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Center for American Indian and Alaska Native Health Disparities

Overview


The Center for American Indian and Alaska Native Health Disparities is a Center of Excellence sponsored by the National Institute on Minority Health and Health Disparities (U54 MD000507). The Center has been continuously funded since 2003, but the focus of the Center differs with each funding cycle, as the health needs of the population change and as our methods to confront disparities evolve.

An elderly person holding a babies hand

Alzheimer’s Disease and American Indians


In its current funding cycle (2017-2022), the Center focuses on risk, onset, and duration of Alzheimer’s Disease among older American Indians and Alaska Natives within a precision medicine framework. We respond to the increasing incidence of cognitive impairment, dementia, and Alzheimer's Disease among American Indian and Alaska Native people, and the burden this poses for individuals, caregivers, their communities, and relevant systems of care. Our active outreach to and engagement with key stakeholders affirm the personal as well as scientific impetus for developing more precise approaches to preventing, diagnosing, and treating such conditions in this population. The proposed work will advance the relevant science and its application to improving care.

Programmatic components


Community engagement and dissemination

To meet its goal of nurturing and disseminating innovative research of cognitive impairment, dementia, and Alzheimer's Disease among American Indians and Alaska Native, the Center partners with five Satellite Centers located throughout the US (Rocky Mountain, Pacific Northwest, Southwest, Alaska, and Northern Range) to extend the parent Center’s impact to local stakeholder groups critical to growing and sustaining a successful disparities research agenda. Through this collaboration, we:

  • Work with our Community Action Board to modify and culturally tailor the AD8 Dementia Screener for use with AI/AN elders. Thereby advancing our understanding of this assessment tool’s performance with this population
  • Support the Community Action Board in culturally tailoring brain health infographics developed by AARP
  • Support each Satellite Center in administering the AD8 to 75 urban and 75 rural older AI/ANs, typically embedded within a health survey
  • Collaboratively analyze the data, examining its psychometric properties and associated risk/protective factors
  • Develop infographics for dissemination to local stakeholders and presentations
  • Conduct webinars and symposia for dissemination of the information gained through the AD8 revision process 
  • Develop youth-driven ‘Zines—self-published works of original or appropriated texts and images—focused on meaning and experience of AD and dementia 

View the AD8 dementia screener results and health infographics

>> Brief - AD8 Screening Results with Rural/Urban Comparison for Rocky Mountain Region

>> Infographic - Physical Health Supports Memory Health

>> Infographic - Mental Health Supports Memory Health

Collage of the briefs together

View the Rural/Urban Comparison Brief, Mental Health Infographic, and Physical Health Infographic

Health Disparities Scholar Program

The Health Disparities Scholar Program provides financial, logistical, and scientific resources to support early-stage investigators preparing for a career in research. The program uses the scientific review process as a learning opportunity for interested junior investigators and integrates, coordinates, and centralizes research services that support these investigators.

Pilot Studies

The Center funds innovative Pilot Studies with meaningful implications for personalizing the prevention, diagnosis, and treatment of cognitive impairment, dementia, and Alzheimer’s Disease in AI/AN communities. Two to three Center Pilot Studies are supported each year, depending upon available resources. In January 2021, two investigators were chosen and their studies are currently underway. 

Research projects

  • Longitudinal Study of MRI, Clinical, and Genetic Biomarkers of Cognitive Impairment and Alzheimer’s Disease in Elderly American Indians. This study draws on data from the Strong Heart Study and the ancillary Cerebrovascular Disease and its Consequences in American Indians (CDCAI) study to evaluate cognitive function, Alzheimer’s Disease risk factors, and MRI-defined biomarkers of Alzheimer’s Disease in elderly American Indians.
  • Addressing the Knowledge and Recruitment Gap in Alzheimer’s Disease Precision Medicine among Native People: A Randomized Controlled Trial. This study created culturally tailored materials on Alzheimer’s Disease and precision medicine and tests the effect of these materials on completion and enrollment through conducting a randomized controlled trial. Results will highlight communication strategies that facilitate or hinder AI/AN recruitment and elucidate knowledge gaps regarding Alzheimer’s Disease and precision medicine.

Previous funding cycles


The initial cycle of the Center focused on health issues facing AI/AN children and youth, including quality of diabetic care for AI youth; documenting obesity among AI infants and children; increasing fitness among urban Al/AN youth; smoking cessation; understanding performance properties of a widely used health quality measure and assessing/improving the quality of mental health care for AI children; and telepsychiatry. Major accomplishments of this funding period include expanding the focus of the Special Diabetes Program for Indians to include attention to obesity and early onset type 2 diabetes among Native youth and establishing a growing network of telepsychiatry programs in rural, distant AI/AN communities, which generated clinical outcomes and cost-effectiveness data that justified its expansion to 14 clinics in South Dakota, Wyoming, Montana, and Alaska.

In this funding period, the Center turned its attention to the impact of the loss of Medicaid insurance on patient outcomes and survival among low-Income American Indians and Alaska Natives and treatment for depression in primary care. During this cycle, 66,000 AN/AI primary care patients were screened for depression using the Screening Brief Intervention and Referral for Treatment (SBIRT) protocol. Screening was followed up by co-located masters-level clinicians in primary care teams. Those patients found to be at risk were given an intervention and triaged to the appropriate level of care. 

After 3 years, the results of this study led the State of Alaska to revise its Medicaid CPT codes to fund 36 SBIRT clinicians at Southcentral Foundation, a tribally-owned and operated health care system in Anchorage, Alaska. The SBIRT protocol was expanded to address alcohol/substance abuse, suicidality, and trauma, and screening was extended to six other AI/AN primary care settings across the United States.


In the third phase of funding, the Center focused on the development, implementation, and evaluation of a culturally relevant Primary Care Screener for PTSD and an Internet-based supportive intervention. Over the course of funding, a culturally relevant screening tool for PTSD was developed and performance characteristics were established through rigorous test design. The Screener was implemented in primary care settings in healthcare systems at Southcentral Foundation in Alaska and Cherokee Nation in Oklahoma. In all, 11,298 AI/AN primary care patients were screened. Patients identified as at risk were triaged to a self-activated Internet-based psychoeducational support module, and then triaged to appropriate level of care based upon results. 

Funding information

Sponsor: National Institute of Minority Health and Health Disparities

Years Funded: 2003-

Grant No.: U54 MD000507

Principal Investigator: Spero Manson, PhD, CAIANH, University of Colorado

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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