Success Stories | Tribal Epidemiology Centers

Tribal EpiCenters

02/28/2018

NWTEC Success Story: February 2018

NW Tribal Food Sovereignty Coalition: Inter-tribal Collaboration to Strengthen Food Systems

The Northwest Tribal Epidemiology Center at the Northwest Portland Area Indian Health Board has a focus on data, training and tribally driven technical assistance. Since its earliest efforts the NWTEC has focused on tribally driven projects. The NWTEC has had strong support for our Good Health and Wellness in Indian Country (GHWIC) projects, impacting policies, systems and the environment to promote health change and improvement.

WEAVE-NW is the project that has been funded by the Center for Disease Control and Prevention (CDC) under the Good Health and Wellness in Indian Country (GHWIC) initiative. Five staff members at the NWTEC are working specifically on WEAVE-NW.

Using funding provided by CDC to the NPAIHB, WEAVE-NW has given sub-awards to various tribes throughout the three state region served by the NWTEC; Idaho, Oregon and Washington States.

Many of the funded Tribes are focused on community gardens, reintroduction and support for traditional foods, and food policy initiatives.

In 2016, sub-awardee tribes attended the Native American Nutrition conference in Prior Lake, Minnesota. During a debriefing session, provided by WEAVE-NW with the sub-awardees, there was interest for more inter-tribal collaboration for addressing their community food systems. Elected leaders and community leaders, elders, and tribal employees from across the region have also expressed the need for more partnership, planning, and policy development for tribal food sovereignty.

WEAVE-NW has taken the lead in developing and facilitating a new coalition, the NW Tribal Food Sovereignty Coalition. Currently the coalition is in the planning and recruitment stages. This coalition is being formed to ensure the sustainability and viability of the food sovereignty work begun by the funded tribes. The purpose will be a mixture of networking, sharing resources, and development of sub-groups that will work on identified priority areas and goals. The coalition has met twice via video conferencing in the fall of 2017 and the first official in-person meeting will be held on March 1st, 2018 in Portland, Oregon.

There is an epidemic of preventable, diet-related diseases that is directly associated with the lack of access to healthy and traditional food resources. The coalition is an opportunity for tribes and tribal organizations to convene efforts that are driven by cultural revitalization, empowering communities, and the use of innovative strategies to improve the health of the people.

Tribal EpiCenters

01/31/2018

AASTEC Success Story: January 2018

Success Stories, TEC News

Tribal Healthy Homes Project

BACKGROUND

To help address indoor radon concerns and to establish a baseline of general housing conditions, two northern pueblo communities partnered with the Albuquerque Area Southwest Tribal Epidemiology Center (AASTEC) located in Albuquerque, New Mexico. AASTEC epidemiologists collaborated with the health and community services, Indian Health Service Environmental Health Department, health boards, environmental services departments, one housing authority, and the community health representative (CHR) programs in both pueblo communities to help develop an extensive spatial database. We geospatially mapped homes, measured their indoor radon concentrations, and recorded general housing conditions. Prior to the Tribal Healthy Homes Project, each community expressed a desire to apply for environmental health grants. However, existing data were limited on indoor radon measurement as well as current housing conditions. Therefore, this project provided an ideal opportunity for each community to customize and develop a survey of housing attributes and indoor air quality levels; with the end result of an indoor radon dataset as well as in-depth home assessments.

METHODS

As part of the tribal environmental public health tracking program, we facilitated and provided the following services in collaboration with both pueblo communities. First, we participated in determining and prioritizing the health priorities for the overall project. Second, using the established environmental health priority list, we assisted in the development of a customized home assessment data dictionary tailored for conducting home assessments. Third, we provided pilot funds whereby both communities were able to: a) attend a geographical information system (GIS) training at a local tribal community college and b) purchase indoor radon kits and GPS handheld equipment, including essential software licenses. Both communities chose to use a Trimble® handheld device because it is compatible with software capable of easily recording and storing data using the customized home assessment dictionary developed by both tribal communities. The fundamental advantage of using a handheld GPS device lies in its ability to spatially record the location of each home and to record certain housing characteristics, respectively. Fourth, we assisted in developing culturally specific radon brochures for both communities. Lastly, we assisted in training exercises on how to conduct home assessments, how to measure home indoor radon concentration levels, and how to assess homes for fall injury risk factors using an injury prevention checklist.

Tribal Healthy Homes Project

RESULTS

The project yielded immediate and long-term impacts in both tribal communities.

First, members in each community had the option to expand their technical skillset by learning how to appropriately use a geographical information system database and associated hardware. Prior to the project, some members were beginners and others were more advanced in utilizing GIS software and hardware. Second, both communities spatially mapped and assessed selected homes in their communities. Sample size was based on the population of each tribal community and at the end of the pilot project funding period, each community mapped and assessed nearly half of the homes in their communities. Third, each community was able to attain updated indoor radon concentration measurements picocuries per liter (pCi/L) for both public and residential buildings. As a result, each community is now able to target follow-up testing with homes and buildings with observed higher indoor radon levels above 4.0 pCi/L, the action limit set forth by the Environmental Protection Agency. Fourth, each community was able to capture and record critical housing characteristics including the demographic make-up of residents within each home. For example, the housing department was interested in the number of operating detectors in the home, e.g., smoke and carbon monoxide; the clinical services department was interested in identifying where at-risk populations live within the community, such as children who may have asthma or elderly who require accessibility and mobility assistance.

Long-term impacts of the project include just a few of the following benefits. First, providing opportunities to develop advanced training in utilizing GIS software and hardware will aid in tribal capacity surrounding GIS usage. Second, each community will have spatially mapped homes in their communities, including housing characteristics, recorded as part of the home assessment. Such a map could provide a very powerful tool in prioritizing funds for home repairs, mitigation, and outreach to assist children and elderly in cases of emergencies. Last, homes retested for indoor radon concentration levels observed to be above the action limit could be targeted for home mitigation to reduce indoor radon levels below the action limit. One community is actively querying and utilizing their database to quantify the number of homes with elevated indoor radon levels and the number of home repairs needed to assist at risk populations in their community.

ENVIRONMENTAL HEALTH IMPACT

This project highlights and illustrates impacts of environmental health in several ways. First, the promotion of a healthier environment is a direct impact of the pilot project. By assessing homes for indoor radon levels as well as for housing conditions, tribal housing departments in both communities have information: to target home repairs, to apply for mitigation funds, and to encourage homeowners with potentially elevated indoor radon levels to retest their homes. Second, the availability of a map of geo-located homes along with their respective housing conditions and demographic make-up, would undoubtedly prove useful for public health workers in prioritizing resources in cases of emergencies. Last, the Tribal Healthy Homes project can be used to inform homeowners in both communities on how to create healthier homes to reduce unintentional injuries related to fall risk factors, such as lack of handrails for elderly, or the long-term health effects associated with elevated indoor radon levels.

Tribal EpiCenters

12/31/2017

UIHI Success Story: December 2017

Success Stories, TEC News

Creating Culturally Adapted Resources on PrEP

American Indians/Alaska Natives (AI/AN) are disproportionately affected by HIV. The CDC reported that HIV diagnoses increased in AI/AN from 2010-2014, while diagnoses most other race groups decreased (1). Despite this disparity, AI/AN communities are often left out of conversations on HIV prevention, which has directly resulted in a lack of patient education materials that are culturally appropriate for AI/AN people.

In particular, there are few AI/AN-specific patient education materials on pre-exposure prophylaxis (PrEP), the pill that can prevent HIV. To address the need for AI/AN-specific PrEP education materials, Urban Indian Health Institute (UIHI) established a partnership with Project Inform, a national HIV and hepatitis C education and advocacy group to culturally adapt pre-exposure prophylaxis (PrEP) education materials. These new materials were based off of information previously created by Project Inform.

To create these materials, UIHI conducted a survey on HIV knowledge, attitudes, and beliefs in self-identifying AI/ANs at local events. Results showed that 62% of respondents (195/317) had never heard of PrEP. In addition to the survey, UIHI worked on creating a brief educational postcard by adding appropriate AI/AN imagery, including an HIV awareness ribbon in the shape of a feather, and information regarding PrEP access at Indian health facilities.

Project Inform and other stakeholders (e.g. Urban Indian Health Program leaders, community members, etc.) reviewed the postcard and provided feedback on both the design and content. In addition, 10 AI/AN current or former PrEP users participated in key informant interviews to provide feedback on the postcard. The postcards will be distributed to all Urban Indian Health Programs and launched in 2018. In the future, UIHI will work with Project Inform to fulfill the need for materials targeted at AI/AN sub-populations, including Two Spirit people and heterosexual women.

1. CDC. (2015). HIV surveillance report: Diagnoses of HIV infections in the US and dependent areas, 2015.

View/Download Electronic PrEP Pamphlet (PDF 989KB)

For more information on the HIV, STI, and Hepatitis C work being done at UIHI visit our website.

Tribal EpiCenters

12/22/2017

Call for Tribal Success Stories

Press Release, Success Stories, TEC News

Tribal nations are active and important contributors to public health, and tribal cultures have long fostered health and wellness among American Indians/Alaska Natives (AI/AN). The Centers for Disease Control and Prevention (CDC) invites you to share stories that show how you do just that, so they can be a part of an exciting new exhibit at the David J. Sencer CDC Museum in Atlanta.

Will you please widely share this call for stories with your tribal partners?

The exhibition — to be held from Sept 22, 2019, through May 1, 2020, in Atlanta—will recognize the public health contributions of the AI/AN community in a visually compelling, culturally appropriate manner. CDC’s exhibition will showcase how native traditions and wisdom have affected public health in the past and present, and how AI/AN people have made a difference in the health of their people.

Compared with other Americans, AI/AN people have higher rates of some diseases, disorders, and deaths. This call for stories offers an opportunity for individuals, tribes, tribal organizations, and others to showcase the strengths and resilience of tribal communities, their heritage and traditions, and how their culture addresses risk factors unique to tribes and promotes their health and well-being.

What Types of Stories Are Needed?

Please send stories that highlight how native traditions and wisdom have affected health, or show contributions of specific AI/AN individuals to health and wellness among AI/AN people. CDC will consider stories that represent the diverse array of tribes, tribal organizations, health issues, and people of Indian Country and AI/AN culture, such as:

Locations—reservation and non-reservation, urban, rural, all geographic areas across the United States
Health issues—environmental health, chronic diseases, infectious diseases, emergency preparedness and response, injury, behavioral health
People—individuals, tribes, organizations

How To Submit A Story?

Story submissions, which should be no more than two pages, single spaced, and size 12 font, can be emailed to TribalSupport@cdc.gov by January 15, 2018. Please include website links to photos and pictures of objects that could be included in the exhibit, when available.

All submissions must include the following:

Brief historical background information that puts the story in context. For example, what is the traditional or cultural practice? How did it contribute to health and wellness in AI/AN people in the past?
A description of how this tradition or culture affects people’s lives today. The impact could be lives saved, suffering reduced, fewer visits to health care facilities, adoption of a healthier lifestyle, or other similar benefits. This section should also describe how the practice is promoted among tribes and AI/AN people.
A list of potential photographs, pictures, documents, media, and objects that can be used to illustrate the story. Is there artwork or children’s drawings that represents the practice? Are there radio recordings, letters, posters, or other communications from public health efforts? Are there traditional objects that have evolved to become used in modern day? Are there objects that are still in use today? Please include images and files with the submission, if available.

CDC values the privacy and ownership rights of those in stories. As such, each agency, organization, or individual that contributes a story is responsible for obtaining any necessary permissions or releases from any parties involved in the story.

How Will Submissions Be Evaluated?

Submissions will be assessed based on the following criteria in the initial review:

Impact. Is the story educational, inspiring, and persuasive? Does it clearly convey how the culture or tradition being practiced promotes health and wellness?
Visual components. Are there compelling, high-resolution photographs that illustrate the story? Are there physical objects that are available for use in a museum exhibit? Are there opportunities for interactive displays or actions that could be part of an exhibit?
Quality, clarity, and historical accuracy. Is the information presented accurately and clearly?

CDC intends to showcase a broad array of public health success stories from across Indian Country, so even if a story isn’t a part of the museum exhibit, it could still be showcased on other CDC channels, such as social media, websites, print materials, and presentations. We can’t wait to read your story!

Tribal EpiCenters

11/30/2017

USET TEC Success Story: November 2017

Success Stories, TEC News

Starting to Quit

By: Angela Snell

SUMMARY

Poarch Band of Creek Indians (PBCI) Tribal Nation was able to focus on their tobacco cessation program due to the CDC Good Health and Wellness in Indian Country (GHWIC) grant. PBCI utilized the funding from the GHWIC to conduct a community health assessment. Through this assessment, Tribal Council could hear from Tribal citizens their desire for smoke-free buildings and protection from secondhand smoke. Policies were approved and changes made to prohibit smoking within 100 feet of the Health Center.

CHALLENGE

Every year, about 3,000 adult nonsmokers die from lung cancer and 35,000 from coronary heart disease nationwide. People exposed to secondhand smoke (the smoke that comes from the burning end of tobacco and exhaled smoke from smokers) greatly increase their risk of developing lung cancer, heart disease, asthma, bronchitis, ear infections, pneumonia, croup, and sore throats. People can be protected from the harms of secondhand smoke by having smoke-free buildings and not allow smoking within 100 feet of the buildings.

RESULTS

Because Tribal Council knew they had the support of their Tribal citizens, Tribal Council passed a resolution to not allow smoking within 100 feet of the Health Center. The Health Center has designated smoking areas by the placement of picnic tables on each side of the building that are 100 feet away from the building. The picnic tables have been secured in place so that they cannot be moved. The GHWIC staff are now working to expand the smoke-free policies to the entire reservation.

The Health Department is also working on their Tobacco Cessation program. Approximately ten patients a month are being referred to the tobacco cessation program.

SOLUTION

Thanks to the CDC’s GHWIC funding, the PBCI health department conducted a community health assessment in 2016. A key component of the assessment was the development of surveys that asked if their Tribal citizens were in favor of having smoke-free buildings and not allowing smoking within 100 feet of those buildings. 82% of the respondents were in favor of smoke-free buildings and not allowing smoking around those buildings. This illustrated to the Tribal Council and Tribal leaders that their citizens did not want to be exposed to secondhand smoke and were in favor of policies that would protect them.

SUSTAINING SUCCESS

The PBCI health department’s goal is to continue the work in making more buildings with a 100 feet perimeter that is smoke-free. The success of policy change is encouraging and the dream is to one day have a smoke-free reservation. The PBCI health department will continue to educate the community about the harmful nature of commercial tobacco and assist smokers in quitting.

Contact:
Toria Reaves, Epidemiologist
USET
711 Stewarts Ferry Pike
Suite 100
Nashville, TN 37214
615-467-1557
http://www.usetinc.org

Smoke Free Zone – Thank You for Not Smoking

Poarch Creek Indians

“Through our Community Health Assessment that was sent out to the Tribal community, 82% said they would like to see a smoke-free facility on the Tribal reservation. I hope that one day we can have a smoke-free campus.”
– Kay Thomas, Health Educator
Poarch Band of Creek Indians Health Dept.

Say Yes, Say No