California Native American Research Center
for Health (CA-NARCH)
CA-NARCH
Community and Scientific Advisory Board
Annual Meeting
July 7, 2011
NIGMS
Tribes
NARCH
CSUSM
UCSD
SDSU
Palomar
CA-NARCH
 CA-NARCH began in 2001
 6 cycles of funding, with 18
NARCH centers established
 NARCH 5-Projects funded
effective: September 1, 2009August 31, 2013
CA-NARCH Specific Aims
 Develop a cadre of American Indian scientists & health
professionals.
 Increase the capacities of academic institutions and NA
organizations to work in partnership and reduce distrust.
 Facilitate competitive research linked to health priorities of NA
organizations to reduce health disparities.
CA-NARCH Student Development Project
 Stephanie Brodine, MD-Principal Investigator
 Dan Calac, MD-Co-Investigator
 Lucy Cunningham- Project Manager
 Geneva Lofton-Fitzsimmons- Student Program
Coordinator
 Selise Linton-Administrative Assistant
CA-NARCH Student Development
Activities
 Match students to existing programs, research interests,
existing IHC research projects, campus and summer programs
 Faculty Mentoring with Interventions/Advocacy/Academic
Preparation
 Campus/IHC based student meetings and Student Events
 Limited stipends for research/CANDR funded research for
UG/graduate students
 Conferences and GRE prep courses
 Online tracking system
 Palomar (8); CSUSM (4); SDSU (4); UCSD (11); Other
(3)
CA-NARCH Student Programs
(2010-2011)
Palomar Community College- Bridges to the Future
CA-NARCH Directed Research- CANDR
Minority Access to Research Careers- MARC
Minority Biomedical Research Support- MBRS
University Link Medical Science Program - UC LINK
Office for Biomedical Research Training – OBRT
The Louis Stokes Alliance for Minority Participation- LSAMO
SUMMER PROGRAMS
 Harvard Four Directions
 University of Arizona
 UCLA Summer Medical/Dental Program
 UCSF Summer Research Program
 Loma Linda Summer Research Program
1
9
2
1
1
2
2
CA-NARCH Students
Whitney Baugher, Cahuilla, 2007
Joe Hill, Mohawk, 2008

UCSD- Psychology major

UCSD- Human Biology major

Goal: to become a Clinical Psychologist

Goal: to become an M.D.
CA-NARCH support: Provided
academic/personal advice

paid $500/month, CANDR student 2011

paid for GRE Prep course

paid for Whitney to attend annual SACNAS
conference/ assisted with support for AISES
conference
CA-NARCH support:

Provided academic advice and assistance
with challenges faced in transition from
Community College to UCSD

In the process of scheduling a shadowing
day for Joe with Dr. Dan

provided Joe with contacts for possible
research experience

Paid for Joe to attend annual SACNAS
conference
Preventing Underage Drinking Among
Southern California Indians
Jennifer Roberts, BS
Tony Luna, BA
Nadeana Nelson
Sergio Quintero
Patricia Gonzales
Daniel Calac, MD
Cindy L. Ehlers, PhD
David Gilder, MD
Roland Moore, PhD
Prevention Research Center
Pacific Institute for Research and Evaluation
NIAAA Grant AA016479
Reward and Reminder
• Preparation: Resolutions
• Meeting with all the tribes to demonstrate support of the
reward and reminder program: 7 Tribal Resolutions passed.
• Implementation: Convenience Store Visits
• Young-looking volunteers 21+ visit all stores within 10 miles
of reservations (Baseline of sales with no ID check: 26.6%).
• Reward clerks who refuse to sell alcohol to young people;
Remind clerks who do not check identification
• Collect data on R&R visits- name and address of outlet,
volunteer’s age, gender, clerk’s approximate age, gender,
whether the clerk asker for ID, whether a purchase was made.
• Provide feedback to merchants- the power in this intervention
is to positively reward clerks who ask for ID.
Motivational interviewing:
Individual-level Intervention
• Goal: to study the effectiveness of motivational
interviewing vs. psycho-education about alcohol in
reducing underage drinking.
• Youth come to IHC (or we visit them) for 2 meetings,
each lasting 2 hours. A family member joins 1 session.
• Each youth participant will receive a $25 gift card each
session. Participation is voluntary.
Healthy Women: Healthy
Native Nation
• Christina Chambers Ph.D., M.P.H. PI
• Dan Calac, M.D. Co-PI
• John Clapp Ph.D., M.S.W. Co-PI
Study Coordinators: Jessica Gorman (past) and Annika Montag (present)
Recruitment of potential study participants
AI/AN @ 18-45 years
Screening of potential study participants
Informed consent procedure
Baseline survey
Randomization of study participants
Picture of
Liana here
Web-based Instrument
(n=125)
Control: Treatment as usual
(n=125)
1 month follow-up
1 month follow-up
3 month follow-up
3 month follow-up
6 month follow-up
6 month follow-up
We want every baby to have the
best possible start!
oal: To prevent fetal alcohol syndrome by finding effective ways to
screen for and prevent drinking during pregnancy.
Fetal Alcohol Syndrome is 100% preventable!
Methods: Test the effectiveness of two methods of screening, brief
intervention, and referral for risky alcohol consumption among
AI/AN women who are or have the potential to become pregnant.
Future Plans
– Complete enrollment of 250 participants
• Rincon and Santa Ysabel clinics
– Prepare for Protocol 2 (already initiated)
• Peer-to-peer script
• Motivational Interviewing training
• Hard-copy materials
• Focus groups
– Complete enrollment of 500 participants in both protocols by
end of 2012
– Complete follow-up calls of all 500 participants by end of 2012
– Complete birth outcome data collection by end of 2012
Progress to Date
• Approvals from UCSD, SDSU, and IHC IRBs
• Web-based instrument made culturally appropriate to this
population
• 3 Research Assistants hired and trained
• 1 manuscript completed and 1 in preparation
• Recruitment has begun as of 4/28/2011!
• Relationships established in clinic departments to provide referrals
• Community events: OB clinic, Family Night classes, Teen
Pregnancy Intervention, SY Child Safety Seat class
• Office allocated in Human Services
– close proximity to services we may refer participants to
– computer and designated confidential printer
– laptop for use in over-flow room
• 62 participants have been recruited (9 pregnant)
Fatty Liver Disease is associated with:

Obesity (particularly central obesity)

Glucose disturbances (insulin resistance, diabetes,..)

Sedentary lifestyle

Diet high in saturated fats, high fructose corn
syrup, carbohydrates, alcohol, etc.

Viral etiologies (HBV, HCV, etc.)

Toxin exposures


Metabolic disease (glycogen storage disease,
hemochromatosis, etc.)
Family history of fatty liver disease
The Liverlicious Project
(Fatty Liver among Adolescent American
Indians of the Indian Health Council, Inc.)
Dan Calac, MD - Principal Investigator
Claude Sirlin, MD - Co-Investigator
Deborah Wingard, PhD - Co-Investigator
Jeffrey Schwimmer, MD - Co-Investigator
Michael Middleton, MD - Co-Investigator
Annika Montag, PhD student - Co-Investigator
Progress to Date
• Material design
– For Recruitment
• Pamphlet
• Presentation
• Contest – The Liverlicious Project!!
– Survey
• IRB approvals
• Recruitment has started!
• Participants to date:
– Fully consented students
– Survey
– OGTT, blood draw, and physical
14
– Liver scans
21
15
16
How we are going to find out:




How much fatty liver is there?
 Using a new non-invasive MRI technique
If it is present, what might be causing it?
 Using culturally appropriate questionnaires and
laboratory measures
clinical/
What materials might be effective in identifying and reducing fatty
liver?
 Using feedback from students, parents, school administrators,
local professionals, NARCH
students, and an informal
community advising group
How possible would a future intervention be?
 Indicated by our experience during this pilot study
What we want to know:
In our local adolescents, represented by 12-18 year olds at
All Tribes Charter School,




Is there a problem?
 How much fatty liver is there?
If there is, what is fatty liver associated with?
 What might be causing it?
What materials might be effective in identifying and reducing fatty
liver?
How possible would a future intervention be?
NAFLD: Non-Alcoholic Fatty Liver
Disease


Buildup of fat in the liver not caused by alcohol
Most common cause of chronic liver disease in adults and
adolescents

Rapidly increasing prevalence

Often asymptomatic

May progress to liver failure
if untreated
or liver cancer
Image source: http://www.elements4health.com/images/stories/health/fatty-liver.jpg
Mayo Foundation for Medial Education and Research
SDSU BioScience Center
Healthy Gums = Healthy Heart
•
•
•
•
Enroll patients age 21-40 seen in dental clinic
Evaluate periodontal status, vascular function
Obtain dental scrapings for metagenomic analysis
Treat periodontal disease, reevaluate 3 mo later
• Status: 45 Enrolled, 26 Active, 9 Completed
Association between dental
health and heart attack (AMI)
Used index based on caries, periodontal disease, periapical lesions,
pericoronitis.
Patients admitted for acute myocardial infarction had higher scores than
matched controls.
Patients above the upper quartile had twice the risk of acute myocardial
infarction than did those
with a score of zero.
This was comparable to risk of cigarette smoking, hypercholesterolemia
and hypertension.
Matilla KJ et al Brit. Med. J. 1989 298: 774
What will we learn,
and where will it take us?
• Identify known and new organisms associated with gum
disease
• Identify organisms that are associated with gum disease
and endothelial dysfunction
• Learn whether treating periodontal disease early can
reduce risk of atherosclerosis
• Could lead to new health policies – it may be costeffective to provide dental care if it decreases cost of
heart disease later
Background/Significance:
Gum Disease:
GeneEx
Dental Exam
Swish ‘n’ Spit
Metagenomics
Systemic
Inflammation
Cytokines
NO
Endothelial
Dysfunction:
Functional/Structural
Measures of Blood Vessels
Atherosclerosis
Heart Attack
SDSU BioScience Center
• Roberta Gottlieb (Director of the BioScience Center)
• Crystal Anderson-Antoniades (study coordinator)
• Scott Kelley, John Mokili (SDSU Dept. Biology)
– Rosalin Le, Karen Schwartzberg
• Carrie Lambert, Dan Calac (Dental and Medical Directors,
IHC)
• Sue Lindsay, Balambal Bharti (SDSU GSPH)
• Jack Luomanen (Public Health Dentist)
• Rob Knight (U. of Colorado, Boulder)
Human Supragingival Plaque
TOOTH SURFACE