Personal Website

Project Description:

Health disparities represent the adverse health outcomes experienced by racial/ethnic minorities that occur in the context of broad historic and contemporary social and economic inequality as well as health care system factors.  The Zuni Pueblo, located in a rural portion of western NM, is home to approximately 11,000 Zuni Indians. Low rates of emigration and immigration have led to a relatively endogamous population characterized by large extended families. This socio-economically disadvantaged population faces a major public health challenge from growing health disparities. Changing lifestyles have led to decreased physical activity and increased caloric intake with high consumption of fast food, soda pop and alcohol. As a result the Zuni are experiencing interrelated epidemics of obesity, diabetes, hypertension (HTN), kidney disease and related intermediate phenotypes. Since these conditions are also risk factors for cardiovascular disease there may be an unidentified epidemic of heart disease. Decreasing the burden of these interrelated epidemics is complicated by a unique combination of historical, economic and cultural barriers, which limit health care utilization, increase morbidity and mortality and diminish health related quality of life (HRQOL). Reducing heath disparities between the Zuni and more affluent populations poses a major public health challenge. To meet this challenge we will utilize a chronic care model that takes into account Zuni demographics, family structure, tribal culture, health care needs and utilization of the on site Indians Health Service (IHS) to develop and pilot the Zuni Health Initiative (ZHI). When the full scale ZHI is implemented, it will have the potential to significantly reduce health disparities among the Zuni. We have established an education and health care consortium consisting of the Zuni Tribal Council, The Zuni Pueblo, IHS, Dialysis Clinic Inc. (DCI)and the University of New Mexico (Health Sciences Center) to develop and pilot the ZHI. This consortium, built upon the infrastructure created by the current phase of the NIH funded Zuni Kidney Project (ZKP). Hypothesis: It is feasible to develop and pilot a ZHI that combines family, community and IHS clinic based education to achieve life style modification and reduce the barriers to utilization of IHS health care delivery, decrease health disparities and improve the public health of the community that will inform the design of a planned full-scale study. We will evaluate four specific aims: 1) Hold a series of focus groups to inform the design of a culturally sensitive chronic care model (ZHI) that when implemented will decrease the burden of chronic disease in Zuni.; 2) Develop a culturally sensitive education curriculum for community, family and individual based to teach healthy life styles, chronic disease prevention and improved health care utilization; 3) Recruit 100 participants from 10 randomly selected extended families who are participating in the current phase of the ZKP to pilot the ZHI and 4) Collaborate with IHS to implement nationally recognized screening and treatment guidelines for hypertension, diabetes, obesity, hyperlipidemia, and kidney disease and monitor clinical outcomes in the 100 participants.