Вы находитесь на странице: 1из 17

Department of Health and Human Services

The Department of Health and Human Services supports and conducts Arctic
health research through the National Institutes of Health and the Centers for
Disease Control and Prevention.

National Institutes of Health Funding (thousands)


FY 04 FY 05
The National Institutes of Health (NIH) is an National Institutes of Health 25,000 22,000
agency of the Department of Health and Human Centers for Dis. Control/Prevent. 3,400 3,700
Subst. Ab. & Men. Health Serv. Ad. 25,900 21,200
Services. NIH is headquartered at Bethesda, Total 54,300 46,900
Maryland, and is composed of 27 institutes and
centers. NIH supports research on Arctic-related
health issues through grants and contracts to Canadian organizations, and the discussion
non-Federal scientists and through the projects focused on updating NIH on its current status,
carried out by scientists in NIH laboratories and receiving feedback, and exploring future collabo-
clinics. ration.
NIH works with colleagues around the world to
achieve its mission. In the area of Arctic research,
NIH has fostered international research collabora-
Fogarty International Center
tions and agreements with a range of counterparts The FIC’s mission is to address global health
abroad. For example, NIH and its Canadian coun- challenges through innovative and collaborative
terpart, the Canadian Institutes of Health Research research and training programs and to advance
(CIHR), signed a Letter of Intent on September 20, the NIH mission through international partner-
2004, directed at strengthening research coopera- ships. As the designated focal point for Arctic
tion between the U.S. and Canada on the issues issues at the NIH, FIC plays a key role in advanc-
related to indigenous peoples. This agreement ing bilateral and multilateral ties between and
serves as a cornerstone for future bilateral health- among governments, institutions, and scientists
related activities in the circumpolar region. working on circumpolar issues. In 2004 and 2005,
In May 2005, NIH hosted a delegation from FIC led the development and conduct of two inter-
CIHR, with representation from the Institute of national scientific conferences on inhalant abuse
Neurosciences, Mental Health and Addiction and suicide, two critical Arctic health needs areas.
(INMHA), Institute of Genetics, and Institute of FIC worked closely with all relevant NIH partners
Aboriginal Peoples’ Health Research (IAPHR). in developing and conducting these conferences,
The primary purpose of this visit was to discuss each of which provided insights to researchers
the opportunities for moving forward on the 2004 and policymakers on gap areas and areas of
NIH–CIHR Letter of Intent on collaboration in potential collaboration. In addition, FIC, working
indigenous peoples’ health research. A presenta- across NIH and with CDC, has been a key partner
tion was made on IAPHR activities and priorities in preparing for the International Polar Year (IPY)
as a platform for collaboration with NIH. In addi- to take place in 2007–2008. FIC provided leader-
tion, the Fogarty International Center (FIC) hosted ship and input to a range of groups working to
a roundtable discussion on the Regenerative prepare for IPY, including the Polar Research
Medicine and Nanomedicine initiative with the Board of the National Academies of Science, the
National Institute of Neurological Disorders and Department of State, and the CDC.
Stroke (NINDS), the National Institute of Mental
Health (NIMH), and the National Institute on Drug
Abuse (NIDA) at NIH and the Institute of Genet-
National Institute on Aging
ics of the CIHR. This initiative is a partnership The National Institute on Aging (NIA) is con-
involving CIHR and a number of other leading tinuing to fund the Age, Gene/Environment Sus-

125
ceptibility (AGES) Study: The Reykjavik Healthy Caucasians. Alcohol use has also been linked to
Aging Study for the New Millennium introduced child abuse, accidental death, assaults, rapes, and
in 2001. This initiative was launched under the suicides in Alaska. The NIAAA goal is to identify
U.S. Arctic Research Plan and is part on the ongo- the causes and consequences of alcohol consump-
ing collaboration between NIA and the Icelandic tion and to develop and validate effective treat-
Heart Association. The first round of data collec- ment and prevention strategies for adverse health
tion was completed in February 2006, with approxi- and behavioral consequences of drinking. The
mately 5,800 individuals examined on four physical institute supported three projects in the Arctic
and neuropsychological domains, including neuro- region in FY 2003–2005. One project examined the
cognitive, cardiovascular, musculoskeletal, body economic and public health impact of raising alco-
composition, and metabolic functioning. A major holic beverage taxes in Alaska. A second project
aspect of the study is a cross-sectional examina- examined the efficacy of a pharmacological treat-
tion of phenotypes to be used for candidate gene ment on relapse rates among alcohol-dependent
studies and to allow for a better understanding of Native Alaskans in treatment. The third project
factors contributing to disease in old age, apart supports the development of a culturally specific
from genetic factors. These phenotypes will also alcohol abuse prevention intervention for Yupik
be examined in relation to specific mortality out- Eskimo children.
comes such as coronary heart disease, fractures,
and cancers that are ascertained in Iceland. In
addition, a large specimen bank and repository is
National Institute on Drug Abuse
being established as part of this study, and collab- Since 1994 the National Institute on Drug
orations with interested investigators outside of Abuse (NIDA) has been funding basic and
the study are actively sought. A follow-up mea- applied research on drug abuse in the Alaskan
sure is planned for 2007–2011. Native population. Several of these NIDA-funded
The NIA also continues to fund the Native research projects have published data on sexually
Elder Research Center, located within the Division transmitted disease in Alaskan Native drug users
of American Indian and Alaska Native Programs of and have also focused on unemployment, HIV
the Department of Psychiatry, School of Medicine, risk, and alcohol use. NIDA’s current portfolio of
at the University of Colorado Health Sciences Alaska-Native-relevant research focuses on the
Center in Denver. The center coordinates a cultur- prevention of inhalant abuse; chronic stress and
ally relevant, scientifically meritorious research substance use; co-occurrence of substance use,
career development program targeted at American depression, and risk of HIV/AIDS; and tobacco
Indian (AI) and Alaska Native (AN) investigators, cessation programs for youth. During 2005, NIDA
focusing on aging, health, and culture. The center sponsored two scientific meetings that included
augments ongoing partnerships with AI/AN com- research presentations addressing issues of Alas-
munities to ensure access to and involvement of ka Natives and aboriginal people in Canada. The
elders, their families, and local systems of care in first conference was entitled “Bridging Science
aging. and Culture to Improve Drug Abuse Research in
Minority Communities” and the second meeting
National Institute on Alcohol was entitled “Inhalant Abuse among Children and
Adolescents: Consultation on Building an Interna-
Abuse and Alcoholism tional Research Agenda.” The latter conference
Alcoholism continues to be one of the most included a description of a new research project
important public health problems among Alaska on the implementation of inhalant abuse preven-
Natives in the Arctic region. Alaska’s alcohol con- tion programs in four relatively small communities
sumption rate is among the highest in the nation. in Alaska. In the first year the project mobilized the
Alaska Natives have unusually high rates of interest of communities to ensure their buy-in and
drinking and associated health problems, includ- the cultural appropriateness of the programs. The
ing fetal alcohol syndrome. Furthermore, alcohol is next steps included setting up retailer, family, and
substantially involved in accidents and injuries school environmental strategies and testing a
among both Alaska Natives and Alaska whites. A prevention curriculum for fifth-graders based on
review of medical records indicated that alcohol life-skills training for Native Americans. Subse-
was noted on the record of 37.5% of injuries to quent efforts will involve testing the school-based
Alaska Natives and 15.5% of injuries to Alaskan curriculum in 16 other Alaskan communities. A

126
complete description is available at international. such as the genetic evolution of HCV in response
drugabuse.gov/downloads/Inhalant_Summary. to host neutralizing antibodies and CD4 and CD8
pdf. T cell activity against virus proteins—are linked to
the persistence of infection and progression of
National Institute of Allergy chronic liver disease.
NIAID has long supported a large study of the
and Infectious Disease relationship between HCV replication, evolution,
Haemophilus influenzae type b and disease progression in Alaska Natives and
Before the introduction of a vaccine against American Indian populations. In studies published
Haemophilus influenzae type b (Hib) in the late in April 2006 in Clinical Infectious Diseases, it was
1980s, an estimated 16,000–25,000 children in the shown that, at least in Alaska Natives, sporadic
U.S. annually showed signs of invasive bacterial episodes of viral control in patients with chronic
infection by Hib. Today, with the use of a conju- HCV infection are more common than had been
gate vaccine developed with support from NIAID, appreciated. This clinically surprising, and poten-
Hib bacterial infection has been reduced by 99% tially very important, observation, if independently
in the U.S. Interestingly there is evidence that the confirmed, could open new avenues for the devel-
Hib vaccine decreases the rate of Hib carriage opment of future therapies.
among vaccinated children, decreasing the chance In ongoing studies, serum samples, stored in a
that unvaccinated children will be exposed. serum bank dating back over 30 years and repre-
NIAID provided support for a three-year pilot senting approximately 1,000 subjects, in conjunc-
intervention trial that was initiated in FY 2002 in tion with a large clinical and virology database, are
three Alaska Native villages known to have high being studied for HCV genetic evolution in the
numbers of asymptomatic carriers of Hib. The goal context of host immune responses in different clin-
was to determine if Hib conjugate vaccine could ical settings. Results from these studies, in the
be given to persons of all ages to eliminate or well-defined Alaska Native populations, will pro-
reduce Hib colonization. The researchers hoped vide additional important insights regarding the
to determine what treatment most effectively elimi- natural history of hepatitis C, HCV persistence,
nated the Hib reservoir from a village. Several and liver disease progression.
treatment regimes were compared, including a
comparison of treatment with the Hib conjugate Histocompatibility and Immune Recognition
vaccine, with and without the antibiotic rifampin, In FY 2004 and 2005, NIAID, in conjunction
to that of treatment with rifampin alone (the stan- with several other NIH institutes and centers and
dard treatment). the Juvenile Diabetes Research Foundation Inter-
Various immunologic parameters were measured national, continued its support of the International
before and after Hib vaccination. Prior to vaccina- Histocompatibility Working Group (IHWG)
tion, Hib carriers had a higher IgG antibody level through a resource-related research project coop-
than controls, as well as higher serum bactericidal erative agreement at the Fred Hutchinson Cancer
activity (SBA). Both groups responded to vacci- Research Center in Seattle, Washington. The
nation with increased IgG and SBA levels. These IHWG is a network of more than 200 laboratories
results suggest that Hib colonization can induce in over 70 countries that collect and share data
an immune response, so Hib carriage in these on genes of the human leukocyte antigen (HLA)
communities is likely due to multiple factors rather complex.
than an overall lack of immune response. The Alaskan Yupik project was an integral
part of one of the seven projects conducted by
Hepatitis C the Fred Hutchinson Cancer Research Center.
Hepatitis C virus (HCV) is a blood-borne agent Researchers analyzed HLA genes in the Yupik
that usually causes chronic infection of the liver, cohort to determine the different types of histo-
leading to severe progressive liver diseases such compatibility genes and their frequency in that
as cirrhosis and primary liver cancer and resulting population. Data from the Yupik population were
in an estimated 12,000 deaths per year in the U.S. placed with data from thousands of other individ-
There is poor understanding at present of the uals to catalog and enable discoveries about
mechanisms of virus-induced immune failure human diversity in the HLA region of the genome.
and pathogenesis. Studies suggest that dynamic The project ended officially in June 2005 but was
interactions between HCV and the infected host— extended through June 2006 without funding.

127
National Cancer Institute Health Research (CIHR) President Dr. Alan Bern-
stein and NIH Director Dr. Elias Zerhouni signed
Division of Cancer Control an agreement intended to strengthen research
and Population Sciences cooperation on health issues of priority to Ameri-
Alaska Native Tumor Registry. The Alaska can Indian, Alaska Native, Canadian First Nations,
Native Tumor Registry was initiated in 1974 as a Métis, and Inuit populations of the U.S. and Canada.
collaboration between the National Cancer Insti- This represents important institutional support
tute, the NIH, and the CDC using procedures for a collaborative project under development
developed by the National Cancer Institute’s Sur- through the CDC, the National Cancer Institute,
veillance, Epidemiology and End Results Program. the Indian Health Service, and several health orga-
In 1989 the National Cancer Institute entered into nizations in Canada. The purpose of the project is
an interagency agreement with the Alaska Native to assemble existing cancer surveillance data on
Medical Center through the Indian Health Service, American Indian/Alaska Native populations in the
with technical assistance provided by the Univer- U.S. and First Nations and Inuit populations of
sity of New Mexico. In 1999 the Alaska Native Canada into a North American cancer surveillance
Tumor Registry became an official part of the Sur- and cancer burden profile that will be useful for
veillance, Epidemiology and End Results (SEER) better identifying cancer risk factors and high risk
program. Accurate information on the unique can- groups, learning more about and improving our
cer patterns occurring in this population is useful ability to generate accurate data, and promoting
for provider education and training, program plan- collaboration between the U.S. and Canada. Sev-
ning, studies of cancer etiology, evaluation of eral challenges face the collaborating partners,
screening programs, and the development of inter- including the fact that the health agencies in the
ventions to improve patient care and programs for U.S. and Canada operate independently with dis-
cancer prevention and risk reduction. The Alaska tinct systems of health care and health data collec-
Native Tumor Registry is participating in several tion. The complexity and political sensitivity of
research projects, including a study of breast indigenous health issues and autonomous tribal
cancer and exposure to environmental organo- governments, U.S. health information privacy laws
chlorines among Alaska Native women and the and their Canadian equivalents, tribal distrust of
Nicotine Research and Tobacco Control Program. research and government, and tribal taboos relat-
The registry will play an important role in the col- ed to cancer pose additional challenges for this
laborative project between the U.S. and Canada project. This project will address the need to im-
described below. prove cancer surveillance for Native peoples in
Cancer Burden in Native Populations in the North America by assembling existing data for a
U.S. and Canada. With a difference of 6.4 years in North American cancer profile and promoting
life expectancy compared to the general popula- cross-border collaborative research addressing
tion, the First Nations and Inuit populations of data gaps.
Canada experience similar health disparities as Network for Cancer Control Research among
American Indian and Alaska Natives in the U.S., American Indian and Alaska Native Populations.
who experience life expectancies 4.7 years less The National Cancer Institute, through its Surveil-
than the general U.S. population. In Canada, can- lance Research Program, Division of Cancer Con-
cer is the third leading cause of death, following trol and Population Sciences, supports the Net-
injuries/poisonings and cardiovascular disease. work for Cancer Control Research between
In the U.S., cancer is the second leading cause of American Indian and Alaska Native Populations.
death for American Indians and the leading cause Established in 1990, this network of researchers
of death for Alaska Natives. In addition, five-year working among American Indians and Alaska
survival of American Indians and Alaska Natives Natives developed a National Strategic Plan for
is poorer than the general population. A better Cancer Prevention and Control Research in 1992.
understanding of the cancer burden in these The National Cancer Institute shares support for
culturally and genetically related populations network meetings with the Mayo Comprehensive
exposed to differing health care and social envi- Cancer Center.
ronments could lead to improved understanding Northwest Portland Tribal Registry Project.
of risk factors for cancer and effective preventive Over the last two decades, health care delivery for
interventions. Northwest American Indians and Alaska Natives
In September 2004, Canadian Institutes of has evolved from a centralized system maintained

128
by the Indian Health Service (IHS) to a diverse ern China, in northern Africa, and among Eskimos.
and complex environment. The Northwest Tribal The viral genes that are expressed in NPC include
Registry Project was developed in January 1999 the latent membrane proteins LMP1 and 2 and a
by the Northwest Tribal Epidemiology Center, a new family of mRNAs, transcribed through the
tribally operated program located at the Northwest BamHI A fragment. Glutathionein transferase
Portland Area Indian Health Board (NPAIHB) in fusion proteins will be synthesized to produce
Portland, Oregon. Through a contract with the monospecific antisera to identify the proteins in
National Cancer Institute, the existing disease transfected cell lines and in NPC tumor tissues.
registry has completed record linkage studies with The proteins will be tested for interactions with
state vital statistics data. The goal is to ascertain cellular proteins and for transactivation of the
the incidence and prevalence of diseases such as LMP1 promoter. To investigate the high incidence
cancer among Northwest American Indians and in specific populations and to explore a possible
Alaska Natives with an accuracy not previously genetic contribution to NPC, additional NPC sam-
possible. A critical difference between the North- ples will be obtained from Chinese, Caucasian,
west Tribal Registry Project and previous linkage Black, and possibly Inuit Americans.
studies is the longitudinal focus on building trend
data. National Heart, Lung,
Patterns of Cancer Care Among Native Ameri-
cans. Limited information is available about con-
and Blood Institute
temporary cancer care among Native American NHLBI has supported the Genetics of Coronary
populations. Data have been combined from Artery Disease in Alaska Natives (GOCADAN),
several sources, including SEER and the IHS, aug- which is a working partnership between the
mented by abstracting data from medical records Native-owned corporation that manages the
in a sample of cancer patients. The first project health care of the Alaska Natives of Norton Sound
focused on the linkage of SEER and IHS data files and investigators from the Strong Heart Study.
to evaluate the completeness and quality of data The Strong Heart Study is an 18-year study of car-
elements. A current effort involves gathering data diovascular disease (CVD) in American Indians.
on patterns of care for American Indians and Alaska GOCADAN presents an important opportunity
Natives living in South Dakota. to examine the marked increase in the prevalence
Native Cancer Information Resource Center of atherosclerosis and coronary artery disease
and Learning Exchange. Native C.I.R.C.L.E. has among the indigenous peoples of American Indian
been in operation as a national clearinghouse for and Alaskan descent. Furthermore, this is the first
cancer education materials specific to American project to identify and map genes that contribute
Indian and Alaska Native communities since 1998. to the risk of CVD in this unique and understudied
The center has become the educational arm for the population. The Eskimo villages that are partici-
American Indian/Alaska Native Leadership Initia- pating in GOCADAN are located in remote areas
tive on Cancer, funded as a cooperative agree- around the Norton Sound region of Alaska, where
ment. The center has the most up-to-date bibliog- the traditional Eskimo lifestyle is slowly being
raphy in the nation on cancer affecting American eroded by mechanization and a westernized diet
Indians and Alaska Natives. and where there has been relatively little outside
In 2005 the National Cancer Institute assisted genetic influence. The initial five-year (FY 2000–
the Native C.I.R.C.L.E. in funding the semi-annual 2004), $7.8 million study documented CVD and
meetings of the Network for Cancer Control related risk factors among 1,214 Alaska Natives
Research among American Indian and Alaska who are members of approximately 40 families.
Native Populations, in Rochester, Minnesota, and During 2005 the initial GOCADAN study was
Rockville, Maryland. extended to continue through 2010. This will
enable a thorough reexamination of the family
Division of Cancer Biology cohort. Early findings indicate high levels of
EBV Expression in Nasopharyngeal Carcinoma. smoking consumption, low but rising levels of dia-
The University of North Carolina–Chapel Hill is betes, and blood pressures and cholesterol levels
conducting research to determine the role of the that are similar to the general U.S. population.
Epstein–Barr virus (EBV) in the etiology of naso- NHLBI and the Canadian Institutes of Health
pharyngeal carcinoma (NPC), an epithelial malig- Research (CIHR) cosponsored a Working Group
nancy that develops with high incidence in south- meeting in July 2004 titled “Research with Arctic

129
Peoples: Unique Research Opportunities in Heart, social, economic, and cultural consequences that
Lung, Blood and Sleep Disorders” to address could result from a shift to alternative, market-
three objectives related to research with Arctic based diets.
peoples. The meeting included investigators from Many Alaska Natives obtain the majority of
Greenland, Iceland, and Russia, as well as Canada their diet through the harvest of wild foods, foods
and the U.S. The meeting concluded with a list of that are collected from the land and sea near their
recommendations for future research priorities, villages. Often the local economy is similarly
barriers, and solutions to Arctic research (avail- driven. Such is the case with the villages of Atka
able at www.nhlbi.nih.gov/meetings/workshops/ and St. Paul, Aleut villages dependent on tradi-
arcticpeoples.htm). A summary of the working tional foods collected from the Bering Sea. NIEHS
group recommendations was published in the Feb- funded a four-year project, focused on establish-
ruary 2006 issue of the International Journal of ing a model for addressing traditional food con-
Circumpolar Health. cerns and designed to demonstrate methods for
increasing village-based leadership and coopera-
tion among communities, researchers, and govern-
National Institute on Mental Health ment agencies. Over the next four years the
NIMH, in partnership with other agencies, project will develop a curriculum about dietary
has held two major conferences to introduce the risks and benefits in rural Alaska and disseminate
importance of suicide prevention in indigenous it throughout the state. If successful, these efforts
youth in the Americas for the International Polar will provide the capacity to address widespread
Year in 2007. In September 2005, NIMH and the popular concerns about the contamination of the
Fogarty International Center sponsored a half-day Alaskan traditional food supply and a methodology
symposium on international suicide prevention for villages to examine other food types that may
research at the XXII World Congress of the Inter- be widely consumed and potentially suffer from
national Association of Suicide Prevention (IASP) contamination because of environmental releases.
in Durban, South Africa. The presentations fea- Another NIEHS-funded project, Alaska Com-
tured findings from evidenced-based interven- munity Action on Toxics, works in partnership
tions and current information on the prevalence, with fifteen communities in the Norton Sound
risk factors, and prevention strategies in circum- region of Alaska to find effective means to limit
polar countries. the release of contaminants in the natural environ-
In February 2006, NIMH held a second confer- ment and to mitigate the human health effects. The
ence in conjunction with the IHS, the Canadian majority of the residents of these villages are Inu-
Institutes of Health Research, Health Canada, and piat and Yupik, indigenous people who depend on
the Assembly of First Nations and Inuit Tapiriit the harvest of wild foods to sustain them and their
Kanatomi. The goals of this meeting were to foster ways of life. Collaborative work will include con-
knowledge exchange on suicide prevention strate- structing a database of information regarding for-
gies, increase the number of indigenous research- merly used defense sites (FUDS) in the region and
ers, and promote collaborative projects. Recom- the contaminants found at these sites. Building
mendations that arose from the conference focused on successful work at St. Lawrence Island, Alaska,
on increasing the dialogue between communities investigators will develop a model for exchanging
and researchers in order to capture traditional cul- information among the communities about those
tural knowledge and practices and to refocus strategies that proved effective with the govern-
treatment on life-affirming messages rather than ment agencies responsible cleaning up FUDS in
on suicide and death. the region. They will work with village leaders to
provide training to oversee FUDS clean-up work,
National Institute of establish independent monitoring programs for
contaminants, and develop an environmental
Environmental Health Sciences health care curriculum for the diagnosis and treat-
NIEHS has been at the forefront of working ment of human health problems associated with
toward addressing dietary questions raised by environmental contaminants.
Native people living in villages throughout Alaska. The investigators will work with regional health
Issues include the risks associated with environ- care providers to develop an information exchange
mental contaminants bioaccumulating in traditional for health care professionals in the Norton Sound
foods and how they compare with the health, region to discuss the diagnosis and effective

130
treatment of human health effects of environmen- ences on Health among Alaska Natives, and
tal contaminants. They will analyze historical data Trauma and Treatment Paths for Alaska Native
from the Alaska Birth Defects Registry and work Children, Families, and Communities.
with regional health care providers to collect data The NCMHD Community-Based Participatory
on the frequency of birth defects among children Research Program (CBPR) aims to develop effec-
in the region. tive community-based participatory research pro-
Another goal of the project is to build the grams, which will accelerate both the translation of
research capacity in the affected communities. A research advances to health disparity communities
pilot study will analyze breast milk samples for the and the elimination of health disparities.
presence of contaminants. This study will help The University of Alaska Fairbanks’ Center for
residents design a methodology for conducting Alaska Native Health Research and the Yukon
research on contaminants that may be important Kuskokwim Health Corporation are collaborating
factors affecting the health of their communities to design, plan, and implement a CBPR project
so that they can be fully engaged in future human called Ellangneq (Awareness), which has the fol-
health and contaminants studies planned for the lowing aims:
region. This methodology will include protocols • To determine the highest-priority behavioral
for environmental sampling near FUDS in the health need in a preventative intervention in
region, examining body burdens of contaminants the largest Alaska Native cultural group, the
in residents, and documenting incidences of envi- Yupik of southwestern Alaska, through a
ronmental diseases. CBPR process led by a group of Yupik leaders
who will constitute the Yupik Research Coor-
National Center on Minority dinating Council (YRCC);
• To develop a manual of interventions appro-
Health and Health Disparities priate to a multilevel and multifactorial cultur-
NCMHD was charged by Congress to lead the ally based intervention procedure at the com-
Federal effort in health disparities research, research munity, family, and individual levels;
capacity-building, and outreach. The NCMHD has • To pilot test a universal, selective, or com-
fostered many initiatives to address health dispari- bined preventative intervention model for the
ties through collaborations across the DHHS) and behavioral health need identified; and
through implementing and nurturing its congres- • To design a five-year project for a random-
sionally mandated programs. Below is an overview ized, community-based prevention trial to
of NCMHD programs that have supported re- compete for the next round of funding.
search in the Arctic region, in countries such as The process involves a partnership led by a Yupik
Finland, Sweden, Canada, Russia, and Norway. Research Coordinating Council in which univer-
The NCMHD administers two loan repayment sity researchers and community partners become
programs that support its mission to attract health co-researchers. The knowledge acquired from this
professionals to careers in clinical and health research project can contribute to the design of
disparities research. The programs—Health Dis- prevention projects for small, remote, rural con-
parities Research (HDR-LRP) and Loan Repay- texts and small neighborhoods in the U.S., as well
ments for Clinical Researchers from Disadvan- as internationally within the developing world and
taged Backgrounds (ECR-LRP)—provide loan circumpolar north.
repayment of up to $35,000 per year to qualified The Minority Health and Health Disparities
doctoral degree professionals in exchange for two International Research Training (MHIRT) program
years of service in health disparities research or enables U.S. institutions to tailor short-term basic
clinical research. These programs promote a science, biomedical, and behavioral mentored stu-
diverse and strong scientific work force of individ- dent international research training opportunities
uals from health disparity, medically underserved, to address global issues related to eliminating
and disadvantaged communities. In FY 2005 these health disparities. Students participating in the
programs supported 12 researchers specifically MHIRT program address cultural, linguistic, and
targeting their research studies towards the Alaska ethical issues associated with biomedical, clinical,
Native and/or Native American communities. or behavioral health research. The program has
Examples of HDR-LRP awardees’ research projects exposed students to research training opportuni-
at the University of Alaska Fairbanks include Eth- ties in Sweden, Russia, and Finland. While in
nographic Research of Cultural–Behavioral Influ- these countries, the students have the opportunity

131
to conduct health disparities research in areas National Institute of Neurological
such as cell biology, molecular biology, toxicology,
endocrinology, genetics, and pharmacology.
Disorders and Stroke
A Florida International University (FIU) MHIRT Alaska Native Stroke Registry. The Alaska
program focuses on providing international Native Medical Center maintains several Alaska
research training opportunities to U.S. students. Native disease registries, including ones for can-
FIU’s nursing faculty will partner with foreign cer and diabetes. These registries have existed for
nursing faculty at the University of Tampere, Fin- several decades and have provided valuable data
land, and other institutions in Europe to provide for epidemiological studies of disease trends and
minority undergraduate and graduate nursing stu- for clinical studies of heath care management and
dents with international research training focused treatment intervention outcomes in the Alaska
on clinical research about disparities in the care Native population.
of chronically ill patients and their families. Stu- This hospital-based stroke registry started in
dents become part of a faculty research team, the fall of 2005 at the Alaska Native Medical Cen-
choose a topic of interest within the area of health ter in Anchorage. Its purpose is to study the
disparity in chronic illness care, and continue their unique determinants of stroke in Native Ameri-
study in a European country with an international cans/Alaska Natives, a population with an
mentor. Students will take additional courses increasing incidence of stroke. A pilot stroke regis-
focused on research conduct, culture and health, try, targeting Yupik Eskimos living in the Yukon–
skill development, attitudes, team roles, and the Kuskokwim Delta and Bristol Bay regions, will
rationale underlying the research. They will also establish registry infrastructure and data gather-
learn about the other country, its culture, and the ing methods. The registry will then expand state-
health needs of ill patients and families. They will wide and will include all Alaska Native subgroups.
be mentored in research throughout their current Ultimately this information will be used to con-
educational program and will participate actively struct uniquely tailored prevention and interven-
in the research team and contribute to disseminat- tion programs that are pertinent to Alaska resi-
ing the collaborative research through publica- dents, as well as people from other regions of the
tions and presentations toward promotion of a U.S.
research career. Over the four years of the FIU
MHIRT grant, it plans to recruit and mentor 19
undergraduate students and 6 graduate students.
National Library of Medicine
The Project EXPORT Centers of Excellence Pro- NLM has served as the primary repository of
gram promotes minority health and/or health dis- electronic resources on Arctic health-related
parities research; encourages the participation of issues, through the development of a web site:
members of health disparity populations in bio- arctichealth.org. In 2001 the Arctic Health web
medical and behavioral research, prevention, and site was moved to the University of Alaska, where
intervention activities through education and it has been supported with $65,000 annually. NML
training; and builds research capacity in minority- continues to contribute with recent updates
serving institutions. focused on the International Polar Year.
The University of Alaska Anchorage’s three-
year Project EXPORT grant established a Center
for Minority Health Research, for and with Alaska
Centers for Disease
Natives. The program, through the Alaska Control and Prevention
Native Science Research Partnerships for Health
(ANSRPH), had three aims. Alaska Natives were Arctic research programs of the Centers for
mentored and trained to initiate and conduct Disease Control and Prevention (CDC) are focused
health science research with disparate minority on improving public health in Arctic communities.
populations in Alaska. Non-Native researchers For the period 2004–2005, programs were con-
were mentored and trained to work within cross- ducted by the National Center for Infectious Dis-
cultural settings. Health science research partner- ease (NCID), the National Center for Environmen-
ships (with the Alaska Native Health Board, for tal Health (NCEH), and the National Institute for
example) were fostered for the development of Occupational Safety and Health (NIOSH). These
new investigations and for building on historic or programs represent an excellent example of inter-
current endeavors. agency cooperation and collaboration with the

132
Alaska Division of Public Health, the Alaska divisions, programs and centers within CDC; the
Native Medical Center, the Alaska Native Tribal National Institutes of Health; the Indian Health
Health Consortium, the Indian Health Service Service; and the State of Alaska.
(IHS), the Alaska Area Native Health Service
(AANHS), local and regional Native health corpo- Streptococcus pneumoniae
rations, universities, and other state and local Rates of invasive pneumococcal infection (bac-
agencies and organizations. teremia and meningitis caused by Streptococcus
The CDC’s goals include: pneumoniae) for Alaska Natives are the highest
• Healthy People in Every Stage of Life: All in the U.S. and are approximately five times higher
people, and especially those at greater risk of than non-Natives living in Alaska. This disease is
health disparities, will achieve their optimal most common in the very young and the elderly.
lifespan with the best possible quality of The case fatality from pneumococcal infection is
health in every stage of life. highest in the elderly. Once fully susceptible to
• Healthy People in Places: The places where antibiotics, Streptococcus pneumoniae has
people live, work, learn, and play will protect acquired resistance to commonly used antibiotics,
and promote their health and safety, especially which has complicated therapy. A 23-valent
those at great risk of health disparities. pneumococcal polysaccharide vaccine has been
• People Prepared for Emerging Health Threats: licensed for use in adults in the U.S. since 1983.
People in all communities will be protected The overall effectiveness against invasive pneu-
from infectious, occupational, environmental, mococcal disease among immuno-competent per-
and terrorist threats. sons above 65 years of age is 75%; however, effi-
• Healthy People in a Healthy World: Peoples cacy may decrease with increasing age.
around the world will live safer, healthier, and A new 7-valent pneumococcal conjugate vac-
longer lives through health promotion, pro- cine (PCV7) was licensed in 2000 for the preven-
tection, and health diplomacy. tion of pneumococcal disease in infants and
young children. Since then, routine use of PCV7
National Center for has resulted in a 90% decrease in invasive disease
in children less than two years old. This decline
Infectious Diseases was seen among both Alaska Native and non-
Infectious diseases are a continuing menace to Native children. This has eliminated the long-
all peoples of the globe, regardless of age, gender, standing health disparity suffered by Alaska
lifestyle, ethnic background, and socioeconomic Native children for vaccine-type disease. Because
status. They cause suffering and death, curb sus- the vaccine protects against the acquisition of
tainable economic development, and impose an new colonizing vaccine-type pneumococcus, vac-
enormous financial burden on all societies. Arctic cination has had the indirect effect of reducing
populations have long endured the debilitating transmission from vaccinated children to older
effects of both endemic and epidemic infectious children and adults. As a result, disease rates in
diseases, the effects of which have impacted both adults declined by 60% for vaccine serotypes. In
social and economic development in circumpolar addition, because vaccine-type pneumococci tend
regions of the globe. to be more often drug-resistant, the percentage of
The Arctic Investigations Program (AIP), located invasive pneumococci nonsusceptible to penicillin
in Anchorage, Alaska, is one of three U.S. field fell from 24% in 2000 to 15% in 2005.
stations operated by the National Center for Infec- AIP’s efforts to prevent pneumococcal disease
tious Diseases. The mission of AIP is prevention include ongoing pneumococcal disease surveil-
of infectious diseases among residents of all ages lance, case investigation, and efforts to evaluate
who live in the Arctic and Subarctic regions, and the best ways to promote and use pneumococcal
in particular the elimination of health disparities vaccines in the U.S. Arctic. This includes state-
that exist among the indigenous populations of wide laboratory surveillance, including confirma-
these regions. Research on the prevention and tion, serotyping, antimicrobial susceptibility test-
control of infectious diseases in these remote and ing, and molecular methods of diagnosis and
widely scattered populations with limited resources characterization through the use of polymerase
is accomplished through the development of part- chain reaction and pulsed-field gel electrophore-
nerships with communities; local, regional, and sis. AIP also collaborates on pneumococcal dis-
Native health organizations; universities; other ease prevention through the International Circum-

133
polar Surveillance, with all participating countries Methicillin-Resistant Staphylococcus aureus
involved in surveillance and standardization of In the past ten years, community-acquired
laboratory methods. MRSA soft tissue infections have become a prob-
lem among certain populations. In Alaska, out-
Haemophilus influenzae breaks of furuncles (boils) associated with S.
Haemophilus influenzae type b (Hib) was the aureus have long been a problem, especially in
most common cause of bacterial meningitis in pre- rural villages, although reports suggest that epi-
school-aged children prior to the development sodic clusters also occur in urban areas. Past
and widespread use of protein conjugate vac- investigations by AIP have revealed that MRSA
cines. Routine immunization of all Alaska Native has become the predominant S. aureus type (more
infants with an Hib conjugate vaccine began in than 85% of isolates) in large parts of rural Alaska
1991, reducing the incidence of invasive Hib infec- and has increased in urban Alaska, too. Risk fac-
tion more than ten-fold by 1993. The effectiveness tors for acquisition of MRSA infections in rural
of these vaccines is largely due to the induction villages include prior increased use of antimicrobi-
of circulating antibodies and the interruption of als, household members with boils, use of crowded
oropharyngeal carriage, leading to protection saunas, and use of a sauna with evidence of MRSA
of susceptible children through herd immunity. surface contamination. The public health response
Despite high vaccination rates and the success to this outbreak has included a revision of treat-
of Hib conjugate vaccines in preventing disease, ment guidelines emphasizing more careful use of
cases continue to occur among fully and partially antibiotics and recommendations for community
vaccinated Alaska Native children at rates higher education regarding judicious use of antibiotics
than for children in the general U.S. population. and the proper cleaning of home saunas. In addi-
Investigations into causes for the persistent cases tion, in 2005 the AIP established surveillance for
included a community-wide colonization survey MRSA infections in an urban location and a rural
in rural Alaska communities that revealed a contin- location to better understand the epidemiology
ued reservoir of Hib colonization among school- of the disease and to characterize the circulating
aged children and adults, indicating ongoing types by their Staphylococcal chromosomal
transmission. A case-controlled study of Hib- cassette carrying the mec A gene, the presence
colonized persons who revealed no immunologic of virulence factors, and antimicrobial resistance
deficiencies at the time of colonization showed elements.
that the response to the vaccine was robust
among children and adults. Future studies into Helicobacter pylori
factors related to transmission and virulence fac- High rates of Helicobacter pylori infection
tors among disease-causing organisms (such as have been documented in Alaska Natives. In gen-
excess capsule production) are planned. eral, Helicobacter pylori causes stomach ulcers,
A recent outbreak of Haemophilus influenzae and gastritis in about 10% of persons infected has
serotype A (Hia) disease among Alaska Native been associated with iron deficiency anemia and
children raised concerns about the emergence of a the development of gastric cancer. Past research
new pathogenic type. Data from the International has established that Alaska Natives have high
Circumpolar Surveillance revealed that an elevated rates of H. pylori infection that is acquired early in
rate of Hia was also present in Inuit children of childhood and that these infections are associated
northern Canada. In response, in 2004 AIP devel- with high rates of antimicrobial resistance, fre-
oped a rapid response plan to investigate each quent treatment failures, and a high rate of recur-
case of invasive H. influenzae disease in children rence. In addition, gastric cancer rates among
less than 10 years old in Alaska to determine risk Alaska Natives are three times higher than the
factors for disease acquisition, prevalence of colo- general U.S. population. Ongoing studies on Heli-
nization of the causal agent among close contacts cobacter pylori infection in three groups—urban
and the general community, immunologic response Alaska Natives, rural Alaska Natives, and urban
to infection, and effectiveness of chemoprophy- non-Natives following successful treatment of
laxis used to treat persons colonized with non-b infection—are now being completed. These stud-
serotypes. This effort is expected to provide some ies indicate that reinfection rates are much higher
of the data necessary for developing a prevention in urban than non-urban residents; risk factors for
strategy in case non-b-type Haemophilus should reinfection are being evaluated. Also, to promote
increase as a public health threat. diagnosis of antimicrobial resistance among clini-

134
cal H. pylori infections, AIP has evaluated a rapid ple and their environment. NCEH conducts
fluorometric technique for determining Clarithro- research in the laboratory and in the field to inves-
mycin resistance, a key antimicrobial in H. pylori tigate the effects of the environment on health.
treatment. AIP also supported a recently complet- They track and evaluate environment-related
ed study of H. pylori treatment among children health problems through surveillance systems,
with iron deficiency anemia that shows anemia to and they also help domestic and international
be refractory to eradication of H. pylori infection. agencies and organizations prepare for and
respond to natural, technologic, humanitarian, and
Respiratory Syncytial Virus terrorism-related environmental emergencies.
and Respiratory Disease The National Center for Environmental Health’s
The highest published RSV hospitalization Division of Environmental Hazards and Health
rate was reported in Native infants from Alaska’s Effects will continue a study of human exposure to
Yukon–Kuskokwim (YK) Delta. These illnesses environmental pollutants in the Arctic. The Mater-
have been implicated in a cycle of repeated lung nal Organics Monitoring Study (MOMS) collects
infections requiring hospitalizations leading to serum and urine samples from mothers during one
severe lung damage and bronchiectasis in some pre-natal visit and umbilical cord blood samples at
children. Ongoing disease surveillance, which delivery from Alaska Natives. These samples are
has been conducted in this region since 1993, has analyzed for persistent organic pollutants, non-
shown a remarkably high RSV hospitalization rate persistent pesticides, and trace metals, as well as
of 156 per 1,000 infants per year. During this period, for various nutritional markers. Pregnant women
lower respiratory tract infections (LRTIs) accounted are enrolled at the Yukon–Kuskokwim Delta
for 67% of all infant hospitalizations, and 32% Regional Hospital in Bethel in collaboration with
of the hospitalizations were associated with RSV the Yukon–Kuskokwim Health Corporation Delta
infection. Introduction of a monoclonal antibody and in communities in the Aleutian and Pribilof
treatment (palivizumab) has prevented illness Islands in collaboration with the Aleutian–Pribilof
among the highest-risk infants, but a prevention Island Association. Additional sites may be added
strategy for other children is lacking. Additionally, as the study progresses.
although the rate of RSV hospitalization in YK Preliminary results from MOMS suggest that
Delta children decreased from 178 per 1,000 infants lead concentrations in Bethel are two times higher
per year (1994–1997) to 104 per 1,000 infants per than in northern Alaska, where steel shot is the
year (2001–2004), the rate of non-RSV LRTI hospi- predominant form of ammunition used for hunting
talizations increased, and the overall LRTI hospi- animals, waterfowl in particular, which make up
talization rate remained stable at 284 per 1,000 part of the Native subsistence diet. A study was
infants per year. conducted to identify whether lead shot used for
Recent efforts have been to enhance utilization hunting is a source of lead exposure in Alaska
of palivizumab in rural Alaska and to use surveil- Natives. A cross-sectional exposure assessment
lance data to determine what months of the year study utilized isotope ratio (IR) methodology
it needs to be administered to high-risk children. to compare the isotopic profiles of blood lead in
Also, a recent study to evaluate the non-RSV bur- Alaska Native women of Bethel and Barrow, lead
den of respiratory hospitalizations among Alaska shot samples from Bethel and Barrow, and lead
Native children was begun in 2005 using poly- mineral and ore from a large smelter in Torreon,
merase chain reaction diagnostics to detect infec- Mexico, implicated as the source of the lead in the
tion of nine viral pathogens. This is intended to shot. The lead IRs from Torreon were significantly
provide an understanding of what pathogens have different from the blood samples of residents in
increased to replace the declining burden of dis- Bethel and Barrow, implying a different source of
ease due to RSV. lead exposure.
A study of environmental contaminants as
National Center for cofactors in breast cancer in Alaska Natives is
nearing completion. Two hundred study subjects
Environmental Health were enrolled, and analysis of their serum is com-
CDC’s National Center for Environmental plete. A unique aspect of this study is the inclu-
Health (NCEH) strives to promote health and qual- sion of serum collected from the women over time
ity of life by preventing or controlling diseases or and stored in the Alaska Area Specimen Bank. By
deaths that result from interactions between peo- analyzing stored serum and serum collected for

135
this study, researchers will be able to model expo- rapidly changing weather, and often poor local air-
sure to organochlorines over time. Preliminary port infrastructure, presents numerous challenges
results indicate a decline in levels of PCBs as well to commercial pilots. Between 1990 and 2002, avia-
as DDT and its metabolites. No relationship was tion crashes in Alaska caused 130 occupational
found between breast cancer and PCBs or DDT. pilot deaths. As part of the Alaska Interagency
Analysis of adipose tissue collected during breast Aviation Safety Initiative, NIOSH conducted a
biopsy will be completed this summer. survey of air taxi and commuter operators and
pilots across the state between August 2001 and
National Institute for January 2002. In 2004 and 2005 the final results
of these surveys were published in two articles
Occupational Safety and Health appearing in Aviation, Space and Environmental
Occupational Injury Prevention Medicine. When NIOSH compared companies
The National Institute for Occupational Safety with high fatal accident rates to other companies,
and Health (NIOSH) is the Federal agency respon- it found that pilots who worked for companies
sible for conducting research and making recom- with high fatal accident rates:
mendations for preventing work-related injury • Were three times more likely than pilots who
and illness. NIOSH has made a concerted effort to worked for other companies to fly daily into
decrease the number and rate of work-related inju- unknown weather conditions;
ries in the U.S. Arctic through its establishment of • Had less career flight experience than their
the Alaska Field Station (AFS). During 1990–2004, counterparts who worked for companies with-
the number of occupational fatalities in Alaska out high fatal accident rates; and
decreased by 60%, an average decrease of almost • Worked an average of ten more hours per
four deaths per year. AFS was established to spe- week than their counterparts who worked for
cifically target industries that face extreme hazards companies without high fatal accident rates.
due to the Arctic environment. This report contains These results have been used by the nonprofit
information on recent progress in preventing work- Medallion Foundation and local Federal offices
to target their prevention activities. During the 10-
year period of 1990–1999, there was an average of
11 fatal occupational aviation accidents per year;
however, since the start of the initiative (2000–
2004), that number had been reduced to an aver-
age of seven fatal occupational aviation accidents
per year. NIOSH will continue to work with other
Federal agencies, industry, and local safety orga-
nizations to improve aviation safety in the Arctic.

Commercial Fishing
The commercial fishing industry is a vital com-
ponent of Alaska’s economy. The crab fishing
vessels operating in the Bering Sea have histori-
cally had the highest work-related fatality rate
Occupational fatalities in related injuries in the air transportation industry, the of all fishing operations in Alaska. NIOSH has
Alaska by occupation, commercial fishing industry, and during subsis- worked with the U.S. Coast Guard, industry, and
1990–2004. The total tence activities, as well as summarizing NIOSH’s in- safety organizations to develop practical injury
was 862.
ternational work. NIOSH continues its commitment prevention solutions, evaluate these interven-
to preventing work-related injuries in the Arctic tions, and organize scientific conferences to dis-
through research, outreach with industry and com- cuss findings. From 1990 through 2004, deaths in
munity partners, and active prevention activities. commercial fishing in Alaska declined by 77%, due
to stronger safety policies under the Commercial
Air Transportation Fishing Industry Vessel Safety Act and partner-
Air transportation is the main method for trans- ships between CDC/NIOSH, the U.S. Coast Guard,
porting goods and people between rural Arctic vil- and other programs and agencies
lages and larger Alaskan cities. This dependence In addition to collecting information on fatal
on aviation, in conjunction with long distances, work-related events, NIOSH also conducts sur-

136
veillance for non-fatal injuries occurring to Alas- being made available in these communities to help
kan workers. NIOSH found that severe injuries in decrease falls on ice and snow.
the commercial fishing industry most commonly
were caused by deck machinery and fishing gear. International and Circumpolar
In November 2004 the NIOSH Alaska Field Station Collaboration, Conferences, and Workshops
partnered with the NIOSH Spokane Research Lab- The NIOSH Alaska Field Station has continued
oratory to develop engineering solutions for haz- its international research in partnership with com-
ards posed by fishing machinery and gear. An mercial fishing research scientists and injury pre-
emergency-stop system for use on capstan-style vention program workers, the circumpolar health
deck winches, typically found on purse seine fish- networks, and the World Health Organization’s
ing vessels, has been developed and tested at sea. International Safe Communities Program.
These winches have a long history of causing A representative from the NIOSH Alaska Field
severe or fatal injuries to fishermen, who can Station co-chairs the International Union for Cir-
become entangled in the capstan as the purse line cumpolar Health’s Injury and Occupational Safety
is being retrieved. The “e-Stop” system adds a and Health Working Groups. In addition, the AFS
switch that can immediately shut off hydraulic staff continues to work on hypothermia and cold-
power at the winch in the event someone becomes water drowning, on the prevention of worker
entangled, thus stopping it in time to prevent a deaths in Alaska, and on deaths of scientific field
serious injury or fatality. This technology is the workers in Alaska. In addition, AFS staff have
latest effort in ongoing injury prevention partner- continued to provide technical assistance to col-
ships between CDC/NIOSH, other government leagues at Karolinska Institute, Stockholm, Swe-
agencies, NGOs, industry, and workers. den; Linkopping University, Sweden; The Alberta
Additionally, in 2005 NIOSH evaluated the Injury Prevention Center, Alberta, Canada; and
Commercial Fishing Industry Vessel Safety Act Harstad Safe Communities, Harstad, Norway. They
requirements. When NIOSH compared victims also assisted in planning and vetting Occupational
from fishing vessel sinkings to survivors, it found Safety and Health submissions for the 13th Inter-
that victims were 7 times more likely not to have national Congress on Circumpolar Health held in
worn an immersion suit and 15 times more likely Novosibirsk, Siberia, Russia, in June 2006.
not to have used a life raft. This study shows that
immersion suits and life rafts save lives and that International Circumpolar
training in the use of equipment and the enforce-
ment of current regulations is needed.
Surveillance Initiative
The ICS network was established in 1999 by the
Subsistence Injuries CDC’s Arctic Investigations Program, first linking
NIOSH has also started to characterize the inju- clinical and public health laboratories in Alaska and
ries that occur during subsistence activities to northern Canada for the surveillance of invasive
formulate recommendations for injury prevention. diseases caused by Streptococcus pneumoniae.
Subsistence hunting, fishing, and gathering are Greenland joined the pneumococcal surveillance
common ways to supplement food supplies for network in 2000, followed by Iceland, Norway, and
people living in rural Alaska. It is also an important Finland in 2001. In 2000 an expand surveillance of
part of the Alaska Native lifestyle and tradition. other invasive bacterial diseases caused by Hae-
However, the nature of these activities and the mophilus influenzae, Neisseria meningitidis, and
harsh Alaskan environment may introduce multi- groups A and B streptococcus was implemented
ple hazards that could cause serious injury. in the U.S. Arctic and northern Canada. A northern
Injury events were identified using the Alaska region of Sweden joined ICS in 2003. Surveillance
Trauma Registry (ATR), a population-based sur- of invasive disease caused by these bacteria was
veillance system that compiles comprehensive chosen because rates of these diseases are elevated
information on all injuries requiring hospitalization in indigenous northern peoples, strains of these
in Alaska. Cutting instruments, firearms, and falls bacteria may acquire antibiotic resistance, these
were the three most common causes of injury. bacteria are routinely cultured in the clinical labo-
Efforts are being made to prevent these injuries, ratory, and diseases caused by clinically important
including firearm safety programs and local train- serotypes of Streptococcus pneumoniae, Haemo-
ing in the safe use of knives and other cutting philus influenzae, and Neisseria meningitidis are
instruments. Cleats or spike boot covers are also preventable by vaccine.

137
zae in Arctic countries is important to be able to
monitor the impact of conjugate vaccine programs
and the potential emergence of other serotypes
that may replace Hib as a major cause of severe
diseases in Arctic populations.
Similarly, surveillance of diseases caused by
Neisseria meningitidis showed that in the U.S.
Arctic, the highest rates of disease occurred in
Alaska Native children less than two years old
(19.5 per 100,000). As in the case of Streptococcus
pneumoniae and Haemophilus influenzae, contin-
ued surveillance of invasive diseases caused by
Neisseria meningitidis allows for the monitoring
of disease trends in populations and the detection
of clusters of disease, and it provides serogroup
information critical for vaccine recommendations.
The transfer of the Arctic Council chair to the
Russian Federation for 2005–2006 presents a
unique opportunity to explore the possibility of
expanded ICS activities to include the northern
Locations of clinical and Rates of invasive pneumococcal disease (com- regions of the Russian Federation. Other plans for
hospital laboratories monly pneumonia and bacteremia) for the period ICS include the continued surveillance of invasive
(small red dots), reference 1999–2005 were higher in Alaska Native and north- diseases caused by Streptococcus pneumoniae,
laboratories (large red
ern Canadian aboriginal populations than in non- Haemophilus influenza, Neisseria meningitidis,
dots), and countries
(shaded) participating in Native and non-aboriginal populations. The high- and groups A and B streptococcus in the U.S. Arc-
the International Circum- est rates occur in Native and aboriginal children tic, northern Canada, Greenland, and one region
polar Surveillance of in- under the age of two years. Analysis of pneumo- of northern Sweden and expansion in 2006 of the
fectious diseases during coccal serotypes causing disease in Arctic north- surveillance of diseases caused by Haemophilus
2004–2005. ern American populations indicates that 78–84% influenza, Neisseria meningitidis, and groups A
of invasive pneumococcal disease could poten- and B streptococcus to include Iceland and Nor-
tially be prevented. In Alaska, statewide use of the way. The surveillance of other diseases, such as
infant 7-valent conjugate vaccine began in 2001. tuberculosis, HIV/AIDS, and hepatitis, as well as
Immunization programs using both the 23-valent those infectious diseases that may emerge as a
adult vaccine and the 7-valent conjugate vaccine consequence of climate change, can be added to
were begun in two northern Canadian regions in ICS as the need and support arise.
2002. Continued surveillance of invasive pneumo-
coccal disease in these regions will monitor the International Polar Year:
impact and effectiveness of these vaccine pro-
grams.
Arctic Human Health Initiative
Prior to 1991, rates of invasive Haemophilus The Arctic Human Health Initiative (AHHI) is
influenzae type b (Hib) disease in the U.S. Arctic a U.S.-led IPY (2007–2008) Arctic Council (AC)
were among the highest in the world. However, project that aims to increase the visibility and
since the introduction of conjugate vaccine pro- awareness of health concerns of Arctic peoples,
grams in 1991, the rates of invasive Hib disease foster human health research, and promote health
have declined by 92%. Universal vaccine pro- protection strategies that will improve the health
grams for invasive Hib disease began in Canada and well-being of all Arctic residents. The AHHI is
in 1992, and there have been similar reductions in co-coordinated by the Department of State, the
rates of the disease there. Surveillance in 2000– U.S. Centers for Disease Control and Prevention’s
2005 show that overall rates of Hib remain elevated Arctic Investigations Program, the National Insti-
in the U.S. Arctic compared to the general U.S. tutes for Health’s Fogarty International Center,
population. The most common serotype in north- and the International Union for Circumpolar
ern Canada was serotype a. Health.
Continued surveillance for invasive diseases The AHHI core project will seek to advance the
caused by all serotypes of Haemophilus influen- joint circumpolar human health research agendas

138
of the Arctic Council (www.arcticcouncil.org ), an eases, and emerging infectious diseases such
eight-nation intergovernmental forum for sustain- as SARS;
able development and environmental protection, • The changing Arctic environment, as it affects
and the working groups of the International Union the evolution, ecology, and emergence of
for Circumpolar Health (IUCH). Current AC human zoonotic disease, particularly avian influenza;
health activities include monitoring the human • Chronic diseases such as cancer, cardiovas-
health impact of anthropogenic pollutants, climate cular diseases, obesity, and diabetes; and
variability, and infectious diseases and expanding • Behavioral issues, such as suicide, interper-
and assessing tele-health innovations in Arctic sonal violence, and substance abuse, and un-
regions. The IUCH (www.iuch.org) promotes inter- intentional injuries.
national cooperation, research, scientific informa- Research activities will include the use of cul-
tion exchange, and education in the areas of Arctic turally sensitive health interview surveys, which
health policy, birth defects and genetics, cancer, are a useful tool for characterizing health and risky
diet and heart, environmental health and subsis- behaviors, the health status of populations, and
tence food security, family health, fetal alcohol the development of culturally appropriate inter-
syndrome, health surveys, HIV/AIDS, STDs, ventions.
indigenous peoples’ health, infectious diseases, In the area of health communication, several
injury prevention, occupational safety and health, symposia and topic-specific workshops are
population-based planning, tobacco and health, planned before, during, and following IPY, which
and women’s health. An anticipated outcome of will allow the development of new collaborations,
the AHHI will be the development of an organiza- evaluations of advances made in the health of
tional infrastructure for coordinating human health Arctic peoples, assessments of the health dispari-
research activities in Arctic regions. ties that remain, and examinination of future risks
A key element of the AHHI will be developing to the health and well-being of all Arctic residents.
new, and expanding existing, human health sur- Details regarding AHHI specific projects, plans,
veillance, monitoring, and research networks. and progress can be found at www.arctichealth.org.
These circumpolar networks will allow the moni-
toring of diseases of concern in Arctic communi-
ties through the development of standardized Substance Abuse and
study protocols, data collection, laboratory meth-
ods, and data analysis. Once established, these Mental Health Services
networks will allow monitoring of disease preva-
lence over time, determination of risk factors for
Administration
disease, and evaluation and implementation of dis-
ease prevention and control strategies. Networks Cooperative Agreements for the Comprehensive
also provide opportunities for the development of Community Mental Health Services for Children
sustainable partnerships between communities and Their Families Program
and researchers through community-based moni- Under this program the Center for Mental
toring activities. Health Services (CMHS) provides grants and co-
A focus of the AHHI is the establishment operative agreements for states and tribal govern-
of research activities related to human health ments to develop systems of care for children with
issues of concern to Arctic residents. Priority severe emotional disturbance, along with their
areas include the human health impact of: families. Grantees include the Yukon Kuskokwim
• Regional and intercontinentally transported Health Corporation’s People Working Together
anthropogenic pollution in Arctic regions; Project in Bethel, which completed the six years of
• Oil, gas, and other sustainable development funding at the end of September 2005. Key pro-
activities; gram elements of their system of care initiative
• Contaminants and zoonotic infectious diseases, were sustained by the corporation and program
particularly as they relate to the traditional partners and were expected to continue to func-
food supply; tion successfully and serve children and families
• Climate variability, also as it relates to the tra- in the remote villages of southeast Alaska in the
ditional food supply; post-Federal funding phase. The Fairbanks Native
• Infectious diseases, including tuberculosis, Association’s Ch’eghutsen’ Project completed
HIV/AIDS, hepatitis, vaccine-preventable dis- their third of six years of funding under a coopera-

139
tive agreement at the end of September 2005 and • Identifying communities that have exemplary
were developing their system for providing com- comprehensive systems of care for these indi-
prehensive services to Alaska Natives in Fair- viduals so that they can provide technical
banks and the surrounding remote villages. assistance to other communities attempting to
set up similar systems of care;
Circles of Care Program • Providing technical assistance to communi-
Supported by CMHS, this program provides ties that do not have comprehensive systems
grants for tribes and urban Indian communities to of care for these individuals and their families;
plan, design, and assess culturally specific mental • Developing innovative techniques for pre-
health services system models for American Indian venting alcohol use by women in childbearing
and Alaska Native children and their families. There years; and
were no grants awarded this year for a new cohort • Supporting 35 subcontractors to integrate
of Circles of Care. However, bidders meetings were evidence-based practices to eliminate alcohol
held by contractors, and several Alaska Native consumption by pregnant women or improve
corporations submitted proposals for the next functioning and quality of life of those with a
cohort of Circles of Care grants announced in fetal alcohol spectrum disorder. Subcontracts
October 2005. were awarded in FY 2005 to initiate the plan-
ning year. The Bristol Bay Area Health Corpo-
Alaska Fetal Alcohol Syndrome/ ration, located in southwest Alaska, was one
Alcohol-Related Birth Defects Program of the 35 subcontractors funded to serve rural
Alaska has had a relatively high incidence of communities. Bristol Bay developed a plan in
fetal alcohol syndrome/alcohol-related birth defects FY 2005 to implement both FASD prevention
(FAS/ARBD) births. The overall goal of this pro- and treatment services in FY 2006.
gram was to improve the practice of identifying,
preventing, and treating FAS/ARBD. The project State Targeted Capacity Expansion Screening,
was a comprehensive, integrated approach to FAS, Brief Intervention, Referral and Treatment Program
involving prevention, intervention, and service Through a grant with the Cook Inlet Tribal
delivery in Alaska. It was a $5.8-million Congres- Council, the Screening, Brief Intervention, Referral
sionally earmarked project that was jointly funded and Treatment program enhances screening, refer-
by the Center for Substance Abuse Prevention and ral, brief intervention, and treatment services for
the Center for Substance Abuse Treatment. The adults and establishes those services for adoles-
project provided prevention activities, including cents. Its overarching goal is to reduce substance
education and training of service providers, public use by participating patients.
school students and their families, and the general
public. Interventions included family planning, alco- Targeted Capacity Expansion—
hol treatment, and other services for women of child- American Indians/Native Alaskans Program
bearing age at high risk for having a child with The project will expand service to provide resi-
FAS/ARBD. The project ended in September 2005. dential substance abuse treatment to 32 Alaska
Native Elders annually. The project is through the
Fetal Alcohol Spectrum Disorders Cook Inlet Tribal Council, and clients are drawn
Center for Excellence from throughout the state. The grantee uses a
Supported by the Center for Substance Abuse therapeutic community treatment model, modified
Prevention and funded for approximately $38 mil- for Alaska Native culture and conceptualized as a
lion for five years (through FY 2006), the Fetal “Therapeutic Village of Care.”
Alcohol Spectrum Disorders Center for Excellence
coordinates activities to ensure that advances in Enhanced New Life Project
both science and practice are synthesized and effi- The Enhanced New Life Project expands a com-
ciently disseminated to the field. Among the cen- prehensive continuum of care for 12 additional
ter’s activities are: adolescents living in interior and northern Alaska.
• Studying adaptations of innovative clinical Services are provided through the Fairbanks Native
interventions and service delivery improve- Association and range from residential co-occurring
ment strategies for children and adults with disorders treatment to outpatient chemical depen-
fetal alcohol syndrome or alcohol-related birth dence treatment. The continuum of care embraces
defects and their families; an evidence-based treatment model integrating

140
conventional western treatment and traditional focusing on staffing competency, credentialing
Athabascan healing techniques, practices, and and licensure, financial planning and reimburse-
principles. ment, and information sharing and data collection.

Pregnant/Post-Partum Women Program Treatment for Homelessness Grants


This program expands the availability of com- The goal of the Treatment for Homelessness
prehensive, high-quality residential substance Grants is to reduce substance abuse among
abuse treatment coupled with primary health, men- Anchorage’s population of homeless individuals
tal health, and social services to women and their with substance abuse disorders by expanding and
children. The grant funds the Fairbanks Native strengthening services. Wraparound and case
Associations’ Women and Children’s Center for management services are provided to move home-
Inner Healing to expand its services through the less people who chronically abuse substances to-
Healthy Women–Healthy Children Project. It pro- ward self-sufficiency in health and basic needs,
vides critical medical and substance abuse treat- including housing.
ment services, including residential services, par- Through the Homeless Addictions Treatment
ticularly to Alaska Native women in isolated rural Program in Anchorage, the Rural Alaska Commu-
areas with limited health care available. nity Action Program provides services for home-
less, late-stage chronic alcoholics by using
Treatment of Persons with Co-Occurring engagement, detoxification, case management,
Substance Related and Mental Disorders and life skills training.
This grant to the State of Alaska is designed The Cook Inlet Tribal Council operates the
to improve the identification and treatment of indi- Transitions Program in the Recovery Services
viduals with co-occurring disorders throughout a Division. The Transitions Program is a one-stop
diverse delivery system. Alaska has committed to access point for health care, mental health care,
addressing SAMHSA goals of improved screen- self-sufficiency services, social supports, housing
ing, assessment, treatment, and training, which is and substance abuse treatment, and follow-up
accomplished by developing infrastructure and services for persons with chronic alcoholism.

141