People Of Alaska Research Articles

Adapting a Financial Incentives Intervention for Smoking Cessation With Alaska Native Families: Phase 1 Qualitative Research to Inform the Aniqsaaq (To Breathe) Study.

Alaska Native and American Indian (ANAI) peoples in Alaska currently experience a disproportionate burden of morbidity and mortality from tobacco cigarette use. Financial incentives for smoking cessation are evidence-based, but a family-level incentive structure has not been evaluated. We used a community-based participatory research and qualitative approach to culturally adapt a smoking cessation intervention with ANAI families. We conducted individual, semistructured telephone interviews with 12 ANAI adults who smoke, 12 adult family members, and 13 Alaska Tribal Health System stakeholders statewide between November 2022 and March 2023. Through content analysis, we explored intervention receptivity, incentive preferences, culturally aligned recruitment and intervention messaging, and future implementation needs. Participants were receptive to the intervention. Involving a family member was viewed as novel and aligned with ANAI cultural values of commitment to community and familial interdependence. Major themes included choosing a family member who is supportive and understanding, keeping materials positive and encouraging, and offering cash and noncash incentives for family members to choose (eg, fuel, groceries, activities). Participants indicated that messaging should emphasize family collaboration and that cessation resources and support tips should be provided. Stakeholders also reinforced that program materials should encourage the use of other existing evidence-based cessation therapies (eg, nicotine replacement, counseling). Adaptations, grounded in ANAI cultural strengths, were made to the intervention and recruitment materials based on participant feedback. Next steps include a beta-test for feasibility and a randomized controlled trial for efficacy. This is the first study to design and adapt a financial incentives intervention promoting smoking cessation among ANAI peoples and the first to involve the family system. Feedback from this formative work was used to develop a meaningful family-level incentive structure with ANAI people who smoke and family members and ensure intervention messaging is supportive and culturally aligned. The results provide qualitative knowledge that can inform future family-based interventions with ANAI communities, including our planned randomized controlled trial of the intervention.

Aulukluki neqkat: Centering care of salmon and relational research in Indigenous fisheries in the Kuskokwim River, Alaska

This Indigenous-led project aims to better understand historical and contemporary ways in which Alaska Native Peoples steward salmon and the values connected to salmon stewardship. Indigenous Peoples have stewarded Alaska lands and waters for thousands of years yet have been largely excluded from western science and management systems. In this project we utilize a participatory approach that allows for the equitable valuing of ideas and knowledges to document the breadth and depth of Yup’ik and Athabascan knowledge and governance systems in southwestern Alaska. We reshape research methodologies by centering Indigenous frameworks and research methodologies including circle dialogues and multi-generational interviews led by Indigenous scholars and students in their home communities and regions. In this paper, we share the Yup’ik and Athabascan values, knowledge, management, and governance mechanisms that can improve the long-term sustainability and equity of Alaska salmon systems. This research elevates the voices of Alaska Native salmon stewards and experts from the Kuskokwim Bay and the Kuskokwim River. We elaborate on five key themes that emerged from this research including: traditional Indigenous ways of life, Indigenous stewardship, self-determination, food and livelihood sovereignty, and ecosystem changes, and identify a more equitable and sustainable path forward for salmon and people in Alaska.

Hospitalized Infections in Patients With Rheumatic Disease Hospitalizations in Alaska, 2015-2018.

Rheumatic diseases are associated with increased rates of hospitalized infection, but few studies have included Indigenous North American populations. Our objective was to evaluate the association of rheumatic disease diagnosis during a hospitalization with odds of hospitalized infections in Alaska and assess differences by race. We used hospital discharge data from the Alaska Health Facilities Data Reporting Program from 2015 to 2018. We identified people with a rheumatic disease diagnosis based on any hospital discharge diagnosis of a set of rheumatic diseases and compared them to people hospitalized but without a rheumatic disease diagnosis. We determined odds of hospitalized infection by rheumatic disease diagnosis status and type, race, and type of infection. Using multivariable modeling, we determined factors associated with hospitalized infection. Having a rheumatic disease diagnosis other than osteoarthritis was associated with 1.90 higher odds of hospitalized infection overall, whereas people of Alaska Native/American Indian (AN/AI) race with rheumatic disease had 2.44 higher odds. The odds varied by rheumatic disease and were increased in all rheumatic diseases except osteoarthritis (0.73). The most common type of hospitalized infection was sepsis, but opportunistic infections and pneumonia were most associated with a rheumatic disease diagnosis. On multivariable analysis, having a rheumatic disease diagnosis other than osteoarthritis, being of older age, and being of AN/AI race were associated with increased odds of hospitalized infection, with an interaction between race and rheumatic disease status. This study confirmed the association of hospitalized infections with rheumatic disease diagnosis (other than osteoarthritis) during hospitalization and identified disparities by race.

Measuring Attitudes About Alcohol Misuse and Dependence Among Alaska Native People Within a Tribal Health Care System.

Attitudes about alcohol misuse and dependence influence alcohol use and help-seeking behavior. Alaska Native and American Indian (AN/AI) people have higher rates of alcohol-related morbidity and mortality but engage in treatment at lower rates than the general population. No validated instruments exist to assess attitudes of AN/AI people about alcohol misuse and dependence to inform treatment and prevention efforts. This study aimed to develop an instrument to assess public attitudes among AN/AI people of alcohol misuse and dependence. This multiphase, mixed-methods study was conducted at Southcentral Foundation, a tribally owned health system serving 65,000 AN/AI people in Alaska. We conducted focus groups and interviews with health system users, providers, and leaders to adapt the Public Attitudes About Addiction Survey. The adapted instrument was piloted with 200 people. Cognitive interviews and exploratory and confirmatory factor analyses were used to refine the instrument, which were then administered to 777 AN/AI people. Initial exploratory factor analysis identified 5 factors, including 3 from the original Public Attitudes About Addiction Survey (moral, disease, nature), a combined psychology and sociology factor (psychosocial), and a new factor (environment). A final 4-factor model (psychosocial, moral, disease, nature) with 14 items had good fit with root mean square error of approximation (0.035; comparative fit index = 0.977; Tucker-Lewis index = 0.970; standardized root mean residual = 0.040) and loadings ranging from 0.41 to 0.80. This study developed the first instrument to assess AN/AI attitudes about alcohol misuse and dependence. This instrument has potential to inform alcohol-related treatment in AN/AI communities. Future research is warranted to adequately measure place-based contributors salient to AN/AI people.

Alaska Native Subsistence Rights: Taking an Anti-Racist Decolonizing Approach to Land Management and Ownership for Our Children and Generations to Come

The colonization of Indigenous Peoples in Alaska was based on racism and founded the current systemic racism, discrimination, and marginalization they experience today. Land stewardship was in the hands of Indigenous Peoples, and through colonization their land and rights to steward that land were taken away. This paper is based on a participatory research project conducted in partnership with the Ninilchik Village Tribe (NVT) in Alaska utilizing ethnographic futures research scenario storytelling through Indigenous methodologies. Scenario interviews with community members explored land-based understandings of Indigenous sustainability and the roles that subsistence, food security, and food sovereignty have in maintaining sustainability and cultural continuity for children in the future. Due to state and federal land and water management practices, Alaska Natives are limited in their abilities to practice subsistence and steward their lands. An anti-racist approach to decolonizing land management and ownership is key to Alaska Natives regaining control of their subsistence rights for food security and cultural continuity for future generations. This paper speaks to policy makers, explaining the current racist and colonial situation and suggests an antiracist and decolonizing path forward through respecting Tribal sovereignty, prioritizing Indigenous-led stewardship, and giving land back to the Alaska Native Tribal Nations.

Hospitalizations Associated With Rheumatic Disease in Alaska, 2015-2018.

ObjectiveFew studies have evaluated hospitalizations associated with rheumatic disease in Indigenous North American populations. The objective of this study was to determine the characteristics of people hospitalized with rheumatic disease in Alaska, including a comparison of hospitalizations for Alaska Native/American Indian (AN/AI) people in Alaska compared with those of other races.MethodsWe used statewide hospital discharge data from the Alaska Health Facilities Data Reporting Program from 2015 to 2018 for this study. Cases were ascertained based on discharge diagnosis (any listed) of a defined set of rheumatic diseases. We determined characteristics associated with rheumatic disease hospitalizations, including age, gender, and race. Using multivariate modeling, we determined risk factors for hospitalization overall, as well as for specific rheumatic diseases. We compared characteristics of hospital encounters for people with or without rheumatic diseases and by race.ResultsWe identified 15975 people ever hospitalized with rheumatic disease in the study period and 87138 controls hospitalized but without any rheumatic disease diagnosis. Cases were older than controls and more likely to be female. The three most common types of rheumatic disease associated with hospitalization were osteoarthritis, gout, and rheumatoid arthritis. Compared with other races, AN/AI people were more likely to be hospitalized with rheumatic disease, and this association was true for all specific diseases other than gout.ConclusionHospitalizations associated with rheumatic disease are common in Alaska, with an increased likelihood of hospitalization for AN/AI people. This adds to the literature on health disparities in Indigenous North American populations.

Evaluating a Cluster and the Overall Trend of Invasive Haemophilus influenzae Serotype b in Alaska 2005-2019.

In 2019, 5 cases of invasive Haemophilus influenzae serotype b (Hib) occurred in the Anchorage region of Alaska over a period of 16 days. No cases had occurred in Alaska in the preceding 26 months. Alaska Hib isolates from 2005 through 2019 were analyzed using whole-genome sequencing (WGS). Rates were compared with the CDC's Active Bacterial Core surveillance (ABCs) data. A total of 33 cases of invasive Hib occurred in Alaska from 2005 through 2019. Of the 5 cases associated with the cluster, 2 (40%) occurred in adults and all occurred in the Anchorage region. In contrast, only 14% (4/28) of the noncluster cases occurred in this region (P < 0.01). Two cluster cases were linked epidemiologically and the bacteria were nearly identical. The other 3 cluster cases were caused by 3 genetically distinct bacteria. When the full period was evaluated, the unadjusted rate of invasive Hib disease in Alaska was 15.5 times higher in Alaska Native (AN) people than non-AN people [1.3/100,000 vs. 0.07/100,000, 95% confidence intervals (CI): 10.2-22.5). The age-adjusted rate of invasive Hib disease in Alaska was 9.4 times higher than the ABCs rate (95% CI: 6.3-14.1). While clustered in time and space, the 5 cases in 2019 were not due to a single bacterial strain. AN people continue to have elevated rates of invasive Hib infection compared with both non-AN people in Alaska and the ABCs population.

Nicotine metabolism and its association with CYP2A6 genotype among Indigenous people in Alaska who smoke.

Prevalence of smoking is higher in Alaska Native and American Indian (ANAI) populations living in Alaska than the general US population. Genetic factors contribute to smoking and cessation rates. The objective of this study was to compare CYP2A6 genetic variation and CYP2A6 enzyme activity toward nicotine in an ANAI population. ANAI (N = 151) people trying to quit smoking were recruited. DNA samples were genotyped for CYP2A6 variants *1X2A, *1B, *2, *4, *9, *10, *12, and *35. Multiple nicotine metabolites were measured in plasma and urine samples, including cotinine and 3′‐hydroxycotinine used to determine CYP2A6 activity (e.g., nicotine metabolite ratio [NMR]). We calculated summary statistics for all of the genotypes and metabolites and assigned CYP2A6 activity scores based on known information. We studied the association of CYP2A6 variants with the NMR and smoking histories. The overall frequency of the CYP2A6*1B gain of function allele was high in the ANAI versus non‐ANAI populations in other studies. Both *4 null and *9 decrease of function alleles had frequencies similar to previous studies of ANAI populations. In a multivariate analysis, the genotype‐inferred CYP2A6 activity score was associated with both plasma and urine NMR (p value = 8.56E‐08 and 4.08E‐13, respectively). Plasma NMR was also associated with duration of smoking (p value < 0.01) but not urinary total nicotine equivalents uncorrected for creatinine (TNE9uc) or biological sex. Urine NMR was significantly associated (p value < 0.01) with TNE9uc. Variation in NMR in this ANAI population is explained in part by CYP2A6 genetic variation.

Falsification in the sources of the history of Russian America and their effects

ABSTRACT Intentional or unintentional falsification of data, understatement of information, distortion of statistics, manipulation or invention of new facts are periodically encountered in official documents connected with Russian colonization of America. People in Alaska and St. Petersburg who managed the process of colonization, as well as the highest officials of the empire, resorted to such methods. Some falsifications were revealed during the time of Russian America, others continue their existence up to the present on the pages of the works of historians. The most negative effects resulted from falsifications based on which important and extremely rash management decisions were made. As an example, it is possible to cite the royal decree of 4 September 1821, which resulted in serious consequences for Russian America and the birth of the famous Monroe Doctrine in Washington, as well as press materials, documents, and notes of officials related to preparation for the sale of Alaska to the United States in 1867.

Characterization of CYP3A pharmacogenetic variation in American Indian and Alaska Native communities, targeting CYP3A4*1G allele function.

The frequencies of genetic variants in the CYP3A4 and CYP3A5 genes differ greatly across global populations, leading to profound differences in the metabolic activity of these enzymes and resulting drug metabolism rates, with important consequences for therapeutic safety and efficacy. Yet, the impact of genetic variants on enzyme activity are incompletely described, particularly in American Indian and Alaska Native (AIAN) populations. To characterize genetic variation in CYP3A4 and CYP3A5 and its effect on enzyme activity, we partnered with AIAN people living in two regions of Alaska: Yup’ik Alaska Native people living in the Yukon‐Kuskokwim Delta region of rural southwest Alaska and AIAN people receiving care at the Southcentral Foundation in Anchorage, Alaska. We identified low frequencies of novel and known variation in CYP3A4 and CYP3A5, including low frequencies of the CYP3A4*1G and CYP3A5*1 variants, and linkage disequilibrium patterns that differed from those we previously identified in an American Indian population in western Montana. We also identified increased activity of the CYP3A4*1G allele in vitro and in vivo. We demonstrated that the CYP3A4*1G allele confers increased protein content in human lymphoblastoid cells and both increased protein content and increased activity in human liver microsomes. We confirmed enhanced CYP3A4‐mediated 4β‐vitamin D hydroxylation activity in Yup’ik people with the CYP3A4*1G allele. AIAN people in Alaska and Montana who carry the CYP3A4*1G allele—coupled with low frequency of the functional CYP3A5*1 variant—may metabolize CYP3A substrates more rapidly than people with the reference CYP3A4 allele.

Developing a Social Media Intervention to Connect Alaska Native People Who Smoke with Resources and Support to Quit Smoking: The Connecting Alaska Native Quit Study.

Face-to-face tobacco cessation has had limited reach and efficacy in Alaska Native (AN) communities. We describe our two-phased approach to develop content for Connecting Alaska Native People to Quit Smoking, a Facebook group intervention to reduce barriers to evidence-based smoking cessation treatment for AN people in Alaska. Phase 1 included semi-structured telephone interviews with 30 AN people who smoke and ten stakeholders. They provided feedback on existing content from the Centers for Disease Control and Prevention Tips campaign and AN digital stories. Phase 2 included an online survey with a new group of 40 AN smokers who provided feedback on existing content via a measure of perceived effectiveness and cultural relevance. Phase I results revealed participants evaluated content based upon story strength, relevance to AN culture, emotional appeal, relatability to AN people, and favorite video. No single posting was rated highly across all themes. All perceived effectiveness (PE) and cultural relevance median scores fell between 3.5 and 4.4 (range 1-5). PE scores varied across participant demographic groups. Content embodying characteristics perceived to be most appealing, effective, and culturally relevant were selected for the private Facebook group content library with refinements made to incorporate images of AN people engaged in AN activities. PE scores indicate a need for a wide variety of content that moderators could pull from when conducting the intervention. Social media content targeting specific population sectors, such as American Indian/AN people for tobacco cessation needs to be culturally tailored. Our approach provides a model others can follow to determine what is appealing, relevant, and effective messaging. NCT03645941.

Tribal Leadership and Care Services: "Overcoming These Divisions That Keep Us Apart".

American Indian and Alaska Native (AI/AN) Peoples are among groups continuing to experience health disparities. Eliminating health disparities, a national priority in the United States, requires addressing structural forces, also known as structural determinants of health. This case study examines linkages between health disparities, structural forces, and colonial trauma relevant to care services and AN Peoples in Alaska. It centers on an Inupiaq Elder with leadership experience in AN tribal care services. Guided by a conceptual lens based on division-unification processes, this study yields the following findings as represented by five in vivo themes: severing of relationship, aftereffects of colonization, striking alliances, overcoming these divisions that keep people apart, and growing together in relationship. Colonial legacies continue to linger and have a multidimensional impact on AI/AN communities, including tribal care services. Healing from colonial trauma requires collective effort among AI/AN Peoples and people from the wider community. Practice implications emphasize trauma-informed approaches to promote reconciliation and a larger collective commitment to reconciliation in a global reality of increasing interdependence.

Climate change in Alaska: Social workers’ attitudes, beliefs, and experiences

The average temperature in Alaska and the North American Arctic has risen at twice the rate of the global average due to climate change, causing changes to the natural environment that affect the physical, social, and emotional well‐being of people and communities. Social workers must be prepared to respond. Using a non‐probability, convenience sample, this study surveyed 159 social workers in Alaska to assess their attitudes and their perceptions of the effects of climate change on their clients and constituents. Results indicate that social workers in Alaska believe that climate change is happening, that human activities are responsible, and that it is a large threat to people in Alaska. Over 75% believe that climate change is dangerous for their clients now or will be dangerous in 10 years. Social workers report that in the past year their clients or constituents have experienced multiple climate change‐related problems with community infrastructure, health, and mental health.

Disentangling Benefit-Sharing Complexities of Oil Extraction on the North Slope of Alaska

This paper analyses benefit-sharing arrangements between oil companies, native corporations, the North Slope Borough, and Indigenous Peoples in Alaska. It aims to disentangle the complexities of benefit-sharing to understand existing procedural and distributive equity. We identified benefit-sharing regimes involving modes, principles, and mechanisms of benefit-sharing. This includes modes that reflect institutionalized interactions, such as paternalism, company centered social responsibility (CCSR), partnership, and shareholders. Principles can be based on compensation, investment and charity. Mechanisms can involve negotiated benefits and structured benefits, mandated by legislation, contracts, or regulation. Furthermore, mechanisms can involve semi-formal and trickle-down benefits. Trickle-down benefits come automatically to the community along with development. The distribution of money by the North Slope Borough represents the paternalistic mode, yet involves investment and mandated principles with top–down decision making. They are relatively high in distributional equity and low in participatory equity. Native corporations predominantly practice the shareholders’ mode, investment principle, and mandated mechanisms. The oil companies’ benefit-sharing represents a mixed type combining CCSR and partnership modess, several principles (investment, compensatory, charity) and multiple types of mechanisms, such as mandated, negotiated, semi-formal and trickle-down. These arrangements vary in terms of distributive equity, and participatory equity is limited.

Le jeu vidéo comme vecteur d’expression du patrimoine culturel des Iñupiats d’Alaska.

En 2014, une collaboration entre le studio Upper One Games et des conteurs et aînés iñupiats d’Alaska a mené au lancement du jeu vidéo Kisima Inŋitchuŋa (Never Alone). Ce jeu de plateforme invite à une immersion poétique dans un univers nordique guidée par une trame narrative inspirée d’une légende traditionnelle. Dans une perspective culturelle, les fonctions ludique et documentaire du jeu permettent d’acquérir des connaissances en lien avec les pratiques traditionnelles et la vision du monde des Iñupiats. Ainsi, l’étude exploratoire présentée dans cet article contribue à comprendre les caractéristiques du jeu (design, narration, mécaniques) et les stratégies relevant de sa conception. Les résultats invitent à reconsidérer des représentations dominantes du Grand Nord et soulignent en quoi le jeu vidéo se fait vecteur d’expression du patrimoine culturel, artistique et oral d’un peuple autochtone de l’Arctique.

The One Two Punch – Warm Alaskan Winters – Global Warming

People in Alaska have been suffering due to the absence of sea ice and the warm Winters of 2017-18 and 2018-19 affecting their livelihood. The weather has taken to very unusual conditions in the winter. Weathermen have done an excellent job of reporting the occurring conditions. The high pressure ridges of weather school 101 have been blamed for the poor winter conditions. The real reason for the trouble is the impacts of exploding stars discussed in a number of papers as the SNIT theory. The major exploding stars being considered also cause heat waves in Sweden, Pakistan, and India with deaths and drought in Pakistan and India at the same time they are melting sea ice in the Antarctic. The variation of Earth’s average temperature confirms the SNIT theory.

Therapeutic effect of Northern Labrador tea extracts for acute myeloid leukemia

Acute myeloid leukemia (AML) is an aggressive hematological malignancy that is one of the more common pediatric malignancies in addition to occurring with high incidence in the aging population. Unfortunately, these patient groups are quite sensitive to toxicity from chemotherapy. Northern Labrador tea, or Rhododendrontomentosum Harmaja (a.k.a. Ledumpalustresubsp.decumbens) or "tundra tea," is a noteworthy medicinal plant used by indigenous peoples in Alaska, Canada, and Greenland to treat a diversity of ailments. However, laboratory investigations of Northern Labrador tea, and other Labrador tea family members, as botanical sources for anticancer compounds have been limited. Utilizing an AML cell line in both in vitro and in vivo studies, as well as in vitro studies using primary human AML patient samples, this study demonstrated for the first time that Northern Labrador tea extracts can exert anti-AML activity and that this may be attributed to ursolic acid as a constituent component. Therefore, this medicinal herb holds the potential to serve as a source for further drug discovery efforts to isolate novel anti-AML compounds.

Особенности этноконфессионального сознания народов Аляски и его значение в историко-культурном наследии Русской Америки

Особенности этноконфессионального сознания народов Аляски и его значение в историко-культурном наследии Русской Америки

Empowering Community-Driven Change: Leadership in Southcentral Foundation’s Nuka System of Care

Health care organizations often struggle with the question of how to implement change. The process of implementing change can be difficult and is sometimes met with institutional resistance. Southcentral Foundation’s approach may prove useful for other organizations to study. SCF is an Alaska Native customer-owned system responsible for providing health care and related services to approximately 65,000 Alaska Native and American Indian people in Alaska’s Cook Inlet region. SCF took on this responsibility in 1998 and subsequently implemented major reforms to the health care system with the goal of better serving its patients (referred to as “customer-owners” at SCF). All change at SCF is driven by customer-owners. SCF constantly solicits their input, and engages with the community in a variety of ways on a regular basis, to gather their feedback and determine the changes and improvements they want to see made. Once the customer-owners have given direction for what to do, SCF implements change on an organizational level. SCF leadership empowers employees to make needed change while ensuring that everyone in the organization remains focused on the goals and values of the organization. SCF’s leadership is committed to several principles to support employees as they make improvements desired by customer-owners. SCF’s leadership encourages calculated risk-taking innovation and creativity on the part of employees; they are encouraged to try out new ideas and look for new approaches to problems. SCF’s leadership drives quick change while being conscious of the potential for work fatigue in employees. SCF also strives to grow leadership from within by mentoring employees and supporting them in educational efforts. SCF’s leadership works to maximize individual employee skill while encouraging personal relationships within all employee ranks without sacrificing accountability. Employees are encouraged to take ownership of the organization and are given power in decision-making. SCF’s leadership is also committed to building and maintaining the infrastructure needed to support the organization, as well as a data system to measure quality and improvements. SCF’s approach to making changes, both large and small, has proven beneficial both for the organization and for customer-owners. ER visits for customer-owners declined by 36 percent from 2000 to 2015, and hospital admissions also declined by 36 percent in that same period. SCF has exceeded the 90th percentile in Healthcare Effectiveness Data Information Set (HEDIS) measures such as diabetes care annual testing and diabetes hba1c control. 96 percent of customer-owners are satisfied with the care provided by SCF, and SCF has also achieved 93 percent employee satisfaction. SCF has sustained these improvements for almost two decades. Although SCF’s operating principles are derived from Alaska Native culture and values, other organizations can learn valuable lessons from SCF’s approach to leadership and driving change. Though specifics will vary between organizations, SCF’s culture of encouragement and support can work in any organization, and can bring better results for both employees and the people being served. Empowering employees and patients both to drive organizational change is something that every health care organization should consider.

Maximizing Community Voices to Address Health Inequities: How the Law Hinders and Helps.

This paper highlights the need to apply an equity lens when assessing the impact of preemption and related legal doctrines on community health. Community autonomy to set and pursue public health priorities is an essential part of achieving health equity. Unfortunately, the priorities of organized industry interest groups often conflict with health equity goals. These groups have a history of successfully using law to limit community autonomy to pursue public health measures, most notably through preemption and related legal doctrines. We examine this phenomenon using two examples. First, we look at dental association efforts to block the spread of dental therapists in Indian Country. Native dental therapists have been improving the oral health of native people in Alaska for over a decade; yet the national and state dental associations have sought with mixed success to leverage state and federal laws to hinder other tribal governments from utilizing these providers. We compare these efforts with a restaurant association-led movement to limit what municipal governments can do to address food-based health inequities, focusing on a "model" ALEC bill that started in Ohio. Finally, we discuss how municipalities and Tribes are fighting back and continuing to pursue health equity for their communities.