Join Us in Big Sky This September!

In this space in CAIRHE’s last newsletter, I wrote that the health challenges in Montana are too pervasive for any one entity to address them alone. That being said, I added that CAIRHE wants to be among the leaders in a statewide effort toward positive change—“coordinating and partnering with communities, other researchers, and organizations of all types.”

To that end, we’re proud to announce a landmark event coming this fall.

CAIRHE and our colleagues at Montana INBRE will sponsor the Montana Health Research Summit on September 14-16 in Big Sky, Mont. The Summit will bring together leading health researchers, public health professionals, and representatives from the state’s diverse tribal and rural communities to foster collaboration, enhance Montana’s health research capacity, and improve outcomes in the areas of health equity, environmental health, food sovereignty, mental health, and infectious diseases.

Other objectives for the Summit include:

  • Helping Montana’s health researchers—at MSU, the University of Montana, and institutions across the INBRE network—prioritize research needs and set common goals with state, local, and tribal health organizations;
  • Presenting success stories in community-based health research across Montana and beyond;
  • Teaching best practices in community-based participatory research; and
  • Giving researchers an insider’s view of successful grant proposals to the National Institutes of Health and other sponsoring agencies.

It’s an ambitious agenda for an inaugural conference, but we feel sure that the Summit will forge new connections that will have a lasting impact on the health of Montana’s citizens. We hope you will help us spread the word and join us for a great event. For the latest information on the program and conference registration, simply Google “Montana Health Research Summit.” See you in Big Sky!

Alexandra Adams, M.D., Ph.D.

Director and Principal Investigator

 

Project Leader Updates

Here’s the latest activity among CAIRHE’s project leaders. 

 In May, Elizabeth Kinion, Ed.D., MSN (Increasing Access to Oral Health Care), submitted an NIH R01 grant proposal titled, Great Beginnings for Healthy Native Smiles: An Early Childhood Caries Prevention Program. The project, with co-PI Julie Baldwin of Northern Arizona University, would involve communities on the Crow Reservation in Montana and the Hopi Reservation in Arizona.

 Elizabeth Rink, Ph.D., MSW (The Fort Peck Sexual Health Project), recently completed an in-school survey of 300 youth ages 15 to 18 on the Fort Peck Reservation, followed by data analysis. Her student research assistant, McNair Scholar Phillip Eaton, gave a presentation in December at the MSU McNair Research Symposium on his Fort Peck–related research. Rink has met twice with her Community Advisory Board (CAB) during recent regular visits to the Reservation. In conjunction with her CAB and research partner Paula FireMoon at Fort Peck Community College, she is designing and writing an R01 grant proposal to the National Institutes of Health for submission in August.

The Guardians of the Living Water project, under the direction of Vanessa Simonds, Sc.D., and Project Coordinator Velma Pickett, has completed its 15th and final after-school club for the 2016-17 school year at Crow Agency Public School. Throughout the year, club students have worked on a photovoice project using pictures to tell stories about themselves and their community. Students learned basic photography from Barbara Needum, a local photographer, and media production skills from Levi Black Eagle. The students’ final work will be on display during the Little Big Horn College Pow Wow on May 20 and at the Guardians of the Living Water photo exhibit at the LBHC Health & Wellness Center on May 25. The project’s CAB continues to meet monthly to discuss ongoing collaboration, including the next Guardians of the Living Water camp this summer.

In May, Simonds presented at the Institute for Healthcare Advancement’s Health Literacy Conference in Irvine, Calif. Student research assistants Deborah LaVeaux and Jessica Milakovich presented at MSU’s Student Research Celebration on April 21. Simonds submitted an R01 grant proposal in May with MSU’s Dr. Mari Eggers, and she will present her own R01 proposal in October—both pertaining to environmental health on the Crow Reservation.

Monica Skewes, Ph.D. (The Fort Peck Substance Abuse and Resilience Project), has continued regular CAB meetings during her visits to the Fort Peck Reservation, with data analysis and manuscript preparation ongoing. In March she presented at the Collaborative Perspectives on Addiction conference in Albuquerque, N.M. More recently Skewes and her mentor, Dr. Art Blume of Washington State University–Vancouver, were accepted for the prestigious Bellagio Center Academic Writing Residency in Bellagio, Italy, where next March they will draft a treatment manual for Fort Peck recovery and relapse prevention groups, subject to community guidance. Skewes received tenure and promotion to associate professor at MSU this spring.

Kelly Knight, Ph.D., and Colter Ellis, Ph.D. (Rural Montana Victim Needs Assessment), continue to build strong partnerships on the Blackfeet Reservation as part of their related project funded by the Montana Healthcare Foundation. Having met more than a dozen times to date with their Community Advisory Board, they will conduct a needs assessment on the reservation in May through interviews and focus groups. Their undergraduate research lab at MSU, the Secondary Trauma Intervention Learning Lab (STILL), currently supports eight students (see “Center News”). Knight and Ellis recently submitted one manuscript based on their CAIRHE-funded research with another one in preparation.

Rebecca Brooker, Ph.D. (Maternal Mental Health …), will complete data collection later this year for her two studies funded either wholly or partially by CAIRHE. Around 200 Montana families have participated across the two studies. Brooker’s two graduate students who have received some CAIRHE support graduated in May with M.S. degrees in Psychology and recently published first-author papers citing the CAIRHE grant. Three of her CAIRHE-supported students presented posters of their work at a national conference last fall.

Earlier this spring Brooker presented at the biennial meeting of the Society for Research in Child Development in Austin, Texas, and she is lead author on a paper to appear soon in Psychophysiology. This fall she will leave MSU and assume a new tenure-track position in the Department of Psychology at Texas A&M University.

Kaylin Greene, Ph.D. (Discussions of Driving After Drinking Among Young Adults in Montana), recently collected survey data about substance use and driving from an online panel of young adults living around the country. She has submitted a paper on her CAIRHE research, and she gave a presentation about the Surgeon General’s report Facing Addiction in America to SAFE (Substance Abuse Free Environment), a coalition of community members and MSU representatives.

Cody Warner, Ph.D., continues to clean and analyze administrative data from the Montana Department of Corrections. One manuscript in development will examine the role of neighborhood features and reentry resources in fostering successful prisoner reentry, while a second will focus on racial disparities among recidivism rates in Montana.

In March, CAIRHE Director Alex Adams, M.D., Ph.D., submitted a renewal proposal for her NIH R01 grant, Healthy Children, Strong Families: American Indian Communities Preventing Obesity. On April 9 Adams presented a lecture on research in childhood obesity during the symposium of the American Indian/Alaska Native Clinical and Translational Research Program in Bozeman, Mont. Video of her presentation is available on the CAIRHE website.

CAIRHE mentor Suzanne Held, Ph.D., in collaboration with the nonprofit Messengers for Health and its executive director, Alma McCormick, has received a five-year NIH grant to help communities of the Apsáalooke (Crow) Nation manage chronic illness. The Báa nnilah Project builds on Held and McCormick’s work together over the past 21 years.

 

CAIRHE To Fund New Projects for 2017-18

Following its first Request for Proposals (RFP) that concluded April 3, CAIRHE will add three new pilot projects to its interdisciplinary research program later this year, pending approval from the National Institutes of Health.

The new projects, to be announced this summer, will begin September 1 and run for one year with the possibility of competitive renewal. CAIRHE also will continue support for current pilot project leaders Colter Ellis and Kelly Knight, Kaylin Greene, and Monica Skewes. CAIRHE’s External Advisory Committee approved all six pilot projects for funding on April 19. The proposals now move to the NIH for final review.

CAIRHE will issue its next RFP in December 2017 with a deadline in April 2018. For more information, see the Request for Proposals page on CAIRHE’s website.

 

Oren Lyons: It’s Time to Share, Work Together

Oren Lyons, a world-renowned member of the Onondaga Council of Chiefs and Faithkeeper of the Turtle Clan of the Onondaga, thrilled an audience of more than 240 people in Bozeman, Mont., with his message of togetherness at a time of environmental peril.

The full-to-capacity April 13 event at the Museum of the Rockies, which attracted some audience members as early as two hours before the lecture, was sponsored by CAIRHE and the Department of Native American Studies at Montana State University. Lyons, 87, spoke for an hour on his central theme that humanity must work together now for the benefit of future generations.

“When I was 20 years old, there were 2.5 billion people in the world,” he said. “It took millions of years to get there. Today there are 7.5 billion, after just 67 years. We’re in trouble, and the carrying capacity of the Earth is already behind us.”

A lack of water resources and poor stewardship of the environment have created a crisis with far-reaching consequences for public health, peace, and equity across society, Lyons said. The solution?

We must learn to share.

“In a country built on capitalism and individuality, we are going to have to learn to share,” he said. “Share the good and the bad. The people who know how to do that best are Indians. We share everything. If it’s the last of something, we still share it.”

He implored the large number of Native students in the audience to take the lead in the “common cause” of sharing. “Get it done. Make a stand as people,” he said. “Do what you can, and know who you are. Our [U.S.] leaders may be M.I.A., but you have the power.”

Having addressed activists and policymakers around the world, including the United Nations, on the urgency of environmental causes, Lyons said he focuses more on global warming now “because it’s not just growing, it’s compounding” as a problem. He also related how water sources and traditional foods have changed drastically since his days as a boy on Onondaga lands in New York, where he fished for his lunch every day. “Now you can’t eat the fish out of Lake Ontario,” he said. “It’s contaminated.”

The decline in the quality of food people eat is the greatest contributor to poor health, he added, and that, in turn, affects everything else. “You can’t have peace without health,” he said.

The evening wasn’t without its lighter moments. As a former All-American in lacrosse in the 1950s and a 1992 inductee in the National Lacrosse Hall of Fame, Lyons is as well-known as a legendary athlete as he is an activist. He described one epic match between his Syracuse team and Army when both were undefeated (“We beat ’em,” he said with a grin), and the evening began with a Syracuse University video recounting his career highlights.

“Lyons was the ‘absolute goods’ out there on the field,” the video’s narrator said, “where he played the Creator’s game with a near reverence—and did so, at least in Medicine Games, right into his 60s.”

The event began with a one-hour reception before Walter Fleming, head of the Department of Native American Studies, welcomed the audience and introduced an opening song by Joaquin Small-Rodriguez. Alex Adams, director of CAIRHE, presented Lyons by noting that his address came at an opportune moment.

“At a time in our world when it’s easy to feel consumed with worry about the present and anxiety for our future, he reminds us of the strength and resilience in tradition, and the power and preeminence of Nature,” she said.

Speaking on those very themes, Lyons reassured the audience that he doesn’t feel helpless or defeated, but rather energized. “I don’t think it’s too late,” he said of humanity’s challenges. “The game isn’t over yet.”

 

A complete video recording of Chief Lyons’s lecture is available on CAIRHE’s website.

 

Belcourt and Byerly Join CAIRHE as Mentors

Annie Belcourt, Ph.D., and Matt Byerly, M.D., have joined CAIRHE as its newest faculty mentors, part of the center’s mission to develop the careers and grant support of its junior investigators. CAIRHE Director Alex Adams announced their appointments in January.

“We’re fortunate to have two more established, well-funded investigators of Annie’s and Matt’s caliber on our team,” Adams said.

Belcourt is an associate professor in the College of Health Professions and Biomedical Sciences at the University of Montana. An enrolled member of the Blackfeet, Chippewa, and Mandan and Hidatsa Tribes, she was raised on the Blackfeet Reservation and later received her doctorate in clinical psychology from UM. Her research and clinical priorities include mental health disparities, environmental health, trauma, post-traumatic stress reactions, risk, resiliency, psychiatric disorder, and public health intervention within the cultural context of American Indian communities.

Byerly is director of the Center for Mental Health Research and Recovery at MSU. As a psychiatrist with expertise in clinical and translational mental health research, he led the Schizophrenia and Adult Fragile X Research Programs at the University of Texas Southwestern Medical Center for 18 years before relocating to MSU in 2015. His research efforts now involve collaborations on mental health issues in Montana, including suicide prevention, the mental health needs of rural and frontier settings, the mental health needs of Native Americans and military veterans, and improved methods to diagnose and treat mental disorders.

 

Salois Wins MSU Service Award

Emily Salois, MSW, a community research associate in the Community Engagement Core for both CAIRHE and Montana INBRE, was recognized for service excellence during MSU’s 28th annual Celebrating Excellence in Service and Employee of the Year Awards, held April 20.

MSU President Waded Cruzado presented Salois with the award in the service standard of courtesy, recognizing the many lasting relationships she has forged between university investigators and Montana’s tribal communities.

“Emily is the most cheerful, humble, and compassionate advocate for American Indian health I have ever met,” said CAIRHE Director Alex Adams. “She works extremely well with our junior faculty investigators and is a wonderful mentor to them as they learn new cultures and ways of doing research.”

The ceremony also recognized longtime CAIRHE partner Ann Bertagnolli of Montana INBRE in the service standard of reliability.

 

 

Warner Research Receives National Media Coverage

Student loan debt has reached an all-time high, but don’t blame increasing loan burdens for more young adults “boomeranging,” or returning to their parents’ home. This was one of the conclusions in a paper co-authored by CAIRHE investigator Cody Warner, Ph.D., and recently published in the journal Sociology of Education.

The paper, “Into the Red and Back to the Nest? Student Debt, College Completion, and Returning to the Parental Home among Young Adults,” examines the popular assumption that more young adults are living with their parents because they are saddled with high amounts of student loan debt. Warner and his co-author, Jason Houle of Dartmouth College, found that student loan debt was not associated with the boomeranging in their complete sample, although they noted that the association differs by race. Instead, college completion was a stronger predictor.

“The findings are not only relevant because they challenge this popular narrative about the student debt crisis and boomeranging,” said Warner, an assistant professor in MSU’s Department of Sociology and Anthropology. “We find that, among college-goers, noncompletion is a much bigger risk factor for returning home. But given that debt burdens fall disproportionately on racial minorities, our findings also point to larger concerns about the benefits and harms of taking on debt across racial lines.”

Within just a week of the paper’s publication on January 5, the study findings were featured in stories from Inside Higher Ed, Market Watch, Psych Central, and Time, among others. An Associated Press story (“Study Explores Link Between College Debt, ‘Boomerang’ Effect”) resulted in hundreds of articles nationwide, in print and online, when it was picked up by media outlets of all sizes, including the Washington Post.

The research detailed in the article is not associated with Warner’s CAIRHE study, which is currently in its third year.

“Our investigators are multifaceted researchers, and we’re proud of this work that Cody has done on his way to becoming an independent and highly regarded investigator in his field,” said CAIRHE Director Alex Adams.

 

Skewes Receives Excellence in Outreach Award

Monica Skewes, Ph.D., an investigator for CAIRHE and associate professor in MSU’s Department of Psychology, received the 2017 Provost’s Excellence in Outreach Award in January.

The honor recognizes Skewes for her research and community engagement through CAIRHE, as well as her work as a frequent speaker and trainer at MSU and across the state, particularly in the areas of diversity and inclusion.

As part of her ongoing CAIRHE project, The Fort Peck Substance Abuse and Resilience Project, Skewes has established close collaboration with community partners from the Assiniboine and Sioux tribes of the Fort Peck Reservation in northeastern Montana.

“Of all the things I love about my job, outreach is what I value most,” Skewes said. “Sharing research findings and scientific knowledge with the communities I work with is so important. What good is the best study in the world if people don’t know about it?”

Skewes added that making research accessible and understandable, helping people connect science with their daily lives and experiences, and using research to promote social justice are critical for improving public health. “It’s also so rewarding,” she added. “The feedback I receive through discussions with community members makes my research better too.”

CAIRHE Director Alex Adams praised Skewes as a model for all MSU faculty. “Monica’s level of outreach exceeds what is required for research or for service expectations,” she said, “and it goes far toward establishing the positive relationships that may open doors to further collaboration between the reservation and MSU researchers down the road.

“We couldn’t be prouder of the work Monica is doing,” Adams added.

In addition to her work funded by CAIRHE, Skewes has given public talks on addictive behaviors; has appeared on the Montana Television Network program Face the State, where she discussed Montana’s methamphetamine epidemic; has given annual talks to tribal college students enrolled in the MSU Bridges program about how to succeed in the university setting; and has helped coordinate and deliver the annual Cultural Awareness and Training Program for MSU faculty and Montana INBRE students.

Skewes was nominated for the award by her colleagues in the Department of Psychology. She received the award at MSU’s Spring Convocation on January 10.

 

CAIRHE Profile: Jack Westfall

Name: Jack Westfall, M.D., MPH

Home: Denver, Colo.

Position: Member of the CAIRHE External Advisory Committee. At the University of Colorado-Denver, founder and director of the High Plains Research Network (HPRN), a practice-based association of rural primary care practices, hospitals, healthcare facilities, and communities located in eastern rural Colorado.

What areas of public health are you most passionate about?

I was lucky to attend a medical school that had a long history of public health embedded in its standard medical curriculum. The University of Kansas was a leader in public health in the early 20th century, and that continued throughout my time at KU. I still have an old sidewalk brick from the early 1900s with an imprint “Don’t spit on sidewalk” as a public health tuberculosis prevention program. Throughout my MPH training and my career since then, my interests have been on how to integrate public health and primary care to build local communities of solution. I’ve had lots of specific topic interests—from cancer prevention to oral health, reproductive health, and cardiovascular disease. But the unifying feature has been, how do we link all the folks committed to health, primary care, behavioral health, public health, and community organizations so that their combined efforts can make a difference for individuals and communities?

What are the most urgent issues you see in rural health today? How have they changed over the past 20 years since you founded the HPRN?

People are dying from preventable illness. And there has been a gradual return to the old days when disease was seen as moral weakness. Whether it’s obesity and diabetes, pain and opioid use, or depression and behavioral healthcare, our society seems to be returning to an era of judgment and stigma. “You’re ill? You probably did something to deserve it. And you should be the one (and only one) to fix it.” Our communities have become somewhat dis-integrated. We have fewer meaningful connections within our towns and neighborhoods. This has led to social isolation and, I believe, a general level of stress that impacts everyone in our communities. Johann Hari has said, “The opposite of addiction may not be sobriety. The opposite of addiction is connection.” That may be true for all of our healthcare ills. Connection.

How did you succeed in assembling rural practitioners, facilities, and communities into a cohesive network to improve care in rural Colorado?

We spend a lot of time out in the communities. The High Plains Research Network has primary care research extension agents who live and work in rural eastern Colorado. I practice clinical family medicine part-time in a rural community 100 miles east of the University. So we are present. We listen. Community and patient engagement is a long-term commitment. You find a community, you meet with them regularly, you listen to them, and you invite them to hang out. You listen again. You change your work and ideas based on their input. You join the best science you know with the best community knowledge they have to produce something better than you could do without them. If it matters to them, it matters. And people show up.

If you could describe to urban policymakers just one or two unique characteristics of delivering healthcare in rural settings, what would those be?

When we send medical students on clinical rotations out in rural Colorado, we typically have them stay with a host family. So they meet a local community member outside the confines of the family practice office and exam room. The care of a patient with high blood pressure in a rural community is pretty much the same as the care of a patient with high blood pressure in an urban clinic: same medications, same salt restrictions, same exercise recommendations. But the context in which the patient lives—the cultural constructs, social determinants of health, access to care and services—are all quite different. Same disease process, very different human experience. Does the rural town have a pharmacy to dispense the medication? What dietary habits and standards and cultural norms impact the use of salt? Are the streets paved, and do they have sidewalks for walking? Is there a park? Or a 24-hour fitness center?

So the first thing to share with an urban policymaker is that rural is not urban. While the biology is similar, the context and biological expression are different. Too often, an urban policymaker comes up with a great new solution to a problem, implements policy, and then tries to disseminate that same policy out into rural communities. This is usually met with a pause and a blank stare, followed by a head shake and a soft chuckle. You get it; that just doesn’t work. On the flip side, many rural communities are coming up with local solutions to local problems every day. And many of these local solutions just might be effective in urban communities as well. Not all of them, but there are many, many good ideas generated and put into practice in rural communities. Listen to them and give them a try.

How do you like to spend your spare time?

I have a great family. My spouse is a neurologist working with the Veterans Administration in Denver. We enjoy spending time with our two grown sons—hiking, fishing, watching Firefly and Mozart in the Jungle. We have a large garden of raised beds and do our best to outsmart the rodents, rabbits, and bugs as we grow lettuce, tomatoes, beets, carrots, berries, and so on. Digging in the dirt is therapy. Watching germination, growth, harvest, and compost is a great reminder of our mortal nature. And it reminds us to tread lightly and be kind, and that life is, for the most part, generous.

 

Heather Olson Wins Students Awards

Heather Olson, a senior in the Department of Sociology and Anthropology and a longtime CAIRHE research assistant, received three university awards this spring recognizing her academic achievement.

In April, Olson received the College of Letters and Science Dean’s Award for Academic Excellence, presented by Dean Nicol Rae (pictured). The award is given to the top two seniors in the College each year. Olson also received an Award for Excellence from the MSU Alumni Foundation and the Bozeman Area Chamber of Commerce in February. Later in the spring Olson was honored with a Student of Achievement award from the MSU Women’s Center and the Alumni Foundation.

Olson has worked as a funded research assistant for CAIRHE investigators Kelly Knight and Colter Ellis since the beginning of their project in 2015. She was one of eight students who worked for Knight and Ellis’s Secondary Trauma Intervention Learning Lab (STILL) during the 2016-17 academic year.

“Heather exemplifies excellence in all her hard work,” Knight said. “She has been tremendously helpful to our CAIRHE project, and we will miss her when she graduates. Her work and accomplishments have set the example for students in our department.”