About the California Tribal Epidemiology Center
Epidemiology is the study of the trends, causes, and distribution of health and disease conditions in defined populations. Epidemiologists assist with research study design, data collection, survey instruments design, statistical analyses of data, and interpretation of study results. In order to do this, epidemiologists use techniques from a combination of scientific disciplines including biology, social sciences, and statistics.
The California Tribal Epidemiology Center (CTEC) was established in 2005 to assist in collecting and interpreting health information for American Indians and Alaska Natives (AIAN) in California. CTEC is 1 of 12 Indian Health Service (IHS) Division of Epidemiology and Disease Prevention-funded Tribal Epidemiology Centers that provide epidemiologic support to each IHS region and often partner with local IHS area offices to provide these services. CTEC receives core funding from IHS along with supplemental grants. Our mission is to work directly with Tribes and Indian Health Programs (Tribal Health Programs and Urban Indian Health Organizations) to monitor the health status of AIAN in California and develop effective public health services that respect the cultural values and traditions of our communities. CTEC aims to align its activities with the strategic plan of its parent organization, the California Rural Indian Health Board (CRIHB).
Our mission is to improve AIAN health in California to the highest level by engaging American Indian communities in collecting and interpreting health information to establish health priorities, monitoring health status, and developing effective public health services that respect cultural values and traditions of the communities. CTEC services are available to all tribes and Indian Health Programs in California through Data Sharing Agreements. For more information about Data Sharing Agreements, visit CTEC Services.
CTEC Core Objectives
- Maintain communication and obtain input from the CTEC Advisory Council, CRIHB Board of Directors, IHS California Area Office, California Department of Public Health (CDPH), and AIAN populations.
- Obtain access to data and assist Indian Health Programs in public health activities that are needed to address the AIAN public health priorities.
- Produce Community Health Profiles for AIAN populations that address public health priorities.
- Conduct a California Tribal Behavioral Risk Factor Community Surveillance Survey.
- Participate in data, research, epidemiology, and public health forums and committees.
- Develop and maintain outbreak response capacity, which is coordinated with the response efforts by Local Health Departments, CDPH, and IHS.
- Align CTEC activities to reflect and support IHS Priorities as delineated by the Office of the IHS Director.
In order to be a CTEC member, Indian Health Programs sign a Data Sharing Agreement with CTEC. The agreement allows CTEC access to pertinent health information which is used to monitor health status, and evaluate needs to improve available information to our member programs. CTEC Data Sharing Agreement
CTEC is available to provide technical assistance to tribal health programs (member and non-member) as well as individual tribes. Technical assistance requests include, but are not limited to, gathering relevant health statistics, reviewing sections of grant applications that discuss collecting health data, helping develop data collection instruments, and providing assistance analyzing data. Can CTEC assist your tribe or health program with services? Let us know!
CTEC monitors reported disease clusters/outbreaks through national and state health alert networks and maintains a capacity to conduct cluster investigations on behalf of tribes, including collaborative efforts with other public health entities. CTEC also promotes tribal community readiness by participating in the California Health Alert Network.
Tribal Behavioral Risk Factor Community Survey
CTEC has implemented a Tribal Behavioral Risk Factor Community survey project. The purpose of this project was to gather information about health behaviors and outcomes, preventive practices, and health care access to track health conditions in American Indian populations in California. The modules and questions asked included the core CDC Behavioral Risk Factor Surveillance System (BRFSS), those suggested by the CTEC Advisory Council and those identified in the Indian Health Priorities Assessment. From 2012-2013 CTEC attended 13 AIAN cultural and community events such as Pow Wows, Big Times, health fairs, and community gatherings in California and collected 975 surveys. To be eligible, participants must have self identified as AIAN, been present at the event, at least18 years of age, and reside in California. The information obtained from the Tribal Behavioral Risk Factor Community Survey will assist in identifying health behaviors that need to be addressed in tribal communities and will be used to develop strategies to prioritize health care needs, identify gaps, and enhance currently available services and programs.
Native Oral Health Project
The Native Oral Health Project is an R21 pilot project funded by the National Institute of Dental and Craniofacial Research (NIDCR) of the National Institutes of Health (NIH). The NOHP aims to evaluate the feasibility of an educational intervention to educate on dental health and is based on the traditional practice of storytelling.
Participants included AIAN women 18-45 years of age, either pregnant or the mother of children aged 6 or younger. They were asked to listen to a traditional story with oral health messaging, and provide feedback through surveys and focus groups.
This pilot projectwas conducted between 2012 and 2014 in 3 locations across California – Hoopa, Redding and Eureka/Arcata region.
Community Participation – The NOHP is advised by a Community Advisory Board with members representing Northern, Southern and central CA, including out study locations. Tribal Liaisons in each of the 3 study locations helped with publicity and participant recruitment.
For more information and latest news, including results, and future direction – Click Here.
Public health accreditation is a national initiative to advance quality and performance among Tribal, state, local and territorial health departments. The TARGET Project (Tribal Accreditation Readiness through Guidance, Education & Technical assistance), is a partnership with California Tribal Epidemiology Center, Red Star Innovations, the Inter Tribal Council of Arizona, and the Institute for Wisconsin’s Health through a grant from the Robert Wood Johnson Foundation. CTECs role was to coordinating a Tribal Accreditation Training Institute and a Public Health Accreditation Roundtable, which occurred in October, 2013. For more information – [insert red star link]
Record Linkage Project
Health-related data for AIANs are often prone to significant race misclassification, as demonstrated by the results of earlier record linkage studies of state data. The resulting underestimation of disease burden for AIANs often hides the true number of cases among AIAN in California. This has wide implications for effectiveness of advocacy effort as well as perceived need for Indian health care funding. Thus CTEC’s concern over the issue of racial misclassification of AIAN has led us to conduct the record linkage studies for STDs and Injuries, in collaboration with government entities including the California Department of Public Health (CDPH), the Office of Statewide Health Planning and Development (OSHPD), and IHS. CTEC is in the process of requesting data from these agencies.
Health Priorities Assessment
CTEC seeks to conduct projects guided by the health priorities of the communities we serve. In order to determine community health priorities, CTEC disseminates the Health Priorities Assessment survey at the beginning of every cooperative agreement with IHS. The survey asks respondent to rank the top 10 health priorities in their respective community as well as provide basic demographic information such as age group, and tribal affiliation.
For the 2011-2015 cooperative agreement, CTEC collected over 450 surveys through online dissemination. The heath issues of highest concern for California AIAN are:
- Drug Abuse
- Eating Healthy, Exercise, and Controlling Obesity
- Mental Health
- Alcohol Abuse
- Dental Health
- Elder Care and Support
- Heart Disease and Stroke
- Getting or Paying for Medications
- Mother and Child Health
To see the full report of CTEC Indian Health Priorities – Click Here.
- National Tribal Epidemiology Centers (TEC) Community Health Profile (CHP): The National TEC CHP report is a collaborative initiative between all the 12 Tribal Epidemiology Centers across the nation. The CHP is an advocacy tool to better educate health professionals, legislators and policy makers on Indian health care issues. To see the final report [insert link]
- Obesity Research Study: CTEC , in collaboration with researchers at John’s Hopkins Bloomberg School of Public Health is conducting a study ‘The effects of increased economic resources on weight-related health: A quasi-experimental study.’ This study seeks to understand how economic resources resulting from the introduction of Indian gaming impact weight-related health outcomes, particularly in children. Outcomes under investigation include childhood obesity, gestational weight gain, and children’s size at birth. CTEC developed a community health profile of American Indian childhood obesity among 5th, 7th and 9th graders in California using data from this project from the California Department of Education. [insert link]
- Gaining Ground Initiative: Gaining Ground is a two-year initiative managed by the National Network of Public Health Institutes. California was one of 7 states selected for the funding from the Robert Wood Johnson Foundation with the goal to develop sustainable statewide systems to catalyze public health accreditation and support performance improvement in tribal and small, rural local health departments. CTEC’s involvement is to assist in the development and dissemination of a tribally relevant assessment instrument that is an adjunct to the state instrument to conduct a tribal public health accreditation readiness assessment and a tribal needs assessment to determine tribal status on accreditation-related activities.
- CASPER: CTEC assisted Napa County Public Health and the California Department of Public Health in a Community Assessment for Public Health Emergency Response (CASPER) following the August 24th earthquake. Volunteers walked door-to-door conducting the in-person survey in Napa and American Canyon, California on September 16, 17, and 18 to better understand how the earthquake impacted the residents and to determine needs when preparing for future emergencies. A total of 241 surveys were completed in the two communities, a 95.5% completion rate.
What is the CTEC Advisory Council?
The CTEC Advisory Council is comprised of community and health professional representatives from member Indian Health Programs and universities in California. The Advisory Council assists CTEC staff in planning the use of gathered information, conducting epidemiologic studies, and reviewing publications prior to release.
Community Health Profiles
- California AIAN Community Health Profile 2015
- Central Valley Indian Health, Inc. Community Health Profile 2015Chapa-
- De Indian Health Program, Inc. Community Health Profile 2015
- Consolidated Tribal Health Project, Inc. Community Health Profile 2015
- Feather River Tribal Health, Inc. Community Health Profile 2015
- Greenville Rancheria Tribal Health Program Community Health Profile 2015
- Indian Health Council, Inc. Community Health Profile 2015
- K’ima:w Medical Center Community Health Profile 2015
- Karuk Tribal Health and Human Services Program Community Health Profile 2015
- Lake County Tribal Health Consortium, Inc. Community Health Profile 2015
- Lassen Indian Health Center Community Health Profile 2015
- Mariposa, Amador, Calaveras, Tuolumne (MACT) Health Board, Inc. Community Health Profile 2015
- Pit River Health Service, Inc. Community Health Profile 2015
- Redding Rancheria Tribal Health Center Community Health Profile 2015
- Riverside-San Bernardino County Indian Health, Inc. Community Health Profile 2015
- Round Valley Indian Health Center Community Health Profile 2015
- Santa Ynez Tribal Health Clinic Community Health Profile 2015
- Shingle Springs Health and Wellness Center Community Health Profile 2015
- Sonoma County Indian Health Project, Inc. Community Health Profile 2015
- Southern Indian Health Council, Inc. Community Health Profile 2015
- Sycuan Medical Dental Center Community Health Profile 2015
- Toiyabe Indian Health Project, Inc. Community Health Profile 2015
- Tuolumne Me-Wuk Indian Health Center Community Health Profile 2015
- United Indian Health Services, Inc. Community Health Profile 2015
- Warner Mountain Indian Health Program Community Health Profile 2015
- California Tribal Behavioral Risk Factor Community Survey (CTBRFCS) Summary Report
- AIAN Childhood Obesity in California
- Evaluation of CTEC Resources and Services
- Indian Health Priorities
- Native Oral Health Project
- Tribal Asthma Survey (Final Report)
- Tribal Asthma Lay Project (Lay Report)
- California Tribal Advisory Committee Delegates
- AIAN Drug Abuse Infographic
- Body Mass Index and California American Indian/Alaska Native Adults
- AIAN Race Misclassification in STD Data
- Evaluation of CTEC Resources and Services
- Indian Health Priorities
- Native Oral Health Project
- California IHS User Population
Cross-Jurisdictional Sharing of Emergency Management Services
- National Scope of Cross-Jurisdictional Sharing of Emergency Management Services
- Toolkit: Cross-Jurisdictional Sharing Between Tribes and Counties for Emergency Management
Good Health and Wellness in Indian Country
- Community-Clinical Linkages Factsheet: ACORNS
- Physical Activity Factsheet: ACORNS
- Success Stories: ACORNS