Native Americans - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

NATIVE AMERICANS A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES J ...

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NATIVE

AMERICANS A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES

J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS

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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright ©2004 by ICON Group International, Inc. Copyright ©2004 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1

Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Native American Health: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-497-11075-X 1. Native American Health-Popular works. I. Title.

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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.

Copyright Notice If a physician wishes to copy limited passages from this book for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications have copyrights. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs, or other materials, please contact us to request permission (E-mail: [email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International, Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this book.

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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on Native American health. Books in this series draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this book. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany Freeman for her excellent editorial support.

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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for health books by ICON Health Publications. Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for ICON Health Publications.

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About ICON Health Publications To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes&Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health

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Table of Contents FORWARD .......................................................................................................................................... 1 CHAPTER 1. STUDIES ON NATIVE AMERICAN HEALTH ................................................................... 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Native American Health ............................................................. 10 E-Journals: PubMed Central ....................................................................................................... 55 The National Library of Medicine: PubMed ................................................................................ 55 Academic Periodicals covering Native American Health ............................................................ 80 Dissertations on Native American Health................................................................................... 80 CHAPTER 2. NUTRITION AND NATIVE AMERICAN HEALTH ......................................................... 83 Overview...................................................................................................................................... 83 Finding Nutrition Studies on Native American Health.............................................................. 83 Federal Resources on Nutrition ................................................................................................... 85 Additional Web Resources ........................................................................................................... 86 CHAPTER 3. BOOKS ON NATIVE AMERICAN HEALTH ................................................................... 89 Overview...................................................................................................................................... 89 Book Summaries: Federal Agencies.............................................................................................. 89 Book Summaries: Online Booksellers........................................................................................... 91 Chapters on Native American Health .......................................................................................... 91 Directories.................................................................................................................................... 94 CHAPTER 4. MULTIMEDIA ON NATIVE AMERICAN HEALTH ......................................................... 97 Overview...................................................................................................................................... 97 Video Recordings ......................................................................................................................... 97 Audio Recordings......................................................................................................................... 98 CHAPTER 5. RESEARCHING MEDICATIONS .................................................................................... 99 Overview...................................................................................................................................... 99 U.S. Pharmacopeia....................................................................................................................... 99 Commercial Databases ............................................................................................................... 100 APPENDIX A. PHYSICIAN RESOURCES .......................................................................................... 103 Overview.................................................................................................................................... 103 NIH Guidelines.......................................................................................................................... 103 NIH Databases........................................................................................................................... 105 Other Commercial Databases..................................................................................................... 107 APPENDIX B. PATIENT RESOURCES ............................................................................................... 109 Overview.................................................................................................................................... 109 Patient Guideline Sources.......................................................................................................... 109 News Services and Press Releases.............................................................................................. 113 Newsletters on Native American Health ................................................................................... 115 Newsletter Articles .................................................................................................................... 115 Finding Associations.................................................................................................................. 117 APPENDIX C. FINDING MEDICAL LIBRARIES ................................................................................ 119 Overview.................................................................................................................................... 119 Preparation................................................................................................................................. 119 Finding a Local Medical Library................................................................................................ 119 Medical Libraries in the U.S. and Canada ................................................................................. 119 ONLINE GLOSSARIES................................................................................................................ 125 Online Dictionary Directories ................................................................................................... 125 NATIVE AMERICAN HEALTH DICTIONARY..................................................................... 127

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INDEX .............................................................................................................................................. 169

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FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with Native American health is indexed in search engines, such as www.google.com or others, a non-systematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about Native American health, using the most advanced research tools available and spending the least amount of time doing so. In addition to offering a structured and comprehensive bibliography, the pages that follow will tell you where and how to find reliable information covering virtually all topics related to Native American health, from the essentials to the most advanced areas of research. Public, academic, government, and peer-reviewed research studies are emphasized. Various abstracts are reproduced to give you some of the latest official information available to date on Native American health. Abundant guidance is given on how to obtain free-of-charge primary research results via the Internet. While this book focuses on the field of medicine, when some sources provide access to non-medical information relating to Native American health, these are noted in the text. E-book and electronic versions of this book are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). If you are using the hard copy version of this book, you can access a cited Web site by typing the provided Web address directly into your Internet browser. You may find it useful to refer to synonyms or related terms when accessing these Internet databases. NOTE: At the time of publication, the Web addresses were functional. However, some links may fail due to URL address changes, which is a common occurrence on the Internet. For readers unfamiliar with the Internet, detailed instructions are offered on how to access electronic resources. For readers unfamiliar with medical terminology, a comprehensive glossary is provided. For readers without access to Internet resources, a directory of medical libraries, that have or can locate references cited here, is given. We hope these resources will prove useful to the widest possible audience seeking information on Native American health. The Editors

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From the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.

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CHAPTER 1. STUDIES ON NATIVE AMERICAN HEALTH Overview In this chapter, we will show you how to locate peer-reviewed references and studies on Native American health.

The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and Native American health, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type “Native American health” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is what you can expect from this type of search: •

Access of Native Americans to Renal Transplantation in Arizona and New Mexico Source: Blood Purification. 14(4): 292-304. July-August 1996. Contact: Available from S. Karger Publishers, Inc. 26 West Avon Road, P.O. Box 529, Farmington, CT 06085. Summary: Lower rates of transplantation among minority groups are a nationally recognized phenomenon. Native Americans nationally have nearly four times the risk of end-stage renal disease (ESRD) as white Americans and are significantly overrepresented in the Network 15 ESRD population. This article reports on a study undertaken to understand more about Native American and white transplant rates. The authors looked at all reported Arizona (AZ) and New Mexico (NM) resident cases from

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Native American Health

the Network 15 database. Age of onset, sex, primary diagnosis, payment source, transplant donor source, and other factors were examined. Native Americans experienced a slightly earlier onset of ESRD than whites, and diabetes mellitus was the primary ESRD diagnosis for 63 to 73 percent of Native Americans and for 34 to 39 percent of whites. Because age distribution and frequency of diabetes mellitus of the Native American ESRD population differ from those of whites in the Network, agespecific and diagnosis-specific transplant rates were examined. Age-adjusted transplant rates for 100 ESRD patients for AZ were 16.4 (Native Americans) and 21.0 (whites) and for NM 14.2 (Native American) and 22.4 (whites). Diagnosis-specific, age-adjusted transplant rates for patients with the primary diagnoses of diabetes mellitus and glomerulonephritis, the two most common causes of ESRD among Native Americans, showed a large difference between white and Native American rates. In all comparisons and in both the white and Native American ESRD populations, women were transplanted at lower rates than men. Native Americans experienced a greater delay from onset of treated ESRD to transplant than whites. Payment source and transplant donor source did not appear to be significantly different between the two populations. The authors conclude that the lower transplant rates in Native Americans versus whites in Network Number 15 cannot be explained by age-specific or diagnosis-specific factors. 12 tables. 7 references. (AA-M). •

Prevalence and Correlates of the Insulin Resistance Syndrome Among Native Americans: The Inter-Tribal Heart Project Source: Diabetes Care. 22(3): 441-447. March 1999. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: This article describes a study that examined the clustering of four traits for cardiovascular disease (CVD), hypertension, diabetes, high triglycerides, and low high density lipoprotein (HDL) cholesterol, and the association of these traits with adiposity and fasting insulin levels among people living in three Chippewa and Menominee communities in Wisconsin and Minnesota. Cross sectional data from 488 men and 822 women aged 25 or older in the Inter-Tribal Heart Project were included. Results indicate that, among the men, 40.4 percent, 32.6 percent, 17.4 percent, and 9.6 percent had none, one, two, or three of the four traits, respectively. Among the women, the respective percentages were 53.2 percent, 25.6 percent, 15.3 percent, and 6.0 percent. The percentage of those who had each particular trait increased significantly among those with none, one, or at least two other syndrome traits. Among those who had normal fasting glucose levels, insulin positively correlated with serum glucose and triglycerides and who inversely related to HDL cholesterol for both men and women. Insulin was also positively associated with systolic and diastolic blood pressure, weight, and all measures of adiposity. Insulin was not associated with low density lipoprotein cholesterol. Having more syndrome traits was significantly related to higher body mass index (BMI), conicity index, waist circumference, and waist to hip and waist to thigh ratios. Among those who had normal glucose levels, having more syndrome traits was significantly related to higher fasting insulin levels after adjusting for age and measures of adiposity, although associations were attenuated with adjustment for either BMI or waist circumference. The article concludes that traits characterizing the insulin resistance syndrome were clustered to a significant degree among Native Americans in this study. Comprehensive public efforts are needed to reduce adverse levels of these risk factors in this high-risk population. 2 figures. 4 tables. 39 references. (AA-M).

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Diabetes Education for the Native American Population Source: Diabetes Educator. 27(2): 181-182, 187-188. March-April 2001. Contact: Available from American Association of Diabetes Educators. 100 West Monroe Street, 4th Floor, Chicago, IL 60603-1901. (312) 424-2426. Summary: This article discusses diabetes education for the Native American population. There is a diversity among Native American tribes and villages with regard to language or dialect, philosophy, customs, and government structure, so it is difficult to develop a diabetes education program that is culturally specific. Various educational materials are available and can be adapted for use in an existing program. Native Americans have a present oriented sense of time, and this flexible time orientation tends to conflict with rigidly timed appointment schedules. Therefore, accommodation should be made for this view. Scheduling appointments and follow up teaching during the pow wow season can also be challenging. Exercise is encouraged for Native Americans, and culturally specific exercise videos are available. Diet varies greatly among Native Americans, but generally the westernized diet of high fat and fast food is common among most Native Americans. Clients should be encouraged to eat more traditional foods and to prepare foods in the traditional manner. 12 references.

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Professional Practice at a Native American Community: An Introduction to Renal Social Services with Pima-Maricopa Tribal Community Members Source: Contemporary Dialysis and Nephrology. 11(12): 23-25, 28. December 1990. Summary: This article discusses renal social services within the Pima-Maricopa tribal community. The cultural heritage and kinships of the Salt River Pima-Maricopa Indian Tribal Community represent a foundation of individual and community strengths needed to support the Native American patient when interacting with the medical, psychological, social, and cultural environments endemic to chronic renal failure and dialysis therapy. The author demonstrates this support through case studies and tribal stories. 8 references. (AA-M).

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Type II Diabetes and Cognitive Function: A Population-Based Study of Native Americans Source: Diabetes Care. 17(8): 891-896. August 1994. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: This article presents a short report on a research study exploring the relationship between noninsulin-dependent diabetes (NIDDM) and cognitive function in older Native Americans and assessing the effects of other selected risk factors for cognitive dysfunction on this relationship. Cognitive function was assessed in 80 Native Americans with diabetes and 81 Native Americans without diabetes; all were 45-76 years of age and included in a cross-sectional population-based substudy of the Strong Heart Study. Thirteen cognitive function tests were administered during a personal interview. Information about six other risk factors for cognitive dysfunction, including depressive symptoms, physical function, alcoholism, current alcohol use, hypertension, and myocardial infarction, was ascertained from interviews and from abstraction of medical records. Results showed little evidence that NIDDM in this population of Native Americans is associated with decrement in cognitive function. The authors note that some of the cognitive impairment previously attributed to diabetes may be related to the influence of other risk factors. 4 tables. 31 references. (AA-M).

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Diabetic End-Stage Renal Disease Among Native Americans Source: Diabetes Care. 16(Supplement 1): 346-348. January 1993. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Summary: This article reports on a study that examined why end-stage renal disease (ESRD) has become a major source of morbidity and mortality for Native Americans with diabetes mellitus. Using data from the Medicare ESRD Program, the authors examined incidence rates for ESRD among Native Americans for the years 1983 through 1987. During this period, the annual incidence of total ESRD in Native Americans increased by 18 percent, from 170.5 per million to 200.1 per million. The incidence of diabetes-related ESRD increased by 47 percent, from 80.6 per million to 118.2 per million. In 1987, the age-adjusted incidence rate of diabetes-related ESRD was 6.8 times higher in Native Americans than in whites. The authors present recommendations for the prevention of diabetes-related ESRD including early identification of renal disease and improved control of hypertension and blood glucose levels. The magnitude of diabetes-related ESRD among Native Americans also underscores the need for primary prevention of noninsulin-dependent diabetes mellitus (NIDDM). 3 figures. 1 table. 15 references. (AA-M).

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Study of Dental Caries and Risk Factors Among Native American Infants Source: Journal of Dentistry for Children. 62(4): 283-287. July-August 1995. Summary: This article reports on a study undertaken to establish the prevalence of caries among Native American infants and to identify risk factors contributing to the disease. The subjects were 77 infants, 12 to 36 months of age, and their parents or caregivers. All parents/caregivers completed questionnaires that consisted of 29 questions focusing on behavioral risk factors for dental diseases. Caries experienced was assessed in the children. An overall caries prevalence of 46.8 percent and average number of carious teeth per child of 2.09 were obtained. The authors note that no child had filled or missing teeth caused by caries; this may suggest that these young Native American children do not have access to dental care. It appears that children with caries ingest snacks between meals more frequently than children without caries. In addition, other lifestyle-related behaviors, e.g., toothbrushing behavior, were found to be risk factors for dental caries. The authors call for culturally appropriate preventive, screening, and education efforts. 4 tables. 25 references.

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Participant Satisfaction with a Culturally Appropriate Diabetes Education Program: The Native American Diabetes Project Source: Diabetes Educator. 25(3): 351-363. May-June 1999. Contact: Available from American Association of Diabetes Educators. 100 West Monroe Street, 4th Floor, Chicago, IL 60603-1901. (312) 424-2426. Summary: This article reports on participant satisfaction with the Native American Diabetes Project (NADP). This project was developed to facilitate diet and lifestyle modifications among Native Americans with type 2 diabetes in New Mexico. The NADP consisted of five sessions designed according to the transtheoretical model of change and social action theory with input from community members. Eight pueblo communities participated in the program. Sessions were taught by a community mentor in three sites in New Mexico. One site taught sessions in one-on-one format, and two sites taught sessions in a group format. There were 151 participants in the education

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program as measured by attendance at session one. Retention was high across all sites. Retention rates for the sessions were 81 percent for group sessions and 91 percent for one-on-one sessions. Overall, participants responded positively to sessions designed according to social action theory and with cultural competency. However, qualitative and quantitative analyses show different aspects of participant satisfaction. The qualitative analyses results reveal a very similar range of responses across sites and program delivery format regarding aspects of the program that were designed to be culturally appropriate and theoretically based. The quantitative chi square analysis that compared the proportion of negative to nonnegative responses and retention rates shows some statistically significant differences. The proportion of negative comments was smaller at one site than the other two sites and smaller for one-on-one program delivery than for the group format. The qualitative range of responses highlights the overall similarities in the types of program aspects that participants liked, disliked, and would alter. The quantitative measures of retention and negative responses proved an overall proportional account of participant satisfaction. The article concludes that using a strong theoretical framework and community input to design diabetes education sessions may be important factors in participant satisfaction and retention in diabetes lifestyle education sessions. 5 tables. 24 references. (AA-M). •

Strong in Body and Spirit: Lifestyle Intervention for Native American Adults with Diabetes in New Mexico Source: Diabetes Care. 25(1): 78-83. January 2002. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: This article reports on research undertaken to determine the effects of a culturally appropriate diabetes lifestyle intervention for Native Americans on risk factors for complications of diabetes. A nonrandomized, community based diabetes intervention trial was conducted in three Native American sites in New Mexico from 1993 to 1997. Participants were assigned to intervention or control based on community of residence. Intervention sessions were held approximately 6 weeks apart over a period of 10 months. The intervention was delivered in site A in family and friends (FF) groups (n = 32); site B received the same intervention in one on one (OO) appointments (n = 39); and site C received usual medical care (UC, n = 33). Total participants were 104. Primary change in HbA1c level (a measure of blood glucose levels over time) was assessed at 1 year. Adjusted mean change in HbA1c value varied significantly across the three intervention arms at 1 year. The UC arm showed a statistically significant increase in adjustment mean HbA1c change, whereas both intervention arms showed a small nonsignificant increased in the adjusted mean change. The increase was statistically significantly smaller in the combined intervention arms compared with the UC arm. An increase in HbA1c levels indicates a reduction in effective diabetes management. The authors conclude that lifestyle intervention has the potential to substantially reduce microvascular complications, mortality, and health care utilization and costs if the change is sustained over time. 1 figure. 2 tables. 32 references.

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Dental Experiences and Parenting Practices of Native American Mothers and Caretakers: What We Can Learn for the Prevention of Baby Bottle Tooth Decay Source: Journal of Dentistry for Children. 66(2): 120-126. March-April 1999. Contact: Available from American Society of Dentistry for Children. John Hancock Center, 875 North Michigan Avenue, Suite 4040, Chicago, IL 60611-1901. (312) 943-1244.

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Summary: This article reports on the dental experiences and parenting practices of Native American mothers and caretakers, with an emphasis on the prevention of baby bottle tooth decay (BBTD). The authors discuss the prevalence of BBTD, interventions for BBTD, the use of a focus group study to elucidate the American Indian experience in this area, the dental treatment experiences of the adult and the child, concerns and caring for the parent's and the child's teeth, and feeding practices. The authors note that an ethnographic approach (training local women to gather perceptions) has provided sensitive and useful information. In addition to promoting early screening and preventive services for young children, enhancing efforts to provide positive dental experiences for mothers and women of childbearing age is recommended. While some parents and caretakers may lack knowledge concerning BBTD, effort should be made to correct misinformation, such as that a young child can clean his or her own teeth, and providing brief counseling regarding culturally appropriate options. 16 references. •

Population At Risk: Diabetes and Native Americans Source: Living Well With Diabetes. 5(4): 12-13. Fall 1990. Summary: This article reviews the hereditary and environmental risk factors for diabetes among Native Americans and discusses current Federal programs addressing the problem. The author reviews the history of diabetes in the Native American population and the history of Federal funding and participation in Native American health care. A description of the Indian Health Service (IHS) Diabetes Program is also provided.

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Peripheral Vascular Disease Among Native Americans: Pitfalls of the Vascular Examination in Patients with Diabetes Source: IHS Primary Care Provider. Indian Health Service Primary Care Provider. 18(3): 49-51. March 1993. Contact: Available from IHS Primary Care Provider. Indian Health Service/PHS, Clinical Support Center, 4212 North 16th Street, Phoenix, AZ 85016. (602) 640-2140. Fax (602) 640-2138. Summary: This is the first in a series of two articles about peripheral vascular disease in Native Americans with diabetes. The author deals with the diagnosis of peripheral vascular disease, the basic vascular examination of the diabetic foot, and pitfalls of the vascular examination in patients with diabetes. The author discusses the symptoms of ischemia, including claudication (pain that occurs with exercise), trophic changes, and the absence of a pulse in the foot. The author then considers the diagnostic tests used to confirm peripheral vascular problems, including doppler signals, the ankle arm index (AAI), capillary refill, and plethysmography. The authors stresses that, in addition to controlling infection, debriding dead tissue, and providing proper footwear (or keeping a patient off his or her foot), a vascular examination should be performed. If the patient can withstand vascular surgery, the he or she should be evaluated by a vascular surgeon, and perhaps obtain angiograms for the purpose of undergoing revascularization. Revascularization offers the potential for limb salvage for those individuals presenting to the provider with a threatened limb. 4 references. (AA-M).

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Cross-Cultural Perspectives: Caribbean, Native American, and Yoruba Source: International Psychogeriatrics. 8(Supplement 3): 483-486. 1996.

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Summary: This journal article describes a cross-cultural comparison of the behavioral disturbances of dementia in four population groups: Jamaicans in Kingston; Cree in Northern Manitoba, Canada; Yoruba in Ibadan, Nigeria; and African-Americans in Indianapolis, Indiana. The severity of dementia tended to be greatest in the Jamaican group and least in the Nigerian group. American caregivers were the most likely to report personality changes, and the Nigerian caregivers were the most concerned about the possibility of their spouses with dementia becoming involved in embarrassing situations. Treatment of behavioral symptoms in the Jamaican, Cree, and Nigerian groups depended on various psychosocial and demographic factors, including the availability of health care services. In all three societies, older people are held in high regard and a considerable degree of tolerance exists for some regressive behaviors. The authors conclude that caregivers in these diverse cultures all recognize the problem of behavioral disturbances of dementia, but differ in their approach to treatment and the frequency with which such treatment is sought. 3 tables, 5 references. •

Supplement 1: Diabetes in Native Americans Source: Diabetes Care. 16(1): 211-382. January 1993. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: This special supplement in Diabetes Care includes proceedings of a symposium held as part of a conference in Mesa, Arizona, in November 1989. The symposium was sponsored by the Indian Health Service and the National Institute of Diabetes and Digestive and Kidney Diseases, in collaboration with the Intertribal Council of Arizona. The 32 articles in the supplement include reports on diabetes prevalence, complications, and mortality in Native Americans and Alaska Natives; descriptions of prevention, treatment, and educations programs in tribal communities; an introductory overview; and a concluding statement.

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Association of the Insulin Resistance Syndrome and Microalbuminuria Among Nondiabetic Native Americans. The Inter-Tribal Heart Project Source: JASN. Journal of the American Society of Nephrology. 13(6): 1626-1634. June 2002. Contact: Available from Lippincott Williams and Wilkins. 12107 Insurance Way, Hagerstown, MD 21740. (800) 638-6423. Summary: This study investigated the association between microalbuminuria (the presence of microscopic protein in the urine) and the insulin resistance syndrome (IRS) among nondiabetic Native Americans. In a cross-sectional survey, age-stratified random samples were drawn from the Indian Health Service clinic lists for one Menominee and two Chippewa reservations. Information was collected from physical examinations, personal interviews, and blood and urine samples. the urinary albumin to creatinine ratio (ACR) was measured using a random spot urine sample. The IRS was defined by the number of composite traits: hypertension (high blood pressure), impaired fasting glucose (IFG), high fasting insulin, low HDL cholesterol, and hypertriglyceridemia (high levels of blood fats). Among the 934 eligible non-diabetic participants, 15.2 percent exhibited microalbuminuria. The prevalence of one, two, and three or more traits was 17.0 percent, 16.6 percent and 7.4 percent, respectively. Of the individual IRS traits, only hypertension and IFG were associated with microalbuminuria. Among these nondiabetic Native Americans, the IRS was associated with a twofold increased prevalence of microalbuminuria. The authors conclude that

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health promotion efforts should focus on lowering the prevalence of hypertension, as well as glucose intolerance and obesity, in this population at high risk for renal and cardiovascular disease. 1 figure. 4 tables. 47 references.

Federally Funded Research on Native American Health The U.S. Government supports a variety of research studies relating to Native American health. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to Native American health. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use animals or simulated models to explore Native American health. The following is typical of the type of information found when searching the CRISP database for Native American health: •

Project Title: ACNP ANNUAL MEETING SPECIAL PROGRAMS Principal Investigator & Institution: Sanders-Bush, Elaine; Professor; Pharmacology; Vanderbilt University 3319 West End Ave. Nashville, Tn 372036917 Timing: Fiscal Year 2003; Project Start 30-SEP-1998; Project End 31-JUL-2008 Summary: (provided by applicant): There is ample evidence for racial and ethnic disparities in the health of our nation and, specifically, in the neuroscience research community. An emerging central component of the strategic plans to eliminate health disparities focus on medical research and research training. With RFAs such as "Increasing Diversity", the NIH seeks to address the need to expand both the size and the diversity of the scientific workforce committed to reducing health disparities. The under-representation for African Americans, Hispanic Americans and Native Americans is especially acute in neuroscience. As reported in Doctorate Recipients from United States Universities - Summary Report, published by the National Academic Press, Washington, D.C., in 1997, 432 Ph.D.'s were awarded in neuroscience by U.S. universities. Six (1.4%) African Americans, 8 (1.9%) Hispanic Americans and no Native Americans were among these Ph.D. recipients. Furthermore, a review of the statistics for the three-year period from 1997 to 1999 showed that underrepresented minorities (defined as African Americans, Hispanic Americans and Native Americans) were awarded only 4.2% of the neuroscience Ph.D. degrees conferred by U.S. universities. This shocking statistic illustrates an immediate, pressing challenge - to expand the human resource pool in neuroscience to include a more representative number of minorities. The American College of Neuropsychopharmacology (ACNP) shares the scientific community's concerns over the need to increase minority participation in the

2

Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).

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medical sciences and scientific research. The Minority Travel Program is an important part of our effort to increase diversity in neuroscience research and education. The ACNP believes that the continued support of a Travel Award Program providing funding for post-doctoral minority professionals to attend the annual scientific meeting would play a significant role in encouraging young minority scientists to enter the field of neuroscience research. Attendance at the Annual Meeting provides an opportunity for the awardee to become familiar with the evolving field of neuropsychopharmacology and experience the stimulation and excitement of meeting experts in the field. The evident success and effectiveness of the NIMH Minority Travel Award Program, and the clear continuing need to encourage minority post-doctoral professionals to enter and pursue careers in science, merits the continuation of the NIMH Minority Travel Award Program. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ATHLETICS & EATING PROBLEMS IN NATIVE & CAUCASIAN YOUTH Principal Investigator & Institution: Lynch, Wesley C.; Psychology; Montana State University (Bozeman) Bozeman, Mt 59717 Timing: Fiscal Year 2002; Project Start 01-JUN-2002; Project End 31-MAY-2004 Summary: (provided by applicant): Current literature indicates that risk factors for eating disorders (ED) among native Americans are poorly understood. However, available evidence suggests that Native American adolescents females are one of the few groups at equal or greater risk for eating disorders than age-matched Caucasian females. Other recent research suggests that strenuous physical activity may be an independent risk factor for ED, although it remains unknown whether or not this applies to sub-clinical eating problems in adolescents. Still other evidence suggest that athletic involvement may either enhance or reduce the risk of ED depending on factors such as age, self-esteem, and level of competition. In light of this, the proposed study has two main goals: 1) to characterize the weight control practices of matched samples of Caucasian and Native American females at various ages pre-and post puberty and 2) to determine what aspects of athletic involvement may increase or reduce ED risks in each group. We expect athletic involvement to modify the risk for maladaptive weight control behaviors depending on ethnicity, type and level of athletic involvement, and the individual's level of sexual maturation. A proposed structural equation model (SEM) expressing specific hypotheses about various potential risk factors will be tested with data from each ethnic group. A cross-sectional survey will be administered to students in grades 5-10 from selected public schools in Billings and Hardin, MT. Measures of maladaptive weight control behavior, assessed by the Mc Knight risk factor Survey (MRFS-IV) and ED symptom profiles, assessed by the Eating Disorders Symptoms Checklist, will provide measures of the main dependent variables. As a supplement to goodness-of-fit analyses of the proposed model, a more exploratory regression-tree analytical approach will be used to examine which of several independent variables (predictors), including ethnicity, age, gender, maturational status, body shape satisfaction, height, weight, waist/hip ratio, and BMI, best predict specific ED symptoms. In addition of the survey data, a selected sample of the oldest students will participate in interviews designed to assess the onset-age and development history of specific weight control behaviors and physical activity patterns. A part of each interview will also assess differences in Native and Caucasian cultural views regarding eating weight-management and related issues. This work is a first attempt to our knowledge to compare age-matched Native American and Caucasian youth along these dimensions

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and should provide valuable data not currently available. Ultimately this work should inform decision-making regarding the advisability of specific types of athletic participation as interventions aimed at reducing the risk of eating disorders and/or obesity. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: BRIDGES TO BACCALAREATE FOR NATIVE AMERICANS Principal Investigator & Institution: Cruickshank, Brandon J.; Chemistry and Biochemistry; Northern Arizona University Department of Biological Sciences Flagstaff, Az 86011 Timing: Fiscal Year 2001; Project Start 30-SEP-2001; Project End 29-SEP-2004 Summary: (Provided by applicant): At Northern Arizona University (NAU), two of our goals are to increase the number of Native Americans majoring in the biomedical sciences and to increase the academic performance, retention, and graduation rates of these students. This program proposes to serve Native American students at two community college campuses: Dine College at Tsaile and Dine College at Shiprock. The proposed program requests 3 years of funding to introduce Native American students to baccalaureate and career opportunities in the biomedical sciences. As a result of this program, we plan to support and encourage a larger number of Native American students to pursue degree and career opportunities in the biomedical sciences. We also plan to increase the number of students that transfer to NAU from Dine College and to increase the retention and academic performance of these students once on the NAU campus. To achieve our goals, we plan to implement a Bridges to the Baccalaureate Degree Program, The specific aims of the program are: 1) To conduct an annual program to provide students at Dine college with information regarding career opportunities in the biomedical sciences and to encourage them to choose to pursue a baccalaureate degree in the biomedical sciences. 2) To develop a program of research seminars at Dine College with a goal of encouraging Native American students to pursue research and career opportunities in the biomedical sciences. 3) To provide up to ten annual scholarships to students at Dine College with a goal of encouraging the most promising students to become part of the Bridge program. 4) To host a 2-day orientation program at NAU to introduce Dine students and faculty to our campus, our research and laboratory facilities, faculty mentors that did not present seminars, and our minority academic support system. 5) To provide an 8-week summer research experience for up to ten students and two faculty from Dine College each under the direction of an NAU faculty mentor, with a goal of encouraging Native American students to pursue research opportunities in the biomedical sciences. 6) To provide a laboratory skills workshop and field work experience for the ten Native American students participating in the summer research experience. 7) To continue to provide research opportunities for Native American students who transfer from Dine College to biomedically related degree programs at NAU. Students will be encouraged to join active research programs funded through our Minority Student Development and Howard Hughes Medical Institute programs. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: CLINICAL OUTCOME OF HEMODIALYSIS IN UTAH Principal Investigator & Institution: Cheung, Alfred K.; Professor of Medicine; Internal Medicine; University of Utah Salt Lake City, Ut 84102 Timing: Fiscal Year 2001; Project Start 30-SEP-1994; Project End 31-AUG-2004

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Summary: The mortality rate of U.S. chronic hemodialysis patients is higher than that in other industrialized nations. Available data suggest that this high mortality rate is partially a result of inadequate delivery of dialysis. The MMHD is a prospective, randomized, multicenter, two-by-two factorial trial sponsored by NIDDK to determine if increasing the amount of delivered dialysis (as assessed by a two-pool, variablevolume urea kinetic model) and using high flux biocompatible dialysis membranes would improve the clinical outcome of these patients. This application describes the University of Utah Dialysis Program (together with the Salt Lake City VA Medical Center dialysis unit) and proposes that this Program participates as a Clinical Center in the MMHD Full Scale Study. The University of Utah Dialysis Program consists of 7 dialysis units, some of which are located in suburban communities, that have common administrative and medical guidelines originating from the University headquarters. The VA-unit is also closely affiliated and has similar protocols. The investigators in this proposal have significant expertise in their respective areas. Both the institution and the investigators have a long tradition in laboratory and clinical dialysis research. They have recently performed several clinical studies involving patients from the different dialysis units within the Program. The P.I. has also participated in several multicenter clinical trials with centers outside Utah. The ESRD population in this Program has been growing. The number of in-center hemodialysis patients, as of December 31, 1993, was 237, of which 37% were diabetic. The majority of these patients are Caucasian (78%), but there is a significant fraction (5%) of Native Americans. This Program will recruit approximately 108 patients during the first 18 months of the Study and randomly allocate 60 of them to 4 hemodialysis treatment strategies that differ in the amount of delivered dialysis and/or the type of dialysis membrane. Sixty patients will be maintained throughout the study by using a "recruit to replace" strategy. Many of the medical and technical aspects of therapy, including nutritional intake, will be standardized during the baseline and a 60 month follow-up period. The primary outcome is death of the patient; secondary outcomes include non-access related hospitalization, hospitalization for heart disease or infection, and declining serum album in. The results from this trial will guide hemodialysis therapy in the future. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: AMERICANS

COGNITIVE

EFFECTS

OF

SUBSTANCE

USE

IN

NATIVE

Principal Investigator & Institution: Halpern, John H.; Mc Lean Hospital (Belmont, Ma) Belmont, Ma 02478 Timing: Fiscal Year 2002; Project Start 01-SEP-2000; Project End 31-AUG-2004 Summary: This application is designed to train Dr. John Halpern to be an independent investigator with special skills in assessing both neuropsychological effects and cultural aspects of substance abuse. Dr. Halpern is now completing a third-year postdoctoral fellowship in substance abuse research at the Alcohol and Drug Abuse Research Center, McLean Hospital, Harvard Medical School-a nationally recognized major substance abuse research facility. Dr. Halpern has already published several peer-reviewed papers on substance abuse, most recently a critical review of studies of the long-term neuropsychological effects of hallucinogens-a class of drugs increasing in popularity among high school students and young adults, 1,2 yet still inadequately studied. Dr. Harrison G. Pope, Jr., the proposed mentor for this project, is a well-recognized substance abuse investigator with an established record of mentoring junior investigators. With Dr. Pope's guidance, Dr. Halpern has already obtained pilot data assessing neuropsychological performance in 42 Native Americans. Ten of these

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subjects are members of the Native American Church. The practitioners of this religion are virtually unique in North America in that they extensively ingest a hallucinogen, the peyote cactus, but typically use no other drugs. Thus, they offer a valuable opportunity to assess the long-term effects of hallucinogen use without the confounding effects of other substances. Dr. Halpern has also obtained pilot data on comparison groups of 11 Native Americans with past alcohol dependence and 21 Native American controls. Under Dr. Pope's mentorship, Dr. Halpern proposes to expand this work over the next four years to study an additional 210 Navajo subjects: 70 peyote users, 70 former alcohol users, and 70 controls. These data will provide information of major public health significance, both for the Native American population itself and for the population at large, regarding the long-term neuropsychological effects of hallucinogens and alcohol. Dr. Halpern will supplement this work with a full program of courses in the Harvard School of Public Health, leading to an MPH degree within the four years, and with continued didactic experience with Dr. Pope and other investigators at the Alcohol and Drug Abuse Research Center. This program will enable Dr. Halpern to become an experienced investigator, capable of designing and performing future studies independently. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CORE--BEHAVIORAL MEASUREMENT Principal Investigator & Institution: Giuliano, Anna R.; Associate Professor; University of Arizona P O Box 3308 Tucson, Az 857223308 Timing: Fiscal Year 2003; Project Start 04-AUG-2003; Project End 30-JUN-2008 Summary: (Revised Abstract) (provided by applicant): The Behavioral Measurement Shared Service (BMSS) provides services to support AZCC researchers investigating behaviors such as diet and food consumption, physical activity patterns, body composition, tobacco exposure, solar protection, sexual practices, cancer screening knowledge, and lifestyle risk factors in the context of cancer prevention or therapy. This research requires accurate and reliable questionnaires and research designs for assessing human behavior related to primary and secondary prevention of cancer and for identifying atrisk populations in community and clinical environments. Behavioral assessment instruments are available across a wide range of behaviors, with specialized instruments for culturally diversified groups such as Mexican Americans and Native Americans. The BMSS provides an accurate and reliable source of technical support for the use of these tools (optical scanning technology, nutrition assessment software, and light pen entry system for developmental instruments). Consultation in research design development, measurement methodologies, and collection and analysis of data on human behavior remain important functions of the BMSS. The objectives of the BMSS are as follows: To provide consultation and expertise regarding the design, validation, and implementation of behavioral measurement instruments in the context of clinical research; To develop and provide standardized, validated questionnaires for assessing human behavior; To provide technical support for data collection in the following areas: physical activity, diet, solar protection, screening, body composition, sexual practices, tobacco use knowledge, and behavior assessment methods; To provide technical support on data management for research trials involving human behavior and behavior change. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: CORE--CANCER RESEARCH Principal Investigator & Institution: Baquet, Claudia R.; Associate Dean / Associate Professor Of; University of Maryland Balt Prof School Baltimore, Md 21201 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 31-AUG-2007 Summary: Background: Cancer is the second leading cause of death in the United States. Yet, while of national public health significance, cancer presents a disproportionate burden on health disparity populations (i.e. African Americans, Native Americans, rural and urban underserved and the poor, and certain Hispanic communities). The factors that produce disparities in incidence, morbidity, mortality and survival are complex. While some factors upon which interventions may be applied to reduce these disparities are known, there remain substantial unknown factors, which require rigorous investigation and discovery. This research core will focus on the spectrum of multidisciplinary research, from basic, clinical, translational, behavioral and health services research. The aims of this research core are consistent with the overall aims of the Center. The Cancer Research Core aims are: Specific Aim One: Foster Cancer Disparities Research at each Partnering Institution. Research will be consistent with the research aims of the UMSOM's Program in Oncology Cancer Disparities Program: surveillance, explanatory research, intervention, translation and application of results. Specific Aim Two: Create a UM Program in Oncology-wide focus on cancer disparities by increasing the number of UM investigators who incorporate disparities related aspects into their ongoing research. This will involve expanding the breadth and effectiveness of UMSOM cancer-related research to benefit minority and medically underserved populations in Maryland. Specific Aim 3: Create a stable, long-term collaborative relationship between UMES and UMSOM in cancer research, outreach, and faculty development that will increase the emphasis on problems and issues relevant to the disproportionate cancer rates in minorities in Maryland's urban and rural underserved communities. Specific Aim 4: Build and stabilize independent, competitive cancer research projects at UMES. Key activities designed to foster the interaction of faculty members of the UM Program In Oncology will allow the systematic increase in disparities research, training and community outreach and dissemination of research results at both UMSOM and UMES. Note that faculty of UMES have been members of the UMSOM Program in Oncology for over a year. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: CORE--CLINICAL Principal Investigator & Institution: Weiner, Myron F.; University of Texas Sw Med Ctr/Dallas Dallas, Tx 753909105 Timing: Fiscal Year 2002 Summary: The Clinical Core will recruit, diagnose and follow control subjects and patients with Alzheimer's disease (AD) and other dementias. We will provide wellsubjects, clinical data and body fluids to investigators at UT Southwestern and other institutions. Our emphases will be (a) recruiting, evaluating and following controls and AD patients, (b) providing to investigators materials for antemortem and postmortem studies, (c) employing SPECT in the differential diagnosis of dementia, (d) increasing service to and data collection from minorities and other under served populations, (e) designing and participating in studies through the Alzheimer's Disease Study Unit (ADSU) and contributing data to the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) (f) educating healthcare professionals in the diagnosis and management of dementing illness, and (g) analyzing and correlating our clinical data

16


with neuropsychological, imaging, CSF and neuropathological findings. We will continue to train and to monitor staff at our North Texas and Northern Oklahoma Satellites, which have given us access to a significant number of African-Americans, Hispanics and Native Americans. We will also encode data and collect CSF for those sites. We will direct vigorous efforts to increasing our recruitment of controls and following patients whom we have evaluated. To maximize patient retention, we will undertake a user satisfaction survey with the Education and Information Transfer (EIT) Core. Our research efforts will be focused, with the help of the Statistics and Data Management (SDM) Core, on analysis of data we gather routinely in patient evaluations, such as assessments of mood and agitation. We will add to our database the CERAD Behavioral Rating Scale for Dementia, and will continue to refine our databasing operation with the help of the SDM Core. We will continue our clinicopathologic conferences cosponsored by the Neuropathology Core. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CORE--CLINICAL Principal Investigator & Institution: Kaye, Jeffrey A.; Professor and Director of Adcc; Oregon Health & Science University Portland, or 972393098 Timing: Fiscal Year 2002 Summary: The Clinical Core operates as the unit of the OADC with responsibility for identification, recruitment, characterization, and follow-up of populations of wellcharacterized subjects for clinical dementia research. In order to fulfill this mission, the Clinical Core completes systematic assessments resulting in standardized diagnoses of the research cohort which are then entered into the relational database of the OADC. Many types of data are collected in order to be responsive to current and anticipated needs of the research community; clinical histories, physical and neurological examinations, neuropsychological and behavioral assessments, and laboratory data. The Clinical Core works closely with the other Cores of the Center to ensure if possible tissue donations (Neuropathology Core), characterization of genetic-associations (Genetics Core) and smooth transfer, entry, storage and eventual retrieval for analysis of the data. The Clinical Core is dedicated to on-going evaluation of its identified cohorts and to ensuring that no subjects are lost to follow-up. Several groups form a particular focus of the Clinical Core. These include Alzheimer disease patients, Parkinson disease patients and healthy elderly control subjects. The latter subjects are formed primarily from a unique community-based population of oldest old (those 85 years or older) who are at high risk to develop incident dementia over a five year period. The Clinical Core also enhances its research mission of the OADC through its Satellite Programs comprising of two main components: (1) an African-American minorities program in Northeast Portland targeted to enroll at least a representative sample of all elderly African-Americans with dementia in the Portland metropolitan area and (2) a rural Oregon program which enrolls subjects from 3 rural counties and Native Americans over 65 years of age residing on the Warm Springs Reservation. Clinical Core personnel will also function as a resource for consultation and guidance in designing and operating research projects in their early or developmental phases or to problem-solve at latter stages. Members of the Clinical Core will participate frequently in the educational and information transfer activities of the OADC. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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CULTURALLY-APPROPRIATE

TREATMENT

FOR

17

NATIVE

Principal Investigator & Institution: Venner, Kamilla; Assistant Professor; Psychology; University of New Mexico Albuquerque Controller's Office Albuquerque, Nm 87131 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 31-AUG-2007 Summary: (provided by applicant): There are ongoing debates but very few empirical data regarding the development of culturally appropriate treatment methods for alcohol use disorders among Native Americans. The usual research-practice gap is further widened by the fact that many Indian people receive substance abuse treatment through separate programs specifically for Native American clientele but not usually empirically based. The University of New Mexico requests early career development and training support for Dr. Kamilla Venner, whose primary research interests are in the advancement of treatment methods for Native American peoples. Her training plan focuses on the development of independent investigator skills in three areas: (1) research design, statistics and grant-writing (2) research management skills and (3) training therapists to provide manual-guided therapies for use in future clinical trials. Each of these areas is incorporated into an integrated sequence of coursework, mentored research experience, training with expert colleagues and scientific writing. Her research plan builds upon her predoctoral research studying processes of recovery from alcohol dependence among Native Americans. One hundred Native Americans will be recruited to provide quantitative and qualitative data designed to describe the severity of alcohol problems, create a chronology of events used to resolve alcohol dependence, and examine factors contributing to change and maintenance. This research will yield the first empirical study examining the natural history of recovery events among Native Americans, and will contribute new cross-cultural knowledge regarding successful methods for resolving alcohol dependence. The primary goal of the proposed research is to advance knowledge about how current evidence-based treatment methods could be modified or supplemented to be more culturally appropriate for treating Native American patients and in training Native American practitioners. Dr. Venner's career plan includes the development of R03 and R01 proposals to develop and test such treatment methods within Indian-specific treatment services, thus forming a strong foundation for a research scientist career. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DEVELOPING NATIVE AMERICAN SCIENTISTS Principal Investigator & Institution: Ruffolo, John J.; Research/Sponsored Programs; South Dakota State University Brookings, Sd 57007 Timing: Fiscal Year 2001; Project Start 01-AUG-2000; Project End 31-JUL-2004 Summary: South Dakota State University (SDSU) will collaborate with Lower Brule Community College, Oglala Lakota College, Si Tanka College, and Sisseton Wahpeton Community College [tribal colleges] to provide qualified Native American students enrolled in a two-year academic program at a tribal college and majoring in an area of science with academic and program support to: attain a high level of academic achievement; gain an appreciation for scientific research and career opportunities; transition from the tribal college to SDSU and complete their educational program for the baccalaureate degree. The goal is to increase the number of Native Americans who graduate with baccalaureate degrees in the sciences. The specific objectives (outcomes) are to: Expand collaboration of SDSU with tribal colleges in education and research; Increase awareness of professional opportunities in the sciences for Native Americans;

18


Increase access to education in the sciences for Native Americans; Increase retention and academic achievement of Native American students; Enhance the quality of science education at the tribal colleges: and Produce role models of educational and professional achievement among American Indians. The consortium will attain the project objectives by the following methods: Recruit and enroll qualified students into this program at the tribal colleges (8/year for 2 years); Facilitate transfer from tribal colleges to SDSU by course credit transfer articulation and orientation; Provide a system of student support through advising, mentoring, and counseling; Establish a program of mentoring and student research apprenticeships through individual funded projects; Enrich science curricula and develop science faculty at the tribal colleges through individual funded projects; Support visiting lectureships at tribal colleges by science faculty from SDSU. Establish and maintain a database on the students in the program; Track future placement and accomplishments of students in the program; and Assess program outcomes. By increasing access to education in the sciences for Native Americans this program aims to increase the number of American Indians who will become active in biomedical sciences and health professions. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DIABETES BASED SCIENCE EDUCATION IN TRIBAL SCHOOLS PROG* Principal Investigator & Institution: Abeita, Catherine L.; Southwestern Indian Poly Institute Institute Albuquerque, Nm 87184 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 31-AUG-2007 Summary: (provided by applicant): Jemez Valley Schools, Jemez's Indian Education Programs and Jemez Pueblo will collaborate with Southwestern Indian Polytechnic Institute to develop a science based diabetes prevention education curriculum for students in grades 7-12 that are aligned with national and state teaching standards and benchmarks. The curriculum design will enhance the understanding and appreciation of this devastating disease by the development of culturally appropriate activities and career awareness opportunities. The goal is two-fold: to enhance the students, family and community members as well as teachers' understanding of diabetes in order to prevent the development of diabetes and to help Tribal members better manage diabetes and, to increase the numbers of Native Americans entering the health science professions. The objectives of the Diabetes Based Science Education in Tribal Schools, Grades 7-12 program are: 1) To decrease the incidence of NIDDM [non-insulin dependent diabetes mellitus] among Native American populations, thereby decreasing diabetes related heart disease, glycemic, digestive and kidney diseases; and 2) To stimulate career choices in the Biomedical field among Native American students. The Curriculum will include: culturally sensitive teaching materials designed to enhance the understanding attitudes and knowledge levels of students in grades 7 - 12; hands-on, science based materials that reflect traditional learning styles emphasizing visual, spatial and perceptual modes of learning; multi-dimensional lesson plans facilitating ease of use in a variety of classrooms and core subject areas; diabetes education web site and lesson plan center; CD ROM will provide teacher support including educational tips and tools for distance instruction; and evaluation tools for pre and post-testing for determining the progress, attitude change and knowledge increase in students. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: EIGHTH INTERNATIONAL WORKSHOPS ON OPPORTUNISTIC PROTISTS Principal Investigator & Institution: Cushion, Melanie T.; Associate Professor; Internal Medicine; University of Cincinnati 2624 Clifton Ave Cincinnati, Oh 45221 Timing: Fiscal Year 2003; Project Start 01-APR-2003; Project End 31-MAR-2004 Summary: (provided by applicant): The 8th meeting of the International Workshops on Opportunistic Protists (IWOP 8) will be held with the International Conference on Anaerobic Protozoa (ICAP) in Hilo, Hawaii July 25-29, 2003. This Workshop series focuses on the AIDS-related opportunistic protists, Pneumocystis, Cryptosporidium, Toxoplasma, microsporidia as well as the free living amoebae. The goals of the Workshops, sponsored by The Society of Protozoologists, were first set at the initial Workshop held in Bristol, U.K., 1988 and remain generally the same: a free exchange of information facilitated by open admission to the meeting and rapid publication of the proceedings. The organisms discussed at these scientific meetings are responsible for much of the morbidity and mortality in immunocompromised individuals. Although meetings sponsored by other organizations have had special sessions on one or several of these opportunistic pathogens, the Workshops on Opportunistic Protists have become the primary mechanism by which many investigators gather to obtain comprehensive information that focuses only on these eukaryotic pathogens. This is the one crossdisciplinary meeting in which most major research groups working on these organisms participate. The rapid publication of the proceedings resulting from these workshops in The Journal of Eukaryotic Microbiology ensures efficient dissemination of up to date information on these pathogens and the diseases they cause. One of the outstanding features of the Workshops is that participation (presentations by platform or poster) is open to anyone wishing to present their findings; the only requirement being registration and attendance. Another is the use of the Workshops as a forum to make community decisions on matters such as gene and species nomenclature. Previous NIHfunding of these Workshops has been used to promote participation by young investigators, minorities, and students by issuance of travel awards and remains a primary budgetary item in the present proposal. Additional support is requested for the rentals and supplies necessary to ensure a high quality meeting. For the first time in the history of the Workshops, specific and widespread advertisements for minority travel awards targeting students and young investigators will be implemented. We hope to not only increase diversity in this manner, but also foster the entrance of young investigators into these fields. The site of the meeting, Hilo Hawaiian International Hotel, is handicap accessible and adheres to all regulations and guidelines governing handicap access. The joint sponsor is the University of Hilo, Hawaii. The organizers of IWOP 8 reflect the population diversity of the USA and the meeting attendees: Cushion, Kaneshiro, Marciano-Cabral, and Mead are females; Lindsay and Weiss are males. Mead's and Cushion's ancestors include native Americans; Marciano-Cabral is Hispanic; Kaneshiro has Pacific-Asian ancestry; Lindsay, Weiss are white. Lindsay is a physically handicapped individual. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: ENHANCING NATIVE AMERICAN PARTICIPATION IN RT TRIALS Principal Investigator & Institution: Petereit, Daniel G.; Radiation Oncologist; Rapid City Regional Hospital Rapid City, Sd 57701 Timing: Fiscal Year 2002; Project Start 27-SEP-2002; Project End 31-AUG-2007

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Summary: (provided by applicant): The Cancer Care Institute (CCI) in Rapid City, South Dakota, serves approximately 100,000 Native Americans from three reservations. Some patients live up to four hours from the cancer center. Identifying barriers which prevent Native Americans from presenting with earlier stages of cancer, or in some circumstances not at all, will be investigated. A culturally responsive questionnaire will be administered to randomly selected Native Americans on the reservation who do not have cancer. A second questionnaire will be given to cancer patients, and address similar issues, but concentrate on additional questions of oncologic relevance. It is hypothesized that a major barrier is geographic dislocation from cultural/community roots close to home. Traditional radiotherapy involves a 6 to 8 week course and daily treatments. This treatment approach may represent a major barrier. With the use of advanced technologies such as intensity modulated radiotherapy and brachytherapy, the treatment course can be shortened to 1 to 4 weeks. Therefore, to address this barrier, clinical trials have been developed which shorten treatment duration. A series of phase II studies are proposed for malignancies commonly seen among the Native Americans: metastatic disease, non-small cell lung (NSCLC), breast, prostate and head and neck (H and N) cancer. For patients with stage I and II breast cancer, high-dose-rate (HDR) brachytherapy will be substituted for a conventional course of external beam radiation. Patients with advanced prostate cancer will be treated with a 2 week course of conformal external beam radiation followed by an HDR implant in combination with androgen ablation. Pilot tomotherapy trials are proposed for patients with metastatic disease, locally advanced H&N, and NSCLC. The final pilot trial will investigate the use of HDR brachytherapy alone for early stage prostate cancer. A genetic milieu may exist which renders Native Americans more sensitive to radiation. Therefore, a laboratory study will be conducted to investigate whether Native Americans have a higher mutation rate of the AT (ataxia-telangiectasia) gene determined through HPLC of the peripheral blood lymphocytes. Through patient education, screening, assessing potential barriers to health care, and innovative treatment strategies, it is hoped that Native Americans will eventually present earlier in their disease process. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •


ENVIRONMENTAL

RESPIRATORY

DISEASE

IN

NATIVE

Principal Investigator & Institution: Burchiel, Scott S.; Medicine; University of New Mexico Albuquerque Controller's Office Albuquerque, Nm 87131 Timing: Fiscal Year 2002; Project Start 01-APR-1999; Project End 31-MAR-2004 Summary: This abstract is not available. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: EVALUATION OF ALASKAN PLANTS FOR TUBERCULOSIS TREATMENT Principal Investigator & Institution: Smith, David C.; Alaska Green Gold Box 100558 Anchorage, Ak 99510 Timing: Fiscal Year 2003; Project Start 01-SEP-2003; Project End 31-AUG-2004 Summary: (provided by applicant): This proposal aims to evaluate the efficacy of Native American ethnobotanical treatments for tuberculosis for the purpose of making available acceptable, affordable alternatives to current TB drugs, especially in developing countries with massive TB case loads such as the People's Republic of China. No new drugs have been introduced for the treatment of tuberculosis for the past 30

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years. Today the world faces a resurgence of tuberculosis, the number one bacterial killer and an intensive search has been launched to find new drugs, primarily in the public, academic and biotech sectors. One of the confounding factors is the high cost of any new drug development (and thus cost of the drugs to the public) together with the relatively low profit potential for TB drugs, thus discouraging big pharmaceuticals from investing in TB. Native Americans relied entirely upon botanical treatments for tuberculosis following the epidemics that occurred with the introduction of this disease by the European colonialists. Some of these treatments continued to be used ethnomedically throughout the 20th century. Preliminary phytochemical and bacteriological studies confirmed the anti-TB activity of 2 such plants but studies were discontinued prematurely due to lack of funds (and perceived lack of urgency at the time). This study will evaluate the activity of ethobotanical and organic solvent preparations of 2 plants in mice infected by aerosol with low doses of Mycobacterium tuberculosis. Both acute and chronically infected mice will be treated for 2-3 weeks and the treatment evaluated by determining the number of bacteria in lungs and comparing to untreated controls. Concurrent with this evaluation will be a bioassay-guided fractionation of the plants in order to identify the active principle(s) for the purpose of standardization of botanical preparations. At every step of the fractionation, both cytotoxicity and anti-TB activity will be assessed in an attempt to identify a preparation requiring minimal processing that possesses maximum selectivity for the tubercle bacillus. Such a preparation would be the subject of further development for use in clinical TB. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: FAS, SIDS AND STILLBIRTHS IN CAPE TOWN, SOUTH AFRICA Principal Investigator & Institution: Jacobson, Sandra W.; Professor; Psychiatry & Behav Neuroscis; Wayne State University 656 W. Kirby Detroit, Mi 48202 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 31-JUL-2006 Summary: (provided by applicant):Sudden infant death syndrome (SIDS) is a leading cause of infant mortality with incidence of about 0.8/1000 live births in the U.S. and considerably higher rates in at-risk populations, including Native Americans and the Cape Coloured (mixed ancestry) community in South Africa. A recent study has implicated prenatal alcohol exposure as an important risk factor for SIDS that warrants further investigation. It has been hypothesized that medullary serotonergic network deficits may be responsible, in part, for some SIDS deaths. For the past 5 years, we have been conducting a prospective, longitudinal study on the effects of prenatal alcohol exposure in the Cape Coloured community in collaboration with researchers from the University of Cape Town School of Medicine. This research has demonstrated our ability to recruit mothers from this community; obtain valid assessments of FAS, prenatal alcohol exposure, maternal alcoholism, smoking and depression, and socioenvironmental and medical risk; and perform state-of-the-art infant neurobehavioral assessments with Cape Town infants. We have found an exceptionally high rate of alcohol abuse and dependence among pregnant women in this population and of FAS among their infants. The high incidence of both SIDS and FAS in this large metropolitan area, the readily accessible maternal heavy drinking population, and our established, productive research collaboration make Cape Town uniquely appropriate as a Comprehensive Clinical Site. The proposed cooperative agreement would expand our ongoing collaboration to include researchers in pathology and obstetrics. The aims are (1) to conduct an assessment of the incidence of SIDS and stillbirths in Cape Town, using contemporary diagnostic criteria and procedures, including neuropathological

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examinations of SIDS victims and controls; (2) to test the hypothesis that prenatal binge drinking increases the risk of SIDS and to evaluate that risk in relation to risks associated with prenatal maternal smoking, preterm birth, infant gender and sleeping position, seasonal variation, parental education, and maternal depression; (3) to test the hypothesis that certain moderator variables-- years of drinking, severity of maternal alcohol abuse and dependence, lower maternal weight and prenatal smoking, and the absence of an ADH2*2 allelo will increase the risk of SIDS in alcohol-exposed infants; and (4) to examine whether heavily alcohol-exposed neonates will exhibit alterations in autonomic nervous system behaviors similar to those described in SIDS victims, which are known to be regulated by the medullary serotonergic system, including arousal, cardiorespiratory reflex integration, and sleep/wake patterns. This research has the potential to improve our understanding of neurophysiological mechanisms involved in SIDS and to contribute to developing interventions for mothers and infants whose behaviors indicate that they are at risk for this adverse outcome. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: GENETIC EDUCATION FOR NATIVE AMERICANS Principal Investigator & Institution: Burhansstipanov, Linda; Executive Director; Native American Cancer Research 3022 S Nova Rd Pine, Co 804707830 Timing: Fiscal Year 2002; Project Start 30-SEP-1998; Project End 31-MAR-2003 Summary: The proposal addresses the area of genetic research and testing among Native Americans, particularly so that they can make informed decisions related to genetics. Although the need for genetic information by all individuals cannot be understated, it is especially important for genetic information to be presented in a culturally acceptable manner. The 3 year project intends to modify existing genetics education curricula to create culturally competent education interventions (i.e., independent modules and a 20-hour comprehensive intervention) which will be targeted to the Native American college and university students, and to educators who teach Native Americans. The genetic education interventions are destined to improve the Native Americans' understanding of genetics, thereby helping the student to make decisions based on sound information and cultural perspectives relevant to their local tribal Nation. This educational intervention will assist in informing and in encouraging Native American students to pursue genetic science careers, including genetic counseling and research. The interventions will be implemented in geographically diverse settings throughout the U.S., primarily in conjunction with selected Native American science and education conferences and meetings, in order that more Native Americans can benefit from the proposed genetic education interventions. The specific aims are to (1) develop, pretest, refine, promote, implement, and evaluate the effectiveness of culturally competent genetic education interventions (e.g., individual modules and comprehensive workshop) for Native American college and university students, and educators; (2) pretest and modify culturally relevant genetic educational information and resources, including, pre- and post-tests for the educational interventions; (3) compare the effectiveness (knowledge and attitudes) of the individual education modules implemented independently with the same module implemented as part of the 20-hour comprehensive education workshop; and, (4) initiate the development of a national database of scientists willing to provide genetic research mentorship opportunities, and Native American students (college and graduate students) who are interested in genetic education, research and care. The overall goal of this application is to develop culturally acceptable materials providing Native American

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students with information so that they can make informed decisions about genetic issues. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: HARVARD MENTORED CLINICAL SCIENTIST DEVELOPMENT PROGRAM Principal Investigator & Institution: Lipsitz, Lewis A.; Professor of Medicine; Divison on Aging; Harvard University (Medical School) Medical School Campus Boston, Ma 02115 Timing: Fiscal Year 2002; Project Start 01-AUG-1985; Project End 30-JUN-2004 Summary: This revised competing renewal proposal seeks support to continue a highly successful, NIA-funded Mentored Clinical Scientist Development Program Award. The program represents a major, multidisciplinary and interdepartmental collaboration among the medical school, school of public health, as well as the affiliated institutions in the Longwood Medical Area and around Boston. We have increased our efforts at recruiting candidates widely, including those who are members of under-represented minorities in aging research, and those who are from other medical schools including schools of osteopathy. We have provided information on eight superb prospective trainee candidates of which five are women, three are African American, one is Hispanic, and one is a doctor of osteopathy working with underserved elderly (including Native Americans) in rural Maine. Many of these candidates are interested in pursuing research in public and social medicine, especially the care of minority elderly in the underserved, inner-city and underserved rural communities of America. The proposed Program is designed to support and enhance research experience in several interrelated gerontologic disciplines. Six specific areas will be emphasized. These are (1) cardiovascular disease, (2) cell proliferation disorders, (3) neurodegenerative disease and dementia, (4) endocrine/renal dysfunction, (5) geriatric syndromes, and (6) public health. More than 50 experienced, well-funded faculty scientists (20 of whom are women), many of whom are established gerontologic investigators, will serve as potential primary or secondary mentors for the clinician scientist trainees. A dual mentoring system has been implemented to ensure ongoing exposure to gerontologic/geriatric expertise and orientation. Ultimately, we plan to develop the trainees into clinician investigators who can facilitate the translation of important research findings into improved care for all older Americans. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: HAZARDOUS MATERIALS WORKER SAFETY AND HEALTH TRAINING Principal Investigator & Institution: King, Judith L.; Associate Professor; Educational Development; University of Alabama at Birmingham Uab Station Birmingham, Al 35294 Timing: Fiscal Year 2002; Project Start 16-SEP-1992; Project End 31-AUG-2005 Summary: The University of Alabama at Birmingham 's Center for Labor Education and Research, in its application for funding an EPA- HWWT cooperative agreement, will provide courses to four populations of workers who share the need for general and specialized training in topics related to 29 CFR 1910.120, Hazardous Waste Operations and Emergency Response. The overall goal is to improve the health and safety of members of the Communications Workers of America (CWA), Native Americans, emergency health care providers and fire fighters, by helping them reduce exposures to hazardous chemicals. Classes include Hazardous Materials Awareness, Operations, and Technician, adapted for the four different training populations; Handling Contaminated

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Patients; Hazardous;SCBA Fit Testing; Air Surveillance in Chemical Emergency Incidents; Health Effects of Chemical Exposure; Confined Space Entry and Rescue, Hazardous Waste Handling; and Worker Training Methods. Classes will be taught in train-the-trainer mode, and materials provided for workplace training by the participants and for outreach to their respective communities. The four target populations have in common their potential for exposures to chemicals, training budgets that are inadequate or nonexistent, and job- and finance- related restrictions on extensive travel for training. CWA workers in manufacturing, product distribution and service, health care, printing and publishing, and numerous crafts will have regional classes throughout the United States, as will members of all 557 federally-recognized Native American tribes. Indian law enforcement officers, fire fighters, highway and hospital workers, emergency planners, natural resource personnel, environmental planners, and search-and-rescue units will be trained in safe Awareness Level response and Incident Management in classes coordinated through cooperation with the Native American Fish and Wildlife Society. In the southeastern United States, emergency room personnel will be trained to handle contaminated patients; surveys show most are unprepared for this problem and are in violation of the regulations of several agencies, including OSHA 1910.120. Because fire fighters have increased risk of diseases shown to be related to the inhalation of chemicals and smoke, they will be trained in toxicology, fit testing, air monitoring, and rescue from confined spaces with hazardous atmospheres. Computer-based asynchronous training will be utilized to achieve some of the objectives, and this method formally compared with traditional training. Professional safety and health trainers will develop and deliver all training using curricula developed and piloted under previous cooperative agreements. Total number of trainees will exceed 20,000, with tribal peer trainees and community outreach participants not included in the estimate. The total proposed cost of the five- year project is 3,296,947 dollars. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: HEALTH SURVEY OF TWO-SPIRITED NATIVE AMERICANS Principal Investigator & Institution: Walters, Karina L.; Associate Professor; None; University of Washington Grant & Contract Services Seattle, Wa 98105 Timing: Fiscal Year 2002; Project Start 28-JUN-2002; Project End 31-MAY-2007 Summary: (provided by applicant): American Indian and Alaskan Native lesbian, gay, bisexual, transgendered, and two-spirited individuals (two spirits) are a drastically understudied and underserved group, at risk for multiple health and mental health problems. There are no national, quantitative, representative studies of this population on any topic. This application, in response to PA-01-096, is for a FIRST TIME R01 by a NEW INVESTIGATOR. Building upon solid preliminary data, it proposes three innovative and significant aims. First, we will conduct structured survey interviews with 400 two spirits drawn from six sites across the U.S. With these interview data, we will test a theoretical model of stress and coping specific to this population. Sub-aims are to (a) establish preliminary prevalence rates of trauma and health outcomes (i.e., HIV sexual risk behaviors, alcohol and other drug use, and mental health indicators); (b) test the direct associations between trauma and health outcomes; (c) determine how cultural and spiritual coping factors moderate the effect of trauma on health outcomes; and (d) examine the mediating role of substance use on the trauma-HIV sexual risk behavior and trauma-mental health relationships. The second aim is to test the, feasibility of an innovative non-probability sampling methodology that combines targeted, partial network, and respondent-driven sampling procedures in order to

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approximate a representative national sample of two spirits. Additionally, we will test the feasibility of two different mechanisms (agency based vs. census based) by which we execute this sampling method. Our results will contribute toward the refinement of a sample strategy useful in studying other hidden and stigmatized populations. Our third and final aim is to conduct a qualitative study involving 12 focus groups and 60 key informant interviews in order to identify emergent themes regarding stressors and coping strategies specific to two spirits. Through the course of this project, we aim to develop the research infrastructure at the six community agencies comprising our participant recruitment sites in order to facilitate future goals of designing and evaluating interventions to address the urgent needs of two spirits. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: HEPATITIS C VIRUS REPLICATION AND LIVER INJURY Principal Investigator & Institution: Fausto, Nelson; Professor and Chairman; Pathology; University of Washington Grant & Contract Services Seattle, Wa 98105 Timing: Fiscal Year 2002; Project Start 01-SEP-2000; Project End 30-JUN-2005 Summary: (Adapted from application): Hepatitis C is an emerging infectious disease of major public health importance. Approximately 2% of the population of the USA and Europe are chronically infected with hepatitis C virus (HCV). Although major progress has been made in studies of the HCV genome and its encoded protein, basic aspects of the mechanisms of HCV pathogenesis are still poorly understood. One of the major difficulties has been the lack of an adequate tissue culture in which to study the interactions between HCV and hepatocytes, its natural host. Furthermore, the mechanisms of viral persistence and quasispecies evolution in HCV infected patients as well as the relationships between viral replication and disease progression remain to be determined. This application seeks to study the relationships between HCV replication and hepatocyte injury in a newly developed tissue culture system for human fetal hepatocytes (HFH) as well as in the human host. It is hypothesized that cell killing by apoptosis, preservation of permissive cells in which the virus persists and activation of cytokine signaling are events that occur in HCV infection and can be modified by the virus, the hepatocyte as its natural host or by interaction between virus and host cells. The application consists of 3 projects and 2 cores. Project 1 proposes to analyze HCV replication and the mechanisms of HCV-induced apoptosis in cultures transfected with full length HCV RNA or a 3'deleted virus used as control as well as in HFH cultures infected with patient sera. Project 2 will use cDNA microarrays to conduct a comprehensive analysis of gene expression in HFH transfected with full length and mutant HCV RNAs and investigate the effects of interferon on these cells. Project 3 will investigate the relationships between HCV replication, quasispecies evolution and hepatitis C disease progression in a population of Alaskan Native Americans (ANA cohort) from which serum, liver biopsies and clinical and epidemiological data have been collected. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: HOWARD UNIV.EXCELLENCE IN HEALTH PROFESSIONAL EDUCATION Principal Investigator & Institution: Lecca, Pedro J.; None; Howard University Washington, Dc 20059 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 29-SEP-2003

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Summary: (provided by applicant): The purpose of this proposal is to extensively expand the teaching, research and recruitment endeavors of Howard University, College of Pharmacy, Nursing, and Allied Health Sciences through the formation of the Excellence in Health Professional Education Program. This program will be closely affiliated with the Center of Excellence in the School of Pharmacy, and will function with the following primary goals; a. Reduce the disparities in professional health education training among African-Americans, Hispanics, Native Americans, and other underserved populations through the funding of merit-based tuition scholarships; b. Improving student performance in the health professional programs through the Endowment Fund Summer Academy, and enhancement of tutorial and remediation programs. These elements are critical to the success of our institution in the recruitment and retention of talented minority students and the development of our professional programs at this institution in the healthcare arena. The administrative functions of this program will be executed through the Principal Investigator (PI), Co-investigators, Project Director, and an Administrative Assistant. The PI will have prime responsibility for development and implementation of policies and procedures, and execution of all requirements of the grant as specified by NCMDH, National Institute of Health (NIH). Again, the Excellence in Health Professional Education Program will enhance the efforts of the existing Center of Excellence, and provide resources for the development of needed educational and financial programs to aid in the efforts to increase opportunities for health professional training among ethnic minorities, and socioeconomically disadvantaged students. Howard University is applying as a S-22 Institution based upon the criteria established for this RFA. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: HUMAN DIVERSITY IN KILLER CELL INHIBITORY RECEPTOR GENES Principal Investigator & Institution: Parham, Peter R.; Professor; Structural Biology; Stanford University Stanford, Ca 94305 Timing: Fiscal Year 2002; Project Start 01-MAY-1981; Project End 31-JAN-2004 Summary: Since its inception the goal of this project has been to understand how HLA class I polymorphisms modulate the immune response to viral infections and transplanted tissues. Initially, the cytolytic T cells of adaptive immunity formed the functional context for the research. They are now joined by the natural killer (NK) cells of innate immunity, which are also regulated by cell-surface receptors that interact with HLA class I determinants. These receptors consist of two kinds: CD94:NKG2 and killer cell inhibitory receptors (KIR), encoded by gene families unlinked to the HLA complex. Within individuals, expression of different receptor combinations by subsets of NK cells creates diverse NK-cell repertoires. Such repertoires are influenced by the HLA types of individuals and also by differences in their KIR. Whereas knowledge of HLA class I polymorphism is fairly complete, that of KIR is rudimentary. An initial survey reveals diversity in KIR phenotype, due both to the types of KIR genes, as well as their allelic polymorphism. A systematic analysis of KIR gene diversity will in four Aims test hypotheses emerging from the initial survey. To define individual KIR haplotypes, recently developed DNA typing methods will be used in Aim 1 to track the segregation of Kir genes in families. In Aim 2, a multiethnic panel of B-cell lines will be analyzed by Southern blotting and DNA typing. This approach will assess the extent of KIR genotype and haplotype diversity in the human population. Aim 3 will define the extent of allelic polymorphism at each of the Kir genes by cDNA cloning and sequencing. Analysis of these sequences will place KIR diversity in the context of the three-

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dimensional structure of KIR glycoproteins and their function, and assess the importance of natural selection. An expanded database of accurate KIR nucleotide sequences will permit design and development of high-resolution KIR typing, applicable to the study of populations, disease associations and clinical outcome in transplantation. Aim 4 is a study of KIR in Native Americans, populations whose genetic diversity is most likely due to natural selection rather than population admixture. This study will provide a yardstick for KIR diversity in other populations, assess KIR diversity that can be maintained under natural selection, and determine whether KIR have, like HLA class I, undergone rapid evolution in South America. The proposed investigation of KIR diversity will greatly benefit from prior experience with HLA class I diversity, and will complement genomic analyses of the KIR gene family from other laboratories. Collectively, the four Aims should give a picture of KIR diversity and an understanding of how polymorphic KIR and their HLA class I ligands assort in human population to produce NK-cell receptor repertoires. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: INCREASING DIVERSITY IN NEUROSCIENCE RESEARCH Principal Investigator & Institution: Berger-Sweeney, Joanne E.; Associate Professor; Society for Neuroscience 11 Dupont Cir Nw, Ste 500 Washington, Dc 20036 Timing: Fiscal Year 2002; Project Start 20-JUL-2000; Project End 30-JUN-2005 Summary: In 1991, the Society for Neuroscience (SFN) established a fellowship program to increase the pool of underrepresented minority groups pursuing careers in mental health-related neuroscience research and teaching programs. This Fellowship Program is now under new direction and the SFN has developed an innovative 5-year program to recruit, train and track outstanding individuals of traditionally underrepresented racial and ethnic minorities (African Americans, Hispanics, Native Americans, Alaskan Natives, and Asian/Pacific Islanders) to work in preeminent neuroscience research laboratories. The integrated study of the nervous system has evolved into one of the most challenging areas of mental health research. Although some strides have been made in increasing representation of racial and ethnic minorities in mental health research careers, equity has not been achieved in either academia, industry or government research arenas. The SFN, as the largest organization of researchers studying the nervous system, is ideally suited to direct a national effort to increase the diversity of the pool of individuals participating in neuroscience research. The objectives of this 5 year program are to: a) recruit and select individuals of underrepresented minorities for 8 predoctoral fellowships and 3 postdoctoral fellowships, b) support the development of each Fellow through networking, mentoring, and enrichment activities, c) develop an organizational structure to support the program and coordinate with other established minority fellowship programs, d) track the Fellows and counsel them in ethical conduct of research, and e) undertake an evaluation of the program since its inception in 1991 to determine the most effective strategies to support and retain underrepresented minorities. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: INFO CONFERENCE - MINORITIES ON THE HUMAN GENOME PROJECT Principal Investigator & Institution: Malvern, Kathryn T.; Zeta National Educational Foundation 1734 New Hampshire Ave Nw Washington, Dc 20009 Timing: Fiscal Year 2002; Project Start 01-MAR-2002; Project End 28-FEB-2004

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Summary: (provided by applicant): This project is an Information Conference for Minorities on the Human Genome Project: The Challenges and Impact of Human Genome Research for Minority Communities. The two-day conference is designed primarily for representatives from the minority communities (African-Americans, Hispanics, Asian Americans, Native Americans), but will be open to all interested persons. Outreach for conference attendance will be targeted to minority community leaders, community organizations, churches, educators, government officials, fraternal groups, civic and social groups, business and professional organizations, and health care organizations. The project's broad objective is to raise the level of awareness in minority communities of the rapid strides being made in human genome research, and the potential and value to minorities, particularly with respect to health care; to identify issues that are important to the minority communities and avenues for more involvement of these communities; and to explore post-conference ways of continuing input. Through presentations, workshops and open discussions, the conference will address the ethical, legal and social issues raised by human genome research developments; the impact on treatments for health problems such as sickle cell anemia, cancer and other physical and mental health concerns. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: INSTITUTIONAL NATIONAL RESEARCH SERVICE AWARD HISPANIC * Principal Investigator & Institution: Hromas, Robert A.; Medicine; University of New Mexico Albuquerque Controller's Office Albuquerque, Nm 87131 Timing: Fiscal Year 2004; Project Start 01-APR-2004; Project End 31-MAR-2009 Summary: (provided by applicant): The percentage of scientists investigating Lung and Blood disease that belong to ethnic minorities is far below their representation in the general population. This is also a self-perpetuating phenomenon, where the lack of role models and supportive mentors produces further declines in the number of minorities seeking advanced degrees in these fields. To address this, there has been a concerted effort to increase the number minorities obtaining advanced degrees in biomedical research. However, these efforts have not been as successful as hoped, mainly because there are simply not enough qualified undergraduate students applying for advanced degrees in these fields. Therefore, the most important method of increasing the number of minorities entering biomedical research as principle investigators is to increase the undergraduate applicant pool for these advanced degrees. Perhaps the best way to increase the undergraduate applicant pool would be to provide minority undergraduate students an exciting and rewarding experience in biomedical research early in their collegiate career, before they have made career decisions. This proposal seeks funds to provide rewarding research experience to minority undergraduate students in New Mexico in a Research Internship Program (RIP). There are three unique advantages to this proposal. First, New Mexico is a minority-majority state, where Hispanics and Native Americans together represent the majority of the population. Second, the University of New Mexico has long established and nationally-recognized research programs in pulmonary and hematologic diseases. Third, the University of New Mexico has a highly successful undergraduate training program to assist minorities entering careers in clinical medicine. A minority student research program here would 1) Recruit ten Hispanic or Native American students per year for 3 months of remunerated research in pulmonary or hematology research, 2) Assist in the presentation of their research at national meetings or in publications, 3) Mentor these students during and

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after the research program to enhance retention in a research career track, and 4) Assist these students in the application process for graduate degree programs. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: INTERDISCIPLINARY SUMMER BIOMEDICAL RESEARCH FOR UNDERGR Principal Investigator & Institution: Slaughter, Gayle; Associate Professor; Molecular and Cellular Biology; Baylor College of Medicine 1 Baylor Plaza Houston, Tx 77030 Timing: Fiscal Year 2002; Project Start 01-MAR-2001; Project End 28-FEB-2005 Summary: (taken from application): This project will provide a 10-week summer mentored biomedical research experience to 10 undergraduates each year who are majoring in a physical science (chemistry, physics, etc.), computer science, engineering or mathematics. Students will be participants in biomedical projects at the forefront of research, often using high-tech equipment. Their projects will span the spectrum of biomedical research and be designed to make use of their specialized skills and introduce them to the opportunities for careers in biomedical research. They will make a final oral or poster presentation on their work and write a critiqued abstract. Students will realize how valuable their talents and skills are through solving biomedical problems. The participants will be co-registered in the SMART Program at Baylor College of Medicine (www.bcm.mac.edu/smart/). They will have access to all elements of the SMART Program including the unique daily interdisciplinary Fundamentals and Frontiers of Biomedical Research seminar series, a weekly research discussion group, career development activities and career counseling. Participants will have the opportunity to enroll in the SMART GRE Prep Course, which has helped more than 50% of the enrollees raise their general GRE Scores by more than 300 points with limited interference to their research productivity. Social activities and dormitory housing in the Texas Medical Center will facilitate interaction between the 80-90 participants in the umbrella SMART Program. Students from different majors and backgrounds will learn about science, careers and life from each other. Participants will be chosen from a variety of disciplines and campus environments, with a concerted effort to recruit students from populations that are under-represented in SMET (science, math, engineering and technology), including women, African Americans, Hispanics, Native Americans and Pacific Islanders. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: MARC AT ARIZONA STATE UNIVERSITY Principal Investigator & Institution: Bustoz, Joaquin; Zoology; Arizona State University P.O. Box 873503 Tempe, Az 852873503 Timing: Fiscal Year 2003; Project Start 01-JUN-1993; Project End 31-MAY-2008 Summary: (provided by applicant): This proposal seeks to increase the participation of currently underrepresented minorities in bio-medical research. There is a special focus on Native Americans in the proposal. Minorities, especially Native Americans, suffer disproportionately from health problems. Increased participation in bio-medical research by members of these groups will help to address this problem. The proposal identifies recruitment of high potential minority students into appropriate university science majors as the first step in the solution. These recruitment efforts must reach into minority communities and reservations, contacts must be made with secondary school students and their families; this is being completed by the SUMS Institute. The desired outcome of these recruitment efforts is full-time enrollment in a science major at Arizona

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State University. The second step in the solution is the main focus of this MARC proposal. This involves a nucleus of minority students already enrolled at Arizona State University. This proposal seeks to recruit high potential minority students into the MARC and PreMARC programs via an intensive summer course on Minority Health Issues and Science Research. Newly recruited students will join this existing nucleus of like-minded minority students (Pre-MARC and MARC trainees) majoring in areas such as Biology, Mathematics, Chemistry, and Physics. They will become members of an undergraduate research community whose members have high aspirations. Through the Pre-MARC and MARC programs, these students will be introduced to research, they will work with carefully selected faculty mentors who will teach and guide them. Throughout, the students will have a support structure that includes faculty mentors, MARC advisement, mandatory MARC coursework and the Guaymas Course, as well as individual tutoring when necessary. In their first two years of university they must develop the self-confidence necessary to persist in difficult majors, the PreMARC program is designed to do just that. The support structure, which already exists at Arizona State University and in the SUMS Institute, is an indispensable part of this process. Their last two undergraduate years, years where they will be MARC trainees, are very critical, this is the time when they will rely on the self-confidence they have developed in order to graduate with academic records that are competitive for admission to graduate school. They will have well-developed academic and research skills that will sustain them through graduate school and into professional research careers. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MATERNAL ANTITHYROID ANTIBODIES AND CONGENITAL HYPOTHYROIDISM IN NATIVE AMERICANS Principal Investigator & Institution: Selva, Karin A.; University of New Mexico Albuquerque Controller's Office Albuquerque, Nm 87131 Timing: Fiscal Year 2002 Summary: This abstract is not available. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: MINORITY SCIENTIST DEVELOPMENT PROGRAM Principal Investigator & Institution: Weiss, Richard L.; Professor; Chemistry and Biochemistry; University of California Los Angeles 10920 Wilshire Blvd., Suite 1200 Los Angeles, Ca 90024 Timing: Fiscal Year 2002; Project Start 30-SEP-1996; Project End 31-JAN-2006 Summary: (provided by applicant): The long-term objective of this proposal is to increase the number of underrepresented UCLA students who go on to enter careers in biomedical research. The general approach proposed to meet this objective is to interest students from those ethnic groups that are significantly underrepresented in science programs nationally (African Americans, Hispanic Americans [Chicanos and Latinos], Puerto Ricans, Native Americans, Alaskan Natives, and Pacific Islanders) in biomedical research careers and to prepare them for success as undergraduate and graduate students. The specific goals are to increase the number of UCLA undergraduates from underrepresented groups who complete majors in the biomedical sciences, enter into graduate studies at UCLA (and other institutions) in areas of biomedical science, and subsequently pursue careers in biomedical research. The UCLA Minority Scientist Development (MSD) program will build a cadre of underrepresented undergraduate

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and graduate students in the biomedical sciences, supporting them with university resources, mentors, and promising career experiences. The MSD program has three major components: outreach, recruitment and preparation for university life; academic support and enrichment; and research training and career development. Through the MSD program and experience gained from other science development programs, we can increase the numbers of underrepresented students at UCLA who enter into biomedical related majors and who successfully complete both undergraduate and advanced programs in these majors, leading to careers in biomedical research. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MONTANA CANCER CONSORTIUM Principal Investigator & Institution: Cobb, Patrick W.; Md, Facp; Montana Cancer Consortium 1236 N 28Th St, Ste 204 Billings, Mt 59101 Timing: Fiscal Year 2002; Project Start 18-SEP-1995; Project End 31-MAY-2003 Summary: (Applicant's Description) The Montana Cancer Consortium (MCC) consists of three components (two from Billings and one from Great Falls) and seven affiliates (Missoula, Helena, Kalispell, Butte, Bozeman and Great Falls). The Consortium encompasses a catchment area which includes the entire state of Montana with extension into Wyoming, Idaho, and the Dakotas (some 150,000 sq. miles/population of 900,000). This area is uniquely rural, as well as home to Native Americans from eight reservations which are served by MCC. The Consortium has a centralized data management office in Billings which serves to register participants and transmit data to the national cooperative groups. The components and affiliates of the MCC have been accruing participants on NCI-approved clinical studies for more than 18 years with a current composite total of 2200 patients. All medical oncologists from the state of Montana will be participating in the Montana Cancer Consortium. Objective 1: Accrual. MCC has named the Southwest Oncology Group (SWOG), the National Surgical Breast and Bowel Project (NSABP) and Gynecologic Oncology Group (GOG) as primary research bases with future addition of Radiation Therapy Oncology Group (RTOG). First-year therapeutic credits are projected at 70. Cancer control credits for the first year are projected at 75. This clearly exceeds the requirements of the RFA for 50 treatment credits and 50 cancer control credits. Objective 2: Quality. MCC centralized data management for this large geographic area to one office in Billings. Centralization will facilitate registrations and data management for 22 participating Montana Oncologists and expedites the transmittal of data to the research bases. Quality of data submitted to the national groups will be enhanced by quality assurance measures within the central office. Centralized data management will add to the efficiency of quality assessments (i.e. site visits). Objective 3: Access. The cooperative effort of the MCC with hospital and health care providers from Montana and surrounding states will improve access to state-of-the-art cancer treatment and prevention for an extensive, largely rural population. The network of oncologists will provide a higher profile for clinical trials which will create a stimulus to increased accrual. By promoting protocol participation in this geographically unique area with its inclusion of the minority component, MCC provides an excellent site for diffusion of knowledge and improved cancer care in a consortium which embodies the NCI's CCOP intent. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: NATIVE AMERICANS AND RESEARCH CAREERS Principal Investigator & Institution: Matyas, Marsha L.; Education Officer; American Physiological Society 9650 Rockville Pike Bethesda, Md 20814

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Timing: Fiscal Year 2002; Project Start 01-SEP-2000; Project End 31-AUG-2005 Summary: This abstract is not available. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: NATIVE AMERICANS IN BIOLOGICAL SCIENCE AT OK STATE UNIV Principal Investigator & Institution: Miller, Robert V.; Microbiol & Molecular Genetics; Oklahoma State University Stillwater Stillwater, Ok 74078 Timing: Fiscal Year 2004; Project Start 05-MAR-2004; Project End 30-APR-2008 Summary: (provided by applicant): The Native Americans in Biological Sciences (NABS) program at Oklahoma State University (OSU) is designed to increase the number of Native American students at OSU who successfully earn a degree in a biomedical related field, and to increase the number of Native Americans students entering careers in biological science. The NABS program targets Native Americans, who are the largest group of minorities on the campus of OSU and in the state of Oklahoma. Native American students from OSU and surrounding Indian communities will be recruited to the NABS program, as many of these students come to OSU from rural communities or 2-year colleges which lack quality science education. The NABS program consist of two main components: 1) curriculum enhancement for freshmen and sophomores, and 2) research experiences for junior and seniors. The curriculum enhancement program will increase the success of Native Americans in the biology, mathematics, and chemistry disciplines. Difficulty in these courses is the reason most Native American students decide to change majors from science to a non-science discipline. The program will provide supplemental courses using cooperative learning techniques to teach independent learning skills and to strengthen scientific communication skills, as well as to provide inclusion into their field of study. The research experience program will provide an opportunity for Native American students from a diversity of biological related disciplines to engage in laboratory research. These students will learn and understand basic research, under the mentorship of experienced scientists who have volunteered to prepare the students for graduate school, professional school or research careers in biological science. The success of the NABS program will be evaluated by analyzing baseline data and data from the general measurable objectives. The NABS program provides a unique opportunity for the largest minority group in the state of Oklahoma, as it seeks to increase the number of Native Americans in biological science. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: NEUROBIOLOGY OF ALZHEIMER'S DISEASE AND AGING Principal Investigator & Institution: Rosenberg, Roger N.; Professor; Neurology; University of Texas Sw Med Ctr/Dallas Dallas, Tx 753909105 Timing: Fiscal Year 2002; Project Start 01-MAY-1994; Project End 31-MAR-2005 Summary: The Alzheimer's Disease Center (ADC) has as its long-range goal to continue to develop and expand its Clinical Core functions to evaluate and follow comprehensively, selected patients with memory loss, Alzheimer's Disease (AD), and other dementias, and similarly to longitudinally follow and evaluate control subjects and encode pertinent data in a central database. Patients will be assigned to appropriate follow- up and study protocols and a computerized tracking system to monitor and document progress will be employed. Minority recruitment has been emphasized to increase our number of patients who are African- American, Hispanic, and Native-

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American. It is our plan to evaluate potential predisposing events to AD, clinical course and complications of AD, clinical course and complications of AD, quantify emotional/behavioral symptoms and quality of life, utilization of imaging studies in the diagnosis of AD, and obtain clinical pathologic correlations. It will be our intent to achieve an 80% follow-up rate for persons designated for long-term studies. Wellstudied subjects, clinical data and body fluids will be supplied to investigators, and in particular antemortem and perimortem information to investigators using postmortem tissues from our controls and patients. Patients and control subjects will be evaluated with comprehensive neuropsychological testing, brain imaging, CSF and neuropathologic findings, in order to detect and assess preclinical and early AD. A Memory Disorders for Native Americans will be developed in Dallas to study their prevalence and clinical features of AD. The collaboration with the Alzheimer's Disease Clinical Studies Unit will continue. ADC patients and controls will be autopsied to provide an accurate diagnosis of AD or other basis of dementia. The Brain Bank will be expanded over the next five years from these autopsy studies and banked tissues will be made available to be utilized by investigators on our campus and at other ADC's. The Clinical Core will also supply information about the ante mortem state of control and AD patients for correlation with cellular and molecular analyses. Genotyping of AD autopsied cases for apolipoprotein E will be conducted as will ELISA assays for synaptophysin and tau proteins, and quantification of neocortical neuritic dystrophy in immunostained sections using image analysis. It is our intent as well to expand the isolation and banking of DNA from frozen and fixed autopsied tissue samples to facilitate ongoing and new studies of molecular alterations in AD and aging. The Statistics and Data Management Core will enter, store and analyze additional new patient data for comparative studies. The functionality of the existing centralized database will be enhanced with appropriate security over a central network to authorized ADC investigators at our institutions. The Education Core has extensive plans that have been developed over the past five years to extend knowledge about AD and specifically, availability of patient services to minority populations and also to primary health care providers. Educational videotapes and TV announcements will be developed both in English and Spanish. The Alzheimer's Researcher Newsletter will be published semi-annually and distributed to our 5000 subscribers in this five-state region. The number and scope of research projects will be increased during the next five years. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: NIDDM PRIMARY PREVENTION TRIAL (DPT-2) Principal Investigator & Institution: Horton, Edward S.; Director, Endocrinology & Metabolism; Joslin Diabetes Center Boston, Ma 02215 Timing: Fiscal Year 2002; Project Start 20-AUG-1994; Project End 14-MAY-2003 Summary: Several factors are known to increase the risk of developing NIDDM, including a family history of diabetes, previous history of gestational diabetes (GDM), obesity, decreased physical activity, presence of impaired glucose tolerance (IGT) or insulin resistance. Moreover, the incidence of NIDDM is higher in several racial and ethnic minority groups in the US including African Americans, Hispanics, Native Americans, Native Alaskans, and Asian Americans. A five year multicenter trial is proposed to evaluate intervention strategies to prevent or delay the progression of IGT to NIDDM, or the progression of previously undiagnosed NIDDM with normal fasting glucose to fasting hyperglycemia. Within the context of the overall study design, the Joslin Diabetes Center, (JDC) South Cove Community Health Center (SCCHC) and Brigham and Women's Hospital (BWH) will collaborate to form a participating clinical

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center and will identify a cohort of 200 high risk patients (equal to approximately 100 patients with IGT or previously undiagnosed NIDDM and 100 obese women with a previous history of GDM) to be prospectively and randomly assigned to one of four intervention groups, comprising a 2 x 2 factorial design. Half of the patients will receive standard diet and exercise recommendations (standard group), while half will receive an intensive lifestyle modification program, including individualized dietary and exercise programs, instruction in behavioral change, stress reduction, smoking cessation and close follow up (intensive group). Within each group, half will be randomized to treatment with low dose sulfonylurea, and half will receive placebo. Volunteers will be screened and recruited from specifically identified high risk populations. These include first degree relatives of patients with NIDDM at the JDC, first degree relatives of patients with NIDDM at the SCCHC, first degree relatives of patients with NIDDM in the Harvard Community Health Plan and patients with a past history of obesity and GDM at BWH. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: NM MINORITY BASED COMMUNITY CLINICAL ONCOLOGY PROGRAM Principal Investigator & Institution: Willman, Cheryl L.; Director, Univ Cancer Research and Treat; Pathology; University of New Mexico Albuquerque Controller's Office Albuquerque, Nm 87131 Timing: Fiscal Year 2003; Project Start 17-AUG-2000; Project End 31-MAY-2008 Summary: (provided by applicant): The State of New Mexico is characterized by ethnic diversity and unusual patterns of cancer incidence and mortality. A substantial number of New Mexicans are young, rural, poor, and medically uninsured and underserved. With a higher percentage of Hispanics and Native Americans than any other State, New Mexico's 1.8 million citizens are 45% White, 42% Hispanic, 10% Native American, 2% Black, and 1% other ethnic minorities. In addition to English and Spanish, our Pueblo, Navajo, Apache, and Ute Indian Tribes speak over twenty different languages and dialects. In this context, the mission of the University of New Mexico Cancer Research and Treatment Center (UNM CRTC) is to use its expertise in basic, translational, and clinical cancer research, cancer epidemiology, and community intervention to reduce the incidence and mortality of cancer in New Mexico's multiethnic populations. Participation in cooperative cancer prevention and treatment trials sponsored by the National Cancer Institute (NCI) and the MB-CCOP program, is a critical part of this mission. CRTC investigators have been contributing patients and scientific expertise to the NCI program since the Center opened in 1975. Currently funded with an NCI P20 Cancer Center Planning Grant, the CRTC has excellent research and primary cancer prevention programs supported by $83 million in total peer-reviewed funding. Among these is the New Mexico Tumor Registry (NMTR), one of the original Surveillance, Epidemiology and End Results (SEER) programs, now in its 30th year of NCI funding. The NMTR holds the world's largest database on cancer incidence and mortality in Hispanics and Native Americans and has documented strikingly different patterns of cancer incidence and mortality in these groups. Funded under the the MB-CCOP program since August 2000, the CRTC is building strong clinical cancer programs through the recruitment of 14 new oncology clinical specialists and the development of a new expanded clinical trials infrastructure at UNM and its affiliate sites. Together, the UNM CRTC and its Affiliates serve 80% of the cancer patients in the State. In close parallel with New Mexico's ethnic diversity, 52% of the patients currently enrolled from our MB-CCOP program to NCl-sponsored treatment and prevention trials are ethnic

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minorities: 31% Hispanic, 16% American Indian, 4% Asian, and 1% Black. Prior to being funded as a MB-CCOP program, the CRTC was a member institution of the Southwest Oncology Group (SWOG) and the Pediatric Oncology Group (POG); CRTC faculty continue to play significant leadership roles in these groups. Additional Research Bases include the National Surgical Adjuvant Breast and Bowel Project (NSABP) and most recently, the Eastern Cooperative Oncology Group (ECOG). Renewed funding of this MB-CCOP program will insure increased access and accrual of minorities to clinical trials, strengthen our Affiliate Network, facilitate the building of clinical trials programs with Hispanic and Native American Tribes and communities, and expand outreach to minority populations and the medically underserved in our region. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: NORTHERN ARIZONA UNIVERSITY: MINORITY STUDENT SUPPORT Principal Investigator & Institution: Nishikawa, Kiisa C.; Professor; Biological Sciences; Northern Arizona University Department of Biological Sciences Flagstaff, Az 86011 Timing: Fiscal Year 2002; Project Start 01-APR-1998; Project End 31-MAR-2006 Summary: (provided by applicant): At NAU, our goals are to increase the academic performance, retention, and graduation rates of underrepresented minority students, especially Native Americans, who are or who could become interested in careers in biomedical sciences. As a result of this program, we hope to increase rates of acceptance into and completion of post- graduate degree programs in biomedical sciences at NAU as well as at other institutions across the nation. To achieve these goals, we have implemented a Minority Student Development Program (MSD). The MSD Program includes research participation, academic enrichment, academic support and faculty development activities. The specific aims of the MSD program are: 1) to provide opportunities for minority students to become involved in biomedical research projects with selected NAU faculty. Students will be encouraged to give presentations on their research at national meetings and to publish the results of their research in peerreviewed journals. Changes from the previous funding cycle include an increase in participating faculty from 16 to 30 and development of two new courses, "Introduction to Biomedical Research" and "Research Rotations" that will provide MSD students with more information about careers in biomedical research. 2) to implement academic enrichment programs for minority students that will strengthen their academic performance in gatekeeper courses in science and mathematics. Continuing activities include Supplemental Instruction (SI), faculty-led recitations and a readiness test. We also propose the development of a new course, "Skills for Science" which will target students whose readiness scores indicate that they may not succeed in gatekeeper courses. 3) to maintain an academic support system for minority students. This support system will include a central meeting place where students can meet with academic advisors and Supplemental Instruction leaders. Through this support system, academic advisors will provide academic advisement and personal counseling for MSD students, and provide them with information about research participation and academic enrichment opportunities that are available through the MSD program. 4) to provide professional development for faculty who teach gatekeeper courses in biomedical sciences. Faculty will reform their courses by using new models of teaching that facilitate increased learning by underrepresented students, especially Native Americans. Ultimately, the faculty are catalysts for the persistence of the MSD program at NAU. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: NORTHWEST/ALASKA CENT. TO REDUCE ORAL HEALTH DISPARITIES Principal Investigator & Institution: Milgrom, Peter M.; Professor of Dental Public Health Scienc; Dental Public Health Sciences; University of Washington Grant & Contract Services Seattle, Wa 98105 Timing: Fiscal Year 2002; Project Start 30-SEP-2001; Project End 31-JUL-2008 Summary: This proposal is in response to RFD DE-99-003 to establish the Northwest and Alaska Center for Oral Health Disparity for research to reduce oral health disparities in the Pacific Northwest and Alaska. It is proposed that the Center develop basic and applied knowledge that addresses the needs of poor, minority, and rural children and their caretakers, utilizing approaches that go beyond the traditional strategies from dental public health that have not found success in these populations. While the research in the proposed center may involve traditional dental personnel, it also stresses the roles of pediatricians, mothers as well as children; and preventive agents beyond fluorides. Participants include Alaska Natives, Native Americans from the Yakima Indian Nation, Hispanics from the agricultural areas of Washington, African Americans and Hispanics from the local military reservations, Hispanics and Pacific Islanders served by urban hospitals as well as rural and low-income Whites. We propose to accomplish this goal through five specific aims: (1) To address the needs of the Pacific Northwest and Alaska by conducting clinical research to evaluate the efficacy of nontraditional interventions to prevent and treat oral disease in children and their caretakers; (2) To develop community-based research that translates existing knowledge and new information regarding children and their caretakers into new technologies and interventions that hold promise for reducing disparities in these high risk populations; (3) To expand health science education and research training opportunities for minority populations in the Pacific Northwest and Alaska by collaborations with key minority educational and health serving institutions in the region; (4) To conduct basic research to further understand the role of host defenses and genetic bases for caries and periodontal disease affect underserved populations as well as to probe the biologic basis for antibacterial that change disease susceptibility; and (5) To increase the impact of the center beyond the projects included in this proposal by recruiting investigators and students from minority institutions in the Pacific Northwest and Alaska and prioritizing and encouraging pilot and center-affiliated studies in which they are involved. The collaborating institutions and partners are Heritage College (Hispanic and Native American-serving institution sited on the Yakima Indian Nation), Alaska Native Tribal Health Consortium/Yukon-Kuskokwim Native Health Corporation, Yakima Valley Farm Workers Clinic, Northwest Portland Area Indian Health Board/Northwest Tribal Epidemiology Center, Washington Dental Service an Foundation (major private dental insurer); and Medical Assistance Administration (Medicaid agency for Washington State). Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: OKLAHOMA NATIVE AMERICAN EXPORT CENTER Principal Investigator & Institution: Lee, Elisa T.; Professor; Ctr/Amer Indian Health Res; University of Oklahoma Hlth Sciences Ctr Health Sciences Center Oklahoma City, Ok 73126 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 31-AUG-2007 Summary: (provided by applicant): There is ample evidence of health disparities in the Native American population. One of the major health disparities in this population is

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Type 2 diabetes. The prevalence rate of Type 2 diabetes in Native Americans is several times higher than the general population. More alarmingly, type 2 diabetes, which was considered to be a disease for middle-aged adults, is increasingly present in Native American children and adolescents. It is therefore imperative that health promotion and disease prevention strategies to reduce diabetes be developed and validated in this population. This proposal is to establish an Oklahoma Native American EXPORT Center to reduce health disparities in Native Americans with an emphasis on diabetes prevention in children and adolescents. Our approach is to partner with Native American tribes, community-based programs and organizations, and programs at the University of Oklahoma. The proposed Oklahoma Native American EXPORT Center has five components: Administrative Core, Research Core, Community Outreach and Information Dissemination Component, Training Component, and Shared Resources Core. Two full projects and one pilot pROJECT are proposed in the Research Core. These projects focus on strategies for preventing diabetes and obesity from infancy to adolescents involving family, school and community organizations. Activities proposed in the Community Outreach and Information Dissemination Component include disseminating information on the epidemiology, intervention and prevention of diabetes and obesity to American Indian communities, promoting positive attitudes towards treatment and prevention of diabetes and obesity, encouraging and preparing communities to participate in scientific studies of health, and providing science education opportunities to Indian high school students. The Training component will provide opportunities to increase knowledge in Indian health and introduce health field career opportunities to Native American students, sponsor continuing education workshops/conferences on Indian health to health care providers, University of Oklahoma faculty and other health professionals, and recruit Native American students to the University of Oklahoma and its Health Sciences Center. Lastly, the Shared Resources Core will provide resources for study design and monitoring, data management and statistical analysis. It is believed that the proposed EXPORT Center will be effective in the efforts to reduce health disparities, particularly in childhood diabetes and obesity. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PARKINSON'S DISEASE CLINICAL TRIAL GROUP SITE Principal Investigator & Institution: Calabrese, Vincent P.; Mc Guire Research Institute, Inc. 1201 Broad Rock Blvd, Res 151 Richmond, Va 23249 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 31-AUG-2007 Summary: (provided by applicant): Researchers at the McGuire Veterans Affairs Medical Center (MVAMC) bring to the Parkinson Disease (PD) Neuroprotection Clinical Trial Group exceptional expertise, outstanding clinical and laboratory resources, and a qualified and motivated patient population from which to recruit subjects. The McGuire Parkinson Disease Research, Education, and Clinical Center (PADRECC) provides PD treatment for military personnel and veterans throughout the southeastern United States, ranging from Pennsylvania down to Florida (including Puerto Rico) and west to the Mississippi River. Veterans with PD from this entire region are referred to MVAMC for treatment. Native Americans in this region seeking treatment for PD and patients referred from private practice are also eligible to attend the MVAMC PADRECC. This combined pool of potential study participants will exceed the enrollment needs for a member site of the proposed PD Neuroprotection Clinical Trial Group. The research mission of the MVAMC PADRECC is to establish a center of excellence for clinical trials, emerging biomolecular strategies, and integrated health services. The MVAMC and its

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affiliate university, Virginia Commonwealth University/Medical College of Virginia Hospitals (VCU/MCVH), boast a talented group of scientist-practitioners with a broad range of clinical interests and research expertise related to PD. The MVAMC PADRECC personnel, resourc6s, and patient population will be available for the PD Neuroprotection Clinical Trial Group. MVAMC investigators have a long history of excellent recruitment and retention capabilities and a supportive clinical environment in which to conduct studies. Their history of participation in multicenter trials managed by pharmaceutical companies, the Parkinson Study Group, and the NIH demonstrate their commitment to cooperative research projects. MVAMC investigators will cooperate fully with all other centers in the PD Neuroprotection Clinical Trial Group in the conduct of each pilot and main study to test agents approved by the Oversight and Steering Committees. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PATHWAYS TO MENTAL HEALTH SERVICES AMONG NATIVE WOMEN Principal Investigator & Institution: Duran, Bonnie M.; Family and Community Medicine; University of New Mexico Albuquerque Controller's Office Albuquerque, Nm 87131 Timing: Fiscal Year 2002; Project Start 18-JUL-2001; Project End 30-JUN-2006 Summary: (provided by applicant): For Native American populations, mental disorder prevalence, distribution and subsequent treatment seeking is not well known. Evidence from the few studies that have been published and research underway now, however, suggests a serious disparity in the prevalence of mental disorders for this population compared to the general US population and a very low utilization of mental health services. Research Plan: Two complementary studies are proposed. The first is a small qualitative investigation of illness experience and contextual factors related to treatment seeking among Native American women with current and lifetime psychological pathology. The second is a quantitative secondary analysis of pathways to mental health treatment and care seeking among Native women. Both studies aim to provide descriptive and analytic information on utilization by type of disorder and treatment system and identify other influences on care seeking as suggested by the NetworkEpisode Model theory. The research will test models regarding the pathways into care that consider social, community and system variables as determinants of access to treatment and provide narratives to contextualize the results. One data set to be used for the secondary analysis is drawn from the largest psychiatric epidemiologic, risk and protective factors study ever conducted among Native Americans (the SUPERPFP study N=3200). The other data set is from the candidates own study of the same variables drawn from Native women in a primary care setting (Mental Health and Abuse Among Native Women in Primary Care N=234) Career Development Program: This study will be conducted within the broader context of an expert-led training program. The proposed 5-year course of study includes instruction in advanced quantitative research design and statistical methods, multi-level and mixed method approaches, psychiatric nosology, and the operationalization of theory in pathways to mental health care research. The ultimate goal of this revised Career Development Award is for the candidate to have the skills, knowledge, and experience to teach and conduct rigorous, culturally competent mental health services research for Native Americans and other culturally distinct groups. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: PILOT--NATIVE AMERICAN USE OF TRADITIONAL MEDICINE Principal Investigator & Institution: Reifel, Nancy M.; Dental Public Health Information Systems; University of California Los Angeles 10920 Wilshire Blvd., Suite 1200 Los Angeles, Ca 90024 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 29-SEP-2007 Summary: Although the incidence of many different types of cancer appears to be less among Native Americans than white or African American patients, their survival rate appears to be worse. Native peoples employ a variety of prevention and treatment approaches, including traditional Indian treatments, to decrease mortality associated with cancer. The overall goal of this research is to determine the resources - clinical, complementary, and historically traditional Native American treatments - used by American Indian/Alaska Native people for cancer care. Native Americans have a longstanding mistrust of the medical research community, therefore, this preliminary study will be conducted to determine the feasibility of conducting research on the use of traditional Native American healing practices. Twenty key informants will be interviewed for this study. Eight health care practitioners, specifically, four biomedical clinicians and four traditional Native American practitioners, will be interviewed. Twelve Native American cancer survivors will be interviewed, specifically, six urban American Indians and six Native Americans who are reservation-based in Southern California. The interviews will be designed to elicite the following information: descriptions of clinical, complementary and traditional Native American treatments, Southern California Native peoples' beliefs the aspects of traditional medicine amenable to systematic research, and opinions about what physicians need to know about traditional Native American medicine in order to improve outcomes of cancer treatment. Grounded Theory coding methods will be used on the audio-taped interviews for content analysis. Follow-up interviews will also be used to pursue new areas that emerge from the analyses. Findings from this preliminary study will help us develop research methodologies for a larger study to question Native Americans about the frequency and function of distinct types of cancer treatment resources, including traditional American Indian treatments. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: PILOT--PAIN MANAGEMENT AND TELEHEALTH FOR CROW INDIANS Principal Investigator & Institution: Zuklowski, Karen; Montana State University (Bozeman) Bozeman, Mt 59717 Timing: Fiscal Year 2002 Summary: (from applicant's Abstract) Cancer-related pain and nonmalignant pain is a health concern for the Native American people of Montana and Wyoming because reservations are geographically remote from health specialists, alternative approaches to health care delivery are necessary Telehealth is currently being used to bring specialized health care to under-served Americans throughout the United States. Native American reservations are a prime location for telemedicine interventions because of the specialized resources on the reservations and the long distance needed to travel to access specialized health care. Little research is available on the use of telehealth with the Native American population. Even less is available on the pain experience in Native Americans. A person's response to pain is influenced by his or her past experience with pain, the duration and intensity of the pain, and their culture. Culture is an especially important consideration in the Native American population. Current pain assessment

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instruments do not take the Native American culture and language barriers into consideration. Adequate pain management and alternative methods of health care delivery in the Native American population have not been well researched. Therefore, the overall goal of this study is to evaluate the adaptation of a standardized pain assessment questionnaire as well as the acceptance of telemedicine as a means of delivery for pain management treatment in the Crow Native American population. Specific aims this study will address include. 1) Evaluation of the adaptability of the Brief Pain Inventory for use with a Native American population, and 2) Evaluation of the feasibility of nursing management of chronic pain using telehealth technology with a Native American population. The Brief Pain Inventory will first be adapted in culturally sensitive English. This translation will be refined and preliminary testing conducted. Expert-patient agreement will be established and intra-item correlation performed. There will be 10 Crow patients with complaints of pain over 3 months in duration. Each participant will have one face-to-face consultation with the Advanced Practice Nurse pain expert There will be three consultations over telehealth Telehealth will be considered an acceptable mechanism of pain management delivery if Crow participants' pain scores decrease over the course of the study and they score 4 or above on the Acceptance of Telehealth Questionnaire. Results of this study provide the basis for tool development and alternative methods of health care delivery in a medically underserved Crow population. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: POPULATION AND EVOLUTIONARY GENETICS OF NIDDMI Principal Investigator & Institution: Di Rienzo, Anna D.; Associate Professor; Human Genetics; University of Chicago 5801 S Ellis Ave Chicago, Il 60637 Timing: Fiscal Year 2002; Project Start 01-FEB-2001; Project End 31-DEC-2004 Summary: (Investigator's Abstract): Type 2 diabetes is one of the most common metabolic disorders in humans and has a complex etiology due to environmental and genetic factors. Recently, a positional candidate region, NIDDM1, has been proposed to contain variation which contributes to diabetes risk. According to the thrifty genotype hypothesis, diabetes susceptibility genotypes conferred a selective advantage in the ancient past in times of feast a famines. In this application, we propose to conduct a detailed study on the population and evolutionary genetics of the candidate region for the genetic susceptibility to type 2 diabetes. The ultimate goals of our study are to provide information on the haplotype structure of variation that can be used to design and interpret replication studies, understand the forces that shape sequence variation and LD at this locus in aboriginal human populations, and use the signature of natural selection on this region to validate the mapping evidence. To advance these goals, we propose to: Survey sequence variation in small random samples (10 individuals) from each of four major ethnic groups (Africans, Asians, Europeans, and Native Americans) in the two genes found in the NIDDM1 candidate susceptibility region. The data generated in this survey will be analyzed to identify sub-regions with evidence for positive natural selection. These regions in addition to those containing candidate diabetes susceptibility variants will be further studied in Specific Aim 2. Conduct a detailed analysis of sequence variation and LD in a sample of 25 individuals each from large outbred populations from three major ethnic groups (Africa, Asia, and Europe). We will use these data to provide critical information for disease mapping and look for the signature of natural selection based on the "thrifty" genotype hypothesis. Carry out an extensive survey of allele frequencies at NIDDM1 candidate susceptibility variants in 20 human population samples with a broad range of ethnic and geographic origins and

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rates of type 2 diabetes prevalence. The survey results will be analyzed to ask if the atrisk genotype frequencies correlate with diabetes prevalence rates In different populations. In addition, we will be able to determine whether the degree of interpopulation differentiation is significantly different from that observed at a large number of neutrally evolving nuclear loci and whether the geographic distribution of allele frequencies is correlated with environmental features, such as latitude or climate. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PRIMARY PREVENTION TRIAL (DPT-2) Principal Investigator & Institution: Molitch, Mark E.; Professor; Northwestern University Office of Sponsored Research Chicago, Il 60611

Medicine;

Timing: Fiscal Year 2002; Project Start 20-AUG-1994; Project End 30-APR-2003 Summary: This proposal is submitted in response to the RFA: DK-93-07, "NIDDM primary Prevention Trial" NIDDM is a major public health problem in the United States and its prevalence is disproportionately high among a number of minority groups including Native American, Hispanics and African-Americans, Members of these minority groups, obese subjects, persons with a family history of NIDDM among first degree relatives and women with prior gestational diabetes mellitus (GDM) of all racial and ethic groups are at high risk for the development of NIDDM. We have developed a protocol for a multicenter study to test the hypothesis that the appearance of NIDDM can be delayed or prevented by life style or pharmacological intervention in women with prior GDM or in subjects at high risk for NIDDM who presently have impaired glucose tolerance (IGT). We propose to compare the rate of progression of IGT to NIDDM and mild NIDDM to NIDDM with fasting hyperglycemia in groups receiving intensive life-style intervention with diet, (low fat moderated fiber reduced calorie) and exercise (supervise instruction and maintenance of physical fitness) or drug treatment (sulfonylurea oral hypoglycemic agent or an anorectic agent) with conventional advice regarding diet and exercise. We propose that subjects with prior GDM represent half of the women recruited for the study and that the total population enrolled include 20 percent Hispanics, 20 percent African-American, 10 percent native Americans and 50 percent Caucasians and members of other minorities. We have identified a large population of women with previous GDM that includes approximately equal numbers of Black, hispanic and White women and are prepared to serve as a center for a concentrated subgroup enrollment of such subjects. We are also prepared to recruit Hispanic, African- American and White subjects from the general population who are at high risk for IGT. Our study investigators have extensive experience in the care of patients with diabetes mellitus, have broad and in depth experience in collaborative diabetes related and cardiovascular disease related clinical and epidemiological studies. These projects have provided extensive experience in recruitment and retention of minority subjects including women with prior GDM. The project investigators are prepared to collaborate and cooperate in the final design of the study protocol by the steering committee as well as implement it with enthusiasm and to the best of our collective abilities. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PRIMARY PREVENTION TRIAL (DPT-2) Principal Investigator & Institution: Schade, David S.; Professor; Medicine; University of New Mexico Albuquerque Controller's Office Albuquerque, Nm 87131 Timing: Fiscal Year 2002; Project Start 20-AUG-1994; Project End 14-APR-2003

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Summary: During the last 30 years, the combined mortality of the Native American and Hispanic populations living in New Mexico has almost doubled. This dramatic rise can be partially attributed to the increased incidence of type II diabetes. We will assess the outcome of interVention strategies to prevent the onset of type Il diabetes in high risk groups (impaired glucose tolerance and/or a history of gestational diabetes). The two principal minority groups in the state of New Mexico will be studied: the urban Native American population and the urban Hispanic (Mexican-American) population. Recruitment techniques will include direct interrogation of three large health care databases and participation of many community support organizations involved with Native Americans and Hispanics. Two hundred individuals (100 Native Americans, 100 Hispanics) will be randomized into one of four treatment groups. The first treatment group will receive standard therapy (diet plus exercise counseling every six months). The second treatment group will also receive standard therapy plus glyburide 5 mg once per day. The third treatment group will receive' intensified dietary instruction plus scheduled exercise with the goal of achieving ideal body weight and a healthy lifestyle. These individuals will exercise three times per week and meet monthly for dietary counseling and body weight measurements. The fourth treatment group will receive the same therapy as the third group (a combination of the intensified dietary instruction and scheduled exercise) plus glyburide 5 mg once per day. In order to increase adherence, volunteers and their families will interact with nurse/educators sensitive to the cultural needs of the study population. Positive reinforcement techniques will be used. Primary study endpoints include 75 gm oral glucose tolerance testing every six months plus measurement of integrated C-peptide and insulin. Secondary endpoints include hemoglobin AlC, body composition measurements, body weight, dietary alterations, and changes in health status. Administratively, a Central Coordinating Unit, composed of individuals experienced in the various treatments, will oversee the trial. Guidance to the Central Coordinating Unit will be provided by an Advisory Committee comprised of prominent members of both the Native American and Hispanic communities. A nurse/educator will be provided for each of the three satellite clinics caring for the volunteers. Comparing standard treatment against other treatment(s), the protocol design provides 90% power to detect a 33% minimum improvement in the conversion rate from impaired glucose tolerance to diabetes, p

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