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Dreifuss HM, Yuan NP, Russo Carroll S, Bauer MC, Teufel-Shone NI. Utilizing Digital Storytelling to Develop a Public Health Professions Pathway for Native American High School Students. Health Promot Pract 2023; 24:1174-1182. [PMID: 36565227 DOI: 10.1177/15248399221135586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Digital storytelling is a decentering methodology in health promotion that positions the storyteller as an expert to create a narrative of their lived experiences. This article describes using a two-phase digital storytelling process within the Diné (Navajo) Educational Philosophy framework to guide the development of a culturally grounded curriculum plan that actively engages Diné youth in exploring health professions pathways in their community. The first phase consisted of developing a high school digital storytelling team by training three Diné youth attending high school on the Navajo Nation located in southwest United States, in digital storytelling. In the second phase, the high school digital storytelling team worked collaboratively with seven Diné students enrolled at the local tribal college to develop digital stories about navigating from high school to college. Data from seven completed digital stories were analyzed with assistance from a community advisory board to identify asset-based themes that contributed to positively transitioning from high school to a tribal college. The results revealed several strategies for successful transitions from high school to a public health college major. The culturally relevant strategies and stories were incorporated into a school-based health professions pathway curriculum plan for Diné youth.
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Kahn CB, John B, Shin SS, Whitman R, Yazzie AS, Goldtooth-Halwood R, Hecht K, Hecht C, Vollmer L, Egge M, Nelson N, Bitah K, George C. Teacher and Caregiver Perspectives on Water Is K'é: An Early Child Education Program to Promote Healthy Beverages among Navajo Children. Int J Environ Res Public Health 2023; 20:6696. [PMID: 37681836 PMCID: PMC10487536 DOI: 10.3390/ijerph20176696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 08/08/2023] [Accepted: 08/20/2023] [Indexed: 09/09/2023]
Abstract
The Water is K'é program was developed to increase water consumption and decrease consumption of sugar-sweetened beverages for young children and caregivers. The pilot program was successfully delivered by three Family and Child Education (FACE) programs on the Navajo Nation using a culturally centered curriculum between 2020 to 2022. The purpose of this research was to understand teacher and caregiver perspectives of program feasibility, acceptability, impact, and other factors influencing beverage behaviors due to the pilot program. Nine caregivers and teachers were interviewed between June 2022 and December 2022, and a study team of four, including three who self-identified as Navajo, analyzed the data using inductive thematic analysis and consensus building to agree on codes. Five themes emerged, including feasibility, acceptability, impact, suggestions for future use of the program, and external factors that influenced water consumption. The analysis showed stakeholders' strong approval for continuing the program based on impact and acceptability, and identified factors that promote the program and barriers that can be addressed to make the program sustainable. Overall, the Water is K'é program and staff overcame many challenges during the COVID-19 pandemic to support healthy behavior change that had a rippled influence among children, caregivers, teachers, and many others.
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Affiliation(s)
- Carmella B. Kahn
- College of Population Health, University of New Mexico, Albuquerque, NM 87131, USA
| | - Brianna John
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA 02115, USA
- Community Outreach and Patient Empowerment Program, Gallup, NM 87301, USA
| | - Sonya S. Shin
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA 02115, USA
- Community Outreach and Patient Empowerment Program, Gallup, NM 87301, USA
| | - Rachel Whitman
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA 02115, USA
- Community Outreach and Patient Empowerment Program, Gallup, NM 87301, USA
| | - Asia Soleil Yazzie
- Community Outreach and Patient Empowerment Program, Gallup, NM 87301, USA
| | | | - Ken Hecht
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Oakland, CA 94607, USA
| | - Christina Hecht
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Oakland, CA 94607, USA
| | - Laura Vollmer
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Oakland, CA 94607, USA
- Cooperative Extension, Division of Agriculture and Natural Resources, University of California, Davis, CA 95618, USA
| | | | | | - Kerlissa Bitah
- T’iis Nazbas Community School, Teec Nos Pos, AZ 86514, USA
| | - Carmen George
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA 02115, USA
- Community Outreach and Patient Empowerment Program, Gallup, NM 87301, USA
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Lindly OJ, Henderson DE, Vining CB, Running Bear CL, Nozadi SS, Bia S. "Know Your Children, Who They Are, Their Weakness, and Their Strongest Point": A Qualitative Study on Diné Parent Experiences Accessing Autism Services for Their Children. Int J Environ Res Public Health 2023; 20:5523. [PMID: 37107805 PMCID: PMC10138717 DOI: 10.3390/ijerph20085523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 01/05/2023] [Accepted: 03/13/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND AND OBJECTIVE Marked inequities in access to autism services and related health outcomes persist for U.S. children, undermining broader initiatives to advance the population's health. At the intersection of culture, poverty, and ruralness little remains known about autism in many Indigenous communities. This qualitative study on the lived experiences of Navajo (Diné) parents raising a child with autism sought to identify factors affecting access to services. METHODS A Diné researcher conducted in-depth interviews with 15 Diné parents of children with autism living in or around the Navajo Nation. A directed content analysis approach was used to identify themes, subthemes, and connections between themes. RESULTS Twelve overarching themes emerged on Diné parents' experiences accessing autism diagnostic and treatment services, as well as ways access to autism services can be improved. The following themes were related to diagnosis: the diagnostic process was often emotionally fraught; long wait times of up to years for diagnostic services were commonplace; limited clinician training and cultural humility impeded access to diagnostic services; and adequate health insurance, Indian Health Service referrals, care coordination, financial aid for travel, and efficient evaluation facilitated diagnosis. Themes on treatment access were as follows: parent perceptions of the extent to which an autism service helped their child affected access; social support helped parents to access treatment; obtaining referrals and care coordination influenced treatment access; treatment costs affected access; and service availability and geographic proximity impacted treatment access. Themes on ways to improve access to autism services were as follows: greater autism awareness is needed; autism-focused support groups may be helpful; and increased availability and quality of autism services across and around the Navajo Nation is paramount. CONCLUSIONS Diné parents' access to autism services was dynamically affected by sociocultural factors that must be addressed in future health equity-oriented initiatives.
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Affiliation(s)
- Olivia J. Lindly
- Department of Health Sciences, Northern Arizona University, Flagstaff, AZ 86011, USA
| | - Davis E. Henderson
- Department of Communication Sciences and Disorders, Northern Arizona University, Flagstaff, AZ 86011, USA
| | | | - Candi L. Running Bear
- Department of Educational Specialties, Northern Arizona University, Flagstaff, AZ 86011, USA
| | - Sara S. Nozadi
- Health Sciences Center, University of New Mexico, Albuquerque, NM 87131, USA
| | - Shannon Bia
- National University, San Diego, CA 92123, USA
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Kahn CB, James D, George S, Johnson T, Kahn-John M, Teufel-Shone NI, Begay C, Tutt M, Bauer MC. Diné ( Navajo) Traditional Knowledge Holders' Perspective of COVID-19. Int J Environ Res Public Health 2023; 20:3728. [PMID: 36834423 PMCID: PMC9964790 DOI: 10.3390/ijerph20043728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 06/18/2023]
Abstract
From the start of the COVID-19 pandemic on the Navajo Nation, Diné (Navajo) traditional knowledge holders (TKHs), such as medicine men and women and traditional practitioners, contributed their services and healing practices. Although TKHs are not always fully acknowledged in the western health care system, they have an established role to protect and promote the health of Diné people. To date, their roles in mitigating the COVID-19 pandemic have not been fully explored. The purpose of this research was to understand the social and cultural contexts of the COVID-19 pandemic and vaccines based on the roles and perspectives of Diné TKHs. A multi-investigator consensus analysis was conducted by six American Indian researchers using interviews with TKHs collected between December 2021-January 2022. The Hózhó Resilience Model was used as a framework to analyze the data using four parent themes: COVID-19, harmony and relationships, spirituality, and respect for self and discipline. These parent themes were further organized into promoters and/or barriers for 12 sub-themes that emerged from the data, such as traditional knowledge, Diné identity, and vaccine. Overall, the analysis showed key factors that could be applied in pandemic planning and public health mitigation efforts based on the cultural perspective of TKHs.
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Affiliation(s)
- Carmella B. Kahn
- College of Population Health, University of New Mexico, Albuquerque, NM 87131, USA
| | - DeeDee James
- Center for Health Equity and Research, Northern Arizona University, Flagstaff, AZ 86011, USA
| | | | | | | | | | - Chassity Begay
- Center for Health Equity and Research, Northern Arizona University, Flagstaff, AZ 86011, USA
| | - Marissa Tutt
- Center for Health Equity and Research, Northern Arizona University, Flagstaff, AZ 86011, USA
| | - Mark C. Bauer
- Public Health Program, Diné College, Shiprock, NM 87420, USA
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Tutt M, Begay C, George S, Dickerson C, Kahn C, Bauer M, Teufel-Shone N. Diné teachings and public health students informing peers and relatives about vaccine education: Providing Diné ( Navajo)-centered COVID-19 education materials using student health messengers. Front Public Health 2022; 10:1046634. [PMID: 36589984 PMCID: PMC9794580 DOI: 10.3389/fpubh.2022.1046634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 11/08/2022] [Indexed: 01/03/2023] Open
Abstract
Introduction/background On 9 April 2021, the Centers for Disease Control and Prevention (CDC) reported that only 19. 9% of United States (US) adults were fully vaccinated against COVID-19. In that same week, the Navajo Nation (NN) reported that 37.4% of residents were fully vaccinated, making the NN a leader in the uptake of COVID-19 vaccines. Despite high vaccination rates, vaccine hesitancy exists within the NN. The Diné (Navajo) Teachings and Public Health Students Informing Peers and Relatives about Vaccine Education (RAVE) intervention was designed to utilize trusted health messengers as an effective means to address adults' vaccine concerns and hesitancy. Methods The research team used COVID-19 vaccine materials developed in a previous collaboration with non-Navajo tribal communities and publicly available materials. Diné Traditional Knowledge Holders (TKHs) were interviewed to develop and incorporate Diné-specific information on individual and collective health behaviors into the RAVE materials. These drafted health education materials were presented to NN community health representatives (CHRs) and Diné public health students using a consensus panel approach. NN residents who participated in the intervention completed a 16-element retrospective pretest. Results The adaptation and tailoring process of materials yielded 4 health education materials. The students recruited 46 adults for health education sessions. These participants then completed the retrospective pretest. Changes in the 16 elements were in the desired direction, although only six were significant: four related to attitudes and two concerned with vaccination intention. Participants were more likely to consider vaccination and to try to get vaccinated after the education session. Discussion Trusted messengers and culturally centered materials have been identified as effective means of health behavior education with Native American audiences. RAVE applied these intervention elements by (1) training Diné College public health students to leverage their cultural knowledge and social relationships (cultural and social capital) to recruit vaccine-hesitant adults and provide education; (2) building on previous understanding of Native American communities' vaccine concerns; and (3) integrating Diné perspectives on individual and collective health into the adaptation of materials designed for general audiences; this knowledge was gained from interviews with TKHs.
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Affiliation(s)
- Marissa Tutt
- Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ, United States,*Correspondence: Marissa Tutt
| | - Chassity Begay
- Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ, United States
| | - Shawndeena George
- Diné College, School of Science, Technology, Engineering and Math, Shiprock, NM, United States
| | - Christopher Dickerson
- Diné College, School of Science, Technology, Engineering and Math, Shiprock, NM, United States
| | - Carmella Kahn
- Diné College, School of Science, Technology, Engineering and Math, Shiprock, NM, United States
| | - Mark Bauer
- Diné College, School of Science, Technology, Engineering and Math, Shiprock, NM, United States
| | - Nicolette Teufel-Shone
- Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ, United States
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Beresford SA, Ornelas IJ, Bauer MC, Garrity GA, Bishop SK, Francis B, Rillamas-Sun E, Garcia LV, Vecenti FS, Lombard KA. Group Randomized Trial of Healthy Eating and Gardening Intervention in Navajo Elementary Schools (Yéego!). AJPM Focus 2022; 1:100033. [PMID: 37791240 PMCID: PMC10546586 DOI: 10.1016/j.focus.2022.100033] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Introduction Few healthy eating, school-based interventions have been rigorously evaluated in American Indian communities. Gardening and healthy eating are priorities in the Navajo Nation. Collaborations between researchers and local partners supported the design and implementation of this project. Design The Yéego! Healthy Eating and Gardening Study was a group-randomized controlled trial to evaluate a school-based healthy eating and gardening intervention in 6 schools in the Navajo Nation. Schools were randomized 1:2 to intervention or comparison. Setting/participants The Shiprock and Tsaile/Chinle areas in the Navajo Nation were selected. Elementary schools were screened for eligibility. All students in third and fourth grades were invited to participate in the assessments. Intervention Delivered during 1 school year in the intervention schools, the intervention included a culturally relevant nutrition and gardening curriculum and a school garden. Main outcome measures Student self-efficacy for eating fruits and vegetables, student self-efficacy for gardening, and student healthy foods score from a modified Alternative Healthy Eating Index were assessed in third and fourth graders at the beginning and end of a school year affected by the COVID-19 pandemic. Primary analyses used repeated measures linear mixed models accounting for students nested within schools to estimate the intervention effect and 95% CIs. Results Students in the intervention schools had self-efficacy scores for eating fruits and vegetables that were 0.22 points greater (95% CI=0.04, 0.41) than those in the comparison schools, although the student healthy foods score increased in the intervention schools by 2.0 (95% CI=0.4, 3.6); the differential change was modest at 1.7 (95% CI=-0.3, 3.7). The self-efficacy to grow fruits and vegetables in the school garden increased among those in the intervention schools (OR=1.92; 95% CI=1.02, 3.63) but not significantly more than it increased in the comparison schools (OR=1.29; 95% CI=0.60, 2.81). Conclusions The intervention was efficacious in improving self-efficacy for eating fruits and vegetables among third- and fourth-grade students over a school year. The findings warrant further evaluation of the intervention in larger-group randomized trials with schools in Navajo communities. Trial registration This study is registered at clinicaltrials.gov NCT03778021.
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Affiliation(s)
- Shirley A.A. Beresford
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington
- Cancer Prevention Program, Fred Hutchinson Cancer Center, Seattle, Washington
| | - India J. Ornelas
- Cancer Prevention Program, Fred Hutchinson Cancer Center, Seattle, Washington
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, Washington
| | | | | | - Sonia K. Bishop
- Cancer Prevention Program, Fred Hutchinson Cancer Center, Seattle, Washington
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, Washington
| | - Brandon Francis
- Agricultural Science Center at Farmington, College of Agricultural, Consumer, and Environmental Sciences, New Mexico State University, Farmington, New Mexico
| | - Eileen Rillamas-Sun
- Cancer Prevention Program, Fred Hutchinson Cancer Center, Seattle, Washington
| | | | | | - Kevin A. Lombard
- Agricultural Science Center at Farmington, College of Agricultural, Consumer, and Environmental Sciences, New Mexico State University, Farmington, New Mexico
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Huang AC, Ebel NH, Romero D, Martin B, Jhun I, Brown M, Enns GM, Esquivel C, Bonham C. Outcomes after liver transplantation in MPV17 deficiency ( Navajo neurohepatopathy): A single-center case series. Pediatr Transplant 2022; 26:e14274. [PMID: 35466509 DOI: 10.1111/petr.14274] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 02/22/2022] [Accepted: 03/09/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND MPV17-related mitochondrial DNA maintenance defect (MPV17 deficiency) is a rare, autosomal recessive mitochondrial DNA depletion syndrome with a high mortality rate in infancy and early childhood due to progression to liver failure. Liver transplantation for children with MPV17 deficiency has been considered controversial due to uncertainty about the potential progression of extrahepatic manifestations following liver transplantation. METHODS We describe our institution's experience for two infants diagnosed with infantile MPV17 deficiency who presented in acute on chronic liver failure, but with normal development and normal neurological status who successfully underwent liver transplantation. RESULTS Both patients underwent successful liver transplantation with normal development and neurological status at 3 years and 16 months post-transplant, respectively. CONCLUSIONS In this rare disease population, we describe two infants with MPV17 deficiency who underwent liver transplantation for acute on chronic liver failure who continue to have normal development, without progression of neurological disease. MPV17 deficiency should not be considered a contraindication to liver transplantation.
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Affiliation(s)
- Alice C Huang
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Noelle H Ebel
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Lucile Packard Children's Hospital Stanford, Stanford University, Palo Alto, California, USA
| | - Danielle Romero
- Department of Pediatric Liver Transplant, Lucile Packard Children's Hospital Stanford, Stanford University, Palo Alto, California, USA
| | - Brock Martin
- Department of Pathology, Stanford University, Palo Alto, California, USA
| | - Iny Jhun
- Department of Pathology, Stanford University, Palo Alto, California, USA
| | - Megan Brown
- Department of Pediatric Liver Transplant, Lucile Packard Children's Hospital Stanford, Stanford University, Palo Alto, California, USA
| | - Gregory M Enns
- Division of Medical Genetics, Department of Pediatrics, Lucile Packard Children's Hospital Stanford, Stanford University, Palo Alto, California, USA
| | - Carlos Esquivel
- Division of Abdominal Transplantation, Department of Surgery, Stanford University, Palo Alto, California, USA
| | - Clark Bonham
- Division of Abdominal Transplantation, Department of Surgery, Stanford University, Palo Alto, California, USA
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Ji N, Rule AM, Weatherholtz R, Crosby L, Bunnell JE, Orem B, Reid R, Santosham M, Hammitt LL, O'Brien KL. Evaluation of indoor PM 2.5 concentrations in a Native American Community: a pilot study. J Expo Sci Environ Epidemiol 2022; 32:554-562. [PMID: 34349228 DOI: 10.1038/s41370-021-00373-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 07/20/2021] [Accepted: 07/22/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Indoor air pollution is associated with adverse health effects; however, few studies exist studying indoor air pollution on the Navajo Nation in the southwest U.S., a community with high rates of respiratory disease. METHODS Indoor PM2.5 concentration was evaluated in 26 homes on the Navajo Nation using real-time PM2.5 monitors. Household risk factors and daily activities were evaluated with three metrics of indoor PM2.5: time-weighted average (TWA), 90th percentile of concentration, and daily minutes exceeding 100 μg/m3. A questionnaire and recall sheet were used to record baseline household characteristics and daily activities. RESULTS The median TWA, 90th percentile, and daily minutes exceeding 100 μg/m3 were 7.9 μg/m3, 14.0 μg/m3, and 17 min, respectively. TWAs tended to be higher in autumn and in houses that used fuel the previous day. Other characteristics associated with elevated PM exposure in all metrics included overcrowded houses, nonmobile houses, and houses with current smokers, pets, and longer cooking time. CONCLUSIONS Some residents of the Navajo Nation have higher risk of exposure to indoor air pollution by Environmental Protection Agency (EPA) standards. Efforts to identify the causes and associations with adverse health effects are needed to ensure that exposure to risks and possible health impacts are mitigated.
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Affiliation(s)
- Nan Ji
- Department of Environmental and Occupational Health, Rutgers University School of Public Health, Piscataway, NJ, USA
| | - Ana M Rule
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Robert Weatherholtz
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Lynn Crosby
- United States Geological Survey, Reston, VA, USA
| | | | - Bill Orem
- United States Geological Survey, Reston, VA, USA
| | - Raymond Reid
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mathuram Santosham
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Laura L Hammitt
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Katherine L O'Brien
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Dreifuss HM, Belin KL, Wilson J, George S, Waters AR, Kahn CB, Bauer MC, Teufel-Shone NI. Engaging Native American High School Students in Public Health Career Preparation Through the Indigenous Summer Enhancement Program. Front Public Health 2022; 10:789994. [PMID: 35273937 PMCID: PMC8902068 DOI: 10.3389/fpubh.2022.789994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 01/12/2022] [Indexed: 11/27/2022] Open
Abstract
Native American1 populations are systematically marginalized in the healthcare and public health workforce. One effective approach to reduce health disparities and improve health care delivery among Indigenous populations is to train more Native American health professionals who integrate academic and cultural knowledge to understand and influence health behaviors and perspectives. Diné College partnered with Northern Arizona University to develop the Navajo Native American Research Center for Health (NARCH) Partnership, funded by the National Institutes of Health. The high school component of the Navajo NARCH Partnership created the Indigenous Summer Enhancement Program (ISEP), a 1-week summer training program providing exposure to health careers and mentorship in pursuing public health careers for Native American high school students. ISEP utilizes the Diné Educational Philosophy (DEP), a Navajo conceptual framework to serve as the foundation of the program. In 2020–2021, due to COVID-19 restrictions, the DEP model had to be incorporated in the Navajo NARCH high school virtual program activities. ISEP used 2018 and 2019 past program evaluation data to inform the virtual programming. Students' perception of the program was collected using an online Qualtrics evaluation questionnaire. Students stated appreciation for program staff, fellow students, peer mentors and culturally relevant learning experiences in both virtual and in-person environments. Recommendations included: expanding the length of ISEP and continuing the hands-on activities and Public Health Leadership series.
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Affiliation(s)
| | - Kalvina L Belin
- Center for Health Equity and Research, Northern Arizona University, Flagstaff, AZ, United States
| | - Jamie Wilson
- Center for Health Equity and Research, Northern Arizona University, Flagstaff, AZ, United States
| | - Shawndeena George
- Center for Health Equity and Research, Northern Arizona University, Flagstaff, AZ, United States
| | | | | | | | - Nicolette I Teufel-Shone
- Center for Health Equity and Research, Northern Arizona University, Flagstaff, AZ, United States
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Claw KG, Dundas N, Parrish MS, Begay RL, Teller TL, Garrison NA, Sage F. Perspectives on Genetic Research: Results From a Survey of Navajo Community Members. Front Genet 2021; 12:734529. [PMID: 34925442 PMCID: PMC8675633 DOI: 10.3389/fgene.2021.734529] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 11/03/2021] [Indexed: 11/13/2022] Open
Abstract
The Navajo Nation placed a moratorium on genetic research studies in 2002, in part due to concerns about historical distrust, exploitation, limited expertise and resources, and the lack of a genetics policy. Navajo tribal leaders, scientists, and policy experts are exploring the possibility of lifting the moratorium, developing a genetic research policy, and discussing its potential health implications. This study aimed to identify the key concerns, needs, and desires of Navajo people regarding genetic research. We conducted a survey of Navajo individuals to assess knowledge of the moratorium and research, gauge interest in genetic research, and quantify appropriate genetic research topics to understand broad views and concerns. We performed descriptive statistics and tested associations between relevant categorical variables using Chi-square tests. We hypothesized that individuals with more knowledge about the moratorium and health research increased the likelihood of supporting and participating in genetic research. A total of 690 surveys from Navajo respondents were analyzed. Of these, 63% of respondents reported being unaware of the Navajo Nation's moratorium on genetic research. There were positive associations between those who knew about the moratorium and willingness to donate biospecimens for research under certain conditions, such as community involvement, review and approval by community leaders, research on diseases affecting the community, and support for lifting the moratorium (p-values < 0.001). We found no significant differences between age, gender, religious/spiritual beliefs, or agency affiliation with knowledge levels of genetics and related topics, participation in relation to beliefs, and donation of biospecimens. Interestingly, respondents who resided off the Navajo Nation were positively associated with having knowledge of the moratorium, having heard of discussions of genetics on the Navajo Nation, and the lawsuit filed by the Havasupai Tribe. Most respondents agreed that it was very important to develop a policy that incorporates cultural knowledge (56%), is beneficial (56%), and has data sharing protections (59%) before allowing genetic research on the Navajo Nation. Overall, a large proportion of respondents (46%) were unsure about lifting the moratorium and instead wanted more genetics education to assess its potential implications. The study results can inform the direction of future guidelines and policies.
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Affiliation(s)
- Katrina G Claw
- Division of Biomedical Informatics and Personalized Medicine, Colorado Center for Personalized Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Nicolas Dundas
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, WA, United States
| | | | - Rene L Begay
- Centers for American Indian and Alaska Native Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | | | - Nanibaa' A Garrison
- Institute for Society and Genetics, College of Letters and Science, University of California, Los Angeles, CA, United States.,Institute for Precision Health, David Geffen School of Medicine, University of California, Los Angeles, CA, United States.,Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, CA, United States
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Webber ZR, Webber KGI, Rock T, St Clair I, Thompson C, Groenwald S, Aanderud Z, Carling GT, Frei RJ, Abbott BW. Diné citizen science: Phytoremediation of uranium and arsenic in the Navajo Nation. Sci Total Environ 2021; 794:148665. [PMID: 34218141 DOI: 10.1016/j.scitotenv.2021.148665] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 06/15/2021] [Accepted: 06/21/2021] [Indexed: 06/13/2023]
Abstract
Mid-20th century mining in Naabeehó Bináhásdzo (Navajo Nation) polluted soil and groundwater with uranium and arsenic. The Diné and other indigenous residents of this region use groundwater for drinking, livestock, and irrigation, creating a serious environmental health risk. Currently, many individuals and communities on the Navajo Nation must purchase and transport treated water from hours away. Sunflowers (Helianthus annuus) preferentially take up uranium and arsenic, potentially representing a tool to remove these contaminants through on-site, low-cost phytoremediation. This study reports the results of a collaboration among researchers, high school students, teachers, and tribal leaders to analyze water chemistry and perform a phytoremediation experiment. In 2018 and 2019, we compiled existing data from the Navajo Nation Environmental Protection Agency (NNEPA) and collected samples from surface and groundwater. We then used sunflower seedlings grown in local soil to assess whether phytoremediation could be effective at removing arsenic and uranium. For the NNEPA-sampled wells, 9.5% exceeded the maximum contaminant level for uranium (30 μg per liter) and 16% for arsenic (10 μg per liter). For the new samples, uranium was highest in surface pools, suggesting leaching from local soil. Unlike studies from humid regions, sunflowers did not decrease uranium and arsenic in soil water. Instead, there was no change in arsenic concentration and an increase in uranium concentration in both planted and control treatments, attributable to weathering of uranium-bearing minerals in the desert soil. Because much of global uranium mining occurs in arid and semiarid regions, the ineffectiveness of phytoremediation on the Navajo Nation emphasizes the importance of prevention and conventional remediation. More generally, the participatory science approach created meaningful relationships and an important collaboration between a tribal chapter and a university, providing both cultural and scientific experiential learning opportunities for Diné high school students, undergraduate researchers, and senior personnel.
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Affiliation(s)
- Zak R Webber
- Brigham Young University, Department of Plant and Wildlife Sciences, 4105 LSB, Provo, UT 84602, USA
| | - Kei G I Webber
- Brigham Young University, Department of Chemistry and Biochemistry, C-104 BNSN, Provo, UT 84602, USA
| | - Tommy Rock
- University of Utah Rocky Mountain Center for Occupational and Environmental Health, 391 Chipeta Way Suite C, Salt Lake City, UT 84108, USA
| | - Isaac St Clair
- Brigham Young University, Department of Statistics, 223 TMCB, Provo, UT 84602, USA
| | - Carson Thompson
- Brigham Young University, Department of Plant and Wildlife Sciences, 4105 LSB, Provo, UT 84602, USA
| | | | - Zach Aanderud
- Brigham Young University, Department of Plant and Wildlife Sciences, 4105 LSB, Provo, UT 84602, USA
| | - Gregory T Carling
- Brigham Young University, Department of Geological Sciences, S-389 ESC, Provo, UT 84602, USA
| | - Rebecca J Frei
- University of Alberta, Department of Renewable Resources, 751 General Services Building University of Alberta, Edmonton, Alberta, Canada
| | - Benjamin W Abbott
- Brigham Young University, Department of Plant and Wildlife Sciences, 4105 LSB, Provo, UT 84602, USA.
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12
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Erickson RP. Autosomal recessive diseases among the Athabaskans of the southwestern United States: anthropological, medical, and scientific aspects. J Appl Genet 2021; 62:445-453. [PMID: 33880741 PMCID: PMC8057858 DOI: 10.1007/s13353-021-00630-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/31/2021] [Accepted: 04/05/2021] [Indexed: 11/30/2022]
Abstract
The peopling of the Americas by Native Americans occurred in 4 waves of which the last was Nadene language speakers of whom Athabaskans are the largest group. As the Europeans were entering the Southwestern states of the USA, Athabaskan hunting-gathering tribes were migrating South from Canada along the Rocky Mountains and undergoing potential bottlenecks reflected in autosomal recessive diseases shared by Apaches and Navajos. About 300 years ago, the Navajo developing a sedentary culture learned from Pueblo Indians while the Apache remained hunter-gathers. Although most of the tribe was rounded up and forced to relocate to Bosque Redondo, the adult breeding population was large enough to prevent a genetic bottleneck. However, some Navajo underwent further population bottlenecks while hiding from the brutal US Army action (under Kit Carson’s guidance). This led to an increased frequency of other autosomal recessive diseases. Recent advances in population genetics, pathophysiology of the diseases, and social/ethical issues concerning their study are reviewed.
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13
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Kahn CB, Dreifuss H, Teufel-Shone NI, Tutt M, McCue K, Wilson J, Waters AR, Belin KL, Bauer MC. Adapting Summer Education Programs for Navajo Students: Resilient Teamwork. Front Sociol 2021; 6:617994. [PMID: 33869570 PMCID: PMC8022615 DOI: 10.3389/fsoc.2021.617994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 01/04/2021] [Indexed: 06/12/2023]
Abstract
In May 2020, the Navajo Native American Research Center for Health Partnership (Navajo NARCH) was scheduled to launch two summer programs: a 10 weeks-long Summer Research Enhancement Program (SREP) for undergraduate students to learn and practice health research methods and participate in a practicum experience, and a week-long Indigenous Summer Enhancement Program (ISEP) for high school students that introduces a range of health professions and develops leadership qualities. Students accepted into the programs are predominantly Navajo and live within Navajo Nation (NN) during the summer. Due to NN restrictions and CDC guidelines for physically distancing in response to the coronavirus (COVID-19) pandemic, the Navajo NARCH team organized to offer both programs entirely online via Zoom™. This paper explores the instructional teams' adaptation process to maintain a commitment to preserve the programs' supportive environment for exploring and developing strong multicultural approaches in public health and health research. In preparation for online instruction, the team developed and offered workshops for staff and instructors to address anticipated challenges. The team identified the following challenges: technological difficulties, social disconnectedness, consistent student engagement, and facilitation of a practicum research experience. Results showed that program adaptations were successful as the team applied collaborative and holistic approaches, and established social connections remotely with students to offer meaningful research and practicum experiences.
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Affiliation(s)
| | - Heather Dreifuss
- Center for Health Equity and Research, Northern Arizona University, Flagstaff, AZ, United States
| | | | - Marissa Tutt
- Center for Health Equity and Research, Northern Arizona University, Flagstaff, AZ, United States
| | - Kelly McCue
- Center for Health Equity and Research, Northern Arizona University, Flagstaff, AZ, United States
| | - Jamie Wilson
- Center for Health Equity and Research, Northern Arizona University, Flagstaff, AZ, United States
| | | | - Kalvina L. Belin
- Center for Health Equity and Research, Northern Arizona University, Flagstaff, AZ, United States
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14
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Borgman M. The 1993 Hantavirus Pulmonary Syndrome Outbreak and Lessons for Today. Med J (Ft Sam Houst Tex) 2021:22-27. [PMID: 33666908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
While grappling with the implications of the current COVID-19 pandemic, we have perhaps overlooked recent history dealing with previous outbreaks. In the spring of 1993, America was presented with an outbreak of Hantavirus Pulmonary Syndrome caused by the Sin Nombre virus. This article recounts the investigation into this disease and discusses the spectrum of issues that medical communities must face as it deals with a mysterious outbreak.
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15
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Jones LJ, VanWassenhove-Paetzold J, Thomas K, Bancroft C, Ziatyk EQ, Kim LSH, Shirley A, Warren AC, Hamilton L, George CV, Begay MG, Wilmot T, Tsosie M, Ellis E, Selig SM, Gall G, Shin SS. Impact of a Fruit and Vegetable Prescription Program on Health Outcomes and Behaviors in Young Navajo Children. Curr Dev Nutr 2020; 4:nzaa109. [PMID: 32734135 PMCID: PMC7377262 DOI: 10.1093/cdn/nzaa109] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 05/04/2020] [Accepted: 06/17/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Rates of childhood obesity are higher in American Indian and Alaska Native populations, and food insecurity plays a major role in diet-related disparities. To address this need, local healthcare providers and a local nonprofit launched the Navajo Fruit and Vegetable Prescription (FVRx) Program in 2015. Children up to 6 y of age and their caregivers are enrolled in the 6-mo program by healthcare providers. Families attend monthly health coaching sessions where they receive vouchers redeemable for fruits, vegetables, and healthy traditional foods at retailers participating in the FVRx program. OBJECTIVES We assessed the impact of a fruit and vegetable prescription program on the health outcomes and behaviors of participating children. METHODS Caregivers completed voluntary surveys to assess food security, fruit and vegetable consumption, hours of sleep, and minutes of physical activity; healthcare providers also measured children's body mass index [BMI (kg/m2)] z score at initiation and completion of the program. We calculated changes in health behaviors, BMI, and food security at the end of the program, compared with baseline values. RESULTS A total of 243 Navajo children enrolled in Navajo FVRx between May 2015 and September 2018. Fruit and vegetable consumption significantly increased from 5.2 to 6.8 servings per day between initiation and program completion (P < 0.001). The proportion of participant households reporting food insecurity significantly decreased from 82% to 65% (P < 0.001). Among children classified as overweight or obese at baseline, 38% achieved a healthy BMI z score at program completion (P < 0.001). Sixty-five percent of children were retained in the program. CONCLUSIONS The Navajo FVRx program improves fruit and vegetable consumption among young children. Children who are obese or overweight may benefit most from the program.
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Affiliation(s)
- Leandra J Jones
- Community Outreach and Patient Empowerment Program, Gallup, New Mexico
| | - Joan VanWassenhove-Paetzold
- Community Outreach and Patient Empowerment Program, Gallup, New Mexico
- Partners In Health, Boston, Massachusetts
| | - Kymie Thomas
- Community Outreach and Patient Empowerment Program, Gallup, New Mexico
| | - Carolyn Bancroft
- Community Outreach and Patient Empowerment Program, Gallup, New Mexico
| | - E Quinn Ziatyk
- Chinle Comprehensive Health Care Facility, Chinle, Arizona
| | | | - Ariel Shirley
- Community Outreach and Patient Empowerment Program, Gallup, New Mexico
| | - Abigail C Warren
- Community Outreach and Patient Empowerment Program, Gallup, New Mexico
| | - Lindsey Hamilton
- Community Outreach and Patient Empowerment Program, Gallup, New Mexico
| | - Carmen V George
- Community Outreach and Patient Empowerment Program, Gallup, New Mexico
- Partners In Health, Boston, Massachusetts
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts
| | - Mae-Gilene Begay
- Navajo Nation Community Health Representative Outreach Program, Navajo Department of Health, Window Rock, Arizona
| | - Taylor Wilmot
- Community Outreach and Patient Empowerment Program, Gallup, New Mexico
- Partners In Health, Boston, Massachusetts
| | - Memarie Tsosie
- Community Outreach and Patient Empowerment Program, Gallup, New Mexico
| | - Emilie Ellis
- Community Outreach and Patient Empowerment Program, Gallup, New Mexico
- Partners In Health, Boston, Massachusetts
| | - Sara M Selig
- Community Outreach and Patient Empowerment Program, Gallup, New Mexico
- Partners In Health, Boston, Massachusetts
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts
| | - Gail Gall
- Community Outreach and Patient Empowerment Program, Gallup, New Mexico
| | - Sonya S Shin
- Community Outreach and Patient Empowerment Program, Gallup, New Mexico
- Partners In Health, Boston, Massachusetts
- Northern Navajo Medical Center, Shiprock, New Mexico
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16
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De La Rosa VY, Hoover J, Du R, Jimenez EY, MacKenzie D, Lewis J. Diet quality among pregnant women in the Navajo Birth Cohort Study. Matern Child Nutr 2020; 16:e12961. [PMID: 32026554 PMCID: PMC7296825 DOI: 10.1111/mcn.12961] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 01/07/2020] [Accepted: 01/16/2020] [Indexed: 01/30/2023]
Abstract
Proper nutrition during pregnancy is vital to maternal health and fetal development and may be challenging for Navajo Nation residents because access to affordable and healthy foods is limited. It has been several decades since reported diet quality during pregnancy was examined on Navajo Nation. We present the first study to estimate iodine intake and use the Healthy Eating Index (HEI-2015) to assess maternal diet quality among pregnant women in the Navajo Birth Cohort Study (NBCS). Based on dietary intake data derived from food frequency questionnaires, overall estimated micronutrient intake has remained similar since the last assessment in 1981, with potential improvements evident for folate and niacin. A high proportion of women (>50%) had micronutrient intakes from dietary sources below the Estimated Average Requirements during pregnancy. The median urinary iodine concentration for NBCS women (90.8 μg/L; 95% CI [80, 103.5]) was less than adequate and lower than concentrations reported for pregnant women that participated in the National Health and Nutrition Examination Survey (NHANES) between 2011 and 2014. Overall, average diet quality of NBCS women estimated using the HEI-2015 (62.4; 95% CI [60.7, 64.0]) was similar to that reported for women of child-bearing age and pregnant women in NHANES. Although, NBCS women had diets high in added sugar, with sugar-sweetened beverages as the primary contributors. Our study provides updated insights on maternal diet quality that can inform health and nutrition initiatives in Navajo communities emphasizing nutrition education and access to prenatal vitamins and calcium, iodine, and vitamin E dense foods.
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Affiliation(s)
- Vanessa Y. De La Rosa
- College of Pharmacy, Community Environmental Health ProgramUniversity of New Mexico Health Sciences CenterAlbuquerqueNew MexicoUSA
| | - Joseph Hoover
- College of Pharmacy, Community Environmental Health ProgramUniversity of New Mexico Health Sciences CenterAlbuquerqueNew MexicoUSA
- Environmental Studies Program, Department of Social Sciences & Cultural StudiesMontana State University BillingsBillingsMontana
| | - Ruofei Du
- University of New Mexico Comprehensive Cancer CenterUniversity of New MexicoAlbuquerqueNew MexicoUSA
| | - Elizabeth Yakes Jimenez
- Departments of Pediatrics and Internal MedicineUniversity of New Mexico Health Sciences CenterAlbuquerqueNew MexicoUSA
| | - Debra MacKenzie
- College of Pharmacy, Community Environmental Health ProgramUniversity of New Mexico Health Sciences CenterAlbuquerqueNew MexicoUSA
| | - NBCS Study Team
- College of Pharmacy, Community Environmental Health ProgramUniversity of New Mexico Health Sciences CenterAlbuquerqueNew MexicoUSA
| | - Johnnye Lewis
- College of Pharmacy, Community Environmental Health ProgramUniversity of New Mexico Health Sciences CenterAlbuquerqueNew MexicoUSA
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17
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Franz C, Atwood S, Orav EJ, Curley C, Brown C, Trevisi L, Nelson AK, Begay MG, Shin S. Community-based outreach associated with increased health utilization among Navajo individuals living with diabetes: a matched cohort study. BMC Health Serv Res 2020; 20:460. [PMID: 32450874 PMCID: PMC7247176 DOI: 10.1186/s12913-020-05231-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 04/15/2020] [Indexed: 11/17/2022] Open
Abstract
Background Navajo community members face high rates of diabetes mellitus and other chronic diseases. The Navajo Community Health Representative Outreach Program collaborated with healthcare providers and academic partners to implement structured and coordinated outreach to patients living with diabetes. The intervention, called Community Outreach and Patient Empowerment or COPE, provides home-based health coaching and community-clinic linkages to promote self-management and engagement in healthcare services among patients living with diabetes. The purpose of this study was to evaluate how outreach by Navajo Community Health Representatives (“COPE Program”) affected utilization of health care services among patients living with diabetes. Methods De-identified data from 2010 to 2014 were abstracted from electronic health records at participating health facilities. In this observational cohort study, 173 cases were matched to 2880 controls. Healthcare utilization was measured as the number of times per quarter services were accessed by the patient. Changes in utilization over 4 years were modeled using a difference-in-differences approach, comparing the trajectory of COPE patients’ utilization before versus after enrollment with that of the control group. The model was estimated using generalized linear mixed models for count outcomes, controlling for clustering at the patient level and the service unit level. Results COPE enrollees showed a 2.5% per patient per quarter (pppq) greater increase in total utilization (p = 0.001) of healthcare services than non-COPE enrollees; a 3.2% greater increase in primary care visits (p = 0.024); a 6.3% greater increase in utilization of counseling and behavioral health services (p = 0.013); and a 9.0% greater increase in pharmacy visits (p < 0.001). We found no statistically significant differences in utilization trends of inpatient, emergency room, specialty outpatient, dental, laboratory, radiology, or community encounter services among COPE participants versus control. Conclusions A structured intervention consisting of Community Health Representative outreach and coordination with clinic-based providers was associated with a modest increase in health care utilization, including primary care and counseling services, among Navajo patients living with diabetes. Community health workers may provide an important linkage to enable patients to access and engage in clinic-based health care. Trial registration NCT03326206, registered 10/31/2017, retrospectively registered.
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Affiliation(s)
- Calvin Franz
- Eastern Research Group, Inc., Lexington, MA, USA
| | - Sidney Atwood
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - E John Orav
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Cameron Curley
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
| | - Christian Brown
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
| | - Letizia Trevisi
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Adrianne Katrina Nelson
- Department of Global Community Health and Behavioral Sciences, Tulane School of Public Health and Tropical Medicine, 1440 Canal Street, New Orleans, LA, USA
| | - Mae-Gilene Begay
- Navajo Nation Community Health Representative Outreach Program, Navajo Nation Department of Health, Window Rock, AZ, USA
| | - Sonya Shin
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA. .,Harvard Medical School, Boston, MA, USA.
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18
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Kahn-John M, Badger T, McEwen MM, Koithan M, Arnault DS, Chico-Jarillo TM. The Diné ( Navajo) Hózhó Lifeway: A Focused Ethnography on Intergenerational Understanding of American Indian Cultural Wisdom. J Transcult Nurs 2020; 32:256-265. [PMID: 32406788 DOI: 10.1177/1043659620920679] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Purpose: Hózhó is the cultural wisdom that guides the Diné lifeway. This study examines understanding of cultural wisdom (CW) across three generations: elders, adults, and adolescents. Method: A focused ethnography was conducted on the Navajo Nation. Twenty-two Diné (Navajo) were recruited through convenience sampling. Data were collected via two semistructured interviews and photovoice methods. Data were analyzed using content analysis, thematic analysis, and participatory visual analysis of photos. Results: The Diné elders embodied the greatest in-depth understanding of CW followed by the adolescents. An unexpected finding was the scarcity of understanding of CW among the adults. Conclusion: The Diné understanding of CW is transferred through discussion with elders, listening to and speaking traditional language, cultural preservation activities, and participation in cultural practices. The Diné believe cultural wisdom is a health sustaining protective factor, therefore strategies to restore, promote, and support the intergenerational transfer of cultural wisdom remains a tribal priority.
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Sinicrope PS, Bauer MC, Patten CA, Austin-Garrison M, Garcia L, Hughes CA, Bock MJ, Decker PA, Yost KJ, Petersen WO, Buki LP, Garrison ER. Development and Evaluation of a Cancer Literacy Intervention to Promote Mammography Screening Among Navajo Women: A Pilot Study. Am J Health Promot 2020; 34:681-685. [PMID: 31986899 DOI: 10.1177/0890117119900592] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Develop and evaluate a mammography intervention that provides hope about cancer prevention and treatment. DESIGN Pilot randomized controlled trial. SETTING Two communities on the Navajo Nation. PARTICIPANTS Navajo women and support persons. INTERVENTION Both groups received standard care: one home visit discussing mammography pros/cons and barriers. The treatment group received an intervention based on Navajo language via an additional home visit with health education materials (written and oral) in English and Navajo, including a Navajo Cancer Glossary with a new descriptive phrase for cancer. ANALYSIS Between control and intervention conditions, we compared baseline sociodemographics; changes from baseline to 3 months on mammography completion and breast cancer literacy scores. MEASURES (1) intervention feasibility; (2) self- and clinic-reported mammography screening completion; (3) breast cancer literacy. RESULTS A total of 25 participants were randomly assigned (13 treatment, 12 control), with 7 support persons in each arm. Mean age was 53 years, 90% had a high school degree or higher, 86% spoke Navajo and English. At 3 months, 44% had a clinically verified mammogram. Mammography completion was 57% among those with a support person and 27% among those without (P = .14). Intervention women reported more breast cancer beliefs consistent with mammography (P = .015). CONCLUSIONS Increases in breast cancer beliefs consistent with mammography show promise. Findings highlight a need to tailor education materials to Navajo culture/language and focus on enhancing support.
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Affiliation(s)
- Pamela S Sinicrope
- Department of Psychiatry and Psychology and Behavioral Health Research Program, Mayo Clinic, Rochester, MN, USA
| | | | - Christi A Patten
- Department of Psychiatry and Psychology and Behavioral Health Research Program, Mayo Clinic, Rochester, MN, USA
| | | | | | - Christine A Hughes
- Department of Psychiatry and Psychology and Behavioral Health Research Program, Mayo Clinic, Rochester, MN, USA
| | - Martha J Bock
- Department of Psychiatry and Psychology and Behavioral Health Research Program, Mayo Clinic, Rochester, MN, USA
| | - Paul A Decker
- Department of Health Sciences Research, Biomedical Statistics and Behavioral Health Research Program, Rochester, MN, USA
| | - Kathleen J Yost
- Department of Health Sciences Research, Survey Research Center, Mayo Clinic, Rochester, MN, USA
| | - Wesley O Petersen
- Department of Psychiatry and Psychology and Behavioral Health Research Program, Mayo Clinic, Rochester, MN, USA
| | - Lydia P Buki
- Department of Educational and Psychological Studies, University of Miami, Coral Gables, FL, USA
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20
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Lalla A, Salt S, Schrier E, Brown C, Curley C, Muskett O, Begay MG, Shirley L, Clark C, Singer J, Shin S, Nelson AK. Qualitative evaluation of a community health representative program on patient experiences in Navajo Nation. BMC Health Serv Res 2020; 20:24. [PMID: 31914997 PMCID: PMC6950858 DOI: 10.1186/s12913-019-4839-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 12/16/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Community Health Representatives (CHRs) overcome health disparities in Native communities by delivering home care, health education, and community health promotion. The Navajo CHR Program partners with the non-profit Community Outreach and Patient Empowerment (COPE), to provide home-based outreach to Navajo clients living with diabetes. COPE has created an intervention (COPE intervention) focusing on multiple levels of improved care including trainings for CHRs on Motivational Interviewing and providing CHRs with culturally-appropriate education materials. The objective of this research is to understand the participant perspective of the CHR-COPE collaborative outreach through exploring patient-reported outcomes (PROs) of clients who consent to receiving the COPE intervention (COPE clients) using a qualitative methods evaluation. METHODS Seven COPE clients were selected to participate in semi-structured interviews one year after finishing COPE to explore their perspective and experiences. Qualitative interviews were recorded, transcribed, and coded to identify themes. RESULTS Clients revealed that health education delivered by CHRs facilitated lifestyle changes by helping them understand key health indicators and setting achievable goals through the use of accessible material and encouragement. Clients felt comfortable with CHRs who respected traditional practices and made regular visits. Clients also appreciated when CHRs educated their family members, who in turn were better able to support the client in their health management. Finally, CHRs who implemented the COPE intervention helped patients who were unable to regularly see a primary care doctor for critical care and support in their disease management. CONCLUSION The COPE-CHR collaboration facilitated trusting client-CHR relationships and allowed clients to better understand their diagnoses. Further investment in materials that respect traditional practices and aim to educate clients' families may foster these relationships and improve health outcomes. TRIAL REGISTRATION clinicaltrials.gov: NCT03326206. Registered 9/26/2017 (retrospectively registered).
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Affiliation(s)
- Amber Lalla
- University of New Mexico, 2425 Camino de Salud, Albuquerque, NM 87106 USA
| | - Shine Salt
- Division of Global Health Equity, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115 USA
| | | | - Christian Brown
- Division of Global Health Equity, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115 USA
| | - Cameron Curley
- Division of Global Health Equity, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115 USA
| | - Olivia Muskett
- Division of Global Health Equity, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115 USA
| | - Mae-Gilene Begay
- Navajo Nation Community Health Representative & Outreach Program, Navajo Nation Department of Health, Hwy 264 and St. Michael Road, St Michael, AZ 86511 USA
| | - Lenora Shirley
- Navajo Nation Community Health Representative & Outreach Program, Navajo Nation Department of Health, Hwy 264 and St. Michael Road, St Michael, AZ 86511 USA
| | - Clarina Clark
- Community Outreach and Patient Empowerment (COPE), 210 East Aztec Avenue, Gallup, NM 87301 USA
| | - Judy Singer
- Community Outreach and Patient Empowerment (COPE), 210 East Aztec Avenue, Gallup, NM 87301 USA
| | - Sonya Shin
- Division of Global Health Equity, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115 USA
| | - Adrianne Katrina Nelson
- Department of Global Community Health and Behavioral Sciences, Tulane School of Public Health and Tropical Medicine, 1440 Canal Street, New Orleans, LA 70112 USA
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Samuel-Nakamura C, Hodge FS. Occurrence and Risk of Metal(loid)s in Thelesperma megapotamicum Tea Plant. Plants (Basel) 2019; 9:E21. [PMID: 31877937 DOI: 10.3390/plants9010021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 11/22/2019] [Accepted: 11/29/2019] [Indexed: 12/02/2022]
Abstract
This study reports on the harvesting, ingestion, and contamination of American Indian tea Thelesperma megapotamicum grown on the Navajo Reservation in New Mexico. Uranium (U) and co-metal(loid)s (As, Cd, Cs, Mo, Pb, Se, Th, and V) have contaminated local soil and plants. Tea plants were gathered for analysis near U mining impacted areas. The study collected samples of wild tea plants (n = 14), roots (n = 14), and soil (n = 12) that were analyzed with inductively coupled plasma mass spectrometry. Tea harvesting activities, behavior, and ingestion information were collected via questionnaires. Harvesting took place in community fields and near roadways. Results indicate edible foliage concentration levels for Cd exceeded the World Health Organization (WHO) raw medicinal plant permissible level guidelines. Tea samples collected near high traffic areas had significantly greater Cd and Mo concentrations than those collected near low traffic areas (p < 0.001). Tea sample metal(loid) concentration levels ranged from 0.019–7.916 mg/kg. When compared to established food guidelines including the WHO provisional tolerable weekly intake (PTWI), reference dietary intake, recommended dietary allowance, and the tolerable upper limit (UL), Cd exceeded the WHO guidelines but none exceeded the PTWI nor the UL. These findings warrant improved standardization and establishment of universal guidelines for metal(loid) intake in food.
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Trevisi L, Orav JE, Atwood S, Brown C, Curley C, King C, Muskett O, Sehn H, Nelson KA, Begay MG, Shin SS. Integrating community health representatives with health care systems: clinical outcomes among individuals with diabetes in Navajo Nation. Int J Equity Health 2019; 18:183. [PMID: 31771603 PMCID: PMC6880375 DOI: 10.1186/s12939-019-1097-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 11/18/2019] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND We studied the impact of Community Outreach and Patient Empowerment (COPE) intervention to support Community Health Representatives (CHR) on the clinical outcomes of patients living with diabetes in the Navajo Nation extending into the States of Arizona, Utah, and New Mexico. The COPE intervention integrated CHRs into healthcare teams by providing a structured approach to referrals and home visits. METHODS We abstracted routine clinical data from the Indian Health Service's information system on individuals with diabetes mellitus seen at participating clinical sites from 2010 to 2014. We matched 173 COPE participants to 2880 patients with similar demographic and clinical characteristics who had not participated in COPE. We compared the changes in clinical outcomes between the two groups using linear mixed models. RESULTS Over the four years of the study, COPE patients had greater improvements in glycosylated hemoglobin (- 0.56%) than non-COPE participants (+ 0.07%) for a difference in differences of 0.63% (95% confidence interval (CI): 0.50, 0.76). Low-density lipoprotein fell more steeply in the COPE group (- 10.58 mg/dl) compared to the non-COPE group (- 3.18 mg/dl) for a difference in differences of 7.40 mg/dl (95%CI: 2.00, 12.80). Systolic blood pressure increased slightly more among COPE (2.06 mmHg) than non-COPE patients (0.61 mmHg). We noted no significant change for body mass index in either group. CONCLUSION Structured outreach by Community Health Representatives as part of an integrated care team was associated with improved glycemic and lipid levels in the target Navajo population. TRIAL REGISTRATION Trial registration: NCT03326206. Registered 31 October 2017 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/study/NCT03326206.
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Affiliation(s)
- Letizia Trevisi
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - John E Orav
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Sidney Atwood
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
| | - Christian Brown
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Cameron Curley
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
| | - Caroline King
- School of Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Olivia Muskett
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Katrina A Nelson
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Sonya S Shin
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA.
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Rizzo M. Hand Surgery in Underserved Populations in the United States: The Author's Experience with the Navajo at the Gallup and Chinle Indian Health Service Hospitals. Hand Clin 2019; 35:441-448. [PMID: 31585605 DOI: 10.1016/j.hcl.2019.07.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Even in the most affluent country in the world there are many underserved population groups with limited or no access to health care. This article shares my experience with hand surgery volunteering with the Indian health service at Gallup, New Mexico and Chinle, Arizona. Although it has nuances with respect to logistics and challenges with regard to resources, the rewards of helping the patients in need has been among the best experiences of my career. I encourage anyone to consider domestic outreach because it reminds us of why we went to medical school.
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Affiliation(s)
- Marco Rizzo
- Department of Orthopedic Surgery, Division of Hand Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
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24
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Rock T, Camplain R, Teufel-Shone NI, Ingram JC. Traditional Sheep Consumption by Navajo People in Cameron, Arizona. Int J Environ Res Public Health 2019; 16:E4195. [PMID: 31671510 DOI: 10.3390/ijerph16214195] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 10/23/2019] [Accepted: 10/25/2019] [Indexed: 11/17/2022]
Abstract
Over 500 abandoned uranium mines are located on the Navajo Reservation. Different pathways of environmental uranium exposure have been studied with respect to the Navajo people including water, soil, and plants; however, uranium exposure from traditional Navajo food, specifically mutton (sheep), has not been reported. This study focuses on mutton consumption in the small community of Cameron, Arizona, located in the southwestern region of the Navajo Nation and initiated after community members expressed concern with the uranium exposure of their sheep. Preliminary investigation into the presence of uranium in sheep raised near Cameron showed elevated uranium levels in the kidneys the sheep tested. The goal of this study is to investigate mutton consumption among the Navajo living in Cameron. Mutton is a traditional food of the Navajo, but consumption practices are not well documented. An important aspect of determining the extent of exposure through food consumption is to assess the frequency of consumption. The results of this study indicate the Cameron participants consume mutton most commonly at family gatherings or celebrations. The survey suggests that less mutton is consumed now compared to the past, and there is concern that contaminated mutton may change traditional ceremonies.
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Lowe AA, Bender B, Liu AH, Solomon T, Kobernick A, Morgan W, Gerald LB. Environmental Concerns for Children with Asthma on the Navajo Nation. Ann Am Thorac Soc 2018; 15:745-53. [PMID: 29485894 DOI: 10.1513/AnnalsATS.201708-674PS] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE Navajo children living on the reservation have high rates of asthma prevalence and severity. Environmental influences may contribute to asthma on the Navajo Nation and are inadequately understood. OBJECTIVES We performed a comprehensive, integrative literature review to determine the environmental factors that may contribute to increased asthma prevalence and severity among Navajo children living on the reservation. METHODS A systematic search was conducted in four databases regarding the environmental risk factors for asthma in Navajo children living on the reservation. Relevant studies between 1990 and 2017 were examined. Nonexperimental literature was also integrated into the review to describe the environmental injustices that have historically, disproportionately, and systematically affected the Navajo people, thus contributing to respiratory disparities among Navajo children. RESULTS Eight studies met inclusion criteria for systematic review; however, limited research regarding environmental risk factors specific to asthma and Navajo children living on the reservation was identified. Our integrative review indicated both indoor and outdoor environmental risk factors commonly found on the Navajo reservation appear to be important determinants of asthma. CONCLUSIONS Future research should examine indoor and outdoor air pollution from wood-burning stoves and cook stoves, coal combustion, tobacco and traditional ceremonial smoke, diesel exhaust exposure from long bus rides, indoor allergens, ambient pollutants, and regional dusts. Comprehensive mitigation efforts created in partnership with the Navajo Nation are necessary to address less-recognized risk factors as well as the common risk factors known to contribute to increased childhood asthma prevalence and severity.
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26
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Yazzie JO, Fulé PZ, Kim YS, Sánchez Meador A. Diné kinship as a framework for conserving native tree species in climate change. Ecol Appl 2019; 29:e01944. [PMID: 31267598 DOI: 10.1002/eap.1944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 02/12/2019] [Accepted: 03/12/2019] [Indexed: 06/09/2023]
Abstract
Climate change affects all ecosystems but despite increasing recognition for the needs to integrate Indigenous knowledge with modern climate science, the epistemological differences between the two make it challenging. In this study, we present how Indigenous belief and knowledge system can frame the application of a modeling tool (Climate-Forest Vegetation Simulator). We focus on managing forest ecosystem services of the Diné (Navajo) Nation as a case study. Most Diné tribal members depend directly on the land for their livelihoods and cultural traditions. The forest plays a vital role in Diné livelihoods through social, cultural, spiritual, subsistence, and economic factors. We simulated forest dynamics over time under alternative climate change scenarios and management strategies to identify forest management strategies that will maintain future ecosystem services. We initialized the Climate-Forest Vegetation Simulator model with data from permanent plots and site-specific growth models under multiple management systems (no-management, thinning, burning, and assisted migration planting) and different climate scenarios (no-climate-change, RCP 4.5, RCP 6.0). Projections of climate change show average losses of basal area by over 65% by 2105, a shift in tree species composition to drier-adapted species, and a decrease in species diversity. While substantial forest loss was inevitable under the warming climate scenarios, the modeling framework allowed us to evaluate the management treatments, including planting, for conserving multiple tree species in mixed conifer forests, thus providing an anchor for biodiversity. We presented the modeling results and management implications and discuss how they can complement Diné kinship concepts. Our approach is a useful step for framing modern science with Indigenous Knowledge and for developing improved strategies to sustain natural resources and livelihoods.
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Affiliation(s)
- Jaime O Yazzie
- School of Forestry, Northern Arizona University, P.O. Box 15018, Flagstaff, Arizona, 86011, USA
| | - Peter Z Fulé
- School of Forestry, Northern Arizona University, P.O. Box 15018, Flagstaff, Arizona, 86011, USA
| | - Yeon-Su Kim
- School of Forestry, Northern Arizona University, P.O. Box 15018, Flagstaff, Arizona, 86011, USA
| | - Andrew Sánchez Meador
- School of Forestry, Northern Arizona University, P.O. Box 15018, Flagstaff, Arizona, 86011, USA
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Credo J, Torkelson J, Rock T, Ingram JC. Quantification of Elemental Contaminants in Unregulated Water across Western Navajo Nation. Int J Environ Res Public Health 2019; 16:E2727. [PMID: 31370179 PMCID: PMC6696199 DOI: 10.3390/ijerph16152727] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 07/26/2019] [Accepted: 07/27/2019] [Indexed: 01/09/2023]
Abstract
The geologic profile of the western United States lends itself to naturally elevated levels of arsenic and uranium in groundwater and can be exacerbated by mining enterprises. The Navajo Nation, located in the American Southwest, is the largest contiguous Native American Nation and has over a 100-year legacy of hard rock mining. This study has two objectives, quantify the arsenic and uranium concentrations in water systems in the Arizona and Utah side of the Navajo Nation compared to the New Mexico side and to determine if there are other elements of concern. Between 2014 and 2017, 294 water samples were collected across the Arizona and Utah side of the Navajo Nation and analyzed for 21 elements. Of these, 14 elements had at least one instance of a concentration greater than a national regulatory limit, and six of these (V, Ca, As, Mn, Li, and U) had the highest incidence of exceedances and were of concern to various communities on the Navajo Nation. Our findings are similar to other studies conducted in Arizona and on the Navajo Nation and demonstrate that other elements may be a concern for public health beyond arsenic and uranium.
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Affiliation(s)
- Jonathan Credo
- College of Medicine Clinical Translational Science Graduate Program, University of Arizona, Tucson, AZ 85721, USA
| | - Jaclyn Torkelson
- Department of Chemistry & Biochemistry, Northern Arizona University, P.O. Box 5698, Flagstaff, AZ 86011, USA
| | - Tommy Rock
- Department of Chemistry & Biochemistry, Northern Arizona University, P.O. Box 5698, Flagstaff, AZ 86011, USA
| | - Jani C Ingram
- Department of Chemistry & Biochemistry, Northern Arizona University, P.O. Box 5698, Flagstaff, AZ 86011, USA.
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Samuel-Nakamura C, Hodge FS, Sokolow S, Ali AMS, Robbins WA. Metal(loid)s in Cucurbita pepo in a Uranium Mining Impacted Area in Northwestern New Mexico, USA. Int J Environ Res Public Health 2019; 16:ijerph16142569. [PMID: 31323819 PMCID: PMC6679051 DOI: 10.3390/ijerph16142569] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 07/11/2019] [Accepted: 07/15/2019] [Indexed: 12/22/2022]
Abstract
More than 500 unreclaimed mines and associated waste sites exist on the Navajo Nation reservation as a result of uranium (U) mining from the 1940s through the 1980s. For this study, the impact of U-mine waste on a common, locally grown crop food was examined. The goal of this site-specific study was to determine metal(loid) concentration levels of arsenic (As), cadmium (Cd), cesium (Cs), molybdenum (Mo), lead (Pb), thorium (Th), U, vanadium (V) and selenium (Se) in Cucurbita pepo Linnaeus (squash), irrigation water, and soil using inductively coupled plasma-mass spectrometry. The concentrations of metal(loid)s were greatest in roots > leaves > edible fruit (p < 0.05), respectively. There were significant differences between metal(loid)s in squash crop plot usage (<5 years versus >30 years) for V (p = 0.001), As (p < 0.001), U (p = 0.002), Cs (p = 0.012), Th (p = 0.040), Mo (p = 0.047), and Cd (p = 0.042). Lead and Cd crop irrigation water concentrations exceeded the United States Environmental Protection Agency (USEPA) Maximum Contaminant Levels for drinking water for those metals. Edible squash concentration levels were 0.116 mg/kg of As, 0.248 mg/kg of Pb, 0.020 mg/kg of Cd, and 0.006 mg/kg of U. Calculated human ingestion of edible squash did not exceed Provisional Tolerable Weekly Intake or Tolerable Upper Limit levels from intake based solely on squash consumption. There does not appear to be a food-ingestion risk from metal(loid)s solely from consumption of squash. Safer access and emphasis on consuming regulated water was highlighted. Food intake recommendations were provided. Continued monitoring, surveillance, and further research are recommended.
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Affiliation(s)
- Christine Samuel-Nakamura
- School of Nursing, University of California, Los Angeles (UCLA), 4-246 Factor Bldg., Mailcode 691821, Los Angeles, CA 90095, USA.
| | - Felicia S Hodge
- School of Nursing, University of California, Los Angeles (UCLA), 5-940 Factor Bldg., Mailcode 691921, Los Angeles, CA 90095, USA
| | - Sophie Sokolow
- School of Nursing, University of California, Los Angeles (UCLA), 5-238 Factor Bldg., Mailcode 691921, Los Angeles, CA 90095, USA
| | - Abdul-Mehdi S Ali
- Department of Earth and Planetary Sciences, University of New Mexico, Northrop Hall MSCO 3-2040 Albuquerque, NM 87131, USA
| | - Wendie A Robbins
- Center for Occupational and Environmental Health Fielding School of Public Health, Environmental Health Sciences, University of California, Los Angeles (UCLA), 5-254 Factor Bldg., Mailcode 956919, Los Angeles, CA 90095, USA
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29
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de Heer HD, Bea J, Kinslow B, Thuraisingam R, Valdez L, Yazzie E, Schwartz AL. Development of a culturally relevant physical activity intervention for Navajo cancer survivors. ACTA ACUST UNITED AC 2019; 2. [PMID: 33615234 DOI: 10.33596/coll.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Despite well-documented benefits of physical activity for cancer survivors, few interventions have been developed for Native American cancer survivors, the population with the poorest survival rates of any group. This paper describes the development and cultural adaptation of a physical activity intervention for Navajo cancer survivors using Intervention Mapping (IM). IM procedures were guided by the PEN-3 (Perceptions-Enablers-Nurturers) and Health Belief Models and informed by a qualitative study with 40 Navajo cancer survivors and family members. For each theoretical construct (perceived benefits, barriers, enablers of healthy behaviors, etc.), a measurable objective was identified. These objectives were then matched with intervention strategies. The IM process indicated the need for a highly culturally sensitive environment (site and providers), culturally acceptable measurements and materials, and integrating cultural and environmental activity preferences. Program objectives aligned directly with these areas. Intervention strategies included: (a) collaboration with providers sensitive to historical/cultural context and environmental barriers; (b) cultural adaptation of surveys, non-invasive physical measurements, no biospecimen storage; (c) materials, terminology and symbols embracing cultural values of return to harmony; (d) physical activities that are flexible and aligned with cultural preferences and environment/travel issues (e.g., outdoor walking; community and home-based options; portable, inexpensive resistance equipment; local resources; family/friends participation and more community cancer education); (e) clinical adaptations by site and symptoms. This study is the first to document the process of adaptation of a physical activity program for Navajo cancer survivors. Objectives and strategies incorporated via IM are expected to foster sustainability and enhance uptake, satisfaction, and adherence.
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Affiliation(s)
- Hendrik D de Heer
- Department of Health Sciences, Northern Arizona University, Flagstaff, AZ
| | - Jennifer Bea
- Department of Medicine, University of Arizona, Tucson, AZ
| | - Brian Kinslow
- Department of Physical Therapy, Northern Arizona University, Flagstaff, AZ
| | | | - Luis Valdez
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ
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30
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King C, Atwood S, Brown C, Nelson AK, Lozada M, Wei J, Merino M, Curley C, Muskett O, Sabo S, Gampa V, Orav J, Shin S. Primary care and survival among American Indian patients with diabetes in the Southwest United States: Evaluation of a cohort study at Gallup Indian Medical Center, 2009-2016. Prim Care Diabetes 2018; 12:212-217. [PMID: 29229284 DOI: 10.1016/j.pcd.2017.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 11/06/2017] [Accepted: 11/18/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To evaluate the role of primary care healthcare delivery on survival for American Indian patients with diabetes in the southwest United States. METHODS Data from patients with diabetes admitted to Gallup Indian Medical Center between 2009 and 2016 were analyzed using a log-rank test and Cox Proportional Hazards analyses. RESULTS Of the 2661 patients included in analysis, 286 patients died during the study period. Having visited a primary care provider in the year prior to first admission of the study period was protective against all-cause mortality in unadjusted analysis (HR (95% CI)=0.47 (0.31, 0.73)), and after adjustment. The log-rank test indicated there is a significant difference in overall survival by primary care engagement history prior to admission (p<0.001). The median survival time for patients who had seen a primary care provider was 2322days versus 2158days for those who had not seen a primary care provider. CONCLUSIONS Compared with those who did not see a primary care provider in the year prior to admission, having seen a primary care provider was associated with improved survival after admission.
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Affiliation(s)
- Caroline King
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States; Community Outreach and Patient Empowerment (COPE), Gallup, NM, United States
| | - Sidney Atwood
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, United States
| | - Chris Brown
- Community Outreach and Patient Empowerment (COPE), Gallup, NM, United States; Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, United States
| | - Adrianne Katrina Nelson
- Community Outreach and Patient Empowerment (COPE), Gallup, NM, United States; Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, United States
| | - Mia Lozada
- Gallup Indian Medical Center, Indian Health Service, Gallup, NM, United States
| | - Jennie Wei
- Gallup Indian Medical Center, Indian Health Service, Gallup, NM, United States
| | - Maricruz Merino
- Gallup Indian Medical Center, Indian Health Service, Gallup, NM, United States
| | - Cameron Curley
- Community Outreach and Patient Empowerment (COPE), Gallup, NM, United States; Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, United States
| | - Olivia Muskett
- Community Outreach and Patient Empowerment (COPE), Gallup, NM, United States; Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, United States
| | - Samantha Sabo
- Health Promotion Sciences Department, University of Arizona, Tucson, AZ, United States
| | - Vikas Gampa
- Dept. of Internal Medicine, Cambridge Health Alliance, Boston, MA, United States
| | - John Orav
- Harvard School of Public Health, Boston, MA, United States
| | - Sonya Shin
- Community Outreach and Patient Empowerment (COPE), Gallup, NM, United States; Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, United States; Gallup Indian Medical Center, Indian Health Service, Gallup, NM, United States.
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31
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Samuel-Nakamura C, Robbins WA, Hodge FS. Uranium and Associated Heavy Metals in Ovis aries in a Mining Impacted Area in Northwestern New Mexico. Int J Environ Res Public Health 2017; 14:E848. [PMID: 28788090 DOI: 10.3390/ijerph14080848] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 06/21/2017] [Accepted: 06/22/2017] [Indexed: 11/21/2022]
Abstract
The objective of this study was to determine uranium (U) and other heavy metal (HM) concentrations (As, Cd, Pb, Mo, and Se) in tissue samples collected from sheep (Ovis aries), the primary meat staple on the Navajo reservation in northwestern New Mexico. The study setting was a prime target of U mining, where more than 1100 unreclaimed abandoned U mines and structures remain. The forage and water sources for the sheep in this study were located within 3.2 km of abandoned U mines and structures. Tissue samples from sheep (n = 3), their local forage grasses (n = 24), soil (n = 24), and drinking water (n = 14) sources were collected. The samples were analyzed using Inductively Coupled Plasma-Mass Spectrometry. Results: In general, HMs concentrated more in the roots of forage compared to the above ground parts. The sheep forage samples fell below the National Research Council maximum tolerable concentration (5 mg/kg). The bioaccumulation factor ratio was >1 in several forage samples, ranging from 1.12 to 16.86 for Mo, Cd, and Se. The study findings showed that the concentrations of HMs were greatest in the liver and kidneys. Of the calculated human intake, Se Reference Dietary Intake and Mo Recommended Dietary Allowance were exceeded, but the tolerable upper limits for both were not exceeded. Food intake recommendations informed by research are needed for individuals especially those that may be more sensitive to HMs. Further study with larger sample sizes is needed to explore other impacted communities across the reservation.
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Abstract
Following the start of uranium mining after World War II, progress toward addressing the hazards it created for workers and nearby communities was slow, taking many decades. This essay asks why it took so long and suggests several factors that might have contributed.
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Affiliation(s)
- Doug Brugge
- Tufts University School of Medicine, Boston, MA, USA
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33
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Kwan A, Hu D, Song M, Gomes H, Brown DR, Bourque T, Gonzalez-Espinosa D, Lin Z, Cowan MJ, Puck JM. Successful newborn screening for SCID in the Navajo Nation. Clin Immunol 2015; 158:29-34. [PMID: 25762520 DOI: 10.1016/j.clim.2015.02.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 02/25/2015] [Accepted: 02/27/2015] [Indexed: 11/18/2022]
Abstract
Newborn screening (NBS) for severe combined immunodeficiency (SCID) identifies affected infants before the onset of life-threatening infections, permitting optimal treatment. Navajo Native Americans have a founder mutation in the DNA repair enzyme Artemis, resulting in frequent Artemis SCID (SCID-A). A pilot study at 2 Navajo hospitals assessed the feasibility of SCID NBS in this population. Dried blood spots from 1800 infants were assayed by PCR for T-cell receptor excision circles (TRECs), a biomarker for naïve T cells. Starting in February 2012, TREC testing transitioned to standard care throughout the Navajo Area Indian Health Service, and a total of 7900 infants were screened through July 2014. One infant had low TRECs and was diagnosed with non-SCID T lymphopenia, while 4 had undetectable TRECs due to SCID-A, all of whom were referred for hematopoietic cell transplantation. This report establishes the incidence of SCID-A and demonstrates effectiveness of TREC NBS in the Navajo.
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Affiliation(s)
- Antonia Kwan
- Allergy Immunology and Blood and Marrow Transplant Division, Department of Pediatrics, Benioff Children's Hospital and University of California San Francisco, San Francisco, CA 94143, USA
| | - Diana Hu
- Department of Pediatrics, Tuba City Regional Health Care Center, Tuba City, AZ 86045, USA
| | - Miran Song
- Department of Pediatrics, Tuba City Regional Health Care Center, Tuba City, AZ 86045, USA
| | - Heidi Gomes
- Department of Pediatrics, Chinle Comprehensive Health Care Facility, Chinle, AZ 86503, USA
| | - Denise R Brown
- Department of Pediatrics, Tuba City Regional Health Care Center, Tuba City, AZ 86045, USA
| | - Trudy Bourque
- Department of Pediatrics, Chinle Comprehensive Health Care Facility, Chinle, AZ 86503, USA
| | - Diana Gonzalez-Espinosa
- Allergy Immunology and Blood and Marrow Transplant Division, Department of Pediatrics, Benioff Children's Hospital and University of California San Francisco, San Francisco, CA 94143, USA
| | - Zhili Lin
- Research and Development, PerkinElmer Genetics, Inc., Bridgeville, PA 15017, USA
| | - Morton J Cowan
- Allergy Immunology and Blood and Marrow Transplant Division, Department of Pediatrics, Benioff Children's Hospital and University of California San Francisco, San Francisco, CA 94143, USA
| | - Jennifer M Puck
- Allergy Immunology and Blood and Marrow Transplant Division, Department of Pediatrics, Benioff Children's Hospital and University of California San Francisco, San Francisco, CA 94143, USA.
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Gordon PH, Mehal JM, Holman RC, Bartholomew ML, Cheek JE, Rowland AS. Incidence and prevalence of Parkinson's disease among Navajo people living in the Navajo nation. Mov Disord 2015; 30:714-20. [PMID: 25649219 DOI: 10.1002/mds.26147] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 12/03/2014] [Accepted: 12/17/2014] [Indexed: 11/06/2022] Open
Abstract
Parkinson's disease (PD) is largely unstudied among American Indians. Unique populations might harbor clues to elusive causes. We describe the incidence and prevalence of PD among Navajo people residing in the Navajo Nation, home to the largest American Indian tribe in the United States. We analyzed 2001-2011 inpatient and outpatient visit data for Navajo people obtained from the Indian Health Service, which provides health care to American Indian people living on the Navajo Reservation. Cases were defined by at least two inpatient or outpatient visits with the diagnosis of PD. Crude and age-adjusted incidence and prevalence rates were calculated overall as well as by age, sex, region of residence, and time period. Five hundred twenty-four Navajo people with median age-at-onset of 74.0 years were diagnosed with PD during the study period, yielding an average annual crude incidence rate of 22.5/100,000. Age-specific incidence was 232.0 for patients 65 years of age or older and 302.0 for 80 years of age or older. Age-adjusted incidence was 35.9 overall (238.1 for ≥65 years), was higher in men than in women (47.5 vs. 27.7; P<0.001), varied by region (P=0.03), and was similar between time periods (2002-2004 vs. 2009-2011). The age-adjusted point prevalence rate was 261.0. The rate of PD among Navajo People appears to be as high as or higher than rates reported in many other populations. Rates increased to the highest age group, consistent with population-based studies. Further investigation is warranted to examine risk factors for PD in this remote population.
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Affiliation(s)
- Paul H Gordon
- Indian Health Service, U.S. Department of Health and Human Services, Northern Navajo Medical Center, Shiprock, New Mexico
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Adams N. A review of Yellow Dirt: A Poisoned Land and the Betrayal of the Navajos. Appl Nurs Res 2014; 28:114-5. [PMID: 25172455 DOI: 10.1016/j.apnr.2014.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 07/21/2014] [Accepted: 07/22/2014] [Indexed: 11/28/2022]
Abstract
Yellow Dirt is a thorough account of the past and present state of the Navajo Nation with regards to uranium mining. Through a journalistic approach Judy Pasternak weaves the story of the betrayal of the Navajo people. This book highlights the impact of environment on health and this review calls all nurses to be aware of these impacts and incorporate this type of knowledge into their practice.
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Affiliation(s)
- Nicole Adams
- University of New Mexico, Albuquerque, NM 87131, USA.
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