Alaska Native Health Research Research Articles

Supporting Traditional Foodways Knowledge and Practices in Alaska Native Communities: The Elders Mentoring Elders Camp.

The transmission of generational knowledge in Alaska Native communities has been disrupted by colonization and led to declining health among Alaska Natives, as evidenced by the loss of knowledge regarding traditional foods and foodways and increasing rates of cardiometabolic disorders impacting Alaska Natives. Elders play a central role in passing down this generational knowledge, but emerging Elders may have difficulty in stepping into their roles as Elders due to the rapid social and cultural changes impacting their communities. The Center for Alaska Native Health Research (CANHR) and the Denakkanaaga Elders Program are partnering with the Center for Indigenous Innovation and Health Equity to uplift and support traditional food knowledge and practices to promote health in Alaska Native communities. Guided by a decolonizing and Indigenizing framework, researchers at CANHR are working with Athabascan Elders in the Interior of Alaska to strengthen and protect the intergenerational transmission of cultural knowledge and practices for emerging Elders. This community-academic partnership will implement and evaluate an Elders Mentoring Elders Camp to focus on repairing and nurturing relationships through the practice and preservation of cultural knowledge and practices, including traditional foodways. This initiative contributes to the intergenerational transmission of knowledge, which is necessary to keep culture alive and thriving.

Using Social Network Analysis to Visualize Networks in American Indian Health Research.

The Collaborative Research Center for American Indian Health (CRCAIH) is a transdisciplinary, collaborative center focused on building American Indian tribal research infrastructure. Funded by the National Institute of Minority Health and Health Disparities in 2012, it was created as a platform to join tribal communities and researchers in South Dakota, North Dakota, and Minnesota to develop research infrastructure and stimulate research in American Indian health. The CRCAIH infrastructure has created a large network of transdisciplinary research partnerships. To understand the initial development of the CRCAIH network and understand the broader impact it has had on American Indian and Alaska Native health research, CRCAIH undertook a network analysis based on publications by collaborators working with and within CRCAIH. The network analysis showed how far the CRCAIH network went in a short period of time to create a platform for networking to build collaborations and further stimulate research with American Indian communities.

The Collaborative Research Center for American Indian Health's Partnership River of Life: Special Issue Introduction.

In 2012, the National Institutes of Health funded the Collaborative Research Center for American Indian Health (CRCAIH) to work toward two broad goals: 1) to build tribal research infrastructure, and 2) to increase research on social determinants of health in American Indian communities. As the introduction to this special issue of American Indian and Alaska Native Mental Health Research, we highlight results from the Partnership River of Life evaluation tool in order to provide broader context for the other manuscripts presented here. Insights were gained during the Partnership River of Life group discussion and evaluation process of combining the groups' rivers to create one representation of the CRCAIH partnership. Detailed results underscore insights for similar transdisciplinary groups.

Disseminating the Results of a Depression Management Study in an Urban Alaska Native Health Care System.

Increased attention to diagnostic accuracy in depression screening and management within primary care has demonstrated inadequate care when patients prematurely discontinue recommended treatments such as medication and counseling. Decision-support tools can enhance the medical decision-making process. In 2010, the Southcentral Foundation (SCF) Research Department developed a stakeholder-driven decision support tool to aid in depression management. This paper describes feedback from attendees at SCF's 2016 Alaska Native Health Research Forum (Forum) regarding a dissemination product highlighting the aforementioned study. Forum attendees participated in a small group discussion and responded to a brief survey using the audience response system. Thematic analysis was conducted on data from the small group discussion. Overall, Forum attendees responded favorably to the dissemination product. Most agreed the presentation was clear, the amount of information presented was appropriate, and that results were presented in an interesting way. Small group discussion participants provided constructive feedback about why depression-related research results should be shared; how they believed results should be best shared; who results should be shared with; when and where results should be shared; and what level of research results should be shared. The stigma associated with depression treatment may be assuaged if results are shared in a way that normalizes support for depression treatment. Community member involvement in disseminating results has potential to make information more acceptable and meaningful.

Approach and Methods of the 2016 Alaska Native Research Forum.

Southcentral Foundation, a tribal health organization serving Alaska Native and American Indian (AN/AI) people in southcentral Alaska, convened the Alaska Native Health Research Forum (Forum) for AN/AI people in May 2016. The purpose of the Forum was to obtain AN/AI community member feedback about sharing health research results. This article describes the funding mechanism that provided resources for the Forum and other factors that were considered when designing the Forum. This is followed by a description of how attendees were invited, the audience response system, and process used to collect quantitative data on participants and qualitative feedback from small group discussions with Forum attendees. Finally, we describe the quantitative and qualitative data analysis processes used to evaluate responses.

Future Directions in Disseminating Research Findings to Urban Alaska Native People.

Southcentral Foundation (SCF), a tribal health organization based in Anchorage, Alaska, operates and plans health care services in response to the priorities and tribal values of Alaska Native and American Indian (AN/AI) people, including traditional concepts of wellness, reciprocity, and working in relationship. In an effort to better incorporate AN/AI priorities and values in research dissemination, the SCF Research Department hosted the Alaska Native Health Research Forum (Forum) in May 2016. In this paper, we describe the communication strategies used by the SCF Public Relations Department, which were shared with Forum attendees, describe attendee recommendations for researchers to consider and implement, and then discuss future directions for dissemination. Lessons learned through the Forum were 1) customer-owners are interested in learning more about research, 2) dissemination should be done throughout all stages of projects using a variety of media channels, and 3) SCF Research Department dissemination should continue to shape health care.

Alaska Native Health Research Forum: Perspectives on disseminating research findings.

In May 2016, Southcentral Foundation (SCF), a regional tribal health corporation based in Anchorage, Alaska convened a half-day health research forum for Alaska Native and American Indian community members to obtain feedback on communication of research findings. Thirty one individuals attended the Forum and 22 completed a pre and post survey. Respondents found the Forum to be a useful method to learn about research projects and their willingness to participate in health research reportedly increased because of the event. Forum attendees also endorsed use of direct mail, electronic mail, and messages via an electronic health record patient portal as communication methods for health researchers to inform potential participants about research studies occurring at SCF and for return of individual and community level results.

Developing Trust, Multiple Identities, and Participatory Research: Select Examples.

Developing Trust, Multiple Identities, and Participatory Research: Select Examples Scarlett Hopkins In community–based participatory research (CBPR), trust among participating individuals and groups is paramount to achieving goals. Trust is an ever–changing and evolving concept implying increasing willingness to take risks with potentially delicate information, an assumption that promises will be kept, and a belief in the good will of the other. When outside researchers enter a community, they are greeted by community members and organizations who have often had prior experience with outside researchers. A critical aspect of this process is the value of outside researchers developing what clinical psychologist James Kelly called an ‘eco–identity” or a way of becoming known in the local community that helps community members “locate” the researcher in the community context and provides a basis for relationship development and subsequent trust. In this paper, I will describe the development of trusting relationships involving genetic studies with Alaska Native communities. The Center for Alaska Native Health Research (CANHR) located at the University of Alaska Fairbanks was funded in 2001 by the National Institutes of Health (NIH) as a Center of Biomedical Research Excellence (COBRE) focusing on obesity and cardiometabolic disease in Yup’ik Alaska Native people in rural southwestern Alaska. Initially, it was comprised of three multi-disciplinary research studies including genetics of obesity, nutrition and physical activity, and cultural understandings of health. Now, CANHR includes behavioral health and nutritional research as well as epigenomic and pharmacogenomic research to address health disparities in Alaska Native people. As a Registered Nurse, I am interested in health disparities in Alaska Native people and the influence of culture on health beliefs, behavior and outcomes. I began working with CANHR in 2002, first as a graduate student in cultural anthropology, then as a research coordinator, and now leading the Community Engagement and Clinical Support Core. One of my responsibilities as a graduate student was initial contact with potential communities who had been selected by the Yukon–Kuskokwim Health Corporation (YKHC), the native health entity providing medical services and overseeing health research in this region. These initial contacts included several visits to the communities to meet with Tribal Governments and community members to discuss the research and gain approval. These first visits were the beginning of trusting and sustained partnerships spanning a 15–year period with over 1,800 Yup’ik participants in our genetic studies. It is important to reflect on and document how trust develops in community research, particularly when it involves basic science rather than community interventions intending to have direct community impact. In the 15 years that I have been involved in multiple projects involving multiple communities, my primary role has been to facilitate the relationship between the university research project team members while simultaneously being involved in recruitment of participants, data collection and dissemination of research progress and findings. During these years, I have come to understand how my various identities have played a role in allowing and promoting relationships with community members. These identities involve my [End Page E12] southern upbringing, being a mid–aged woman with a family, a clinical background in nursing, and my role as a researcher. Initially, I was very nervous, but also very excited about my first visits to these communities. I was not sure what to expect, how I would be received, and what I should or should not do to be culturally respectful. I had read much of the ethnographic literature about Yup’ik people to prepare myself. However, I felt the best and most genuine approach was to just be myself. Being brought up in the South, I was taught to be friendly and greet everyone, whether I knew him or her or not. In each Yup’ik community, I would smile and nod or say hello when passing. I found Yup’ik people were very friendly and welcoming to me. When appropriate, I would introduce myself, and share why I was in their community. I think my excitement over being in their community and my eagerness to learn about their culture was evident. Over time, I got to know many individuals in the communities by name, learned much abut their lives and their...

Declines in traditional marine food intake and vitamin D levels from the 1960s to present in young Alaska Native women.

To measure the trends in traditional marine food intake and serum vitamin D levels in Alaska Native women of childbearing age (20-29 years old) from the 1960s to the present. We measured a biomarker of traditional food intake, the δ15N value, and vitamin D level, as 25-hydroxycholecalciferol (25(OH)D3) concentration, in 100 serum samples from 20-29-year-old women archived in the Alaska Area Specimen Bank, selecting twenty-five per decade from the 1960s to the 1990s. We compared these with measurements of red-blood-cell δ15N values and serum 25(OH)D3 concentrations from 20-29-year-old women from the same region collected during the 2000s and 2010s in a Center for Alaska Native Health Research study. The Yukon Kuskokwim Delta region of south-west Alaska. Alaska Native women (n 319) aged 20-29 years at the time of specimen collection. Intake of traditional marine foods, as measured by serum δ15N values, decreased significantly each decade from the 1960s through the 1990s, then remained constant from the 1990s through the present (F 5,306=77·4, P<0·0001). Serum vitamin D concentrations also decreased from the 1960s to the present (F 4,162=26·1, P<0·0001). Consumption of traditional marine foods by young Alaska Native women dropped significantly between the 1960s and the 1990s and was associated with a significant decline in serum vitamin D concentrations. Studies are needed to evaluate the promotion of traditional marine foods and routine vitamin D supplementation during pregnancy for this population.

Linkage and association analysis of obesity traits reveals novel loci and interactions with dietary n-3 fatty acids in an Alaska Native (Yup’ik) population

ObjectiveTo identify novel genetic markers of obesity-related traits and to identify gene-diet interactions with n-3 polyunsaturated fatty acid (n-3 PUFA) intake in Yup’ik people. Material and methodsWe measured body composition, plasma adipokines and ghrelin in 982 participants enrolled in the Center for Alaska Native Health Research (CANHR) Study. We conducted a genome-wide SNP linkage scan and targeted association analysis, fitting additional models to investigate putative gene-diet interactions. Finally, we performed bioinformatic analysis to uncover likely candidate genes within the identified linkage peaks. ResultsWe observed evidence of linkage for all obesity-related traits, replicating previous results and identifying novel regions of interest for adiponectin (10q26.13-2) and thigh circumference (8q21.11-13). Bioinformatic analysis revealed DOCK1, PTPRE (10q26.13-2) and FABP4 (8q21.11-13) as putative candidate genes in the newly identified regions. Targeted SNP analysis under the linkage peaks identified associations between three SNPs and obesity-related traits: rs1007750 on chromosome 8 and thigh circumference (P=0.0005), rs878953 on chromosome 5 and thigh skinfold (P=0.0004), and rs1596854 on chromosome 11 for waist circumference (P=0.0003). Finally, we showed that n-3 PUFA modified the association between obesity related traits and two additional variants (rs2048417 on chromosome 3 for adiponectin, P for interaction=0.0006 and rs730414 on chromosome 11 for percentage body fat, P for interaction=0.0004). ConclusionsThis study presents evidence of novel genomic regions and gene-diet interactions that may contribute to the pathophysiology of obesity-related traits among Yup’ik people.

Evidence for novel genetic loci associated with metabolic traits in Yup'ik people.

To identify genomic regions associated with fasting plasma lipid profiles, insulin, glucose, and glycosylated hemoglobin in a Yup'ik study population, and to evaluate whether the observed associations between genetic factors and metabolic traits were modified by dietary intake of marine derived omega-3 polyunsaturated acids (n-3 PUFA). A genome-wide linkage scan was conducted among 982 participants of the Center for Alaska Native Health Research study. n-3 PUFA intake was estimated using the nitrogen stable isotope ratio (δ(15) N) of erythrocytes. All genotyped SNPs located within genomic regions with LOD scores > 2 were subsequently tested for individual SNP associations with metabolic traits using linear models that account for familial correlation as well as age, sex, community group, and n-3 PUFA intake. Separate linear models were fit to evaluate interactions between the genotype of interest and n-3 PUFA intake. We identified several chromosomal regions linked to serum apolipoprotein A2, high density lipoprotein-, low density lipoprotein-, and total cholesterol, insulin, and glycosylated hemoglobin. Genetic variants found to be associated with total cholesterol mapped to a region containing previously validated lipid loci on chromosome 19, and additional novel peaks of biological interest were identified at 11q12.2-11q13.2. We did not observe any significant interactions between n-3 PUFA intake, genotypes, and metabolic traits. We have completed a whole genome linkage scan for metabolic traits in Native Alaskans, confirming previously identified loci, and offering preliminary evidence of novel loci implicated in chronic disease pathogenesis in this population.

Enculturation, perceived stress, and physical activity: implications for metabolic risk among the Yup'ik – The Center for Alaska Native Health Research Study

Objectives. American Indians and Alaska Natives (ANs) report among the lowest levels of physical activity in the USA, but there is very little systematic research examining the determinants of physical activity patterns in these populations. This study investigated the relationships between enculturation (or cultural traditionality), psychosocial stress, and physical activity in a community-based sample of Yup'ik women and men living in rural AN communities. Associations between these variables and several metabolic risk factors were also examined.Design. A sample of 488 Yup'ik participants (284 women and 204 men) from six villages in the Yukon-Kuskokwim Delta region completed a wellness survey and an array of physiological assessments [e.g., body mass index (BMI), blood pressure]. A subset of 179 participants also completed a 3-day pedometer assessment of physical activity.Results. Multivariate linear regression models indicated that participants who were more enculturated (i.e., living more of a traditional lifestyle) and who experienced lower levels of psychosocial stress were significantly more physically active. In turn, both lower levels of psychosocial stress and higher levels of physical activity were associated with lower BMI, lower percent body fat, and lower waist circumference.Conclusions. Findings underscore the importance of gaining a culturally specific understanding of physical activity patterns in indigenous groups in order to inform effective health promotion strategies.

Using exploratory factor analysis of FFQ data to identify dietary patterns among Yup'ik people

An FFQ developed by the Center for Alaska Native Health Research for studies in Yup'ik people includes market foods and subsistence foods such as moose, seal, waterfowl and salmon that may be related to disease risk. Because the FFQ contains >100 food items, we sought to characterize dietary patterns more simply for use in ongoing pharmacogenomics studies. Exploratory factor analysis was used to derive a small number of 'factors' that explain a substantial amount of the variation in the Yup'ik diet. We estimated factor scores and measured associations with demographic characteristics and biomarkers. South-west Alaska, USA. Yup'ik people (n 358) aged ≥18 years. We identified three factors that each accounted for ≥10 % of the common variance: the first characterized by 'processed foods' (e.g. salty snacks, sweetened cereals); the second by 'fruits and vegetables' (e.g. fresh citrus, potato salad); and the third by 'subsistence foods' (seal or walrus soup, non-oily fish). Participants from coastal communities had higher values for the 'subsistence' factor, whereas participants from inland communities had higher values for the 'fruits and vegetables' factor. A biomarker of marine intake, δ 15N, was correlated with the 'subsistence' factor, whereas a biomarker of corn- and sugarcane-based market food intake, δ 13C, was correlated with 'processed foods'. The exploratory factor analysis identified three factors that appeared to reflect dietary patterns among Yup'ik based on associations with participant characteristics and biomarkers. These factors will be useful for chronic disease studies in this population.

Seasonal and annual variation in intake of traditional marine foods by a Yup'ik Eskimo population: a sequential dietary record from hair stable isotope analysis

There has been considerable research and public health interest in the potentially protective effects of traditional diets on disease risk in Yup'ik Eskimos. Traditional diets include high levels of fish and marine mammal intake, which provide omega‐3 fatty acids, vitamin D, and other protective nutrients. However, self‐report methods of diet assessment do not capture seasonal patterns of intake. Here, we investigate seasonal patterns of traditional marine mammal and fish intake by measuring variations in a biomarker of marine intake, the nitrogen isotope ratio (δ15N), sequentially along hair from a subset of participants in the Center for Alaska Native Health Research (CANHR) study (n = 19). We found pronounced seasonal variations in δ15N values, which we interpret as reflecting seasonal differences in the availability of specific fish and marine mammals. A pronounced summer peak in δ15N values corresponded to increased salmon availability. Furthermore, variations occurred fairly consistently across participants. Thus, participants’ ranking with respect to traditional food intake tended to stay constant. This is particularly relevant for the CANHR study, as participation varied seasonally and participants were recruited primarily during the winter months. This work was funded by a Centers of Biomedical Research Excellence grant from the NIH National Center for Research Resources (P20 RR333065).

Forging a new legacy of trust in research with Alaska Native college students using CBPR

Objectives. Disparities in the rates of matriculation and graduation are of concern to Alaska Native (AN) students and the universities committed to their academic success. Efforts to reduce attrition require a keen understanding of the factors that impact quality of life (QOL) at college. Yet, a long-standing legacy of mistrust towards research poses challenges to conducting inquiry among AN students. We introduced a partnership between the University of Alaska Fairbank's Rural Student Services (RSS) and the Center for Alaska Native Health Research (CANHR) within which we conducted the “What makes life good?” study aimed towards developing a QOL measure for AN students. Equally important was building a legacy of research trust among AN partners.Study design. We describe Phase I of a 2-phase study that employed a sequential mixed methods approach. Discussed are facilitators, challenges and lessons learned while striving to adhere to the principles of community-based participatory research (CBPR).Methods. Phase I included formative focus groups and QOL measurement development. The research involved the interplay among activities that were co-developed with the goal of enhancing trust and research capacity. Emphasis was placed on ensuring that data collection and analyses were student driven.Conclusions. All partners resided at the same university. However, trust and collaboration could not be assumed. Working within a collaborative framework, our partnership achieved the aim of developing a culturally informed QOL measure, while also creating an empowering experience for all partners who became co-investigators in a process that might normally be regarded with mistrust.

We Will be Known Forever by the Tracks we Leave: Rising up to Meet the Reproductive Health Needs of American Indian and Alaska Native Youth

Many U.S. adolescents of all races/ethnicities engage in multiple behaviors that increase their risk for poor reproductive health outcomes (Eaton, 20101; Everett Jones, Anderson, Lowry, & Conner, 2011; Ramisetty-Mikler & Ebama, 2011; Rutman, Park, Castor, Taualii, & Forquera, 2008). American Indian and Alaska Native (AI/AN) youth are disproportionately affected by poor reproductive health outcomes, including high rates of sexually transmitted diseases (STDs) and teen pregnancy. Peer-reviewed literature on AI/AN reproductive health issues is sparse and often not generalizable to all AI/AN because of small and geographically specific study populations. In the limited studies that have been conducted, some have shown high rates of STDs and teen pregnancy among AI/AN adolescents may result from a lack of familial support, a history of sexual and physical abuse, and early sexual debut (Palacios & Kennedy, 2010); alcohol and substance use and low and inconsistent condom use (Kaufman, 2006); and multiple sex partners (Marsiglia, Nieri, & Stiffman, 2006). The Journal of American Indian and Alaska Native Mental Health Research disseminated the call for submissions for this special issue through its extensive formal and informal networks. The journal received 11 submissions; 9 of those are included in this special issue of the journal and 2 will appear in a later issue. No submission was rejected. Authors were instructed to attain necessary approvals prior to submission. Every author was assigned a mentor to help polish and finalize the manuscripts; the articles were reviewed by two external reviewers with expertise in the manuscripts’ subject areas. We hope that this special journal issue on sexual risk behaviors and assets among AI/AN youth will lead to increased attention and efforts to meet the health care needs of Native youth and that the tracks that we leave will lead to the elimination of health disparities. STD rates among AI/AN youth are among the highest in the country. In 2009, non-Hispanic AI/ANs had the second highest rates of STDs in the U.S.; compared to non-Hispanic White (NHW) youth, they were 4.5 times as likely to be diagnosed with chlamydia, more than three times as likely to be diagnosed with gonorrhea, and twice as likely to be diagnosed with primary or secondary

Genetic polymorphisms in carnitine palmitoyltransferase 1A gene are associated with variation in body composition and fasting lipid traits in Yup'ik Eskimos

Variants of carnitine palmitoyltransferase 1A (CPT1A), a key hepatic lipid oxidation enzyme, may influence how fatty acid oxidation contributes to obesity and metabolic outcomes. CPT1A is regulated by diet, suggesting interactions between gene variants and diet may influence outcomes. The objective of this study was to test the association of CPT1A variants with body composition and lipids, mediated by consumption of polyunsaturated fatty acids (PUFA). Obesity phenotypes and fasting lipids were measured in a cross-sectional sample of Yup'ik Eskimo individuals (n = 1141) from the Center of Alaska Native Health Research (CANHR) study. Twenty-eight tagging CPT1A SNPs were evaluated with outcomes of interest in regression models accounting for family structure. Several CPT1A polymorphisms were associated with HDL-cholesterol and obesity phenotypes. The P479L (rs80356779) variant was associated with all obesity-related traits and fasting HDL-cholesterol. Interestingly, the association of P479L with HDL-cholesterol was still significant after correcting for body mass index (BMI), percentage body fat (PBF), or waist circumference (WC). Our findings are consistent with the hypothesis that the L479 allele of the CPT1A P479L variant confers a selective advantage that is both cardioprotective (through increased HDL-cholesterol) and associated with reduced adiposity.

Characterizing beverage patterns among Alaska Natives living in rural, remote communities: the CANHR study

Caloric beverages, particularly sugar‐sweetened beverages (SSBs), have gained attention as a risk factor for obesity and its sequelae. The prevalence of obesity among AI/ANs exceeds the rates for all other ethnic groups, however little is known about beverage patterns in this group. Here, we characterize beverage intake among Yup'ik Eskimos and present public health and policy recommendations around beverage intake. Beverage and nutrient data, estimated with NDS‐R, are presented from 471 Yup'ik Eskimos (ages 14–92 years) who participated in the Center for Alaska Native Health Research (CANHR) Study. Beverages were classified as: Sugar sweetened soda and fruit drinks (SSBs), Artificially sweetened soda and fruit drinks (ASBs), Coffee, Tea, Milk, 100% juice, Other (beverages reported &lt;10 times). Beverage patterns were strongly associated with age. Over 75% of beverages consumed by youth were SSBs, contributing on average 300kcals and 78g added sugar to daily intake. In contrast, SBBs represented less than 20% of beverage intake among older age groups. Intake of milk, 100% juice, and ASBs were low among all age groups. Reduction in SSB has the potential to reduce the burden of obesity in Yup'ik communities; a culturally and geographically relevant intervention, particularly one that takes a systems approach, should be pursued.Supported by NIH grant (P20‐RR16430)

Found in translation: Decoding local understandings of genetics and heredity in a Yup’ik Eskimo community

The Center for Alaska Native Health Research is a community-based participatory research center that conducts studies involving genetic research with Yup'ik Eskimo community members in Southwest Alaska, where Yup'ik remains the first language for most residents. Cultural equivalents are needed to communicate results of these studies among all partners and members of the participating communities, since many scientific terms have no direct translation in Yup'ik. To inform that effort, we examined local understandings of genetics and heredity in one community. Here, we report results from back-translated Yup'ik interviews, and identify working genetic concepts shared by participants from interviews and focus groups. We suggest issues involved in, and some potential steps toward, developing a concise, scientifically accurate and culturally relevant term for "genetics" and other health concepts.

Clustering of health and behavioral risk factors for cardiovascular disease in Alaska Native youth

Evidence indicates that rural youth are more likely than their urban counterparts to participate in risky behaviors, many of which translate into a higher burden of cardiovascular disease (CVD). Alaska Native youth may be at particularly high risk. Our objective was to evaluate the clustering of health and behavioral risk factors for CVD in 315 Alaska Native youth and young adults (ages 14‐25 years) who participated in the Center for Alaska Native Health Research Study. The prevalence of health risk factors (overweight, hypertension and high HDL, low glucose, and high triglyceride concentration) was estimated using age and gender appropriate criteria. Behavioral risk factors (diet and smoking) were assessed using computer assisted 24‐hour recalls and standardized questionnaires. Clustering of risk factors was common. Approximately 75% of the sample had 0‐1 health risk factors; the remaining 25% had 2‐3 risk factors. The most prevalent risk factors were overweight (40.3%), low HDLs (26.3%) and high triglycerides (21.3%). More than 30% reported smoking regularly. Added sugars and saturated fat contributed substantially to energy intake (19% and 11%, respectively). The risk of CVD increases with each additional risk factor. To promote healthy aging among Alaska Native youth the development of ecologically appropriate CVD prevention programs is essential.NIH (P20 RR16430)