Funded Pilot Projects

Current projects


Headshot Wenjun Fan
Wenjun Fan, PhD, Assistant Professor, Department of Epidemiology & Biostatistics, Joe C. Wen School of Population & Public Health, University of California, Irvine

Effectiveness of SGLT-2 Inhibitors and GLP-1 RAs on Aging Outcomes Among American Indian and Alaska Native Adults with Diabetes

Pilot Investigator: Wenjun Fan, PhD

The aim of this proposed study is to evaluate the effectiveness of two novel therapies, SGLT-2 inhibitors (SGLT-2is) and GLP-1 receptor agonists (GLP-1 RAs), on aging-related outcomes, specifically the risk of cardiovascular disease and dementia in American Indian and Alaska Native (AI/AN) adults with diabetes. Clinical trials have demonstrated these therapies could cause a 14%-26% risk reduction in cardiovascular events beyond the current standard of care, while recent meta-analyses and epidemiological studies have suggested an 11%-18% reduced risk of dementia associated with these therapies. However, the AI/AN population has been significantly underrepresented in these studies, leaving their efficacies in this group uncertain. To address this gap, we propose to utilize Medicare data to identify AI/AN adults with diabetes from 2015-2016, with follow-up data extending to 2024. We will compare the effectiveness of SGLT-2is, GLP-1 RAs, and traditional diabetes medications on the outcomes of incident or recurrent cardiovascular events and all-cause dementia. We anticipate identifying ~45,000 and ~ 28,000 AI/AN users of traditional and novel diabetes medications, respectively, in 2016, with higher expected sample sizes when including data from 2015. Propensity score matching will be employed to balance differences in patient characteristics between comparison groups, and Cox proportional hazards models will be used to estimate hazard ratios for each outcome. Our findings will provide robust evidence to support increased access to novel therapies within the AI/AN population, thereby improving diabetes care, life expectancy, and quality of life in this severely underserved population.

Project supported in part by American Diabetes Association.

 

Headshot of Marie Kainoa Fialkowski Revilla
Marie Kainoa Fialkowski Revilla, PhD, Associate Researcher/ Associate Professor, Director of Nutrition Support Shared Resource, University of Hawaiʻi Cancer Center

History of Breastfeeding and Diabetes in a Multiethnic Cohort Study

Pilot Investigator: Marie Kainoa Fialkowski Revilla (Native Hawaiian), PhD, RDN, LD, IBC, CLC

Breastfeeding is a potent protective factor for many adverse perinatal outcomes and subsequent chronic conditions. Compared to non-breastfeeding counterparts, mothers who breastfed experience a 30% reduction in the risk of diabetes later in life while breastfeeding more than 13 months reduces diabetes risk by 32% in comparison to breastfeeding <1 month. Native Hawaiians (NH) have a higher incidence for type 2 diabetes in comparison to non-Hispanic whites and NH women in Hawai‘i are at high risk of gestational diabetes. The 2021 Hawaiʻi Pregnancy Risk Assessment Monitoring Surveys revealed that NH women are less likely to initiate breastfeeding and to be breastfeeding at 8 weeks. Most research on breastfeeding among NH women has been hampered by the problematic aggregation of Asian and NHPI women in national data emphasizing the need for disaggregated data sources. This study involves an analysis of the Multiethnic Cohort (MEC) Study to explore type 2 diabetes and breastfeeding history among NH women compared to the other MEC racial and ethnic groups. Breastfeeding history, duration, and related determinants, and how they differ for NH women compared to the other racial and ethnic groups, will be assessed. Then the association between the incidence of type 2 diabetes with breastfeeding duration and frequency among the NH women in comparison to the other MEC race and ethnic groups will be examined using Cox regression. Findings will inform future proposals seeking to address the relationship between type 2 diabetes and other chronic conditions with breastfeeding among NH women.

 

Headshot of Tara Maudrie
Tara L. Maudrie, PhD, Johns Hopkins Bloomberg School of Public Health

Assessing Cultural Food Security and Diabetes-related Health Outcomes: The Indigenous Supported Agriculture Study

Pilot Investigator: Tara L. Maudrie (Sault Ste Marie Tribe of Chippewa Indians), PhD

The traditional foods and food practices of American Indian (AI) peoples have supported their health and the wellbeing of their environments since time immemorial. However, the intrusion of settler colonialism disrupted these relational food practices while introducing chronic diseases and food insecurity. In recent years, Indigenous food sovereignty initiatives have garnered attention for their efforts in promoting healthy food access and reinforcing connections to cultural foods. Cultural food security and connectedness to traditional foods are two potentially important indicators of traditional food intake and food sovereignty, but the effects of food sovereignty interventions on these indicators are not well studied.

 

A food sovereignty initiative led and implemented by the Osage Nation provided produce boxes delivered to community members through the Indigenous Supported Agriculture (ISA) study. The ISA study included approximately N = 353 AI participants aged 18-75 years, who were residents of Osage Nation, and classified as overweight and obese according to BMI criteria. This project’s secondary analysis of the ISA randomized control trial study will address the following aims: 1) Determine the associations between cultural food security, traditional food intake, cultural connectedness to traditional foods, and a primary outcome: physical activity. 2) Determine intervention effect on cultural food security, traditional food intake, cultural connectedness to food, and physical activity. This research will provide critical insights into the role of food sovereignty initiatives in promoting holistic health and cultural connectedness among Indigenous communities, while informing the design of future interventions to enhance these outcomes.

 

Headshot of Emily Melnichik
Emily Melnick, PhD, MPH, Research Associate, University of Denver

Evaluate Fruit and Vegetable Benefit Redemption Patterns among Inter Tribal Council of Arizona WIC Households after Recent Policy Changes

Pilot Investigator: Emily M. Melnick, PhD, MPH

 

Diets rich in fruits and vegetables promote overall health and reduce risk for diabetes. However, less than 40% of American Indian (AI) youth and adults meet fruit and vegetable intake recommendations. This gap is largely driven by systemic inequities in the food system that create barriers to accessing healthy foods. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides a monthly cash value benefit (CVB) for purchasing fruits and vegetables, which could help improve intake among AI families. Yet, CVB redemption rates are relatively lower among WIC-participating AIs. The Inter Tribal Council of Arizona (ITCA) WIC—a state agency serving AI populations in Arizona, most of whom live on tribal lands—recently implemented two new policies to increase CVB purchasing flexibilities. The first allows households to use their CVBs to purchase canned produce in addition to fresh and frozen options. The second allows households with an infant to receive CVBs as a substitute for jarred infant fruit and vegetables. Our study partners at ITCA WIC want to learn about the uptake of these options and implications for redemption. Using administrative data from ITCA WIC, our team will (1) assess whether household characteristics, including WIC beneficiary composition, SNAP participation, and urbanicity, associate with uptake of new policies and (2) evaluate whether household CVB redemption rates vary by household patterns of utilizing expanded redemption options. Findings will inform future collaborative work with ITCA WIC to improve fruit and vegetable benefit redemption to maximize health benefits for participating AI families.

 

Headshot of Reagan Miller

Reagan L. Miller, PhD, Assistant Professor, Colorado State University

Exploring Mental Health, Adversity, and Obesity through an Intersectional Lens among AI/AN Adolescents

Pilot Investigator: Reagan L. Miller, PhD

American Indian/Alaska Native (AI/AN) adolescents experience significant disparities in obesity and type 2 diabetes, due to social determinants of health including historical and ongoing experiences of adversity. Mental health problems (e.g., depression/suicidality) that can arise from adversity have also been related to greater risk of developing obesity/diabetes. Yet, most existing research has focused on AI/AN adults and utilized small sample sizes and it is unclear how mental health and adversity may contribute to obesity/diabetes risk among AI/AN adolescents. In addition, it is likely that holding more minoritized identities (e.g., identifying as AI/AN, lesbian/gay/bisexual) may increase the strength of the association between mental health concerns and obesity/diabetes risk, but this has yet to be explored. In an effort to clarify these relationships and inform the tailoring of culturally aware preventative intervention programs for AI/AN adolescents, we will leverage the CDC’s 2023 Youth Risk Behavior Surveillance System to: 1) evaluate the associations of mental health problems and two key dimensions of adversity (i.e., threat/deprivation) with body mass index (BMI) among AI/AN adolescents (Aim 1) and 2) assess the extent to adversity (threat/deprivation) and intersectional identities moderate the mental health-BMI connection (Aims 2/3). Findings from this study will serve as preliminary data for future NIH funding related to optimizing evidence-based preventative intervention programs to most effectively reduce disparities in obesity and type 2 diabetes risk among AI/AN adolescents.

 

Project supported in part by American Diabetes Association.

Headshot of Melinda Smith

Melinda S. Smith, PhD, Postdoctoral Scholar, Northern Arizona University, Center for Health Equity Research

Assessing Cancer Risk among Indigenous Citizens Living with Type 2 Diabetes in Arizona

Pilot Investigator: Melinda S. Smith, PhD

Epidemiological evidence has shown that type 2 diabetes (T2D) increases risk for several cancers, including endometrial, colorectal, and breast cancer. Given that American Indian and Alaska Natives (AIAN) continue to suffer from disproportionately high rates of T2D and poor cancer survival outcomes, understanding the relationship between T2D and cancer among AIAN is critical to reduce secondary complications of T2D and cancer risk.
Using a retrospective cohort design, we propose to examine the relationship between T2D and diabetes-associated cancers (liver, pancreatic, female breast, bladder, endometrial and colorectal) among Indigenous Medicaid beneficiaries between January 1, 2008 to December 31, 2021. Data will include healthcare claims from 519,460 Medicaid beneficiaries. An adjusted Poisson regression model will used estimate the association between T2D and cancer incidence.
Though the association between T2D and certain cancers is well established, epidemiological data on the relationship between these chronic diseases among AIAN remains largely unresearched. The shortage of accurate epidemiological data for AIAN in the U.S. calls for concentrated effort to ensure AIAN are included in public health surveillance and vital statistics efforts, despite small population sizes. Our hope is that this information will help inform healthcare professionals, leaders, and researchers in identifying population needs and in developing locally relevant screening policies and interventions to address T2D and cancer related disparities.

2022-2025


Headshot of Kaipeng Wang
Kaipeng Wang, PhD, Associate Professor, University of Denver

Evaluating the Association Between Mental Health and Diabetes Management Behaviors among American Indians and Alaska Natives Living with Diabetes

Pilot Investigator: Kaipeng Wang, PhD

Mental health conditions, especially depression, appear to influence diabetes self- management behaviors, such as diet, exercise, and blood sugar monitoring. However, research on such relationships among AI/ANs with diabetes is limited. To address this gap, this project will evaluate the association between mental health and self-management behaviors (e.g., blood sugar testing, foot exams, taking diabetes management courses, self-monitoring of blood glucose, physical activity, routine health care visits) among AI/ANs with diabetes. Using data from the Behavioral Risk Factor Surveillance System (BRFSS), Dr. Wang will complete the following aims: (1) Explore the association between mental health, especially depression, and diabetes self-management behaviors among AI/AN with diabetes. (2) Explore the role of urban-rural residence status and education in affecting the relationship between mental health and diabetes self-management behaviors in AI/AN with diabetes.
Ginny Lane
Ginny Lane, PhD, Assistant Professor, University of Idaho

Diabetic Ketoacidosis in Children: Risk Factors and Racial Disparities

Pilot Investigator: Ginny Lane, PhD

Diabetic ketoacidosis (DKA) is an acute hyperglycemic emergency in people with diabetes. Noted risk factors for recurrent DKA include low socioeconomic status, adolescence, female sex, high glycated hemoglobin (HbA1c), previous episodes of DKA, and a history of mental health problems. Among children, risk factors for DKA include poor diabetes control, previous episodes of DKA, unstable or challenging family or social circumstances, adolescent age, being a peripubertal girl, and having limited access to medical services. It is unknown whether Native American children with diabetes experience the same risk factors for DKA. Using secondary data from the SEARCH for Diabetes in Youth project, the study team will address the following specific aims: (1) Evaluate the association of socioeconomic status, sex, HbA1c, treatment cost burden, diabetic instruction, episodes of missed medication, frequency of blood testing, disordered eating, quality of life, and dietary glycemic load with episodes of DKA among children; and (2) Evaluate whether there are differences in these relationships between various racial and ethnic groups.
Maja Pedersen
Maja Pedersen, PhD, Faculty Affiliate at University of Montana & Postdoctoral Fellow at Stanford University

Using CBPR and A Life Course Perspective to Examine Physical Activity among Rural American Indian Mid-life and Older Adults

Pilot Investigator: Maja Pederson, PhD

American Indian (AI) adults are more likely to develop heart disease and die from it than non-Hispanic white (NHW) adults. Likewise, diabetes mellitus (diabetes) has a three-fold higher rate in AI adults than in NHWs and is the most important clinical risk factor for heart disease among AI populations. Physical activity (PA) is a powerful protective behavior known to reduce risk for heart disease and diabetes. Yet, PA rates are low among AI adults, and understanding of PA influences among this population is limited. This study responds to recent calls for advanced knowledge on PA among historically marginalized populations by attending to contextual factors (e.g., social, and environmental influences), and life course factors (e.g., life events and life transitions), that may impact PA engagement and participation. This study is part of an ongoing community-based participatory research (CBPR) partnership, including AI and non-AI study team members representing academic and tribal community-based entities. The team will use a CBPR approach and qualitative description to analyze data from semi-structured interviews (N=21) conducted among rural AI adults on topics of PA and wellbeing. The study is theoretically grounded in the NIMHD Health Disparities framework and the life course perspective. A collaborative, iterative content analysis process will be applied, guided by the theoretical framework. Findings will provide insight into contextual and life course factors influencing PA engagement and participation among AI adults, informing optimized timing and settings for customized interventions to increase PA, reduce diabetes and heart disease, and promote long-term wellbeing among AI populations.

Previously funded projects


Centers for American Indian & Alaska Native Health

Colorado School of Public Health

CU Anschutz

Nighthorse Campbell Native Health Building

13055 East 17th Avenue

Mail Stop F800

Aurora, CO 80045


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