The Cerebrovascular Disease and its Consequences in American Indians (CDCAI) Study recruited surviving members of a 20-year, longitudinal, population-based cohort of American Indians focused on cardiovascular disease, its risk factors, and its consequences. The goal of the CDCAI Study is to characterize the burden, risk factors, and manifestations of vascular brain injury identified on cranial MRI. The CDCAI Study investigators enrolled 1,033 participants aged 60 and older from 11 American Indian communities and tribes in the Northern Plains, Southern Plains, and Southwestern United States. In addition to cranial MRI performed according to standardized protocols, participants underwent extensive medical interview, clinical examination, neurocognitive testing, physical function evaluation, electrocardiogram, and provided blood and urine specimens. Participants also self-administered questionnaires covering demographics, quality of life, and medical history. This report describes the design, implementation, and some of the unique challenges of this study and data collection.

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Elevated exposure to arsenic disproportionately affects populations relying on private well water in the United States (US). This includes many American Indian (AI) communities where naturally occurring arsenic is often above 10 µg/L, the current US Environmental Protection Agency safety standard. The Strong Heart Water Study is a randomized controlled trial aiming to reduce arsenic exposure to private well water users in AI communities in North Dakota and South Dakota. In preparation for this intervention, 371 households were included in a community water arsenic testing program to identify households with arsenic ≥10 µg/L by inductively coupled plasma mass spectrometry (ICP-MS). Arsenic ≥10 µg/L was found in 97/371 (26.1%) households; median water arsenic concentration was 6.3 µg/L, ranging from <1-198 µg/L. Silica was identified as a water quality parameter that could impact the efficacy of arsenic removal devices to be installed. A low-range field rapid arsenic testing kit evaluated in a small number of households was found to have low accuracy; therefore, not an option for the screening of affected households in this setting. In a pilot study of the effectiveness of a point-of-use adsorptive media water filtration device for arsenic removal, all devices installed removed arsenic below 1 µg/L at both installation and 9 months post-installation. This study identified a relatively high burden of arsenic in AI study communities as well as an effective water filtration device to reduce arsenic in these communities. The long-term efficacy of a community based arsenic mitigation program in reducing arsenic exposure and preventing arsenic related disease is being tested as part of the Strong Heart Water Study.

Objective: Perceptions of social-contextual food environments and associated factors that influence food purchases are understudied in American Indian (AI) communities. The purpose of this study was to: (1) understand the perceived local food environment; (2) investigate social-contextual factors that influence family food-purchasing choices; and (3) identify diet intervention strategies. Design: This qualitative study consisted of focus groups with primary household shoppers and key-informant interviews with food retailers, local government food assistance program directors, and a dietician. An inductive, constant comparison approach was used to identify major themes. Setting: This study setting was a large AI reservation community in the North-Central United States. Participants: Four focus groups (n=31) and seven key-informant interviews were conducted in February and May 2016. Results: Perceptions of both the higher cost of healthy foods and limited access to these foods influenced the types of foods participants purchased. Dependence on government assistance programs (and the timing of benefits) also contributed to the types of food purchased. Participants described purchasing foods based on the dietary needs and preferences of their children. Suggestions for improving the purchase and consumption of healthy foods included: culturally-relevant and family-centered cooking classes and workshops focused on monthly food budgeting. Participants also emphasized the importance of involving the entire community in healthy eating initiatives. Conclusions: Cost and access were the major perceived barriers to healthy eating in this large rural AI community. Recommended interventions included: (1) family-friendly and culturally-relevant cooking classes; (2) healthy food budgeting-skills training; and (3) approaches that engage the entire community.

To understand the local food environment in a rural American Indian community, we assessed the availability and price of healthy foods offered at all stores (n = 27) within a 90-mile radius of the town center of a large American Indian reservation. Stores were classified by type, and availability and cost of foods were measured using the Nutrition Environment Measures Survey in Stores (January–February 2016). Healthy foods were available at most grocery stores (>97%), although the price of foods varied considerably among stores. Having quantified the availability and cost of food, efforts must focus on understanding other structural and contextual factors that influence diet in this community.