Sanford School of Medicine Project EXPORT


EXPORT Research Projects 
  • The EXPORT grant has funded a series of research projects on topics of significant interest to the Tribes. 
  • These include two major multi-year studies, five planning studies, and three Tribally-requested studies.  
Specific Projects
  • Cultural Resilience and Adolescent Risk Behaviors
  • Early Predictors of Adverse Neurobehavioral Outcomes in Young Children of the Northern Plains
  • Characterizing BASE and HER2 for Use as Breast Tumor Markers in American Indians  
  • Adversarial Growth within American Indian Communities: Trauma and Recovery among Community College Samples
  • Role of Myotonic Dystrophy Protein Kinase (DMPK) in Cervical Cancer in American Indian Women
  • Cultural Viewpoints of Prenatal Care: A Pilot Study with the Oglala Sioux Nation
  • Breathing Relief Education and Tribal Health Empowerment (BREATHE) Project
  • Health of Prisoners Study Health Beliefs and Attitudes Survey
  • Effects of Targeted Training of Tribal Staff on Physical Activity Participation    
Major Research Study I:
Cultural Resilience and Adolescent Risk Behaviors – (current status)
  • This project was designed in a community-based, participatory research model which first uses surveying to identify the factors that contribute to American Indian adolescents' choices to avoid or engage in risk behaviors that are detrimental to transitions to successful adulthood, including the extent to which cultural 'attachment' and involvement is a protective factor.
  • This information then aids in the development and implementation of culturally-appropriate interventions to reduce identified risk factors and strengthen cultural resilience of adolescents, with Tribal guidance and participation in conducting/structuring the interventions. 
  • The outcomes of these interventions are then evaluated over a three-year period and the resulting information then shared.  
  • To date this surveying has been conducted on three reservations (Ft. Peck, Ft. Belknap, Crow) and encompassed 460 participants.
  • The design of the intervention database was created in September 2008 and enrollment and participation data were entered on an ongoing basis. 
  • This year has focused on the intervention phase of this research. 
  • Fort Peck and Ft. Belknap have continued into this implementation phase, but Crow participation ended following the survey phase.   
  • Analysis of the baseline data has resulted in a series of key findings which now await publication.    
Major Research Study II:
Early Predictors of Adverse Neurobehavioral Outcomes
in Young Children of the Northern Plains – (current status)
  • This project seeks to better define the relationship between prenatal alcohol exposure, SIDS, and FASD. It is built upon the infrastructure established by the Safe Passage Study, a longitudinal study of the effect of prenatal alcohol exposure of fetal and infant mortality. 
  • The Safe Passage Study enrolled women early on during pregnancy and followed the infants through 2 months of age. 
  • The women enrolled in the Safe Passage Study were then eligible to participate in the Early Predictors study, where their child's health and development is followed through age 2 ½ . 
  • The Early Childhood Predictors Study has two study sites located on the Pine Ridge and Spirit Lake reservation communities. 
  • A cohort of 106 infants was recruited and are being followed. 
  • The data garnered is now reaching a point where analysis is possible. 
  • Analysis priorities include: (1) how knowledge of fetal alcohol syndrome relates to prenatal alcohol consumption and avenues for more effective public health campaigns to decrease prenatal alcohol use, (2) comparison of reports of maternal alcohol use during pregnancy versus retrospective accounts two years later, and (3) prevalence of behaviors that place infants at risk for death in the first year of life.    
Planning Study 1
Characterizing BASE and HER2 for Use as Breast Tumor Markers
in American Indians (Kristi Egland, Ph.D.)
  • The overall goals were to define the frequency of a newly discovered breast tumor marker, BASE, and amplification of a clinically validated marker, HER2, in breast cancers from Native American women. 
  • The lab screened 51 breast cancer samples from Native American women, and only 8 were identified as being HER-2 positive. Thus, only about 15.6% of the Native American breast cancers studied exhibit HER-2 amplification. 
  • Compared to the general population, this percentage is considerably lower and suggests that breast cancers from Native American women have a lower frequency of HER-2 amplification.  
Planning Study 2
Adversarial Growth within American Indian Communities:
Trauma and Recovery among Community College Samples
(Dr. Annie Belcourt-Dittloff) 
  • The aims were to investigate health disparities within mental health that may impact rates of suicide and mental health problems for American Indians and identify potential protective factors hypothesized to help individuals adaptively cope with trauma.  
  • A total of 160 self-identified Native American students from the Blackfeet Community College were recruited. 
  • The major finding of this study was that, while the majority of the sampled participants (118 of 143) experienced significant traumatic events in their lives, the majority of the participants demonstrated significant resiliency and were asymptomatic for PTSD. 
  • The participants were able to positively cope by relying on their American Indian identity, culture, being attached to their community, relying on their spirituality, and adaptively responding to significant traumatic experiences.  
Planning Study 3
Role of Myotonic Dystrophy Protein Kinase (DMPK) in Cervical Cancer
in American Indian Women (Subhash C. Chauhan, Ph.D.)
  • Aim 1: To determine the expression pattern of myotonic dystrophy protein kinase (DMPK) in cervical cancer at different stages. A total of 58 clinical samples were analyzed and the resulting data clearly suggest a marked down regulation of DMPK in cervical cancer samples of different stages. Data also suggest that DMPK downregulation starts upon initiation of early stages of cervical cancer such as CIN1 or CIN2.  Thus, DMPK may be associated with early events of cervical cancer and may serve as a surrogate marker of cervical cancer.
  • Aim 2: To determine the effect of HPV infection on DMPK expression and the role of DMPK in cervical cancer. To determine the effect of HPV infection on DMPK expression researchers optimized the double IHC staining to co-localize HPV E6/E7 onco-protein and DMPK. DMPK overexpression through adenoviral system markedly reduced cell proliferation via arresting cells in G1/G0 phase of cell cycle. These data suggest that DMPK may be target for gene therapy.  
Planning Study 4
Cultural Viewpoints of Prenatal Care:
A Pilot Study with the Oglala Sioux Nation (Jessica Hanson, M.A.)
  • Specific aims were: (a) to identify current trends of prenatal care for American Indian women of the Oglala Sioux Tribe and (b) to define conflicting viewpoints between traditional American Indian views of prenatal care and pregnancy and current medical practices. A total of 58 women were the interviewing and survey from which this study drew its conclusions. 
  • It was noted by various participants that: (1) physicians seemed too busy to ask or respond to questions, (2) that physicians did not care about the patient or their reasons for seeking care, and (3) that there is an overall lack of trust of physicians, especially white physicians, and "modern ways of medicine."  Other barriers included transportation, work schedules not responsive to appointments, severe interpersonal problems interfering, and lack of support from their partner/spouse.
  • The majority of participants preferred having a female provider during her prenatal care, especially when it was a provider that they saw regularly and continuously.  
Planning Study 5
Breathing Relief Education and Tribal Health Empowerment (BREATHE) Project (James Wallace, M.D)
  • The main hypothesis was that individualized asthma education & subsequent follow-ups can improve medication compliance and positively impact quality of life in people with asthma.
  • The outcomes were demonstrably positive for the 50 participants (20 male, 30 female) from the Cheyenne River Sioux Tribe. 
  • At the onset and previous to the education, the Asthma Control score of 2/3 of the participant's (33 of 50) placed them in the "Very Poorly Controlled" category. All of the remaining participants qualified as "Not Well Controlled." Obviously, none managed to attain the  "Well Controlled" level. 
  • Within four weeks of education, the percentage had changed markedly. Over 50%  (51.4%) of the continuing participants qualified as "Well Controlled." 
  • Three additional follow-ups verified that this percentage held up even a year out from the educational experience. 
  • There were also substantial positive impacts on the Asthma Quality of Life and Asthma Knowledge scales.  
Tribally-Requested Preliminary Study 1
Health of Prisoners Study (Dr. Mary Rogers)

A survey instrument was developed and administered to selected American Indian and non-Indian prisoners at two Montana prisons. (147 total).  Key findings of the study include:

  • 43 percent of all participants in the study reported having a brain injury at some point in their lifetime; 30 percent of all participants reported a physical disability; and almost 30 percent reported having a learning disability or having been in special education classes or on an IEP during elementary or high school
  • Over 40 percent of all inmate medical records had no documentation on Hepatitis C status
  • Almost 80 percent of all inmates reported use/abuse of drugs; 53 percent reported engagement in high risk behaviors (IV drug use/multiple sex partners/unprotected sex)
  • When asked to express their opinions about the health care system while incarcerated, 61 percent said that they believed that they would not likely receive major medical care while in prison.  
Tribally-Requested Preliminary Study 2
Health Beliefs and Attitudes Survey (Dr. Cheryl Anagnopoulos)

This preliminary study was conducted with the Northern Cheyenne Tribe in Montana and with a sample of non-Indian respondents in Western South Dakota (Spearfish, SD).  The total number surveyed was 836 with approximately equal numbers at each site.  Analysis of data showed that:

  • In contrast to the non-Indian comparison group, Northern Cheyenne participants had a higher frequency of high blood pressure, strokes, and diabetes and significantly more visits to the emergency room than the non-Indian comparison group
  • Northern Cheyenne participants perceived their health as being worse, were more concerned about their health, and reported greater concern about their future health conditions than the non-Indian comparison group
  • Responses from Northern Cheyenne participants indicated that health care was hard to obtain, that they were not treated with courtesy and respect, nor had they received enough time with the doctor. Participants also reported greater concerns over the side effects of medications than the non-Indian comparison group
  • Data from Northern Cheyenne participants indicated that a high percentage use traditional healing practices. The use of traditional healing practices was not predicted by health status.  
Tribally-Requested Preliminary Study 3
Effects of Targeted Training of Tribal Staff
on Physical Activity Participation (Dr. Robert Schurrer)

This pilot study assessed the impact of targeted training of Wellness Center program staff on the Crow Creek Reservation. Following training of staff assessments demonstrated that: (a) Tribal Wellness Center staff increased their knowledge of appropriate physical activity levels and plans for people with diabetes and (b) There was a subsequent increase in the number of Tribal members with diabetes for whom exercise plans were prepared and, in turn, an increase in the use of the Wellness Center by Tribal members with diabetes.