Northern Plains NARCH Project Activities and Products

Northern Plains NARCH Program
Aberdeen Area Tribal Chairmen’s Health Board

Program Summary and Update

Funding Update:

The Northern Plains Native American Research Centers for Health (NARCH) Program is comprised of NARCH III and NARCH IV program dollars. The Northern Plains NARCH III Program is now in its 2nd year of operation and was awarded $375,000 for Year 2. The Northern Plains NARCH III Program includes the Insulin Resistance in Native American Youth Project, Screening for Asthma among American Indian Youth Project, and the Scholarship Program for AI/AN Students. We also recently received notice of funding of $86,552 for the NP NARCH IV Program to conduct the Mood Disorder Assessment in Northern Plains Indians Project.

Core Personnel:

• Principal Investigator: Francine C. Romero, PhD, MPH; tel: (505) 834-7835; email: epiromero@aatchb.org
• Program Director: Jennifer Larsen, MD; tel: 402-559-4837; email: jlarsen@unmc.edu
• Program Coordinator: Sayaka Kanade; tel: 605-338-2339; email: epikanade@aatchb.org
• Program Assistant: DeAnne Swan; tel: 605-721-1922 x108; email: dswan@aatchb.org

Core Activities:

Core activities consist of administering the three research programs. In addition, in Year 2 of NARCH III we were able to develop an American Indian student scholarship component in which students are eligible to apply for financial support to attend school and travel to scientific conferences, see below for additional details.

Research Project: Insulin Resistance in Native American Youth

• Principal Investigator: Jennifer Larsen, MD, University of Nebraska Medical Center
• Co-Investigators: James Lane, MD; Pascale Lane, MD; Julie Stoner, PhD; Gay Canaris, MD; Tim Ryschon, MD
• Staff: Sylvia Lasley (Rosebud Sioux Tribe); Ramona Zephier (Flandreau Sioux Tribe), Judi Erickson, RN, CDE

Project Period: Northern Plains NARCH III September 2005-September 2009

Tribal site: Rosebud Sioux Tribe, Diabetes Prevention Program

Background: The incidence of diabetes is increasing faster in Native American adolescents than other age groups. Insulin resistance is known to precede diabetes and lifestyle changes can improve future risk of diabetes in individuals with insulin resistance, so identifying those at risk may be important to prevention of disease. The purpose of the study is to: 1) Determine prevalence of diabetes, and impaired glucose tolerance; 2) Identify which factors best predict insulin resistance, including life stresses; and 3) Determine if cultural affiliation reduces insulin resistance.

Update: We have screened 47 youth, ages 5-18 years (27 boys and 20 girls). Below are some preliminary findings:

• Average body mass index percentile for age and sex is 75%. In this group, 43% are "at risk" and 17% are considered "overweight." (The Centers for Disease Control suggest that all youth above the 85% for their age are at risk for being overweight and above 95% are overweight.)
• 4% have elevated blood pressure. (Blood pressure above 90% for their age is considered elevated.)
• 11% had acanthosis nigricans. (AN is sometimes used as a marker of insulin resistance.)
• 6% had elevated triglycerides >150 mg/dl. (High triglycerides accompanies insulin resistance.)
• 8% have small quantities of albumin in the urine. (Albumin in urine is used to identify risk of vascular disease or future kidney disease in individuals with diabetes, but has also been observed in individuals with insulin resistance. We are repeating those to be sure they were not caused by a recent infection, but thismay be another way to identify individuals at risk.)
• 12% have a HOMA-IR score >4. (HOMA-IR is a mathematical representation of insulin resistance based on fasting glucose and insulin.)
• Importantly, no one screened has been found to have diabetes suggesting that current screening methods are effective in identifying children and youth with diabetes.

We will continue to screen children and youth to obtain additional samples. At the end of October, we presented at the National NARCH Conference, October 30-31, 2006 in Rockville, MD.

Research Project: Screening for Asthma among American Indian Youth

• Principal investigator: Kim Rodehorst, PhD, RNC, University of Nebraska Medical Center
• Co-Investigators: Susan Wilhelm, PhD, RNC; Mary Beth Stephans, PhD
• Research Assistants: Romaine Tobacco (Oglala Sioux Tribe); Francisco de la Paz (Spirit Lake Tribe)

Project Period: Northern Plains NARCH III September 2005-September 2009

Tribal Site: Oglala Sioux Tribe, Tribal Health Administration, and Spirit Lake Tribe, Asthma Clinic

Background: Screening for asthma in children has been reported to be feasible and cost-effective in selected populations, but has not been studied among AI/AN children. The overall purpose of this pilot study is to test the feasibility and utility of conducting an asthma screening program. The specific aims for this study are to: 1) Determine the proportion of children not previously diagnosed with asthma who meet diagnostic criteria for asthma; 2) Determine the proportion of children previously diagnosed with asthma whose treatment plan is not appropriate for their level of severity; and 3) Assess children who have risk factors for asthma, but who do not meet the diagnostic criteria for asthma.

Update: In September, focus groups were conducted in Pine Ridge to obtain feedback from community members and tribal leaders on how best to conduct the screening in their community. Suggestions included meeting with parents about the study during parents night and parent-teacher conferences, raising awareness about asthma screenings in the community, and determining how to be equitable in the selection of who will be screened (considering the size of the reservation). The actual screenings will begin in January 2006. At the Spirit Lake Tribe, focus groups have been conducted and the results are being compiled. In addition, the PI and RAs presented at an Asthma Conference in October to showcase the project.

Research Project: Mood Disorder Assessment in Northern Plains Indians

• Principal Investigator: Jacque Gray, PhD, (Choctaw/Cherokee) University of North Dakota
• Research Assistant: Angelique Gillis, M.S. ( Mandan, Hidatsa, Arikara Nation) University of North Dakota

Project Period: Northern Plains NARCH IV September 2006-September 2009

Tribal Sites: IHS clinics and hospitals in North Dakota and South Dakota

Background: The purpose of this study is to determine if the assessments used in the clinical setting accurately measure depression, anxiety, Post Traumatic Stress Disorder (PTSD), and suicidal ideation among American Indians in North and South Dakota. These assessments are commonly used in clinical settings among American Indians as well as for the general population, but have never been examined to determine whether they are effective in the American Indian population. The project will use RPMS data to compare diagnosed depressed, diagnosed anxious and post-traumatic stress disorder, and controls with no mental health diagnosis (both men and women).

Update: The project began as of September 15, 2006. Work is underway to obtain the necessary tribal, IHS, and IRB approvals.

Scholarship Program: Northern Plains NARCH Scholarships

The purpose of this scholarship is to help support American Indian and Alaska Native (AI/AN) students pursue an education in the health field. This scholarship is intended for students seeking a degree in a health-related area or for individuals currently working in tribal health and pursuing general education.

The scholarship may be applied to tuition, books, and living expenses. Funds will be provided directly to the students. Recipients are responsible for any applicable tax.

Click here for a copy of the Northern Plains NARCH Scholarship brochure.

Scholarship amount: $1,500

Who is eligible:

• Any American Indian or Alaska Native student who is enrolled in an undergraduate or graduate program, preferably in a health-related field.
• Students must be enrolled in a minimum of two courses (typically 6 credits).
• Priority will be given to members of tribes in North Dakota, South Dakota, Nebraska, or Iowa.
• Priority will be given to students enrolled in a health-related field. Students not enrolled in health-related field, but working towards a degree that will serve them in their health careers should explain this link in their statement.

Number of available scholarships: Approximately 20 scholarships are available in 2007. Depending on availability, those who are awarded scholarships in Winter or Spring may be eligible for another round of funding later in the academic year, pending grades.

Scholarship Application Process and Requirements:

• Applications must be received by March 1, 2007
• Application Form
• Copy of tribal ID or proof of enrollment
• Copy of transcript(s) (unofficial transcripts accepted)
• Resume or Curriculum Vitae
• Statement of Need: Explain how this scholarship will help you to pursue your goals in the health-related field. If the degree that you are seeking is not directly health-related but will serve you in your health career (this may be most applicable at the undergraduate level), please explain how your education will support your work. Provide details of your past experiences and future goals to show your commitment in completing your degree and in working to improve the health of AI/ANs (250 word maximum).

Award notification will be made before April 2007.

Applications should be mailed to:
Aberdeen Area Tribal Chairmen’s Health Board
Attn: DeAnne Swan, NARCH Assistant
1770 Rand Road
Rapid City , South Dakota 57702