Within the past 2 decades, community capacity building and community empowerment have emerged as key strategies for reducing health disparities and promoting public health. As with other strategies and best practices, these concepts have been brought to indigenous (American Indian and Alaska Native) communities primarily by mainstream researchers and practitioners. Mainstream models and their resultant programs, however, often have limited application in meeting the needs and realities of indigenous populations. Tribes are increasingly taking control of their local health care services. It is time for indigenous people not only to develop tribal programs but also to define and integrate the underlying theoretical and cultural frameworks for public health application.

Background: Downward trends have been observed in oral cancer incidence and mortality in the US over the past 30 years; however, these declines are not uniform within this population. Several studies have now demonstrated an increase in the incidence and mortality from oral cancers among certain demographic groups, which may have resulted from increased risks or risk behaviors. This study examines the underlying data that comprise these trends, to identify specific populations that may be at greater risk for morbidity and mortality from oral cancers.

The practicality and moral value of community review of human genetic research has become a focus of debate. Examples from two Native American communities are used to address four aspects of that debate: (1) the value of community review in larger, geographically dispersed populations; (2) the identification of culturally specific risks; (3) the potential conflict between individual and group assessments of research-related risks; and (4) the confusion of social categories with biological categories. Our experiences working with these two communities suggest that: (1) successful community review may require the involvement of private social units (e.g., families); (2) culturally specific implications of genetic research may be identifiable only by community members and are of valid concern in their moral universes; (3) community concerns can be incorporated into existing review mechanisms without necessarily giving communities the power to veto research proposals; and (4) the conflation of social and biological categories presents recruitment problems for genetic studies. These conclusions argue for the use of community review to identify and minimize research-related risks posed by genetic studies. Community review also can assist in facilitating participant recruitment and retention, as well as in developing partnerships between researchers and communities.

Objective The Life in BALANCE (LIB) study is a pilot translational study modeling the Diabetes Prevention Program (DPP) intensive lifestyle coaching intervention among an underserved, high-risk population: American Indians/Alaska Natives (AI/ANs) living in a large urban setting (Las Vegas, Nevada). Research Design and Methods A total of 22 overweight/obese AI/ANs (age, 39.6 ± 10.4 years; BMI, 34.1 ± 6.3 kg/m2) at increased risk for developing type 2 diabetes (HbA1c > 5.4 (36 mmol/mol) < 6.4 percent (46 mmol/mol) participated in the program between April and December, 2011. Study participants completed a 16 week intensive lifestyle coaching intervention. In addition to obtaining qualitative data regarding opportunities and challenges of applying the lifestyle intervention for AI/AN participants in an urban setting, clinical data, including BMI, waist circumference, blood pressure, fasting blood glucose, and blood lipids (HDL, LDL and Triglycerides), were collected. Results Only 12 of the 22 participants remained in the LIB program at the final post-program follow-up. Participants demonstrated significant decreased waist circumference and elevated HDL cholesterol. Triglycerides manifested the highest percentage change without statistical significance. No significant change was observed in blood pressure or fasting blood glucose. Conclusions LIB participants’ improvements in BMI, waist circumference, HDL cholesterol and triglycerides suggests type 2 diabetes prevention programs aimed at urban AI/ANs show significant potential for reducing the risk of developing type 2 diabetes among this underserved and high risk community. Qualitative data suggest the main challenge for type 2 diabetes prevention specific to this population is a need for improved community outreach strategies.