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Descripton of Projects

Missouri Breaks Industries has been a legal Indian-owned entity working with and promoting American Indian made products throughout the Dakotas since 1982.  In 1995, at the behest of Dr. Paul Enright of the University of Arizona Health Sciences Center, Missouri Breaks Industries Research Inc., (MBIRI) was reorganized to become an Indian-owned research company.  Since its inception as a legal entity in 1995 specifically conducting research it has successfully conducted and/or contributed to the following projects:




Strong Heart Study - Phase I(1988-1992)

The purpose of the Phase I exam was to measure the extent of heart disease and heart disease risk factors among the three SHS centers. 

The Phase I exam was conducted between 1989 and 1991. 4549 tribal members, ages 45-74 years of age (62% of the total population ages 45-74 yrs) were seen. In the Phase I examination, medical history, family history of related illness, diet, alcohol and tobacco consumption, physical activity, degree of acculturation, and socioeconomic status of the participants were assessed in personal interviews. The physical examination included measurements of body fat, body circumferences, and blood pressure, an examination of the heart and lungs, an evaluation of peripheral vascular disease, and a 12-lead resting electrocardiogram (ECG). Laboratory measurements in the baseline exam included fasting and post-load glucose and fasting insulin, fasting lipids, apoproteins B and AI, apo E phenotype, fibrinogen, Lp(a), LDL size, Gm allotype, and glycated hemoglobin. Measures were also made of urinary creatinine and urinary albumin, and some blood samples were frozen and stored for future analysis.


Most of the information about factors that increase the risk of heart disease comes from non-Indian populations. We assume that the same factors contribute to heart disease in Indians. To be sure of which factors contribute to heart disease in Indians, it was necessary to do more than one examination. The second examination was conducted to show whether these risk factors change with time. In addition, new measurements were added to increase our understanding of heart disease and lung disease among American Indians. These were the objectives of the second examination – the Phase II examination.

The Phase II examination was conducted between 1993 and 1995. It re-examined 89% of all surviving members of the original cohort. During the examination, medical history was updated and a 24-hour dietary recall was performed on all individuals. Alcohol consumption and tobacco use were reassessed. The physical examination included measures of body fat, body circumferences and blood pressure, an evaluation of peripheral vascular disease, and a 12-lead resting electrocardiogram (ECG). Measures of pulmonary function, an echocardiogram, and a gallbladder sonogram were added. Laboratory measurements included fasting and post-load glucose, and fasting insulin, fasting lipids, fibrinogen, PAI1, glycated hemoglobin, and urinary albumin and creatinine; red blood cell allotypes were also assessed. Blood samples for future analysis were again stored at -70°.


Diabetes Today – 1995-1996, Centers for Disease Control and Prevention/State of South Dakota

This project was designed and funded by the Centers for Disease Control and Prevention in conjunction with the State of South Dakota.  Its goal was to promote empowerment of diabetic control among community members.  Projects were held in Cheyenne River in the communities of Eagle Butte and Red Scaffold with a small support group being formed out of these sessions.  Other teaching sessions were held in Rapid City, specifically in the Lakota Homes section, and on the Lower Brule reservation.  Staff on this project included two RN’s and one recruiter, with two of the three personnel being tribal members. 


Sleep Heart Health Study - Phase I (1995-1999), University of Arizona Health Sciences Center, Stuart Quan, M.D., Principal Investigator (PI)

This project was funded by the National Heart Lung and Blood Institutes (NHLBI), a division of National Institutes of Health, Missouri Breaks Industries Research Inc. (MBIRI) subcontracted with the University of Arizona Health Sciences Center.   Two hundred home polysomnography (PSG) studies were performed during the period of 1995-1996.  In spite of one of the harshest winters on record in the Dakotas, the MBIRI staff led all the centers in completion of their studies.  Staff on the study included two RN’s, two recruiters, one data entry clerk, and one student with 5 of the 6 staff members being tribal members.

Morbidity and Mortality Surveillance – Strong Heart Study – 1995-present, Dakota Strong Heart Study (SHS), Thomas Welty, M.D., MPH, PI

Medical Records for 1200 Strong Heart Study cohort were reviewed on two separate occasions for cardiovascular events during a period of time from 1996 through August of 1999, and copies were made of records describing cardiovascular disease events.  Pertinent parts of medical records of cohort members who died were copied regardless of cause of death.  Participant charts were located in IHS, VA, and private hospitals in a 600-mile radius and by mail in areas outside of this radius.  Personal interviews of next of kin were conducted on all participants with unobserved deaths.  Staff for this project included one RN, one recruiter, one student, and one RN applicant, of which three are tribal members.



Insulin Resistance Study – 1996, MedStar Research Institute (formerly Medlantic Research Co.), Barbara Howard, Ph.D., PI

Study of 30 participants, which required them to follow a high carbohydrate diet for several days prior to the procedure.  The participant was given a glucose load and then an insulin challenge with a series of 12 blood samples taken in a four hour time period.  Staff for this project included four personnel, which included three tribal members.



Medical Staff and Field Personnel Strong Heart Study - Phase II (1997-1999), Dakota Strong Heart Study, Thomas Welt, M.D., MPH, PI

Field staff was responsible for the recruitment of the entire Dakota center SHS cohort of which 91% retention was achieved.  Staff conducted all of the physical exam and laboratory procedures on the participants per the SHS protocol.  This project also included an Asthma sub-study through the University of Arizona in which antigen skin tests and spirometry was conducted on 214 participants from the Dakotas.  Reservations included the Spirit Nation at Ft. Totten, ND, Cheyenne River Reservation and Pine Ridge Reservations in South Dakota.  Personnel for this project included 3 RN’s, one RNA, two phlebotomists, 6 recruiters and one sonographer of which 10 of the personnel are tribal members.




Strong Heart Study - Phase II(1997-1999)  (Asthma Sub Study), National Institutes of Health, Dr. Thomas Welty, M.D., PI

 This continuation study was funded by the NHLBI through the Aberdeen Area Tribal Chairman’s Health Board. MBIRI field staff was responsible for the recruitment of the entire Dakota Center SHS cohort of which 91% retention was achieved. Staff conducted all of the physical exam and laboratory procedures on the participants per the SHS protocol. This project also included an asthma sub-study through the University of Arizona in which antigen skin tests and spirometry were conducted on 214 participants.


Human Leukocyte Antigen Study – 1999, John Hopkins University, Susan Lefelle, Ph.D. PI

This project required a blood draw and surveillance instrument administered to 300 participants from across both the Pine Ridge and the Cheyenne River Reservations of South Dakota.  Personnel on this project included 2 RN’s, one RNA and one recruiter of which 2 are tribal members.

Sleep Heart Health Study – Phase III (1999-2004), National Institutes of Health, Helaine Resnick. Ph.D, MPH, PI

This study has been approved and funded by the National Heart, Lung, and Blood Institute to reexamine the original living SHHS cohort with a follow-up PSG study. The project also included continuation of morbidity and mortality review of the participant’s health events.  Missouri Breaks Industries Research Inc. is the grant recipient for the Strong Heart Study group, which included the Phoenix SHS and the Oklahoma SHS as well as the Dakota SHS.  MedStar Research and the University of Oklahoma Health Sciences Center are subcontractors to MBIRI. The Dakota SHHS site maintained a 93% retention rate for Phase II of SHHS. Three RN’s, one data entry person and one recruiter were involved with this project with 3/5 staff tribal members.



Strong Heart Study - Phase IV (2000-2006), National Institutes of Health, Dr. Lyle Best, M.D., PI

Cardiovascular disease has become the leading cause of death in American Indians. Several problems have made it difficult to determine the prevalence and severity of cardiovascular disease among American Indians. Small community size, relatively young age, and cultural and anthropologic diversity make it difficult to include large numbers of Indians in research examinations. High rates of CVD in younger Indians suggest that the overall rate will increase as the population ages, and be a much more serious health problem in the future. In addition, health care services available to Indians differ considerably in geographic areas. Since it is well established that many risk factors for CVD and the tendency toward atherosclerosis are familial, Phase IV of the Strong Heart Study now provides a very valuable resource for genetic determinations of CVD. Since family sizes are large we have the opportunity to map genes that influence cardiovascular risk factors in this population. The Strong Heart Study is the only large-scale study of CVD risk factors in American Indians. Until now, however, analyses of the contribution of genetic factors to CVD risk have not been included in the Strong Heart Study. A long-term goal of the Strong Heart Study is to detect and map new polymorphic genes that influence variation in risk factors for CVD and other related disorders in American Indians. Using new methods for human gene mapping, we will conduct a genome-wide search for genes that influence CVD risk.


Oyate BliHelya – 2002, Pine Ridge Tribal Health

The purpose of this grant is to serve the people of the Oglala Sioux Tribe with methods of prevention, intervention and screening activities.  This will help to promote healthier lifestyles with the knowledge gained through education services provided by staff members.  The project will collaborate with existing health care programs to assure the diabetes activities are accessible through increased transportation, awareness and reinforcement of treatment and education received during regular health care visits. 

Outreach activities will stress the importance of self-care.  Increased access to screenings and educational sessions in the diabetic project enhances the decrease for risks/prevention of Diabetes.  School based screenings will assist in providing education to the youth and give them tools to make wiser nutritional and wellness choices as a method of prevention. MBIRI personnel assisted with database and protocol development and training of field staff.  The Pine Ridge Tribal Health operates the Oyate BliHelya Diabetes program.

Dakota Plains Diabetes Center – 2002, Centers for Disease Control, Cheyenne River and Standing Rock Sioux Tribes                                                                                                                                              

The Dakota Plains Diabetes Center (DPDC) project is targeted toward maximizing the impact of selected strategies in the prevention of diabetes and its complications among Lakota people of the northern plains state of ND and SD.  The unique attribute of the DPDC is its commitment to the self-determination of American Indian Nations, with the Center leadership being provided by northern plains tribes themselves.  The DPDC will focus on a combination of medical and community partnerships, using culturally specific approaches to the prevention and control of diabetes in American Indian communities.  The Cheyenne River Sioux Tribe and the Standing Rock Sioux Tribe jointly direct it.  The DPDC will address the prevention of the disease on three levels:

Primary:  Community based promotion and adoption of individual behavioral health practices known to be effective in the prevention of diabetes and enhancement of health promotion through use of culturally appropriate strategies.

Secondary:  Screening for early detection of diabetes and successful prevention of complications through early detection and consistent treatment of diabetes.

Tertiary:  Prevention of disability and mortality resulting from diabetes-related complications. 

The MBIRI personnel assisted with the database and protocol development and training of field personnel.  Cheyenne River Sioux Tribe acted as grant recipient for this program.


EARTH Study – 2003-2006, Black Hills Center for American Indian Health, Jeffrey Henderson, M.D., M.P.H., PI


The National Cancer Institute funded this five-year project.  The goal of the study is to determine how diet, physical activity, and other lifestyle and cultural factors relate to the development and progression of chronic diseases such as cancer, cardiovascular disease, Type 2 diabetes, stroke, chronic lung and respiratory disease, and related mortality from these diseases.  There is a three-year enrollment period in which 6,500 participants from the Navajo Nation, Alaska and the Dakotas will be recruited.  Participants will complete a series of questionnaires, have a short physiological exam and have medical history obtained from IHS records to complete the data.  All data will be used to assess health status and identify groups of the population at risk for various health conditions. Morbidity and mortality reviews for incidence will also be conducted for this study. Ten MBIRI staff members work for this project of which 7 are of Native American descent.

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 Missouri Breaks Durable Medical Equipment – 2003-present

The Durable Medical Company is a subsidiary of MBIRI.  It was established as a direct result of the identification the communities need for this type of service on the reservation.  Employees have a thorough understanding of the Native American beliefs and lifestyles.  All types of medical equipment from large to small; e.g. wheelchairs, oxygen concentrators, nebulizers, hospital beds, walkers, toilet seat risers, shower chairs, drain pouches and all accessories are available.  It is the mission of Missouri Breaks to provide consistent quality service and equipment to all patients, customers, hospitals and clinics in Western South Dakota including the Cheyenne River, Rosebud and Pine Ridge Reservations.


Four Winds Native Nutrition Project – 2004, South Dakota State University, Kendra Kattelmann, Ph.D, PI

This project is funded by National Institutes of Health, NIDDK Branch and conducted by SDSU and Missouri Breaks.  This is a 6-month nutrition project that is targeted towards diabetics.  The program will track a teaching group that will be asked to eat a traditional diet following the “Four Winds Model for Native Nutrition”.  They will also receive nutrition education at monthly meetings, followed by talking circles.  The control group will be asked to eat their regular diet.  At the completion of the project, the control group will also receive the same nutrition education classes that the teaching group received.  Each group will be asked to fill out forms tracking their diet history during the study.  We want to see if there is better blood sugar control for those who ate like the Native American ancestors.  This project is taking place on the Cheyenne River Sioux Reservation.



Strong Heart Study - Phase V (2006-2011)  NHLBI, Dr. Lyle Best, PI

Phase VI will continue the mortality and morbidity surveillance of the original SHS cohort and of the SHFS participants to better understand cardiovascular disease, cancer, liver disease, and inflammation in American Indians.  All surviving participants will be invited to participate in Phase VI and fill out a medical history questionnaire after a written consent is given.  Their medical records will then be reviewed and pertinent information will be abstracted for morbidity and mortality events that are suspected to relate to the diseases of interest.  The abstracted information will then be reviewed by physicians on the Morbidity and Mortality Review Committees to determine whether the event is related to cardiovascular disease, cancer, liver disease, etc.  Incidence rates and prevalence proportions of these health conditions as well as their risk factors, including genetic factors, will be determined from analyses of the data collected in Phase VI and those collected in Phases I-V.


Myocardial Infarct to Treatment Project – 2007-2009, CDC, Nell Brownstein, Ph.D., PI

Heart disease is a growing cause of mortality in the American Indian communities. The goal of this project is to identify the issues and impediments that surround a patient’s response to the signs and symptoms of a heart attack with the assistance of the community members including the medical providers, community leaders, persons at risk for heart attack and those who have experienced a MI.  Through these voices, a public campaign will be designed and tested to determine the best approach to promoting education and recognition of not only the signs and symptoms but more importantly the desired response in order to reduce mortality events in this population. 

Breathing Relief Education and Tribal Health Empowerment (BREATHE) Project – 2007-2009, NIH and Sanford Research, James Wallace, MD, PI

The goal for this project was to validate the evident need for asthma education within the Native American population.  The project began with the Cheyenne River community.  Asthma education included a one-on-one 30 minute session and 5 phone follow-ups in the following year.  BREATHE aimed to improve the quality of life for individuals with asthma by providing education, identifying undiagnosed cases, and reinforcing self-sufficiency and empowerment in diagnosed individuals.  Results showed that the above method of asthma education successfully improved asthma control, quality of life and medication compliance as well as reduced emergency room visits.  This method of asthma education is predicted to have similar effects in other rural Native American populations.



Lakota Oyate Wicozani Pi Kte (LOWPK)– 2008, Black Hills Center for American Indian Health, Jeffrey Henderson, M.D., M.P.H., PI

A study of 180 type II DM with either elevated cholesterol or elevated blood pressure or both.  Because this is a interventional study and not a secondary, participants become eligible if they have the diagnosis of type II DM but have had no cardiovascular events.  Once enrolled, the participants are into two categories.  All participants will receive new computers and will be given basic computer training.  The control group will be given the opportunity to work on their own to learn about the newest interventions and educational information on the world wide web by working at their own pace.  The intervention group will be assigned to work with a physician’s assistant and a dietician via the Internet and phone to modify their lifestyles, diet and medications.  They will be given access to an online program that will assist in monitoring their blood glucose levels once they upload their weekly reading from their personnel glucose monitors to the online program.  This study which is being conducted to determine if online interaction can improve provider/patient contact which will result in better patient outcomes, will run for about 3 years.

Circles of Care – 2008-2011, SAMHSA, Standing Rock Reservation

The Aberdeen Area of the IHS has the highest suicide death of the 12 IHS areas in the U.S.  The Aberdeen areas rate for the latest reported statistics is 87.4 per 100,000, which is 13.9 times higher than the U.S. rate of 6.3.  The focus of the Circles of Care grant is to identify gaps and solutions to missing mental health services through the perspective of the health care providers, the community at large but first and foremost the family and individuals with Severe Emotional Behavior Disorder (SEBD) 

Mercury Study2008/2010, Johnnye Lewis, Ph.D., DABT, PI, University of New Mexico, CDC

The study looked at markers of immune function in blood samples in relationship to mercury exposures determined from survey and validated by the CDC blood analysis.



Strong Heart Stroke Study – 2009 - present, NHLBI and University of Washington at Seattle, Dr. Dedra Buchwald, PI

A study of 333 original cohort to better characterize and understand stroke in the American Indian population.  A number of project conducted across the country have looked at stroke in the mainstream population but very little is know about stroke in the American Indian population even though it has been documented by the SHS that stroke is significantly higher in this population. 



Canli Coalition of the Cheyenne River Sioux Tribe – 2009-present, American Nonsmokers Rights & South Dakota Department of Health Tobacco Control Program,

The Canli (Lakota for tobacco) Coalition was started in 2009 to educate the public about the dangers of commercial tobacco and to build support for commercial tobacco-free environments.  The ultimate goal was to to protect people from the dangers of secondhand smoke exposure by making CRST a smoke-free reservation.  




 Breathe Well – Live Well - 2009

Asthma 101 – 2009-2010

Topography and Genetics of Smoking and Nicotine Dependence in American Indians. – 2010-present,  National Cancer Inst., Black Hills Center of American Indian Health & University of Washington, Jeffrey Henderson, M.D., M.P.H., PI

This study involves working with the original EARTH study participants to look at the factors that relate to cigarettes smoking and how the body processes and breaks down nicotine.


Study of Autoimmune Illnesses among the Lakota (SAIL) – 2011 - 2013, NIH, Black Hills Center of American Indian Health, Stanford University School of Medicine, Jeffrey Henderson, M.D., M.P.H., PI

This study is being done to find out the genetic risk factors that cause rheumatoid arthritis in Lakota people.  100 former EARTH Study participants will be recruited along with 100 of their siblings to participate in the study.





Chronic Kidney Disease Knowledge and Awareness among American Indians -2011 – 2016, National Institute of Diabetes and Digestive and Kidney Diseases,Cleveland Clinic Lerner College of Medicine, Dr. Stacey Jolly, PI

CKD a leading contributor of both morbidity and mortality and the prevalence is increasing, with approximately 13% of the U.S. population currently affected. CKD is especially problematic among certain racial or ethnic minority groups. In its most serious form, AIANs have double the prevalence and incidence rate ESRD compared to non-Hispanic Whites. American Indians have a high prevalence of risk factors for CKD, including diabetes mellitus and albuminuria, both being independent risk factors for progression to ESRD, cardiovascular disease, and mortality. Metabolic syndrome has also been shown to be a risk factor for the development of CKD among American Indians.

The majority of people with CKD are unaware of their disease. In a recent nationally representative study, less than 10% of individuals with CKD stage, or moderately decreased kidney function, reported ever being told that they had weak or failing kidneys by their health care provider. In another study, only 6% of persons with CKD stages 1 to 4 reported being told that they had weak or failing kidneys. In a study of African-Americans, where CKD was defined as moderately decreased kidney function, the presence of albuminuria, or dialysis therapy, the prevalence was 20%. Yet awareness of CKD was only 16% among persons who actually had CKD.

This study will utilize a focus group approach to develop culturally appropriate digital story telling DVD’s and will then test the effectiveness of educational tools in increasing understanding of the disease.



American Indian Adult Tobacco Survey – 2011-2012, Inter-Tribal Council of Michigan, Health Education and Promotion Council, Favian Kennedy, MSW, MPH

The purpose of this survey is to better understand attitudes, behaviors, and beliefs regarding smoking among CRST members while building research capacity of our local colleges.  The survey was completed by 400 adult tribal members randomly selected by household. The survey is a follow-up to the AI-ATS done in 2005 on the Cheyenne River Sioux Tribe.

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Community/School Partners Tobacco Education Project for Cheyenne River – 2011-present,  South Dakota Department of Health Tobacco Control Program

This project targets education and information on the dangers associated with commercial tobacco use and secondhand smoke to the community at large, Head Start Families, Families participating in the Women Infant & Children Program, SD Social Services and the five area school districts.

‘Impact of ethnicity on platelet function and response to aspirin and clopidogrel’ – 2011-2012, Julie Oestreich, PharmD, PhD, PI, University of Nebraska Medical Center

The purpose of this study is to evaluate the effectiveness of dual antiplatelet therapy with aspirin and clopidogrel in American Indians and to determine the incidence of CYP2C19 variant alleles in this understudied population. The original study design evaluates several underrepresented groups, however, due to limited funding; we have temporarily restricted our study population to Native Americans (50 healthy subjects and 50 subjects taking aspirin and clopidogrel) and Caucasians and will evaluate platelet function in the treated patients and genotyping of the CYP2C19 gene in all subjects.

Respiratory Therapy Contract – 2011- 2017, Cheyenne River Sioux Tribal Health Department

In response to a growing need for local respiratory therapy services, MBIRI established a contract to offer respiratory care to members of CRST.  Services available based on a referral include pulmonary function tests, disease education and management, oxygen evaluations, smoking cessation, medication evaluation and pulmonary stress tests.

American Indian Environmental Improvements for Children’s Asthma – 2011-present, Housing and Urban Development, American Lung Association

This project provides asthma education and management to families with asthmatic children as well as a thorough home assessment and remediation of identified asthma triggers.  The project has previously been conducted with youth in the Minneapolis/St. Paul area and has demonstrated a significant improvement on asthma-related health service utilization, quality of life outcomes and return on investment.


Community Health Assessment Grant – 2012, South Dakota Department of Health Office of Chronic Disease Prevention & Health Promotion Nutrition & Physical Activity Program

This study is looking at the overall health of the Timber Lake Community and surrounding rural area for residents ages 55 and over.  The overall goal is to identify indicators that make it an age-friendly community and activate community government, organizations, businesses and other to address barriers to make the community a healthier place where residents are physically active and have lower incidents of chronic disease.  


Factors in Pediatric Asthma –(FIPA) - 2012 – 2017 – Lyle Best, PI 

Specific Aim 1) Characterize the influence of risk factors and the resulting disability of asthma in the Cheyenne River Sioux and Oglala Sioux communities utilizing a case/control methodology.

Specific Aim 2) Test the hypothesis that intensive patient education regarding self-directed, stepped care will result in reduced morbidity and medical care utilization, while increasing quality of life.

Specific Aim 3) Explore and test various hypotheses regarding associations between certain genetic polymorphisms and risk of asthma or response to medication.

Specific Aim 4) improving the understanding of research methods and encouraging young American Indian students to consider careers in biomedical fields.


Strong Heart Study – Phase VI – 2013-2018 – Lyle Best, PI

Aim 1:  Re-consent and interview of participants of both the original cohort and the family cohort to establish updated demographic data, morbidity and comorbidity information.

Aim 2:  Surveillance:  Mortality and morbidity surveillance of the 631 original SHS cohort and the 1,135 family SHS participants (N=1766) to better understand the etiological predictors of incident and recurrent morbidity and mortality events in the SHS population.

Aim 3:  Continue maintenance of community and tribal partnerships to maximize data use through translational and outreach efforts to the various communities including the scientific, medical, tribal and lay populations.

Complex metal exposure and immune status evaluation on the Cheyenne River – 2013-2017, Esther Erdei, PI

Aim 1: Construct a profile of metal and pesticide/herbicide environmental exposures to the CRST community

Aim 2: To characterize immune system changes by measuring immune cell populations, immune cell activation, cytokine levels and autoantibodies in whole blood and serum samples

Aim 3: Integrate biomonitoring data on arsenic, pesticides/herbicides and mercury with immune system markers data into our multivariate biostatistical models.  These biostatistical models will allow us to better understand the complex linkages among environmental exposures and health on CRST.

The Experience of Chest Pain in a Lakota Community – 2013 – 2017 Jeff Henderson, PI

Aim 1: Assess and document, by survey, the knowledge, attitudes, and beliefs regarding chest pain symptoms among American Indians presenting to the Emergency Department with symptoms of chest pain from two Northern Plains’ reservations.

Aim 2: Enact a simple baseline data collection effort for assessing the time between onset of symptoms and care presentation or Emergency Medical Service (EMS) use within the Indian Health Service hospital emergency departments serving the two reservations.

Aim3: Use focus group methodology to generate information from members of these communities representing different CVD risk categories, key family members, and providers to enhance and render a culturally appropriate intervention to reduce the delay in seeking medical care for potential cardiac chest pain.

Aim 4: Develop and deliver to the members of one reservation a culturally appropriate intervention through targeted education and a broad social marketing campaign, while using the other reservation as a comparison group.

Aim 5: Assess and document, by survey, any post-intervention change in knowledge, attitudes, and behaviors about chest pain by the members on each reservation and to document the change in delay times in seeking medical attention for cardiac chest pain on these reservations

Aim 6: Deliver the intervention, if shown effective, on the control reservation.

Center for Native population health Disparities – HPV Prevention 2013-2015, National Cancer Institute, Un of Washington, Dedra Buchwald, PI

Healthy People 2010 set a goal that 90% of adult women will have received a Pap test within the preceding 3 years.  A recent report predicts that increasing current rates of compliance to this goal could reduce annual cervical cancer incidence by 23%.  However, many barriers to getting a Pap test exist including lack of times, discomfort, poor access to care, fear of embarrassment or pain and fear of doctors.

These observations suggest that participation in screening programs might increase if an alternative private, self-administered method for cervical cancer screening were available. One such option is self-collecting vaginal samples for HPV testing.  If samples for HPV screening could be self-collected at home with clinical follow up, the need for in clinic screening could be eliminated for a majority of women.  Studies have shown that self-collected samples are as sensitive as clinician-collected samples for detecting HPV and that women find self-collecting samples for HPV testing to be acceptable. This study will be conducted to determine the feasibility and acceptability related to self HPV DNA testing in AI/AN populations living in rural communities.



Indoor Air quality Interventions for individuals with COPD – American Lung Association, 2014-2015

The objectives are: (1) To measure the impact that IAQ interventions for particulate matter, nitrogen dioxide, carbon monoxide, carbon dioxide, VOCs, and formaldehyde in tribal homes have on COPD symptoms and severity using objective measures for lung functioning, quality of life, and activities of daily living; (2) to measure the correlation between these IAQ hazards and COPD symptoms severity and gain a new understanding of the extent of the impact by using objective measures of lung functioning for the first time in this kind of study; (3) to gain a new understanding about the impact of known and suspected IAQ hazards on the daily activities of living and quality of life of people with COPD by using standardized tools for the first time in this kind of study; (4) to determine the impact of interventions to remediate mold on secondary fungal infections in residents with COPD; (5) to determine the feasibility of bringing effective and cost-effective IAQ intervention services to limited income, geographically isolated tribal populations with COPD; (6) to measure the impact of IAQ interventions on the health care utilization of individuals with COPD; and (7) to measure the additional impact of the IAQ interventions on children and other household members in terms of asthma, acute respiratory infections, other respiratory symptoms, acute bronchitis, and otitis media.


Does Adolescent Cardiovascular Risk Profile Predict Adult Sub-Clinical Cardiovascular Disease (CVD) in American Indians?,- 2015-2016, Dr. Jason F. Deen


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Strong Heart Stroke Study II, 2015-2020

 This study is intended to characterize the longitudinal prevalence, incidence, and associations among risk factors, brain abnormalities, cognitive function, and probable Alzheimer's disease in American Indian elders that participated in the Strong Heart Stroke Study (SHSS) . 

Specific Aims:

1.     Repeat standard tests of cognitive function administered by SHSS1 in 2010 - 2013 and document changes over time by age and sex. Tests include global cognitive function, episodic memory, verbal fluency, and processing speed. 

2.     Expand the cognitive battery of tests to include components of the Uniform Data Set, a standardized set of measures used to assess neurocognitive function in relation to Alzheimer's Disease.

3.     Repeat cranial MRI's using the same SHSS1 protocol as in 2010 - 2013. At the same SHSS1 facilities,  a 1.5 Tesla magnet and FLAIR images will be used to measure presence and grade of sulcal widening, ventricle atrophy, and white matter disease; presence and number of infarcts and hemorrhages; volumetric estimates of intracranial space, total brain (both grey and white matter), hippocampus, and white matter hyperintensities.

4.     Repeat the same SHSS1 protocol to administer physical and  clinical examinations, questionnarires, and interviews covering personal and family medical history, health behaciors, quality of life and depression, and medication use.

5.     Assess the associations between within-person changes in MRI findings and neurocognitive test scores.  

6.     Obtain biological samples such as urine and blood for standard clinical assays, including gluclose, HbA1c, lipids, cystatin C, C-reactive protein, creatinine, and albumin.


CRST Tobacco Retailer Audit - 2015-2016, Counter Tools, SD Department of Health Tobacco Control Program

MBIRI staff and youth volunteers collected data on all retail stores on the Cheyenne River Sioux Tribe selling commercial tobacco products in 2015 initially and in 2016 as a follow-up. Following completion of survey collection and data analysis, education on point of sale, "Big Tobacco" marketing techniques and modifications to avoid tobacco sales to minors was provided to all Tobacco Retailer Managers/Owners.




Strong Heart Study Water Study   2015-2019:

Arsenic in Groundwater Intervention Program is a partnership between John Hopkins University, Missouri Breaks Industries Research Inc., the Cheyenne River Sioux Tribe, the Oglala Sioux Tribe and the Spirit Lake Nation to identify and implement a sustainable well-water infiltration intervention to test and control arsenic levels in household water sourced from wells on the Reservation;

Whenever possible, Missouri Breaks Research personnel collaborate with medical staff from the Tribal, Private and Indian Health Services, regional State, Private and Tribal colleges and State Health Departments.  Medical staff and Tribal government in the areas of projects conducted by MBIRI are briefed frequently regarding the activities of MBIRI personnel.  Missouri Breaks staff frequently participate in local and regional community health fairs, Tribal Health Fairs, workshops for IHS and Tribal medical staff on project procedures –diabetic foot screen, spirometry, antigen skin testing; participate in radio and literature education of community members.  Staff meets routinely with the Tribal Councils and their health committees, to help with education on health issues, the significance of research and promoting Tribal government as partners in guiding the goals and objectives for future health delivery in Indian Country. Translation of research results into practical applications for community programs is a priority of all MBIRI staff. 


Family Intervention in the Spirit of Motivational Interviewing (FITSMI) 2015-201?, Innovative Multigenerational Household Intervention to Reduce Stroke and Cardiovascular Disease

The Primary Objectives are to (1) Using a stroke risk score developed for research in American Indian (AI) populations, estimate the effectiveness of the Family Intervention in the Spirit of Motivational Interviewing (FITSMI) in adults ages 45 and older by comparing the change in stroke risk scores from baseline to 1-year follow-up in households randomized to the intervention and control conditions. (2) Quantify the impact of the FITSMI among AI adolescents and adults ages 11 to 44 by comparing changes in blood pressure and smoking behavior from baseline to 1-year follow-up in intervention and control households.

While the Secondary Objectives are (1) Evaluate the impact of the FITSMI on individual components of the stroke risk score, including blood pressure, blood lipids, smoking, microalbuminuria, and prevention of diabetes and cardiovascular disease, and (2) If the FITSMI is effective, quantify the population impact in terms of preventable strokes over 10 years.

Center for Native American Environmental Health Equity Research;  2015-2020, Johnnie Lewis, PI, UNM, NIH/NIEHS


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Healthy Foods, Healthy Families, and Healthy Communities – 2015-2016Amanda Fretts, PhD, Sanford Collaborative Research Center for American Indian Health

This study investigated food purchasing choices among Reservation families and to developed grocery store initiatives to improve family food choices at Cheyenne River.


Talking Circles on Bio-banking: Deliberation and Consensus in Native Communities, 2015-2016  Kai’im Sinclair, PhD, Ron Whitener, JD, University of Washington

The project conducted talking circles in Reservation communities on the concept of creating a Cheyenne River BioBank.


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Teens Against Tobacco Use (T.A.T.U.) – 2011 – current, Cheyenne Eagle Butte School and South Dakota Department of Health Tobacco Control program

Missouri Breaks works with a group of youth in middle and high school to train teens about tobacco health facts while helping them develop leadership skills to use to educate younger children and the greater community on the dangers of commercial tobacco use.  T.A.T.U. teens also work to educate on keeping canasa (tobacco) sacred and helping to bring policy change to protect all from secondhand smoke exposure and to prevent tobacco initiation.  

Harvard Health & Spirituality Study – 2015-2016

Dr. Alexandra Shields, director of the Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, is working to incorporate detailed religion and spirituality information into five national longitudinal health studies, in which a set of nearly 90 religion and spirituality metrics are being gathered for more than 5,000 participants. This added contextual data will aid researchers in determining, for instance, whether spirituality is associated with lower stress levels, which are in turn associated with better health, and in identifying other correlations between spiritual practice and health outcomes. More than 3,000 studies indicate that religion has a potentially beneficial effect on health. “For those of us interested in reducing health disparities, religion and spirituality may be particularly important,” says Dr. Shields. State of mind is important during stressful or poor living conditions. Mindfulness/meditation has been the subject of multiple studies on the effects of gene expression in immune system response pathways & stress. Religious or Spiritual devotion may work similarly. In addition to questionairres and clinical data, there are also biological measurements.  Here it is proposed that spirituality be looked at through the lens of epigenetics. Epigenetics is the study of how genes get turned on or off by a process called DNA methylation. DNA methylation is one of the epigenetic mechanisms that changes the way genes perform under stress. When methylation goes awry, it contributes to disease. American Indians & Alaska Natives and their unique Spiritualities have been left out of studies like these. Often, Native people are prevented from bringing their spiritual practices into a health care setting. Therefore, its critical to capture and document the health benefits of such practices so that such practices can be included in the standard care of their communities. http://projects.iq.harvard.edu/rshm/people/alexandra-e-shields-phd



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 Cheyenne River 1st Annual Research Symposium -2015

A Research Symposium for Cheyenne River…
Researching, Restoring & Rebuilding

Our Oyate for a Longer Life

The Research Symposium design is to help participants better understand the importance of research and the benefits of research now and for our future. The theme “Researching, Restoring & Rebuilding Our Oyate for a Longer Life” centers on the needed to make a longer life for our people. Tribal led, self-directed research serves the people and makes a greater impact. Leading researchers from Cheyenne River and beyond shared research results; high school and college students participated in a Student Research Competition and scholarships were awarded to the winning entries. 

The March 2015 Cheyenne River Research Symposium was sponsored by: Cheyenne River Sioux Tribe; Missouri Breaks Industries Research, Inc.; Cheyenne River Sioux Tribal Ventures; Oglala Lakota College; and Sanford Health.


Cheyenne River Sioux Tribe Community Health Assessment – 2016, Great Plains Tribal Chairman’s Health Board, CDC Good Health and Wellness in Indian Country, Cheyenne River Sioux Tribal Health Department

Missouri Breaks assisted the development of a comprehensive community health assessment to gather opinions on community health and quality life from 500 adults living across CRST.  Results were analyzed and compiled in a document for CRST to use to educate the public on community health needs and highlight community health successes.

Nagi Kicopi, Revitalizing Health through Tradition Project -2016

Ryia LeBeau, a graduating senior of Cheyenne River Eagle Butte High School, was inspired to do a project she called "Nagi Kicopi: Revitalizing Health through Tradition" after attending a seminar on food sovereignty, where she 'realized that food is much more than nourishment for our bodies; our food is Medicine.' Ryia wants to see the overall wellbeing (mind, body and soul) of the people improved. She also would like to see some food sovereignty and sustainability in our communities. The Project was funded by Great Plains Tribal Chairman’s Health Board through Cheyenne River Sioux Tribe. Funding is allocated for Community Action Plans to promote health at the local level and address local needs. Missouri Breaks Partnered with Ryia LeBeau to make this possible. Missouri Breaks also distributed hundreds of flyers, posters, recipe cards, social media advertisements and educational material and two newspaper articles on traditional healthy food. 

Ryia and her family prepared and served 150 meals, and over 50 samples of nutritional traditional foods at the Eagle Butte Wacipi and Pow-wow on September 3, 2016; 140 surveys regarding healthy traditional food were completed. Ryia hopes to see local vendors and stores carrying more of the healthy traditional food that sustained the Native Americans for centuries. The project started in August 2016                                                                                                                                                            and is in the final stages of talking to food vendors about selling healthy traditional foods. 


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Thiwáhe Patítaŋ "Supporting Families" – 2016-2017, NIH, University of Washington, Dedra Buchwald, Cathryn Booth-LaForce, Monica Oxford, PI's

Thiwáhe Patítaŋ "Supporting Families" is a project designed to test the effectiveness of the Promoting First Relationships program on Cheyenne River Sioux Tribe. Promoting First Relationships is an Intervention program designed by the University of Washington for service providers to help parents and other caretakers nurture young children’s social and emotional development. Designed on attachment theory, this program focuses on caregiver strengths and a reflective process to promote a developing relationship. Other attachment studies have found that sensitive parenting and close attachments benefit the child’s development and success in life. Missouri Breaks Industries Research Incorporated is conducting the research. Participants are recruited as a dyad (caretaker and child) and are randomly placed into either the Promoting First Relationships intervention group, or the Resource and Referral control group. Each dyad is interviewed prior to and after receiving the services. Thiwáhe Patítaŋ Supporting Families is projected to run through 2017 and 2018 on Cheyenne River Sioux Tribe. 


RED Talks – 2016-2017, National Congress of American Indians

RED Talk videos share Native wisdom, tribal research, policy and community success stories to shape the future of tribal nations. The data and ideas shared empower tribes to use their sovereignty to implement programs and policies that work, build research capacity, and create sustainable opportunities for 7 generations of Native people.

If you are interested in creating a RED Talk, contact Rae O'Leary at raeoleary@yahoo.com.





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Cheyenne River 2nd Annual Research Symposium – 2016

Researching, Restoring & Rebuilding Our Oyate for a
Longer Life
is a venue for community members to learn about current research, meet presenters and have face to face discussions with researchers and other scientists. Topics addressed: Health Disparities in Indian Country; Research Creating a Lasting Legacy; RED Talks an Innovative Way to Share Ideas; Reducing the Silo Effect in Tribal Communities; Discover the Native Food Agriculture Program; and Learn the Latest Research Results.

The March 2016 Research Symposium was sponsored by: Missouri Breaks Industries Research, Inc.; Cheyenne River Sioux Tribal Ventures; Cheyenne River Youth Project, Cheyenne River Sioux Tribe, and South Dakota Humanities Council an Affiliate of the National Endowment for the Humanities.


We RISE – 2016-2017, Sanford Research CRCAIH, South Dakota State University, Lacey McCormack, PhD, MPH, PI

It is well documented that socioeconomic status (SES), specifically income and education, is associated with health disparities, especially in minority populations such as American Indians.  The We RISE (Raising Income, Supporting Education) Project will investigate whether using motivational interviewing techniques with individuals to set and attain goals related to income and education, as well as improving utilization of community resources, will impact participant behaviors affecting health such as, locus of control, general well-being, and self-efficacy.  If proven successful, the We RISE intervention and utilization of community resources could be used in other health disparate and low SES populations as a means to ultimately improve community health outcomes.

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Minority Supplement - Genetics and Pre-Eclampsia 2016-2018 – Dr. Lyle Best, PI

The Pre-Eclampsia Study is looking to verify if genetics play a role in causing pre-eclampsia; if a mother is more likely to develop pre-eclampsia base on her DNA genetic markers; and if a genetic marker can be identified to better diagnose and treat pre-eclampsia. 

Rhythm & Timing – 2016-2019



SPHERE Bio-repository for American Indian Capacity, Education, Law, Economics and Technology (BRAICELET) - 2016-2019

We are asking questions to the community on what they feel about genetic research, samples, data, outcomes and intervention strategies. We are asking how all of those things relate to bio-banking and if they’d all improve if a tribe managed it themselves.


Center of Ethical Indigenous Genome Research (CEIGR) – 2016-2019

We are asking questions to the community on what they feel about genetic research, samples, data, outcomes and intervention strategies. We are asking how all of those things relate to bio-banking and if they’d all improve if a tribe managed it themselves.  We are asking similar questions to the BRAICELET but comparing across three tribal groups, Alaska’s South Central Foundation, CRST and the Chickasaw nation.





Cheyenne River 3rd Annual Research Symposium -2017

Researching, Restoring & Rebuilding Our Oyate for a Longer Life is where community members and Tribal Leaders come together to learn about current health research and have face to face discussions with researchers and other scientists. This year’s symposium featured an adult tract and a high school tract. Topics covered were: Ethics in Research, Sharing Results & Return of Benefit from American Indian Research; Significance of Science & How it Impacts Your Community; Importance of Institutional Review Board (IRB) Protocol & Protections; How Native American Philosophies Can Enable Us to Protect Our World; Interconnection: Indigenous Knowledge, Astrophysics & Environmental Health; Study of Autoimmune Disease in Lakota the SAIL Project; and Preserving Cultural Sites. Participating area high school students shared their research projects and had the opportunity to apply for scholarships and summer internships in the research field.

The April 2017 Research Symposium was sponsored by: Missouri Breaks Industries Research, Inc.; The University of Oklahoma; and the South Dakota Humanities Council.

Promoting Smoke-Free Homes in Lakota Communities 2017-2020 Patricia Nez-Henderson PI

The project aims are to assess knowledge, attitudes and beliefs about secondhand smoke exposure and perceived barriers to adoption of smoking restrictions in tribal member households on CRST; to augment, implement, and evaluate a nonsmokers’ urinary cotinine and carcinogen biomarker feedback intervention on the adoption of household smoking restrictions; and to determine the effect of the intervention on health-related quality of life 6 months after implementation of the advocacy and biomarker feedback intervention.  Fifteen Key Informant interviews will be conducted and 138 participants will be enrolled in the study. 


Native Center for Alcohol Research and Education Project – CRST CHOICES N-CARE 2018 - 2020

The CRST CHOICES Program uses the Prevention Spectrum of the Continuum of Care Theoretical Framework.   It is a program for women choosing a healthy way of life.  Its focus is to help prevent babies from being hurt by alcohol during pregnancy.  It helps to decrease a women’s risk of having an alcohol-exposed pregnancy by reducing drinking or preventing pregnancy.   

Cheyenne River Cooking For Health – 2018 -2021 – Amanda Fretts, PI

This study strives to evaluate the effectiveness of a culturally-tailored healthy food budgeting, purchasing, and cooking program on diet quality and cooking skills among 165American Indians with type 2 diabetes to see if participation: lowers consumption of sugar-sweetened beverages and processed foods; increases cooking skills and knowledge about healthy foods; and lowers weight, blood pressure, cholesterol, and blood sugar levels.   

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2018    4th Annual Cheyenne River Research Symposium

The 4th Annual Cheyenne River Research Symposium Researching, Restoring & Rebuilding our Oyate for a Longer Life focused on the theme of data sovereignty.  The symposium brings community members together with researchers from across the nation to learn, discuss health issues, and much more.   Other research areas explored during the symposium were decolonizing science and technology; rheumatoid arthritis and DNA; mercury exposure and sources in communities; environmental quality; exposure to metals and immune response; and how local research impacts community members. 

The Research Symposium also featured a Student Research Day for high school students.  All six schools on Cheyenne River were invited to participate in the daylong event.   The students rotated through four hands on learning sessions where they learned about the Strong Heart Study and Informed Consent; What’s in Their DNA; Looking Thru Dirt with X-Ray Eyes to See If Anything is Bad; and Spit, Cotinine and Nicotine Exposure.   Some of the descriptive words shared from students about their day were:  excellent, pleased, productive, interesting, important, and liked.   Participating students also learned about other science related summer activities at various universities and other locations.  Students were also able to apply for scholarships and summer internships.    

The 2018 Research Symposium was sponsored by:  The Bush Foundation, South Dakota Humanities Council, The Keya Foundation, and Missouri Breaks Industries Research, Inc.