"Nobody Is Talking About It": Diné (Navajo) Communities Speak About Stomach Cancer and Helicobacter pylori Infections.

Stomach cancer is the third leading cause of cancer death globally. Helicobacter pylori plays a role in the healthy human gut, but is also associated with multiple chronic diseases, including stomach cancer. Though H. pylori prevalence is declining in parts of the world, it remains high among certain populations. In Arizona, stomach cancer rates are 3-4 times higher among the Navajo Nation population as compared with the non-Hispanic white population. This pilot project assessed adult Diné (Navajo) individuals' understanding and awareness regarding H. pylori infection and stomach cancer. Focus groups were held in three Diné communities. Data were analyzed thematically using a multi-investigator consensus approach. Participants had limited knowledge of H. pylori infection and stomach cancer and perceived local medical providers as also having limited knowledge on these conditions. Participants described poor health care experiences, structural inequalities, and environmental concerns and associated these with H. pylori infection and stomach cancer. This study highlights the need for additional research and education on current knowledge and perceptions of stomach cancer and H. pylori infections in Navajo Nation.

Breathing clean air is Sa'áh Naagháí Bik'eh Hózhóó (SNBH): a culturally centred approach to understanding commercial smoke-free policy among the Diné (Navajo People).

INTRODUCTION: Indigenous worldviews and research approaches are fundamental to make meaning of complex health issues and increase the likelihood of identifying existing cultural protective factors that have contributed to the resilience and survival of Indigenous people worldwide. OBJECTIVE: We describe the process for applying the Diné (Navajo) paradigm of Sa'áh Naagháí Bik'eh Hózhóó (SNBH), a belief system that guides harmonious living, and demonstrate how the application of SNBH enhances understanding of Navajo principles for well-being. Specifically, we juxtapose this analysis with a conventional qualitative analysis to illuminate and interpret Diné perspectives on the health and economic impact of commercial secondhand smoke and smoke-free policy. METHODS: Focus groups were conducted throughout Navajo Nation to assess the appeal and impact of several evidence-based messages regarding the health and economic impact of smoke-free policy. RESULTS: Diné perspectives have shifted away from family and cultural teachings considered protective of a smoke-free life, and struggle to balance the ethical and economics of respect for individual and collective rights to live and work in smoke-free environments. CONCLUSIONS: Indigenous-centred approaches to public health research and policy analysis contribute to understanding the cultural knowledge, practices and beliefs that are protective of the health and well-being of Indigenous people.

Advancing smoke-free policy adoption on the Navajo Nation.

BACKGROUND: Comprehensive smoke-free laws are effective at protecting non-smokers and reducing tobacco use, yet they are not widely adopted by tribal governments. METHODS: A series of smoke-free policy initiatives on the Navajo Nation, beginning in 2008, were reviewed to identify key issues, successes and setbacks. RESULTS: It has been essential that proposed policies acknowledge the Navajo people's spiritual use of nát'oh, a sacred plant used for gift-giving, medicinal purposes and traditional ceremonies, while simultaneously discouraging a secular use of commercial tobacco. Concern that smoke-free policies economically harm tribal casinos has been a major barrier to broad implementation of comprehensive smoke-free laws in Navajo Nation. CONCLUSIONS: It is necessary for tobacco control researchers and advocates to build relationships with tribal leaders and casino management in order to develop the business case that will take comprehensive smoke-free policies to scale throughout tribal lands.

Development of a Culturally Anchored Qualitative Approach to Conduct and Analyze Focus Group Narratives Collected in Diné (Navajo) Communities to Understand the Impacts of the Gold King Mine Spill of 2015.

The Gold King Mine Spill (Spill) occurred in August 2015 upstream from Silverton, Colorado and released three million gallons of contaminated water into the Animas River, a tributary to the San Juan River that flows across the Navajo Nation. Using principles of community-engaged research, the Gold King Mine Spill Diné Exposure Project co-developed a culturally anchored approach to conduct focus groups and analyze narratives collected in three Diné (Navajo) communities along the San Juan River within 9 months of the Spill. Focus group questions were designed to document the socio-cultural impacts of the Spill. This paper: (1) outlines the partnerships and approvals; (2) describes focus group design, training, data collection and analysis; and (3) reflects on the use of a culturally anchored approach in Indigenous, specifically Diné-centered research. Diné social and cultural etiquette and concepts of relationality were used to adapt standard (non-Indigenous) qualitative methods. Findings describe community perceptions of short-term impacts of the disaster, as well as past and present injustices, communication related to the Spill, and concerns of persistent threats to Diné lifeways. The culturally anchored approach was critical in fostering trust with Diné participants and aligned with the candor of the discussions.

Diné (Navajo) Healer Perspectives on Commercial Tobacco Use in Ceremonial Settings: An Oral Story Project to Promote Smoke-Free Life.

Many American Indian (AI) healers are faced with a dilemma of how to maintain the ceremonial uses of traditional tobacco meant to encourage the restoration and balance of mind, body, and spirit, while discouraging commercial tobacco use and protecting against secondhand smoke exposure in ceremonial settings. To explore this dilemma and offer culturally informed solutions, researchers conducted qualitative interviews with Navajo healers who describe the history and role of commercial tobacco within ceremonial contexts. Healers understand the importance of their role on their community's health and expressed deep concern about the use of commercial tobacco in the ceremonial setting. Healers play an important role in curbing the use of commercial tobacco and limiting the exposure to secondhand smoke in ceremonial settings and beyond. Study implications include the importance of understanding traditional and cultural knowledge and its potential as a pathway to solve contemporary public health issues facing AI communities.