Diné-centered Research Reframes the Gold King Mine Spill: Understanding Social and Spiritual Impacts Across Space and Time

This paper explores how Indigenous-led research reframes the impacts and response to environmental disasters in the context of acid mine spills in rural communities of the Southwest United States. The collaborative research project addressing the Gold King Mine Spill (GKMS) designed qualitative methodologies that center Indigenous worldviews and contribute to broader understandings of environmental justice. The research team, led by Diné scholars and community leaders, gathered qualitative responses from 123 adult participants in twelve focus groups from three rural communities on the Navajo Nation. The project incorporated fluent Diné speakers and cultural consultants to lead focus groups in a manner consistent with cultural worldviews. The analysis of the focus group data resulted in original findings that reframe previous understandings of environmental harm by broadening the boundaries to include: 1) social relations across time; 2) social relations across space; 3) spiritual relations; and 4) restoring balance. The findings allow for greater insight into the colonial context of disaster on rural and Indigenous lands and confronts colonial-rooted disasters through Indigenous-informed political action.

A multisectoral approach to advance health equity in rural northern Arizona: county-level leaders' perspectives on health equity

BACKGROUND

Multisectoral and public-private partnerships are critical in building the necessary infrastructure, policy, and political will to ameliorate health inequity. A focus on health equity by researchers, practitioners, and decision-makers prioritizes action to address the systematic, avoidable, and unjust differences in health status across population groups sustained over time and generations that are beyond the control of individuals. Health equity requires a collective process in shaping the health and wellbeing of the communities in which we live, learn, work, play, and grow. This paper explores multisectoral leaders' understanding of the social, environmental, and economic conditions that produce and sustain health inequity in northern Arizona, a geographically expansive, largely rural, and culturally diverse region.

METHODS

Data are drawn from the Southwest Health Equity Research Collaborative's Regional Health Equity Survey (RHES). The RHES is a community-engaged, cross-sectional online survey comprised of 31 close-ended and 17 open-ended questions. Created to assess cross-sectoral regional and collective capacity to address health inequity and inform multisectoral action for improving community health, the RHES targeted leaders representing five rural northern Arizona counties and 13 sectors. Select open-ended questions were analyzed using an a priori coding scheme and emergent coding with thematic analysis.

RESULTS

Although leaders were provided the definition and asked to describe the root causes of inequities, the majority of leaders described social determinants of health (SDoH). When leaders described root causes of health inequity, they articulated systemic factors affecting their communities, describing discrimination and unequal allocation of power and resources. Most leaders described the SDoH by discussing compounding factors of poverty, transportation, housing, and rurality among others, that together exacerbate inequity. Leaders also identified specific strategies to address SDoH and advance health equity in their communities, ranging from providing direct services to activating partnerships across organizations and sectors in advocacy for policy change.

CONCLUSION

Our findings indicate that community leaders in the northern Arizona region acknowledge the importance of multisectoral collaborations in improving health equity for the populations that they serve. However, a common understanding of health equity remains to be widely established, which is essential for conducting effective multisectoral work to advance health equity.

"Nobody Is Talking About It": Diné (Navajo) Communities Speak About Stomach Cancer and Helicobacter pylori Infections

Stomach cancer is the third leading cause of cancer death globally. Helicobacter pylori plays a role in the healthy human gut, but is also associated with multiple chronic diseases, including stomach cancer. Though H. pylori prevalence is declining in parts of the world, it remains high among certain populations. In Arizona, stomach cancer rates are 3-4 times higher among the Navajo Nation population as compared with the non-Hispanic white population. This pilot project assessed adult Diné (Navajo) individuals' understanding and awareness regarding H. pylori infection and stomach cancer. Focus groups were held in three Diné communities. Data were analyzed thematically using a multi-investigator consensus approach. Participants had limited knowledge of H. pylori infection and stomach cancer and perceived local medical providers as also having limited knowledge on these conditions. Participants described poor health care experiences, structural inequalities, and environmental concerns and associated these with H. pylori infection and stomach cancer. This study highlights the need for additional research and education on current knowledge and perceptions of stomach cancer and H. pylori infections in Navajo Nation.

Helicobacter pylori Prevalence and Risk Factors in Three Rural Indigenous Communities of Northern Arizona

Helicobacter pylori (H. pylori) is one of the most common bacterial stomach infections and is implicated in a majority of non-cardia gastric cancer. While gastric cancer has decreased in the United States (US), the incidence in the Navajo Nation is nearly four times higher than surrounding Non-Hispanic White populations. Little is known about H. pylori prevalence in this population or other Indigenous communities in the lower 48 states. In this cross-sectional study, 101 adults representing 73 households from three Navajo Nation chapter communities completed surveys and a urea breath test for active H. pylori. Accounting for intrahousehold correlation, H. pylori prevalence was 56.4% (95% CI, 45.4–66.8) and 72% of households had at least one infected person. The odds of having an active infection in households using unregulated water were 8.85 (95% CI, 1.50–53.38) that of the use of regulated water, and males had 3.26 (95% CI, 1.05–10.07) higher odds than female. The prevalence of H. pylori in Navajo is similar to that seen in Alaska Natives. Further investigation into factors associated with prevention of infection is needed as well as understanding barriers to screening and treatment.

Development of a Culturally Anchored Qualitative Approach to Conduct and Analyze Focus Group Narratives Collected in Diné (Navajo) Communities to Understand the Impacts of the Gold King Mine Spill of 2015

The Gold King Mine Spill (Spill) occurred in August 2015 upstream from Silverton, Colorado and released three million gallons of contaminated water into the Animas River, a tributary to the San Juan River that flows across the Navajo Nation. Using principles of community-engaged research, the Gold King Mine Spill Diné Exposure Project co-developed a culturally anchored approach to conduct focus groups and analyze narratives collected in three Diné (Navajo) communities along the San Juan River within 9 months of the Spill. Focus group questions were designed to document the socio-cultural impacts of the Spill. This paper: (1) outlines the partnerships and approvals; (2) describes focus group design, training, data collection and analysis; and (3) reflects on the use of a culturally anchored approach in Indigenous, specifically Diné-centered research. Diné social and cultural etiquette and concepts of relationality were used to adapt standard (non-Indigenous) qualitative methods. Findings describe community perceptions of short-term impacts of the disaster, as well as past and present injustices, communication related to the Spill, and concerns of persistent threats to Diné lifeways. The culturally anchored approach was critical in fostering trust with Diné participants and aligned with the candor of the discussions.

Using a Multisectoral Approach to Advance Health Equity in Rural Arizona: Community-Engaged Survey Development and Implementation Study

BACKGROUND

Over the past decade, public health research and practice sectors have shifted their focus away from identifying health disparities and toward addressing the social, environmental, and economic determinants of health equity. Given the complex and interrelated nature of these determinants, developing policies that will advance health equity requires collaboration across sectors outside of health. However, engaging various stakeholder groups, tapping into their unique knowledge systems, and identifying common objectives across sectors is difficult and time consuming and can impede collaborative efforts.

OBJECTIVE

The Southwest Health Equity Research Collaborative at Northern Arizona University, in partnership with an 11-member community advisory council, is addressing this need with a joint community-campus effort to develop and implement a Regional Health Equity Survey (RHES) designed to generate an interdisciplinary body of knowledge, which will be used to guide future multisectoral action for improving community health and well-being.

METHODS

Researchers and community partners used facilitated discussions and free listing techniques to generate survey items. The community partners pilot tested the survey instrument to evaluate its feasibility and duration before survey administration. Respondent-driven sampling was used to ensure that participants included leadership from across all sectors and regions of northern Arizona.

RESULTS

Over the course of 6 months, 206 participants representing 13 sectors across the 5 counties of northern Arizona were recruited to participate in an RHES. Survey response rates, completion percentage, and sector representation were used to assess the effectiveness and feasibility of using a community-engaged apporach for survey development and participant recruitment. The findings describe the current capacity to impact health equity by using a multisectoral approach in northern Arizona.

CONCLUSIONS

The Southwest Health Equity Research Collaborative effectively engaged community members to assist with the development and implementation of an RHES aimed at understanding and promoting multisectoral action on the root causes of health inequity. The results will help to build research and evaluation capacity to address the social, economic, and environmental conditions of health inequity in the region.

Voices of Community Partners: Perspectives Gained from Conversations of Community-Based Participatory Research Experiences

Community-based participatory research (CBPR) has been documented as an effective approach to research with underserved communities, particularly with racial and ethnic minority groups. However, much of the literature promoting the use of CBPR with underserved communities is written from the perspective of the researchers and not from the perspective of the community partner. The purpose of this article is to capture lessons learned from the community partners’ insight gained through their experiences with CBPR. A multi-investigator consensus method was used to qualitatively code the transcripts of a CBPR story-telling video series. Seven major themes were identified: (1) expectations for engaging in research, (2) cultural humility, (3) respecting the partnership, (4) open communication, (5) genuine commitment, (6) valuing strengths and recognizing capacities, and (7) collaborating to yield meaningful results. The themes drawn from the community partner’s voice align with the tenets of CBPR advanced in the academic literature. More opportunities to include the community voice when promoting CBPR should be undertaken to help introduce the concepts to potential community partners who may be research cautious.

Abstract D109: Helicobacter pylori infections in Navajo communities of Northern Arizona

Background: Helicobacter pylori (Hp) is a gastric pathogen associated with development of duodenal or stomach ulcers, stomach cancer, and mucosa associated lymphoid-tissue (MALT) lymphomas. While Hp prevalence is declining in many regions, it remains the leading infectious cause of cancer worldwide. In the United States prevalence varies by geographic location, ethnic background, socioeconomic status, and age. This pilot project seeks to understand the role of Hp infection in the development of stomach cancer among Native Americans of Northern Arizona, where stomach cancer incidence rates are approximately three times higher than the general Arizona population and it is the leading cause of cancer mortality. Methods: A cross-sectional survey based on a random sample of households selected using census block vectors for tribal lands overlaid onto satellite imagery. Potential household structures were marked and randomly sorted with recruitment goals set to be proportional to underlying population size. Houses were ‘ground-truthed’ for eligibility and residents approached for participation. A total of 72 households were recruited between June-August 2018 with 105 self-identified Navajo >18 years old living in three communities in northern Arizona participating. Participants were assessed on household and individual level factors associated with infection. A urea breath test (UBT) was performed to test for active infection. We used logistic regression, adjusted for household clustering, to calculate odds ratios (aOR) and 95% confidence intervals (CI) for associations between UBT results and individual and household factors. Results: Active Hp infection was found in 66 of the 101 participants with valid UBT, crude prevalence of 65.4%. Male participants were more likely to be positive (aOR=2.89, 95% CI, 1.03-8.09). Participants with an unregulated household water source had the highest odds for positive UBT (aOR=8.85, 95% CI, 1.50-53.38). There was no association with age or education and a modest association with history of gallbladder disease. Only 23.8% reported they had ever heard of Hp infections and 12.9% previously tested for the infection. Conclusion: Prevalence of Hp is high among individuals in these Navajo communities. Use of household water that was not regulated, was strongly associated with active Hp infection. Further work is needed to determine if there is geographic variation and what Hp substrains are involved for this population. Attention also needs to focus on developing strategies to reduce the infection and target earlier detection.

Citation Format: Robin B Harris, Rachel Begay, Priscilla R Sanderson, Carmenlita Chief, Fernando Monroy, Heidi E Brown, Eyal Oren. Helicobacter pylori infections in Navajo communities of Northern Arizona [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr D109.

A National Epidemiologic Profile of Physical Intimate Partner Violence, Adverse Childhood Experiences, and Supportive Childhood Relationships: Group Differences in Predicted Trends and Associations

INTRODUCTION

Adverse childhood experiences (ACEs) are common in the USA and associated with multiple health sequelae. Physical intimate partner violence (IPV) is a type of revictimization that some adults with ACEs may be more prone to. Positive and supportive childhood environments may buffer the effects of ACEs, but little is known about the differential associations between physical IPV and ACEs and supportive childhood environments. We sought to illustrate racial/ethnic and gender differences in the adjusted predicted probability of physical IPV across multiple ACE and supportive childhood scores.

METHODS

We used multivariate linear regression to model the predicted probability of experiencing physical IPV across ACE (physical, psychological, sexual, household environment, mother's abuse) and supportive childhood scores in a national sample (National Epidemiologic Survey on Alcohol and Related Conditions-III, 2012-2013, n = 35,614). Data analyses were conducted in 2019.

RESULTS

American Indian/Alaska Native (AI/AN) women demonstrated the highest proportion of experiencing physical IPV (21%). AI/AN men had the highest mean physical ACE score (1.6/4), while AI/AN women had the highest mean scores for all other ACE typologies. ACE scores were positively associated with predicted physical IPV among women, and among AI/AN women in particular. Supportive childhood scores were negatively associated with predicted physical IPV primarily among women.

CONCLUSION

Physical IPV and ACEs are exceedingly high among AI/AN women. A better understanding of differential associations between childhood experiences and IPV is needed to more effectively tailor childhood and family-based health promotion strategies among multiple diverse communities.

Breathing clean air is Są'áh Naagháí Bik'eh Hózhóó (SNBH): a culturally centred approach to understanding commercial smoke-free policy among the Diné (Navajo People)

Introduction

Indigenous worldviews and research approaches are fundamental to make meaning of complex health issues and increase the likelihood of identifying existing cultural protective factors that have contributed to the resilience and survival of Indigenous people worldwide.

Objective

We describe the process for applying the Diné (Navajo) paradigm of Są’áh Naagháí Bik'eh Hózhóó (SNBH), a belief system that guides harmonious living, and demonstrate how the application of SNBH enhances understanding of Navajo principles for well-being. Specifically, we juxtapose this analysis with a conventional qualitative analysis to illuminate and interpret Diné perspectives on the health and economic impact of commercial secondhand smoke and smoke-free policy.

Methods

Focus groups were conducted throughout Navajo Nation to assess the appeal and impact of several evidence-based messages regarding the health and economic impact of smoke-free policy.

Results

Diné perspectives have shifted away from family and cultural teachings considered protective of a smoke-free life, and struggle to balance the ethical and economics of respect for individual and collective rights to live and work in smoke-free environments.

Conclusions

Indigenous-centred approaches to public health research and policy analysis contribute to understanding the cultural knowledge, practices and beliefs that are protective of the health and well-being of Indigenous people.