A research center at Montana State University is coordinating a statewide effort to address health disparities affecting Montana citizens in rural and tribal communities.
In collaboration with local partners and other researchers, the MSU Center for American Indian and Rural Health Equity, or CAIRHE, determines underlying causes and implements solutions for health problems that impact the lives of rural Montanans and American Indians to a greater degree than urban and white residents.
Established in 2014 by a $10.6 million grant from the National Institutes of Health, CAIRHE was named a state research center by the Montana University System Board of Regents at the board’s meeting in Billings earlier this month.
“This recognition is really just a first step,” said Dr. Alexandra Adams, director and principal investigator of CAIRHE — pronounced “care.” “We hope it will open doors for us around the state as we partner with local communities, other researchers and organizations in the pursuit of our important mission.”
According to the Montana Department of Public Health and Human Services, the median lifespan for American Indians in the state is roughly 19 years shorter than that for whites. American Indians typically die at a younger age than whites from every major cause, including cancer, diabetes, heart disease and suicide.
Limited access to health care across the mostly rural state can reduce treatment options and prevent early diagnosis of medical problems — challenges not seen in more populous, urban states, Adams said. A 2013 DPHHS report said 53 percent of the state’s population lives in rural or frontier areas with limited services, and most Montana counties are medically underserved.
During the center’s first two years, CAIRHE investigators launched projects across the state involving community partners at every stage, from initial design to published results. The center uses a research method called community-based participatory research, or CBPR, which differs radically from outdated research practices in which scientists collected sensitive data with little involvement from a community and scant regard for its cultural beliefs.
“Instead we believe that our state’s communities are the best judge of what their most pressing health challenges are, and what may be behind them,” Adams said. “So they are true partners as we work together to address these important health issues.”
The center’s three major projects to date address early childhood oral health, environmental health literacy, and sexual and reproductive health, respectively, on three of Montana’s American Indian reservations. In addition to meeting regularly with local community advisory boards, project leaders collaborate with faculty and students at the local tribal colleges.
Smaller center projects include a study of addiction and resilience in a tribal community, as well as a unique investigation of drinking and driving in rural settings. Current CAIRHE project leaders are faculty in the MSU Department of Health and Human Development, Department of Psychology, Department of Sociology and Anthropology and College of Nursing.
The center’s $2 million in research expenditures last year contributed to one of MSU’s strongest research years on record, with $118 million in total expenditures and gains in biomedical and health research.
“We will continue to be a major part of that growth,” Adams said.
Adams, a family medicine physician and nutritional scientist, assumed her position as director of CAIRHE in January. Previously Adams worked for two decades on the faculty of the University of Wisconsin School of Medicine and Public Health, where she developed a national reputation as a health equity researcher.
Adams collaborates with American Indian communities on healthy lifestyle interventions for families with young children, as well as community-wide interventions to prevent chronic disease. Though her research began with Wisconsin tribes, in recent years it has expanded to tribal communities in five states, including Montana.
She credits her youth in inner-city New York and travel overseas with her British mother for showing her how differences across communities can result in vastly different health outcomes. Her work with the Rosebud Sioux Tribe of South Dakota during medical school ignited her interest in American Indian health.
“On the reservation you could plainly see the connection between bad policies, like shipping in poor-quality food and removing traditional food systems, and bad health outcomes,” Adams said. “That’s when I knew I didn’t just want to treat symptoms. I wanted to change fundamental causes.”
Adams said she will spend the next year building coalitions across the state and welcoming research partners of all types. A special meeting held in July with officials and faculty from MSU and the University of Montana discussed ways that CAIRHE hopes to collaborate with colleagues in Missoula who are already well-established in many areas of community-based public health research.
“The health challenges we face in Montana’s rural areas are too widespread and deeply ingrained for any one entity to tackle them,” Adams said. “We have to leverage the strengths of our individual communities and our reservations so we can all work together.”
CAIRHE is supported by an Institutional Development Award from the National Institute of General Medical Sciences division of the National Institutes of Health.
More information about CAIRHE is available online at http://www.montana.edu/cairhe/.