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Multilevel and Community-Level Interventions with Native Americans: Challenges and Opportunities

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Multilevel and community-level interventions that target the social determinants of health and ultimately health disparities are seldom conducted in Native American communities. To contextualize the importance of multilevel and community-level interventions, major contributors to and causes of health disparities in Native communities are highlighted. Among the many documented socioeconomic factors influencing health are poverty, low educational attainment, and lack of insurance. Well-recognized health disparities include obesity, diabetes, and hypertension. Selected challenges of implementing community-level and multilevel interventions in Native communities are summarized such as the shortage of high-quality population health data and validated measurement tools. To address the lack of multilevel and community-level interventions, the National Institutes of Health created the Intervention Research to Improve Native American Health (IRINAH) program which solicits proposals that develop, adapt, and test strategies to address these challenges and create interventions appropriate for Native populations. A discussion of the strategies that four of the IRINAH grantees are implementing underscores the importance of community-based participatory policy work, the development of new partnerships, and reconnection with cultural traditions. Based on the work of the nearly 20 IRINAH grantees, ameliorating the complex social determinants of health disparities among Native people will require (1) support for community-level and multilevel interventions that examine contemporary and historical factors that shape current conditions; (2) sustainability plans; (3) forefronting the most challenging issues; (4) financial resources and time to collaborate with tribal leaders; and (5) a solid evidence base.

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This Supplemental Issue of Prevention Science was supported through funds from the National Cancer Institute (NCI). The research projects in which the issue is based include 26 awards through PAR-11-346 and PAR-14-260, funded through the National Cancer Institute (NCI), National Heart, Lung, and Blood Institute (NHLBI), National Institute on Alcohol Abuse and Alcoholism (NIAAA), National Institute of Dental and Craniofacial Research (NIDCR), National Institute on Drug Abuse (NIDA), National Institute of Environmental Health Sciences (NIEHS), National Institute of Mental Health (NIMH), National Institute of Nursing Research (NINR), Office of Behavioral and Social Sciences Research (OBSSR), and National Institute on Minority Health and Health Disparities (NIMHD). Support for this paper included grants from NHLBI (R01HL117729, Jernigan, PI); NIMHD (R01MD011266, Jernigan, PI); and NIAAA (R01AA022066, D’Amico, PI; R01 AA022068, Duran, PI).

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Correspondence to Valarie Blue Bird Jernigan.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The studies referenced in this article did not include animals.

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Informed consent was obtained from all individual participants included in these studies.

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Blue Bird Jernigan, V., D’Amico, E.J., Duran, B. et al. Multilevel and Community-Level Interventions with Native Americans: Challenges and Opportunities. Prev Sci 21 (Suppl 1), 65–73 (2020).

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