Public Health Digest
publication of the National Indian Health 
Winter 2014 
In This Issue
Restoring Traditional Foods and Hope
Increasing Awareness 
with Latest Rapid HIV Testing Tool 
Building Tribal Health Workforce and Infrastructure
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Did you know...

April is National Child Abuse Prevention Month

The impact of child abuse and neglect is greatly felt within American Indian and Alaska Native (AI/AN) peoples, and research suggests that child abuse is related to increased risk for developing adverse physical and mental health outcomes in children and family members affected. The Child Maltreatment 2012 Report totaled 7,770 victims of child abuse among AI/AN's, who have the second highest rate of victimization demographically. Tribal nations, Tribal organizations, and federal agency partners are working to raise awareness of the issue and provide guidance. 


Click Here

for more information. 


You may also Learn more from other partners in child abuse prevention: 

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MSPI and DVPI Funding Comment Period 
 Dr. Yvette Roubideaux, the Director of the Indian Health Service (IHS) recently sent a Dear Tribal Leader Letter requesting recommendations on funding
for Fiscal year (FY) 2014 for Methamphetamine and Suicide Prevention Initiative (MSPI) and Domestic Violence Prevention Initiative (DVPI). This is an important opportunity for Tribal Leaders to provide direct comment and feedback to the Director on the importance of the project, the impact that it has had locally, and the need for continued support of both the MSPI and DVPI initiatives. Specific comments are requested on the following questions:
1. Should IHS 
   continue to fund 
   the same Tribes 
   for MSPI and DVPI 
   or open the 
   opportunity to 
   other Tribes who 
   have not received 
   MSPI and DVPI 
2. Do you agree that 
   the funding should 
   be distributed for a 
   five-year cycle?
3. Should the same 
   funding formula be 
The letter can be found online HERE.
All comments should be received by March 30, 2014, and can be emailed to, or submitted in writing to: 
Yvette Roubideaux, MD, MPH, Director
Indian Health Service
801 Thompson Ave, Suite 440
Rockville, MD 20852
ATTN: MSPI/DVPI Funding Consultation
Upcoming Funding Opportunities 

Farm to School Grant Program 
The Department of Agriculture recently announced the release of a request for applications for a third round of grants, including the addition of a new funding track. These grants help eligible schools improve the health and wellbeing of their students and connect with local agricultural producers. USDA is focused on improving childhood nutrition and empowering families to make healthier food choices by providing science-based information and advice, while expanding the availability of healthy food. 
Learn more about Farm to School and request your Application.
Application Deadline:
April 30, 2013
AmeriCorps Indian Tribes Grants
The Corporation for National and Community Service (CNCS) recently announced grants that seek to prioritize the investment of national service resources in economic opportunity, education, veterans and military families, and disaster services in Native American communities. Federally recognized Tribes and Tribal organizations are eligible to apply.

Application Deadline: 
April 30, 2014
Mission of the National Indian Health Board

One Voice affirming and empowering American Indian and Alaska Native peoples to protect and improve health and reduce health disparities.

This Publication
The National Indian Health Board (NIHB) invites you to learn more about the latest developments in Tribal public health, including updates on NIHB's current projects.  We also invite you to share your news items, comments or questions. 
Analyzing Ancestral Knowledge: The Traditional Western Apache Diet Project


Twenty years ago, while teaching employees of the San Carlos Apache Tribe's Department of Forest Resources staff about traditional Apache plants, the late elder Wallace Johnson said, "If we eat our traditional Apache food and exercised, there would be none of these new diseases."  



That simple statement has stuck in the heads of those employees, and they wondered if the knowledge of Mr. Johnson's generation (who was born in 1903) - directly taught to him from forebears who grew up before Apaches were herded onto reservations - held keys to combating the epidemics of poor physical and emotional health, suicide, and sexual violence amid the Reservation backdrop of generationally-embedded toxic stress.


To test part of this idea, San Carlos Apache staff launched the Traditional Western Apache Diet Project two years ago.  The purpose of this project is to study and analyze the pre-Reservation diet of the San Carlos Apache Tribe, White Mountain Apache Tribe, Tonto Apache Tribe, and Apaches of the Yavapai-Apache Nation, all in Arizona.  The project aims to produce:

  • General and detailed narratives and nutritional analyses of the pre-Reservation Apache diet;
  • An analysis of commercially-available modern equivalents to wild Apache food species and wild candidates for cultivation; 
  • A cookbook of pre-Reservation dishes and modern, traditionally-based dishes;
  • Educational products including peer-reviewed papers, articles, and curriculum; and
  • Meaningful Tribal food and health policy.

To accomplish this, project staff reviewed interviews with Apache elders from past projects and conducted an exhaustive literature search.  With funding from the Tribe's Department of Health and Human Services, staff conducted over 70 formal and countless informal - interviews with elders, and hired a nutritionist who began the detailed work of analyzing the over 200 species of wild plant foods, several strains of Apache corn and squash, and over 40 kinds of wild meat.  Staff also began compiling sample daily menus for nutritional analysis.


While analysis is still in process, two years of work have yielded some initial findings:

  1. The pre-Reservation diet is extremely healthy, and is:
    • High in fiber
    • Low in saturated fat
    • High in healthy fats
    • Low in cholesterol
    • Low in sodium and processed sugar
    • Rich in a wide variety of whole foods
    • Filling, with little volume
  2. The pre-Reservation diet is seasonal; varying with the seasons, tying individuals and the community to the natural order of seasons in terms of nutrition, activity, and ceremony. 
  3. In pre-Reservation times, food production was the basis of activity and movement, economy, ceremony, and political structure.
  4. The traditional Apache relationship with food is deeply personal, respectful, and spiritual.
With current funding ending, and to complete the work necessary to fully analyze the diet, the project is looking at ways to sustain this promising work. For Twila Cassadore, a Project Assistant and a San Carlos Apache Tribal member, working on the project has been a profound and healing experience for her and her family.  "You can't bring healing to Native people without involving a connection to the land.  Nothing will work without that."


For more information contact:

Seth Pilsk

Department of Forest Resources

San Carlos Apache Tribe

(928)475-2329 ext. 343



INSTI Rapid HIV Testing: A Quick Tool for American Indian/Alaska Natives

The number of American Indians and Alaska Natives that tested positive for the Human Immunodeficiency Virus (HIV) rose by 8.7% between 2007 and 2011.  This was the largest percent increase among any race/ethnicity.  Tribes have responded to this growing concern by stepping up both prevention and testing efforts.  More and more Native clinics are adopting routine HIV testing as a standard clinical practice.  However, in order to align this practice with community demand and need, it will be important for clinical and administrative staff to understand the technology and testing options that are available.  HIV tests have come a long way - from waiting two weeks for test results twenty years ago to twenty minutes and now waiting just one minute. 


The INSTI Rapid HIV Antibody test was approved on Dec. 1, 2012 (World AIDS Day) for distribution and use in the United States.  It is a single-use, rapid, chemical test used to detect HIV Type 1 antibodies in human whole or fingerstick blood or plasma specimens in as little as 60 seconds.  The U.S. clinical trial data show minimum sensitivity and specificity of 99.8% and 99.5% respectively in these samples.  The test itself does not require refrigeration or specialized storage, and is currently the fastest HIV diagnostic test available today. As with all rapid HIV tests, reactive test results are considered preliminary and must be confirmed before establishing a diagnosis of HIV infection.


A test with such a rapid processing time could be helpful to Native programs that are working in high prevalence and/or high-volume settings, or in challenging outreach settings.  Although it would also mean that programs would need to re-examine their counselling and referral protocols in order to account for a decreased required amount of time spent with each person. Programs and clinics should meet with their staff and health directors to determine what testing technologies will work best for their staff, clinic flow, and community.  Sometimes, while a quicker test may appeal to staff, it could simultaneously alarm community members or not provide community members enough time with a clinician to feel truly comfortable to talk about and address sensitive topics.


The Native American Community Health Center (NATIVE HEALTH), a non-profit health organization in Phoenix, Arizona, recently implemented the use of the one minute test as part of their Native Pathways HIV program. Due to the increasing rate of HIV incidence in Arizona, NATIVE HEALTH wanted faster result times so that people could be linked to care sooner - an important piece in providing seamless HIV care.


Several other HIV/AIDS organizations throughout the country are also using the one minute test, and it appears to be another tool that Native programs can place in their HIV prevention and testing 'toolkit.'  For more information on the one minute test, contact your local tribal health department or local Indian Health Service facility.

Key Programmatic Components of a Tribal Health Workforce and Infrastructure Program


With the advent of the Affordable Care Act, the United States has been examining the state of its healthcare infrastructure and workforce.  Significant shortages have been noted in the number of people entering the healthcare field, and these shortages are compounded by the growing demand for quality healthcare services by an aging population. 


Programs are now being put in place to address the shortage of those pursuing healthcare careers.  In 2009, the Administration for Children and Families (ACF) Office of Family Assistance (OFA) utilized funds through the Affordable Care Act to create the Health Profession Opportunity Grant (HPOG) program to provide education, training, assistance and support to recipients of Temporary Assistance for Needy Families (TANF) and other low-income individuals who are interested in pursuing a career in the healthcare field.  Five HPOG grants were awarded to Tribal organizations and Tribal Colleges (Blackfeet Community College [Browning, MT], Cankdeska Cikana Community College [Fort Totten, ND], College of Menominee Nation [Keshena, WI], Cook Inlet Tribal Council, Inc. [Anchorage, AK], and Turtle Mountain Community College [Belcourt, ND]). 


Tribal HPOG programs created supportive systems and educational processes that more closely aligned to the culture and realities of their respective communities - which varied from other non-Tribal HPOG programs.  An evaluation conducted by the National Opinion Research Center (NORC), National Indian Health Board (NIHB), and Red Star Innovations found that there were recurring elements within the programs that both faculty and students cited as significantly contributing to the success of the programs.  This writing seeks to highlight some of these factors.  A more detailed account of the evaluation, factors for success, challenges and lessons learned can be accessed at It is important to understand the diverse programming put forth and the outcomes produced in order to enhance program sustainability, share lessons learned, avoid unnecessary duplications, and inform the broader field about how to establish similar programs in their own communities. 


Strong and Dedicated Program Staff

Staffing remains a cornerstone of most public health programming, and it is no surprise that within a program that seeks to bolster healthcare staffing, that staffing itself is noted as a key programmatic element.  All of the Tribal HPOG sites noted that a dedicated, strong, and consistent staff were important to the success and sustainability of the programming. 


The dedication of the staff was important, as students in the program were able to feel the level of engagement, commitment, and concern that the staff displayed.  Students noted that the quality of the staff and the consistent presence of the staff really conveyed a sense of dedication to the program and a caring for the success of the students. Many of the staff working in the HPOG programs are Tribal members.  Students appreciated this fact, as it made them feel comfortable in approaching staff and sharing some of their more personal concerns or issues.  Staff noted that being Native themselves allowed them to better empathize with the experiences of today's Native students; they were able to tap into similar experiences that they had when they were college students. 


A strong staff also contributed to the sustainability of the programming.  This went beyond securing continued funding, however. Having a strong staff ensured that students viewed the program as sustaining source of support where they could continue to access the services being offered. A dedicated staff created a strong program presence on campus and in the community.


Application and Screening Process

The Tribal HPOG programs all had some manner of screening or application process in place for those students seeking to enroll to receive services.  The eligibility criteria varied, as did the actual application processes, but included some of the following components: verification of Tribal enrollment, income requirements, background check, letters of reference, individual interviews, applications that included essay questions, and faculty and student review of applications.


Those with more stringent screening requirements felt that it was a very important step in ensuring that students are eligible, but more importantly that the process would help identify those likely to be successful.  Screening for earnest interest in healthcare, academic performance, and commitment were important indicators of potential success. Such a thorough screening (including a background check) may also prevent a student who may perform exemplary academically from being denied certification because of past criminal charges, or other similar barriers.  By ensuring that only the most committed and dedicated students enter the program, staff can be assured that the resources are directed to students most likely to succeed and ultimately, graduate. The screening and application process ends up being a strategy for student retention. 


Use of Assessments to Create Support Plans

Once students enter an HPOG program, an assessment was found to be a critical step in the development of an individualized success plan.  Assessments varied from site to site, but were used primarily to examine academic achievement and identify current academic and supportive needs. 


This was seen as critical because it allowed staff to learn about their enrolled students, prioritize what assistance was most needed, and provide assistance that was based upon actual needs reported by the students (not those assumed by the staff).  Some common academic needs identified included: monetary support for tuition, books, and tutoring. Other common supportive needs included housing, transportation, and childcare.  As needs were different for each student, a thorough assessment was required to identify the individual, specific, most pressing needs.  The results of the assessments were used to formulate a tailored success plan for students.  The plan was used to measure progress and create benchmarks which staff could use to monitor the students' success.  The plan was also used as a tool to continually engage the students in the program, which helped to ensure that the proper support was being offered.


Instilling Sense of Pride and Accomplishment

Students that participated in the evaluation efforts displayed a deeply held sense of pride in their accomplishments to date.  This feeling ended up serving as a significant motivating factor in working hard. Some students believed that what they were doing and how they were composing themselves would prove them to be positive role models for their children and future generations.  Students felt that the program was contributing to their personal and professional betterment, and helping them avoid setbacks such as unemployment or underemployment.  This sense of pride in their participation, and esteem for the program was reflected in the ways they connected and referred to other students in the HPOG program.


All four key programmatic components featured here lay the foundational processes through which similar programs can be implemented in Tribal communities.  First, a strong and dedicated staff must be secured, and utilized to find and enroll the most committed students.  These students should have their needs identified and addressed to ensure not just academic success, but also alleviate personal stress that may hinder their studies.  The end result will be a graduating student that can walk away from the school and the program proud of what they accomplished and looking forward to a career in the healthcare field

This article is a synopsis of a brief published by the National Opinion Research Center at the University of Chicago on the Tribal Health Professions Opportunities Grant.

Meit, M., et al. (2013). OPRE Report 2013-55. Washington, DC; Office of Planning Research and Evaluation. Administration for Children and Families, U.S. Department of Health and Human Services: NORC at the University Chicago, Red Star Innovations, National Indian Health Board. 


The National Indian Health Board welcomes your input!  If you would like to submit materials for consideration, please contact the NIHB Public Health Department through
Director of Public Health Programs Carolyn Angus-Hornbuckle at or (202)507-4084 or Public Health Communications and Program Manager Robert Foley at 
or (202)355-5494.