Grantee Research Project Results
Final Report: Center for Indigenous Environmental Health Research
EPA Grant Number: R836151Center: Center for Indigenous Environmental Health Research
Center Director: Burgess, Jefferey L.
Title: Center for Indigenous Environmental Health Research
Investigators: Burgess, Jefferey L. , Harris, Robin B. , O’Rourke, Mary Kay , Ingram, Jani Cheri , Teufel-Shone, Nicolette I. , Hadeed, Steve , Blohm, Jonathan , Shammari, Modhi Al , Carl, Adam , Yuan, Nicole , Teufel-Shone, Nicky , Mayer, Brian , Clichee, Dominic , Whitewater, Shannon , Chico-Jarillo, Tara
Institution: University of Arizona
EPA Project Officer: Callan, Richard
Project Period: July 1, 2015 through June 30, 2020 (Extended to June 30, 2021)
Project Amount: $1,500,000
RFA: NIH/EPA Centers of Excellence on Environmental Health Disparities Research (2015) RFA Text | Recipients Lists
Research Category: Human Health
Objective:
Center for Indigenous Environmental Health Research
The University of Arizona and Northern Arizona University Center for Indigenous Health Research (CIEHR) has been dedicated to tribally or community-driven, community-based research collaborations with tribal, community, university, and other partners. The overall goals of this research and these research collaborations have been to:
- Build Indigenous community capacity to address environmental health concerns;
- Increase environmental health literacy, weaving together traditional knowledge and western science, to improve translation of research in order to inform decision-making; and
- Improve conditions to enhance environmental health
CIEHR’s research collaboration with Indigenous communities to address environmental health concerns have provided several key findings, outcomes and lessons learned:
- Measuring exposure in communities including in traditional foods and housing
- Understanding how Indigenous communities are resilient in the face of environmental health challenges
- Supporting academic and community Indigenous scholars in their use of both Western science and Indigenous knowledge, including:
- Training and financial support of CIEHR’s first indigenous early-stage investigator or career development investigator, Dr. Stephanie Carroll Rainie (Ahtna Athabascan)
- Training and financial support of CIEHR’s first post-doctoral scholar, Dr. Carrie Nuva Joseph (Hopi)
- Training and support of two NIH Diversity Supplement Grantees, Jenny Richards and Jonathan Credo.
- Training and financial support of JoRee LaFrance (Apsáalooke Crow), a doctoral student in Environmental Science
- Training and financial support of numerous Indigenous undergraduate, graduate, and doctoral students on the ‘Health and Wellbeing Impact of Contamination of Traditional Foods and Water on the Navajo’ Project (RP1) and ‘Cumulative Environmental Effects – Expanding Research with the Hopi Tribe’ (RP2) Project research teams.
- Hopi community partners and research team members
- Collaborating with a diverse array of formal institutions, grassroots organization, and community members/organizations to address environmental health challenges
- Engaging schools, neighborhoods, and others in science practice to collect, analyze and use data
- Working with community partners for local knowledge, priorities, and responsibilities to guide the dissemination and sharing of research results
- Expanding environmental health literacy through dissemination of research results and risk communication
- Establishing and evaluating techniques to report back study results to the community
Contributions of Funded Research
Community Engagement Core Development of Community Advisory Board (CAB) Guidelines.
The CIEHR Community Engagement Core (CEC) developed an important resource entitled Guidelines for Community Advisory Boards to Engage in Research. The Guidelines promote best practices for the formation, operation, sustainability, and evaluation of Community Advisory Boards (CABs). The Guidelines have been disseminated using the CIEHR website (https://ciehr.arizona.edu/community-advisory-board-guidelines), an article published by the Progress in Community Health Partnerships: Research, Education, and Action (June 2020, volume 14, issue 2), and other publications. To date, the CEC has received requests for copies of the Guidelines from 9 individuals across the country. Each individual requested the Guidelines to support the use of CABs for their projects dedicated to health equity with diverse populations. By creating and disseminating the Guidelines, the CIEHR CEC continues to promote community-engaged research that will result in more culturally relevant and sustainable solutions for the environment and population health.
Exposure Science Core Contributions to the Research and Pilot Projects.
The Exposure Science Core was a service unit within CIEHR dedicated to providing technical support to the proposed projects and tribal pilot projects funded by CIEHR. The greatest contributions were made to the “Hopi Environmental Health Project”(HEHP) and the San Carlos Apache “Stop the Burn” project. Other projects did not require support or faced significant restrictions due to personnel changes and to the COVID-19 pandemic.
ESC and the Hopi Environmental Health Project
The primary service was the maintenance and operation training associated with equipment used in the projects. Another part of that service was the interpretation of pollutant data to reduce health effects and communicate information to limit exposures.
Approaches were developed to communicate with individual study participants, local communities, and tribal officials as well as the scientific community through publications.
- Use of real-time monitors in HEHP stimulated the interest of the study participants. The ESC developed a flier where the final reading (from each sampling session) could be provided to the participant by the field technicians.
- Integrated results booklets were returned to the participant after both heating and non-heating home samples were conducted. The results included a quick color-coded summary page of any issues in the home, green or black values indicated no problem and red values indicated an exceedance or a level of concern. Additional information was provided for each contaminant on subsequent pages of the booklet and suggestions on how the individual can reduce exposure were provided.
- Prepared summaries will be presented to the communities and the tribal officials when as Hopi lands are open to visitors. The summaries take two forms: (1) a handout providing people with ways to reduce exposure, (2) a “poster” summarizing the complex data and presenting it consistently for each medium. Each poster describes what we measured and why we measured it, a summary of results found on Hopi and ways to reduce exposure.
On behalf of the HEHP, the exposure core also provided outreach through the Hopi Junior/Senior High School. Modules were developed and delivered addressing (1) Arsenic in Water, (2) Radon in homes, (3) Solid waste disposal on Hopi Land, (4) Arthropods found in homes, (5) Energy sources and use to heat Hopi Homes…a cost benefit analysis.
- The modules followed a “citizen science” model. Each unit had two sessions with a week for students to obtain samples. The first session was short discussion of the issue followed by instructions on how to collect the data. Samples were sent off to various laboratories and results were returned to students (arsenic and radon); or students quantified the material they collected (garbage, bugs, energy bills). Then an analysis session followed using pooled data collected across several classes. This involved graphing data, interpreting trends and drawing a conclusion form the data collected.
- Senior ESC personnel were present to facilitate but each session was conducted by a UA student including several Indigenous students.
- The goal was three-fold: (1) to show students how science is conducted (following the scientific method), (2) building confidence among the students, and (3) modeling the ability of minority students to go to a university and serve their communities.
- These outreach efforts benefited the Tribe in several ways: (1) students discussed the information with their parents (2) one Mesa instituted its own litter removal program, (3) a students came to the UA as a freshman and performed a COVID related outreach project for the Tribe with additional IHS print support.
ESC and the San Carlos Apache “Stop Burning” Project
The San Carlos Apache Tribe pilot project aim was to reduce air pollution by eliminating garbage burning on tribal land. The ESC provided research support to demonstrate the presence of the air pollution through local collection of air polluting contaminant. The ESC collected summer and winter air pollution data at 12 homes targeted by the Tribe. The SCAT environmental offices scheduled the sampling for times when individuals planed on burning their garbage. Each house was visited during the hot summer season and again on a wet winter day. Samples were collected for PM2.5, dioxins, PAHs and VOCs. Following collection individual results were returned to participants and a public community presentation was made by ESC personnel. Additional presentations were made to the project community advisory board and the Tribal council. The relationship is ongoing, and analysis of this information continues.
The Tribe continues to use information provided to convince residents to sign up for tribal waste collection services. Each of the 12 houses we sampled, enrolled in the tribal waste removal service, and now pay to have their garbage removed. Increased enrollment continues as the tribe uses the data in their outreach efforts.
The Navajo Food and Water Contamination Project – Providing Water Quality Data to Navajo Nation
The Navajo project provided the water quality data to the Navajo Nation through a variety of ways.
- Results reported directly to communities on the water quality of water wells in their region
- Results reported to Navajo Nation tribal leaders such as the Navajo Nation Department of Natural Resources and other departments within the Navajo Nation.
- We worked with other researchers working on the Navajo Nation doing water quality work including Dr. Johnnye Lewis’ group at the University of New Mexico to build a water quality database for the Navajo Nation to utilize.
- Finally, our research group has become part of the Navajo Water Access Coordination Group that was formed in March 2020 to address water issues on Navajo with respect to the COVID‐19 pandemic. We have contributed our results and experiences to this group.
The other aspect of our project is in the investigation of contaminants in traditional food, specifically in livestock. We were able to provide our results to community members and tribal leaders. We are still in the process of developing some consumption guidelines to provide
The Hopi Environmental Health Project (HEHP) -
The Hopi Environmental Health Project (HEHP) recruitment and sampling approach were developed with substantial feed from Hopi community advisory board (CAB) members and tribal leadership. All recruitment, household monitoring, survey administration, and reporting back to households were performed with our Hopi field partners.
A multilayered and broad approach to return results into the community included: participants, households, local research team, community members and tribal leadership. The research staff and community partners spent considerable time assuring that the results would be understandable and appropriate for the population.
- Detailed written reports were returned to participating households and participants.
- This return of results included steps that could be taken by the household if mitigation was necessary and/or whom to contact in the Hopi community.
- Prior to COVID-19, these reports were combined with personal visits to the household by a Hopi environmental health student from the University of Arizona and local research staff. However, the last batch of reports were sent out after the beginning of COVID-19 shutdowns so that only mailed reports were sent out with telephone numbers of staff at UA and Hopi if there were questions.
- Posters and flyers were developed for each of the exposure analytes measured. These posters will be reviewed by the community advisory board (CAB) with plans for them to be viewed at the Hopi Indian Health Center. Hopi Tribe community health workers and community health representatives (CHRs) agreed to distribute pertinent flyers also in their community presentations.
- Formal report to the Hopi leadership will be presented in early 2022. Copies of all flyers, posters, data reports, policy recommendations, and executive summary will be part of the formal return of results.
In addition, return of the data is also required by the Memorandum of Agreement signed at the beginning of the Project. All manuscripts are required to be reviewed and approved by Tribal leadership prior to submission.
Community presentations have been planned (now several times but postponed because of COVID-19 and its large impact for Hopi Tribe) that will summarize work done. These presentations will be organized with our community partners.
Continuing medical education units were developed and presented to medical staff at Hopi Health Care Center to assist them in assessment of spirometry and FeNO results. With the increased prevalence of asthma identified in this population this is a needed opportunity.
Some of the findings provide opportunities for policy changes, and several are included in the report to the Tribe. Here is a brief review:
- Findings from this study provide additional rationale for conversion of indoor heating and cooking sources from coal and wood. With the closure of Black Mesa mining, tribal members are using less coal, but the energy sources have moved to wood. The community and Tribe are aware of these issues. As Dr. O’Rourke mentions, one solution is for individuals to switch exclusively to liquid propane gas heating. The cost may be prohibitive, and some tribal or federal subsidy could aid the conversion and reduce factors contributing to respiratory inflammation and disease (as is described in our recent publication by Hadeed et al., 2021).
- Arsenic routinely exceeded water quality standards in piped water delivered to over half the homes (Cooksey et al., in tribal review). However, Carl (2021, MS thesis in tribal review), evaluated exposure to arsenic via the ingestion and inhalation pathways and found that food consumption accounted for the greatest of amount of arsenic intake; followed by water and then inhalation. The impact of water-based exposure has been mitigated by individuals who now consume bottled water as their primary drinking water source. While the Tribe is aware of the As issue for some locations, Dr.O’Rourke noted homes on First Mesa and in Polacca also experienced elevated As exposure through piped water, this presents a further opportunity for remediation by the Tribe and EPA.
- At the request of the CAB, the house visits included monitoring of radon exposure. Extremely high values were found in a few homes and notification was made to the household and the Hopi Environmental Health Office. It was noted that hourly radon values in the winter frequently exceeded 4.0 pCi/L of air particularly between midnight and 9 am when air exchange in homes was limited. These results provide opportunities for the tribe to institute policy around building structures.
- Again, at the request of the CAB, the study sought information regarding garbage disposal and contaminants from garbage. Most of the homes we sampled used municipal garbage collection. However, many homes burning wood or coal continue to dump ash outside on the soil and increase the heavy metal concentration of the outdoor air through this contamination. The Tribe provides bins for ash disposal. Additional policy opportunities may exist to address issues of trash and ash disposal.
Project 1
The focus of Research Project 1 (RP1) – Health and Wellbeing Impact of Contamination of Traditional Foods and Water on the Navajo is to determine health risk and community impacts (e.g. consumption issues, threats to cultural values, spiritual concerns, and public health impacts) from exposure to environmental uranium and arsenic contamination of traditional food, in particular mutton, and water for two Navajo communities.
The overall objective proposed project is to determine health risks and community impacts (e.g., consumption issues, threats to cultural values, spiritual concerns, and public health impacts) from exposure to environmental uranium and arsenic contamination of traditional food and water for Navajo communities. This will be achieved through three specific aims.
- Characterize the extent of metal contamination in culturally significant food and water sources for two Navajo communities. Uranium and arsenic associated with abandoned uranium mines in traditional food such as sheep as well as water are a major concern to the Navajo. This Aim will determine the extent of contamination in the food and water sources of the two Navajo communities. Following initial characterization of metal contamination, field work with subsequent chemical analysis is proposed for this Aim, involving Navajo students and the community.
- Characterize arsenic contamination in mutton
- Characterize uranium and arsenic contamination in water sources
- Explore targeted sources of environmental contamination
- Model dietary metal exposure and utilize the Indigenous Health Indicator to Assess Health Impact. This Aim will focus on collecting a dietary history of individuals in the Navajo communities to model uranium and arsenic exposure through consumption of traditional foods and water. Community level socio-cultural public health pathways will be identified and evaluated. The physiological exposure pathways and socio-cultural significance will be integrated in a culturally relevant and effective impact assessment model called the Indigenous Health Indicator (IHI) developed by Swinomish tribal environmental health workers. Members of the Swinomish team have agreed to collaborate on adapting their IHI for this study. Surveys and dietary histories are proposed for the data collection for this aim.
- Assess the ingestion exposure pathway of uranium and arsenic in sheep and water
- Identify and assess the cultural-ecological exposure pathways for selected contaminant
- Integrate the socio-cultural and physiological exposure pathways into a culturally relevant and effective impact assessment model
- Development of a Community-Participatory Multi-Level Policy Intervention Model. Results from Aims 1 and 2 will be utilized to develop a culturally-relevant policy focused on contamination of traditional Native American foods. We are proposing to deploy a culturally directed, empirically tested model that will allow Native American communities to establish (and assess) culturally applicable environmental health interventions. It will be important in the policy work to consult with the Traditional Knowledge Holders from the tribes to best shape policies around traditional food consumption. We believe that this approach will result in policy that other Native American tribes can adapt to address contamination of traditional foods in their communities.
- Integrate baseline policy & public health data to establish the CPMLIPI model
- Primary risk assessment including definition, exposure assessment, hazard assessment, risk characterization & management
- Initialize community consultation on community readiness for change in policy and public knowledge data collection
- Create community-specific models for policy & public health action
- Work with the CEC to evaluate policy development based on the community viewpoint
- Initiate community engaged development of dissemination pla
Project 2– Hopi Environmental Health Project (HEHP)
The focus of Research Project (RP2) – Cumulative Effects: Expanding Research with the Hopi Tribe, also known as the Hopi Environmental Health Project (HEHP), is to work with the Hopi Tribe in northern Arizona to gather household samples to examine cumulative and aggregate exposures during both heating and non-heating seasons from air, water, and food. Based on tribal concerns, the project examines PM2.5 in indoor and ambient air, assessment of metals (speciated As and U) in air, water, and urine. Additional analytes are added at the request of the Tribe or to enhance the science, including collection of personal air samples, evaluation of soil and house dust for metals, radon in air, and evaluation of food frequency and dietary recall to evaluate food exposures as well as personal measures of lung function.
The overall objectives of this community-based participatory research (CBPR) project is to collaborate with the Hopi Tribe to provide information on HH exposures that can inform tribal programs and policies. The proposed work will employ multiple methods to evaluate the HH exposome and assess the impact of hazards, moderated by physical and social factors, on respiratory health and obesity. This will be achieved through three specific aims.
- Characterize the magnitude of environmental exposures to particulate matter (PM), As species, U and other contaminants from air, water, and food in households among the Hopi. Ninety households will be recruited to conduct HH and individual measurements assessing seasonal variation in exposures by heating fuel type (coal, wood, natural gas/electric). Inside and outside air will be sampled for PM, and air and water analyzed for As species, U, and other contaminants. For HH residents, height, weight, and lung function will be assessed. Urine samples, as allowed, will be analyzed for metals and metalloids. Dietary food and beverage consumption records will be collected, and specific traditional foods analyzed for As species and U. Research team decisions on protocols will be developed in collaboration with the CAB, the ESC and the CIEHR Community Engagement Core (CEC).
- Evaluate how exposures are moderated by social determinants of health, social capital and community resilience. Interviews will be used to measure social resources available to Hopi households and identify personal, material, and social capital that can modify exposure using social network methods. Relationships among household characteristics, environmental measures, cumulative exposures, and social capital will be examined as they relate to two outcomes, respiratory health and obesity.
- Expand the Hopi Tribe’s capacity to address areas of environmental concern that can inform programs and policy. Concurrent with aims 1 and 2, and with aid of the CAB, tribal leaders, the ESC and the CEC, the research team will determine the best approach to strengthen Hopi Tribe research capacity, community resilience, and environmental health literacy. Activities will include monitoring of ambient air quality, development of community events, and reporting of results. The sum of these activities will inform Hopi programs and policy to mitigate environmental exposures and associated health disparities.
Community Engagement Core Overview
The Community Engagement Core (CEC) of the Center for Indigenous Environmental Health Research (CIEHR) at the University of Arizona Mel and Enid Zuckerman College of Public Health and Northern Arizona University serves to collaborate with American Indian and Alaska Native (AI/AN) communities to develop the resources and support the processes needed to advance sustainable strategies for reducing adverse exposures and improving health.
The overall objective of the CIEHR Community Engagement Core is to ensure that research projects are carried out within a community resilience framework and that research findings are translated into culturally relevant materials. This will be achieved through four specific aims.
- Dialogue - To equitably engage AI/AN stakeholders and CIEHR members for the ethical and culturally-appropriate translation and application of Center findings. Each CIEHR proposed research pilot project will have a Community Advisory Board (CAB). The CEC will assist with the recruitment of CAB members and facilitate meetings during the project period. The CEC will enhance CAB members’ understanding of CIEHR’s mission and obtain input on project-specific goals, planned outcomes, and dissemination activities targeting tribal and scientific audiences both regionally and nationally. For Research Project 1, the CEC will collaborate with partnering chapters (similar to counties) within the Navajo Nation to disseminate and translate findings on metal exposures found in traditional foods to reduce risk of exposure. For Research Project 2, the CEC will collaborate with the Hopi Tribe’s Departments of Health and Environmental Safety to disseminate and translate findings on chemical exposures found in water, food, cooking, and coal burning to reduce risk of environmental hazards exposure in homes. For the pilot studies, the CEC will work with CABs on recruitment for these projects, to identify and address environmental factors affecting the health of rural and urban AI/AN communities across the nation.
- Knowledge - To strengthen the environmental health literacy (EHL) of AI/AN leaders, policy-makers and community members. The CEC will collaborate with and build on approaches developed by the SWEHSC COEC and tribal health departments including the effective educational approaches of tribal community health representative (CHRs) to improve the EHL of the CAB members and communities participating in CIEHR research projects (Satterfield et al. 2002). This process will integrate professional and lay health educators’ skills in to develop strategies to reach AI/AN decision makers and the general public.
- Action - To strengthen community resilience and capacity to promote environmental health in AI/AN communities on tribal lands and in urban settings. The CEC will build on the resources, expertise, and experiences of the CABs of the proposed research and pilot projects to adapt a CBPR training developed by CAIR and co-deliver to tribal employees and partners engaged in research activities and other community stakeholders. The CEC and CAB collaboration will identify socio-cultural determinants linked to community health, capacity and resilience among each participating community.
- Evaluation - To assess the effectiveness of the CEC activities and contributions to the mission of the Center. The CEC will use NIH-NIEHS’ Partnerships for Environmental Public Health Evaluation Metrics and indicators of community capacity and resilience to develop qualitative and quantitative measures of changes. Key outcomes will include quality of relationships and partnerships, improved EHL, enhanced community resilience and adaptive strategies, and established/modified AI/AN health policies and programs.
Summary/Accomplishments (Outputs/Outcomes):
Project 1
Aim 1. Characterize contamination in culturally significant food and water sources
The RP1 research team collected sheep/mutton samples from three Navajo communities, Cameron, Leupp and Cove and the off-reservation community of Eagar, Arizona to examine exposure and contamination. The Navajo community of Cameron is located on the southwest portion of the Navajo Reservation, near many abandoned uranium mines. The Navajo community of Leupp is also located in the southwest portion of the Navajo Reservation but in contrast, is not located near any abandoned uranium. Thus, sheep/mutton sampled from the Leupp community area served as the on-reservation, non-mining control site. Previous analysis of sheep tissue and organs samples (dried, ground and treated with nitric to measure uranium levels) from these reservation sites showed statistically similar level of uranium. Consequently, the off-reservation control sample site, Eagar, AZ was added. The off-reservation site, Eagar, AZ, is approximately 2-3 hours southeast of the on-reservation sites. In year 5 (2019-2020), the work was expanded to the community of Cove, AZ which is in the northeastern region of the Navajo Nation. The community of Cove requested assistance with assessing the level of contamination in their livestock (sheep, goats, cattle). This new work was in collaboration with an EPA grant that is from the Tronox settlement funds to the Navajo Nation. It was also in collaboration with the University of New Mexico, Montana State University Billings, and Diné College. The Cove area was heavily mined for uranium in the mid 1900’s; the mining was underground, and most of the mines have not been remediated.
- Two sheep were sampled on December 12, 2015. On March 5, 2016, three additional Eager sheep were sampled making a total of five off-reservation sheep organs and tissues collected.
- Goat tissue in addition to sheep tissue were collected from Cove.
- Samples from all four sites were collected, processed and analyzed.
- The work involved both sample preparation and analysis for uranium as well as new method development for arsenic analysis.
- Four students from Dine’ College (Tsaile) assisted in the research (sample preparation and analysis) as part of their summer internships.
The RP1 research team collected soil and plant samples from the grazing areas of the sheep in Cameron and Leupp to explore and determine sources of exposure and contamination. These soil and plant samples were processed at the Dr. Ingram’s NAU research laboratory.
- Processing of samples was completed March 1, 2016. Analysis of the samples was delayed for several months because the inductively couple plasma mass spectrometer was inoperable after Dr. Ingram’s research laboratory was moved into a new building at NAU. Results from the soil work was presented at the 251st American Chemical Society National Meeting & Exposition in San Diego, CA.
- Additional work focused on geospatially mapping the chemical analysis results from soil samples.
Dr. Ingram initiated a collaboration with Laura Corbin at Tufts University, who is in a public health doctoral program working with Professor Doug Brugge. Laura is an expert in geospacial mapping of contaminants, and she is interested in uranium mining issues on Navajo.
- In Years 1 and 2, she initiated work on the mapping of water data from Navajo.’
A diversity supplement was submitted and funded for Jonathan Credo, a 3rd year medical student at the University of Arizona who took a one-year leave of absence (2019-2020 ) to pursue research. The focus of Mr. Credo’s research was characterizing water quality across the Navajo Nation and provide important contaminant exposure information for both the Navajo people and their livestock.
- Mr. Credo worked in collaboration with the University of New Mexico and Dr. Johnnye Lewis’ research group to join our water chemistry data sets for a manuscript that will fill the gaps in water quality issues on the Navajo Nation.
- Two manuscripts were prepared and submitted describing water chemistry of the region and temporal changes utilizing information from a number of databases.
Additionally, a master’s student in the Environmental Science & Policy program, Lindsey Jones, investigated unregulated water wells in the Western Agency of the Navajo Nation encompassing 12 Chapters for overall water chemistry.
- Ms. Jones prepared a booklet (Unregulated Groundwater Quality Western Navajo Nation) to disseminate her findings to the community.
- She provided oral presentations for the following Navajo community groups:
- Tuba City Chapter meeting on March 3, 2019
- Grazing Committee meeting on March 7, 2019 (grazing officials from Cameron, Tuba City, Coalmine Canyon, and Bodaway/Gap)
- Western Agency quarterly meeting on March 16, 2019 (all 12 chapters in the study had representatives present).
- She sent electronic versions of the report to all 12 Chapters along with the Navajo Nation Water Resource Department and Environmental Protection Agency.
Aim 2. Model dietary metal exposure
Work to address Aim 2 has involved communication and engagement with Jamie Donatuto and Larry Campbell of Swinomish Indian Tribal Community in Washington regarding the use and application of the Indigenous Health Indicator (IHI) to CIEHR RP1.
- In November 2015, Dr. Ingram traveled to Swinomish to begin discussions of adapting the IHI Navajo traditional foods. Follow-up conversations and communication was conducted.
- In June 2016, Dr. Ingram and Tommy Rock met with Donatuto and Campbell in Flagstaff to continue work on adapting the IHI to Navajo traditional foods.
The RP1 Research Team worked with the CIEHR Exposure Science Core (ESC) on dietary data and assessment.
- In February 2016, Dr. Ingram solicited assistance from the CIEHR Exposure Science Core (ESC). Focused discussions were held with ESC members Dr. Kurzius-Spencer and Dr. O’Rourke regarding dietary questionnaire and protocol development.
The RP1 Research Team worked with CIEHR Community Engagement Core (CEC), to develop a mutton consumption survey. The CEC was involved in the drafting of the survey.
- In December 2016, Dr. Ingram and Tommy Rock presented the survey to the Cameron Chapter and the Western Agency on the Navajo Nation. The survey was approved by both groups who provided resolutions of support.
- In January 2017, Ingram and Rock presented the survey to the Tuba City Regional Health Clinic Board who also approved the survey and provided a resolution of support.
- On February 1, 2017, the Northern Arizona University Institutional Review Board approved the survey.
- On February 21, 2017, the Navajo Nation Human Research Review Board approved the survey.
- On February 20, 2018, the Navajo Nation Human Research Review Board approved a one-year continuation of the project, the request was approved.
- On February 19, 2019, a continuation request was submitted to the NNHRRB for one-year continuation of the project; the request was approved.
- On February 18, 2020, a continuation request was submitted to the NNHRRB for one-year continuation of the project; the request was approved.
- On May 30, 2017, June 22, 2017, June 23, 2017, and October 13, 2017 Tommy Rock and an undergraduate student from the Ingram lab conducted surveys in Cameron in conjunction with various events occurring in the community.
- 72 Cameron community members who participated in the survey.
- The survey information was entered in to a database and the CIEHR Community Engagement Core (CEC) assisted in interpreting the results.
- Results indicate that the majority of participants eat mutton around family functions and holidays, few of the participants eat mutton on a daily basis.
- The mutton survey results were drafted into a manuscript entitled “Pathway of Exposure through Traditional Sheep Consumption in Cameron, Arizona”. This manuscript was written collaboratively with the Community Engagement Core (Drs. Camplain and Teufel-Shone) who assisted in the interpretation of the survey results. The manuscript was submitted to the Navajo Nation Human Research Review Board (NNHRRB) for review on February 20, 2019. It was submitted to and approved by the International Journal of Environmental Research and Public Health following NNHRRB approval.
- An additional survey was conducted in the Cove community as part of a project in collaboration with Diné College and the University of New Mexico. The survey work was led by Tasha Nez, a graduate student from the NAU Environmental Science & Policy program.
- Resolutions of approval were requested from the Cove Chapter and Northern Agency in spring 2019.
- Ms. Nez defended her thesis, entitled “Cove Mutton Consumption Survey: Policy Insights to Address Uranium Contamination of Navajo Traditional Mutton” in November 2020.
- She worked on a booklet to disseminate the information to the Cove Chapter. As soon as she can present her work to the Chapter in person, she will distribute the booklets and present.
- Calcium analysis of blue corn meal was conducted and completed for the blue corn mush traditional food project by Mialynn Jim. She is working on the manuscript for this project
Aim 3: Development of a Community-Participatory Multi-Level Policy Intervention Model
Work to address Aim 3 was performed by Dr. Lerma and focused primarily on the developing advisory circles comprised of traditional knowledge holders in the Cameron community. Discussions and meetings were conducted with knowledge holders from Navajo gain insights on cultural and spiritual understandings of uranium contamination. Scribing notes were collected during these sessions as well as video collection of the discussions.
- A meeting was held in Chinle, AZ on June 24, 2016 with five Navajo Knowledge Holders in attendance.
- A follow-up meeting was planned for February 2017 with an emphasis of gaining a female knowledge holder’s perspective. Unfortunately, due to health issues of some of the participants the meeting was rescheduled for summer 2017.
Tommy Rock worked with Lorenzo Max, a Navajo elder and medicine man who is part of the NAU faculty to better understand the role of Traditional Ecological Knowledge (TEK) in cultural policy development with respect to uranium contamination on the Navajo Nation.
- Activities were conducted as part of Mr. Rock’s dissertation research.
- A manuscript descripted was submitted and published in a special issue in Human Biology on Indigenous Science (published November 17, 2021)
Project 2
Status of Recruitment and Households
- A total of 222 housing structures were randomly selected from 2512 potential housing structures that had been identified using Google Earth. For those 222 structures, it took 395 specific visits to either determine the house was not eligible or if they could be recruited. The recruitment team was asked to attempt at least 5 visits and the following table shows that the team was following the protocol.
- A total of 76 households were recruited and enrolled. The final response rate was calculated as # completed enrollment/# eligible. The # eligible was =total structures-(not eligible+not Hopi resident+other types of non-eligible structures) or 76/134=56.7%.
Completed Return of Results to all participants
- The final round of return of results had to be completed by mail and telephone. In contrast, during pre-COVID distribution, we returned results to the participants in their homes.
Completed all chemical analyses and data entry.
- All chemical analyses for urine, water, soil, ash, and air monitors were completed through the Arizona Laboratory for Emerging Contaminants (ALEC). Also completed data entry, checks, and documentation of all databases
- The table below is a summary of 14 separate datasets that were created and the total number of variables associated with those datasets.
Developed format for Final Report and database for return of data to Hopi Tribe.
In discussion with the Community Advisory Board (CAB) for our project, it was decided to send datafiles and documentation both given to CAB chairperson (Lori Joshweseoma) and Hopi Health Department director (Royce Jenkins)
- Reports to include:
- Excel data files and documentation for all research data
- Infographics suitable for presentation at community events highlighting issues and potential mediation options
- More detailed summaries of research findings (by type of media and analyte). These could become posters for a community event and / or used by the stakeholders in grants.
Maintained community involvement, even though the community was strongly impacted by the COVID-19 pandemic.
- Held regular CAB Meetings.
- Held regular telephone calls to maintain contact with field personnel
Continued analyses of different components of the data.
Data analysis was conducted, utilizing the support of the students working on the project. This work has enabled the return of results to participants, development of materials for community and stakeholders to use, and manuscripts. Table 4 shows the concentration of various air pollutants by sampling season. This table is from the manuscript of Hadeed, et al which is under review by Air Quality.
Included students and community members in data analyses and manuscript preparation.
We regularly involved numerous students in the research, from undergraduates to graduate students. In 2021, we included 3 PhD students, 2 MS students, and 2 undergraduates in preparation of reports and manuscripts.
- This student participation resulted in
- PhD Environmental Health Sciences dissertation defended in August 2021 (Steve Hadeed);
- MS Environmental Health Sciences student is scheduled to defend in June 2021 (Adam Carl, Hopi graduate student who has worked with the project for three years and will start medical school in July 2021);
- PhD candidate in Environmental Sciences (Modhi Alshammari) will be submitting paper one in July with plans to defend in December 2021.
- In addition, Carrie Joseph, who is Hopi community member and PhD in Soil and Water Sciences, is using some of the uranium data to inform her community on the magnitude of issues and potential mediation.
- All manuscripts and presentations were reviewed by the Hopi Field Research team members, the Community Advisory Board, and then tribal approvals prior to submission to a journal.
Community Engagement
Aim 1. Dialogue.
CAB Guidelines
The CEC made several accomplishments related to the CEC’s Community Advisory Board (CAB) Guidelines document and interactive worksheets. The CAB Guidelines promote best practices for the formation, operation, sustainability and evaluation of CABs. In preparation for dissemination, the CEC finalized the feedback surveys to be used by non-CIEHR affiliated researchers and community members who request access and use of the CAB Guidelines and worksheets. The CEC obtained IRB approval to administer the surveys. The CEC also worked with the University of Arizona Department of Biomedical Communications to create a professionally-formatted version of the CAB Guidelines. Information about the CAB Guidelines, process for obtaining access and user surveys were added to the CIEHR website.
The CEC developed and revised the manuscript that provides a justification for and the development of the Community Advisory Board (CAB) Guidelines for Health Research. The revision involved collaborating with the Hopi Tribe to include a description of the pilot testing of the CAB Guidelines with the tribe’s CAB that assists Research Project 2. The revised manuscript includes the Director of the Department of Health and Human Services as a co-author. The manuscript was approved by the Tribal Council prior to submission. The manuscript was submitted to and published by the Progress in Community Health Partnerships: Research, Education, and Action (June 2020, volume 14, issue 2). The article, Development of Guidelines to Improve the Effectiveness of Community Advisory Boards in Health Research, included information about how to access a copy of the CAB Guidelines on the CIEHR website.
The CAB Guidelines were the focus of the article, Improving the Use and Effectiveness of Community Advisory Boards, published by the Partnerships for Environmental Public Health PEPH Newsletter (August 2020, volume 11, issue 7) distributed by the National Institute of Environmental Health Sciences (NIEHS).
The CEC received requests from 8 individuals to obtain copies of the CAB Guidelines. In order to obtain a copy of the CAB Guidelines, the individuals completed an online survey. The online survey consisted of questions about the requestor’s background, project description, funding source, and experiences working with a CAB. Based on data that we obtained from the requestors, we know that they were affiliated with multiple institutions including the University of Arizona, Northern Arizona University, Yale University and the University of South Carolina. Most of the requestors were faculty members, but one was a community engagement program manager. The requestors planned to use the CAB Guidelines for projects that addressed a variety of public health topics and populations, including water quality, breast cancer, environmental risk factors, African-American communities, foster care system stakeholders, family violence victims, and other marginalized communities. It is noteworthy that we granted permission and wrote a letter of support for one requestor who included the CAB Guidelines in their NIH/NIEHS R01 grant application. The application was awarded funding and the research project and use of the CAB Guidelines will begin in July 2021. We also granted permission to another requestor who used the CAB Guidelines in a workshop that they developed for a child abuse conference. Members of the CEC plan to continue to disseminate the CAB Guidelines and maintain a webpage to receive future requests for copies.
CEC and Research Project 1: Navajo Nation
The CEC co-authored a manuscript with the Research Project 1 team based on the study findings. The manuscript entitled, “Pathway of Exposure through Traditional Sheep Consumption in Cameron, Arizona” was reviewed by the Navajo Nation Human Research and Review Board. Upon receiving tribal approval, the manuscript was submitted to the International Journal of Environmental Research and Public Health.
Research Project 2: Hopi Tribe
The CEC worked with the Research Project 2 with the Hopi Tribe to translate and apply the study findings related to aspects of household environmental samples and individual responses to various social determinants of health, social network, and self-rated health questionnaires. The CEC contributed to the development of the framework for the major report-back activities to individual study participants and to the broader Hopi community. Specifically, the CEC proposed the format for reporting back to the community, where a simulation of a typically Hopi home will be laid out in meeting rooms on the Hopi reservation. The simulation will include posters, equipment, and feedback activities placed in virtual representation of specific aspects of the study. Specific aspects might include tap water safety, indoor air quality related to stove use, and radon monitoring within homes.
CEC and Pilot Project 1: San Carlos Apache Tribe
The San Carlos Apache Tribe trash burning study was delayed. Tribal resolution and memorandum of understanding were obtained in spring 2019. The CEC assisted revisions of the baseline and follow-up surveys to assess environmental health literacy and changes in attitudes, knowledge, and behaviors related to trash burning. The CEC provided assistance drafting the University IRB application for this project.
CEC and Pilot Project 2: Navajo Nation
During spring 2019, the CEC reviewed the proposal for the pilot project on water quality with the Aneth community of Navajo Nation. The CEC provided recommendations on strategies for increasing community engagement and opportunities for collaborating with the CEC on specific project activities.
Aim 2. Knowledge.
CEC and Research Project 2: Hopi Tribe
The CEC provided feedback to the Research Project 2 team on report back documents consisting of findings from the exposure assessments. The CEC edited the documents with the focus on improving the accessibility and usefulness of the information to be shared with community members. The CEC also co-authored two articles with tribal partners for the Hopi Tribe newsletter, the Tutuveni.
Post-Doctoral Research Project: Uranium Mining Legacy and the Hopi Tribe
The CEC worked with and mentored the CIEHR post-doctoral fellow, Carrie Joseph. The CEC assisted Dr. Joseph with Aim 3 of her research project. The goal of Aim 3 is to increase environmental literacy around mining legacy and abandoned sites, health-related concerns, and risk reduction and mitigation strategies dependent on her study outcomes. The CEC provided guidance on the pre- and post-survey design including developing items that match the research questions, creating culturally-appropriate responses, and identifying procedures for pilot testing initial versions of the survey.
Aim 3. Action.
Research Project 2: Hopi Tribe
The CEC was involved in the development and implementation of the training of tribal Community Health Representatives to collect environmental health and health disparity data for Research Project 2 with the Hopi Tribe.
Gold King Mine Full Project
The CEC, primarily through the involvement of Dr. Teufel-Shone, was engaged in the qualitative analysis of the focus groups data collected from Diné (Navajo) communities impacted by the contamination of the San Juan River through the Gold King Mine spill. The outcomes of the analysis included contributions to community forums designed to improve the environmental health literacy of Diné communities. The outcomes also resulted in the translation of research findings into mitigation interventions with Navajo Nation Department of Emergency Preparedness and the Medicine Men’s Association in planning community communication community-healing efforts.
The findings were also used to develop community presentations and scientific manuscripts for submission to peer-reviewed journals. The CEC assisted in the development of the manuscript, Development of a Culturally Anchored Qualitative Approach to Conduct and Analyze Focus Group Narratives Collected in Diné (Navajo) Communities to Understand the Impact of the Gold King Mine Spill of 2015. It was approved for publication by the Navajo Nation Human Research Review Board. A request was made to assure that cultural information was correct. Two cultural experts who were also co-authors of the manuscript were asked to revised specific sections of the manuscripts. Revisions were completed and the manuscript was submitted to the International Journal of Environmental Research and Public Health.
Pilot Project: San Carlos Apache Tribe
The CEC developed and implemented an in-person training on human subjects research and survey administration to the project team, consisting of staff and students. The training was videotaped and used as a webinar training for San Carlos Apache college students. Tribal college students were recruited to administer surveys with community members at three separate time points. The training addressed the following topics: CITI human subjects research training program, protecting human subjects research, best practices for and administering research surveys. The training also reviewed and provided guidance on the Stop Burning project consent form process and baseline survey administration.
Systematic Review Project: Resilience among Indigenous Populations
The CEC conducted a comprehensive review of peer-reviewed literature on resilience among Indigenous populations. Articles were categorized by the following topics: culture, health, youth, and climate change. Preliminary coding and analysis of the articles revealed that the most interesting themes emerged from the analysis of articles on Indigenous youth. Members of the CEC plant to continue this project and conduct additional analyses with the identified articles. They will write a manuscript for publication on resilience among Indigenous youth. The manuscript will include recommendations for measurement, research, and public health practice to promote Indigenous youth resilience.
The CEC conducted a comprehensive systematic review of peer-reviewed literature on resilience among Indigenous populations. The purpose of the project was to understand how resilience is defined, measured, and evaluated in the Indigenous health research literature. The CEC conducted searches using several research databases including Web of Science. The CEC identified abstracts based on keywords. The selected keywords were Native, Indigenous, Aboriginal, resilience, resiliency, and health. The total number of abstracts that were identified was 320. Each member of the CEC was assigned about 80 abstracts to review and code based on a codebook developed for the project. The codes included type of article, geographic location, Native nation, rural/urban setting, type of resilience, definition of resilience, special population, outcome variables, and quantitative and qualitative methods. The findings will identify strengths that promote community resilience in Indigenous populations.
In 2018, the CEC submitted an abstract to the 2018 Annual Meeting of the American Public Health Association. The abstract included findings from the literature review on community resilience and points for consideration to promote community health, capacity and resilience among indigenous populations. The abstract was not accepted. The CEC continued with this project by expanding the literature review, identifying gaps in related research and community resources relevant for indigenous populations, and creating a list of potential outputs to develop for use by academic-community partnerships.
Aim 4: Evaluation.
CAB Guidelines
The CEC sent a post-survey to individuals that requested a copy of the CAB Guidelines. The post-survey was available online and included questions about experiences and feedback on specific sections of the CAB Guidelines that were used.
- Three individuals in Year 5 (2019-2020)
- Five individuals in Year 6 (2020-2021)
- Of the eight total surveys sent to individuals, only 1 complete response has been returned.
- Responses to the post-survey will be used to make future changes to the CAB Guidelines and inform additional dissemination strategies.
Evaluation
The CEC explored strategies for assessing effectiveness of CEC activities with the CIEHR-funded research and pilot projects. This aim was accomplished with the development and implementation of pre and post surveys to assess the effectiveness and usefulness of the CAB Guidelines in promoting community engagement in health research. Additionally, the CEC explored options with CIEHR on strategies for examining the effectiveness of CEC activities with the CIEHR-funded research and pilot projects. The CEC developed some potential strategies, including surveys for internal and external evaluation. One survey would be administered to CIEHR faculty and students to obtain feedback on CEC activities and assistance and suggestions for improvement. The second survey would be administered to community partners who collaborated with CIEHR. Execution of this evaluation plan was halted by the COVID-19 pandemic and reduced ability to engage with tribal community partners.
Journal Articles: 14 Displayed | Download in RIS Format
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Coksey E, Verhousgstraete M, Sneed S, Joseph C, Blohem J, Pakugana M, Joshwesonma L, Sheongva G, Hadeed S, Harris R, O'Rourke M. Drinking water and health assessment in a Northern Arizona community. HUMAN AND ECOLOGICAL RISK ASSESSMENT 2022;. |
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Hadeed S, O'Rourke M, Canales R, Joshweseoma L, Sehongva G, Paukgana M, Gonzalez-Figureroa E, Aslhmmari M, Burgess J, Harris R. Household and behavioral determinants of indoor PM2.5 in a rural solid fuel burning Native American community. INDOOR AIR 2021;31(6):2008-2019. |
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Corlin L, Rock T, Cordova J, Woodin M, Durant JL, Gute DM, Ingram J, Brugge D. Health effects and environmental justice concerns of exposure to uranium in drinking water. Current Environmental Health Reports 2017;3(4):434-442. |
R836151 (2017) R836151 (2019) R836151 (2020) |
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Mayer B, Joshweseoma L, Sehongva G. Environmental risk perceptions and community health:arsenic, air pollution, and threats to traditional values of the hopi tribe. Journal of community health 2019;44(5):896-902. |
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Carroll SR, Rodriguez-Lonebear D, Martinez A. Indigenous Data Governance:Strategies from United States Native Nations. Data Science Journal 2019;18(1)3; doi:10.5334/dsj-2019-031. |
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Credo J, Torkelson J, Rock T, Ingram JC. Quantification of elemental contaminants in unregulated water across western Navajo Nation. International journal of environmental research and public health 2019;16(15):2727. |
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Rock T, Camplain R, Teufel-Shone NI, Ingram JC. Traditional sheep consumption by Navajo people in Cameron, Arizona. International journal of environmental research and public health 2019;16(21):4195. |
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Jones MC, Credo JM, Ingram JC, Baldwin JA, Trotter Jr RT, Propper CR. Arsenic concentrations in ground and surface waters across Arizona including native lands. Journal of Contemporary Water Research & Education 2020;169(1):44-60. |
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Yuan NP, Mayer BM, Joshweseoma L, Clichee D, Teufel-Shone NI. Development of Guidelines to Improve the Effectiveness of Community Advisory Boards in Health Research. Progress in Community Health Partnerships:Research, Education, and Action 2020;14(2):259-69. |
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Jones L, Credo J, Parnell R, Ingram JC. Dissolved uranium and arsenic in unregulated groundwater sources–Western Navajo Nation. Journal of Contemporary Water Research & Education 2020;169(1):27-43. |
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Rock T, Ingram JC. Traditional Ecological Knowledge Policy Considerations for Abandoned Uranium Mines on Navajo Nation. Human Biology 2020;92(1):19-26. |
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Ingram JC, Jones L, Credo J, Rock T. Uranium and arsenic unregulated water issues on Navajo lands. Journal of Vacuum Science & Technology A:Vacuum, Surfaces, and Films 2020;38(3):031003. |
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Hadeed SJ, O'Rourke MK, Burgess JL, Harris RB, Canales RA. Imputation methods for addressing missing data in short-term monitoring of air pollutants. Science of The Total Environment 2020:139140. |
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Nanibaa'A G, Barton KS, Porter KM, Mai T, Burke W, Carroll SR. Access and management:indigenous perspectives on genomic data sharing. Ethnicity & Disease. 2019 Dec 12;29(Supp):659-68. |
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Progress and Final Reports:
Original Abstract Subprojects under this Center: (EPA does not fund or establish subprojects; EPA awards and manages the overall grant for this center).
R836151C001 Health and Wellbeing Impact of Contamination of Traditional Food and Water on Navajo
R836151C002 Cumulative Environmental Effects: Expanding research with Hopi Tribe
The perspectives, information and conclusions conveyed in research project abstracts, progress reports, final reports, journal abstracts and journal publications convey the viewpoints of the principal investigator and may not represent the views and policies of ORD and EPA. Conclusions drawn by the principal investigators have not been reviewed by the Agency.
Project Research Results
- 2020 Progress Report
- 2019 Progress Report
- 2018 Progress Report
- 2017 Progress Report
- 2016 Progress Report
- Original Abstract
14 journal articles for this center