Due to the prevalence of diabetes, hypertension, obesity, multi-generational households and poor living conditions, American Indian and Alaska Native people living in urban settings may be dangerously vulnerable to COVID-19. And for these individuals, the risk may be even greater because their access to health care facilities located on reservations is limited. But targeted testing in these communities has been virtually nonexistent, so the severity of the crisis remains unknown.
To meet this threat, a new multi-center project has been launched by IREACH director Dr. Dedra Buchwald, in collaboration with Dr. Rich MacLehose of the University of Minnesota and Dr. Spero Manson of the University of Colorado Anschutz Medical Campus. Funded by a $4.4 million grant from the National Institutes of Health, the project will partner with Urban Indian Health Programs in Albuquerque, Anchorage, Denver, Minneapolis, Seattle, and Wichita. Researchers will assess levels of testing and challenges that prevent urban American Indians and Alaska Natives from getting tested and vaccinated. The aim is to generate creative solutions and fund new resources to increase testing and limit the spread of COVID in these vulnerable populations.
To examine risk factors for elevated blood pressure and hypertension in American Indians and Alaska Natives (AI/ANs), compared to three other ethnic groups in the US. Weighted relative risk regression models, stratified by race/ethnicity, were used to measure the associations between risk factors and elevated blood pressure and hypertension in AI/ANs, compared to non-Hispanic Whites, non-Hispanic Blacks and Hispanics, with data from the National Longitudinal Study of Adolescent to Adult Health. In all groups, females had a lower risk of both elevated blood pressure and hypertension than males. Increasing body mass index raised hypertension risk in all groups. In AI/ANs, financial instability increased the risk of hypertension by 88% (95% CI: 1.27–2.77), but not in other groups. No other statistically significant associations were found. Future interventions should include socio-economic factors in efforts to prevent hypertension in AI/ANs. Read more.
Lonnie Nelson’s work improving the health and well-being of indigenous peoples has earned him grant funding, awards and citations as an academic researcher at Washington State University Health Sciences.
It’s also brought him to a position of vital importance right now: evaluating potential COVID-19 vaccines for how they will be perceived and accepted by Native American and indigenous populations. He was invited to sit on a panel of a dozen scientific experts by the National Institute of Allergy and Infectious Diseases; similar panels of have been convened for other populations that have been disproportionately affected by COVID-19.
Nelson was a natural choice for the panel, said Michele Andrasik of the Fred Hutchinson Cancer Research Center in Seattle, who’s leading community engagement efforts for the COVID-19 Prevention Trials Network.
“It’s no surprise his name came up several times” when seeking recommendations for panelists, Andrasik said. “Lonnie has a longstanding and unwavering commitment to Native and indigenous populations.”
Nelson said the panel has reviewed a handful of vaccines so far. The group’s most common feedback: to try to make the vaccine one dose rather than two.
“If it’s two doses, it makes access a nightmare for people who are under-resourced,” he said.
He also suggests delivery of a vaccine, when it’s ready, should be done in collaboration with members of Native communities – the same approach he has taken as a researcher.
“If you’re trying to develop any kind of intervention you need to work with people in the community where it’s going to be implemented, or it’s very likely not going to be successful,” he said.
Nelson is co-director of Partnerships for Native Health at WSU, one of the largest research centers focused on Native health in the United States, which is housed within the Initiative for Research and Education to Advance Community Health (IREACH). Research studies include examining the causes and prevalence of disease within the American Indian/Alaska Native population and developing culturally appropriate and feasible interventions.
His mother was a nurse in the Indian Health Service and he’s an American Indian with origins in the Eastern Band of Cherokee Indians. “My friends, family, all the people I cared about growing up were from the Native community,” Nelson said.
He and other IREACH researchers joined WSU from the University of Washington in 2015. Since then, Nelson alone has generated $19.6 million in research activity.
He recently received the Largest New Team Grant award from the WSU Office of Research in recognition of a $9.67 million grant to study Alzheimer’s disease and related dementias in the Native population, with Nelson as the principal investigator.
Last year, before he gained tenure, he was one of two researchers receiving WSU’s Pacesetter Award for pre-tenure faculty who “set new achievement standards in obtaining grants, publications and citations.”
“Dr. Nelson’s work is crucial to help improve the health and well-being of American Indian and Alaska Native adults,” said Celestina Barbosa-Leiker, vice chancellor for research at WSU Health Sciences. “His work will assist in decreasing health disparities and lack of access to healthcare that disproportionately impact American Indian and Alaska Native populations.”
Said Julie Postma, associate dean for research at the College of Nursing, “Dr. Nelson’s work is laudable and contributes to the College of Nursing’s commitment to research that advances health equity.”
Nelson attributes his success as an academic researcher to good training and persistence.
“If you look at the list of my grants submitted that were not funded, it’s a longer list than those that were funded,” he noted.
He also said it’s important to be “pro-social,” a term he prefers to networking.
“Make those friendships, make those connections,” he said. “Think of it as making friends with people who have similar interest and expertise and want to do good things for communities.”
Design of a Randomized Controlled Trial of a Diabetes Prevention Intervention for American Indian and Alaska Native Men
American Journal of Men’s Health | July-August 2020
Ka’imi Sinclair, PHD, MPH; Cara Carty, PhD; Kelly Gonzales, PHD, MPH; Cassandra Nikolaus, PhD; Lucas Gillespie, BA; and Dedra Buchwald, MD
Type 2 diabetes is a serious global epidemic that disproportionately affects disadvantaged populations. American Indians and Alaska Natives (AIs/ANs) have the highest rates of diabetes in the nation with a prevalence of 14.7% in 2018, more than twice that of non-Hispanic Whites. AI/AN men have the highest prevalence of diagnosed type 2 diabetes (14.5%) compared to non-Hispanic Black (11.4%), non-Hispanic Asian (10.0%), and non-Hispanic White (8.6%) men. Several landmark clinical trials have shown that lifestyle interventions can effectively prevent or delay the onset of diabetes among those at risk, including in AIs/ANs. Despite positive outcomes for AIs/ANs in these studies, very few were men. Read more.
This study used a parallel, convergent, mixed-methods design with TribalCrit theory and intersectionality as analytical frameworks to identify how the identities of American Indian men intersect with broader structures and systems in shaping their eating and physical activity choices and behaviors, and in eliciting recommendations for a men’s lifestyle intervention. Read more (pdf).
SPOKANE, Wash. – American Indian and Native Alaskan populations have been hit hard by the pandemic—exactly how hard, no one can say for sure, since there is a lack of information and testing in these communities.
A new project led by Dr. Dedra Buchwald, a physician and professor with WSU’s Elson S. Floyd College of Medicine, has received a $4.4 million National Institutes of Health grant to help address that knowledge gap and bring resources to curb the COVID-19 crisis within these populations.
“Many things come together to make American Indians and Native Alaskans particularly vulnerable to COVID-19, and at the same time, make them hesitant to participate in efforts to get tested and get vaccinated,” said Buchwald, who is also the director of the Institute for Research and Education to Advance Community Health or IREACH.
This grant is one of four recently received by College of Medicine researchers to help deal with aspects of COVID-19 crisis. The others include:
A competitive effort headed up by April Needham of the University Center for Innovation will challenge entrepreneurs from Eastern Washington and Northern Idaho to come up with ideas to improve the personal protective equipment (PPE) manufacturing process. The project received a $300,000 grant from the federal CARES (Coronavirus Aid, Relief and Economic Security) act and administered by the Economic Development Administration.
A project led by Dr. Patrik Johansson, an associate professor in the Elson S. Floyd College of Medicine’s Department of Medical Education and Clinical Sciences and an IREACH faculty member, received nearly $100,000 from Empire Health Foundation to study the impact of COVID-19 pandemic on the well-being of rural and American Indian cancer patients in Washington state.
Ofer Amram, assistant professor in nutrition and exercise physiology, will lead an effort to evaluate the impact of deferred preventative care for cancer in the era of COVID-19. This project also received a grant from Empire Health Foundation of nearly $100,000.
The National Institutes of Health grant is intended to help address health disparities among underserved and especially vulnerable Native populations in urban settings. An estimated 71% of American Indians and Native Alaskans live in urban areas. Buchwald said these populations have many risk factors, including a high prevalence of diabetes, hypertension, obesity, multi-generational households and poor living conditions. Many also struggle with poverty and limited access to quality health care and education.
This is complicated by a distrust in the federal government and health care systems, given the long history of atrocities committed against Native peoples, such as the deliberate dispersal of blankets laden with smallpox and sterilization of Native women without true consent.
In the new project, called COVID-19 Epidemiology, Research, Testing and Services or CONCERTS, researchers from WSU, University of Colorado and University of Minnesota will partner with Urban Indian Health Programs in six major cities with large Native populations: Albuquerque, N.M.; Anchorage, Ala.; Denver, Minneapolis, Seattle and Wichita, Kan.
The partners will work to understand who has been tested already and what challenges exist to getting people tested and ultimately vaccinated. The grant will also fund new resources for each site to help promote testing depending on their locally determined needs. Some sites might need PPE or testing kits while others may want to establish a testing drive-through site or send out case workers or COVID navigators to make contact with individuals.
Most of the people working on this project at the health programs will be from the tribal communities they serve, Buchwald said.
“American Indian and Native Alaskan people are more knowledgeable about what is going on in their communities than outside researchers, and we want to make sure that we have good trusting relationships,” she said. “Our partners are really key to encouraging more people to get tested, and in the future, vaccinated, if determined to be desirable.”
This presentation will provide an overview of the study design, methods, and primary outcomes from the Safe Passage Study – the largest international prospective study looking at the relationship between prenatal alcohol exposure, stillbirth and sudden infant death syndrome. Unique cultural and ethical aspects of conducting research in American Indian communities will be highlighted. Finally, strategies for dissemination of results in scientific and non-scientific communities will be presented.
Featuring Dr. Amy Elliott, Chief Clinical Resource Officer for Avera McKennon Hospital and a Professor/Co-division Chief in the Department of Pediatrics, University of South Dakota School of Medicine, and Ms. Jyoti Angal, the Director of Clinical Research for the Avera Center for Pediatrics and Community Research and project director for the Safe Passage Study
Our quest for knowledge goes beyond borders to find the seekers who, with us, can make a positive difference in the lives of others. Washington State University and the University of Colorado Denver collaborate on the Center of Excellence in American Indian and Alaska Native Health Disparities. Read about its vital work in this latest newsletter from the Community Action Board.