Tribal Organizations Research Articles

Building community resilience to extreme heat: Lessons learned from Spokane, WA community conversations

Abstract Heat is the primary cause of weather-related mortality in the United States. The 2021 Northwest heat dome highlighted this susceptibility. In Washington State, 159 excess deaths were attributed to the 7-day period of unprecedented extreme heat between June 26th and July 2nd. This impact was felt even in some of the more acclimatized parts of the state, like Spokane County, where 19 heat-related deaths were reported. As climate change increases the frequency, duration, and intensity of extreme heat events, creating and sustaining heat-resilient communities has become an urgent public health priority. On 6 June 2023, Gonzaga University, in partnership with the University of Washington, hosted the Spokane Extreme Heat Risk Intervention Stakeholder Synthesis Symposium. The goals of the symposium were to debrief from recent heat events, identify extreme heat risk reduction interventions used in the region, and characterize remaining practice-relevant research priorities. The symposium convened 45 stakeholders including representatives from local and state agencies, academia, and community-based and Tribal organizations. Symposium participants engaged in small group discussions using the World Café MethodTM. Notes from each discussion were coded using a content analysis approach. Symposium participants identified strengths, barriers to heat resilience, and solutions to reduce risk throughout the Spokane community. We present these findings by practice topic, including risk communication, intervention, collaboration, policy, and research. Additionally, we utilize the socio-ecological model as a conceptual framework to illustrate the complex interplay of factors that govern an individual’s experience of, and ability to respond to, extreme heat events. Given extreme heat’s impact on global public health, the methods used to increase community resilience in Spokane, WA, USA could be used by other communities worldwide to increase their own heat-resilience.

Quantifying the Burden of Opioid Use Disorder and Non-fatal Opioid Overdose in American Indian and Alaskan Native Populations Using the Cerner Real-World Data™ Database.

This study evaluated the prevalence and incidence of opioid use disorder (OUD), rates of opioid overdose (OD), and rates of non-fatal (NF) OD in American Indian/Alaskan Native (AI/AN) populations. We used de-identified patient data from Oracle Cerner Real-World Data™. Rates were estimated over time, and stratified by sex, age, marital status, insurance, and region. Mann-Kendall trend tests and Theil-Sen slopes assessed changes over time for each group while autoregressive modeling assessed differences between groups. The study identified trends in OUD and OD among 700,225 AI/AN patients aged 12 and above. Between 2012 and 2022, there was a significant upward trend in both OUD and OD rates(p < 0.05) , with OUD diagnosed in 1.75% and OD in 0.38% of the population. The Western region of the US exhibited the highest rates of OUD and OD. The 35-49 age group showed the highest rates of OUD, while the 12-34 age group had the highest rates of OD. Marital status analysis revealed higher rates of OUD and OD among separated, widowed, or single patients. Additionally, individuals with Medicare or Medicaid insurance demonstrated the highest rates of OUD and OD. Results show that rates of OUD, OD, and NF OD continue to rise among AI/AN individuals, with some regional and demographic variation. Our study provides foundational estimates of key AI/AN populations bearing greater burdens of opioid-related morbidity that federal, state, and tribal organizations can use to direct and develop targeted resources that can improve the health and well-being of AI/AN communities.

Funding State and Local Health Departments and Tribal Organizations to Implement and Evaluate Cardiovascular Disease Public Health Strategies: A Collaborative Approach.

Funding State and Local Health Departments and Tribal Organizations to Implement and Evaluate Cardiovascular Disease Public Health Strategies: A Collaborative Approach.

Beraht, harti, kuoni, gund. Heroic traits in Germanic names and surnames

The present study aims to analyze important features of the heroes who fought the Germanic wars of antiquity, starting from Old German words that have been preserved until today in the names of individuals. Thus, in both German first names and surnames, we find the following appellatives from the semantic sphere of war and weapons (ēra ”honour”, gund, hadu, hiltja, wīg ”war”, sigu ”victory”, ask ”ash pike”, brant ”sword”, gēr ”spear”, helm ”helmet”), wild animals (wolf ”wolf”, bero ”bear”, arn ”eagle”, ebur ”boar”, falco ”falcon”), the sovereign (burg ”fortress”, fridu ”protection against weapons”, rīhhi ”ruler, power”, thiot ”people”), as well as adjectives that refer to the attributes of warriors (adal ”distinguished, noble, chosen”, beraht ”bright”, kuoni ”brave”, liob ”kind, dear”, māri ”famous”, trūt ”close, beloved”) (e.g. Erhard, Gunter, Hilger, Siegbert, Wighard; Aschwin, Gerhard, Helmut; Wolfgang, Bernhard, Eberhard; Adalbert, Konrad, Liebward, Dietmar, Trudbert and others). The work also presents the most frequent surnames of Germanic origin in Germany (2005) and Transylvania (1935). With the weakening of gentile and tribal organizations, and with the advent of Christianity, many names of Germanic origin in the German language were replaced by names of saints and names from the New Testament.

Centering Community, Indigenous Relationships, and Ceremony through an Alaska Native Collaborative Hub to Prevent Suicide and Promote Youth Wellbeing

The Alaska Native Collaborative Hubfor Research on Resilience (ANCHRR) engages Indigenous leadership at all levelsin a strength-based study to deepen our understanding of community levelprotective factors in Indigenous communities, which are the collectiveinfluences shaping individual wellbeing across time. Overall, ANCHRR aims toposition Alaska Native Tribes, Tribal organizations, and community members asthe guides for culturally responsive research that is aligned with communitypriorities of increasing resilience and wellbeing among Alaska Native youth andreducing their suicide risk. Our approach brings together Indigenous knowledgeand research methods that humbly draw attention to the solutions that alreadyexist within communities. An Indigenous paradigm shifts the approach from asingular focus on individuals and their risks and deficits, to appreciation forthe cultural, community and systemic ways in which community members support,care for, and guide their young people into adulthood. We describe the lessonslearned about this unique approach to Indigenous leadership and community engagementand discuss the research processes that keep the relational heart-work at thecenter of every project activity. This capacity-building, mutually beneficialand relational approach offers new insights to knowledge development endeavors.

Indigenous research ethics and Tribal Research Review Boards in the United States: examining online presence and themes across online documentation

Researchers seeking to engage in projects related to Tribal communities and their citizens, lands, and non-human relatives are responsible for understanding and abiding by each Tribal nation’s research laws and review processes. Few studies, however, have described the many diverse forms of Tribal research review systems across the United States (US). This study provides one of the most comprehensive examinations of research review processes administered by Tribal Research Review Boards (TRRBs) in the US. Through a systematic analysis, we consider TRRBs’ online presence, online documentation, and themes across documents, for five entity types: Tribal nations and Tribal consortiums, Tribal colleges and universities, Tribal health organizations, Indian Health Services, and other Tribal organizations. Results include an assessment of online presence for 98 potential TRRBs, identification of 118 publicly available online documents, and analysis of 41 themes across four document types: Tribal research codes and TRRBs’ guidelines, applications, and post-approval documents. Altogether, this research provides a macro-level analysis of the most common types of TRRBs in the US in an effort to increase researchers’ understanding of these important processes as they prepare to ethically engage Tribal communities in research. These results aim to empower Tribal decision makers as they align their TRRBs’ online visibility and documentation with community priorities and strengthen their protections for the rights and wellbeing of their citizens and community. Ultimately, by expanding our knowledge of TRRBs across the US, this contribution seeks to uphold Tribal sovereignty in research and promote ethical approaches to research with Indigenous communities.

Exploring Jiarong Tibetan's Diverse Religious Culture through the Intangible Cultural Heritage of Buzha Drama

The Buzha drama of the Garzê Tibetan people is a unique “ritual dance” performed periodically in various religious settings. This form of performance, which falls between theater and dance, reflects the diverse cultural and belief systems of the local people and has been listed as an intangible cultural heritage for protection in recent years. Tribal organizations integrate various religious and cultural forms, including folk beliefs, Bon, Tibetan Buddhism, local customs, and regional knowledge into folk song and dance, transforming them into psychological customs and ethnic emotions, penetrating cultural elements. This article takes an anthropological perspective and examines the relationship between the artistic representation of the Buzha drama and the region's life, spiritual beliefs, and ethnic identity through prop making, ritual procedures, and dance content. The article also explores the characteristics and values of the diverse religious culture of the Garzê Tibetan people.

THE HEALTHY BRAIN INITIATIVE ROAD MAP CATALYZES ACTION AMONG STATE, LOCAL, AND NATIONAL PARTNERS

Abstract The Healthy Brain Initiative Road Map Series (Road Map) has achieved measurable success in spurring action in health departments across the country. Evaluation data from the Alzheimer’s Association shows all 50 states have implemented actions from the 2018-2023 Road Map and the majority of states completed at least one action in each of the four domains of the Road Map. The Healthy Brain initiative has also sponsored initiatives to accelerate the implementation of Road Map actions. The projects described are separate from the CDC’s BOLD Program Awards for state and local health departments. The Road Map Strategist Initiative supports local health departments and tribal organizations. It has funded 16 agencies over the past two years to implement Road Map actions in their communities. A coordinated campaign to increase implementation and utilization of the BRFSS caregiving and subjective cognitive decline modules has near nationwide uptake, and, in 2023, a new project, Data for Action, launched in four states to support the use and dissemination of BRFSS and other data. Together, these projects improve assessment, planning and measurement of community health outcomes related to brain health. The 4th edition of the HBI Road Map has an accompanying evaluation tool offering common measures for state and local health departments to track their success as they implement the new actions. This session will explore the past impact of Road Map actions and opportunities for future measurement.

POLICY SERIES: STRATEGIES TO FRAME OUR PUBLIC POLICY WORK

Abstract Our words and the way we harness the power of them when advocating for age inclusive policies, like the Older Americans Act (OAA), matters. Since 1965 the OAA has supported our nation with funds to strengthen community social services. It currently authorizes a wide array of service programs through a national network of 56 state agencies on aging, 618 area agencies on aging, nearly 20,000 service providers, 281 Tribal organizations, and 1 Native Hawaiian organization representing 400 Tribes. In 2024, the OAA will be considered for reauthorization. We all have a stake in ensuring it is passed so we all have the infrastructure we require as we age. Join The National Center to Reframe Aging and the National Center on Elder Abuse, the leading organizations for effective framing, in this session to discuss the OAA as an example of how we can apply communication strategies in supporting reauthorization, review framing strategies to advance a more equitable story of aging in America and learn how to apply framing tools to your advocacy communications.

STRATEGIES TO FRAME OUR PUBLIC POLICY WORK

Abstract Our words and the way we harness the power of them when advocating for age inclusive policies, like the Older Americans Act (OAA), matters. Since 1965 the OAA has supported our nation with funds to strengthen community social services. It currently authorizes a wide array of service programs through a national network of 56 state agencies on aging, 618 area agencies on aging, nearly 20,000 service providers, 281 Tribal organizations, and 1 Native Hawaiian organization representing 400 Tribes. In 2024, the OAA will be considered for reauthorization. We all have a stake in ensuring it is passed so we all have the infrastructure we require as we age. Join The National Center to Reframe Aging and the National Center on Elder Abuse, the leading organizations for effective framing, in this session to discuss the OAA as an example of how we can apply communication strategies in supporting reauthorization, review framing strategies to advance a more equitable story of aging in America and learn how to apply framing tools to your advocacy communications.

Examining Characteristics of Local Public Health Systems With Exceptional Tribal Organization Participation.

To learn feasible ways to increase multisector community partnership with tribal organizations, meaning tribal health authorities or American Indian and Alaska Native (AI/AN)-serving organizations, by examining characteristics of local public health systems with exceptional tribal organization participation. In total, 728 local public health departments were surveyed in 2018 to generate a nationally representative sample of local public health systems in the United States. A positive deviance approach using logistic regression helped identify local public health systems that had tribal organization participation despite characteristics that make such participation statistically unlikely. Local public health systems with exceptional tribal organization participation were compared with systems with conventional participation, examining measures known to impact the formation of public health partnerships. This study used an exploratory logistic regression approach to identify unique characteristics of local public health systems with exceptional tribal organization participation. Of 728 health systems surveyed, 21 were identified as having exceptional tribal organization participation. Across varying thresholds to identify exceptional participation, having a higher network density and prioritizing equity in public health activities were found to consistently distinguish exceptional tribal organization participation in both nonrural and rural areas. Public health partnerships with tribal organizations are possible even in circumstances that make them unlikely. Efforts to build denser networks of collaborating organizations and prioritize equity may help public health systems achieve success with tribal organization partnerships.

Reducing Cancer Risk Through Primary Prevention Activities Among Children: A Demonstration Project.

Opportunities to reduce the risk of cancer, including cervical, liver, and skin cancer, start early in life. To encourage adoption of primary prevention activities in childhood to reduce cancer risk later in life, Centers for Disease Control and Prevention conducted a demonstration project with 3 National Comprehensive Cancer Control Program (NCCCP) recipients. Iowa, Northwest Portland Area Indian Health Board (NPAIHB), and Pennsylvania NCCCP recipients implemented evidence-based primary prevention activities for cervical, liver, and skin cancer among children using health care provider education, patient education, and policy development. Iowa implemented an announcement approach to improve provider education on human papillomavirus (HPV) vaccination. Pennsylvania focused on patient education for reducing skin cancer risk and both provider and patient education for liver cancer prevention. NPAIHB created a sun safety intervention for tribal organizations, including a policy guide, media materials, and patient education. In Iowa, health care providers taking the announcement approach reported significantly higher mean scores on a posttest compared with a pretest regarding perceptions about HPV vaccination, self-efficacy, and behavioral intentions related to vaccination. Pennsylvania integrated sun safety education and sunscreen dispenser programs as a health and wellness initiative in 8 state parks and the Pennsylvania Department of Conservation and Natural Resources incorporated the program in its Pennsylvania Outdoor Recreation Plan. Pennsylvania also implemented health care provider education on the primary prevention of liver cancer through hepatitis B and hepatitis C screening and hepatitis B vaccination. The NPAIHB skin cancer policy guide was created and distributed for use to all 43 federally recognized tribes of Oregon, Washington, and Idaho served by NPAIHB. The identification, dissemination, and implementation of these efforts can serve as best practices for future childhood primary prevention programs. NCCCP recipients and public health professionals can use health care provider education, patient education, and policy development to reduce future risk for cervical, liver, and skin cancer among children.

Where Are the Children? A Thematic Analysis of State, Territory, and Tribal Organization Comprehensive Cancer Control Plans

BackgroundThe Center for Disease Control's Comprehensive Cancer Control Program (CCCP) funds initiatives in fifty states, the District of Columbia, seven U.S. territories, and seven tribal organizations to prevent and control cancer. These initiatives influence policy, care, research, and advocacy for cancer treatment. We performed an analysis of CCCP plans for states, U.S. territories, and tribal organizations to understand the extent of inclusion of pediatric cancer care. MethodsWe conducted a thematic and quantitative analysis of CCCP plans for states, U.S. territories, and tribal organizations. Plans were assessed by two reviewers and scored for discussion of cancer prevention, risk factors, early detection and screening, treatment and innovation, access, barriers to care, and survivorship in childhood cancer. ResultsPlans from fifty states, the District of Columbia, seven territories, seven tribal organizations, and one Pacific Regional (USAPI) plan were reviewed, for a total of sixty-six plans. Up-to-date CCCP plans were available through the CDC or state websites for 74% of states, 57% of territories, and 71% of tribal organizations; older plans were available for all groups without up-to-date CCCP plans. While all plans referenced children, most did so in the context of childhood exposures influencing adult cancer risks (e.g., sun, tobacco, HPV). Few plans contained a section dedicated to childhood cancer (30% states, 14.3% territories, 14.3% tribes). A minority of plans specifically discussed early detection and screening (14% states, 0% territories, 14.3% tribes), treatment and innovation (32% states, 0% territories, 28.6% tribes), access to cancer care (38% states, 28.6% territories, 28.6% tribes), reducing barriers to cancer care (28% states, 42.9% territories, 28.6% tribes), and pediatric cancer survivorship (42% states, 0% territories, 28.6% tribes). ConclusionsPromoting inclusion of pediatric cancer in CCPs will help to standardize pediatric cancer care, eliminate treatment disparities across state lines, and allow for comprehensive understanding of pediatric oncology. Level of EvidenceLevel IV.

The Role of Opinion Leaders in Resolving Conflicts and Disputes in Muş Province Tribal Organizations

Bu çalışmanın amacı, Muş ilinde görülen ve özellikle aşiretler arasında yaşanan birtakım anlaşmazlıkların çözümünde rol oynayan kanaat önderlerinin hangi konularda ve ne düzeyde etkili olduklarını tespit etmektir. Bu bağlamda kanaat önderlerinin çözüm ürettikleri konulara nasıl müdahale ettikleri ve uyguladıkları yöntemlerde hangi ölçütleri referans aldıkları anlaşılmaya çalışılmıştır. Nitel araştırma yaklaşımıyla yürütülen bu çalışmada Muş’ta yaşayan ve kartopu örnekleme yoluyla ulaşılan 10 kanaat önderiyle yüz yüze görüşmeler gerçekleştirilmiştir. Araştırma verilerinin toplanmasında, açık uçlu bir görüşme formu uygulanmış ve verilerin analizinde betimsel analiz yöntemi kullanılmıştır. Araştırma bulgularında; aşiretlerin özellikleri, aşiretlerde görülen anlaşmazlık ve çatışmaların ortaya çıkış nedenleri, kimlere kanaat önderi dendiği, kanaat önderlerinin ne gibi roller üstlendikleri ve çözüm üretirken uyguladıkları yöntemlere yer verilmiştir. Araştırma sonucunda Muş’ta aşiret sistemine bağlı geleneksel toplum yapısının hâkimiyetini devam ettirdiği ve bu nedenle kanaat önderlerinin toplumsal yaşamda etkili bir aktör olduğu anlaşılmıştır. Muş’ta yaşanan anlaşmazlık ve çatışmaların çözümünde dini inancın ve kültürel değerlerin karar alma süreçlerinde etkili olduğu sonucuna ulaşılmıştır. Kanaat önderlerinin çözüm üretirken söz konusu değer ölçütlerini referans alarak geliştirdikleri tepkilerin toplumsal yaşamda olumlu bir karşılığı olduğu anlaşılmıştır.

A science and management partnership to restore coregonine diversity to the Laurentian Great Lakes

Similar to many freshwater ecosystems, the Laurentian Great Lakes of North America have undergone numerous anthropogenic stressors resulting in considerable loss of biodiversity and habitat. Among Great Lakes fishes, the coregonine sub-family has endured the most extensive declines, including extinction of several species ( Coregonus johannae, C. alpenae, and C. kiyi orientalis) and at least 10 instances of local extirpations of other species ( C. nigripinnis, C. reighardi, C. zenithicus, C. hoyi, and C. artedi) across all 5 lakes, much of which occurred prior to the 1960s owing to overfishing, interactions with non-indigenous species, and habitat loss. Despite these declines, no federal-, provincial-, or state-mandated actions were ever implemented to conserve coregonine diversity, potentially because so much of the coregonine declines occurred prior to the enactment of federal conservation legislation. Possible explanations for inaction since enactment of that legislation include insufficient data on biological vulnerability or threats, unresolved taxonomy, and limited support from the fishery management agencies and their stakeholders prior to the 2000s. In recent decades, however, several fishery management agencies have undertaken efforts to re-introduce coregonine diversity. These efforts helped lead to development of a science-based framework to restore coregonines that was universally endorsed by fishery managers representing eight U.S. states, four U.S. tribal organizations, and the province of ON, Canada, in May 2018. The basin-wide framework is based on principles of conservation biology and adaptive management. We describe details of its key steps, including planning, restoring, and evaluating, while also describing recent implementation efforts to develop methods, improve available resources, and enhance coordination across the basin. Although our paper describes a regional effort to restore native coregonines, our adaptive-management approach could be used by other multi-agency stakeholders seeking to conserve or restore native fishes.

California awards $17 million for SUD prevention for youth

This month Gov. Gavin Newsom of California announced that almost $17 million has been awarded to 44 community‐based and tribal organizations to develop and increase substance use disorder (SUD) prevention services through civic engagement and culturally competent programs. These awards are part of Elevate Youth California, a statewide Department of Health Care Services (DHCS) initiative to help grassroots community‐based and tribal organizations develop programs for young people living in communities that are disproportionately impacted by the war on drugs.

Abstract B061: Development of small media on cancer education for cervical, breast, and colorectal screening in the Pueblo of Zuni

Abstract American Indians (AIs) experience continued disparities in incidence, mortality, and survival on cancers responsive to early screening in the US. In New Mexico, AIs compared with other racial/ethnic populations are substantially less likely to adhere to recommended screening guidelines. Our study focuses on increasing cancer awareness using culturally, linguistically, and health literacy appropriate small media (brochure and fact sheet). Formative research was conducted to adapt small media to convey screening options, cancer risks/benefits, and resources for breast, colorectal, and cervical cancer. The Zuni Health Initiative (ZHI) is located on the Zuni Pueblo, with all staff and student employees identifying as Zuni tribal members. A nine-member Tribal Advisory Panel (TAP) was established that included representation from Tribal organizations, healthcare providers, and Zuni Pueblo leadership. The study obtained approvals from the Zuni Tribal Council, Southwest Tribal IRB, and UNM Health Sciences IRB. ZHI staff recruited TAP/Tribal members to a total of 6 focus groups, 2 each of the three cancer types. Each session lasted 1 hour and was student led. Questions presented related to traditional beliefs about health, graphic layout, artwork, and word usage. Feedback suggested making the small media Zuni-specific, including pictures, artwork, Tribal member testimonies, and resources. Designing educational materials with Zuni-specific cultural, linguistic, and Tribal representation should enhance participation of Zuni Tribal members in cancer control educational interventions. The new small media will form an integral component of multi-level, multicomponent behavioral-cognitive interventions designed to enhance cancer screening uptake through heightened awareness about cancer screenings risks/benefits, and screening resources. Citation Format: Samantha R. Leekity, Keith E. Kelly, Cheyenne Jim, Judith N. Sheche, Shiraz I. Mishra. Development of small media on cancer education for cervical, breast, and colorectal screening in the Pueblo of Zuni [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B061.

AN ACTION PLAN FOR ORGANIZATIONS SERVING OLDER ADULTS AND THEIR CAREGIVERS DURING PUBLIC HEALTH EMERGENCIES

Abstract During public health emergencies, it is critical to maintain the continuity of services and resources essential to health and safety. Public health emergencies can disproportionately affect older adults and their caregivers. Organizations, including community-based, faith-based, rural, and tribal organizations, can play a vital role during a public health emergency response given their familiarity with the community’s unique needs and resources. With support from the CDC Foundation and technical assistance from the Centers for Disease Control and Prevention, NORC at the University of Chicago conducted a study to identify public health interventions to meet the needs of older adults and their caregivers during public health emergencies. Methods included an extensive search of peer-reviewed and grey literature in Spanish and English to identify interventions on six topics: deconditioning; deferral of medical care; elder abuse and neglect; management of chronic conditions; social isolation; and caregiving. NORC identified 300 public health interventions to support older adults and their caregivers during public health emergencies with a focus on underserved populations, including programs to support racial and ethnic minority populations, people with disabilities, and rural and tribal communities. NORC developed Search. Find. Help., a virtual resource library, and an Action Plan to support organizations in using these interventions. Search. Find. Help., which houses the Action Plan, has had 34,000 unique users. This session focuses on how organizations that serve older adults and caregivers can use the Action Plan’s four phases to select, adapt, implement, and evaluate public health interventions before or during a public health emergency.

Impact of Do-It-Yourself and Commercial Air Cleaner Usage on Health and Residential PM2.5

Background and aim: Wildfire smoke can threaten health, necessitating creating cleaner indoor air spaces. Commercially available portable air cleaners (PACs) mitigate smoke impacts indoors but can be expensive or inaccessible. Lower-cost Do-It-Yourself (DIY) PACs (furnace filter attached to box fan) offer an affordable alternative. However, evidence of their effectiveness in real-world settings is limited. This pilot study aimed to 1) evaluate the effect of DIY/commercial PAC usage on indoor PM2.5 and health outcomes during wildfire season among tribal community members in Hoopa, California and 2) assess barriers and facilitators to use of either intervention. Methods: During four one-to-two-week phases (baseline; DIY PAC usage &amp;#x2265;8 hours/day; commercial PAC usage &amp;#x2265;8 hours/day; and air sensor with visual display with optional PAC use), we monitored indoor and outdoor PM2.5 at participants’ homes. We conducted phase-specific phone surveys about participants’ health, behaviors, and perceptions. We analyzed indoor PM2.5 and health outcomes associated with PAC usage using mixed effects multivariate linear regression and tabulated behavioral responses. Results: DIY and commercial PAC usage was significantly associated with reduced infiltrated PM2.5 (n=6). High usage (&amp;#x2265;30% of phase) of either PAC was significantly associated with improved health (measured as a composite score), relative to low usage (&amp;#x3c;10% of phase) (n=10). Noise was the primary barrier to DIY PAC use, while quiet operation and small size of commercial PACs facilitated use. Nonetheless, eight of nine participants who preferred commercial PACs said they would use DIY PACs if the air were very smoky. Conclusions: DIY and commercial PACs were associated with improved indoor PM2.5 and health, but the loudness of DIY PACs hindered use. State, local, and tribal organizations should consider these conclusions in tailoring messaging and allocating resources in preparation for wildfire seasons. Disclaimer: Does not reflect EPA views or policy. Keywords: Indigenous, wildfire smoke, indoor air quality

Anemia Among Pregnant Women Participating in the Special Supplemental Nutrition Program for Women, Infants, and Children - United States, 2008-2018.

Among pregnant women, anemia, a condition of low hemoglobin concentration, can increase risk for maternal and fetal morbidity and mortality, including premature delivery, and other adverse outcomes (1). Iron deficiency is a common cause of anemia, and during pregnancy, iron requirements increase (2). Surveillance of anemia during pregnancy in the United States is limited. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Participant and Program Characteristics (PC) data provide an opportunity to establish national and WIC state agency-level* anemia surveillance for WIC participants. National and state agency anemia prevalences among pregnant WIC participants at enrollment were examined using 2008-2018 WIC-PC data. Across all 90 WIC agencies (50 states, the District of Columbia [DC], five territories, and 34 Indian Tribal Organizations), anemia prevalence among pregnant WIC participants at enrollment increased significantly, from 10.1% in 2008 to 11.4% in 2018 (13% increase). Anemia prevalence increased significantly in 36 (64%) of the 56 agencies in states, DC, and territories, and decreased significantly in 11 (20%). Prevalence of anemia overall and by pregnancy trimester were higher among non-Hispanic Black or African American (Black) women than among other racial or ethnic groups. Anemia prevalence was higher among women assessed during the third trimester of pregnancy than among those assessed during first or second trimesters. Routine anemia surveillance using WIC enrollment anemia data can identify groups at higher risk for iron deficiency. Findings from this report indicate that anemia continues to be a problem among low-income women and reinforces the importance of efforts that ensure these women have access to healthier, iron-rich foods before and during pregnancy. This includes ensuring that eligible women are enrolled in WIC early during pregnancy.