Georgia Moore, MS: Associate Director of Policy, Office for State, Tribal, Local and Territorial 

Support (OSTLTS), Centers for Disease Control and Prevention (CDC)

• Dagny Olivares, MPA: Associate Director for Program Planning and Communication, OSTLTS, CDC

• Katie Ports, PhD: Behavioral Scientist, Research and Evaluation Branch, Division of Violence 

Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and 

Prevention (CDC)

• Carol Redding, (Doctoral Candidate): ACE Study Consultant, Sparrow Consulting, LLC

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

Resources, Office of Public Health Preparedness and Response (OPHPR), Centers for Disease Control 

and Prevention (CDC)

• Todd P. Talbert, MA: Senior Advisor to the Director, Division of State and Local Readiness, Office of 

Public Health Preparedness and Response (OPHPR), Centers for Disease Control and Prevention 

(CDC)J.T Theofilos, MPT, MBA: PHAP Partnerships Stakeholder Engagement Team Lead, Office for 

State, Tribal, Local and Territorial Support (OSTLTS), Centers for Disease Control and Prevention 

(CDC)

• Marilyn Zimmerman, MSW: Tribal Senior policy Advisor, Office of Juvenile Justice and Delinquency 

Prevention, Department Of Justice
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Acronyms

ACA Affordable Care Act

ACEs Adverse Childhood Experiences

ACF Administration for Children and Families

AIP Arctic Investigation Program

ATSDR Agency for Toxic Substances and Disease Registry

ANTHC Alaska Native Tribal Health Consortium

AI/AN American Indian/Alaskan Native 

CAPT Captain, US Public Health Service

CDC Centers for Disease Control and Prevention 

CIO Centers, Institutes, and Offices 

CoAg Collaborative Agreement

CSELS Center for Surveillance, Epidemiology and Laboratory Services 

DFO Designated Federal Official

DOJ Department of Justice

DPHPI Division of Public Health Performance Improvement 

EIS Epidemic Intelligence Service

ENDS Electronic Nicotine Delivery System

EPA United States Environmental Protection Agency

FDA Food & Drug Administration

FOA Funding Opportunity Announcement 

FY Fiscal Year

HHS Department of Health and Human Services

ICWA Indian Child Welfare Act

IHS Indian Health Service 

IRB Internal Review Board

NCBDDD National Center on Birth Defects and Developmental Disabilities

NCCDPHP National Center for Chronic Disease Prevention and Health Promotion 

NCEZID National Center for Emerging and Zoonotic Infectious Diseases

NCEH National Center for Environmental Health 

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

NCIPC National Center for Injury Prevention and Control

NIHB National Indian Health Board

OSTLTS Office for State, Tribal, Local and Territorial Support 

OADP Office of the Associate Director for Policy

ONDIEH Office of Noncommunicable Diseases, Injury and Environmental Health 

OPHPR Office of Public Health Preparedness and Response

PTSD Post-Traumatic Stress Disorder

PHLP Public Health Law Program

PPCU Program Planning and Communications Unit

PHA Public Health Advisor

PHAB Public Health Accreditation Board 

PHAP Public Health Associate Program 
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PHLP Public Health Law Program

DPHPI Division of Public Health Performance Improvement 

PHEP Public Health Emergency Preparedness cooperative agreement

PPCU Program Planning and Communications Unit

PTSD Post-Traumatic Stress Disorder

RADM Rear Admiral

REACH Racial and Ethnic Approaches to Community Health 

SAMHSA Substance Abuse and Mental Health Services Administration 

STD Sexually Transmitted Disease

TAC Tribal Advisory Committee 

TB Tuberculosis

TEC Tribal Epidemiology Center 

TSU Tribal Support Unit 

USPHS United States Public Health Service