Developing a National-Scale Exposure Index for Combined Environmental Hazards and Social Stressors and Applications to the Environmental Influences on Child Health Outcomes (ECHO) Cohort.

Tools for assessing multiple exposures across several domains (e.g., physical, chemical, and social) are of growing importance in social and environmental epidemiology because of their value in uncovering disparities and their impact on health outcomes. Here we describe work done within the Environmental influences on Child Health Outcomes (ECHO)-wide Cohort Study to build a combined exposure index. Our index considered both environmental hazards and social stressors simultaneously with national coverage for a 10-year period. Our goal was to build this index and demonstrate its utility for assessing differences in exposure for pregnancies enrolled in the ECHO-wide Cohort Study. Our unitless combined exposure index, which collapses census-tract level data into a single relative measure of exposure ranging from 0-1 (where higher values indicate higher exposure to hazards), includes indicators for major air pollutants and air toxics, features of the built environment, traffic exposures, and social determinants of health (e.g., lower educational attainment) drawn from existing data sources. We observed temporal and geographic variations in index values, with exposures being highest among participants living in the West and Northeast regions. Pregnant people who identified as Black or Hispanic (of any race) were at higher risk of living in a "high" exposure census tract (defined as an index value above 0.5) relative to those who identified as White or non-Hispanic. Index values were also higher for pregnant people with lower educational attainment. Several recommendations follow from our work, including that environmental and social stressor datasets with higher spatial and temporal resolutions are needed to ensure index-based tools fully capture the total environmental context.

Impact of the COVID-19 Pandemic on Research with American Indian and Alaska Native Populations.

The COVID-19 pandemic forced health research programs across the world to close or pause, threatening the progress of basic science, clinical and social science research, and research careers. Impacts of the pandemic on research occurring with American Indian and Alaska Native (AI/AN) peoples, which is often conducted using community-based and -engaged approaches, offer an opportunity to understand how community-research partnerships shaped decision-making and facilitated adaptations to study design, recruitment, data collection, program implementation, and analyses. The COVID-19 pandemic disproportionately impacted AI/AN peoples, exacerbating many of the health and social inequities already being examined in community-based and -engaged research projects. The nine articles in this special issue share insights from research focused on a variety of topics from food security to diabetes prevention and parenting skills training. In the face of the pandemic, the research teams drew on experience and skills garnered by engaging the perspectives and wisdom of community partners and rooted in the principles of community-based participatory research to respond to shifting research priorities, new processes for remote consent and data collection, and increased needs for clear communication, connection, and support. Lessons from these research teams challenge us to think about how we can carry forward beneficial adaptations to best serve community needs, especially as the pandemic continues and the potential for similar global crises increases.

Positive Indian Parenting: A Unique Collaborative Study in the Age of COVID-19.

Positive Indian Parenting (PIP) is a culturally based training developed by the National Indian Child Welfare Association in the mid-1980s that has been widely used across Indian Country. However, quantitative studies on its efficacy have not been conducted. This manuscript reports on the study design and development of an ongoing pilot study evaluating PIP and related adaptations that occurred within the context of the COVID-19 pandemic. Adaptations to the study were required to accommodate social distancing requirements, including changing to virtual platforms for curriculum delivery, fidelity monitoring, and data collection. Lessons learned include the importance of flexibility and supportive collaborations among study partners, including unique relationships with funders, that have enabled the ongoing study adaptations during the pandemic.

Strategies for culturally safe research with Native American communities: an integrative review.

Background: A history of unethical research and deficit-based paradigms have contributed to profound mistrust of research among Native Americans, serving as an important call to action. Lack of cultural safety in research with Native Americans limits integration of cultural and contextual knowledge that is valuable for understanding challenges and making progress toward sustainable change. Aim: To identify strategies for promoting cultural safety, accountability, and sustainability in research with Native American communities. Method: Using an integrative review approach, three distinct processes were carried out: (1) appraisal of peer-reviewed literature (Scopus, PubMed, and ProQuest), (2) review of grey literature (e.g. policy documents and guidelines), and (3) synthesis of recommendations for promoting cultural safety. Results: A total of 378 articles were screened for inclusion, with 55 peer-reviewed and grey literature articles extracted for full review. Recommendations from included articles were synthesised into strategies aligned with eight thematic areas for improving cultural safety in research with Native American communities. Conclusions: Research aiming to understand, respect, and acknowledge tribal sovereignty, address historical trauma, and endorse Indigenous methods is essential. Culturally appropriate, community-based and -engaged research collaborations with Native American communities can signal a reparative effort, re-establish trust, and inform pragmatic solutions. Rigorous research led by Native American people is critical to address common and complex health challenges faced by Native American communities. Impact statement: Respect and rigorous methods ensure cultural safety, accountability, and sustainability in research with Native Americans.

Tribal IRBs: A Framework for Understanding Research Oversight in American Indian and Alaska Native Communities.

Tribal Institutional Review Boards (IRBs) and other entities that oversee research for American Indians and Alaska Natives are important and unique. They reflect and respond to community needs, changes in research, and revisions to research policy. We provide a framework to capture this dynamism by building on existing work and offering a way to describe the scope of entities that oversee tribal research. As federal research regulations are revised, and policies are developed in response to a rapidly advancing research landscape, it is critical that policy makers, IRB professionals, researchers, and tribal communities have clarity regarding the Tribal IRB.

Ethics and Community Involvement in Syntheses Concerning American Indian, Alaska Native, or Native Hawaiian Health: A Systematic Review.

BACKGROUND: The objective of the research was to review reporting of ethical concerns and community involvement in peer-reviewed systematic reviews or meta-analyses concerning American Indian, Alaska Native, or Native Hawaiian (AI/AN/NH) health. METHODS: Text words and indexed vocabulary terms were used to query PubMed, Embase, Cochrane Library, and the Native Health Database for systematic reviews or meta-analyses concerning AI/AN/NH health published in peer-reviewed journals, followed by a search through reference lists. Each article was abstracted by two independent reviewers; results were discussed until consensus was reached. RESULTS: We identified 107 papers published from 1986-2012 that were primarily about AI/AN/NH health or presented findings separately for AI/AN/NH communities. Two reported seeking indigenous reviewer feedback; none reported seeking input from tribes and communities. Approximately 7% reported on institutional review board (IRB) approval of included studies, 5% reported on tribal approval, and 4% referenced the sovereignty of AI/AN tribes. Approximately 63% used evidence from more than one AI/AN/NH population study, and 28% discussed potential benefits to communities from the synthesis research. CONCLUSIONS: Reporting of ethics and community involvement are not prominent. Systematic reviews and meta-analyses making community-level inferences may pose risks to communities. Future systematic reviews and meta-analyses should consider ethical and participatory dimensions of research.