Promoting AI/AN Health: NW NARCH program

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Overall NARCH Project summary Three premises underlie the development of our NW NARCH. First, despite longstanding efforts by tribal, federal, and state health care programs, the available data show substantial disparities in health for NW American Indians and Alaska Natives (AI/ANs) compared to non-AI/ANs (1–5). NW tribal leaders fear that their health status is getting worse instead of better; this fear unfortunately has been substantiated with health data that show increases in key chronic disease conditions instead of decreases over the past 20 years. Second, Indian communities distrust health research because of negative experiences with non-AI/AN researchers who did not respect tribal needs or sensitivities, even though carefully implemented health research has the potential to provide solutions to reduce, and ultimately eliminate, existing health disparities. Third, health research done by highly skilled AI/ANs who are sensitive to the culture and specific concerns of NW and other Indian communities can bridge the gap between academia and community, though currently we lack the critical mass of AI/AN researchers necessary to accomplish this task. In response to these three issues, Northwest Portland Area Indian Health Board (NPAIHB or ‘the board’) has established the NW NARCH to form a tribal-academic partnership for community-based health research focused on eliminating racial health disparities and will continue this partnership with this application. The NW Indian communities represented by NPAIHB have a long track record of coordinated efforts to improve their health status; our tribal-academic partnerships with Oregon Health & Science University and Portland State University will build a wide-reaching and multi-layered infrastructure to increase the skills of AI/AN researchers, and address health problems of critical importance to the tribes. Our Board delegates and Community and Scientific Board of Advisors have directed us to pursue three projects in this application: 1) cancer prevention and control training; 2) HIV/STD prevention for adolescents and young adults; and 3) asthma education and self-management. We trust that we will have substantial impact on AI/AN communities through increasing the number of rigorously trained tribal people in cancer prevention and control and mentoring them in their careers; in reaching an estimated 2,000,000 tribal people within two years with culturally-appropriate HIV/STD prevention messages than can affect behavior change; and in developing and testing new asthma self-management programs that can have wide applicability in Indian country. Our experienced evaluators will track process and outcomes for each project, in addition to their impact, as we address these important issues in AI/AN health.