The United States has a trust responsibility to provide services to American Indians and Alaska Native (AI/AN) persons. However, a long-standing history of underfunding of the Indian Health Service (IHS) has led to significant challenges in providing services. Twentieth century laws, including the Snyder Act, Transfer Act, Indian Self-Determination and Education Assistance Act, and Indian Health Care Improvement Act (IHCIA) have had an effect on the way health services are provided. IHCIA was reauthorized as part of the Patient Protection and Affordable Care Act (ACA). Several provisions in ACA allow for potential improvements in access to services for AI/AN populations and are described herein. Although policy developments have been promising, IHS underfunding must be resolved to ensure improved AI/AN health.

Increasing American Indian/Alaska Native (AI/AN) representation in genetic research is critical to ensuring that personalized medicine discoveries do not widen AI/AN health disparities by only benefiting well-represented populations. One reason for the under-representation of AIs/ANs in research is warranted research distrust due to abuse of some AI/AN communities in research. An approach to easing the tension between protecting AI/AN communities and increasing the representation of AI/AN persons in genetic research is community-based participatory research. This approach was used in a collaboration between a tribe and academic researchers in efforts to increase AI/AN participation in genetic research. From the lessons learned, the authors propose recommendations to researchers that may aid in conducting collaborative and respectful research with AI/AN tribes/communities and ultimately assist in increasing representation of AIs/ANs in personalized medicine discoveries.

This compilation includes the stories of five Native American and First Nation elders, in which they share their wisdom, experience, and opinions on Indigenous food systems and health. Each of these elders participated in the Fourth Annual Conference on Native American Nutrition, held in September 2019 at Mystic Lake Center on land of the Shakopee Mdewakanton Sioux Community in in Prior Lake, Minnesota.

Introduction A potential precision medicine approach to smoking cessation is tailoring pharmacotherapy to a biomarker known as the nicotine metabolite ratio (NMR). Little is known about the potential impact and acceptability of this approach for American Indian (AI) persons. Methods Tribal-academic collaboration was formed and during 2019-2020 AI adults who smoke(N=54) were recruited to 1) examine correlations between NMR, dependence, and smoking exposure; 2) assess the extent to which pharmacotherapy preference aligned with NMR-informed recommendations; 3) explore acceptability of NMR-informed pharmacotherapy selection. Participants provided samples for assessment of salivary NMR and urinary total nicotine equivalents (TNE) and completed a questionnaire that assessed cigarettes per day (CPD), Fagerstrom Test for Cigarette Dependence (FTCD), pharmacotherapy preference, and perceptions of NMR-informed pharmacotherapy selection. Results Significant positive correlations were observed between NMR and FTCD (r=0.29;p-value=0.0383) and its abbreviated version Heaviness of Smoking Index (r=0.28;p-value=0.0426). Post-hoc analyses suggest relationships between dependence and NMR were driven by time to first cigarette. Non-significant, but directionally consistent, relationships were observed between NMR and CPD (r=0.21;p-value=0.1436) and TNE (r=0.24;p-value=0.2906). Most participants preferred nicotine replacement therapy (71%) over varenicline (29%) and preference for pharmacotherapy matched NMR-based recommendations in 54% of participants. NMR-informed pharmacotherapy selection was supported by 62% of participants. Conclusion In a sample of AI adults who smoke, NMR was related to cigarette dependence and about one-half of participants’ pharmacotherapy preference matched their NMR-informed recommendation. There was lower acceptability of NMR-informed approach in this sample of AI adults than prior studies among White or Black/African American people who smoke. Implications Relationships between NMR, dependence, and self-preference for pharmacotherapy suggest that NMR-informed pharmacotherapy selection may have potential for enhancing smoking quitting success in this Tribe. Lower acceptability of NMR-informed pharmacotherapy in this Tribe suggests that this approach may not be equitably utilized. Future work could include identifying community-driven solutions to mitigate precision medicine concerns.

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