Denise A. Dillard's research while affiliated with University of Washington Seattle and other places

Publications (46)

Article
Full-text available
Background Food insecurity is an important social determinant of health that was exacerbated by the COVID-19 pandemic. Both food insecurity and COVID-19 infection disproportionately affect racial and ethnic minority groups, particularly American Indian and Alaska Native communities; however, there is little evidence as to whether food insecurity is...
Article
Health disparities are driven by unequal conditions in the environments in which people are born, live, learn, work, play, worship, and age, commonly termed the Social Determinants of Health (SDoH). The availability of recommended measurement protocols for SDoH will enable investigators to consistently collect data for SDoH constructs. The PhenX (c...
Preprint
Full-text available
Background Food insecurity is an important social determinant of health that was exacerbated by the COVID-19 pandemic. Both food insecurity and COVID-19 infection disproportionately affect racial and ethnic minority groups, particularly American Indian and Alaska Native communities; however, there is little evidence as to whether food insecurity is...
Article
Full-text available
Objective Create a longitudinal, multi-modal and multi-level surveillance cohort that targets early detection of symptomatic and asymptomatic COVID-19 cases among Native Hawaiian and Pacific Islander adults in the Continental US and identify effective modalities for participatory disease surveillance and sustainably integrate them into ongoing COVI...
Article
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Background Little is known about vaccination rates for American Indian and Alaska Native (AI/AN) parents and their children, or parental decisions in this regard. Improving vaccination rates is a serious concern due to the disproportionate incidence and morbidity of COVID-19 in AI/AN people. Purpose Our goal was to describe urban AI/AN parental at...
Article
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Newborn screening in Alaska includes screening for carnitine palmitoyltransferase 1A (CPT1A) deficiency. The CPT1A Arctic variant is a variant highly prevalent among Indigenous peoples in the Arctic. In this study, we sought to elicit Alaska Native (AN) community member and AN-serving healthcare providers’ knowledge and perspectives on the CPT1A Ar...
Article
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Introduction: Health care organizations of all types have adapted in response to COVID-19. Responding to the pandemic has varied across organizations and there are few standardized frameworks from which to evaluate an organizational response. This article reports COVID-19 responses by a tribal health care organization using a synthesized evaluatio...
Article
Introduction: Alaska Native and American Indian (ANAI) people have a smoking prevalence of 23%. Nicotine metabolite ratio (NMR) and genetic testing may enable tailored selection of tobacco cessation medication. The purpose of this study was to evaluate the relative contributions of NMR, cessation medication, demographics, and tobacco use history t...
Article
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The prevalence of self-reported hypertension is higher among Alaska Native and American Indian (ANAI) individuals than in the majority USA population. Although hypertension is the primary modifiable risk factor for cardiovascular disease and stroke, it can be difficult to manage successfully. The objective of this study was to explore patients’ and...
Article
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Objectives To examine the relationships between pre-pregnancy diabetes mellitus (DM), gestational diabetes mellitus (GDM), pre-pregnancy body mass index (BMI) and county-level social determinants of health, with infant macrosomia within a sample of American Indian/Alaska Native (AI/AN) women receiving Indian Health Service (IHS) care. Methods The...
Article
Objectives: Attitudes about alcohol misuse and dependence influence alcohol use and help-seeking behavior. Alaska Native and American Indian (AN/AI) people have higher rates of alcohol-related morbidity and mortality but engage in treatment at lower rates than the general population. No validated instruments exist to assess attitudes of AN/AI peop...
Article
Participant retention in longitudinal health research is necessary for generalizable results. Understanding factors that correlate with increased retention could improve retention in future studies. Here, we describe how participant and study process measures are associated with retention in a longitudinal tobacco cessation research study performed...
Article
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Background Home blood pressure monitoring (HBPM) is an effective tool in treatment and long-term management of hypertension. HBPM incorporates more data points to help patients and providers with diagnosis and management. The characteristics of HBPM devices matter to patients, but the relative importance of the characteristics in choosing a device...
Article
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Prevalence of smoking is higher in Alaska Native and American Indian (ANAI) populations living in Alaska than the general US population. Genetic factors contribute to smoking and cessation rates. The objective of this study was to compare CYP2A6 genetic variation and CYP2A6 enzyme activity toward nicotine in an ANAI population. ANAI (N = 151) peopl...
Article
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We provide guidance for conducting clinical trials with Indigenous children in the United States. We drew on extant literature and our experience to describe 3 best practices for the ethical and effective conduct of clinical trials with Indigenous children. Case examples of pediatric research conducted with American Indian, Alaska Native, and Nativ...
Article
Objectives: Home blood pressure monitoring (HBPM) is an important component of blood pressure (BP) management. We assessed performance of two HBPM devices among Alaska Native and American Indian people (ANAIs). Methods: We measured BP using Omron BP786 arm cuff, Omron BP654 wrist cuff, and Baum aneroid sphygmomanometer in 100 ANAIs. Performance was...
Article
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The frequencies of genetic variants in the CYP3A4 and CYP3A5 genes differ greatly across global populations, leading to profound differences in the metabolic activity of these enzymes and resulting drug metabolism rates, with important consequences for therapeutic safety and efficacy. Yet, the impact of genetic variants on enzyme activity are incom...
Article
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Meaningful engagement of Alaska Native (AN) tribes and tribal health organizations is essential in the conduct of socially responsible and ethical research. As genomics becomes increasingly important to advancements in medicine, there is a risk that populations not meaningfully included in genomic research will not benefit from the outcomes of that...
Article
Background: The literature on community-engaged research provides important principles to guide research partnerships, but concrete descriptions of the complexities involved in developing, navigating, and maintaining such partnerships are lacking. Objectives: To describe and assess a longstanding, complex research partnership between Indigenous...
Preprint
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Research has identified remarkably effective treatments for breast cancer, but translation of these results to all patients requires pharmacogenetic research using diverse patient populations. Although tamoxifen has been used to reduce the risk of breast cancer recurrence for the past 40 years, little is known about how well the drug works in Ameri...
Article
Background: For populations with high rates of trauma exposure yet low behavioural health service use, identifying and addressing trauma in the primary care setting could improve health outcomes, reduce disability and increase the efficiency of health system resources. Objective: To assess the acceptability and feasibility of a screening, brief...
Article
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Background: Posttraumatic stress disorder (PTSD) is a major public health concern among American Indian and Alaska Native populations. Primary care clinics are often the first point of contact for American Indian and Alaska Natives seeking health care and are feasible locations for trauma-focused interventions. Objective: Web-based therapeutic inte...
Article
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Precision medicine initiatives, such as Cancer Breakthrough 2020, promise to improve cancer outcomes by tailoring treatment to an individual’s genes, environment, and lifestyle. This promise will fall short unless researchers successfully engage diverse communities, including those with histories of medical and research abuse. We examined a rural A...
Article
Introduction: Alaska Native and American Indian (AN/AI) populations have higher tobacco use prevalence than other ethnic/racial groups. Pharmacogenetic (Pgx) testing to tailor tobacco cessation treatment may improve cessation rates. This study characterized polymorphic variations among AN/AI people in genes associated with metabolism of nicotine a...
Data
Figure S1. Linkage disequilibrium (LD) in the VKORC1 locus for rs9923231 (−1639G>A) and rs9934438 (1173C>T) SNVs in all 118 genotyped customer‐owners from SCF. R 2 was 1.0 for this variant pair.
Article
Full-text available
Alaska Native and American Indian (AN/AI) people have unique pharmacogene variation that may affect warfarin disposition and therapeutic response. We performed targeted genotyping for cytochrome P450 (CYP)2C9, vitamin K epoxide oxidase reductase complex subunit 1 (VKORC1), CYP4F2, CYP4F11, and gamma‐glutamyl carboxylase (GGCX) variants in AN/AI peo...
Preprint
BACKGROUND Posttraumatic stress disorder (PTSD) is a major public health concern among American Indian and Alaska Native (AI/AN) populations. Primary care clinics are often the first point of contact for AI/AN people seeking health care and are feasible locations for trauma-focused interventions. OBJECTIVE Web-based therapeutic interventions (WBTI...
Article
Full-text available
Background Posttraumatic stress disorder (PTSD) is a major public health concern among American Indian and Alaska Native populations. Primary care clinics are often the first point of contact for American Indian and Alaska Natives seeking health care and are feasible locations for trauma-focused interventions. Objective Web-based therapeutic inter...
Article
Although alcohol misuse is a priority for health care systems serving Alaska Native and American Indian (ANAI) people, stakeholders’ perceptions of misuse are understudied. Patients (n = 34), providers (n = 20), and leaders (n = 16) at a Tribally owned and operated health care system reported that alcohol misuse results from the interaction of fact...
Article
Background: Depression remains the second leading cause of disability worldwide. Symptoms of depression are expressed and experienced differently across cultural groups, impacting treatment decisions. Patient preferences predict service utilization, treatment selection and persistence, as well as health outcomes for medical and behavioral health c...
Data
Supplementary Figure S1 Linkage disequilibrium pattern of CYP2D6 SNVs identified in the SCF population through resequencing. Each square represents the degree of linkage disequilibrium (LD) between a pair of SNVs: black represents complete linkage (r2 = 1.00); white represents no linkage (r2 = 0.00). Pairwise LD r2 values are indicated within each...
Data
Supplementary Table S2 CYP2D6 allele frequencies in SCF population by Fluidigm assay (n = 726 chromosomes)
Data
Supplementary Table S1 SNVs identified in CYP2D6 resequencing in 94 SCF subjects (n = 188 chromosomes)
Article
Full-text available
Despite evidence that pharmacogenetics can improve tamoxifen pharmacotherapy, there are few studies with American Indian and Alaska Native (AIAN) people. We examined variation in cytochrome P450 (CYP) genes (CYP2D6, CYP3A4, CYP3A5, and CYP2C9) and tamoxifen biotransformation in AIAN patients with breast cancer (n = 42) from the Southcentral Foundat...
Article
Alaska Native and American Indian (AN/AI) people experience a disproportionate burden of health disparities in the United States. Including AN/AI people in pharmacogenetic research offers an avenue to address these health disparities, however the dissemination of pharmacogenetic research results in the community context can be a challenging task. I...
Article
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Alaska Native and American Indian (AN/AI) people have negative research experiences, including lack of timely, respectful, and relevant communication about research findings. Southcentral Foundation (SCF), a tribally owned and operated health care organization in Alaska, has redesigned the health care system, enacted research policies, and establis...
Article
Background: Alaska Native and American Indian people (AN/AIs) have a high incidence of colorectal cancer (CRC) and CRC-related mortality. Screening can prevent death from CRC, but screening rates are low in racially and ethnically diverse populations. The authors conducted a randomized controlled trial using text messaging to increase CRC screenin...
Article
American Indian and Alaska Native (AI/AN) people experience high rates of acute, chronic, and intergenerational trauma. Traumatic experiences often increase the risk of both medical and behavioral health problems making primary care settings opportune places to screen for trauma exposure or symptomology. The objective of this study was to determine...
Article
Alaska Native and American Indian people (AN/AIs) are disproportionately affected by suicide. Within a large AN/AI health service organization, demographic, clinical, and service utilization factors were compared between those with a suicide-related health visit and those without. Cases had higher odds of a behavioral health diagnosis, treatment fo...
Article
Full-text available
Objective: Information technology can improve the quality, safety, and efficiency of healthcare delivery by improving provider and patient access to health information. We conducted a nonrandomized, cross-sectional, self-report survey to determine whether Alaska Native and American Indian (AN/AI) people have access to the health communication tech...
Article
Full-text available
Background: A tribal health organization in Alaska implemented a primary care depression screening, detection and management initiative amongst 55,000 Alaska Native/American Indian people (AN/AIs). Objectives: (a) To describe the proportion of AN/AIs screening positive for depression with depression noted or diagnosed and proportion with guideli...
Chapter
This chapter begins with a discussion of general factors with a potential impact on the assessment and treatment of American Indian and Alaska Native people (AI/ANs). The history of AI/ANs is briefly summarized and followed by a description of the unique demographic, socioeconomic, and health characteristics of the population. Some common cultural...

Citations

... Authors have diverse backgrounds, ranging from clinical geneticists and genetic counsellors to health scientists, policy advisors, psychologists, sociologists, ethicists, legal experts and experts in education. Contributions come from all over the world and discuss applications relevant for many countries or groups, such as Ireland, Turkey, Jordan, USA (including tribal groups in Alaska and Latina women in Texas), and also countries in Africa and South America (Ward et al. 2023;Kadiroğlu et al. 2023;Abudahab et al. 2023;Beans et al. 2023;Madhiri et al. 2023;Opoku et al. 2023;Ruderman 2023). The application of genomics knowledge will, we hope, contribute to sustainable development worldwide, especially in health (SDG3), education (SDG4) and reducing inequalities (SDG10) as these are the areas that not only this journal but also others in the SpringerNature stable are best positioned to support. ...
... A recent observational study of AI/AN adults starting the Quit Tobacco Program (QTP) at Southcentral Foundation found that 28% of participants demonstrated slow nicotine metabolism (NMR < 0.31), 66% had normal nicotine metabolism (NMR ≥ 0.31), and 6% had an NMR that was unquanti able (either cotinine or 3-hydroxycontinine values were < 1.5 ng/mL at baseline). 9 Of the total sample, 24% were smoking-abstinent at six weeks. A combined group of people with slow metabolism who used NRT and people with normal metabolism who used varenicline had a quit rate of 36.5%, a 13% higher quit rate than in the total sample. ...
... Twenty-five studies focused on the association between pre-pregnancy BMI or weight (referred to hereafter as 'pre-pregnancy BMI') and a range of maternal and child health outcomes (Table 2) [10,41,42,46,47,[49][50][51]53,55,56,60,62,64,66,67,72,73,75,85,86,91,[93][94][95]. In general, these studies found associations between a higher pre-pregnancy BMI and adverse maternal and child health outcomes, including gestational diabetes [41,47,51,56,73,75], gestational hypertension [42,50,51], pre-eclampsia [93], caesarean section [51,93], high birthweight [51,55,67,72,85], and developing diabetes after pregnancy [53]. ...
... Specifically, involvement of family members in the study process, emphasizing community benefits, and study flexibility is highlighted as a facilitator to retention in Asian communities [13]. Similar benefits of study retention in longitudinal research were found by making 2 or more successful phone calls to Alaska Native and American Indian people, rather than contact by text or email [14]. While prior studies have identified that young adults respond favorably to incentives as a method of retention, the methods of contact and follow-up are dated in the era of the internet and social media [15]. ...
... Asian Americans have poor control of their HTN and have high HTN medication nonadherent rates [38][39][40]. In addition, the prevalence of selfreported HTN is also high among ANAI individuals than in the majority US population [41,42]. This gap in the literature is a limiting factor to achieve better HTN medication adherence among all racial/ethnic groups. ...
... However, researchers should be aware that RCTs may be viewed as unacceptable within some Indigenous communities (e.g., it may be perceived as unfair that only certain community members receive a desired intervention within a context of scarce resources; Dickerson et al., 2020). Shaw et al. (2021) have recently articulated best practices for conducting responsible clinical trials with Indigenous communities; these practices include principles of community-based research that we discuss in later paths (see Goodkind et al., 2015). In addition, researchers should prioritize the inclusion of Indigenous individuals in clinical trials; when ethically possible, researchers should report data from Indigenous participants, as this could enable for analyses across publications (Crouch et al., 2022). ...
... Table S1, column 6, shows the detailed information for this analysis. Difficulty to enable and enhance trusting relationships 17 8,18,33,35,61,65,87,93,95,114,137,139,154,[175][176][177]183,187,191,194,196,208,216,231,234 Communication challenges 16 18,39,93,95,109,110,131,135,141,149,152,154,161,170,173,177,185,189,194,223,231,239,243,248 Technical difficulties with the technology 16 33,34,39, 73,76,88,91,93,95,109,112,120,137,154,160,167,169,173,176,194,198,231,240 Reduced access to the equipment 16 8 Appropriate training 12 6,19,35,37,39,41,61,72,94,107,110,113,117,127,133,177,179,189,193,199 Good audiovisual quality 9 ...
... Notably, frequencies of CYP variants are highly variable and population-specific. Novel genetic variants at relatively high frequency have been identified in several CYP genes in AIAN populations that may result in altered enzyme activity [16][17][18]21 . There is a tendency to treat AIAN peoples as a homogenous group, but data from CYP pharmacogenes highlight the extensive heterogeneity within AIAN peoples. ...
... AIANs include 574 federally recognized sovereign tribes-and more unrecognized tribes, Native Hawaiians, and Pacific Islanders-with each having distinct cultural, social, and political structures, though many values are shared. Concerns shared among Indigenous peoples about genomics research include maintaining research oversight, upholding tribal sovereignty, biospecimen and data storage/use, and culturally appropriate research 4,5 . While Indigenous values are diverse, respecting holistic relationships in health and the environment, cultural integrity, and the inclusion of Indigenous knowledge resonate with many Indigenous communities, and reflect a commitment to the collective while maintaining a respectful relationship with the land and other beings [6][7][8][9] . ...
... This concept is often implemented as training of community members to participate as members of the research team (e.g.,41 ). In the discussions at this meeting, however, community capacity encompassed the potential to formulate research questions, inform research methodology, and lead research projects, in keeping with more recent commentaries.[42][43][44] In addition, researchers' willingness to become knowledgeable about the communities in which they propose to work emerged as an important factor. ...