Unsung Heroes

As we’ve reached the end of another academic year, I want to take this time to acknowledge the many undergraduate students who have worked with us in our offices at CAIRHE over the years. Their tireless hard work and cheerfulness have made a huge difference to us daily.

Two remarkable students who have worked with us this year are Terrance Limpy and Emory Hoelscher-Hull. Terrance and Emory are both exceptional people (each was recently honored—see pp. 6-7), and they are caring, eager to learn, and smart in all they do.

I first met Terrance, a member of the Northern Cheyenne Tribe, when he was part of the American Indigenous Business Leaders (AIBL) student chapter on campus. The AIBL students helped create a business plan for Turtle Island Tales, our research dissemination program focused on wellness for American Indian families with young children. Their work was so good that they won national awards in 2020 and 2021! We then hired Terrance last summer to help us with a dissemination research pilot project in partnership with the Blackfeet Nation and MSU Extension. His hard work, business acumen, and dedication included creating systems for mailings, ordering of supplies, and managing participants, among many other tasks. He works well with our partners and has kept the project moving along smoothly. Terrance’s quiet leadership and creativity make up much of the glue for this project.

Though he graduated in May, Terrance will stay on with us remotely in the months ahead; we can’t do without his expertise! He recently accompanied me and other members of the Turtle Island Tales team to the Fifth-Annual Conference on Native American Nutrition in Minneapolis, where he presented a poster on his work and helped operate our CAIRHE booth. It was a fantastic conference, and Terrance was an immense help.

Emory, a rising senior in the environmental health program in the Department of Microbiology and Cell Biology, helped us at CAIRHE this semester with the large amount of work that purchasing cards generate, and she also has greatly contributed to our work with the Blackfeet Turtle Island Tales dissemination project. Emory has worked creatively with both projects and always has lots of new ideas and a sense of fun. Her Adobe InDesign expertise is invaluable when we need to modify handouts and other items for dissemination.

As part of Emory’s award from the Rocky Mountain Public Health Training Center (p. 7), she received a stipend to help fund her ongoing undergraduate research, which investigates the prevalence of unsafe levels of strontium in home well water within rural Montana counties designated as low-income and low-access by the USDA.

I have greatly enjoyed working with Terrance and Emory as a team and individually, and we are so lucky to have such excellent and flexible students working with us. Their enthusiasm and hard work are infectious. Providing such opportunities to undergraduate students like Terrance and Emory gives these unsung heroes invaluable real-world research and job experience that will serve them well into the future.

And we know it will be a bright future indeed.

 

Alexandra Adams, M.D., Ph.D.
Director and Principal Investigator

 

Outreach Continues for Climate Change and Human Health Report

Public outreach by CAIRHE and its partners continues for a landmark report published in late 2020.

Climate Change and Human Health in Montana, or C2H2, was released in December of that year as a special report of the 2017 Montana Climate Assessment. C2H2 was produced by MSU’s Institute on Ecosystems, Montana Health Professionals for a Healthy Climate, and CAIRHE, with support from the Montana Healthcare Foundation.

In addition to presentations about the report and its findings made by the C2H2 authors across the state, a new film project will present the health threats of climate change to a broad audience.

A series of four short films, each running 4 to 6 minutes long, will focus on climate change and mental health; the impacts of climate change on the health of children; the impacts of more hot days, wildfire smoke, flooding, and drought on pulmonary health, mental health, heat stroke, and food security; and the impacts of climate change on vulnerable, exposed populations, such as the homeless, outdoor workers, and Indigenous communities.

The short films are funded by the Montana Healthcare Foundation, the Great Montana Foundation, and Montana INBRE. Science journalist and filmmaker Sara Reardon is creating the films.

“It’s critical that the health community discusses the effects of climate on human health in our exam rooms and our policy rooms,” said Lori Byron, M.D., a pediatrician in Harlem, Mont., who co-authored the report as chair of Montana Health Professionals for a Healthy Climate (MtHPHC). “In Montana, we’re fortunate to have a climate and health report specific to our state. Sharing this and the documentaries created to bring the report to life is meaningful. To not discuss the changing climate’s effect on human health is akin to not telling a patient who smokes that smoking is bad for your health.”

The films will be ready for distribution by the end of this year, at which time they could be used at medical and climate conferences, at public agency meetings and departments of health, on television, and in schools.

While Lori Byron and Rob Byron, M.D., MPH, vice chair of MtHPHC, have made the majority of author presentations across the state, CAIRHE Director Alex Adams, M.D., Ph.D., lead author of C2H2, also speaks regularly on the topic.

Her latest talk was an online presentation on April 13 sponsored by the Gallatin Valley Friends of the Sciences and co-sponsored by Hopa Mountain and the Museum of the Rockies. Adams discussed the impacts of the changing climate as well as mitigation and adaptation strategies that individuals, communities, and health care organizations can implement to reduce these effects.

“As a physician, I’ve been worried about our tribal and rural communities under these worsening conditions,” Adams told the audience. “Personally, during the worst days of last summer, I was checking air quality conditions every day.”

She recalled how her oldest son was not able to leave his apartment in Seattle on the worst wildfire smoke days on the West Coast—a scenario that played out for many Montanans, too, throughout the summer. “My motivation for doing this work is not only to protect my own children,” she said, “but also our most vulnerable communities in our tribal and rural areas.”

Adams said particulates from forest fire smoke are a significant health risk in Montana that will only worsen with climate change. Increases in the number of hot days will also have health consequences.

“When we’re not used to heat, it can really cause a lot of stress and worsening mental health,” she said.

Food security and nutrition also suffer with drought and crop losses, she explained. Even when harvests are adequate, the elevated carbon dioxide levels in the atmosphere actually lower protein and micronutrient content in grains.

“Tribal communities, in particular, are working on food security because they recognize that this is coming,” she said, noting several programs on the Blackfeet, Flathead, and Fort Belknap Reservations.

Broad, community-wide coalitions will be required to mitigate the effects of climate change at the local and state level, Adams said.

“We need to recognize that public health and economic well-being are inseparable. We have to plan action on both,” she said. “We can’t divide ourselves anymore. We have to work together and understand that we’re all connected.”

 

Emily Tomayko Appointed as Health & Human Development Faculty

CAIRHE Assistant Research Professor Emily Tomayko, Ph.D., RD, has been appointed assistant professor of Food/Nutrition and Clinical Nutrition in MSU’s Department of Health and Human Development following a national search. The tenure-track position will begin this fall.

“I’m eager to build my research and teaching program, continue rewarding partnerships, and engage with new colleagues on campus and across Montana,” Tomayko said. “In MSU, I feel that I have found my home.”

Tomayko becomes the first CAIRHE research faculty member to receive a departmental appointment at MSU, but she will not be the last, said CAIRHE Director Alex Adams, M.D., Ph.D.

“One of the ways that CAIRHE can continue to build the community of health equity investigators at Montana State is by attracting talented researchers like Emily to join our center,” Adams said. “If we can then find a good fit with a departmental home here, it’s a win for everyone. We look forward to continuing our work with Emily as a CAIRHE investigator as she now also forges ahead as a contributing member of her new department.”

Tomayko joined CAIRHE in January 2020 as an established health researcher who previously served as an assistant professor at Oregon State University. One part of her research interests addresses childhood obesity disparities and promotes obesity prevention initiatives. A more recent interest in childhood well-being includes the health effects of a four-day school week, which she had begun to investigate in Oregon and has continued here.

Shortly after her arrival at MSU, Tomayko was awarded an R21 grant from the NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development, as well as a grant (as co-PI) from the Spencer Foundation. Both projects focus on aspects of the four-day school week.

In addition, Tomayko currently leads a CAIRHE pilot project that is developing traditional foods resource materials in conjunction with her partners in the Confederated Tribes of Warm Springs in Oregon. She has submitted a renewal of that one-year project for a final year in 2022-23.

And, if that weren’t enough, she is part of the academic leadership team for Turtle Island Tales, based on research outcomes from Adams’s Healthy Children, Strong Families projects, on which Tomayko served as a co-investigator. She also serves as training coordinator for the Montana IDeA Community Engagement Core, a joint venture between CAIRHE and Montana INBRE.

 

RESEARCH BRIEFS

Andreas Thorsen, Ph.D., and co-investigator Maggie Thorsen, Ph.D. (Modeling Rural Perinatal Health Outcomes and Service Systems to Improve Health Equity), are currently in their final year leading a CAIRHE project, when they have focused largely on grant writing, team development, and manuscript preparation. In March they submitted an R01 grant application, System-Level Determinants of Rural Obstetric Bypassing: Perinatal Outcomes and Inequities, to the National Institute on Minority Health and Health Disparities. That application emerged from a set of working papers they wrote this year focusing on rural obstetric bypassing, which occurs when patients circumvent local facilities to give birth at a nonlocal facility. A draft of the research from one of these studies has been accepted for presentation at the American Sociological Association’s annual meeting in August.

Lauren Davis, Ed.D. (A Trauma-Informed Intervention for Positive Youth Development and Teacher Wellness in Rural Montana), recently conducted the study’s Year 1 yoga intervention in a rural Montana school district, with data analysis underway. Davis and her team are examining teacher well-being (through career satisfaction and self-efficacy surveys), with additional secondary measures assessing depressive and anxiety symptomology, changes in heart rate variability, and cortisol testing. Davis also gathered classroom behavioral data from students in teacher participants’ classes as tertiary outcomes to assess teacher co-regulation resulting from the intervention. While final results are still pending, qualitative feedback from participants indicates that this was a highly beneficial and meaningful intervention for them on a personal level. The project will begin its second year in September.

Brandon Scott, Ph.D. (A Native Path to Courage), and his team have experienced several COVID-19 delays due to Reservation closures, but in recent weeks the project has collected focus-group data from three groups of elders and one group of mental health professionals on adapting the COMPASS intervention for Native American youth. The team will complete parent, teacher, and youth focus groups during May and June. They will then work with the study’s Community Advisory Board over the summer to develop the conceptual framework for adapting COMPASS for youth residing on the Reservation. The project will begin its second year in September. Meanwhile, Scott and his CAIRHE mentor, Elizabeth Rink, Ph.D., are working on a process paper draft focused on school engagement in tribal communities.

Cara Palmer, Ph.D. (Sleep Health Disparities and Socioecological Risk Factors Among Montana Youth), has completed data collection for her project’s second phase, a quantitative study begun in Year 1 that included diagnostic interviews, surveys, actigraphy, daily diaries, and measures of salivary cortisol. In Year 2, she has included an additional study, or Phase 3, to examine rates of sleep health disparities, examine barriers to sleep-based education and health care, and identify key community-, family-, and individual-level risk and protective factors for sleep health in a representative statewide sample of Montana adolescents. Recruitment is ongoing, and 110 families have signed up or completed the study to date. Analyses for Phase 2 and Phase 3 data collection are ongoing, but preliminary results from the objective sleep data from Phase 2 suggest that nearly all participants were not obtaining enough sleep. Preliminary descriptive data from Phase 3 further indicate high rates of sleep disturbances and provide insight into potential barriers to sleep health. Palmer will present findings from Phase 3 to medical providers across the state at the annual Montana Sleep Society conference in September.

Miranda Margetts, Ph.D. (Investigating Healthcare for Rural Females with Complex Gynecological Conditions), and the project team have made notable progress this year, including preliminary findings in electronic medical record data analysis that have revealed the presence of Congenital Uterine Anomalies across all ethnic categories. The leading variation involves bicornuate uterus diagnoses, which aligns with Montana hospital discharge data analyzed by the project indicating that bicornuate uterus is the most common emergency admission for women with these anomalies. A literature review has revealed a distinct lack of any qualitative research involving women with variations other than the most severe anomaly (known as uterine agenesis), as well as a lack of any research regarding rural cohorts. A draft set of initial questions for a survey, to be administered after Year 1, has been prepared and is undergoing review by the study’s advisory team. A second year of CAIRHE funding awaits NIH approval.

Emily Tomayko, Ph.D. (Development and Community Evaluation of a Traditional Foods Resource), and her team have focused on the development of the toolkit materials, including training on the photogrammetry method being used to create digital models of the foods targeted for inclusion in the toolkit. During the year, Dr. Tomayko has made five visits to her tribal partners in Oregon to photograph various foods, including celery root, huckleberries, choke cherries, salmon, biscuit root, desert parsley, and sweetroot. To date, two digital models of the foods have been completed, and another five are in progress. The team also has begun development of printed educational materials to accompany the digital models for use in classroom settings. There is growing momentum among the community to support this work and to facilitate reconnection with their traditional foods, with a second year of CAIRHE funding awaiting NIH approval.

 

CAIRHE Adds Four New Faculty Project Leaders for 2021-22

Four new project leaders are entering the home stretch of their first year of research funding with CAIRHE, having begun their work in September of last year.

After leading a CAIRHE pilot project for two years during 2019-21, Lauren Davis, Ed.D., assistant professor in the Department of Education, is currently in her first year at the helm of a multiyear research project. That study, A Trauma-Informed Intervention for Positive Youth Development and Teacher Wellness in Rural Montana, builds on the work of her pilot project to design and implement a trauma-informed yoga intervention in rural schools.

“Developing a trauma-informed intervention for teachers was the focus of our first year’s study, and while final results are still pending, qualitative feedback from teachers has been overwhelmingly positive,” Davis said. “Many immediately asked when the next session would be, wanting to participate again, and nearly all noted that the intervention improved their ability to be more calm and present while teaching in their classrooms. Early results also indicate a statistically significant improvement in their sense of self-efficacy as educators as well.”

Brandon Scott, Ph.D., associate professor in the Department of Psychology, leads a new multiyear research project, A Native Path to Courage, that will culturally adapt a prevention and early intervention program for anxiety and depression in Native youth. Scott directs the community-based participatory research study in cooperation with the Chippewa Cree Tribe of the Rocky Boy Reservation, with whom he has collaborated for several years.

“Our research team has been honored to partner with the Chippewa Cree Tribe, tribal-serving schools, and the passionate and caring community members of the Rocky Boy Reservation for the past five years,” Scott said. “We believe our collaborative research efforts have provided both the community and research partners with invaluable information and resources to help further strengthen the resilience and mental health of youth living on the Rocky Boy Reservation.”

CAIRHE’s third research project for the year, Modeling Rural Perinatal Health Outcomes and Service Systems to Improve Health Equity, led by Andreas Thorsen, Ph.D., and co-investigator Maggie Thorsen, Ph.D., is in its third and final year. In March, the Thorsens submitted their first NIH R01 grant application to the National Institute on Minority Health and Health Disparities. That proposal will undergo peer review later this summer, with any resulting award to begin by December.

“Our work has the potential to provide much-needed insight on how rural and Native women access obstetric care, and the implications of this access for health disparities,” Maggie Thorsen said. “Our findings may provide insight into ways to improve access and increase equity in maternal and infant health.”

A new pilot project led by Miranda Margetts, Ph.D., assistant research professor in the Department of Land Resources and Environmental Sciences, is building a research team across multiple institutions, including Billings Clinic, for a long-term plan of study. That project, titled Investigating Healthcare for Rural Females with Complex Gynecological Conditions, examines health care for women in Montana with Congenital Uterine Anomalies, also known as Müllerian Anomalies. Margetts has submitted a competitive renewal of her pilot project, which would begin in September.

“Our investigation provides an important opportunity to learn more about the experiences of Montanan women receiving gynecological care for more complex conditions,” Margetts said. “Given the distances many Montanans travel for access to health care providers—particularly if specialist appointments or referrals are required—this work can begin to shed valuable light on effective models of care to ultimately improve optimal reproductive health outcomes for all women with these conditions.”

Emily Tomayko, Ph.D., newly appointed as an assistant professor in the Department of Health and Human Development beginning this fall (see page 3), leads her pilot project, Development and Community Evaluation of a Traditional Foods Resource, in collaboration with her partners in the Confederated Tribes of Warm Springs in Oregon. She also has submitted a competitive renewal of that project.

“This past year included truly meaningful relationship-building among our team, facilitated by the support I received from CAIRHE,” Tomayko said. “Momentum is growing within the community to engage with this project, and we’re hopeful this significant community input will produce a resource with lasting impact that respects the sacredness of these traditional foods. We’re particularly excited about the creation of digital models of the various plants and animals, which represent a tangible way for community members to interact with these foods.”

CAIRHE’s third pilot project, led by second-year project leader Cara Palmer, Ph.D., assistant professor in the Department of Psychology, is Sleep Health Disparities and Socioecological Risk Factors Among Montana Youth. Palmer’s long-term goal is to inform translational research to reduce sleep health disparities and downstream mental health difficulties among underserved, rural adolescents. She has plans for an NIH R01 application during the coming year.

“Research shows that sleep problems are common for many teenagers across the United States, but we know very little about how living in rural communities can impact sleep, for better or worse,” Palmer said. “This is a particularly important issue in Montana, where so many of our youth experience depression and high risk for suicide, which can be exacerbated by poor sleep. Results from this project will help us understand the types of sleep problems that youth experience across the state, particularly within medically underserved communities, and identify resources that are needed to improve sleep and overall psychological well-being.”

 

CAIRHE Research In Print

Here’s a snapshot of recent publications resulting from CAIRHE-funded research.

 

 

Adams Discusses Belongingness and Health in Harvard Presentation

CAIRHE Director Alex Adams, M.D., Ph.D., gave a national presentation in late April sponsored by the Harvard University Native American Program and the Harvard Medical School Department of Global Health and Social Medicine.

The online talk on April 27, part of the Indigenous Health and Well-Being Colloquium series, was titled, “Belongingness: Impacts on Indigenous Individual and Community Health.” Adams discussed her long-term work with the Menominee Nation and her national promotion of wellness among Native families, including Turtle Island Tales most recently. She focused on the importance of cultivating belongingness as a pathway to health, then summarized her work at CAIRHE to build an alliance of Indigenous and non-Indigenous scholars and research pathways with community partners.

The concept of belongingness and its impact on health is gaining a lot of traction in the scientific community, Adams said, citing the contributions of CAIRHE investigator Neha John-Henderson, Ph.D., and others.

“I’m still learning about belonging,” she said. “These teachings have come to me slowly, but it’s a bit like walking a labyrinth, like a journey. In this difficult time we find ourselves in now, we have to understand that it’s centuries of forgetting, the collective loss of ourselves, that have brought us to where we are. We are hungry for that belongingness again.”

Adams’s work with the Menominee dates to her time as a medical resident. Alongside the Menominee Community Engagement Workgroup, which started small but now has more than 70 members, she and her partners developed the Menominee Trauma Model together, followed by the Menominee Wellness Model.

Turtle Island Tales grew out of Adams’s two R01-funded clinical trials, Healthy Children, Strong Families, when she and her team began to receive requests from other communities for the innovative mailed intervention.

“Long-term partnerships are essential to promoting effective interventions and improving health equity,” she said. “What we’re learning with Turtle Island Tales is that dissemination is complex. It’s fun, but it takes a lot of hard work.”

Adams closed with an overview of CAIRHE, its mission, and its structure, including its mentoring programs. “I always want to highlight our faculty’s commitment and honor their work as partners with their communities,” she said.

 

PEOPLE

CAIRHE Investigators, Staff, and Students Honored for Their Work

From MSU News Service

Two CAIRHE faculty investigators were recently honored for their contributions to public health in Montana, while CAIRHE staff and students received MSU and regional recognition.

Neha John-Henderson, Ph.D., associate professor in the Department of Psychology, received the MSU Letters and Science Meritorious Research and Creativity Award. The award was presented at the College of Letters and Science annual awards ceremony on April 19.

John-Henderson is a former CAIRHE project leader who focuses on understanding how stressful life experiences affect physical health outcomes. Last fall she received a four-year, $2.18 million grant from the National Institute on Minority Health and Health Disparities, part of the National Institutes of Health, to investigate dynamic relationships between social connectedness and health risk factors in American Indians living on the Blackfeet Reservation—the first comprehensive, multiyear study of its kind. She has more than 38 publications in peer-reviewed journals—10 of those published in 2021 alone.

John-Henderson’s Stress, Adversity, Resilience and Health (SARAH) Lab at MSU is the center of these studies that explore how psychosocial experiences in vulnerable populations affect health and disease. Her team measures markers of immune system inflammation and reactivity (including heart rate, blood pressure, and cortisol) in response to psychological stress, sleep, physical activity, and patterns of social interactions and daily life stressors. These measurements are coupled with surveys collecting information about demographics and early life environments to better understand the pathways through which these experiences and environments may later affect health and risk for disease.

“Neha continues to excel as one of MSU’s outstanding young faculty members,” said Alexandra Adams, M.D., Ph.D., director of CAIRHE. “Her innovative work as a CAIRHE investigator is pushing her field forward and earning a well-deserved national reputation for her important contributions.”

Julie Alexander-Ruff, Ed.D., M.S, assistant professor in the Mark and Robyn Jones College of Nursing, received the Dr. Frank Newman Rural Health Leadership in Education award, given annually by the Montana Office of Rural Health and Area Health Education Center, or AHEC, and the Montana Rural Health Association. The award recognizes an individual who has shown exceptional leadership in and commitment to rural health and health care education in Montana.

Alexander-Ruff’s accomplishments include spearheading a partnership with the Affiliated Tribes of Fort Peck to provide undergraduate nursing students with a weeklong cultural immersion service-learning clinical experience. As part of that experience, students work in school clinics on the Fort Peck Reservation during the day and sit with elders of the community in the evenings, listening to stories intended to provide insights into Native ways of knowing and being. The work earned her the 2015 President’s Award for Excellence in Service Learning.

She is currently leading Healing through Education, Art and Resilience Training (HEART), a College of Nursing multidisciplinary research project seeking to improve the resiliency of 3rd-grade students at Fort Peck by enhancing the classroom culture and facilitating the children’s expression through themed monthly art projects. She also completed a CAIRHE Developmental Mini-Grant project on the Fort Peck Reservation in 2020.

Sarah Shannon, Ph.D., R.N., FAAN, dean of the Mark and Robyn Jones College of Nursing and a CAIRHE mentor, said Alexander-Ruff has been a leader in offering service-learning opportunities for nursing students and forming partnerships with tribal communities in Montana.

“Julie’s long-standing partnership with the Fort Peck community exemplifies the land-grant mission of Montana State University,” Shannon said. “She is a health care provider for the Fort Peck community, an educator for nursing students, and an advocate for children across Montana. Her work on resiliency in children is more important now than ever as we emerge from several years of disrupted school and social relationships.”

In addition, on April 21 CAIRHE Program Coordinator James Burroughs was honored at the annual MSU Employee of the Year Awards, receiving the honor for Service Excellence in the area of Competence. Burroughs was nominated by Adams on behalf of CAIRHE’s faculty.

Undergraduate student Emory Hoelscher-Hull, a rising senior in the Department of Microbiology and Cell Biology and an office assistant for CAIRHE, was selected in a regional competition as a Student Leader in Public Health by the Rocky Mountain Public Health Training Center. In addition to her work for CAIRHE this year, Hoelscher-Hull has served as a student assistant on Adams’s Turtle Island Tales project team.

A second student assistant for Turtle Island Tales, recent MSU graduate Terrance Limpy, received a Harriette Cushman Award for Outstanding MSU Indian Student, presented in April. As part of the MSU student chapter of American Indigenous Business Leaders, Limpy was one member of the team that developed the award-winning sustainable business model for Turtle Island Tales in 2020.

 

Congratulations to the following CAIRHE faculty who received tenure and/or promotion this Spring!

 

Promotion to Full Professor:

Monica Skewes, Ph.D. (Psychology)

Ron June, Ph.D. (Mechanical and Industrial Engineering)

 

Tenure and Promotion to Associate Professor:

Neha John-Henderson, Ph.D. (Psychology)

Brandon Scott, Ph.D. (Psychology)

Maggie Thorsen, Ph.D. (Sociology & Anthropology)