The Northern Plains Tribal Epidemiology Center recently received a Native American Research Center for Health (NARCH) grant from the U.S. Department of Health and Human Services Indian Health Service. The Northern Plains Tribal Epidemiology Center will partner with the University of Nebraska Medical Center.
The goal of the four-year grant, expected to total between $900,000 to $1.5 million, includes two research projects to build trust and facilitate research between Native Americans and academic institutions. One of the projects will look at diabetes risk in Native American youths and what can be done to prevent it. The other project is aimed at understanding asthma in Native American youths.
“The grant presents an unparalleled opportunity to conduct health research where partnership with tribal communities and building tribal capacity are at the foundation,” said Francine Romero, Ph.D., director of the Northern Plains Tribal Epidemiology Center and principal investigator, Northern Plains NARCH grant. “Our collaboration with the University of Nebraska Medical Center will undoubtedly bring tangible benefits to tribes.”
The Northern Plains Tribal Epidemiologic Center focuses on health research in tribes and is funded by the United States Indian Health Service. The Center, which serves 18 tribes in North Dakota, South Dakota, Nebraska, and Iowa, was established by the Aberdeen Area Tribal Chairman’s Health Board.
Jennifer Larsen, M.D., professor and section chief, UNMC diabetes, endocrinology and metabolism, said the project will focus on decreasing health disparities, facilitating research, decrease distrust, and train researchers in Native American communities.
“This is another step in how we’re trying to show universities can work with tribes to attack problems that they think are important, in ways that may be most effective and helpful to them, said Dr. Larsen, principal investigator of the diabetes risk project. “The idea is to establish a long-term relationship to work on more than one problem.”
Diabetes is almost an epidemic in all communities, but particularly the Native American community. The prevalence of Type 2 diabetes, the most common form of diabetes, is more than twice as common in Native Americans as in non-Hispanic white populations, Dr. Larsen said. “They also are at higher risk for diabetic complications, especially amputations and end stage renal disease, and are more likely to die from complications of diabetes.”
The prevalence of diabetes is increasing across the United States, but the greatest increases have been seen in Native American youths, ages 15-19. She said programs have been initiated in many tribes to try to reverse this trend but depend on identifying those at risk.
“We are now seeing new onset of diabetes in younger and younger ages,” Dr. Larsen said. “A lot of the data we have about prevalence of diabetes and pre-diabetes is based on those who make it to the physician’s office. There may be a lot of kids who are at risk whom we’re not even seeing.
“This is a whole new thing to have diabetes starting so early. We’re seeing an epidemic of new onset of diabetes type II affecting the whole population.”
The prevalence of diabetes is increasing and varies from tribe to tribe, but is about 9 percent in adults for the Aberdeen Area Great Plains tribes, which is double that described for surrounding states. Prevalence of diabetes across Nebraska has increased in the Great Plains tribes by 16 percent from 1990-1997, Dr. Larsen said.
The diabetes project will evaluate the prevalence of insulin resistance in children of the Rosebud Sioux tribe. The goal is to identify the best predictors in children who might be at risk for diabetes, with the ultimate goal of preventing the onset of diabetes.
“There really haven’t been that many studies to date that really identify the prevalence of diabetes and pre-diabetes. With this study, we hope to gain a more accurate representation of why Native American youths are at higher risk than youths in other groups. Is it just related to disparities in the prevalence of obesity – there is some evidence this is true — but are there other disparities to explain why higher risk for diabetes?”
Three hundred children, ages five to 18, will be screened on the Rosebud Sioux reservation in south central South Dakota. The Rosebud Clinic will serve as the primary study site.
Researchers will use traditional diabetes screening tools that might identify kids at risk, such as body mass index, family history, and newer screening tools, including stress screening. She said if stress is part of the risk of developing diabetes, an intervention can be developed to better identify a successful intervention.
“Which of these is the most sensitive for identifying children at risk has not been well studied,” said Dr. Larsen, principal investigator of the grant. “Better information on which is the easiest and most sensitive at identifying those at risk would be a great value in efforts to change outcomes in high risk populations,” Dr. Larsen said. “There’s very little data about the relative risk of diabetes in Native American kids, the best way to screen for it and the best way to intervene,” she said.
Researchers don’t know why diabetes is increasing in Native American adolescents.
“Could it be that kids on reservations have more stress and that is the reason we’re seeing more obesity and diabetes? One of the things we’re looking at is stress as a potential cause. We want to find out if there are specific stressors that hadn’t been identified. This may change how we intervene to prevent and treat diabetes,” Dr. Larsen said.
Researchers will add a unique component to the grant: depression screening.
Dr. Larsen said depression and stress can be detrimental to diabetes. “Depression and stress causes you to make extra hormones – adrenalin, for example. Almost all the stress hormones inhibit insulin action. If you make the insulin, it doesn’t work as well so you have to make more – kind of like type 2 diabetes. When some people have stress, they decide to eat because it makes them feel better, so if you’re eating more, that also contributes to insulin resistance.”
She said sedentary behavior contributes to insulin resistance. “Insulin resistance may be a direct result of stress hormones or it may indirect because the change of behaviors such as eating and activity behaviors. This also can lead to depression, which can increase stress hormones. It may be all of the above.
“The hope is the info we develop will be available to and valuable to the tribes and lead to more information that will improve on interventions we already have to more effectively prevent diabetes not only in youths but also adults as well.”
In addition, the grant will look at whether involvement of youths in traditional and cultural activities of the tribe may serve as factors that protect against risk of insulin resistance.
The asthma project of the grant involves screening for asthma in Northern Plains tribal communities to identify the prevalence of risk of asthma in children that have not been diagnosed with asthma. Kim Rodehorst, Ph.D., assistant professor of the UNMC College of Nursing West Nebraska Division in Scottsbluff, is principal investigator of the grant.
The project’s objective is to determine the number of asthmatic children currently undiagnosed, and identify those who aren’t receiving the appropriate level of care for their condition.
For more information about the study, contact Dr. Romero at (605)721-1922 or epiromero@aatchb.org.