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FY
2003 Annual Report
on Tribal
Consultation and Budget Summary
Centers for Disease Control and Prevention (CDC)
Agency for Toxic Substances and Disease Registry
(ATSDR)
Report
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return to the Table of Contents (TOC)
PART I: |
TRIBAL BUDGET CONSULTATION ACTIVITIES |
A. |
FY 2003 TRIBAL BUDGET CONSULTATION
ACTIVITIES |
CDC participated in the 5th Annual DHHS Tribal Budget
Consultation Meeting held May 6, 2003 in Washington, D.C. The
primary recommendations for CDC
related to: a) provision of technical assistance about
administrative procedures for CDC grants and developing
competitive applications; b) infrastructure development for
homeland security, participation in preparatory activities, and
direct access to homeland security funds; and (c) greater
participation of American Indian/Alaska Native (AI/AN) students
from TCUs in CDC/ATSDR internships and other training programs.
Subsequently, CDC has examined existing AI/AN-focused activities
and is actively pursuing innovative ways to expand and improve
current efforts. In October 2003, CDC published the CDC/ATSDR
Federal Assistance Funding Book (FAFB) to assist tribes and
other potential applicants in accessing and applying for funding
opportunities at CDC/ATSDR (http://www.cdc.gov/od/pgo/funding/FAFBG.pdf
). In addition, CDC has standardized language in its program
announcements to specifically include tribes and tribal
organizations wherever appropriate and permissible. Within the
FAFB, “eligibility” is now defined as: |
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“The status an entity must possess to be
considered for a grant. Authorizing legislation and
programmatic regulations specify eligibility for individual
grant programs and eligibility may be further restricted for
programmatic reasons. In general, assistance is provided to
nonprofit organizations, including faith-based and
community-based entities, State and local governments, their
agencies, Indian Tribes or tribal organizations, and
occasionally to individuals. For-profit organizations are
eligible to receive awards under financial assistance programs
unless specifically excluded by legislation.” |
In September 2003, CDC senior staff responded to a request from
tribal constituents to conduct a workshop presentation at the
National Indian Health Board’s (NIHB) Annual Consumer Conference
in St. Paul, MN. During this workshop, CDC staff presented an
“Overview of the Federal Budget Process – CDC”, and conducted a
question and answer session for tribal attendees. Specific
reference materials and a graph depicting the timeline for
activities were also distributed. |
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B. |
FISCAL YEAR TRIBAL CONSULTATION ACTIVITIES |
Throughout FY 2003 CDC continued its efforts to systematically
engage tribal partners in discussions relevant to its Tribal
Consultation Initiative and ongoing programs in Indian country.
Between January and August 2003, CDC’s Office of Minority Health
(OMH) produced 10 Executive Summaries from the CDC Regional
Tribal Consultation Sessions held in 2002. Each Summary was
reviewed and cleared by the appropriate Area Health Board hosts
and subsequently shared with all tribes in the Health Boards’
region. In September 2003, the National Indian Health Board
invited CDC to update tribal representatives on the status of
the CDC Tribal Consultation Initiative. With assistance from
the American Indian Higher Education Consortium (AIHEC),
invitations were issued to all federally recognized tribal
leaders, regional and national AI/AN Health organizations, urban
Indian health programs, and tribal colleges and universities (TCUs)
to attend a special plenary session at the NIHB Annual Consumer
Conference in St. Paul, MN. Copies of the 10 Executive
Summaries, plus a comment worksheet, were broadly distributed to
tribal governments and organizations prior to the conference. A
similar session was conducted at an annual meeting of the
National Council on Urban Indian Health in October. At each
session, CDC staff reviewed its consultation activities and
progress to date, and described the proposed next steps CDC
would be taking to complete the process of institutionalizing a
Tribal Consultation Policy. After each presentation, tribal
representatives actively participated in discussion sessions
with CDC staff. Tribal leaders emphasized the importance of
effectively following through with commitments to finalize a
tribal consultation policy and institutionalize an action plan
that will allow ongoing, meaningful tribal input into CDC policy
development and budget formulation activities that have bearing
on Indian country. Early in 2004, CDC will re-examine its
progress in responding to the extensive tribal input received
during fiscal years 2002 and 2003. |
These activities (collectively termed the “CDC Tribal
Consultation Initiative”) will ultimately establish the
mechanisms and procedures by which CDC will formally engage in
tribal consultation activities on an ongoing basis. To ensure
continued input from, and interaction with, tribal leaders
during this process, CDC’s Senior Tribal Liaisons actively
participated in nine of the ten DHHS Regional Tribal
Consultation sessions during fiscal year 2003. Discussions with
tribal representatives also continued on the programmatic level,
as highlighted in Part II, #2 below. For examples of CDC
efforts to facilitate and strengthen interactions between state
health departments and tribal governments or Indian
organizations, please also see Part II, #2 below. Collaborative
efforts with other Federal agencies are also noted in Part II,
#2 (Senior Policy Workgroup) and CDC continues to actively
support the Secretary’s Intradepartmental Council on Native
American Affairs (ICNAA). |
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Table of Contents (TOC) |
PART II: |
DIVISION
ACTIVITIES TO ADDRESS TRIBAL PRIORITIES |
1. |
FUNDING AND RELATED ISSUES |
Funding for prevention activities is one of CDC’s highest
priorities and the majority of CDC efforts involving AI/AN
populations fall within this area. CDC is working with tribal
governments and organizations, Alaska Native corporations, urban
Indian health centers, Indian Health Service (IHS), state health
departments, academic institutions, and others to promote and
facilitate prevention efforts in AI/AN communities through
various mechanisms, including grants and cooperative agreements;
federal intra-agency agreements; training; tribal consultation;
technical assistance; and direct assistance. In FY 2003, CDC
awarded extramural funds to nine tribal governments, nine tribal
health boards, five Alaska Native health corporations, three
urban Indian health centers, and seven AI/AN-operated
organizations. Awardees are located in fifteen states across
the country. Total funds committed through these extramural
funding mechanisms exceeded $14 million; an additional $2.4
million went to academic programs and state health department
programs that benefit AI/AN populations. The following are
examples of CDC’s ongoing efforts to fund prevention and other
critical public health activities in Indian country: |
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National Center for Chronic Disease Prevention and Health
Promotion (NCCDPHP) |
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Steps to a HealthierUS |
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In FY 2003, the Steps
to a HealthierUS Cooperative Agreement Program funded the
Inter-tribal Council of Michigan to implement community-focused
initiatives to reduce the burden of asthma, diabetes, and
obesity. Through the Steps to a HealthierUS Cooperative Agreement
Program, HHS agencies, including CDC and IHS, are committed to
providing and tailoring culturally appropriate technical
assistance for the implementation and evaluation of
community-based initiatives in funded tribal consortia.
Technical assistance will include ensuring collaboration with
key partners, facilitating the sharing of resources, results,
and lessons learned, making available the staff, expertise, and
evidence-based resources of HHS agencies to assist in areas of
surveillance and epidemiology, community assessment and planning,
community mobilization, partnership development, monitoring program
performance outcomes, data management, and program sustainability. |
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REACH 2010 |
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Racial
and Ethnic Approaches to Community Health (REACH) 2010 is a
demonstration program to support community coalitions in the
design, implementation, and evaluation of unique
community-driven strategies to eliminate health disparities.
The Eastern Band of Cherokee Indians (North Carolina), the
Oklahoma State Department of Health (focusing on American Indian
Tribes), and the National Indian Council on Aging, Inc. (New
Mexico), are funded as part of the REACH (Racial and Ethnic
Approaches to Community Health) 2010 Demonstration Program and
the Elderly REACH Program (projects funded through REACH with a
specific focus on the elderly). Additionally, CDC has awarded
five cooperative agreements to fund core capacity projects
targeting American Indians and Alaska Natives (AI/AN). Four
organizations that address the health needs of AI/AN people:
Albuquerque Area Indian Health Board, Inc. (New Mexico);
Association of American Indian Physicians (Oklahoma);
Chugachmiut, Inc. (Alaska); and United South and Eastern Tribes,
Inc., (Tennessee) and one tribe, Choctaw Nation of Oklahoma,
were awarded funds to build core capacity to address health
disparities from the “Healthy People 2010” priority areas of
Immunizations, Infant Mortality, Breast and Cervical Cancer,
Cardiovascular Diseases, and HIV/AIDS. These organizations are
assisting tribes in building infrastructure for scientific
capacity and surveillance, developing culturally competent
health promotion and disease prevention strategies, providing
training and technical assistance, and facilitating networking
and partnership development through the use of Community Action
Plans. |
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National Diabetes Prevention Center |
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To
address the serious epidemic of diabetes in American Indians,
CDC established the National Diabetes Prevention Center (NDPC)
in Gallup, NM. The purpose of the NDPC is to prevent diabetes
and its complications through culturally appropriate and
scientifically sound participatory, community-based prevention
research in AI/AN populations. The goals of the NDPC are to 1)
identify “what works best” in diabetes prevention by testing and
evaluating new and existing models of diabetes prevention and
then sharing the outcomes with others; and 2) provide training
and education activities according to community needs and
priorities, as well as to provide the latest information and
techniques on diabetes and diabetes prevention through
conferences, seminars, and technical assistance. To support its community-based prevention research efforts,
the NDPC provides funds to the American Indian Higher Education
Consortium (AIHEC), a collaboration among tribal colleges and
universities (TCUs) representing 34 colleges in the U.S. and one
in Canada. AIHEC provides a unified voice for the tribal college
network that gives American Indian students access to quality
higher education programs. Through "Honoring Our Health: Tribal
Colleges and Communities Working to Prevent Diabetes," the
National Diabetes Prevention Center supports AIHEC in building
capacity for promoting and sustaining innovative diabetes
prevention programs within TCUs. The NDPC funding
(approximately $1 million/year) supports program development and
technical assistance in the public health approach to diabetes
education and program evaluation. |
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National Diabetes Education Program (NDEP) |
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The National Diabetes Education Program (NDEP), a joint
initiative between CDC and NIH, has created an extensive
partnership network to mobilize public and private sector
organizations to work with the NDEP to improve the way diabetes
is treated. An American Indian Workgroup was formed to assist
with the development of culturally appropriate TV, radio, and
print ads for American Indian communities. With input from
tribal leaders and community members, the campaign message
became, “Control your Diabetes for Future Generations.” In
addition, the Association of American Indian Physicians (AAIP)
was selected by CDC to help disseminate campaign materials. The
American Indian Workgroup is also developing a new campaign
focused on youth. |
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Diabetes Prevention and Control Programs |
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CDC
supports diabetes prevention and control programs (DPCPs) in all
50 states, Washington D.C. and eight territories to reduce the
complications of diabetes. DPCPs with large American Indian
populations partner with tribes to conduct health system, health
communication, and community-based interventions. For example in
Montana, the diabetes program is actively working with IHS,
Indian tribes and other partner organizations in the State to
improve surveillance and diabetes care and prevention efforts at the
local level, and to provide unique training to meet the needs of
Indian and non-Indian communities. |
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Tobacco Prevention and
Control |
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To reduce tobacco related
disparities in AI/AN communities CDC provided technical
assistance and financial support to seven (7) Tribal Support
Centers (TSCs), and the Northwest Portland Area Indian Health
Board (NPAIHB). NPAIHB is one of nine National Networks
designed to develop community networks around tobacco control in
targeted communities. It is also funded as one of seven (7)
Tribal Support Centers. The other TSCs are: Aberdeen Area
Tribal Chairmen’s Health Board; Alaska Native Health Board;
California Rural Indian Health Board; Intertribal Council of
Arizona; Muscogee Creek Nation; and the Intertribal Council of
Michigan. The TSCs work with tribal governments and
organizations to provide them with appropriate tobacco control
initiatives. |
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Cancer Prevention and
Control |
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In FY 2003, the National Breast
and Cervical Cancer Early Detection Program (NBCCEDP) funded 13
tribal governments and organizations. NBCCEDP has helped to
increase mammography use by women aged 50 years and older by 20
percent since the program’s inception in 1991. NBCCEDP targets
low-income women with little or no health insurance and has
helped reduce disparities in screening for women from racial and
ethnic minorities. Approximately 50 percent of screenings
provided by the program were to women from racial or ethnic
minority groups. Of that 50%, approximately 6.8% are AI/AN
women.
NBCCEDP helps low-income,
uninsured, and underserved women gain access to lifesaving
screening programs for early detection of breast and cervical
cancers. The success of NBCCEDP depends on the complementary
efforts of a variety of national organizations and other
partners. CDC has joined with many such partners to help
strengthen and maintain the infrastructure needed to implement
NBCCEDP and other health programs targeting underserved women.
One partnership effort involves the Bureau of Primary Care (a
division of the federal Health Resources and Services
Administration [HRSA]) and the community health centers that it
funds; the Institute of Healthcare Improvement; the National
Cancer Institute (NCI); CDC; and other organizations. This
project is focused on increasing screening for breast, cervical,
and colorectal cancers within the populations served by
community, migrant, and homeless health centers, as well as on
improving follow-up for patients with abnormal screening
results. Health center personnel are learning how small,
incremental changes in clinic practices (e.g., linking screening
to non-routine clinic visits) can lead to improved health
outcomes for the populations they serve. They are being taught
how to plan and pilot-test such changes as well as how to assess
and use test results in implementing effective changes.
Another important CDC partner,
Avon, makes available about $5 million every year to help
community-based organizations recruit women for breast cancer
screening. During 2003, Avon is working to improve links
between these organizations and NBCCEDP grantees. Also, through
the Avon-CDC Foundation Mobile Access Program, a grant of more
than $4 million will fund at least four mammography vans to
expand services for medically underserved women through NBCCEDP.
NBCCEDP grantee organizations in
many states have joined with nontraditional partners, including
Native American tribal leaders, councils on aging, and church
groups, to offer education and outreach in community settings.
Diverse partners and varied intervention strategies have
successfully brought screening services to women living on
American Indian reservations and in rural and inner-city areas.
For example, with grants from
NBCCEDP and added support from Avon and the Susan G. Komen
Foundation, the Native Women’s Wellness Program of the South
Puget Inter-tribal Planning Agency has steadily expanded its
outreach to women in the five tribal communities of Washington
State. Native American outreach workers and tribal health care
providers have built relationships of mutual trust and respect
with these women, and their work continues to increase the
number of women who receive screening through this program.
The National Comprehensive
Cancer Control Program (NCCCP) is a federally-supported program
that integrates a range of activities to develop a coordinated
approach to reduce the incidence, morbidity, and mortality of
cancer through prevention, early detection, treatment,
rehabilitation, and palliation. In FY 2003, CDC expanded NCCCP
adding 26 new programs. With $12 million this year, CDC will
support 51 comprehensive cancer control capacity building
programs across the United States, including 5 tribes and tribal
organizations.
Also in FY 2003, DCPC posted
Program Announcement #03050 - National Organization Strategies
for Prevention, Early Detection or Survivorship of Cancer in
Underserved Populations. Eight organizations were awarded funds
to assist national organizations in the development of health
programs and cancer prevention and control infrastructure
enhancement to deliver cancer education and awareness activities
for individuals who may be underserved, uninsured or
underinsured, at risk, or of racial/ethnic minorities. In
addition, CDC agreed to assist established national programs in
developing and disseminating current national, state, and
community-based comprehensive information on cancer prevention,
early detection, or survivorship. This project includes
facilitating the exchange of expertise and coordination of
program efforts related to cancer prevention and control among a
variety of public and private not-for-profit agencies at the
national level. Minority populations referenced in the program
announcement included but were not limited to American
Indian/Alaska Natives. Of the eight organizations that were
funded, two have specifically stated that their efforts will
address this population. |
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WISEWOMAN |
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The WISEWOMAN program, a sister
program to the NBCCEDP, offers additional preventive health
services to the same women targeted by the NBCCEDP. Preventive
health services through WISEWOMAN include hypertension and
cholesterol screening along with culturally appropriate behavior
or lifestyle interventions, including dietary and physical
activity interventions for the target population. In FY 2003,
CDC awarded cooperative agreements through a competitive process
to two tribal organizations in Alaska for the WISEWOMAN
project. These organizations are the Southcentral Foundation,
and the SouthEast Regional Health Consortium. |
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Prevention Research Centers |
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CDC’s Prevention
Research Centers Program supports the joint efforts of academic
health centers, public health agencies, and community partners
in conducting applied research and practice among underserved
populations. Two of the 28 Prevention Research Centers (PRCs),
the University of Oklahoma and the University of New Mexico,
focus exclusively on American Indian populations. The research
portfolios of three other centers, the University of Arizona,
University of North Carolina at Chapel Hill, and the University
of Washington at Seattle, include projects among American
Indians or Alaska Natives. The centers collaborate with tribal
governments, schools serving American Indians, the Indian Health
Service (IHS) and Bureau of Indian Affairs, local agencies, IHS
clinics, and other organizations. Each PRC depends on one or
more community advisory council to ensure AI/AN involvement in
participatory research, evaluation, education, training, and
practice. |
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Preventive Health and Health
Services Block Grant |
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CDC’s Preventive Health & Health Services (PHHS) Block Grant
program funds 2 Indian Tribes, the Kansas Kickapoo Tribe and
Nebraska Santee Sioux Tribe. The Kickapoo use PHHS Block Grant
dollars to fund youth programs, while the Santee Sioux use funds
to support Emergency Medical Services. |
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National Center for HIV, STD, and TB
Prevention (NCHSTP) |
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Building Capacity for HIV
Prevention |
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In 2003, NCHSTP’s Division of
HIV/AIDS Prevention (DHAP) funded the Inter Tribal Council of
Arizona (ITCA) to enhance regional community mobilization for
AI/AN HIV prevention programs among 19 tribes located in
Arizona, Nevada, and Utah. The goal is to improve delivery and
effectiveness of HIV prevention services for AI/AN tribes,
organizations, and urban health centers in the three states.
ITCA maintains a task force in Arizona and Nevada and a work
group in Utah to prepare AI/AN persons to participate in State
HIV Community Planning Groups. ITCA also provides Native
American Red Cross Instructor Training in HIV Prevention for
adults and youth, including “peer leader” training for youth.
Finally, ITCA conducts training in grant writing, needs
assessments, HIV counseling and testing, and cultural
competency.
The National Minority AIDS
Council was funded by NCHSTP/DHAP in FY 2003 to develop
organizational infrastructure to support HIV prevention in AI/AN
communities.
Also in FY 2003, NCHSTP/DHAP
supported the National Native American AIDS Prevention Center (NNAAPC)
to provide technical assistance to AI/AN and Native Hawaiian
entities for enhancing and improving the delivery and
effectiveness of HIV prevention interventions; strengthening
community capacity for HIV prevention; and strengthening HIV
prevention community planning. NNAAPC has provided general
capacity building assistance, including community planning
services, HIV prevention curriculum development, and HIV
prevention intervention design, implementation, and evaluation.
NNAAPC has also provided the following specific capacity
building assistance: HIV prevention for gay/bisexual AI/AN men,
including development of a curriculum for HIV prevention
education; assistance to increase parity, representation and
inclusiveness of gay/bisexual AI/AN men on community planning
groups; HIV prevention among and assessment of the
prevention-related needs of young AI/AN men who have sex with
men; and prevention among HIV-seropositive AI/AN men. |
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HIV Prevention Education
Programs |
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The Alaska Native Health Board (ANHB)
is a community-based organization that aims to increase public
awareness throughout Alaska about the need for HIV testing and
for a continuum of care for HIV-infected individuals, and to
increase HIV testing among AI/AN people. In FY 2003, NCHSTP/DHAP
funded ANHB to prepare rural communities for HIV testing and to
provide education to and mobilize communities for HIV
prevention. The program accomplishes these goals by providing
culturally relevant prevention media; urban and rural outreach,
education, and awareness campaigns; and by disseminating
prevention technologies. In FY 2003, ANHB completed a
documentary “Breaking the Silence,” that describes the effect of
HIV/AIDS on an Inupiat family living in a remote Native village
in Alaska.
The Indigenous Peoples Task
Force was funded in FY 2003 to provide education to reduce the
transmission of HIV/AIDS and other STDs among at-risk AI/AN
youth between the ages of 13 and 19 years in Minnesota through a
Peer Education Program. In this program, AI/AN youth are
trained to use a curriculum which incorporates traditional AI/AN
spiritual concepts, values, and practices. They then conduct
peer education sessions in schools (urban and
rural/reservation), and at youth conferences and community
programs, and through other social service agencies. Youth who
participate in the Summer Native Arts Prevention Program develop
plays on the subject of HIV/AIDS and STDs which they perform for
peers. |
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HIV Counseling and Testing Services |
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NCHSTP/DHAP
supports the Native American Community Health Center of Phoenix,
Arizona, to provide HIV prevention education, support for
behavior change and referrals to prevention case management and
social services, as well as mobile counseling and testing
services to AI/AN persons who are at high risk of acquiring HIV
infection, or who have been diagnosed with HIV or AIDS. NCHSTP/DHAP supports the Native Family Resource Center to
offer HIV counseling and testing and culturally appropriate
prevention education and case management to AI/AN clients in the
Winnebago Service Area in Iowa and Nebraska. The Resource
Center also collaborates with other health service providers in
the Area to design, implement, and evaluate HIV prevention
interventions. The primary target population is mothers with or
at risk for HIV infection. |
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Comprehensive STD Prevention Systems (CSPS) Grant |
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NCHSTP’s Division of STD Prevention funds 65 project areas
including 7 cities and 8 territories for designing,
implementing, and evaluating high quality, comprehensive
interdisciplinary state and local STD prevention plans, and for
integration of STD/HIV prevention activities. The comprehensive
services are targeted to prevent STDs among at-risk populations,
including AI/AN and other minorities. CSPS awards include
supplemental funds for Infertility Prevention Programs (IPP) and
for Syphilis Elimination efforts. IPP funds support expansion of
chlamydia and gonorrhea screening and treatment efforts at
traditional and nontraditional health care settings for
adolescent and young adult women 25 years old and younger.
Chlamydia and gonorrhea are two leading causes of infertility
among young women. Syphilis Elimination funds are provided to
assure that the necessary infrastructure is in place to carry
out the goals of syphilis elimination, including development of
individual state plans (including behavior change, screening,
diagnosis, treatment and follow-up) that must be in place to
assure the reduction of early and congenital syphilis. |
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Infertility Prevention for AI/AN |
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NCHSTP/DSDTP
continued support in FY 2003 for the "Stop Chlamydia!" project,
which aims to lower Chlamydia infection rates and obtain
comprehensive information about Chlamydia infection within
Northwest AI/AN communities. The Stop Chlamydia! Project
collects surveillance data from participating tribes and
analyzes the information for distribution to participating
clinics. The project also provides technical assistance to
support STD prevention programs as well as free antibiotics (azithromycin)
for treatment of chlamydia in patients and their partners.
Currently 18 Indian health care programs and one urban Indian
center in the Portland area participate in the Stop Chlamydia!
project. |
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Improving Screening and Treatment for STDs, HIV, and
Hepatitis B |
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NCHSTP/DSTDP is pilot testing a system
that combines surveillance, quality of care, and training to
improve prevention for STDs. “ID WEB” is a system that pulls
laboratory, diagnostic, treatment, and patient education
information each month from IHS’s computerized records. “ID WEB”
collects information on individual cases that have received
screening, treatment, counseling, and been offered treatment for
partners, analyzes the information, and makes it available
on-line to providers. Providers can access facility-specific
surveillance data, such as age and gender of patients; feedback
on diagnosis, treatment, and counseling of patients; and
web-based training on STD clinical care and prevention.
Continuing education is available for providers who access the
on-line training. Because specific performance feedback has been
valuable in improving providers’ screening and treatment
practices, this system shows promise for improving management of
other diseases. |
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Diagnostic, Epidemiologic, and Outreach Services for
TB Control |
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NCHSTP’s Division of Tuberculosis
Elimination (DTBE) funding supports activities targeting AI/AN
populations in cooperative agreements with states, cities and
territories to promote tuberculosis (TB) elimination efforts.
The cooperative agreements provide funds for 1) personnel,
including TB control officers, medical consultants,
epidemiologists, outreach workers to provide directly observed
therapy, laboratory technicians and health educators; 2)
materials, including supplies and equipment for TB testing; and
3) incentives for patients to continue and complete treatment.
These resources are coordinated and shared with IHS and Tribal
programs, to meet sporadic needs, in accordance with specific
local agreements. |
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National Center for Infectious
Diseases (NCID) |
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Hepatitis Prevention and Control |
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NCID’s
Division of Viral Hepatitis (DVH) supports a cooperative
agreement to the Alaska Native Tribal Health Consortium to fund
a project titled “Evaluate the Long-Term Protection from
Hepatitis A and B Vaccine among Multiple Cohorts of Alaska
Natives Vaccinated and Study the Natural History of Chronic
Hepatitis C among Alaska Natives.” The project assesses how well
hepatitis A and B vaccines have protected Alaska Natives from
these diseases, and examines the impact of hepatitis C on this
population. The burden of hepatitis A and hepatitis B in both
native and non-native people has been greatly reduced through
vaccination. In fact, the effectiveness of hepatitis B
vaccination in decreasing transmission of hepatitis B virus in
rural Alaska is one of the great public health stories of the
20th century. DVH funding has also allowed a hepatitis A
prevention brochure (focusing largely on vaccination) to be
updated, printed, and distributed in paper and electronic forms
to Indian sites nationwide. In addition, DVH, through an
interagency agreement with IHS, funds community-based Viral
Hepatitis Integration Projects (VHIPs) focuses on AIs/ANs. The
goal of this program is to integrate testing for HIV and viral
hepatitis into pre-existing programs for chemical dependency and
sexually transmitted diseases. The programs also provide risk
factor assessment, behavioral counseling, and referral for
medical treatment. Currently funded organizations are:
Na’Nizhoozhi Center, Inc., Gallup, NM; Seattle Indian Health
Board, Seattle, WA; Phoenix Indian Medical Center, Phoenix, AZ;
Fort Peck Tribal Health Department, Poplar, MT; and Tanana
Chiefs Conference, Fairbanks, AK. |
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Pneumococcal Disease Prevention |
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NCID’s
Office of Minority and Women’s Health (OMWH) provides funds in
support of a 3-year research proposal titled, “Prevention of
Pneumococcal disease in Alaska Native Elders.” This project is
conducted through collaboration with Alaska Native Tribal Health
Consortium and Johns Hopkins University Center for American
Indian and Alaska Native Health. The overall goal of this
project is to demonstrate the effectiveness of a target effort
to increase the 23-valent pneumococcal polysaccharide vaccine
coverage in Alaska Native adults. |
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National Center for Injury
Prevention and Control (NCIPC) |
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Reducing Motor Vehicle
Injuries |
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NCIPC’s Division of Unintentional Injury Prevention has
developed a new program entitled, “Effective Strategies to Reduce
Motor Vehicle Injuries Among American Indians/Alaska Natives”.
Approximately $186,000 is available to fund three awards to any
federally recognized AI/AN tribe or tribal organization. Tribes and
tribal organizations must have a minimum population size of 2,500
people, or serve 2,500 AI/AN people in order to be eligible to
apply. The purpose of the program is to develop, implement, and
evaluate community-based interventions with demonstrated
effectiveness to reduce motor vehicle-related injuries among AI/AN.
It is expected that the awards will begin on or about January 2004. |
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Building Capacity for
Preventing Intimate Partner and Sexual Violence |
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In 2003, NCIPC’s Division of
Violence Prevention (DVP) funded the University of Arizona to
evaluate the effectiveness of the Safe Dates: Adolescent Dating
Violence Prevention Curriculum within the context of
comprehensive youth development activities for AI/AN and Latino
youth. Project staff works through University-affiliated
Cooperative Extension offices in Gila, Coconino, and Navajo
counties to implement dating violence prevention activities in
collaboration with Reservation and non-Reservation schools and
community settings. |
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National Immunization Program (NIP) |
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Student Opportunities, Training, and Vaccines for
Children |
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In FY2003, NIP supported the American Indian
Science and Engineering Society (AISES) Program by paying
$10,701 for a student to work with a health communication
specialist on the development of a training program for the
Immunization CDCynergy Program. During the 2003 National Infant
Immunization Week (NIIW) kickoff in Oklahoma, Dr. Orenstein
presented to the immunization providers of the Choctaw Nation of
Southeastern Oklahoma. As a follow up to the NIIW activities,
two ISD staff presented on immunization practices to providers,
nurses and nursing students at the Area Health Education Center
(AHEC) spring meeting. NIP provided $8,000 in funding through
an Interagency Agreement (02-FED17460-01) with the Indian Health
Service to provide travel support for IHS Coordinators to attend
the National Immunization Conference. NIP also directly funded
a Public Health Advisor position assigned to the Indian Health
Service in the amount of $80,593. The Public Health Advisor
assisted in the planning, development and implementation of
vaccine-preventable disease control programs for AI/AN,
including the implementation of the Vaccines for Children (VFC)
program among AI/AN children. In 2003, VFC purchased over $900
million in vaccines for children - birth through 18 years of
age, who are eligible for the VFC entitlement, including AI/AN
children. CDC estimates that 869,925 AI/AN children 0-18 years
of age are VFC eligible. This represents 2.42% of the total
U.S. population 0-18 years of age. In 2003, CDC granted over
$72 million in categorical VFC operations funding to 61 state,
city and territorial immunization grantees. We do not have an
estimate of the amount of these funds directed specifically for
AI/AN children. |
|
|
National Institute for
Occupational Safety and Health (NIOSH) |
|
National Occupational Research Agenda |
|
In FY
2003, NIOSH spent approximately $1.5 million dollars in support
of occupational safety and health research and services
impacting Native (AI/AN and Native Hawaiian) populations. Most
NIOSH programs are targeted to address the National Occupational
Research Agenda (NORA), a list of 21 research priority areas to
prevent injury and illnesses among all workers, especially
workers in high-risk occupations and industries such as
agriculture and construction. Some examples of our research
and collaborative efforts with Native partners are highlighted
in sections below. |
|
Public Health Practice Program Office (PHPPO) |
|
In FY 2003, PHPPO issued four (4) Program Announcements:
Conference Support Grant Program; Initiative to Integrate Clinical
Laboratories in Public Health Laboratory Testing; Research on the
Impact of Law on Public Health; and Collaborating Centers for Public
Health Law. Tribal governments and organizations were eligible
to apply for all four, but no applications were received. |
|
|
Office of the Director (OD) |
|
Office of Minority Health (OMH) |
|
Within OD,
the Office of Minority Health (OMH) has maintained a cooperative
agreement with the American Indian Higher Education Consortium (AIHEC)
to “Enhance Research, Infrastructure, and Capacity Building for
American Indian Tribal Colleges and Universities (TCUs).” The
purpose of the program is to assist the AIHEC member TCUs in
developing the commitment and capacity to promote education,
student and professional development, evaluation and research,
leadership and community partnerships that enhance the
participation of American Indians and Alaska Natives (AI/ANs) in
the public health professions; and to enhance the health status
of AIANs in the United States. Under this agreement, AIHEC has awarded $90,000 to Northwest
Indian College to develop curricula and/or a project to address
community-based public health concerns as a means of providing a
culturally appropriate educational experience involving their
students and faculty. Their program will encourage and inspire
native students to assume greater roles in public health locally
and nationally and will be shared with other TCUs to assist them
in mimicking a like type program in their communities. |
|
Office of Terrorism Preparedness and Emergency
Response (OTPER) |
|
In June, 2003 OD/OTPER added a
position in the State and Local Readiness Program that is
serving as the Tribal Liaison Officer. This individual’s duties
include having the responsibility for oversight, review and
summarizing of Bioterrorism and Emergency Response tribal
activities across the country related to CDC’s BT Cooperative
Agreement 99051. Although no funds are appropriated through CDC
to directly fund tribal governments, CDC strongly encourages
each state BT office to provide ongoing funds to their
respective tribes. In a continuing process, a number of tribes
have received contractual funds through their state BT program
for implementation of Tribal BT initiatives. In addition, new
State Action Plans are being developed by OTPER Project Officers
that will include a Tribal component specifically addressing
certain critical capacities of the Cooperative Agreement
99051;i.e., Preparedness Planning and Readiness Assessment,
Surveillance and Epidemiology Enhancement, Biological Laboratory
Enhancement, Chemical Laboratory Enhancement, Support for
Communications and Information Technology (Public Health
Information Network, Health Alert Network), Enhancement of Risk
Communication and Health Information Dissemination, Enhancement
of Education and Training. |
|
2. |
INTERGOVERNMENTAL
RELATIONS
AND RELATED ISSUES |
Encouraging collaboration between state and tribal
governments remains a high priority for CDC. In 2003, CDC staff
again helped to conduct an AI/AN public health session at the
annual meeting of the Council of State and Territorial
Epidemiologists (CSTE). In attendance were representatives from
each of the Tribal Epidemiology Centers. CDC and CSTE are also
working directly with tribal health facilities to assess
surveillance and reporting practices. Enhanced federal
cooperation on behalf of tribes is also a high priority for
CDC. In this regard, CDC/ATSDR has partnered with IHS to form
the CDC/ATSDR/IHS Senior Policy Workgroup, which meets twice a
year to improve inter-agency coordination. This workgroup
serves to focus and strengthen collaborative activities between
CDC/ATSDR and IHS by articulating shared visions, priority
issues, and possible collaborative approaches for improving
public health in Indian country. Within a number of CDC
categorical programs, tribal – state – federal cooperation is
often enhanced by CDC staff and projects, as described in the
examples that follow: |
|
NCHSTP, Office of the
Director |
|
Public Health Surveillance Among
AI/AN People |
|
In FY 2003, NCHSTP/OD Office of
Health Disparities staff and partners (RTI International and
Kauffman and Associates) met with members of the Health
Subcommittee of the National Congress of American Indians as
part of the stakeholder engagement phase of a project to assess
how current HIV, STD, TB and viral hepatitis surveillance
systems serve AI/AN people. In the next phase of the project,
focus groups were conducted at a joint meeting of the California
Rural Indian Health Board and the Northwest Portland Area Indian
Health Board and at a meeting of the Aberdeen Area Tribal
Chairman's Health Board. In addition, key informant interviews
were conducted with officials in 7 tribal health facilities. The
purpose of these focus groups and key informant interviews was
to explore the extent to which tribal health agencies
participate in surveillance; describe the availability of
tribe-specific health data, data sources, and tribal authority
to access them; and develop an understanding of existing
surveillance processes as they related to the AI/AN population,
as well as surveillance successes and challenges. |
|
|
NCHSTP, Division of STD
Prevention |
|
Addressing
Increases in Syphilis Cases in the Four Corners Area |
|
Starting in January 2000, the number
of cases of syphilis identified in the Navajo Nation began to
rise, and in 2001, there were three congenital syphilis cases.
In response, the Indian Health Service and the Navajo Nation
requested assistance from NCHSTP/DSTDP, which sent an STD
Syphilis Rapid Response Team to help understand the increases.
Risk factor analysis showed a correlation between syphilis
transmission and alcohol abuse. CDC, the Navajo Nation, the New
Mexico Department of Health, Arizona Department of Health, and
the IHS National Epidemiology Program worked together to conduct
targeted screening efforts to identify and treat patients
infected with syphilis. Although the number of newly identified
cases stabilized during 2002, preliminary 2003 data showed a
second resurgence. NCHSTP/DSTDP deployed a second Rapid Response
team to conduct more in-depth analysis of causes of
transmission. The Navajo Nation Division of Health, the Indian
Health Service, and the state health departments of Arizona, New
Mexico, Colorado, and Utah met to develop a response plan that
outlines ways to build capacity for all STD issues. This meeting
also provided an opportunity to develop memoranda of agreement
between the states and Navajo Nation, and clarify roles of the
groups that are working together. In addition, NCHSTP is
increasing support for development of local capacity and
infrastructure to prevent and control STDs including HIV. |
|
|
NCID, Arctic
Investigations Program (AIP) |
|
AIP is located on the Alaska Native
Health Campus in Anchorage. The mission of AIP is prevention of
infectious diseases among people of the Arctic and sub-arctic
with a special emphasis on diseases of high incidence and
concern among Alaska Native (AN) populations. Employees from
CDC, the Alaska Native Tribal Health Consortium, South-central
Foundation, Indian Health Services, and the University of Alaska
staff the CDC laboratory and office in Anchorage. Current
problems addressed by AIP include infections caused by
drug-resistant bacteria, vaccine-preventable diseases, chronic
diseases caused by infections, and bioterrorism preparedness and
response. AIP laboratory is part of the Laboratory Response
network, a multi-level system connecting local and state public
health, veterinary, food, and water laboratories with advanced
capacity laboratories. This is one of two such laboratories in
Alaska. AIP staff members also assumed a major role in the
Severe Acute Respiratory Syndrome (SARS) outbreak. AIP staff
members were deployed locally and in Ottawa to participate in
the public health response. AIP staff met all incoming passenger
aircrafts from SARS-affected areas to discuss health alerts
notices, to provide health screening and to provide additional
information as needed. AIP staff members also participated in
the Northwest SARS working group, which provided a forum for
quick exchange of information among public health professionals
in Alaska, the Yukon, British Columbia, and Washington, as well
as officials from CDC in Atlanta, Health Canada, and the cruise
line industry. |
|
|
NCID, Division of Viral
Hepatitis (DVH) |
|
Since 1999, DVH has supported a
full-time Medical Officer at the IHS National Epidemiology
Program, in Albuquerque, NM. This epidemiologist coordinates
joint CDC/IHS activity around viral hepatitis epidemiology,
research, prevention, and policy. The epidemiologist also serves
as Project Officer for five CDC-funded Viral Hepatitis
Integration Projects (VHIPs) in Indian populations. Since 2003,
DVH has also supported a full-time Research Officer at the IHS
National Epidemiology Program (NEP). This epidemiologist serves
as coordinator of hepatitis C prevention activities for the IHS
and as Operational Supervisor for the five Indian VHIPs. The two
positions assigned to the IHS NEP by DVH cover AI/AN nationwide,
whether the populations are medically served by IHS, a Tribal
program, or an Urban Indian Health Center. This arrangement
allows CDC to maintain collaborative relationships with all
types of health facilities serving AI/AN, and serves to promote
close working relationships with state health departments. The
following are highlights of CDC program activities that enhance
tribal – state – federal cooperation and partnerships: |
|
|
Epidemiology Program
Office (EPO) |
|
New Mexico
Department of Health Assessment Project |
|
In September 2002, the New Mexico
Department of Health (NM DoH) received $165,000/first year –five
year cooperative agreement to enhance the quality and scope of
community health assessment practices through more systematic
evaluation, coordination, and training from the Division of
Public Health Surveillance and Informatics, EPO. One of the
main projects is providing direct epidemiology support to the 22
tribes within the state. Through this support, it is hoped to
improve the knowledge of the community health status among
tribes; improve the quality and scope of assessments conducted;
and increase the number of tribes with community-level evidence
to improve public health programs and policies. With this
support, the NM DoH has established a tribal epidemiologist
position. This new tribal epidemiologist has been instrumental
in the development of a methodology to create inter-censal
population estimates by tribe. In addition, planning has begun
to add a tribal affiliation field to the reportable infectious
disease database was initiated to provide access to
tribal-specific infectious disease data for use in assessment,
planning, and prevention activities. A tool was developed to
evaluate current tribal assessment capacity and completed with
five tribes. Finally, the development of an American Indian
data report for the state of New Mexico was initiated.
Bi-monthly meetings of the Native American Data Advisory Work
Group are coordinated as a means for tribes, universities, and
state health department staff to share past/present projects and
needs relating to use of health information. As a result, two
collaborative projects were initiated between the NMDOH and
individual tribes: 1) Analysis of Jemez Pueblo asthma survey
data, and 2) Analysis of Navajo Nation vital records data. |
|
|
Public Health Practice
Program Office (PHPPO) |
|
National
Public Health Performance Standards Program (NPHPSP) |
|
Working with tribal and IHS
partners, public health professionals from PHPPO, CDC’s
Epidemiology Program Office (EPO), NCCDPHP/DCPC, and OMH/OD are
working with numerous tribal and state/local health departments
to implement NPHPSP assessment activities in several tribal and
IHS settings. In the context of evaluating how well the local
or regional public health “system” is providing essential public
health services to AI/AN communities, public health
professionals from multiple jurisdictions and organizations are
brought together – often for the first time. In July, 2003, two
Tucson Area Tribal Nations conducted an assessment using the
National Public Health Performance Standards Program (NPHPSP)
Local Public Health System Performance Assessment. A CDC Public
Health Prevention Specialist (EPO) and a CDC medical
epidemiologist (NCCDPHP), both field-assigned to the IHS
National Epidemiology Program in Albuquerque, coordinated the
process over a period of several months with the IHS Area
Offices, Tohono O’Odham and Pascua Yaqui Tribal Nations, the
Inter Tribal Council of Arizona, University of New Mexico and
Atlanta-based PHPPO staff. Also, PHPPO, in a partnership with
National Association of County and City Health Officials (NACCHO),
provided four (4) regional trainings about the planning
processes described in the National Public Health Performance
Standards Program and the Mobilizing for Action through Planning
and Partnerships (MAPP) tool. Tribal Agency representatives and
IHS staff participated in some of these trainings. |
|
|
Office of the Director
(OD), Office of Minority Health (OMH) |
|
Within the CDC Office of the
Director (OD), OMH has responsibility for coordinating the
agency's programs and policies that benefit AI/AN communities.
To lead these efforts, two full-time professional staff
positions have been established within OMH/OD to help plan and
coordinate CDC programs for AI/AN communities: the Senior Tribal
Liaison for Policy and Evaluation and the Senior Tribal Liaison
for Science and Public Health. Located in Atlanta, GA and
Albuquerque, NM, respectively, these senior staff members report
directly to the Associate Director for Minority Health and serve
as official CDC points-of-contact for issues relating to AI/AN
health. As liaisons they work to facilitate and strengthen
relationships between tribal governments and organizations,
federal agencies, and state/local health departments. In
addition, they work closely with CDC's Centers and Offices (CIOs)
that have programs and activities involving AI/AN communities,
and with ATSDR's Office of Tribal Affairs. A critical component
of their duties is to network with CDC CIOs to help integrate
categorical projects and personnel by connecting CDC expertise
and support with tribal communities. |
|
|
Office of the Director
(OD), Office of Terrorism Preparedness and Emergency Response
(OTPER) |
|
OTPER recognizes the critical role
of AI/AN communities in the nation’s effort to be better
prepared for terrorism and other public health emergencies.
CDC/OTPER is committed to working with AI/AN tribes, villages
and corporations on a government-to-government basis and
upholding the federal trust responsibility. OTPER is working
with other CDC centers and offices, IHS, the Health Resources
Services Administration (HRSA), the Agency for Toxic Substances
and Disease Registry (ATSDR), the Environmental Protection
Agency (EPA), the National Indian Health Board, Area Indian
Health Boards, Inter-Tribal Councils, Tribal Epidemiology
Centers, and various tribal health entities in strengthening
terrorism preparedness and emergency response capabilities in
AI/AN governments, communities, and organizations. In FY 03
OTPER staff participated in 5 DHHS Regional Tribal Consultation
Sessions; Las Vegas, Nevada (Region 9), Albuquerque, New Mexico
(Region 6), Nashville, Tennessee, (Region 4), Denver, Colorado
(Region 8), Anchorage, Alaska, (Region 10). Staff formally
introduced and discussed the future of the new office/program.
In addition, staff participated in the listening/consultation
sessions between the tribes and Federal OPDIV’s.
In addition, OTPER staff has been involved in discussions
with IHS, ATSDR, and NIHB in the support and creation of a
National Native American Task Force, a standing committee that
would address Bioterrorism and Emergency Preparedness on a
National level impacting programs out in Indian Country. |
|
3. |
SERVICES AND SERVICE
PROVISIONS |
Although this section is not directly applicable
to CDC (CDC does not provide direct clinical services), several
CDC programs strive to strengthen linkages between clinical and
preventive health services. Details of such programs are
provided elsewhere in this document, but prominent examples
include the Breast and Cervical Cancer Early Detection Program,
the WISEWOMAN Program, the Comprehensive Cancer Control Program,
the Viral Hepatitis Integration Projects, the ID WEB project,
the Stop Chlamydia! Project, the Tobacco Support Centers
program, HIV counseling and testing services, and immunization
programs. |
|
4. |
CARE PROVIDERS |
Not applicable to CDC; however, a number of
CDC’s Commissioned Officers are medical professionals who choose
to complete their required (minimum of 2 weeks annually)
clinical activities at IHS or tribal facilities throughout the
country (e.g., Alaska, Arizona, New Mexico, South Dakota). |
|
5. |
FACILITIES, EQUIPMENT, AND
SUPPLIES |
Not Applicable to CDC. |
|
6. |
INFRASTRUCTURE |
CDC is not directly involved in water/sewer
maintenance/repair, but its mission does include the monitoring
and prevention of waterborne diseases, fluoridation projects,
and certain occupational safety and health efforts that may fit
within this category. Examples include: |
|
|
NCDPHP, Division of Oral
Health |
|
In FY 2003, CDC provided funds and technical
assistance to IHS to support a water fluoridation specialist.
The specialist provides training and technical assistance to
tribes in the Phoenix and Albuquerque Areas of IHS to improve
the quantity, quality and consistency of water fluoridation.
These efforts improve the effectiveness of water fluoridation in
reducing tooth decay in tribal communities. |
|
|
NIOSH |
|
NIOSH’s mandate also includes training
occupational safety and health professionals. The goal is to
have competent professionals trained in such areas as industrial
hygiene, to address issues dealing with water systems.
Hopefully, our Training Project Grants such as the University of
Oklahoma Health Science Center grant will assist in this effort
(FY 2003 funding $61,578). NIOSH has supported a workforce
development award with the University of Oklahoma since 1998.
This grant provides two master’s degree programs in the College
of Public Health: Industrial Hygiene or Industrial
Hygiene/Environmental Management. The university programs are a
resource serving the AI/AN community in the region. The purpose
of the NIOSH training grant is to recruit AI/AN and other
qualified trainees into the field of industrial hygiene, provide
support for an industrial hygiene management program and
strengthen current educational activities. Presently, two AI/AN
students are enrolled in the program. In addition, three
students have graduated from the program since 1998. NIOSH
also conducts surveillance activities, shares information with
AI/AN communities, and implements intervention projects to
reduce and prevent injuries among AI/AN workers and their
families. For example, NIOSH has conducted health hazard
evaluations at two Indian reservations: an evaluation of an
aquaculture facility at the Chippewa Reservation requested by
the St. Croix Chippewa Indian Tribe; and an evaluation of
exposure to contaminants during coin and paper counting at the
Lac Vieux Desert Resort and Casino in Watersmeet, Michigan
requested by the Band of Lake Superior Chippewa Indians.
Currently, NIOSH supports workshops for community members,
health care providers, and as many as 15 western tribes on the
recognition, diagnosis and management of pesticide-related
illnesses and injuries. Details of the specific services
provided are described in our Navajo Nation project and our
Western Center for Agricultural Safety and Health at the
University of California, Davis campus. |
|
7. |
DATA AND RESEARCH |
In collaboration with its numerous partners
(tribal, state, federal, academic, etc.), CDC compiles and
analyzes health data and conducts public health research about
health issues of importance to AI/AN people. The following are
highlights of data and research activities conducted during FY
2003: |
|
NCCDPHP, Division of Adult
and Community Health (DACH) |
|
Behavioral
Risk Factor Surveillance |
|
The Behavioral Surveillance Branch (BSB) in the
Division of Adult and Community Health conducts, in
collaboration with state health departments, the Behavioral Risk
Factor Surveillance System (BRFSS). The BRFSS is a telephone
survey of adults focusing on health behaviors related to chronic
disease. BSB analyzes and publishes reports based on data from
AI/AN respondents in collaboration with the IHS. It provides
data and technical assistance to Tribal Epidemiology Centers and
the CDC Prevention Research Centers. States also analyze data
from AI/AN respondents. |
|
|
NCCDPHP, Division of
Adolescent and School Health (DASH) |
|
Youth Risk
Behavior Surveillance System |
|
CDC developed the Youth Risk Behavior
Surveillance System (YRBSS) to monitor health risk behaviors
associated with the leading causes of morbidity and mortality
among youth and adults. National YRBSS data representing AI/AN
youth are not available because the number of students
completing the survey from this racial group was too small for
meaningful analysis. Consequently, the Bureau of Indian Affairs
conducted an YRBSS survey among high school students attending
BIA-funded schools in 1994, 1997, and 2001 and among middle
school students in 1997 and 2000. In addition, in 1997 and
2000, with assistance from the Indian Health Service, the Navajo
Nation conducted a survey among high school students attending
public schools on the Navajo Nation reservation and students
attending border-town schools with a Navajo enrollment of at
least 50 percent. CDC has provided technical assistance in
survey administration and in using YRBSS data. |
|
|
NCCDPHP, Division of
Cancer Prevention and Control (DCPC) |
|
Cancer
Registries |
|
Previously documented racial misclassification
of AI/AN people in cancer registry data affects cancer
statistics and hampers program planning for cancer prevention
and control efforts for these populations. To address these
problems, DCPC developed protocols for state cancer registries
to conduct case ascertainment for AI/AN using IHS administrative
encounter data. IHS and CDC conducted a 1-year data linkage
project to help registries more accurately describe the burden
of cancer among AI/AN. Data from 25 state registries in the
NPCR will be linked with data from the IHS patient registration
records to improve the classification of AI/AN race in the
registries. Preliminary results are anticipated in late 2003. |
|
Economic
Barriers to Preventive Cancer Screening |
|
This study will use data from the Behavioral
Risk Factor Surveillance System to examine how income, insurance
status, and perceptions of cost as a barrier to medical care
affect participation in screening for breast and cervical
cancers. Researchers will also look at the role of NBCCEDP in
changing the behavior of uninsured women toward breast and
cervical cancer screening services. |
|
|
NCCDPHP, Division of
Reproductive Health (DRH) |
|
Pregnancy
Assessment and Monitoring System (PRAMS) |
|
PRAMS is an ongoing, population-based
surveillance system designed to identify and monitor selected
maternal behaviors and experiences that occur before, during,
and after pregnancy among a sample of mothers who have recently
delivered a live birth. PRAMS collects data on a wide range of
maternal and child health (MCH) indicators such as intendedness
of pregnancy, access to and use of prenatal and infant care,
payment source for prenatal care, alcohol use, smoking, violence
during pregnancy, multivitamin consumption, infant sleeping
position, and economic status of the mother. Currently, PRAMS
is operating in 31 states and New York City, all states collect
data from AI/AN residents and some states oversample AI/AN
populations, including Alaska, Nebraska, and Washington. |
|
Study of
Sudden Infant Death Syndrome (SIDS) |
|
Among the IHS Areas, the highest infant
mortality rate has consistently been found in the Aberdeen Area
(20 per 1,000), with a SIDS rate 4-5 times higher than the
national average. The goal of this study is to reduce infant
mortality in the Aberdeen Area by improving knowledge about the
causes of deaths among infants. Enrollment of cases was
completed in December 1996, and recruitment of controls, all
data collection, entry, and editing, and preliminary analysis
were completed late in 1997. High rates of SIDS were found
among AI/AN in the IHS Aberdeen Area. The results of the study
were presented to the tribes. A report of study results was
prepared for the Aberdeen Area Tribal Chairmen’s Health Board
and published for dissemination to the community and health
staff in June 1998. Analyses were presented at the IHS Research
Conference and American Public Health Association Annual
Conference. The study was published in the Journal of the
American Medical Association in December of 2002. In addition,
collaborative work on serotonergic brainstem abnormalities in
Northern Plains Indians with the Sudden Infant Death Syndrome
has been accepted for publication in the Journal of
Neuropathology and Experimental Neurology. |
|
Ponca Tribe of
Oklahoma Survey |
|
DRH provided assistance to the Ponca Tribe
(Ponca City, OK) for the design and implementation of a health
assessment survey of tribal members living in the Ponca City
area. Fieldwork was completed in November 2002. Preliminary
results were presented at a series of tribal dissemination
meetings in July 2003. An electronic presentation was prepared
by CDC and given to tribal officials and regional Indian Health
Service staff for their use. |
|
Tohono O'odam
Reservation (AZ) Health Status Assessment |
|
DRH also worked with the Tohono O’odham tribe,
IHS, and the Inter-tribal Council of Arizona to develop and
implement strategies for assessing health status and the
prevalence of behavioral risk factors of tribal members living
on the reservation. The first phase of the project was to
conduct a health assessment survey of tribal members living in
the four western districts of the reservation. This was
successfully concluded and tribal health officials presented the
data in early 2002. Phase II of the project, a survey using the
same questionnaire in the remaining districts of the
reservation, has been completed. Survey results have been used
to plan prevention and treatments services to address the
tribe’s health priorities [diabetes, alcohol use, injuries and
violence]. Data have also been used to compare the health
indicators between tribal members living in Mexico and the U.S.
Finally, these data have played a role in the planning of a new
clinic to serve residents on the reservation’s West End.
Results were reported at several meetings (including national
meetings) in November 2002. |
|
|
NCCDPHP, Office on Smoking
and Health (OSH) |
|
Adult Tobacco
Survey |
|
OSH funded six Tribal Support Centers (TSCs) to
conduct a pilot study of the Adult Tobacco Survey (ATS). This
survey is known as the Tribal ATS. Part of the pilot study
includes modifying the existing ATS to be culturally appropriate
for AI/AN. The goal is to assist tribes in identify community
specific tobacco behaviors and develop culturally appropriate
and effective tobacco control measures. The TSCs expect to
implement the Tribal ATS in Fall 2003. The Tribal ATS will be
accompanied by training on survey implementation with ongoing
technical assistance to the tribes on methodology and sampling.
To conduct this study, CDC is collaborating with various tribal
governments and the National Center for Health Statistics. |
|
|
National Center for Health
Statistics (NCHS) |
|
The Questionnaire Development and Research
Laboratory at the National Center for
Health Statistics is conducting Cognitive Testing of
Survey questions that cover various measures important to
public health research and health
disparities. The measures include health status, health
conditions, health behaviors, and socioeconomic status. The
purpose is to use the testing to inform changes in the way
questions are written and asked in personal interview surveys,
e.g., the National Health Interview Survey, in order to reduce
measurement bias. This improves public health surveillance and
allows research and programs to be targeted more effectively to
needy communities. This effort includes participants from
tribes in California, Michigan, Oklahoma, and South Dakota.
Staff members conducted an important study that demonstrated
that disability is a major problem for adults in the AI/AN
population, including those who live in metropolitan areas.
Regardless of the measure of disability used, comparisons
between AI/AN and other racial/ethnic groups show that AI/AN
have higher proportions of functional limitations, sensory
limitation, ADL or IADL difficulties or limitations in major
activities.). Almost one-third (32 percent) of the total AI/AN
adult population report some type of limitation. The prevalence
of physical limitations within the AI/AN population is not
skewed to the elderly population alone, but is substantially
greater than for other racial/ethnic groups among persons aged
18 to 44. |
|
|
NCHSTP, Office of the
Director |
|
Map to LOINC
Project |
|
Standardization of laboratory test names is an
essential step for health information to be aggregated across
clinical facilities or communicated with other information
systems (e.g., for public health surveillance and agency
performance evaluation purposes). Through its interagency
agreement with IHS, the Office of the Director, NCHSTP, provided
ongoing technical assistance in FY 2003 to map clinical
laboratory tests to standardized Logical Observation Identifier
Names and Codes (LOINC). The purpose of this project is to
enhance data exchange capability. |
|
|
NCHSTP, Division of
HIV/AIDS Prevention (DHAP) |
|
Evaluation of
Racial Misidentification in HIV/AIDS Surveillance Databases |
|
In FY 2003, NCHSTP/OD and DHAP continued
analysis of data from projects to evaluate racial
misidentification of AI/AN persons in HIV/AIDS surveillance
databases in 5 states and 1 county (Alaska, Arizona, California,
Oklahoma, Washington, and Los Angeles). These areas represent
states and the urban area with the highest concentration of
AI/AN AIDS cases. The project will also investigate factors
associated with racial misidentification of HIV/AIDS cases among
AI/AN and make recommendations to prevent future undercounting
of AI/AN HIV/AIDS cases. |
|
HIV Testing
Surveys |
|
Beginning in fiscal year 2001, NCHSTP/DHAP
funded the Northwest Portland Area Indian Health Board to
conduct the HIV Testing Survey, which involves anonymous
interviews with AI/AN persons at high risk of acquiring HIV
infection. The purpose of the survey is to assess the reasons
and barriers that influence persons to seek or avoid HIV
testing, knowledge of state policies for HIV surveillance, HIV
testing patterns, behavioral risk factors, and exposure to
prevention efforts. These data are used to evaluate the
representativeness of HIV surveillance data and for local HIV
prevention and community planning. An initial survey targeted
AI/AN residents in an urban area. In FY 2003, the survey was
conducted on two Indian reservations in Oregon and Washington. |
|
|
NCHSTP, Division of STD
Prevention (DSTDP) |
|
Addressing
Racial Misidentification in STD Surveillance Data |
|
To measure racial misidentification occurring in
one State, NCHSTP/DSTDP supported a study of five years’ worth
of data from two major health information databases in Oregon.
Researchers compared almost 40,000 records from the State’s STD
files with about 147,000 records from the Northwest Tribal
Registry. Comparison of the two databases showed significant
misclassification of AI/AN records. Results are being shared
with the Northwest tribal health care programs so that they are
aware of the burden of disease in their communities. In
addition, findings are being shared with managers of the State
program and the tribal communities so that they can take steps
to improve patient classification. |
|
|
NCID, Arctic
Investigations Program (AIP) |
|
Increased rates of drug resistance have been
reported by AN hospitals and detected through ongoing CDC
surveillance. The germs of greatest concern and the diseases
that they cause are: Streptococcus pneumoniae (also
known as the pneumococcus), the leading cause of ear infections,
pneumonia, and bacterial meningitis, and methicillin-resistant
Staphylococcus aureus (MRSA). Since January 2001, AIP
surveillance has documented that rates of pneumococcal
bloodstream infections and meningitis among AN children aged
less than 2 years have declined by 90%. This has been
accompanied by declines in drug-resistant infections. MRSA
infections have been troublesome in hospitals for decades. Since
2000, the number of MRSA infection apparently acquired in the
community has increased dramatically in rural Alaska Native
villages. Investigations conducted collaboratively by AIP and
the Yukon-Kuskokwim health Corporation (YKHC, a Native health
corporation in southwestern Alaska) identified previous uses of
antibiotics and use of crowded traditional saunas. AIP and UKHC
staff members have developed clinical management guidelines for
skin and soft tissue infections to decrease unnecessary use of
antibiotics. Future measures should include methods to decrease
transmission within saunas and households. Helicobacter
pylori causes ulcers and may contribute to development of
stomach cancer. Rates of stomach cancer are three-fold higher
among Alaska Natives compared with rates for the entire U.S.
population. Helicobacter may also cause chronic bleeding
from the stomach and contribute to the high rates of anemia in
Alaska Natives. Nearly one-quarter of isolates from Alaska
Natives which are tested at CDC are resistant to two of the
antibiotics commonly used to treat this infection (clarithromycin
and metronidazole). Data from Alaska Native Medical Center and
CDC show that those people who have taken antibiotics, even up
to 5 years before diagnosis of Helicobacter infection,
are more likely to be infected with drug-resistant strains.
This is the first evidence that antibiotic use may influence
outcome of infections diagnosed years later and the findings for
studies of Helicobacter in Alaska are being incorporated
into treatment guidelines for clinicians at tribally operated
health centers.
The effectiveness of hepatitis B vaccination in decreasing
transmission of hepatitis B virus in rural Alaska is one of the
great public health stories of the 20th century. Prior to
availability of vaccine in the early 1980s, nearly 10 percent of
the Native population in some areas had chronic infection with
hepatitis B virus. These persons are at increased risk for
cirrhosis and cancer of the liver, and are also capable of
transmitting infection to others. Beginning in 1983, a program
to eliminate new hepatitis B infections was launched—53,000
Alaska Natives were tested and those who were not infected or
were not immune were vaccinated against hepatitis B. Since that
time, Alaska Native infants have been routinely vaccinated. As
a result, new infections with hepatitis B virus were virtually
eliminated during the 1990s. However, the duration of full
protection provided by the vaccine and the possible need for a
booster dose of vaccine to maintain protection are unknown.
Therefore, AIP, CDC/NCID’s Division of Viral Hepatitis, the
Alaska Native Tribal Health Consortium, and regional Native
health corporation have undertaken a 20-year follow-up of
persons vaccinated through this program to determine whether
booster doses of vaccine are needed to protect the public health
gains that have been achieved. |
|
|
NCID, Division of
Vector-Borne Infectious Diseases (DVBID) |
|
In addition to training and epidemiologic
responses, DVBID has an active research program involving
collaborations between IHS, NASA, USGS and state health
departments in the region. This research is designed to
identify conditions associated with increased human plague risk
on AI/AN lands and surrounding areas in the Southwest. Among
the research completed to date is a mathematical modeling study
that clearly indicates a close link between climatic variations
and the frequency of human plague in the Four Corners region.
Additional GIS-remote sensing studies on AI/AN lands and other
sites in the Southwest have shown that exposure sites for human
plague cases are closely correlated with the presence of certain
habitat types. Our collaborative studies are significant because
they provide data that can be used to design improved plague
surveillance programs and make more efficient use of limited
prevention resources. |
|
|
NIOSH |
|
Western Center
for Agricultural Safety and Health |
|
California Davis campus has been conducting an
inter-tribal project since FY 2002. The Center investigators
collaborated with the Inter-Tribal Council of Arizona to conduct
three 8-hour workshops on recognizing and managing pesticide
illnesses and injuries. Workshops were held in Yuma and
Phoenix, AZ. They were designed for community members and
health care providers from 15 western tribes. These workshops
provided key clinical personnel and others with information,
resources, and training skills to assist them in training others
in the recognition, diagnosis and management of
pesticide-related illnesses and injuries. The workshops also
provided participants with information about the legal
requirements for reporting suspected and actual
pesticide-related injuries. Seventy-eight community members
participated in the workshops. |
|
Health Survey
of Minority and Female Farm Operators |
|
Since 1997, the U.S. Department of Agriculture's
National Agricultural Statistics Service (USDA/NASS) has
conducted the Census of Agriculture. This Congressionally
mandated survey includes self-reported racial and ethnic
demographics of farm operators. The existence of this database
made it possible for CDC/NIOSH and USDA to collaborate on a
population-based occupational health survey of minority and
female farm operators. The study population ranged from 18–95
years of age with a median of 54 years. They had a median of 13
years of education, and 30 years in farm work. Statistically
significant differences in prevalence of health conditions
between AI/AN farm operators and white farm operators include: |
|
|
AI/AN farm operators had a higher prevalence of
(a) respiratory problems (male 15.5%, female 17.1%, compared to
white male 13.7%, and white female operators 14.7%); (b)
hypertension (male 33.0%, female 33.8% compared to white male
27.6%, and white female operators 29.3%); and (c) diabetes (male
12.2%, female 9.7% compared to white male 7.5%, and white female
operators 7.2%). |
|
|
AI/AN men also had a higher
prevalence of musculoskeletal problems (60.4% compared to white
male operators, 56.3%) |
|
These results were presented at the
2002 American Public Health Association (APHA) Annual Meeting in
Philadelphia. Two abstracts were accepted for presentation at
the APHA 2003 Annual Meeting: "Mental health symptoms in a
population-based survey of minority farm operators" and
"Occupational hearing loss in a population based survey of US
minority farm operators." Analyses of the survey are being
prepared for publication in FY04. |
|
Markers of
Brain Tissue Injury and Alzheimer's Disease and Parkinson's
Disease |
|
This occupational exposure research is being
conducted with NIH, VA, the Hawaii Department of Health, and the
Pacific Health Research Institute. In an autopsy sub-study of a
cohort of Japanese-American men (which has both occupational and
environmental data), the research aimed to use biomarkers of
neurotoxin damage to provide clues into the potential role that
certain chemicals may play in contributing to these diseases.
This collaboration will provide valuable risk assessment
information and early disease intervention measures for Native
Hawaiians and the general population. In 2002, a publication
was released that documented indicators of brain damage in
patients with Alzheimer’s disease and Parkinson’s disease. |
|
Southwest
Center for Agricultural Safety and Health |
|
NIOSH is currently funding an intervention
effectiveness project at the Southwest Center for Agricultural
Safety and Health, through the University of New Mexico Health
Sciences Center that addresses the needs of the Navajo Nation.
The goal of this intervention “Navajo Nation Evaluation” is to
engage community stakeholders in the planning, implementation,
and assessment of a culturally appropriate model program to
reduce and prevent agricultural-related injuries in the Navajo
Nation. The intervention effectiveness evaluation addresses
three specific aims: (1) Convene a stakeholder group to
understand the contributing factors to agricultural-related
injuries on the Navajo Nation and describe the theoretical
foundations of a science-based intervention to influence those
factors. (2) Support the development and implementation of a
science-based, culturally-appropriate model program to reduce
and prevent injury among Navajo agricultural workers and their
families. (3) Evaluate the implementation and the outcomes of
this model program to reduce and prevent injury among Navajo
agricultural workers and their families. The major activities of
the project have been: 1) strengthening collaborative linkages
between community stakeholders of the Navajo Nation and
evaluators from the University of New Mexico; 2) finalizing and
pilot testing of the baseline survey instrument; 3) training of
surveyors to implement the baseline survey; 4) developing the
survey sampling strategy; and 5) overseeing implementation of
220 baseline surveys in December of 2002. The work to date is
providing needed insight into the practicalities of carrying out
survey research on agricultural injury, as well as other topics
in largely rural and ethnically diverse settings. The results
of this research will prove pivotal to the design of
culturally-relevant public health programs aimed at reducing the
adverse impacts of agricultural injury. The project is funded
through FY05. |
|
|
Epidemiology Program
Office (EPO) |
|
Morbidity and
Mortality Weekly Report (MMWR) |
|
The MMWR is published weekly by the
Office of Scientific and Health Communications, Epidemiology
Program Office. In addition to the weekly publication, serial
publications (MMWR Recommendations and Reports and
Surveillance Summaries), occur at irregular intervals - a
frequency of about two a month. The articles summarized below
appeared in the August 1, 2003, issue that was dedicated to
health disparities experienced by American Indians/Alaska
Natives. The citation for all these articles is as follows:
Centers for Disease Control and Prevention. [Article title].MMWR
2003; 52: [inclusive page numbers]. Copies can be found at
http://www.cdc.gov/mmwr. CDC
staff from several CDC Centers and Offices collaborated with
tribal public health professionals, IHS colleagues, and state
health departments to produce these reports. |
|
|
Surveillance for Health
Behaviors of American Indians and Alaska Natives: Findings from
the Behavioral Risk Factor Surveillance System, 1997-2000 |
|
|
In the United States, disparities in risks for
chronic diseases (e.g., diabetes, cardiovascular disease, and
cancer) and human immunodeficiency virus (HIV) and acquired
immunodeficiency syndrome (AIDS) are evident among AI/AN and
other groups. This report summarizes findings from the
1997-2000 Behavioral Risk Factor Surveillance System for
health-status indicators, health-risk behaviors, and HIV testing
and perceived risk for HIV infection among AI/ANs, compared with
other racial/ethnic groups in five regions of the United States. |
|
|
Health Disparities
Experienced by American Indians and Alaska Natives |
|
|
AI/AN are a heterogeneous population with
approximately 560 federally recognized tribes residing in the
rural and urban areas of 35 states. Of all racial/ethnic
populations, AI/ANs have the highest poverty rates (26%)—a rate
that is twice the national rate. This issue of MMWR describes
disparities in health for certain preventable conditions. |
|
|
Injury Mortality Among
American Indian and Alaska Native Children and Youth, U.S.,
1989-1998 |
|
|
This CDC study found that injuries and violence
account for 75 percent of all deaths among children and youth
from one to 19 years old in this population. The risk of
injury-related death is about twice that of all children and
youth in the country and the risk for AI/AN varies from one
region of the country to another. CDC researchers found that
more than 3,300 AI/AN children and youth living on or near
reservations died as a result of injuries or violence between
1989 and 1998. While injury death rates declined for motor
vehicle crashes (18 percent), drowning (34 percent), fire (49
percent), and pedestrian incidents (56 percent); rates increased
for firearm-related deaths (13 percent) and homicide (20
percent). Because each AI/AN community is unique, CDC
researchers recommend that addressing local practices and
cultures can help future prevention measures to narrow the
injury disparity gap with other children in America. |
|
|
Diabetes Prevalence Among
American Indians and Alaska Natives and the Overall Population -
U.S., 1994-2002 |
|
|
Diabetes affects AI/AN disproportionately
compared with other racial/ethnic populations and has been
increasing in prevalence in AI/AN populations during the past 16
years. To examine trends in diabetes prevalence among AI/ANs
and the overall U. S. population and to describe disparities
among these two populations, CDC analyzed data from the Indian
Health Service and the Behavioral Risk Factor Surveillance
System. This report summarizes the results of that analysis. |
|
|
Cancer Mortality Among
American Indians and Alaska Natives, U.S., 1994-1998 |
|
|
In the United States, public health
interventions to control infectious diseases, lower infant and
maternal mortality, and improve basic sanitation have led to a
substantial increase in life expectancy for American Indians and
Alaska Natives. To understand cancer mortality among AI/ANs
subsequent to 1989-1993, the Indian Health Service and CDC
analyzed death certificate data provided by CDC’s National
Health Statistics for deaths among AI/ANs in five U. S.
geographic regions during 1994–1998. This report summarizes the
results of that analysis. |
|
|
Bronchiolitis-Associated
Outpatient Visits and Hospitalizations Among American Indians
and Alaska Native Children, U.S., 1990-2000 |
|
|
Rates of bronchiolitis-associated
hospitalization for AI/AN children are approximately twice that
for the general population of U. S. children. This report
describes the first estimate of rates of outpatient
bronchiolitis-associated visits and updates rates of
bronchiolitis-associated hospitalizations in these populations. |
|
|
Vaccination Coverage Levels
Among Alaska Native Children Aged 19-35 months, National
Immunization Survey, U.S., 2000-2001 |
|
|
This report indicates that Alaska Native (AN)
children aged 19–35 months have a high level of vaccination
coverage that exceeds the national goal for 2010 of 90% for all
vaccines except Varicella and the fourth dose of DTP. This
achievement, despite the presence of barriers to vaccination,
demonstrates the commitment of AN communities, tribal
corporations, and state public health departments to address
health concerns and exemplifies the effectiveness of using
multiple strategies (e.g., reducing financial and access
barriers, making vaccination a priority, using collaborative
efforts, tracking and recall, assessment, and registries). |
|
Changes in Health
Disparities in New Mexico |
|
Rebecca Drewette-Card, a Public Health
Prevention Service Fellow in the Epidemiology Program Office
(Class 2000) worked with the New Mexico Department of Health to
address health disparities. Ms. Drewette-Card utilized data
from the New Mexico Office of Vital Records and Health
Statistics, Behavioral Risk Factor Surveillance System (BRFSS),
National Electronic Telecommunication System for Surveillance (NETSS),
Pregnancy Risk Assessment Monitoring System, (PRAMS) and Youth
Risk and Resiliency Survey (YRRS) to analyze disparities by
race/ethnicity and sex around 25 key health indicators.
Additionally, some indicators were analyzed by income and
education level. A disparity change score was used to examine
disparities over time. Results identified significant
differences in rates between White Non-Hispanics, White
Hispanics and AI/AN. AI/AN have the poorest health status and
White Non-Hispanics have the best health status of New Mexico
racial/ethnic groups. This surveillance research allowed the
Health Department to identify health disparities affecting AI/AN
in NM. In NM AI/AN are experiencing the worst rates of health
disparities. Currently, the NM DOH is working with the State
Secretary of Health to prioritize disparities and develop
systematic mechanism for targeting resources to eliminate
disparities. |
|
Racial
Misclassification Project in New Mexico |
|
Chad Smelser, an Epidemic Intelligence Officer
with the Epidemiology Program Office (Class 2002) worked on an
AI/AN - related racial misclassification project. This project
quantifies the extent of racial misclassification of AI/AN in
New Mexico state mortality records. Data from the New Mexico
vital records database are matched against the Indian Health
Service patient registry. Once the extent of racial
misclassification is quantified, state mortality data can be
better interpreted to accurately identify the leading causes of
death among AI/AN in New Mexico. |
|
Non-traffic
Injuries and Alcohol in New Mexico Native Americans |
|
Dr. Smelser (EIS/EPO) also undertook a project
analyzing fatal non-traffic injuries involving alcohol in the
American Indians in New Mexico. Unintentional injuries are the
third leading cause of death in New Mexico, accounting for 7.1%
of all deaths compared to 3.9% of all U.S. deaths. The extent
to which these fatal non-traffic injuries involve alcohol is
unknown. The project will determine the rate of fatal
non-traffic injuries involving alcohol, compare the rate to the
overall U.S. rate, and analyze case characteristics to identify
high-risk groups. The results of this project will aid in
targeting prevention efforts to high-risk populations in the
state. |
|
|
PHPPO |
|
The PHPPO Academic Programs Office creates and
sustains linkages between all CDC units and the academic
communities of public health and preventative medicine,
including the American Indian Health Education Consortium (AIHEC).
A major focus is on mobilizing CDC-academia partnerships to
address high priority prevention research needs. The Academic
Programs Office also sponsors the annual "Partnering" conference
and other forums for the exchange of ideas and research findings
between public health practitioners and academic researchers,
makes experimental opportunities available at CDC for young
professionals, and provides strategic consultation to academic
partner. |
|
8. |
OTHER |
Included in this section are examples of other
CDC AI/AN-focused activities that are not covered in the seven
categories above. Many of these activities fall under the
broader categories of training, technical assistance, direct
assistance, and workforce development. |
|
|
NCCDPHP, Division of Adult
and Community Health (DACH) |
|
Cardiovascular
Disease Prevention |
|
NCCDPH continues to provide technical assistance
in the implementation and evaluation of cardiovascular disease
risk factor prevention and intervention programs to tribal
communities. CDC continues to publish and disseminate lessons
learned from the Inter Tribal Heart Project and to explore,
develop, and implement surveillance and intervention strategies
useful for tribal communities. In addition, activities include a
focus on mapping the geographic disparities in heart disease and
stroke mortality among American Indians and Alaska Natives. |
|
|
NCCDPHP, Division of
Adolescent and School Health (DASH) |
|
School-based
HIV Prevention |
|
The Division of Adolescent and School Health,
through a memorandum of agreement with the Bureau of Indian
Affairs (BIA), supports training for BIA elementary school
teachers to deliver an AI/AN-specific curriculum called the
Circle of Life designed to provide young people with skills and
information to avoid behaviors that put them at risk for HIV
infection. The curriculum was developed through collaboration
between the BIA, IHS, and CDC. In addition, ten states received
supplemental funds to address HIV prevention among American
Indian and Native American youth: California, Michigan,
Minnesota, Montana, New Mexico, North Carolina, North Dakota,
Oregon, Washington, and Wisconsin. CDC is assisting the BIA in
evaluating Circle of Life, a culture-based HIV/AIDS prevention
curriculum for AI/AN children in grades K-6. This curriculum
was developed by ORBIS Associates in the mid-1990s, under a
contract with the IHS. The curriculum was developed because
there was very little HIV prevention material available that was
culturally-based, and appropriate for AI/AN youth. Circle of
Life was designed and developed based on extensive formative
research that included key informant interviews, focus group
interviews, and pilot testing. Members of the Native community,
health educators, practitioners, and teachers played an
instrumental role throughout the development process. |
|
|
NCCDPHP, Division of
Cancer Prevention and Control (DCPC) |
|
Comprehensive
Cancer Control |
|
In FY 2003, NCCDPHP continued the field
assignment of a chronic disease medical epidemiologist to the
IHS National Epidemiology Program in Albuquerque, NM to support
IHS and tribal epidemiologic capacity for comprehensive cancer
control. In addition to technical support and training, this
physician-epidemiologist leads the cancer registry and racial
misclassification efforts noted elsewhere in this document. |
|
|
NCCDPHP, Division of
Diabetes Translation (DDT) |
|
Diabetes Prevention |
|
CDC staff from DDT provide technical assistance
to the Indian Health Service (IHS) Diabetes Program on
surveillance of diabetes and diabetes–related complications
among AI/AN. CDC works closely with IHS, documenting the large
and disproportionate burden of diabetes in this population and
the increasing trend in diabetes prevalence, particularly among
young AI/AN. For example, CDC used data from the United States
Renal Data System (USRDS) to document trends in incidence of
treatment for diabetes-related end-stage renal disease. Results
of CDC’s work have been 1) used to report to Congress on the
burden of diabetes among AI/AN, 2) used to allocate IHS diabetes
grant funds, 3) disseminated to the IHS coordinators of diabetes
prevention and control efforts, 4) posted on the website of the
IHS Diabetes Program, and 5) included in the CDC National
Diabetes Fact Sheet. |
|
|
NCCDPHP, Division of
Reproductive Health (DRH) |
|
Reproductive
Health |
|
In FY 2003, an epidemiologist from the CDC PRAMS
team provided training on PRAMS at Shiprock, NM. Several tribes
from the Four Corners region were invited. The training was
attended by members of the Navajo tribal administration and the
medical center. Individual training on analyzing PRAMS data was
provided for two epidemiologists. |
|
|
NCCDPHP, Office on Smoking
and Health (OSH) |
|
Tobacco
Control |
|
OSH sponsored a training session
for the Tribal Support Centers June 6-8, 2003, in Chicago, IL.
This was a joint training for the CDC funded National Networks
which includes the Native American National Network out of the
Northwest Portland Area Indian Health Board. Also, provided
ongoing technical assistance to the TSCs. They received funding
to attend the annual Program Manger’s Meeting as well as an
AI/AN specific training held June 4-6,
2003, Chicago, IL. The TSCs are encouraged to attend regular
CDC sponsored trainings such as the Tobacco Leadership
Institute, formerly known as TUPTI, held in July 2003, and the
National Conference on Tobacco or Health (NCTH) held in Boston,
MA, December 2003. Finally, OSH co-sponsored the annual Native
American Tobacco Use Prevention Conference, Nashville, TN,
August 2003. |
|
|
NCHSTP, Office of the
Director (OD) |
|
In-Kind
Support |
|
In fiscal year (FY) 2003,
NCHSTP/OD maintained an intra-agency agreement with the Indian
Health Service. This agreement details arrangements for
technical assistance and consultation services to be provided to
IHS by NCHSTP staff in the Office of Health Disparities and the
Prevention Informatics Office. Under this agreement, NCHSTP
staff managed a project to evaluate racial misidentification of
AI/AN in state/county HIV/AIDS surveillance databases;
conducted an analysis of surveillance systems for monitoring
HIV/AIDS, sexually transmitted diseases (STDs), tuberculosis
(TB) and viral hepatitis among AI/AN people; provided
consultation on the development of an HIV Case Management System
for use by IHS clinicians, and provided technical support for
standardization of laboratory data to the accepted standard,
Logical Observation Identifier Names and Codes (LOINC), and for
data validation and evaluation of “ID Web,” a web-based system
to improve the quality of STD-related care. These activities are
ongoing.
Since 2000, NCHSTP has supported
a full-time Senior Epidemiologist in the Office of Health
Disparities, who serves as liaison for AI/AN activities. NCHSTP
has also partially supported the salary of a Senior CDC-Tribal
Liaison for Science and Public Health, assigned from the CDC
Office of Minority Health to the IHS National Epidemiology
Program. In FY 2003, NCHSTP established a contractual
arrangement with an AI/AN consultant to assist in identifying
ways to improve AI/AN government's and organization's access to
NCHSTP programs, and to better coordinate NCHSTP's public health
activities and leverage resources to address AI/AN health
disparities. |
|
Regional
Capacity Building Coordinators |
|
In FY 2003, NCHSTP/DHAP and DSTDP funded
capacity-building efforts in two IHS Administrative Areas,
Navajo and Aberdeen. Arrangements have been made through
existing contractual mechanisms and specific memoranda of
agreement to place STD/HIV capacity building coordinators with
tribal organizations (a Tribal Health Department and an Indian
Health Board) serving these two Areas. The purpose of these
arrangements is to leverage available resources for STD/HIV
control through better coordination and outreach (linking
agencies with resources with populations in need of services).
The National Native American AIDS Prevention Center also
receives support through a memorandum of agreement with the
National Minority AIDS Council (funded by NCHSTP/DHAP) to
provide technical assistance in infrastructure development to
organizations working with AI/AN populations. |
|
Fellowship and
Internship Programs |
|
NCHSTP supported five American Indians in
fellowship or trainee programs in FY 2003. One was a physician
who completed a Preventive Medicine residency. Two participated
in CDC fellowship programs, and three participated in the
American Indian Science and Engineering Society internship
program. The trainees worked with doctoral-level scientists at
CDC to gain experience using public health methodologies and
tools to describe and address health disparities, particularly
disparities related to HIV/AIDS, STDs, and TB among AI/AN
populations. |
|
Conference on
Academic Needs |
|
NCHSTP contributed funding for, and is
participating in the development of, the conference,
“Identifying the Academic Needs of American Indian, Alaska
Native, and Native Hawaiian (AI/AN/NH) students to Pursue
Careers in Public Health.” The purpose of this conference is to
devise a plan that identifies and addresses the academic needs
of AI/AN and Native Hawaiian (NH) students to pursue careers in
Public Health. The specific objectives of this conference are
to increase the number of AI/AN/NH public health professionals
employed at CDC; to increase the number of AI/AN/NH students
participating in CDC/ATSDR trainings, internships, and
fellowships; and to increase the number of AI/AN/NH public
health professionals. |
|
Development of
a Tribal College Public Health Program |
|
In FY 2003, NCHSTP continued support for the
development of a public health program at Dine’ Community
College, in collaboration with the Arizona College of Public
Health. Dine’ College is the first tribal college and is known
as the “higher education institution of the Navajo.” Dine’
College enrolls approximately 2,000 students. The development of
the Dine’ College-Arizona College of Public Health Joint
Certificate and Degree Programs includes continuing
education/certificate courses, a 1-year Public Health Sciences
Certificate, and an Associate of Science Public Health Program.
The continuing education/certificate courses and the 1-year
Public Health Sciences Certificate are training programs for
Community Health Representatives, who are a vital link in the
American Indian health care system. The Public Health Program is
designed to provide a culturally supportive atmosphere for
training in a multicultural approach to public health. |
|
|
NCHSTP, Division of STD
Prevention (DSTDP) |
|
Intra-agency
Agreement with the Indian Health Service |
|
In FY 2003, NCHSTP/DSTDP supported an
intra-agency agreement with the IHS. This agreement provides
staff to the IHS Epidemiology Program, and technical assistance
to IHS tribal and urban health facilities. Activities included:
site visits to enhance partnerships among agencies that provide
STD services to AI/AN persons; fiscal and staff support for the
“Stop Chlamydia!” program; management of ID Web, a web-based STD
quality-of-care improvement and training project in 5
facilities; and a training needs assessment for public health
workers. These projects, and the Comprehensive STD Prevention
Systems Grant Program, are discussed further in the sections
below. |
|
STD Prevention
Training for Public Health Workers |
|
Under an intra-agency agreement with the IHS,
NCHSTP/DSTDP-Funded Prevention Training Centers conducted an
assessment of training needs of health care providers that
resulted in the provision of six STD training sessions at IHS
facilities. The Prevention Training Centers also developed
customized training for Disease Intervention Specialists for
Navajo Nation Social Hygiene Program Personnel and Public Health
Nurses working at an Indian Reservation in Montana. |
|
|
NCHSTP, Division of
Tuberculosis Elimination (DTBE) |
|
TB Control
Activities |
|
NCHSTP/DTBE funding supports activities
targeting AI/AN populations in cooperative agreements with
States, Cities and Territories to promote tuberculosis (TB)
elimination efforts. In 2003, DTBE provided on-site emergency
technical, programmatic, and financial assistance to
Seattle-King County Public Health/TB Control to investigate a TB
outbreak among homeless persons, half of whom were American
Indians or Alaska Natives. |
|
Building
Capacity for TB Control in Low Incidence States |
|
NCHSTP/DTBE is collaborating with IHS on TB
control initiatives in low incidence states, where most AI/AN
persons diagnosed with TB reside. The goal of this effort is to
identify models for regional capacity-building, which would
encompass Federal, State, and Tribal TB control programs. |
|
|
NCID, Division of
Vector-Borne Infectious Diseases (DVBID) |
|
DVBID frequently responds to requests from IHS
to provide diagnostic and on-site epidemiologic assistance
during plague case investigations on AI/AN lands in this
region. In recent years, DVBID has also provided training to
IHS staff on plague surveillance, control and diagnosis. This
training has been provided during plague case investigations, in
small on-site sessions involving just a few persons, and in
larger workshops presented to staff attending regional IHS
meetings. Recently, DVBID participated in the investigation of
a tick-borne relapsing fever outbreak that occurred on the
Navajo Reservation in New Mexico. During this outbreak DVBID
staff members traveled to the suspected exposure site to assess
ongoing risks and make prevention recommendations. Other DVBID
staff members provided valuable diagnostic support for the
investigation. |
|
|
NCID, Office of Minority
and Women's Health (OMWH) |
|
OMWH increased participation in outreach
activities targeting AI/AN students. Outreach activities
included recruitment events, and public health conferences for
the purpose of providing employment and public health
information to students, faculty, and the AI/AN community. In
addition to outreach activities, OMWH funded one American Indian
Science and Engineering Society (AISES) intern slot. We also
had one American Indian participate in the James A. Ferguson
Fellowship Program. |
|
|
NCIPC |
|
In Kind
Support |
|
In FY 2003, NCIPC maintained an
intra-agency agreement with the Indian Health Service (IHS).
This agreement details arrangements for an IHS Epidemiologist to
be assigned to the Division of Unintentional Injury Prevention.
The Epidemiologist provides technical assistance and
consultation services to IHS, and Tribal organizations working
in injury prevention and control. Under this agreement, the
assignee participated in a project to understand risk and
protective factors for self-directed violence and weapon
carrying among urban American Indian youth, and on projects to
distribute smoke alarms for prevention of fire-related injuries
among high risk communities, including residences on Indian
reservations.
The assignee collaborated with
the IHS on an Atlas of Injuries Among Native American Children
which focused on the eight leading causes of injury; assisted
the United Tribes Technical College’s Associate Degree program
in Injury Prevention for Native American students; and helped
revise and teach the week-long Introduction to Injury Prevention
training course used to educate IHS and Tribal staff about
community-based injury prevention. This course, conducted since
1985, has trained hundreds of IHS and tribal staff members in
basic injury prevention practice. These activities are ongoing
(see also the article on injury mortality cited in section #7
above). |
|
|
NIOSH |
|
During FY 2003, NIOSH committed to providing
program and financial support to the first conference on
increasing American Indian/Alaska Native/Native Hawaiian
(AI/AN/NH) careers in Public Health: “Identifying the Academic
Needs of AI/AN/NH students to Pursue Careers in Public Health.”
The conference will be held in Atlanta, Georgia during the
summer of 2004. The specific objectives of this conference are
to increase the number of AI/AN/NH public health professionals
employed at CDC; increase the number of AI/AN/NHs participating
in CDC/ATSDR training/ internship/fellowship programs; and
increase the number of AI/AN/NH public health professionals. |
|
|
EPO |
|
Epi Info
Training for the Indian Health Service - (White River, AZ) |
|
The Division of Public Health Surveillance and
Informatics (DPHSI), Epidemiology Program Office (EPO) is
working on the details for a collaborative effort with Indian
Health Service to conduct an Epi Info, software for public
health, training workshop in White River, Arizona. The training
session will occur in late winter and will take place over two
days. The Epi Info training will train American Indian health
professionals in the use of the software including how to
develop surveillance on health problems or issues and perform
analysis on the data generated. The “Train-the-Trainer” format
will generate opportunities for those trained at this workshop
to go out and train additional public health professionals to
benefit from the use of Epi Info. |
|
|
OD, OTPER |
|
OTPER staff is assisting the CDC/NCEH/Public
Health Emergency Preparedness Branch Working Group in developing
an emergency response guide for state, local and tribal public
health officials. This guide will be an easy-to-use-all-hazards
public emergency response guide that tribal public health
officials who are responsible for initiating the public health
response during an emergency or disaster so that they may have
immediate access to information and guidance for rapidly
establishing priorities and undertaking necessary actions to
prevent injury, save lives, and mitigate adverse health effects.
It will also contain tribal incident-specific public health
response recommendations and guidelines that are applicable to
specific types of emergencies or disasters (e.g., power outages,
earthquakes, hurricanes, tornados, floods, terrorism,
chemical/hazardous substances releases, etc.) A two day
consultancy forum will be held in Louisville, KY in January 2004
in which several tribal representatives who have been identified
will participate to have an opportunity to offer comments,
suggestions, and information for potential inclusion in the
Guide. A draft version of the Guide will be completed and ready
for distribution for Tribal review and comment by 04/04. In FY
03 OTPER staff has been assisting in the development of a
conference, to be held in 2004, titled “Identifying the Academic
Needs of American Indian, Alaska Native, and Native Hawaiian
(AI/AN/NH) students to Pursue Careers in Public Health.” The
purpose of this conference is to devise a plan that identifies
and addresses the academic needs of AI/AN and Native Hawaiian
(NH) students to pursue careers in Public Health. The specific
objectives of this conference are to increase the number of
AI/AN/NH public health professionals employed at CDC; to
increase the number of AI/AN/NH students participating in
CDC/ATSDR trainings, internships, and fellowships; and to
increase the number of AI/AN/NH public health professionals.
OTPER staff supports and is providing on-going consultation
to Tribes on the Cooperative Agreement 99051, including
conducting tribal site visits and conducting several National
presentations on AI/AN bioterrorism and emergency response
initiatives at annual State BT conferences.
OTPER staff provided support and assisted ATSDR and EPA in a
Pilot Emergency Response Survey. This is an assessment tool to
identify tribal preparedness capabilities for chemical,
biological, and radiological emergencies. OTPER assisted ATSDR
staff on a site visit to the Tohono O’Odham Nation in Arizona.
This site was one of several selected for the survey due to
proximity of air, rail and auto transportation routes,
industrial and commercial business on and near the nation, use
of military fly-overs (with occasional crashes), and border
issues which could lead to chemical and/or bio-terrorism
concerns.
OTPER staff is involved with NCEH staff in the development of
strategies to increase tribal participation in evidence-based
scenarios and table-top exercises for all-hazards preparedness.
OTPER staff assisted OD staff on Border funding/programmatic
issues with tribal governments. With funding and coordination
provided by the OASPHEP, CDC is building the capacity of public
health agencies representing border counties and tribes to
participate in intra-US and cross-border collaborative
activities. CDC was awarded $4 million to be allocated to 20
states that border Mexico and Canada. Each selected state is
being asked to submit a proposal that will include a brief
description of not only planned, but also current border-related
activities and the proposed allocation of funds for these
activities. |
|
Click Here to return to the
Table of Contents (TOC) |
PART III: |
BUDGET SUMMARY FOR RY 2002, 2003, AND 2004 REQUEST |
FY
2002 |
Program or Budget Activity |
Budget Amount |
Epidemiology Program Office |
$137,000 |
National
Center on Birth Defects and Developmental Disabilities |
$223,739 |
National
Center for Chronic Disease Prevention and Health
Promotion |
$21,379,286 |
National
Center for Environmental Health |
$573,000 |
National
Center for Health Statistics |
$0 |
National
Center for HIV, STD, and TB Prevention |
$5,840,930 |
National
Center for Infectious Diseases |
$2,944,000 |
National
Center for Injury Prevention and Control |
$212,114 |
National
Immunization Program |
$131,496 |
National
Institute for Occupational Safety and Health |
$1,152,126 |
Office
of the Director |
$0 |
Public
Health Practice Program Office |
$1,332,824 |
TOTAL |
$33,939,048 |
|
NOTE: Between FY 2002 and FY 2003, CDC
improved its ability to track funds serving AI/AN populations.
Changes in budget amounts noted between FY 2002 and FY 2003
reflect both actual changes in AI/AN program funds and improved
reporting. The figures reported for FY 2003 and FY 2004 reflect
direct grants to tribes and tribal organizations, grants to
states and academic institutions that primarily benefit AI/AN
populations, federal intra-agency agreements (primarily with IHS),
and intramural funds supporting CDC staff that work exclusively
or predominantly on AI/AN health. With the exceptions of the
budgets for the National Immunization Program and the National
Center for Health Statistics, the FY 03 and FY 04 tables do NOT
include indirect funding streams that may benefit AI/AN
populations. Examples of such indirect funds are
grants/cooperative agreements to state and local health
departments whose jurisdictions include AI/AN communities and
grants/cooperative agreements to academic and other institutions
whose funded activities may benefit AI/AN populations in some
way. Because indirect funds may have been included in past
tables, some programs (e.g., the National Institute for
Occupational Safety and Health) may appear to have decreased
resources, which is not necessarily the case. As CDC continues
efforts to improve its ability to more accurately track dollars
that benefit AI/AN populations, future tables will include these
indirect funding streams. |
|
FY
2003 |
Program or Budget Activity |
Budget Amount |
Epidemiology Program Office |
$333,462 |
National
Center on Birth Defects and Developmental Disabilities |
$475,000 |
National
Center for Chronic Disease Prevention and Health
Promotion |
$24,379,286 |
National
Center for Environmental Health |
$604,233 |
National
Center for Health Statistics1/ |
$1,201,461 |
National
Center for HIV, STD, and TB Prevention |
$3,053,551 |
National
Center for Infectious Diseases |
$3,366,645 |
National
Center for Injury Prevention and Control |
$120,000 |
National
Immunization Program |
$24,459,777 |
National
Institute for Occupational Safety and Health |
$92,000 |
Office
of the Director |
$646,061 |
Public
Health Practice Program Office |
$1,319,639 |
TOTAL |
$60,051,116 |
|
1/These funding levels are based on
reasonable estimates of the population served. |
|
FY
2004 REQUEST |
Program or Budget Activity |
Budget Amount |
Epidemiology Program Office |
$333,362 |
National
Center on Birth Defects and Developmental Disabilities |
$475,000 |
National
Center for Chronic Disease Prevention and Health
Promotion |
$24,379,286 |
National
Center for Environmental Health |
$604,233 |
National
Center for Health Statistics1/ |
$1,202,461 |
National
Center for HIV, STD, and TB Prevention |
$3,053,551 |
National
Center for Infectious Diseases |
$3,366,645 |
National
Center for Injury Prevention and Control |
$120,000 |
National
Immunization Program |
$24,459,777 |
National
Institute for Occupational Safety and Health |
$92,000 |
Office
of the Director |
$668,407 |
Public
Health Practice Program Office |
$1,319,639 |
TOTAL |
$60,073,462 |
|
1/These funding levels are based on
reasonable estimates of the population served. |
|
Click Here to return to the Table of Contents (TOC) |
PART IV: |
INTRADEPARTMENTAL COUNCIL ON NATIVE AMERICAN
AFFAIRS PRINCIPAL INITIATIVES: |
1.
|
INCREASE NATIVE AMERICAN ACCESS TO
EXISTING AND NEW HHS PROGRAMS |
Tribal governments and tribal organizations are
broadly eligible for many CDC grants and programs. Some
specific examples from the Centers for Disease Control and
Prevention’s (CDC) CIOs (Centers, Institute, and Offices) are
cited below: |
|
Office of the Director (OD) |
|
In June 2003, the Office of Terrorism
Preparedness and Emergency Response (OTPER) added a position in
the State and Local Preparedness Program (SLPP) that is serving
as the tribal liaison officer. OTPER recognizes the critical
role of AI/AN communities in the nation’s effort to be better
prepared for terrorism and other public health emergencies.
This individual’s duties include being responsible for the
oversight, review, and summarization of Bioterrorism (BT) and
Emergency Response tribal activities across the country, related
to CDC’s BT Cooperative Agreement 99051. Although no funds are
appropriated through CDC to directly fund tribal governments,
CDC strongly encourages each state BT office to provide on-going
funds to their respective tribes. In a continuing process, a
number of tribes have received contractual funds through their
state BT program for implementation of Tribal BT initiatives. |
|
|
National Center for Chronic Disease
Prevention and Health Promotion (NCCDPHP) |
|
Steps to a HealthierUS |
|
The Steps to a HealthierUS
Cooperative Agreement Program 2003 Request for Assistance (RFA)
included set-aside funding for a tribal consortia. Through this
funding mechanism, the Inter-tribal Council of Michigan was
funded to implement community-focused initiatives to reduce the
burden of asthma, diabetes, and obesity. |
|
Smoking and Health |
|
In FY 2000, CDC’s Office on Smoking
and Health released Program Announcement 00065 for tobacco
control and prevention capacity building with AI/AN tribes,
tribal organizations, and urban populations. A total of $1.6
million was distributed among seven projects. Grantees include
Aberdeen Area Tribal Chairmen’s Health Board, Alaska Native
Health Board, California Rural Indian Health Board, Intertribal
Council of Arizona, Muscogee Creek Nation, Intertribal Council
of Michigan and Northwest Portland Area Indian Health Board.
The grantees are beginning their fourth year of program
implementation (of five year program.) In addition to the
funding, CDC supports these programs with training, technical
assistance, and other needs. Supplements to support AI/AN
version of the Adult Tobacco Survey (ATS) Pilot Study awarded to
six of seven Support Centers. The ATS is a random survey of
adults’ tobacco use knowledge, attitudes, and behaviors. In FY
2003, over $3 million was made available to fund nine
organizations serving different population groups (Program
Announcement 00085) for the development of national tobacco
control networks. The Northwest Portland Area Indian Health
Board was funded to serve the AI/AN populations. |
|
Cancer Prevention and Control |
|
Eligibility requirements for the
National Breast and Cervical Cancer Early Detection Program (NBCCEDP)
and the National Comprehensive Cancer Control Program (NCCCP)
include all federally recognized Indian tribal governments and
tribal organizations, urban Indian organizations and
inter-tribal consortia whose primary purpose is to improve
American Indian/Alaska Native health and which represent the
Native population in their catchment area (Program Announcement
#02060). Every year, a competitive open season for application
to these programs is announced in the Federal Register
along with call-in information for technical assistance
conference calls to assist potential applicants in understanding
the application process, scope, and nature of the programs. |
|
Nutrition and Physical Activity |
|
Tribes are eligible to apply for
funding for CDC’s Well-Integrated Screening and Evaluation for
Women across the Nation (WISEWOMAN) program, which is authorized
under CDC’s National Breast and Cervical Cancer Early Detection
Program. |
|
|
National Center for HIV, STD, and TB
Prevention (NCHSTP) |
|
In 2003, the NCHSTP improved AI/AN governments
and organizations’ access to HHS grants by including them as
eligible applicants in two new competitive cooperative agreement
announcements. Federally recognized tribal governments are
eligible to apply for funding under the first announcement,
“Evaluation of Web-based HIV Risk Behavior Surveillance among
Men Who Have Sex with Men,” which is responsive to Healthy
People 2010 objectives 13-6 and 25-11. Federally recognized
Indian tribal governments, Indian tribes, and Indian tribal
organizations are eligible to apply under the second
announcement, “HIV Conference Support.” |
|
|
National Center for Infectious
Diseases (NCID) |
|
In 2003, NCID improved AI/AN governments and
organizations access to grants and research projects enabling
NCID AIP to continue to conduct surveillance, epidemiologic and
laboratory research, prevention projects, training and
information dissemination concerning infectious
diseases/conditions that impact Alaska Native and other Arctic
residents to include programs focusing on prevention of
Pneumococcal Disease in Alaska Native Elders. In 2002, NCID
Division of Viral Hepatitis (DVH) provided $50,000 to Salish
Kootenai College to develop materials and approaches to educate
Indian Health Service and tribal health providers, AI/AN
community health representatives, and public health nurses to
integrate viral hepatitis counseling, testing, immunization,
prevention and clinical services into STD and HIV prevention and
treatment services and settings. NCID/DVH also funds three
tribal organization-based Viral Hepatitis Integration Projects
in Arizona, New Mexico, and Washington; two new sites were added
in FY 2003 in Alaska and Montana.
In 2003 and 2002, NCID’s Minority and Women’s Health
increased participation in outreach activities targeting AI/AN
students. Outreach activities included recruitment events and
women’s health conferences for the purpose of providing
employment and public health information to students, faculty,
and the AI/AN community. In addition to increasing outreach to
AI/AN students for all NCID student opportunities, NCID
specifically funded a slot for an American Indian Science and
Engineering Society (AISES) student fellowship. |
|
|
National Institute for Occupational
Safety and Health (NIOSH) |
|
Indian tribes, tribal governments, and tribal
colleges and universities are institutions eligible for NIOSH
grant announcements. |
|
2. |
INCREASE HHS
RESOURCES FOR TRIBES AND
NATIVE ORGANIZATIONS |
|
Steps to a HealthierUS |
|
Increased funding, as requested in
the FY 2005 budget, would allow the Steps to a HealthierUS
Cooperative Agreement Program to fund current tribal consortia
at higher levels and increase the number of tribes that receive
funding (an average award of $650,000 for up to 3 additional
tribes). |
|
Cancer Prevention and Control |
|
CDC’s National Breast and Cervical
Cancer Early Detection Program (NBCCEDP) has helped to increase
mammography use by women aged 50 years and older by 20 percent
since the program’s inception in 1991. NBCCEDP targets
low-income women with little or no health insurance and has
helped reduce disparities in screening for women from racial and
ethnic minorities. Approximately 50 percent of screenings
provided by the program were to women from racial or ethnic
minority groups. Of that 50 percent, approximately 6.8 percent
are AI/AN women. The President’s budget proposes an increase
in FY 2005 for the NBCCEDP. This increase would yield more
women, including AI/AN, being screened for these cancers. Under
Program Announcement #02060, tribes and tribal organizations
would be eligible to apply for funding to provide these
screening services; the open season competition is expected to
be released early next spring. The increased support will also
allow CDC to potentially increase the number of tribes or tribal
organizations that will receive financial assistance. |
|
3. |
DESCRIBE ANY OTHER
INITIATIVES OR
SPECIAL EFFORTS UNDERTAKEN BY YOUR DIVISION TO IMPROVE HEALTH
AND HUMAN SERVICES FOR NATIVE AMERICAN TRIBAL GOVERNMENTS AND
INDIAN ORGANIZATIONS |
Listed below, and categorized by CIO, are a
number of relevant examples of initiatives and special efforts
undertaken by CDC to improve public health for Native American
tribal governments and Indian organizations. |
|
Office of the Director (OD) |
|
OMH is also partnering with NCHSTP by
supplementing their cooperative agreement with the National
Native American AIDS Prevention Center (NNAAPC) in planning CDC/ATSDR’s
1st Conference on Increasing American Indian/Alaska
Native/Native Hawaiian (AI/AN/NH) Careers in Public Health.
This national conference is being planned for June 2004 with the
purpose of developing a plan that identifies and addresses the
academic needs of AI/AN/NH students to pursue careers in public
health. The specific objectives of this conference are to
increase the number of AI/AN/NH public health professionals
employed at CDC; to increase the number of AI/AN/NHs
participating in CDC/ATSDR trainings internships/fellowships;
and increase the number of AI/AN/NH public health professionals. |
|
|
National Center for Chronic Disease
Prevention and Health Promotion (NCCDPHP) |
|
Office on Smoking and
Health |
|
The
Office on Smoking and Health (OSH) Program Services Branch
staffs a field assignee at the Indian Health Service, National
Epidemiology Program, in Albuquerque, New Mexico, to provide
technical assistance and consultation to tribes, tribal and
urban organizations. OSH has also begun the process aimed at
developing a cessation guide for AI/AN communities. The guide
will be modeled after the Pathways to Freedom guide for African
American communities, a cultural approach to educating, planning
and organizing communities around tobacco use cessation. |
|
Division of Adult and
Community Health (DACH) |
|
The Cardiovascular Health Branch, in
collaboration with IHS, provides technical assistance in the
implementation and evaluation of cardiovascular disease risk
factor prevention and intervention programs to tribal
communities. The branch continues to publish and disseminate
lessons learned from the Inter Tribal Heart Project and to
explore, develop, and implement surveillance and intervention
strategies useful for tribal communities. In addition, branch
activities include a focus on mapping the geographic disparities
in heart disease and stroke mortality among AI/ANs. |
|
Division of Reproductive
Health (DRH) |
|
Assignment of DRH Field Assignees
Leslie Randall is a DRH assignee to the National IHS
Epidemiology Program in Albuquerque, New Mexico. Ms. Randall
provides technical consultation and assistance to federal,
state, tribal, local and other health agencies concerning
various epidemiology projects. She works through a Memorandum
of Agreement between IHS and CDC, on Reproductive
Health/Behavioral Risk Surveys and provides technical assistance
for the design, implementation, analysis, training and
dissemination of findings to the tribes. This past year, Ms.
Randall provided assistance to Rosebud Sioux Tribe on
reproductive health issues. She has given many national
presentations on infant health and interviews on SIDS with the
Associated Press, National Native Calling, National Native News,
and many local newspapers. Ms. Randall also provided technical
assistance to the project officer for the Tobacco Support
Centers funded through the Office of Smoking and Health for the
survey instrument and the IHS Institutional Review Board. In
addition, Lori de Ravello is assigned to NCHSTP in Albuquerque.
She receives 60 percent of her support from DRH to facilitate
work on American Indian Maternal and Child Health issues. |
|
|
National Center for HIV, STD, and TB
Prevention (NCHSTP) |
|
In 2003, NCHSTP also took the following steps to
improve Native American governments and organizations access to
HHS programs: |
|
|
1) establishment of a contractual arrangement
with a Native American consultant to assist in identifying ways
to better coordinate NCHSTP’s public health activities and
leverage resources to address AI/AN health disparities; and |
|
|
2) establishment of three contractual positions
to build regional capacity in two IHS areas (Navajo, Aberdeen)
to prevent and control sexually transmitted diseases, including
HIV. |
|
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