Suicide is at crisis levels in Native youth and young adults. A key goal of suicide prevention is building social connections with suicidal people. Caring Contacts is a suicide prevention program that supplements standard healthcare by promoting human connectedness. It involves sending messages that express care, concern, and interest to suicidal people. It is the only intervention shown to prevent suicide in any population. We adapted this approach to design Caring Texts, an intervention that uses text messages to prevent suicide in Native youth. We are conducting a randomized controlled trial of Caring Texts in 1,200 high-risk Native people aged 18-34 years. Study sites include communities in Alaska, the Rocky Mountain region, and the Great Plains.
American Indians have a high incidence of cerebrovascular disease, which affects cognition, attention, memory, and other aspects of brain function. Therefore, substantial numbers of Native elders can benefit from treatment to improve brain function. This intervention study uses Interactive Metronome (IM) therapy to treat Native elders with cerebrovascular disease. IM is a computer-based system that uses a steady beat to recondition the brain and improve cognitive and motor function. Our planned study sample consists of 180 American Indians aged 68 to 80 years. We will test the effects of IM on cognitive function and health-related quality of life in this group of Native elders.
Family Intervention in the Spirit of Motivational Interviewing (FITSMI)
The prevalence of stroke is higher in American Indians and Alaska Natives than in any other U.S. racial or ethnic group. Native people tend to be younger at stroke onset than non-Hispanic Whites, and they have poor post-stroke survival. In addition, Native people bear a disproportionate burden of stroke risk factors, including high blood pressure, smoking, obesity, and diabetes. However, no rigorous, population-based studies of stroke prevention have included Native participants. With our partners, we designed the Family Intervention in the Spirit of Motivational Interviewing (FITSMI), which is delivered at the household level. This intervention encourages lifestyle changes that will transform the home environment and reduce stroke risk for all household members. FITSMI uses a “talking circle” format in which facilitators guide participants to identify goals for change and then create a tailored plan to reach them. Goals typically address smoking, exercise, diet, and medication adherence. FITSMI requires just two household sessions scheduled one month apart. After the first session, text messages are sent to participants to boost their adherence to household goals. In a group-randomized trial design, we are recruiting 360 households. Half of them are randomly assigned to the FITSMI intervention, and the other half are assigned to the control condition, in which they simply receive educational brochures. All household residents aged 11 years and older are eligible for participation.
American Indians are disproportionately affected by alcohol and drug abuse. Contingency management (CM) is a treatment approach in which patients receive tangible rewards for abstaining from alcohol and drug abuse. Most previous evaluations have shown that the effect sizes of CM interventions are among the largest of all mental health and behavioral interventions. Our goal is to determine whether a culturally appropriate CM treatment program leads to reductions in alcohol and drug abuse on two American Indian reservations. Phases 1 and 2, which included focus groups with providers and patients, have been completed at both sites. Phase 3, which is a randomized controlled trial of CM for alcohol and drugs, is now in progress. As of June 2016, we have successfully consented 30 participants.
Biobanking refers to the process of storing human tissue for use in health research. These tissue samples are known as biospecimens. Rapid advances in the genetic analysis of biospecimens have the potential to improve treatments for chronic disease. However, many American Indian and Alaska Native communities have a well-documented legacy of mistrust for health research, especially research involving biospecimens and genetic analysis. Our study has two closely related aims. The first is to offer culturally relevant education to Native communities on biobanking and measure any changes in community knowledge, attitudes, or beliefs. The second is to hear community members’ opinions and concerns regarding the ownership and appropriate use of biospecimens, as well as the relation between individual rights and tribal regulation.
KaHOLO: Preventing Cardiovascular Disease in Native Hawaiians
The KaHOLO project was designed to reduce blood pressure in Native Hawaiians by promoting the practice of traditional forms of dance. Chronic high blood pressure – also known as hypertension – is a serious risk factor for heart disease and stroke. In Hawaii, Native Hawaiians are 70% more likely than non-Hispanic Whites to suffer a stroke. They also develop heart disease about 10 years earlier than people in other racial and ethnic groups. Based on halau hula training, the KaHOLO project was developed by biomedical scientists in collaboration with Kumu Hula (traditional hula teachers). This project is a five-year effort to assess whether traditional Hawaiian practices can re-establish health and well-being. It consists of a physical activity intervention in which participants dance the hula and receive education on heart health. Participants will attend hula classes for six months and receive coaching on how to make healthy changes a permanent part of their lives.
KaHOLO is a collaboration between the Department of Native Hawaiian Health at the University of Hawaii and Partnerships for Native Health at Washington State University. The researchers have brought this program from Hawaii to benefit Native Hawaiians living in Washington State. Very few public health programs in Washington address the health needs of Pacific Islander communities. This is the first time that Partnerships for Native Health has offered such a program. Recruitment of participants has already started. In August we will begin classes in the cities of Tacoma and Federal Way in Washington.
Compared to other races, American Indians experience a heavier burden of risk factors for heart disease, including high blood pressure (hypertension), Type 2 diabetes, and smoking. Medications are widely prescribed to lower blood pressure. However, adopting low-sodium, heart-healthy diets – collectively known as DASH (Dietary Approaches to Stop Hypertension) – has been shown to lower blood pressure with or without medication. In addition, these evidence-based dietary approaches can be more cost-effective and sustainable than daily medication. The basic DASH diet is simple. It calls for eating more fruits, vegetables, and whole grains, while cutting back on foods high in salt. Researchers with Partnerships for Native Health recently launched a study to test the effectiveness of the DASH diet in two urban Native populations. The overall study name is Diet Intervention for Hypertension: Adaptation and Dissemination to Native Communities. We will conduct a randomized controlled trial at each urban site to compare outcomes in two different study groups.
Partnerships for Native Health is collaborating with the University of Washington’s School of Nursing and a tribal community in Montana to improve the lives of Native families. Together, we are testing a strengths-based home visiting program called Promoting First Relationships. This program focuses on meeting young children’s social and emotional needs by addressing the development of children’s attachment to their primary caregiver. We have two goals: to adapt the program to the unique needs of the local community, and to assess its effects on adult caregivers and children between the ages of 10 and 30 months. We are currently in our third year of funding. After a year of recruiting, we have enrolled 47 primary caregivers along with the 47 children for whom they provide care.
AI STOMP (American Indians STOp smoking by Mobile Phone)
Smoking rates in American Indians are high, leading to poor health outcomes. The AI STOMP study uses motivational text messages to help participants quit smoking. Originally intended for tribal college students in Montana, the study has been expanded to include tribal institutions in the Southwest, Midwest, and Southeast. Recently, the study expanded even further to include people who call state tobacco quit lines. The text messaging module used in this study was adapted from a successful intervention used in New Zealand to help Maori youth (among other groups) quit smoking. By using feedback from focus groups at Montana tribal colleges, the text messages were culturally tailored to be more relevant and effective for American Indian smokers.
In 2013, Partnerships for Native Health conducted a needs assessment with community healthcare workers from partner tribes throughout Washington State. Approximately 80% of those interviewed expressed a need for survivorship support and facilitator training for cancer survivors. To address this need, P4NH staff partnered with Dr. Rachel Ceballos from the Fred Hutchinson Cancer Research Center. Dr. Ceballos and her team had previously developed and evaluated a Spanish-language support group for Latino cancer survivors living in the lower Yakima Valley of Central Washington. Building upon Dr. Ceballos’s successful work, P4NH staff established a new survivorship curriculum called Staying in the Circle of Life (SITCOL).