This article provides guidance on conducting clinical trials with Indigenous children in the United States, emphasizing ethical and effective practices. It highlights three key approaches: sustained community engagement, capacity building for Indigenous research, and ensuring community oversight and ownership of the research process. These practices are illustrated with case examples from research conducted within American Indian, Alaska Native, and Native Hawaiian communities.

Effective engagement with these communities requires equity, trust, and mutual benefits. Building research capacity involves prioritizing the development of Indigenous researchers, while community oversight includes planning for data-sharing, data return or destruction, and securing necessary regulatory approvals.

The article also addresses the significant health disparities faced by Indigenous children, such as higher rates of asthma, obesity, and respiratory infections. It underscores the importance of including Indigenous children in clinical trials to improve health outcomes and reduce these disparities. The establishment of the Environmental Influences on Child Health Outcomes Institutional Development Award States Pediatric Clinical Trials Network (ECHO ISPCTN) in 2016 presents a timely opportunity to enhance the participation of Indigenous children in advanced clinical trials, aiming to address both social and environmental determinants of their health.

Shaw JL, Semmens E, Okihiro M, Lewis JL, Hirschfeld M, VanWagoner TM, Stephens L, Easa D, Ross JL, Graham N, Watson SE, Szyld EG, Dillard DA, Pyles LA, Darden PM, Carlson JC, Smith PG, McCulloh RJ, Snowden JN, Adeky SH, Singleton R. “Best Practices for Conducting Clinical Trials With Indigenous Children in the United States”, American Journal of Public Health, no.  (): pp. e1-e9. https://doi.org/10.2105/AJPH.2021.306372

This article examines how people choose campsites at Zion National Park's Watchman Campground. By analyzing large-scale reservation data, the study explores the influence of factors such as price, availability of electricity, ease of access, and proximity to the Virgin River on campsite selection. The findings provide insights into visitor preferences and have practical implications for park management strategies, including how campsites are allocated. The research also discusses the benefits of using big data for future studies in managing protected areas.

Rice WL, Park S. Big data spatial analysis of campers' landscape preferences: Examining demand for amenities. Journal of Environmental Management. 2021 Aug 15:112773. https://doi.org/10.1016/j.jenvman.2021.112773

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This article investigates the levels of carbon monoxide (CO) exposure among wildland firefighters (WFFs) and identifies factors that predict higher exposures. Between 2015 and 2017, CO levels were measured every minute in the breathing zones of 246 firefighters working on wildfires. The study found that about 5% of these firefighters were exposed to CO levels above the safety limit recommended by the National Wildfire Coordinating Group. Firefighting tasks directly related to fire suppression resulted in significantly higher CO exposures compared to other tasks. The firefighters’ own perceptions of smoke exposure also strongly predicted actual CO levels. These findings suggest that specific firefighting activities and personal perceptions of smoke are key areas for developing targeted strategies to reduce smoke exposure among firefighters.

Semmens EO, Leary CS, West MR, Noonan CW, Navarro KM, Domitrovich JW. Carbon monoxide exposures in wildland firefighters in the United States and targets for exposure reduction. Journal of exposure science & environmental epidemiology. 2021 July 20. PubMed PMID: 34285366; DOI: 10.1038/s41370-021-00371-z 

This article introduces the first use of archetypal analysis on influenza data from Montana, covering the years 2010 to 2018. This method helps break down the data by time and location, offering a clearer view of influenza trends throughout a season. We start by simplifying the data from various counties into a more manageable form using mutual information—a technique that measures how much one variable informs about another. We then use archetypal analysis to explore how influenza cases are interconnected across different counties and regions in Montana. The article concludes by considering how this approach could enhance infectious disease modeling, especially in situations where data is scarce.

Mokhtari EB, Landguth EL, Anderson S, Stone E. Decoding Influenza Outbreaks in a Rural Region of the USA with Archetypal Analysis. Spatial and Spatio-temporal Epidemiology. 2021 Jun 30:100437.

This article explores the challenges of accessing healthcare in the U.S., especially for adults with mental health challenges (MHC). Using data from the 2017-2018 National Health Interview Survey, it investigates how common these access barriers are among adults, focusing on those with no usual source of care (NUSC). The study found that nearly all participants faced at least one barrier to healthcare, with affordability being a major issue. Interestingly, mental health conditions themselves did not significantly impact the likelihood of lacking a usual source of care, although those with severe psychological distress reported more barriers overall. The findings suggest that broader social and economic factors also play a critical role in healthcare access, pointing to the need for further research to fully understand these dynamics.

Coombs NC, Meriwether WE, Caringi J, Newcomer SR. Barriers to healthcare access among US adults with mental health challenges: A population-based study. SSM-Population Health. 2021 Jun 15:100847.

This article investigates the lower vaccination rates in early childhood in Montana's rural areas compared to urban ones. It specifically examines how timely vaccinations are and the patterns of undervaccination, such as delays caused by parental vaccine hesitancy. The study used vaccination records from 2015 to 2019, analyzing when children fell behind on the standard 7-vaccine series and the impact of these delays on completing the series by 24 months old. The findings show that only 38% of children received all vaccines on schedule, and delays, especially between 12-15 months, significantly increased the likelihood of not completing the vaccine series. The study highlights the need for efforts to boost vaccine confidence and ensure that children receive their vaccinations on time.

Newcomer SR, Freeman RE, Wehner BK, Anderson SL, Daley MF. Timeliness of Early Childhood Vaccinations and Undervaccination Patterns in Montana. American Journal of Preventive Medicine. 2021 May 8.

This article investigates whether areas with more greenspace, like parks and forests, have lower COVID-19 death rates. It looks at data from 3,049 U.S. counties, using satellite images to measure greenspace and comparing it to COVID-19 mortality data from Johns Hopkins University. The study finds that counties with more greenspace generally see fewer COVID-19 deaths, suggesting that being around more greenery might help reduce the risk of dying from the virus. Factors like population density, demographics, and health behaviors were also considered to understand their impact on mortality rates. The findings indicate that promoting greenspace in communities could be beneficial for public health, especially in combating diseases like COVID-19.

Russette H, Graham J, Holden Z, Semmens EO, Williams E, Landguth EL. Greenspace exposure and COVID-19 mortality in the United States: January-July, 2020. Environmental Research. 2021 Apr 28:111195. https://doi.org/10.1016/j.envres.2021.111195

This article investigates the link between walking speed and the risk of falling in older adults, focusing on those with mild cognitive impairment (MCI) as well as those without. The study involved 2,705 participants from the Ginkgo Evaluation of Memory Study, who were assessed over periods of 12 and 18 months. Participants completed a 15-foot walking test to measure their gait speed and reported any falls that occurred. Findings suggest that faster walking speeds are associated with a lower risk of falls, regardless of whether participants had MCI. This highlights the potential importance of maintaining or improving walking speed to help prevent falls in older adults.

Adam CE, Fitzpatrick AL, Leary CS, Hajat A, Phelan EA, Park C, Semmens EO. The Association between Gait Speed and Falls in Community Dwelling Older Adults with and without Mild Cognitive Impairment. International Journal of Environmental Research and Public Health. 2021 Apr 2;18(7):3712.  https://doi.org/10.3390/ijerph18073712

This article discusses the scientific community's efforts to predict the spread of COVID-19, caused by the virus SARS-CoV-2, using disease modeling. A key focus is on the "serial interval" (SI)—the time between when one person shows symptoms and when the next person they've infected does. This measure helps scientists estimate how quickly the disease can spread and assess the impact of measures like social distancing. While previous studies mostly used data from crowded cities and found SIs between 3 to 7.5 days, this study looks at the rural areas of Montana, USA, to see if there are differences in how COVID-19 spreads in less populated areas compared to urban ones. The University of Montana Institutional Review Board approved the study as part of public health surveillance.

Reed IG, Walker ES, Landguth EL. Early Release-Severe Acute Respiratory Syndrome Coronavirus 2 Serial Interval Variation, Montana, USA, March 1–July 31, 2020 [Early Release]. Emerging Infectious Diseases. 2021 May. https://doi.org/10.3201/eid2705.204663 

Wood stoves are a popular way to heat homes in many rural parts of the United States but can increase indoor air pollution. In this study, we measured indoor fine particulate matter (PM2.5) over six days during winter in homes from three rural areas. We found that the average PM2.5 levels were higher in homes in Alaska and Navajo Nation compared to Montana. Homes that did not clean their chimneys in the past year showed a 65% increase in PM2.5 levels compared to those that had a recent chimney cleaning. Additionally, homes with lower-quality wood stoves had significantly higher PM2.5 levels. Our research suggests that using higher-quality stoves and regular chimney cleaning can improve air quality in these rural areas.

Walker ES, Noonan CW, Semmens EO, Ware D, Smith P, Boyer BB, Erdei E, Hopkins SE, Lewis J, Belcourt A, Ward TJ. Indoor fine particulate matter and demographic, household, and wood stove characteristics among rural US homes heated with wood fuel. Indoor air. 2021 Feb 23. doi: 10.1111/ina.12808. Epub ahead of print. PMID: 33620109.

This article reviews a virtual meeting hosted by the U.S. Environmental Protection Agency (EPA) that focused on effective ways to maintain clean indoor air during wildfire smoke events. It highlights the need for strategies to combat the health risks posed by prolonged smoke exposure, which is common in wildfire-prone areas around the world. The meeting featured discussions on the public health impacts of wildfire smoke, experiences from public health agencies, and resilience efforts. It also explored methods to enhance indoor air quality, particularly through the use of air filtration systems, including HVAC and portable units. Although filtration has proven effective in improving air quality during smoke and other high pollution events, questions remain about the durability of these systems, their maintenance needs during and after smoke events, the interaction with various pollutants, and the extent to which they mitigate health risks.

Davison G, Barkjohn KK, Hagler GS, Holder AL, Coefield S, Noonan C, Hassett-Sipple B. Creating Clean Air Spaces During Wildland Fire Smoke Episodes: Web Summit Summary. Front Public Health. 2021 Feb 15;9:508971. doi: 10.3389/fpubh.2021.508971. PMID: 33681116; PMCID: PMC7928341.

This study aimed to assess the timeliness of childhood vaccinations in the U.S. and identify patterns of undervaccination among children aged 0-19 months. Using 2017 National Immunization Survey-Child data, we measured the number of days vaccines were delayed and categorized undervaccination patterns, distinguishing between parental vaccine hesitancy-related behaviors like spreading out vaccines ("shot-limiting") and other non-hesitancy patterns such as missing doses or receiving all doses late. Among 15,333 children, only 41.2% received all recommended doses on time by age 19 months, with approximately 20.9% showing patterns suggestive of parental vaccine hesitancy. Uninsured children and those with lower maternal education levels were more likely to exhibit hesitant vaccination behaviors. These findings underscore the importance of ongoing monitoring of vaccine timeliness and adherence to vaccination schedules to inform targeted public health interventions.

Freeman RE, Thaker J, Daley MF, Glanz JM, Newcomer SR. Vaccine timeliness and prevalence of undervaccination patterns in children ages 0-19 months, U.S., National Immunization Survey-Child 2017. Vaccine. 2022;40(5):765-73. Epub 20211224. doi: 10.1016/j.vaccine.2021.12.037. PubMed PMID: 34961632; PubMed Central PMCID: PMC8856130.

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Vermiculite ore from Libby, Montana, contains about 24% toxic and carcinogenic amphibole asbestiform fibers, primarily winchite (84%), with smaller amounts of richterite (11%) and tremolite (6%), collectively known as Libby amphibole (LA). A study of 1883 individuals exposed to LA and diagnosed with asbestos-related pleuropulmonary disease (ARPPD) through community screening programs and follow-ups at the Center for Asbestos Related Disease (CARD) from 2000 to 2010 found that 203 patients had sufficient records for analysis. Among these, 112 (55%) deaths were asbestos-related, including 34 (17%) from asbestos-related malignancy, 75 (37%) from parenchymal asbestosis often with pleural fibrosis, and 3 (1.5%) from respiratory failure due to pleural thickening. The study concludes that asbestos exposure is the leading cause of mortality in individuals with ARPPD.

Miller A, Black CB, Loewen G, Noonan CW, McNew T, Whitehouse AC, Frank AL. Case-fatality study of workers and residents with radiographic asbestos disease in Libby, Montana. Am J Ind Med. 2022;65(3):196-202. Epub 20211227. doi: 10.1002/ajim.23320. PubMed PMID: 34961951; PubMed Central PMCID: PMC9303583.

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In response to the emergence of SARS-CoV-2, the virus causing COVID-19, the scientific community has worked to predict its transmission trends using disease modeling. However, estimates for disease-specific parameters like the serial interval (SI)—the time between symptom onset in primary and secondary cases—vary widely. This SI is critical for estimating the epidemic reproduction number (R0) and assessing the impact of nonpharmaceutical interventions (NPIs) on transmission. Recent studies report SARS-CoV-2 SIs ranging from 2.97 to 7.5 days, mainly in urban settings. While rural areas in the United States saw fewer cases in the early waves, they experienced major outbreaks later, leaving it unclear if transmission patterns differ between rural and urban areas. Our objective was to compare SARS-CoV-2 SI values in Montana, a predominantly rural state, with global and urban estimates. This study was classified as a public health surveillance activity by the University of Montana Institutional Review Board.

Reed IG, Walker ES, Landguth EL. SARS-CoV-2 Serial Interval Variation, Montana, USA, March 1-July 31, 2020. Emerg Infect Dis. 2021;27(5):1486-91. doi: 10.3201/eid2705.204663. PubMed PMID: 33900189; PubMed Central PMCID: PMC8084495.

Neurobiological and psychological research highlights the links between opioid use disorder, especially during pregnancy, and parenting behaviors. Perinatal opioid use poses risks such as increased child maltreatment. We present a model connecting perinatal opioid use, parenting behavior, infant attachment, and child well-being, aiming to improve behavioral interventions for affected mother-infant pairs. The model suggests that recurrent opioid use can heighten stress sensitivity and disrupt reward systems in mothers, leading to disengaged parenting and poor infant attachment, ultimately affecting child well-being. We discuss Mindfulness-Oriented Recovery Enhancement as a treatment, showing its efficacy in addressing these issues. With rising perinatal opioid use in the U.S., such models are crucial for guiding effective treatment development.

Reese SE, Conradt E, Riquino MR, Garland EL. An Integrated Mechanistic Model of Mindfulness-Oriented Recovery Enhancement for Opioid-Exposed Mother-Infant Dyads. Front Psychol. 2021;12:688359. Epub 20211028. doi: 10.3389/fpsyg.2021.688359. PubMed PMID: 34777086; PubMed Central PMCID: PMC8582323.

As opioid use during pregnancy rises, more women with opioid use disorder (OUD) and their newborns are being treated in hospitals. This study aimed to understand the experiences of nurses and nursing assistants working with these patients. By identifying their needs, the study hopes to reduce stigma and improve care. Thirty participants from a postpartum unit at a large urban hospital in Utah attended up to four focus groups. Using Braun and Clarke's thematic analysis, the study found themes of negative feelings toward patients, prioritizing newborns over mothers, and the need for better organizational support and training. The findings suggest strategies for addressing these challenges and highlight the need for further research on reducing stigma and improving satisfaction and outcomes for both employees and patients.

Reese SE, Riquino MR, Molloy J, Nguyen V, Smid MC, Tenort B, Gezinski LB. Experiences of Nursing Professionals Working With Women Diagnosed With Opioid Use Disorder and Their Newborns: Burnout and the Need for Support. Adv Neonatal Care. 2021;21(1):32-40. doi: 10.1097/ANC.0000000000000816. PubMed PMID: 33055519. PMCID [In Process]

Tribal Nations face high rates of substance misuse due to historical and contemporary traumas. To combat this, many Tribal Nations are promoting recovery and prevention efforts. This study aimed to partner with a Tribal Nation to explore factors that support the wellbeing of families with children exposed to substances prenatally and share the findings with the community. Using Community-based participatory research (CBPR) and strengths-based approaches, the two-year study involved collaborating with the Confederated Salish Kootenai Tribes Early Childhood Services program. Key steps included understanding the community, building structural supports for CBPR, incorporating Indigenous principles, and forming a Community Advisory Team. Despite challenges, we developed a study design that ensured participant confidentiality and aligned with community goals, incorporating culturally sensitive measures. This collaboration resulted in a robust study plan and dissemination strategy to address substance misuse effectively within the Tribal Nation.

Russette HC, Graham N, Swanson S, Semmens EO. Relationship-building to develop an Indigenous community-based epidemiological study investigating developmental resilience factors among children with prenatal substance exposure. J Ethn Subst Abuse. 2023;22(3):589-605. Epub 20210901. doi: 10.1080/15332640.2021.1965933. PubMed PMID: 34469277; PubMed Central PMCID: PMC8885795.