Annie Belcourt

Beyond Health Equity: Achieving Wellness Within American Indian and Alaska Native Communities

The author discusses the need for the improvement of health disparities among Native Americans living in the U.S (or American Indians and Alaska Natives). Topics include the life expectancy of Native Americans, which is the lowest of any racial or ethnic group in the U.S., the efforts of tribal communities and the National Institutes of Health (NIH) to implement the Interventions for Health Promotion and Disease Prevention in Native American Populations initiative, and the mistrust for medical research of many tribal communities.

Post-Traumatic Stress Disorder and HIV Risk Behaviors Among Rural American Indian/Alaska Native Women

We assessed the relationship between post-traumatic stress disorder (PTSD), binge drinking, and HIV sexual risk behavior by examining number of unprotected sex acts and number of sexual partners in the past 6 months among 129 sexually active American Indian women. A total of 51 (39.5%) young women met PTSD criteria. Among women who met the PTSD criteria, binge drinking was associated with a 35% increased rate of unprotected sex (IRR 1.35, p < .05), and there was a stronger association between increased binge drinking and risk of more sexual partners (IRR 1.21, p < .001) than among women who did not meet PTSD criteria (IRR 1.08, p < .01) with a difference of 13% (p < .05). HIV intervention and prevention interventions in this population likely would benefit from the inclusion of efforts to reduce binge drinking and increase treatment of PTSD symptoms.

Racial discrimination’s influence on smoking rates among American Indian Alaska Native two-spirit individuals: Does pain play a role?

High rates of racial discrimination and non-ceremonial tobacco smoking exist among American Indian/Alaska Native (AIAN) Two-Spirit/LGBT (Lesbian, Gay, Bisexual, Transgender) populations. The authors examined whether or not pain mediates between racial discrimination and smoking among Two-Spirits. Two-Spirit adults (n=447) from seven urban U.S. locations were surveyed during the HONOR project. The Indigenist stress coping model was used as framework in which to conduct descriptive, bivariate and regression analyses. A majority of the participants reported smoking (45.2%) and pain (57%). Pain was found to mediate the association between racial discrimination and smoking. Racial discrimination appears to be a significant factor influencing tobacco smoking and health behaviors within Two-Spirit populations. Effective tobacco cessation and/or prevention planning for Two-Spirits and others who experience frequent racial discrimination, stress, and trauma should also consider the influence of pain. Pain may serve as the embodiment of discrimination, and this possibility requires future research.

Encompassing Cultural Contexts Within Scientific Research Methodologies in the Development of Health Promotion Interventions

American Indians/Alaska Natives/Native Hawaiians (AI/AN/NHs) disproportionately experience higher rates of various health conditions. Developing culturally centered interventions targeting health conditions is a strategy to decrease the burden of health conditions among this population. This study analyzes characteristics from 21 studies currently funded under the Interventions for Health Promotion and Disease Prevention in Native American (NA) Populations program among investigators currently funded under this grant mechanism. Four broad challenges were revealed as critical to address when scientifically establishing culturally centered interventions for Native populations. These challenges were (a) their ability to harness culture-centered knowledge and perspectives from communities; (b) their utilization of Indigenous-based theories and knowledge systems with Western-based intervention paradigms and theories; (c) their use of Western-based methodologies; and (d) their cultural adaptation, if based on an evidence-based treatment. Findings revealed that qualitative methodologies and community-based participatory research (CBPR) approaches were very commonly used to finalize the development of interventions. Various Indigenous-based theories and knowledge systems and Western-based theories were used in the methodologies employed. Cultural adaptations were made that often used formative mixed qualitative and quantitative methods. Illustrative examples of strategies used and suggestions for future research are provided. Findings underscored the importance of CBPR methods to improve the efficacy of interventions for AI/AN/NH communities by integrating Indigenous-based theories and knowledge systems with Western science approaches to improve health.

An Integrated Socio-Environmental Model of Health and Well-Being: a Conceptual Framework Exploring the Joint Contribution of Environmental and Social Exposures to Health and Disease Over the Life Span

Purpose of the reviewEnvironmental and social determinants of health often co-occur, particularly among socially disadvantaged populations, yet because they are usually studied separately, their joint effects on health are likely underestimated. Building on converging bodies of literature, we delineate a conceptual framework to address these issues.Recent findingsPrevious models provided a foundation for study in this area, and generated research pointing to additional important issues. These include a stronger focus on biobehavioral pathways, both positive and adverse health outcomes, and intergenerational effects. To accommodate the expanded set of issues, we put forward the Integrated Socio-Environmental Model of Health and Well-Being (ISEM), which examines how social and environmental factors combine and potentially interact, via multi-factorial pathways, to affect health and well-being over the life span. We then provide applied examples including the study of how food environments affect dietary behavior.SummaryThe ISEM provides a comprehensive, theoretically informed framework to guide future research on the joint contribution of social and environmental factors to health and well-being across the life span.

The Imperative for Research to Promote Health Equity in Indigenous Communities

Health disparities exact a devastating toll upon Indigenous people in the USA. However, there has been scant research investment to develop strategies to address these inequities in Indigenous health. We present a case for increased health promotion, prevention, and treatment research with Indigenous populations, providing context to the recent NIH investment in the Intervention Research to Improve Native American Health (IRINAH) network. We discuss the disproportionate costs and consequences of disparities borne by Indigenous groups, the limited evidence base on effective intervention for this population, how population uniqueness often makes transfer of existing intervention models difficult, and additional challenges in creating interventions for Indigenous settings. Given the history of colonial disruption that has included genocide, forced removal from lands, damaging federal, state and local policies and practices, environmental contamination, and most recently, climate change, we conclude research that moves beyond minor transformations of existing majority population focused interventions, but instead truly respects Indigenous wisdom, knowledge, traditions, and aspirations is needed, and that investment in intervention science to address Indigenous health disparities represent a moral imperative.

The social construction of violence among Northern Plains tribal members with antisocial personality disorder and alcohol use disorder

Whereas recent reports from national studies have presented extremely high rates for many personality disorders in American Indian communities, persistent concerns about the meaning of these symptoms have left many troubled by these reports. American Indians as a group are known to suffer disproportionately from a number of violent experiences, but the dynamics of this violence have received little attention. This paper examines perspectives on violence in the lives of 15 northern plains tribal members who met criteria for antisocial personality disorder and comorbid alcohol use disorder. It explores how study participants constructed and understood their own violent encounters, as well as the motivations they described (characterized here as reputation, leveling, retaliation, catharsis, and self-defense). Violence was gendered in this study, with men generally presenting as perpetrators and women as victims. Men often described themselves as ready participants in a violent world, while women were quite clear that aggression for them was often simply required as they tried to defend themselves from male violence. While this analysis does not replace clinical analyses of violence in antisocial personality disorder, it does reveal an underlying cultural logic that may play a role in shaping the recourse to violence for that minority of individuals for whom it appears to be the obvious choice.

Building Capacity for Productive Indigenous Community-University Partnerships

This paper describes capacity development as a key aspect of community-based research with indigenous communities. University research engagement with indigenous communities includes extensive, and often negative, historical antecedents. We discuss strategies for developing effective, egalitarian, and balanced indigenous community-university relationships to build research capacity of these communities, and to create sustainable partnerships to improve health and wellness, and to reduce health disparities. We draw on the experience of eight investigators conducting research with indigenous communities to assess effective strategies for building and enhancing partnerships, including (1) supporting indigenous investigator development; (2) developing university policies and practices sensitive and responsive to Indigenous community settings and resources, and training for research; (3) developing community and scientifically acceptable research designs and practices; (4) aligning indigenous community and university review boards to enhance community as well as individual protection (e.g., new human subjects training for Indigenous research, joint research oversight, adaptation of shorter consent forms, appropriate incentives, etc.); (5) determining appropriate forms of dissemination (i.e., Indian Health Services provider presentation, community reports, digital stories, etc.); (6) best practices for sharing credit; and (7) reducing systematic discrimination in promotion and tenure of indigenous investigators and allies working in indigenous communities.

Building a Tribal–Academic Partnership to Address PTSD, Substance Misuse, and HIV Among American Indian Women

Objectives. To describe our partnership and research infrastructure development strategies and discuss steps in developing a culturally grounded framework to obtain data and identify a trauma-informed evidence-based intervention. Method. We present funding strategies that develop and maintain the partnership and tools that guided research development. We share how a community research committee was formed and the steps taken to clarify the health concern and develop a culturally tailored framework. We present results from our needs/assets assessment that led to the selection of a trauma-informed intervention. Finally, we describe the agreements and protocols developed. Results. We produced a strong sustainable research team that brought program and research funding to the community. We created a framework and matrix of program objectives grounded in community knowledge. We produced preliminary data and research and publication guidelines that have facilitated program and research funding to address community-driven concerns. Conclusions. This study highlights the importance of bidirectional collaboration with American Indian communities, as well as the time and funding needed to maintain these relationships. A long-term approach is necessary to build a sustainable research infrastructure. Developing effective and efficient ways to build culturally based community research portfolios provides a critical step toward improving individual and community health outcomes.

Indoor air quality interventions with American Indian populations: Community capacity building towards public health intervention development for indigenous communities

I air quality and biomass smoke within indigenous communites is an emerging topic of significant public health concern. Wood stove use is highly prevalent within many reservation communities and biomass smoke associated with cooking and heating has been associated with chronic health problems. Studies conducted in rural and Native American communities examining indoor levels of fine particulate matter (PM2.5) have frequently found levels that exceeded current health-based air quality standards. Native elderly populations are particularly susceptible to reduced lung function or chronic conditions such as asthma, COPD, and bronchitis. Research conducted by our team has demonstrated that improving the efficacy of household level interventions (e.g., air filtration units) can reduce indoor exposures to biomass smoke and therefore lead to improved health outcomes. The findings from these interventions and qualitative input from wood stove experts, suggests that education interventions related to demonstrated best-practices in wood stove operation and fuel efficiency can translate to low-cost and sustainable strategies for reducing indoor biomass combustion exposures. This recently funded project is guided by community-based participatory research principles in order to create more effective and culturally centered intervention methods to improve indoor air quality. The household level intervention is coupled with a community level intervention that was developed and initiated by tribal stakeholders. This presentation will provide information about environmental concerns within indigenous communities and describe the initial work to culturally adapt the approaches and initial intervention planning. The presentation will seek to advance knowledge regarding community-based efforts to increase the translational public health impact of indoor air quality educational materials and interventions.A important requirement of emergent therapeutics will be the development of pharmaceutical technologies suitable for sustained and preventive health care in remote and sub-optimal environmental conditions. Availability of sustained, stable and targeted delivery of pharmaceuticals for preventive health of major organ systems including gastrointestinal, hepatorenal, musculo-skeletal and immune function are essential for effective pharmacotherapeutics. Specifically, pharmaceutical demands may include multi-drug combinations for hormone replacement, radiation protection, immune enhancement and organ function restoration. Additionally, extended stability of pharmaceuticals dispensed must be also considered in future drug development. Emerging technologies that can deliver stable and multi-therapy pharmaceutical preparations and delivery systems include nanotechnology based drug delivery platforms, targeted-delivery systems in non-oral and non-parenteral formulation matrices. Synthetic nanomaterials designed with molecular precision offer defined structures, electronics, and chemistries to be efficient drug carriers with clear advantages over conventional materials of drug delivery matricies. Nanocarrier materials like the bottle brush polymers may be suitable for systemic delivery of drug cocktails while Superparamagnetic Iron Oxide Nanoparticles or (SPIONS) have great potential to serve as carriers for targeted drug delivery to a specific site. These and other emerging concepts of drug delivery and extended shelf-life technologies will be reviewed in light of their application to address health-care challenges of the future. Innovations in alternate treatments for sustained immune enhancement and infection control will be also discussed.In the present study, we did the non -compartmental pharmacokinetics study of amlodipine using high performance liquid chromatography with ultraviolet detector (HPLC-UV) in wistar rats. Rats were allocated to two groups; intravenous group (IV study n=6) and oral group (PO study n=6).In both groups, surgical procedures were carried out under Ketamine HCL (40 mg/kg) and Diazepam (1.5mg/kg) general anesthesia (intramuscular injection).The blood samples were collected at different time interval and were analyzed using HPLC-UV system. Results showed that Amlodipine had a short terminal half-life with relatively high distribution volumes during the steady and terminal phases, and with low plasma clearance. Furthermore, the availability ratio of amlodipine through the intravenous route was higher than that through the oral route, indicating that first pass metabolism and hepatic blood flow are important factor of drug elimination of amlodipine. Bioavailability was estimated to be 78.60 ± 21.33% based on the AUCinf ratios of oral and intravenous administration.R advances in genomics technologies exert profound impact on the biomedical sciences. The main goal of the pharmaceutical sciences is to understand individual differences in drug response and toxicity, as a foundation for developing and guiding therapy for each patient. Bioavailability and bioequivalence represent important factors in the design of optimal drug therapy. Both genetic variants and epigenetic factors, and interplay between them, determine a portion of inter-individual variability, with expression of drug metabolizing enzymes (DMEs) and transporters playing a key role. A number of genetic variants have already been incorporated into pharmacogenetic biomarker tests, but the vast majority of (epi) genetic variability remains hidden. We have implemented gene-by-gene and genome-wide methods to search for pharmacologically relevant variants and regulatory processes, using next generation sequencing of DNA and RNA (RNAseq of coding and non-coding RNAs). A survey of DME and transporter expression reveals distinct expression profiles in various tissues, and the presence of multiple RNA transcripts at each gene locus (such as splice variants). Broad understanding of the regulation of DMEs and transporters has the potential to guide drug development and clinical application.