American Indian Communities Research Articles

Participatory action research to develop and implement multicomponent, multilevel strategies for implementing colorectal cancer screening interventions in American Indian communities in New Mexico

BackgroundDespite the effectiveness of colorectal cancer (CRC) screening, American Indians (AIs) have low screening rates in the US. Many AIs receive care at Indian Health Services, Tribal, and Urban Indian (I/T/U) healthcare facilities, where published evidence regarding the implementation of CRC screening interventions is lacking. To address this gap, the University of New Mexico Comprehensive Cancer Center and the Albuquerque Area Southwest Tribal Epidemiology Center collaborated with two tribally-operated healthcare facilities in New Mexico with the goal of improving CRC screening rates among New Mexico’s AI communities.MethodsGuided by the principles of Community Based Participatory Research, we engaged providers from the two tribal healthcare facilities and tribal community members through focus group (two focus groups with providers (n = 15) and four focus group and listening sessions with community members (n = 65)), to elicit perspectives on the feasibility and appropriateness of implementing The Guide to Community Preventive Services (The Community Guide) recommended evidence-based interventions (EBIs) and strategies for increasing CRC screening. Within each tribal healthcare facility, we engaged a Multisector Action Team (MAT) that participated in an implementation survey to document the extent to which their healthcare facilities were implementing EBIs and strategies, and an organizational readiness survey that queried whether their healthcare facilities could implement additional strategies to improve uptake of CRC screening.ResultsThe Community Guide recommended EBIs and strategies that received the most support as feasible and appropriate from community members included: one-on-one education from providers, reminders, small media, and interventions that reduced structural barriers. From the providers’ perspective, feasible and acceptable strategies included one-on-one education, patient and provider reminders, and provider assessment and feedback. Universally, providers mentioned the need for patient navigators who could provide culturally appropriate education about CRC and assist with transportation, and improved support for coordinating clinical follow-up after screening. The readiness survey highlighted overall readiness of the tribal facility, while the implementation survey highlighted that few strategies were being implemented.ConclusionsFindings from this study contribute to the limited literature around implementation research at tribal healthcare facilities and informed the selection of specific implementation strategies to promote the uptake of CRC screening in AI communities.

Genetic variant rs1205 is associated with COVID-19 outcomes: The Strong Heart Study and Strong Heart Family Study.

Although COVID-19 infection has been associated with a number of clinical and environmental risk factors, host genetic variation has also been associated with the incidence and morbidity of infection. The CRP gene codes for a critical component of the innate immune system and CRP variants have been reported associated with infectious disease and vaccination outcomes. We investigated possible associations between COVID-19 outcome and a limited number of candidate gene variants including rs1205. The Strong Heart and Strong Heart Family studies have accumulated detailed genetic, cardiovascular risk and event data in geographically dispersed American Indian communities since 1988. Genotypic data and 91 COVID-19 adjudicated deaths or hospitalizations from 2/1/20 through 3/1/23 were identified among 3,780 participants in two subsets. Among 21 candidate variants including genes in the interferon response pathway, APOE, TMPRSS2, TLR3, the HLA complex and the ABO blood group, only rs1205, a 3' untranslated region variant in the CRP gene, showed nominally significant association in T-dominant model analyses (odds ratio 1.859, 95%CI 1.001-3.453, p = 0.049) after adjustment for age, sex, center, body mass index, and a history of cardiovascular disease. Within the younger subset, association with the rs1205 T-Dom genotype was stronger, both in the same adjusted logistic model and in the SOLAR analysis also adjusting for other genetic relatedness. A T-dominant genotype of rs1205 in the CRP gene is associated with COVID-19 death or hospitalization, even after adjustment for relevant clinical factors and potential participant relatedness. Additional study of other populations and genetic variants of this gene are warranted.

Association of Water Arsenic With Incident Diabetes in U.S. Adults: The Multi-Ethnic Study of Atherosclerosis and the Strong Heart Study.

We examined the association of arsenic in federally regulated community water systems (CWS) and unregulated private wells with type 2 diabetes (T2D) incidence in the Strong Heart Family Study (SHFS), a prospective study of American Indian communities, and the Multi-Ethnic Study of Atherosclerosis (MESA), a prospective study of racially and ethnically diverse urban U.S. communities. We evaluated 1,791 participants from SHFS and 5,777 participants from MESA who had water arsenic estimates available and were free of T2D at baseline (2001-2003 and 2000-2002, respectively). Participants were followed for incident T2D until 2010 (SHFS cohort) or 2019 (MESA cohort). We used Cox proportional hazards mixed-effects models to account for clustering by family and residential zip code, with adjustment for sex, baseline age, BMI, smoking status, and education. T2D incidence was 24.4 cases per 1,000 person-years (mean follow-up, 5.6 years) in SHFS and 11.2 per 1,000 person-years (mean follow-up, 14.0 years) in MESA. In a meta-analysis across the SHFS and MESA cohorts, the hazard ratio (95% CI) per doubling in CWS arsenic was 1.10 (1.02, 1.18). The corresponding hazard ratio was 1.09 (0.95, 1.26) in the SHFS group and 1.10 (1.01, 1.20) in the MESA group. The corresponding hazard ratio (95% CI) for arsenic in private wells and incident T2D in SHFS was 1.05 (0.95, 1.16). We observed statistical interaction and larger magnitude hazard ratios for participants with BMI <25 kg/m2 and female participants. Low to moderate water arsenic levels (<10 µg/L) were associated with T2D incidence in the SHFS and MESA cohorts.

Community-Identified Implementation Strategies for Promoting the Adoption of HIV Self-Testing in a Southern California American Indian community: A Rapid Qualitative Analysis

HIV incidence increased by 18% between 2015 and 2019 among American Indians (AIs) despite declining rates in other racial/ethnic groups. Culturally-appropriate implementation of prevention programs is needed to address the intersectional conditions contributing to HIV vulnerabilities experienced by AIs. The objectives of this study were to understand factors influencing HIV testing decisions and identify implementation strategies to promote the acceptability of HIV self-testing (HIVST) in a southern California AI community. A total of 15 semi-structured interviews were completed with adult community members of a southern California AI reservation. Analysis used a rapid analytic approach that was guided by the Exploration, Preparation, Implementation, Sustainment (EPIS) framework and expert recommendations for implementing change (ERIC) compilation. Two team members applied a standardized summary template to elucidate implementation determinants and implementation strategies for adopting HIVST. Barriers to HIV testing identified by community members included HIV-related stigma and privacy concerns within their community. Community members expressed positive perceptions of the acceptability of HIVST, with many identifying ease of use and privacy as appealing attributes. Several implementation strategies were suggested for facilitating the adoption of HIVST, including increasing access to tests by mailing kits to community members and increasing demand for kits through media campaigns (e.g., local flyers, social media posts, and booths at tribal events). Community members also recommended discreet packaging of kits and cultural adaptation of accompanying materials (e.g., educational videos featuring community members). The qualitative input from AI community members facilitated identification of implementation strategies that may promote the acceptability and culturally-appropriateness of HIVST.

Understanding American Indian tribal college student knowledge, attitudes, beliefs, and behaviors surrounding alternative tobacco products

Objectives To examine knowledge, attitudes, beliefs, and behaviors about alternative tobacco products among American Indian tribal college students. Participants One hundred and five tribal college students. Methods Focus groups, one interview, and demographic surveys. Results Tobacco use varied across the sample with 35.2% of the participants being users of ENDS products and 29.5% were cigarette smokers. Overall, participants viewed electronic nicotine delivery systems and chewing tobacco as primary examples of alternative tobacco products and described a generational divide between alternative and conventional tobacco product use. Alternative tobacco products were not considered suitable for use in traditional contexts. Conclusions Previously successful cessation programs in this population have relied on cultural tailoring related to traditional tobacco use in American Indian communities. Our findings suggest that this strategy may be less effective for addressing alternative tobacco use. Reliance on the importance of family relationships may prove more impactful in future programming.

Food insecurity in urban American Indian and Alaska Native populations during the COVID-19 pandemic

BackgroundFood insecurity is an important social determinant of health that was exacerbated by the COVID-19 pandemic. Both food insecurity and COVID-19 infection disproportionately affect racial and ethnic minority groups, particularly American Indian and Alaska Native communities; however, there is little evidence as to whether food insecurity is associated with COVID-19 infection or COVID-19 preventive behaviors such as vaccination uptake. The purpose of this study was to evaluate associations between food insecurity, COVID-19 infection, and vaccination status among urban American Indian and Alaska Native adults seen at 5 clinics serving urban Native people.MethodsIn partnership with health organizations in Alaska, Colorado, Kansas, Minnesota, and New Mexico, the study team conducted a cross-sectional survey in 2021 to assess food security status and attitudes, barriers, and facilitators for COVID-19 testing and vaccination. Logistic regression was used to examine the association of food security status with sociodemographic factors and COVID-19 infection and vaccination status. Marginal standardization was applied to present results as prevalence differences.ResultsAmong 730 American Indian and Alaska Native adults, the prevalence of food insecurity measured during the pandemic was 38%. For participants who reported persistent food security status before and during the pandemic (n = 588), the prevalence of food insecurity was 25%. Prevalence of COVID-19 infection and vaccination did not vary by food security status after adjustment for confounders.ConclusionsHigh rates of food insecurity among American Indian and Alaska Native communities likely increased during the COVID-19 pandemic. However, despite the high prevalence of food insecurity, community-led efforts to reduce COVID-19 infection and increase vaccination uptake across Indian Health Service and Tribal healthcare facilities may have mitigated the negative impacts of the pandemic for families experiencing food insecurity. These successful approaches serve as an important reference for future public health efforts that require innovative strategies to improve overall health in American Indian and Alaska Native communities.

Abstract 1012: Colorectal cancer in the American Indian and Alaska Native community: A holistic review

Abstract Colorectal cancer (CRC) is ranked third in the United States for both cancer incidence and mortality. Despite a decline in both categories, CRC continues to be a great concern in American Indian/Alaska Native (AI/AN) communities. AI/AN populations have also experienced the largest increase in early-onset colorectal cancer, have the second highest CRC incidence rates, and the AN community has the highest rates of CRC worldwide. AI/AN populations face numerous barriers and are susceptible to risk factors that may contribute to these findings. Currently, a significant amount of research is on screening efforts. Through conducting a literature review of 63 articles, as well as an additional 11 supplemental sources, this manuscript aims to look at several aspects of CRC including demographics, diet, screening, and the impact of geography. This review presents and organizes available research on CRC in the AI/AN population and explores research beyond screening because a more comprehensive and population-specific fund of knowledge on the totality of the subject is critical to directing more effective prevention, earlier detection, and management. Evaluating different components of CRC honors the holistic approach to health practiced by AI/AN communities. Citation Format: Angela R. Monetathchi, William Carson, Alyssa Little, Felina M. Cordova-Marks, Jennifer Erdrich. Colorectal cancer in the American Indian and Alaska Native community: A holistic review [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 1012.

Novel signals and polygenic score for height are associated with pubertal growth traits in Southwestern American Indians.

Most genetic variants associated with adult height have been identified through large genome-wide association studies (GWASs) in European-ancestry cohorts. However, it is unclear how these variants influence linear growth during adolescence. This study uses anthropometric and genotypic data from a longitudinal study conducted in an American Indian community in Arizona between 1965-2007. Growth parameters (i.e. height, velocity, and timing of growth spurt) were derived from the Preece-Baines growth model, a parametric growth curve fitted to longitudinal height data, in 787 participants with height measurements spanning the whole period of growth. Heritability estimates suggested that genetic factors could explain 25% to 71% of the variance of pubertal growth traits. We performed a GWAS of growth parameters, testing their associations with 5 077 595 imputed or directly genotyped variants. Six variants associated with height at peak velocity (P < 5 × 10-8, adjusted for sex, birth year and principal components). Implicated genes include NUDT3, previously associated with adult height, and PACSIN1. Two novel variants associated with duration of growth spurt (P < 5 × 10-8) in LOC105375344, an uncharacterized gene with unknown function. We finally examined the association of growth parameters with a polygenic score for height derived from 9557 single nucleotide polymorphisms (SNPs) identified in the GIANT meta-analysis for which genotypic data were available for the American Indian study population. Height polygenic score was correlated with the magnitude and velocity of height growth that occurred before and at the peak of the adolescent growth spurt, indicating overlapping genetic architecture, with no influence on the timing of adolescent growth.

Association of Achievement of the American Heart Association's Life's Essential 8 Goals With Incident Cardiovascular Diseases in the SHFS.

Cardiovascular disease (CVD) is a leading cause of morbidity and mortality in American Indian people. In 2022, the American Heart Association developed the Life's Essential 8 goals to promote cardiovascular health (CVH) for Americans, composed of diet, physical activity, nicotine exposure, sleep, body mass index, blood lipids, blood pressure, and blood glucose. We examined whether achievement of Life's Essential 8 goals was associated with incident CVD among SHFS (Strong Heart Family Study) participants. A total of 2139 SHFS participants without CVD at baseline were included in analyses. We created a composite CVH score based on achievement of Life's Essential 8 goals, excluding sleep. Scores of 0 to 49 represented low CVH, 50 to 69 represented moderate CVH, and 70 to 100 represented high CVH. Incident CVD was defined as incident myocardial infarction, coronary heart disease, congestive heart failure, or stroke. Cox proportional hazard models were used to examine the relationship of CVH and incident CVD. The incidence rate of CVD at the 20-year follow-up was 7.43 per 1000 person-years. Compared with participants with low CVH, participants with moderate and high CVH had a lower risk of incident CVD; the hazard ratios and 95% CIs for incident CVD for moderate and high CVH were 0.52 (95% CI, 0.40-0.68) and 0.25 (95% CI, 0.14-0.44), respectively, after adjustment for age, sex, education, and study site. Better CVH was associated with lower CVD risk which highlights the need for comprehensive public health interventions targeting CVH promotion to reduce CVD risk in American Indian communities.

Healthcare access, attitudes and behaviours among Navajo adults during the COVID-19 pandemic: a cross-sectional study

ObjectiveTo assess factors associated with positive COVID-19 tests, perspectives on health-related care delivery during pandemic and factors supporting resilience among members of the Navajo Nation.Methods and analysisFrom May through October...

Characteristics and outcomes of a hospitalized cohort with reduced mortality from COVID-19, White Mountain apache tribal lands, April 1 – July 31, 2020

BackgroundWidespread transmission of COVID-19 continues to threaten public health, particularly of rural, American Indian communities. Although COVID-19 risk factors for severe disease and clinical characteristics are well described in the general population, there has been little shared on hospitalized American Indian populations.MethodsIn this observational study, we performed chart extractions on all persons hospitalized with COVID-19 from April 1 through July 31, 2020 among an exclusively American Indian population living on or near Tribal lands in eastern Arizona. We provide descriptive statistics for the cohort stratified by presentation, comparing those who self-presented or were referred by an outreach program. Exploratory analyses were performed to identify risk factors for morbidity and mortality.ResultsDuring the observation period, 2262 persons were diagnosed with COVID-19 and 490 (22%) were hospitalized. Hospitalized persons had a median age of 54 years; 92% had at least one comorbidity, 72% had greater than one comorbidity, and 60% had a BMI of > 30. Most persons required supplemental oxygen (83%), but the majority (62%) only required nasal cannula and only 11% were intubated. The case fatality rates were 1.7% for the population, 7.1% among hospitalizations, and 9.3% among hospitalized patients 50 years and older. All rates that are significantly lower than those reported nationally during the same period.ConclusionsWe observed a cohort of American Indian patients hospitalized secondary to COVID-19 with greater number of comorbidities compared to the general population but with lower mortality rates. We posit that the primary driver of mortality reduction for this population and the hospitalized cohort was a community-based referral program that led to disproportionately lower fatality rates among the oldest persons.

Trends in Fatal Opioid-Related Overdose in American Indian and Alaska Native Communities, 1999–2021

IntroductionOpioid-related overdose (OOD) mortality rates have increased sharply in the U.S. over the past two decades, and inequities across racial and ethnic groups have been documented. OOD trends among American Indian/Alaska Native (AI/AN) require further quantification and assessment. MethodsObservational, U.S. population-based registry data on OOD mortality between 1999-2021 were extracted in 2023 using ICD-10 codes from the CDC WONDER multiple cause of death file by race, Hispanic ethnicity, sex, and age. Segmented time series analyses were conducted to estimate OOD mortality growth rates among AI/AN population between 1999-2021. Analyses were performed in 2023. ResultsTwo distinct time segments revealed significantly different OOD mortality growth rates within the overall AI/AN population, from 0.36 per 100,000 (95% CI: 0.32, 0.41) between 1999 and 2019, to 6.5 (5.7, 7.31) between 2019-2021, with the most pronounced increase among those of 24 to 44 years old. Similar patterns were observed within the AI/AN population with Hispanic ethnicity, but the estimated growth rates were generally steeper across most age groups compared to the overall AI/AN population. Patterns of OOD mortality growth rates were similar between AI/AN females and males between 2019-2021. ConclusionsSharp increases in OOD mortality rates among AI/AN communities are evident by age and Hispanic ethnicity, highlighting the need for culturally-sensitive fatal OOD prevention, opioid use disorder treatment, and harm reduction efforts. Future research should aim to understand the underlying factors contributing to these high mortality rates and employ interventions that leverage the strengths of AI/AN culture, including the strong sense of community.

Surveillance methods and interventions implemented in American Indian and Alaska Native communities to increase child restraint device and seat belt use in motor vehicles: a systematic review

BackgroundAmerican Indian/Alaska Native (AI/AN) children are disproportionately affected by injuries and deaths related to motor vehicle crashes. We aimed to synthesise published evidence on surveillance methods and interventions implemented in...

Process evaluation of the Yéego! Program to increase healthy eating and gardening among American Indian elementary school children

BackgroundAmerican Indian children are at increased risk for obesity and diabetes. School-based health promotion interventions are one approach to promoting healthy behaviors to reduce this risk, yet few studies have described their implementation and fidelity. We conducted a qualitative process evaluation of the Yéego! Healthy Eating and Gardening Program, a school-based intervention to promote healthy eating among Navajo elementary school children. The intervention included a yearlong integrated curriculum, as well as the construction and maintenance of a school-based garden.MethodsOur process evaluation included fidelity checklists completed by program staff and qualitative interviews with program staff and classroom teachers after the intervention was implemented. We used content analysis to identify themes.ResultsWe identified several themes related to evidence of delivery adherence, program satisfaction, and lessons learned about delivery. Intervention staff followed similar procedures to prepare for and deliver lessons, but timing, teaching styles, and school-level factors also impacted overall implementation fidelity. Teachers and students had positive perceptions of the program, especially lessons that were highly visual, experiential, and connected to Navajo culture and the surrounding community. Teachers and program staff identified ways to enhance the usability of the curriculum by narrowing the scope, relating content to student experiences, and aligning content with school curriculum standards.ConclusionsThe program was implemented with moderately high fidelity across contexts. We identified areas where modifications could improve engagement, acceptability, efficacy, and sustainability of the program. Our results have implications for the evaluation and dissemination of school-based health interventions to promote healthy eating among children, especially in American Indian communities.

Survival and Continuation: An Analysis of the Women Characters of the American Indian Community in Louise Erdrich’s The Night Watchman

The Night Watchman is a novel published by Native American woman writer Louise Erdrich in 2020. The book tells the story of an Indian tribe located in the Turtle Mountain Reservation in the 1950s which makes arduous efforts to prevent the US government from enacting Termination Bill and relocation plan. The author vividly displays the unity of the tribal people in the Turtle Mountain Reservation. At the same time, the images of American Indian women are portrayed in details. In the mainstream white society, Indian images, especially Indian women’s images, always seem to be shrouded in mystery due to the long-term neglect and discrimination. At the time, Indian women were facing two crises: firstly, as women, they failed to avoid the fate of being persecuted; Secondly, as the members of the Indian community, their tribal survival and development were under threat. Therefore, analyzing the images of American Indian women in Erdrich’s The Night Watchman not only enables the public to pay attention to the identity and awareness of Native American women, but also helps readers better understand how the female characters in the book shape their unique gender and cultural identity through persistence and resistance.

Policies to address the Covid-19 pandemic: Lessons learned from tribal policymakers

Background: The Covid-19 pandemic created many challenges for federal policymakers. However, American Indian Tribal policymakers also had to rely on their treaty relationship the United States and set policies to protect their sovereign nations. The Covid-19 pandemic was devastating to tribal communities and amplified many inequalities these communities already face.Methodology: In this study, we interviewed Tribal policymakers using a phenomenological approach to examine tribal Covid-19 policies enacted and the governmental actions taken in response to the pandemic. Using a purposive sampling method, 11 interviews were included in the analysis.Discussion: These interviews represented 10 tribes across five culture areas. Ten themes were identified, including four related to issues to be addressed at the start of the pandemic and six associated with Covid-19 policy development and implementation. The findings from this study are intended to describe the ways in which some tribes operated within their infrastructures to keep their members safe.Conclusion: The Covid-19 virus had a devastating impact on American Indian communities. This study can aid in the generation of evidence-based information that can influence the development of policies regarding future outbreaks and pandemics.

Unequal Effect of Educational Attainment on Reducing Poverty and Welfare; Diminished Returns of American Indian/Alaska Native Populations.

American Indian and Alaska Native (AIAN) communities face pronounced economic and health disparities compared to White Americans, a situation rooted in long-standing historical injustices and segregation. The theory of Minorities' Diminished Returns (MDR) provides insight beyond the traditional focus on socioeconomic status (SES) disparities, such as educational attainment. It suggests that the beneficial outcomes of educational achievements on health and economic status are less substantial for marginalized and racially non-White groups compared to White Americans. This study investigates the applicability of the MDR theory to AIAN populations by examining whether the positive effects of education on poverty reduction and the decreased risk of disability benefit dependency are weaker for AIAN adults relative to their White counterparts. Utilizing data from the 2022 National Health Interview Survey (NHIS), this cross-sectional study analyzed a cohort of 20,743 adults, comprising 20,474 White and 269 AIAN individuals. We assessed the relationships between educational attainment, poverty level, and the likelihood of receiving disability benefits. A structural equation model was employed, with receipt of disability benefits as a latent factor influenced by racial background (AIAN) as a potential moderator, education as the main predictor, and poverty level and self-rated health as mediators. Gender, age, employment status, marital status, and Hispanic ethnicity served as additional covariates. Findings indicate that higher educational levels are generally associated with a lower likelihood of receiving disability benefits, mediated by improved health and economic status. Nonetheless, the interaction between race (AIAN) and education significantly influenced economic outcomes, subsequently affecting the risk of receiving disability benefits. This suggests that Whites benefit more economically from education than AIAN individuals do. The study underscores the MDR theory's relevance to the disparities in educational outcomes related to poverty risk and receiving disability benefits among AIAN populations. The challenges AIAN individuals face in leveraging their educational achievements for economic gain relative to Whites may be attributed to pervasive racism and discrimination within various sectors, including employment and education. Addressing these disparities necessitates policy interventions that ensure educational returns are equitable across racial groups, with a focus on equal access to resources and opportunities.

How the media framed the COVID‐19 crisis on Native Nations: A case comparison of The New York Times and the Navajo Times

AbstractObjectiveThis article examines how the limited national media reporting covered the pandemic in American Indian communities across the United States, specifically the Diné (Navajo) Nation, and whether and how this coverage differs from American Indian news sources.MethodsThis article compares coverage related to COVID‐19 by The New York Times (NYT) with coverage by the Navajo Times (NT), a Diné newspaper. The authors compiled their own database of news‐based articles published by the NYT and the NT covering the pandemic and its impact on Native Nations between January 1, 2020, and September 30, 2020, and conducted a comparative content analysis of these articles.ResultsWhile coverage was limited, the NYT articles highlight social inequities that settler colonialism and federal Indian law have fostered in the past and present, the cultural backdrop, which contributed to greater adverse impacts from COVID‐19. However, coverage differs from the NT in important ways, particularly when considering the distinction between the Navajo Nation as a bureaucratic entity versus the Diné people, the framing of Native peoples as adaptive, and Indigenous investment in future creation.ConclusionsThe NT was more nuanced in its coverage of stories of the impact of COVID‐19 on American Indian communities as compared to the NYT.

The California Rancheria Termination Act of 1958: The Continuous Assertion of Tribal Governments for Self-Determination

Throughout the history of the United States, the relationship with its original inhabitants has been marked by inequity, persisting from its inception in 1776. This qualitative case study delves into the enduring repercussions of the Rancheria Termination Act of 1958 on California's American Indian communities. Guided by a transformative axiological assumption rooted in respect, beneficence, and justice, this research seeks to shed light on this act's profound and lasting impacts. The California Rancheria Termination Act of 1958 (Rancheria Act) represents a joint effort by the United States government and the State of California to circumvent federal treaty responsibilities and transfer portions of tribal lands to the state. The findings of this study reveal that the Rancheria Act (1958) set tribal governments back by over 650 years. With an average of 17 years of non-existence before restoration, the 41 tribal governments affected by inequitable and racist policies continue to wage a resilient battle to reclaim their identity. In defiance of the federal government's actions, tribal governments persist in their struggle to safeguard their culture, language, spiritual practices, societal contributions, and indigenous identity. These were once threatened by the classification of terminated rancheria inhabitants as non-Indian Indians. The study has uncovered a compelling need for further research into the holistic impact of the Rancheria Act. Such research can provide the foundation for developing initiatives that empower American Indians and tribal governments to exercise their right to self-determination. These initiatives can also foster community reconciliation, addressing historical injustices impacting present issues.

A PUBLIC HEALTH APPROACH TO BRAIN HEALTH: THE HBI ROAD MAP SERIES

Abstract In 2005, congressional support led to the creation of the Healthy Brain Initiative (HBI) and the longstanding collaboration between the Alzheimer’s Association and the Centers for Disease Control and Prevention to advance understanding of and support for cognitive decline as a central part of public health practice. Since then, HBI partners have worked together to implement public health strategies that promote brain health, address dementia and help support caregivers. The Healthy Brain Initiative Road Map Series guides this effort. The first HBI Road Map was released by CDC and the Alzheimer’s Association in 2007 and was the first framework for viewing cognitive health and dementia as a public health issue. The second HBI Road Map was released in 2013 and expanded the role of state and local public health departments and partners in improving cognitive health. The third HBI Road Map, published in 2018, continued to chart a course for state and local public health departments and their partners by aligning actions with the essential services of public health. The HBI Road Map for Indian Country, published in 2019, is the first public health guide focused on dementia in American Indian and Alaska Native communities. The release of the fourth HBI Road Map in 2023 continues to advance the field and prepare public health departments to better address health equity and build capacity as new treatments become available. This symposium highlights successes of the Road Map Series and the development of the 4th edition of the HBI Road Map.