Jan Dyer

There’s some good news in the battle against “superbugs” in acute care hospitals. For example, central line–associated bloodstream infections were down 50% and surgical site infections declined 17% between 2008 and 2014. Plus, some “progress” toward reducing in catheter-associated urinary tract infections was seen between 2009 and 2014. Hospital-onset infections caused by Clostridium difficile, the most common bacteria responsible for hospital-acquired infections (HAIs), dropped by 8% between 2011 and 2014.

However, “antibiotic-resistant HAIs are a threat to all patients,” according to the Centers for Disease Control and Prevention (CDC). In its Vital Signs report, the CDC lists 6 bacteria that are among the “most deadly”: carbapenem-resistant Enterobacteriaceae, methicillin-resistant Staphylococcus aureus, ESBL-producing Enterobacteriaceae (extended-spectrum β-lactamases), vancomycin-resistant Enterococcus, multidrug-resistant Pseudomonas aeruginosa, and multidrug-resistant Acinetobacter. Those bacteria cause 1 in 7 catheter- and surgery-related HAIs in acute care hospitals, and 1 in 4 infections in long-term acute care hospitals.

“Doctors and health care facilities have the power to protect patients—no one should get sick while trying to get well,” said CDC Director Tom Frieden, MD, MPH. The CDC’s report calls on health care professionals to continue prevention efforts. “For clinicians, prevention means isolating patients when necessary,” said Clifford McDonald, MD, associate director for science at CDC’s Division of Healthcare Quality Promotion. The Vital Signs report advises being aware of antibiotic resistance patterns in facilities, following recommendations for preventing infections, and prescribing antibiotics correctly (including reassessing and stopping appropriately). It also urges health care facility CEOs and administrators to establish a stewardship program and enroll their hospitals to submit data to the CDC’s Antimicrobial Use and Resistance Module to target improvements (www.cdc.gov/nhsn/acute-care-hospital/aur/index.html).

Along with the annual progress report, the CDC has released the Antibiotic Resistance Patient Safety Atlas (www.cdc.gov/hai/surveillance/ar-patient-safety-atlas.html), a new web app with interactive data on HAIs. National, regional, and state maps show the percentage of resistance over time using data reported to the National Healthcare Safety Network by more than 4,000 health care facilities.

There’s some good news in the battle against “superbugs” in acute care hospitals. For example, central line–associated bloodstream infections were down 50% and surgical site infections declined 17% between 2008 and 2014. Plus, some “progress” toward reducing in catheter-associated urinary tract infections was seen between 2009 and 2014. Hospital-onset infections caused by Clostridium difficile, the most common bacteria responsible for hospital-acquired infections (HAIs), dropped by 8% between 2011 and 2014.

However, “antibiotic-resistant HAIs are a threat to all patients,” according to the Centers for Disease Control and Prevention (CDC). In its Vital Signs report, the CDC lists 6 bacteria that are among the “most deadly”: carbapenem-resistant Enterobacteriaceae, methicillin-resistant Staphylococcus aureus, ESBL-producing Enterobacteriaceae (extended-spectrum β-lactamases), vancomycin-resistant Enterococcus, multidrug-resistant Pseudomonas aeruginosa, and multidrug-resistant Acinetobacter. Those bacteria cause 1 in 7 catheter- and surgery-related HAIs in acute care hospitals, and 1 in 4 infections in long-term acute care hospitals.

“Doctors and health care facilities have the power to protect patients—no one should get sick while trying to get well,” said CDC Director Tom Frieden, MD, MPH. The CDC’s report calls on health care professionals to continue prevention efforts. “For clinicians, prevention means isolating patients when necessary,” said Clifford McDonald, MD, associate director for science at CDC’s Division of Healthcare Quality Promotion. The Vital Signs report advises being aware of antibiotic resistance patterns in facilities, following recommendations for preventing infections, and prescribing antibiotics correctly (including reassessing and stopping appropriately). It also urges health care facility CEOs and administrators to establish a stewardship program and enroll their hospitals to submit data to the CDC’s Antimicrobial Use and Resistance Module to target improvements (www.cdc.gov/nhsn/acute-care-hospital/aur/index.html).

Along with the annual progress report, the CDC has released the Antibiotic Resistance Patient Safety Atlas (www.cdc.gov/hai/surveillance/ar-patient-safety-atlas.html), a new web app with interactive data on HAIs. National, regional, and state maps show the percentage of resistance over time using data reported to the National Healthcare Safety Network by more than 4,000 health care facilities.

There’s some good news in the battle against “superbugs” in acute care hospitals. For example, central line–associated bloodstream infections were down 50% and surgical site infections declined 17% between 2008 and 2014. Plus, some “progress” toward reducing in catheter-associated urinary tract infections was seen between 2009 and 2014. Hospital-onset infections caused by Clostridium difficile, the most common bacteria responsible for hospital-acquired infections (HAIs), dropped by 8% between 2011 and 2014.

However, “antibiotic-resistant HAIs are a threat to all patients,” according to the Centers for Disease Control and Prevention (CDC). In its Vital Signs report, the CDC lists 6 bacteria that are among the “most deadly”: carbapenem-resistant Enterobacteriaceae, methicillin-resistant Staphylococcus aureus, ESBL-producing Enterobacteriaceae (extended-spectrum β-lactamases), vancomycin-resistant Enterococcus, multidrug-resistant Pseudomonas aeruginosa, and multidrug-resistant Acinetobacter. Those bacteria cause 1 in 7 catheter- and surgery-related HAIs in acute care hospitals, and 1 in 4 infections in long-term acute care hospitals.

“Doctors and health care facilities have the power to protect patients—no one should get sick while trying to get well,” said CDC Director Tom Frieden, MD, MPH. The CDC’s report calls on health care professionals to continue prevention efforts. “For clinicians, prevention means isolating patients when necessary,” said Clifford McDonald, MD, associate director for science at CDC’s Division of Healthcare Quality Promotion. The Vital Signs report advises being aware of antibiotic resistance patterns in facilities, following recommendations for preventing infections, and prescribing antibiotics correctly (including reassessing and stopping appropriately). It also urges health care facility CEOs and administrators to establish a stewardship program and enroll their hospitals to submit data to the CDC’s Antimicrobial Use and Resistance Module to target improvements (www.cdc.gov/nhsn/acute-care-hospital/aur/index.html).

Along with the annual progress report, the CDC has released the Antibiotic Resistance Patient Safety Atlas (www.cdc.gov/hai/surveillance/ar-patient-safety-atlas.html), a new web app with interactive data on HAIs. National, regional, and state maps show the percentage of resistance over time using data reported to the National Healthcare Safety Network by more than 4,000 health care facilities.

Human papillomavirus (HPV) infects an estimated 79 million U.S. adults, and ≥ 30,000 HPV-related cancers occur each year in the U.S., according to the Centers for Disease Control and Prevention (CDC). Native American women living in the Northern Plains and Midwest are twice as likely as the national average to report HPV infection. In some regions, American Indians are 4 times more likely to get cervical cancer, the most common HPV-related cancer.

While vaccination rates are higher among American Indian youth than other groups, rates for the HPV vaccine remain low: Only 39% of females and 26% of males have had all 3 doses.

Studies have shown the vaccine prevents strains of HPV that lead to 70% of HPV-related cancers in men and women, such as oropharyngeal, penile, cervical, and vaginal, the CDC reported. But there are still misconceptions about HPV that help keep vaccination rates low, says Delf Schmidt-Grimminger, a senior scientist with the Sanford School of Medicine at the University of South Dakota and the Avera Cancer Institute, in an article for Native Health News Alliance. One misconception is that boys do not need the vaccination; however, both boys and girls should be vaccinated to eradicate the disease. Preteens are the targeted group because the vaccine is most effective when given before individuals become sexually active. The vaccines are available and free for most American Indian children at any clinic.

Human papillomavirus (HPV) infects an estimated 79 million U.S. adults, and ≥ 30,000 HPV-related cancers occur each year in the U.S., according to the Centers for Disease Control and Prevention (CDC). Native American women living in the Northern Plains and Midwest are twice as likely as the national average to report HPV infection. In some regions, American Indians are 4 times more likely to get cervical cancer, the most common HPV-related cancer.

While vaccination rates are higher among American Indian youth than other groups, rates for the HPV vaccine remain low: Only 39% of females and 26% of males have had all 3 doses.

Studies have shown the vaccine prevents strains of HPV that lead to 70% of HPV-related cancers in men and women, such as oropharyngeal, penile, cervical, and vaginal, the CDC reported. But there are still misconceptions about HPV that help keep vaccination rates low, says Delf Schmidt-Grimminger, a senior scientist with the Sanford School of Medicine at the University of South Dakota and the Avera Cancer Institute, in an article for Native Health News Alliance. One misconception is that boys do not need the vaccination; however, both boys and girls should be vaccinated to eradicate the disease. Preteens are the targeted group because the vaccine is most effective when given before individuals become sexually active. The vaccines are available and free for most American Indian children at any clinic.

Human papillomavirus (HPV) infects an estimated 79 million U.S. adults, and ≥ 30,000 HPV-related cancers occur each year in the U.S., according to the Centers for Disease Control and Prevention (CDC). Native American women living in the Northern Plains and Midwest are twice as likely as the national average to report HPV infection. In some regions, American Indians are 4 times more likely to get cervical cancer, the most common HPV-related cancer.

While vaccination rates are higher among American Indian youth than other groups, rates for the HPV vaccine remain low: Only 39% of females and 26% of males have had all 3 doses.

Studies have shown the vaccine prevents strains of HPV that lead to 70% of HPV-related cancers in men and women, such as oropharyngeal, penile, cervical, and vaginal, the CDC reported. But there are still misconceptions about HPV that help keep vaccination rates low, says Delf Schmidt-Grimminger, a senior scientist with the Sanford School of Medicine at the University of South Dakota and the Avera Cancer Institute, in an article for Native Health News Alliance. One misconception is that boys do not need the vaccination; however, both boys and girls should be vaccinated to eradicate the disease. Preteens are the targeted group because the vaccine is most effective when given before individuals become sexually active. The vaccines are available and free for most American Indian children at any clinic.

“No one is excused from prediabetes.” That is why the CDC, the American Medical Association (AMA), and the American Diabetes Association (ADA) are launching the first national public service advertising campaign about prediabetes.

More than 1 in 3 Americans has blood glucose levels high enough to qualify for prediabetes, but an estimated 90% don’t know it. Current trends suggest that if untreated, 15% to 30% of people with prediabetes will develop type 2 diabetes within 5 years. However, the CDC suggests weight loss, diet changes, and increased physical activity can help cut risk by 58%.

Public service announcements in English and Spanish encourage people to take a short test at www.DoIHavePrediabetes.org or in real time through interactive, “first of its kind,” TV and radio PSAs. People can also take the test and receive support and lifestyle tips via text messages. The ADA, AMA, and CDC are also working through local offices, affiliates, and partners to promote the campaign, with resources for health care providers to aid in screening, diagnosis, and treatment.

“No one is excused from prediabetes.” That is why the CDC, the American Medical Association (AMA), and the American Diabetes Association (ADA) are launching the first national public service advertising campaign about prediabetes.

More than 1 in 3 Americans has blood glucose levels high enough to qualify for prediabetes, but an estimated 90% don’t know it. Current trends suggest that if untreated, 15% to 30% of people with prediabetes will develop type 2 diabetes within 5 years. However, the CDC suggests weight loss, diet changes, and increased physical activity can help cut risk by 58%.

Public service announcements in English and Spanish encourage people to take a short test at www.DoIHavePrediabetes.org or in real time through interactive, “first of its kind,” TV and radio PSAs. People can also take the test and receive support and lifestyle tips via text messages. The ADA, AMA, and CDC are also working through local offices, affiliates, and partners to promote the campaign, with resources for health care providers to aid in screening, diagnosis, and treatment.

“No one is excused from prediabetes.” That is why the CDC, the American Medical Association (AMA), and the American Diabetes Association (ADA) are launching the first national public service advertising campaign about prediabetes.

More than 1 in 3 Americans has blood glucose levels high enough to qualify for prediabetes, but an estimated 90% don’t know it. Current trends suggest that if untreated, 15% to 30% of people with prediabetes will develop type 2 diabetes within 5 years. However, the CDC suggests weight loss, diet changes, and increased physical activity can help cut risk by 58%.

Public service announcements in English and Spanish encourage people to take a short test at www.DoIHavePrediabetes.org or in real time through interactive, “first of its kind,” TV and radio PSAs. People can also take the test and receive support and lifestyle tips via text messages. The ADA, AMA, and CDC are also working through local offices, affiliates, and partners to promote the campaign, with resources for health care providers to aid in screening, diagnosis, and treatment.

According to the DoD’s 2014 Suicide Event Report, 20 active-duty members per 100,000 committed suicide in 2014, along with 22 reserve and 19 U.S. National Guard members.

The suicides include 269 deaths among active-duty members, compared with 259 deaths by suicide in 2013. There were 169 deaths by suicide among the selected reserve members, compared with 220 deaths in 2013.

The 2014 suicide rates for reserve members and active-duty members of the 4 services were largely similar to those of 2013 with 2 notable exceptions: reductions in the rate for the National Guard, Air Force and Army combined, and reductions in the rate for the Army National Guard.

As of March 31, 2015, the report also documents 1,067 service members with 1 reported suicide attempt and 29 service members with 2 or more reported attempts. Five suicides were associated with 1 or more suicide attempt in 2013 or 2014. The median number of days between the most recent suicide attempt and the reported suicide was 108. The largest demographic differences between suicide and suicide attempt were in the prevalence of females (27% for suicide attempts vs 6% for suicides) and rank status (69% E1-E4 for suicide attempts vs 43% for suicides).

Most often, the suicide was committed by a white man, aged < 30 years, a high school graduate, enlisted, and married. The most frequently cited psychosocial stressors were failed relationships and administrative/legal issues.

According to the DoD’s 2014 Suicide Event Report, 20 active-duty members per 100,000 committed suicide in 2014, along with 22 reserve and 19 U.S. National Guard members.

The suicides include 269 deaths among active-duty members, compared with 259 deaths by suicide in 2013. There were 169 deaths by suicide among the selected reserve members, compared with 220 deaths in 2013.

The 2014 suicide rates for reserve members and active-duty members of the 4 services were largely similar to those of 2013 with 2 notable exceptions: reductions in the rate for the National Guard, Air Force and Army combined, and reductions in the rate for the Army National Guard.

As of March 31, 2015, the report also documents 1,067 service members with 1 reported suicide attempt and 29 service members with 2 or more reported attempts. Five suicides were associated with 1 or more suicide attempt in 2013 or 2014. The median number of days between the most recent suicide attempt and the reported suicide was 108. The largest demographic differences between suicide and suicide attempt were in the prevalence of females (27% for suicide attempts vs 6% for suicides) and rank status (69% E1-E4 for suicide attempts vs 43% for suicides).

Most often, the suicide was committed by a white man, aged < 30 years, a high school graduate, enlisted, and married. The most frequently cited psychosocial stressors were failed relationships and administrative/legal issues.

According to the DoD’s 2014 Suicide Event Report, 20 active-duty members per 100,000 committed suicide in 2014, along with 22 reserve and 19 U.S. National Guard members.

The suicides include 269 deaths among active-duty members, compared with 259 deaths by suicide in 2013. There were 169 deaths by suicide among the selected reserve members, compared with 220 deaths in 2013.

The 2014 suicide rates for reserve members and active-duty members of the 4 services were largely similar to those of 2013 with 2 notable exceptions: reductions in the rate for the National Guard, Air Force and Army combined, and reductions in the rate for the Army National Guard.

As of March 31, 2015, the report also documents 1,067 service members with 1 reported suicide attempt and 29 service members with 2 or more reported attempts. Five suicides were associated with 1 or more suicide attempt in 2013 or 2014. The median number of days between the most recent suicide attempt and the reported suicide was 108. The largest demographic differences between suicide and suicide attempt were in the prevalence of females (27% for suicide attempts vs 6% for suicides) and rank status (69% E1-E4 for suicide attempts vs 43% for suicides).

Most often, the suicide was committed by a white man, aged < 30 years, a high school graduate, enlisted, and married. The most frequently cited psychosocial stressors were failed relationships and administrative/legal issues.

Since 2005, 1 million veterans have been screened for traumatic brain injury (TBI) in the VA’s Polytrauma System of Care (PSC).

The 1 million milestone “reflects [the] VA’s success in building an integrated polytrauma care program,” says VA Under Secretary for Health David Shulkin, MD. The PSC was created to address the need for a multidisciplinary system of care for veterans who have 2 or more disabling physical, cognitive, functional, or psychological impairments.

The VA has 110 polytrauma rehabilitation sites that offer comprehensive inpatient or outpatient rehabilitation. Services include interdisciplinary evaluation and treatment, development of a comprehensive plan of care, case management, patient and family education, psychosocial support, and use of advanced rehabilitation treatments and prosthetic technologies. 

Another tool that supports clinical TBI care is the mobile phone application, Concussion Coach. The app provides a self-assessment tool for measuring symptoms, including feedback and a symptom tracker; relaxation exercises and other coping tips; and immediate access to crisis resources, personal support contacts, or professional health care resources.

All veterans are screened for possible TBI with a 4-question test. Those with a positive screen are referred to a TBI specialist for a Comprehensive TBI Evaluation, but specialists are often located at VA medical centers that not all veterans can easily reach. Therefore, the Office of Health Care Transformation funded a project to develop a standardized Comprehensive TBI Evaluation protocol delivered via telehealth technology. In 2013, a pilot project began at 16 sites; more than 40 sites have since been trained.

Since 2005, 1 million veterans have been screened for traumatic brain injury (TBI) in the VA’s Polytrauma System of Care (PSC).

The 1 million milestone “reflects [the] VA’s success in building an integrated polytrauma care program,” says VA Under Secretary for Health David Shulkin, MD. The PSC was created to address the need for a multidisciplinary system of care for veterans who have 2 or more disabling physical, cognitive, functional, or psychological impairments.

The VA has 110 polytrauma rehabilitation sites that offer comprehensive inpatient or outpatient rehabilitation. Services include interdisciplinary evaluation and treatment, development of a comprehensive plan of care, case management, patient and family education, psychosocial support, and use of advanced rehabilitation treatments and prosthetic technologies. 

Another tool that supports clinical TBI care is the mobile phone application, Concussion Coach. The app provides a self-assessment tool for measuring symptoms, including feedback and a symptom tracker; relaxation exercises and other coping tips; and immediate access to crisis resources, personal support contacts, or professional health care resources.

All veterans are screened for possible TBI with a 4-question test. Those with a positive screen are referred to a TBI specialist for a Comprehensive TBI Evaluation, but specialists are often located at VA medical centers that not all veterans can easily reach. Therefore, the Office of Health Care Transformation funded a project to develop a standardized Comprehensive TBI Evaluation protocol delivered via telehealth technology. In 2013, a pilot project began at 16 sites; more than 40 sites have since been trained.

Since 2005, 1 million veterans have been screened for traumatic brain injury (TBI) in the VA’s Polytrauma System of Care (PSC).

The 1 million milestone “reflects [the] VA’s success in building an integrated polytrauma care program,” says VA Under Secretary for Health David Shulkin, MD. The PSC was created to address the need for a multidisciplinary system of care for veterans who have 2 or more disabling physical, cognitive, functional, or psychological impairments.

The VA has 110 polytrauma rehabilitation sites that offer comprehensive inpatient or outpatient rehabilitation. Services include interdisciplinary evaluation and treatment, development of a comprehensive plan of care, case management, patient and family education, psychosocial support, and use of advanced rehabilitation treatments and prosthetic technologies. 

Another tool that supports clinical TBI care is the mobile phone application, Concussion Coach. The app provides a self-assessment tool for measuring symptoms, including feedback and a symptom tracker; relaxation exercises and other coping tips; and immediate access to crisis resources, personal support contacts, or professional health care resources.

All veterans are screened for possible TBI with a 4-question test. Those with a positive screen are referred to a TBI specialist for a Comprehensive TBI Evaluation, but specialists are often located at VA medical centers that not all veterans can easily reach. Therefore, the Office of Health Care Transformation funded a project to develop a standardized Comprehensive TBI Evaluation protocol delivered via telehealth technology. In 2013, a pilot project began at 16 sites; more than 40 sites have since been trained.

Diabetes is a relatively recent phenomenon among American Indian and Alaska Natives (AI/AN). In 1940, only 21 cases of diabetes were identified among a Pima tribe, say researchers from the CDC’s Native Diabetes Wellness Program.

Although rare before the 1940s, diabetes cases have increased exponentially since. During 2010-2012, AI/AN adults were twice as likely to have diabetes as were non-Hispanic white adults. Unfortunately, AI/AN youth are catching up, with a 68% increase in diagnosed diabetes among those aged 15 to 19 years between 1994 and 2004, and a 100% increase between 1994 and 2007 among those aged 18 to 34 years. Moreover, in 2009, 21% of AI/AN children aged 2 to 4 years were obese and at risk for type 2 diabetes.

 In response, the CDC, among other agencies, is encouraging “tribally driven” solutions to the problem, like the CDC-funded Traditional Foods Project (2008-2014), which aims to “reclaim” original native food systems.

The Traditional Foods Project is having promising results, CDC researchers say. During the 6 years of the project, the “food sovereignty” movement to revive foods specific to the landscape, history, and culture of the native people grew both locally and nationally. Partners aligned their efforts with the 2008 Farm Bill and created opportunities to operationalize the Agricultural Act of 2014, such as serving traditional foods in public facilities. Other offshoots include Qaqamiigux: Traditional Foods and Recipes from the Aleutian and Pribilof Islands, published by Traditional Foods Project partner Aleutian Pribilof Islands Association.

Education is key, and tribal schools are providing hands-on learning activities about growing healthful foods, strengthened by local and national efforts such as the Farm to School initiative.

The momentum continues, the researchers say. Although the cooperative agreement ended in 2014, several programs have secured support through tribal councils, university partnerships, state and county health departments, federal agencies, and nonprofit organizations.

Diabetes is a relatively recent phenomenon among American Indian and Alaska Natives (AI/AN). In 1940, only 21 cases of diabetes were identified among a Pima tribe, say researchers from the CDC’s Native Diabetes Wellness Program.

Although rare before the 1940s, diabetes cases have increased exponentially since. During 2010-2012, AI/AN adults were twice as likely to have diabetes as were non-Hispanic white adults. Unfortunately, AI/AN youth are catching up, with a 68% increase in diagnosed diabetes among those aged 15 to 19 years between 1994 and 2004, and a 100% increase between 1994 and 2007 among those aged 18 to 34 years. Moreover, in 2009, 21% of AI/AN children aged 2 to 4 years were obese and at risk for type 2 diabetes.

 In response, the CDC, among other agencies, is encouraging “tribally driven” solutions to the problem, like the CDC-funded Traditional Foods Project (2008-2014), which aims to “reclaim” original native food systems.

The Traditional Foods Project is having promising results, CDC researchers say. During the 6 years of the project, the “food sovereignty” movement to revive foods specific to the landscape, history, and culture of the native people grew both locally and nationally. Partners aligned their efforts with the 2008 Farm Bill and created opportunities to operationalize the Agricultural Act of 2014, such as serving traditional foods in public facilities. Other offshoots include Qaqamiigux: Traditional Foods and Recipes from the Aleutian and Pribilof Islands, published by Traditional Foods Project partner Aleutian Pribilof Islands Association.

Education is key, and tribal schools are providing hands-on learning activities about growing healthful foods, strengthened by local and national efforts such as the Farm to School initiative.

The momentum continues, the researchers say. Although the cooperative agreement ended in 2014, several programs have secured support through tribal councils, university partnerships, state and county health departments, federal agencies, and nonprofit organizations.

Diabetes is a relatively recent phenomenon among American Indian and Alaska Natives (AI/AN). In 1940, only 21 cases of diabetes were identified among a Pima tribe, say researchers from the CDC’s Native Diabetes Wellness Program.

Although rare before the 1940s, diabetes cases have increased exponentially since. During 2010-2012, AI/AN adults were twice as likely to have diabetes as were non-Hispanic white adults. Unfortunately, AI/AN youth are catching up, with a 68% increase in diagnosed diabetes among those aged 15 to 19 years between 1994 and 2004, and a 100% increase between 1994 and 2007 among those aged 18 to 34 years. Moreover, in 2009, 21% of AI/AN children aged 2 to 4 years were obese and at risk for type 2 diabetes.

 In response, the CDC, among other agencies, is encouraging “tribally driven” solutions to the problem, like the CDC-funded Traditional Foods Project (2008-2014), which aims to “reclaim” original native food systems.

The Traditional Foods Project is having promising results, CDC researchers say. During the 6 years of the project, the “food sovereignty” movement to revive foods specific to the landscape, history, and culture of the native people grew both locally and nationally. Partners aligned their efforts with the 2008 Farm Bill and created opportunities to operationalize the Agricultural Act of 2014, such as serving traditional foods in public facilities. Other offshoots include Qaqamiigux: Traditional Foods and Recipes from the Aleutian and Pribilof Islands, published by Traditional Foods Project partner Aleutian Pribilof Islands Association.

Education is key, and tribal schools are providing hands-on learning activities about growing healthful foods, strengthened by local and national efforts such as the Farm to School initiative.

The momentum continues, the researchers say. Although the cooperative agreement ended in 2014, several programs have secured support through tribal councils, university partnerships, state and county health departments, federal agencies, and nonprofit organizations.