Felina Cordova

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Scholarly Contributions

Books

• Cordova, F. M., & Watson, R. R. (2010). New Zealand christmas tree: Historic uses and cancer prevention.

Journals/Publications

• Arambula Solomon, T. G., Jones, D., Laurila, K., Ritchey, J., Cordova-Marks, F. M., Hunter, A. U., & Villanueva, B. (2023). Using the Community Readiness Model to Assess American Indian Communities Readiness to Address Cancer Prevention and Control Programs. Journal of cancer education : the official journal of the American Association for Cancer Education, 38(1), 206-214.
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  Cancer disparities continue among American Indian and Alaska Native (AI/AN) populations while they have decreased among other racial and ethnic groups. No studies were found that utilized the Community Readiness Model (CRM) to ascertain the readiness of Tribal and American Indian organizations to participate in cancer research and cancer prevention and control initiatives. The Partnership for Native American Cancer Prevention conducted an assessment of the status of American Indian communities' readiness to implement activities for prevention, early detection, and treatment to improve AI/AN cancer rates. The assessment was a component of the Community Outreach Core of the grant. Thirty-four key Informants participated in the interview process. The Community Readiness Assessment (CRA) provided a baseline assessment of community partners' readiness to participate in cancer research and programming. Despite years of cancer intervention programs, the communities were classified as being in the early stages of readiness [1-5] of the nine-stage model. Additionally, findings showed low levels of awareness of previous or ongoing cancer research. The findings in prevention and control efforts indicated a need for technical assistance and funding to support community projects in prevention and control. This supported the implementation of a community grants initiative. They also indicated that communities were not ready to conduct research, despite ongoing cancer related research in at least two communities. Communication tools and social media methods and messages were developed to increase awareness of cancer as a health concern and cancer research in the community. The CRM informed these and other engagement activities to meet the appropriate stage of readiness for each Tribe/community, and to build their capacity to participate in cancer research and programming activities.
• Barraza, L. F., Austhof, E., Khan, S. M., Kelley, C., Shilen, A., Ernst, K. C., Cordova, F. M., Pogreba Brown, K. M., Jacobs, E. T., & Hall-Lipsy, E. A. (2023). Differences in Perceptions of Individual and Government-Level COVID-19 Prevention Measures Based on Vaccine Willingness. Journal of Health Care Law & Policy, 26(1), 87-104.
• Barraza, L. F., Kahn, S., Shilen, A., Austhof, E., Cordova, F. M., Ernst, K. C., Heslin, K., Kelly, C., Pogreba Brown, K. M., Jacobs, E. T., & Hall-Lipsy, E. A. (2023). Differences in Perceptions of Individual and Government-Level COVID-19 Prevention Measures Based on Vaccine Willingness.. Journal of Heath Care Law & Policy.
• Cordova, F. M. (2022).

  Depression among underserved rural and urban caregivers of Latinas with breast cancer 

  . Journal of Human Behavior in the Social Environment, 1-8.
• Cordova-Marks, F. M., Valencia, C., Badger, T. A., Segrin, C., & Sikorskii, A. (2023). Depression among Underserved Rural and Urban Caregivers of Latinas with Breast Cancer. Journal Of Human Behavior In The Social Environment, 33(3), 450-464.
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  Among Latino/as, informal caregiving duties are often deemed a family responsibility. Understanding psychological outcomes tied to caregivers of Latina breast cancer survivors is important to identify the impacts of cancer. Secondary analysis of baseline data collected in a randomized clinical trial (RCT) from 230 Latina breast cancer survivor-caregiver dyads. Characteristics of caregivers residing in rural/underserved and urban areas were compared using t- or chi-square tests. General linear models were used to analyze depressive symptoms in relation to residence, survivor-caregiver relationship, acculturation, obligation, reciprocity, and comorbidities. Urban residence was significantly associated with higher levels of depression controlling for survivor-caregiver relationship acculturation, obligation, reciprocity, and comorbidities. Mother caregivers had significantly higher levels of depression than other caregivers. Depression among Latino/a caregiver's providing care to an adult child is an important consideration as Latino/as are less likely to seek out/have access to mental health services than other groups.
• Garba, I., Sterling, R., Plevel, R., Carson, W., Cordova-Marks, F. M., Cummins, J., Curley, C., David-Chavez, D., Fernandez, A., Hiraldo, D., Hiratsuka, V., Hudson, M., Jäger, M. B., Jennings, L. L., Martinez, A., Yracheta, J., Garrison, N. A., & Carroll, S. R. (2023). Indigenous Peoples and research: self-determination in research governance. Frontiers in research metrics and analytics, 8, 1272318.
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  Indigenous Peoples are reimagining their relationship with research and researchers through greater self-determination and involvement in research governance. The emerging discourse around Indigenous Data Sovereignty has provoked discussions about decolonizing data practices and highlighted the importance of Indigenous Data Governance to support Indigenous decision-making and control of data. Given that much data are generated from research, Indigenous research governance and Indigenous Data Governance overlap. In this paper, we broaden the concept of Indigenous Data Sovereignty by using the CARE Principles for Indigenous Data Governance to discuss how research legislation and policy adopted by Indigenous Peoples in the US set expectations around recognizing sovereign relationships, acknowledging rights and interests in data, and enabling Indigenous Peoples' participation in research governance.
• Hall-Lipsy, E. A., Jacobs, E., Cordova, F. M., Pogreba Brown, K. M., Ernst, K. C., Shilen, A., Kelley, C. P., Khan, S., Austhof, E. C., & Barraza, L. F. (2023). Differences in Perceptions of Individual and Government-Level COVID-19 Prevention Measures Based on Vaccine Willingness. J Health Care L & Policy, 26(87).
• Hudson, M., Carroll, S. R., Anderson, J., Blackwater, D., Cordova-Marks, F. M., Cummins, J., David-Chavez, D., Fernandez, A., Garba, I., Hiraldo, D., Jäger, M. B., Jennings, L. L., Martinez, A., Sterling, R., Walker, J. D., & Rowe, R. K. (2023). Indigenous Peoples' Rights in Data: a contribution toward Indigenous Research Sovereignty. Frontiers in research metrics and analytics, 8, 1173805.
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  Indigenous Peoples' right to sovereignty forms the foundation for advocacy and actions toward greater Indigenous self-determination and control across a range of domains that impact Indigenous Peoples' communities and cultures. Declarations for sovereignty are rising throughout Indigenous communities and across diverse fields, including Network Sovereignty, Food Sovereignty, Energy Sovereignty, and Data Sovereignty. Indigenous Research Sovereignty draws in the sovereignty discourse of these initiatives to consider their applications to the broader research ecosystem. Our exploration of Indigenous Research Sovereignty, or Indigenous self-determination in the context of research activities, has been focused on the relationship between Indigenous Data Sovereignty and efforts to describe Indigenous Peoples' Rights in data.
• Jacobs, E. T., Catalfamo, C. J., Colombo, P. M., Khan, S. M., Austhof, E., Cordova-Marks, F., Ernst, K. C., Farland, L. V., & Pogreba-Brown, K. (2023). Pre-existing conditions associated with post-acute sequelae of COVID-19. Journal of autoimmunity, 135, 102991.
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  Post-acute sequelae of COVID-19 (PASC) are conditions that occur or remain at least 28 days after SARS-CoV-2 infection. While some risk factors for PASC have been identified, little is known about pre-existing conditions that render one susceptible to developing PASC. Data from participants (n = 1224) in a longitudinal COVID-19 cohort study in Arizona were used to investigate comorbid conditions associated with PASC. After adjustment of the models for age, BMI, gender, race, and smoking, the following pre-existing conditions were statistically significantly associated with the development of PASC: asthma (OR = 1.54; 95% CI = 1.10-2.15); chronic constipation (OR = 4.29; 95% CI = 1.15-16.00); reflux (OR = 1.54; 95% CI = 1.01-2.34); rheumatoid arthritis (OR = 3.69; 95%CI = 1.15-11.82); seasonal allergies (OR = 1.56; 95% CI = 1.22-1.98); and depression/anxiety (OR = 1.72; 95% CI = 1.17-2.52). When grouping conditions together, statistically significant associations with PASC were observed for respiratory (OR = 1.47; 95% CI = 1.06-2.14); gastrointestinal (OR = 1.62; 95% CI = 1.16-2.26), and autoimmune conditions (OR = 4.38; 95% CI = 1.59-12.06). After adjustment for severity of acute SARS-CoV-2 infection and depression/anxiety, seasonal allergies (OR = 1.48; 95% CI 1.15-1.91) and autoimmune disease (OR = 3.78; 95% CI - 1.31-10.91) remained significantly associated with risk for PASC. These findings indicate that numerous pre-existing conditions may be associated with an increased risk for the development of PASC. Patients with these conditions should consider taking extra steps to avoid infection.
• Jacobs, E. T., Cordova-Marks, F. M., Farland, L. V., Ernst, K. C., Andrews, J. G., Vu, S., Heslin, K. M., Catalfamo, C., Chen, Z., & Pogreba-Brown, K. (2023). Understanding low COVID-19 booster uptake among US adults. Vaccine, 41(42), 6221-6226.
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  Vaccinations against SARS-CoV-2 have consistently been shown to reduce the risk of severe COVID-19 disease. However, uptake of boosters has stalled in the United States at less than 20% of the eligible population. The objective of this study was to assess the reasons for not having obtained a bivalent booster within an existing COVID-19 cohort.
• Carroll, S. R., Plevel, R., Jennings, L. L., Garba, I., Sterling, R., Cordova-Marks, F. M., Hiratsuka, V., Hudson, M., & Garrison, N. A. (2022). Extending the CARE Principles from tribal research policies to benefit sharing in genomic research. Frontiers in genetics, 13, 1052620.
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  Indigenous Peoples have historically been targets of extractive research that has led to little to no benefit. In genomics, such research not only exposes communities to harms and risks of misuse, but also deprives such communities of potential benefits. Tribes in the US have been exercising their sovereignty to limit this extractive practice by adopting laws and policies to govern research on their territories and with their citizens. Federally and state recognized tribes are in the strongest position to assert research oversight. Other tribes lack the same authority, given that federal and state governments do not recognize their rights to regulate research, resulting in varying levels of oversight by tribes. These governance measures establish collective protections absent from the US federal government's research oversight infrastructure, while setting expectations regarding benefits to tribes as political collectives. Using a legal epidemiology approach, the paper discusses findings from a review of Tribal research legislation, policy, and administrative materials from 26 tribes in the US. The discussion specifies issues viewed by tribes as facilitators and barriers to securing benefits from research for their nations and members/citizens, and describes preemptive and mitigating strategies pursued by tribes in response. These strategies are set within the framing of the CARE Principles for Indigenous Data Governance (Collective Benefit, Authority to Control, Responsibility, Ethics), a set of standards developed to ensure that decisions made about data pertaining to Indigenous communities at the individual and tribal levels are responsive to their values and collective interests. Our findings illustrate gaps to address for benefit sharing and a need to strengthen Responsibility and Ethics in tribal research governance.
• Cordova-Marks, F. M., Carson, W. O., Monetathchi, A., Little, A., & Erdrich, J. (2022). Native and Indigenous Populations and Gastric Cancer: A Worldwide Review. International journal of environmental research and public health, 19(9).
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  Gastric cancer is a worldwide concern, particularly for Indigenous populations who face greater disparities in healthcare. With decreased access to screening and critical treatment delays, this group is experiencing adverse health effects. To determine what factors drive these disparities, a systematic review was performed in PubMed. This revealed a lack of research on gastric cancer specific to this population. The literature primarily focused on subset analyses and biological aspects with sparse focus on determinants of health. The results informed this presentation on factors related to Indigenous gastric cancer, which are influenced by colonialism. Indigenous populations encounter high rates of food shortage, exposure to harmful environmental agents, structural racism in the built environment, , and compromised healthcare quality as an effect of colonialism, which all contribute to the gastric cancer burden. Putting gastric cancer into a cultural context is a potential means to respond to colonial perspectives and their negative impact on Indigenous patients. The objective of this manuscript is to examine the current state of gastric cancer literature from a global perspective, describe what is currently known based on this literature review, supplemented with additional resources due to lack of published works in PubMed, and to present a model of gastric cancer through the lens of a modified medicine wheel as a potential tool to counter colonial healthcare perspectives and to honor Indigenous culture.
• Crocker, R. M., Duenas, K., Vázquez, L., Ingram, M., Cordova-Marks, F. M., Torres, E., & Carvajal, S. (2022). "Es Muy Tranquilo Aquí": Perceptions of Safety and Calm among Binationally Mobile Mexican Immigrants in a Rural Border Community. International journal of environmental research and public health, 19(14).
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  Perceptions of community can play an important role in determining health and well-being. We know little, however, about residents' perceptions of community safety in the Southwestern borderlands, an area frequently portrayed as plagued by disorder. The qualitative aim of this community-based participatory research study was to explore the perceptions of Mexican-origin border residents about their communities in southern Yuma County, Arizona. Our team of University of Arizona researchers and staff from Campesinos Sin Fronteras, a grassroots farmworker support agency in Yuma County, Arizona, developed a bilingual interview guide and recruited participants through radio adds, flyers, and cold calls among existing agency clientele. Thirty individual interviews with participants of Mexican origin who live in and/or work in rural Yuma County were conducted remotely in 2021. Participants overwhelmingly perceived their communities as both calm and safe. While some participants mentioned safety concerns, the vast majority described high levels of personal security and credited both neighbors and police for ensuring local safety. These perceptions were stated in direct contrast to those across the border, where participants had positive familial and cultural ties but negative perceptions regarding widespread violence. In conclusion, we argue that to understand environmental factors affecting health and well-being in Mexican immigrant populations, it is critical to examine the role of binational external referents that color community perceptions.
• Erdrich, J., Cordova-Marks, F., Monetathchi, A. R., Wu, M., White, A., & Melkonian, S. (2022). Disparities in Breast-Conserving Therapy for Non-Hispanic American Indian/Alaska Native Women Compared with Non-Hispanic White Women. Annals of surgical oncology, 29(2), 1019-1030.
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  Little is known about the surgical patterns of American Indian/Alaska Native (AI/AN) breast cancer patients. The purpose of this study is to determine whether there are disparities in breast cancer surgery and radiation therapy between non-Hispanic AI/AN (NH-AI/AN) women and non-Hispanic White (NHW) women.
• Garcia, P. C., Barraza, L. F., Peace-Tuskey, K., Jehn, M., Cordova, F. M., Pogreba Brown, K. M., Carr, D. L., Dykinga, M., Dawodu, O., Mantina, N. M., & Nuno, V. L. (2022). Consequences of COVID-19 on adolescents in Arizona: A longitudinal study protocol. . Frontiers in Public Health.
• Godfrey, T. M., Cordova-Marks, F. M., Jones, D., Melton, F., & Breathett, K. (2022). Metabolic Syndrome Among American Indian and Alaska Native Populations: Implications for Cardiovascular Health. Current hypertension reports, 24(5), 107-114.
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  The latest national data reports a 55% prevalence of metabolic syndrome in American Indian adults compared to 34.7% of the general US adult population. Metabolic syndrome is a strong predictor for diabetes, which is the leading cause of heart disease in American Indian and Alaska Native populations. Metabolic syndrome and associated risk factors disproportionately impact this population. We describe the presentation, etiology, and roles of structural racism and social determinants of health on metabolic syndrome.
• Habila, M. A., Valencia, D. Y., Khan, S. M., Heslin, K. M., Hoskinson, J., Ernst, K. C., Pogreba-Brown, K., Jacobs, E. T., Cordova-Marks, F. M., & Warholak, T. (2022). A Rasch analysis assessing the reliability and validity of the Arizona CoVHORT COVID-19 vaccine questionnaire. SSM - population health, 17, 101040.
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  Despite the widespread availability of COVID-19 vaccines in the United States, many that have chosen not to be vaccinated have done so because of vaccine hesitancy. This highlights the need for tools that accurately capture the knowledge, attitudes, and beliefs towards COVID-19 vaccines, and provide steps toward improving vaccine acceptance.
• Khan, S. M., Farland, L. V., Catalfamo, C. J., Austhof, E., Bell, M. L., Chen, Z., Cordova-Marks, F., Ernst, K. C., Garcia-Filion, P., Heslin, K. M., Hoskinson, J., Jehn, M. L., Joseph, E. C., Kelley, C. P., Klimentidis, Y., Russo Carroll, S., Kohler, L. N., Pogreba-Brown, K., & Jacobs, E. T. (2022). Elucidating symptoms of COVID-19 illness in the Arizona CoVHORT: a longitudinal cohort study. BMJ open, 12(1), e053403.
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  To elucidate the symptoms of laboratory-confirmed COVID-19 cases as compared with laboratory-confirmed negative individuals and to the untested general population among all participants who reported symptoms within a large prospective cohort study.
• Leybas Nuño, V., Mantina, N. M., Dawodu, O., Dykinga, M., Carr, D. L., Pogreba-Brown, K., Cordova-Marks, F., Jehn, M., Peace-Tuskey, K., Barraza, L., & Garcia-Filion, P. (2022). Consequences of COVID-19 on adolescents in Arizona: A longitudinal study protocol. Frontiers in public health, 10, 945089.
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  The long-term impact of COVID-19 is unknown. We developed a 5-year prospective cohort study designed to generate actionable community-informed research about the consequences of COVID-19 on adolescents ages 12-17 years in Arizona.
• Solomon, T. G., Starks, R. R., Attakai, A., Molina, F., Cordova-Marks, F., Kahn-John, M., Antone, C. L., Flores, M., & Garcia, F. (2022). The Generational Impact Of Racism On Health: Voices From American Indian Communities. Health affairs (Project Hope), 41(2), 281-288.
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  Structural racism toward American Indians and Alaska Natives is found in nearly every policy regarding and action taken toward that population since non-Natives made first contact with the Indigenous peoples of the United States. Generations of American Indians and Alaska Natives have suffered from policies that called for their genocide as well as policies intended to acculturate and dominate them-such as the sentiment from Richard Henry Pratt to "kill the Indian…, save the man." The intergenerational effect is one that has left American Indians and Alaska Natives at the margins of health and the health care system. The effect is devastating psychologically, eroding a value system that is based on community and the sanctity of all creation. Using stories we collected from American Indian people who have experienced the results of racist policies, we describe historical trauma and its links to the health of American Indians and Alaska Natives. We develop two case studies around these stories, including one from a member of the Navajo Nation's experiences during the COVID-19 pandemic, to illustrate biases in institutionalized structures. Finally, we describe how the American Indian and Alaska Native Cultural Wisdom Declaration can help policy makers eliminate the effect of systemic racism on the health of American Indians and Alaska Natives-for instance, by lifting constraints on federal funding for American Indian and Alaska Native initiatives and allowing payment to traditional healers for their health services.
• Shilen, A., Shilen, A., Pogreba-brown, K., Khan, S. M., Lutrick, K., Garcia-filion, P., Catalfamo, C. J., Harris, R. B., Farland, L. V., Pogreba-brown, K., Cordova-marks, F. M., Lutrick, K., Pogreba-brown, K., Kohler, L. N., Lutrick, K., Klimentidis, Y. C., Khan, S. M., Kohler, L. N., Jehn, M., , Klimentidis, Y. C., et al. (2021). Design of the Arizona CoVHORT: A Population-Based COVID-19 Cohort.. Frontiers in public health, 9, 620060. doi:10.3389/fpubh.2021.620060
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  This study is a prospective, population-based cohort of individuals with a history of SARS-CoV-2 infection and those without past infection through multiple recruitment sources. The main study goal is to track health status over time, within the diverse populations of Arizona and to identify the long-term consequences of COVID-19 on health and well-being. A total of 2,881 study participants (16.2% with a confirmed SARS-CoV-2 infection) have been enrolled as of December 22, 2020, with a target enrollment of 10,000 participants and a planned follow-up of at least 2 years. This manuscript describes a scalable study design that utilizes a wide range of recruitment sources, leveraging electronic data collection to capture and link longitudinal participant data on the current and emerging issues associated with the COVID-19 pandemic. The cohort is built within a collaborative infrastructure that includes new and established partnerships with multiple stakeholders, including the state's public universities, local health departments, tribes, and tribal organizations. Challenges remain for ensuring recruitment of diverse participants and participant retention, although the electronic data management system and timing of participant contact can help to mitigate these problems.
• Erdrich, J., Fennimore, N., Cordova-marks, F. M., & Bruegl, A. S. (2020). What Should Physicians Consider About American Indian/Alaska Native Women's Reproductive Freedom?. AMA journal of ethics, 22(10), E845-850. doi:10.1001/amajethics.2020.845
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  Historically, American Indians and Alaska Natives (AI/AN) have been subjected to a lack of control over various aspects of their lives, including their reproductive health. In discussions of family planning with AI/AN patients, clinicians must consider past violations of reproductive rights and the need for transparent consent. This article explores the following questions: What were historical violations of AI/AN women's reproductive rights? How should physicians express respect for this history and for the autonomy of AI/AN female patients regarding surgical sterilization procedures today?
• Harris, R. B., Harris, R. B., Cordova-marks, F. M., Cordova-marks, F. M., Badger, T. A., & Badger, T. A. (2020). Urban American Indian Caregiving during COVID-19. American Indian Culture and Research Journal, 44(2), 5-19. doi:10.17953/aicrj.44.2.cordova-marks_badger_harris
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  This study examined the experience of caregiving during a pandemic by asking five questions about how COVID-19 was impacting twenty American Indian caregivers providing care to a family member who was disabled, elderly, or had a chronic health condition. Interviews were conducted via Zoom. Themes identified were concern about the care recipient contracting COVID-19, increased caregiving intensity, increased Medical care issues, changes to caregiver health and health behaviors, and support received and increased need for support during the pandemic (material and emotional). Responses indicate that tribes and American Indian health organizations should initiate services that can support caregivers during the pandemic or make changes to their caregiver programs.
• Harris, R. B., Teufel-shone, N. I., Norton, B., Cunningham, J. K., Mastergeorge, A. M., Cordova-marks, F. M., Harris, R. B., Teufel-shone, N. I., Norton, B., Gerald, L. B., Mastergeorge, A. M., Cunningham, J. K., Gerald, L. B., Cordova-marks, F. M., & Cordova-marks, F. M. (2020). Resilience and Stress among Hopi Female Caregivers.. American Indian and Alaska native mental health research (Online), 27(2), 76-89. doi:10.5820/aian.2702.2020.76
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  Resilience and stress are important factors in the caregiving experience, but research has yet to examine their association among American Indian (AI) caregivers. This study examines resilience and stress in a group of Hopi female caregivers. Data came from the Hopi Adult Caregiver Survey (2017), which conducted interviews with 44 Hopi women who were providing care without remuneration to an adult family member. Measures included the abbreviated Connor-Davidson Resilience Scale (CD-RISC-10), the Perceived Stress Scale (PSS-10), and questions about caregiver characteristics, care recipient characteristics, social support/ community support, and cultural factors. Stress and resilience were looked at above the median (higher stress or higher resilience) and below the median (lower stress or lower resilience). Caregivers who reported relatively lower resilience were more likely to report that they lived separately from their care recipients and that all Hopis are expected to be caregivers. Caregivers who reported relatively higher stress reported a higher total number of caregiver difficulties, a poorer self-perception of their own health, use of a traditional healer in the past 5 years, and that females are expected to be caregivers. A regression analysis adjusting for age, education, and employment status indicated that higher resilience among the caregivers was significantly associated with lower stress. In light of these findings, programs working with AI caregivers may wish to explore whether supporting the resilience of these caregivers is a means towards limiting their stress.
• Cordova-marks, F. M., Harris, R. B., Teufel-shone, N. I., Norton, B., Mastergeorge, A. M., Harris, R. B., Gerald, L. B., & Cordova-marks, F. M. (2019). Characteristics of American Indian Female Caregivers on a Southwest American Indian Reservation.. Journal of community health, 44(1), 52-60. doi:10.1007/s10900-018-0552-7
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  American Indian (AI) caregivers have been excluded from national survey efforts. Drawing from a 2012 survey administered on the Hopi Reservation in northern Arizona, 20% of adults are caregivers. More information is needed to guide program development tailored to Hopi needs. In a University-Community collaboration, a 58 question survey was administered to self-identified caregivers of a family member about amount and type of care provided, difficulties, caregiver health, and desired support services. Characteristics of caregivers and their experiences were described. Forty-four (44) female Hopi caregivers were interviewed from June-October 2017, mean age of 59 years (± 12.6) with mean 5.5 year (± 4.4) history of providing care. Over 84% provided care to either a parent or grandparent. Most caregivers provided transportation (93.2%), housework (93.2%), and medical related care (72.7%). Caregivers stated they had difficulties with not having enough time for family and or friends (88.6%), financial burdens (75.0%), and not having enough time for themselves (61.4%). The most frequently identified difficulty was stress (45.5%). Caregivers would like additional services, with 76.7% asking for training. Over 77% would not consider placing their relative in an assisted living facility. Compared to national data, Hopi female caregivers are older, provide more care hours/week, more caregiving duties, and for a longer number of years. Stress is the most reported difficulty, although lower than national levels. As caregivers are resistant to placing the recipient in assisted living, educational efforts should focus on training caregivers to assist the care recipient and decreasing caregiver stress.
• Cunningham, J. K., Cordova, F. M., Solomon, T. G., & Ritchey, J. (2019). Cigarette Use Among American Indians and Alaska Natives in Metropolitan Areas, Rural Areas, and Tribal Lands. Journal of Public Health Management and Practice. doi:10.1097/phh.0000000000001026
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  Cigarette use among the US general population is significantly lower in metropolitan areas than in rural areas.To assess whether cigarette use among American Indians and Alaska Natives (AI/AN) is lower in metropolitan areas than in rural areas and tribal lands (which are predominantly rural).Data came from the National Survey on Drug Use and Health (2012-2016). Regressions with adjustments for demographics were performed to assess whether cigarette use differed in association with type of place.The AI/AN in tribal lands (n = 1569), nontribal large metropolitan (1+ million people) areas (n = 582), nontribal small metropolitan (
• Cunningham, J. K., Ritchey, J., Solomon, T. A., & Cordova, F. M. (2019). Cigarette Use Among American Indians and Alaska Natives in Metropolitan Areas, Rural Areas, and Tribal Lands. Journal of public health management and practice : JPHMP, 25 Suppl 5, Tribal Epidemiology Centers: Advancing Public Health in Indian Country for Over 20 Years, S11-S19.
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  Cigarette use among the US general population is significantly lower in metropolitan areas than in rural areas.
• Harris, R. B., Harris, R. B., Cunningham, J. K., Cordova-marks, F. M., Teufel-shone, N. I., Norton, B., Mastergeorge, A. M., Gerald, L. B., & Cordova-marks, F. (2019). AMERICAN INDIAN FEMALE CAREGIVERS: STRESS AND RESILIENCE. Innovation in Aging, 3(Supplement_1), S941-S942. doi:10.1093/geroni/igz038.3423
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  Abstract Background/Introduction: Increased stress has been found to be a part of the caregiving experience. However, how stress is handled is important. Resilience has been shown to decrease stress in non-caregivers. There is a lack of information about American Indian (AI) caregiver stress. In this study, we seek to investigate if resilience acts as a stress buffer in this population of AI female caregivers.Methods: The Hopi Adult Caregiver Survey was conducted in 2017 with 44 female Hopi caregivers. Resilience and stress scale questions were asked as well as variables potentially affecting these. Resilience as measured by the Connor Davidson Resilience Scale-10 (CD-RISC) and stress as measured by the Perceived Stress Scale-10 scores were calculated as well as categorical levels of higher and lower stress/resilience. Variables possibly associated with each were assessed using linear regression analyses. Results: Forty-four female caregivers were surveyed. The overall mean stress score for caregivers was 17.9 ± 6.2 on the PSS. For difference between higher and lower stress, expectation of females to be caregivers, number of times using a traditional healer/traditional medicine person, number of caregiver difficulties, self-perceived health rating, self-perceived changes to eating habits since becoming a caregiver were significant. Average sum resilience score was 28.7 ± 6.2 on the CD-RISC. In linear regression, it was found that with an increase in the resilience score, stress score decreased.Discussion: In these caregivers, resilience acts as a stress buffer. Increasing resilience and countering factors that decrease resilience may reduce stress experienced by caregivers.
• Cordova, F. M., Garcia, F., & Solomon, T. G. (2017). What's Killing Our Children? Child and Infant Mortality among American Indians and Alaska Natives. NAM perspectives. doi:10.31478/201703b
• Cordova, F. M., Harris, R. B., Brown, S. R., Teufel-shone, N. I., Sanderson, P. R., Saboda, K., Nisson, P. L., Mastergeorge, A. M., Joshweseoma, L., Harris, R. B., Gerald, L. B., Brown, S. R., & Ami, D. (2016). Caregiving on the Hopi Reservation: Findings from the 2012 Hopi Survey of Cancer and Chronic Disease.. Journal of community health, 41(6), 1177-1186. doi:10.1007/s10900-016-0199-1
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  A family caregiver provides unpaid assistance to a family member/friend with a chronic disease, illness or disability. The caregiving process can affect a caregiver's quality of life by reducing time for themselves, for other family members and for work. The 2000 Behavioral Risk Factor Surveillance Survey estimates that 16 % of adult American Indians (AIs) are caregivers. A 2012 survey collected knowledge and personal experience data from a random sample of Hopi men and women (248 men and 252 women). Self-identified caregivers answered questions on time spent caregiving, caregiver difficulties and services requested. Approximately 20 % of the 500 Hopi participants self-identified as caregivers (N = 98), with 56 % female. Caregivers in contrast to non-caregivers had a lower percentage of ever having a mammogram (86, 89 %), a higher percentage of ever having had a Pap smear test (89.1, 85.6 %), a prostate specific antigen test (35, 30.6 %) and ever having had a colonoscopy (51.2, 44 %). Almost 21 % of caregivers reported difficulty with stress and 49 % reported it as their greatest caregiver difficulty. More males (28.6 %) identified financial burden as the greatest difficulty than females (p = 0.01). Training on patient care was the service that caregivers would like to receive most (18.2 %). The percentage of Hopi's providing caregiving was similar to national averages, although among men, was somewhat higher than national data (44 vs. 34 %). Stress was identified as a difficulty, similar to national studies.
• Cordova, F. M., Teufel-shone, N. I., Joshweseoma, L., & Coe, K. (2015). Using a Community-Based Participatory Research Approach to Collect Hopi Breast Cancer Survivors' Stories. American Indian Culture and Research Journal, 39(2), 97-109. doi:10.17953/aicrj.39.2.cordova
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  The Hopi Tribe’s reservation is located in northern Arizona, spreading over four thousand square miles (fig. 1).1 The Hopi live in twelve villages located on three separate mesas known as First, Second, and Third Mesas. Most of the villages are located between five to thirty minutes of one another. The nearest city off-reservation is Flagstaff, which is a one-and-a-half to two-hour drive for most Hopi reservation residents. According to the Hopi Women’s Health Program (HWHP), the Hopi Tribe has 12,442 enrolled members, with 5,143 of those members living off the reservation. Approximately one thousand nonHopis live on tribal lands; they work on the reservation and/or are married into the tribe.2 The HWHP is the primary source of cancer information for the Hopi. The HWHP, in collaboration with Indian Health Service (IHS), provides education, information, and
• Teufel-shone, L., Cordova-marks, F. M., Teufel-shone, N. I., Susanyatame, G., Irwin, S. L., & Cordova-marks, F. (2015). Documenting Cancer Information Seeking Behavior and Risk Perception in the Hualapai Indian Community to Inform a Community Health Program.. Journal of community health, 40(5), 891-8. doi:10.1007/s10900-015-0009-1
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  Cancer incidence among American Indians (AIs) is low, yet their 5-year relative survival rate is the second lowest of all U.S. populations. Culturally relevant cancer prevention education is key to achieve health equity. This collaborative project of the Hualapai Tribe and University of Arizona modified the National Cancer Institute's 2003 Health Information National Trends Survey (HINTS) to yield a more culturally relevant cancer information survey to document the health seeking behaviors and perceptions of cancer risks and preventability of AI adults residing in the Hualapai Indian community. A team of health care providers, educators and cancer survivors (six native and three non-natives) completed the adaptation. Four trained native surveyors administered the survey using a random household survey design. The Hualapai HINTS was well accepted (
• Cordova, F. M., & Watson, R. R. (2014). Food and Supplement Polyphenol Action in Cancer Recurrence. Polyphenols in Human Health and Disease, 191-195. doi:10.1016/b978-0-12-398456-2.00016-5
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  There are 8000 different types of polyphenols. Various polyphenols have been found to be involved in the anticarcinogenesis process. Anticancer mechanisms include inducing apoptosis as well as halting pro-cancer growth processes and acting as antioxidants. In the little data that have been produced, polyphenols have shown promise in decreasing cancer recurrence in the breast, prostate and colon, with further research needed for these types of cancer as well as other types of cancer.
• Zibadi, S., Slack, E. H., Watson, R. R., Larson, D. F., Larson, D. F., & Cordova, F. M. (2011). Leptin's regulation of obesity-induced cardiac extracellular matrix remodeling.. Cardiovascular toxicology, 11(4), 325-33. doi:10.1007/s12012-011-9124-0
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  Obesity-induced remodeling of cardiac extracellular matrix (ECM) leads to myocardial fibrosis and ultimately diastolic dysfunction. Leptin, an adipocyte hormone, is emerging as a novel mechanistic link between obesity and heart diseases. Despite the known essential role of leptin in hepatic and renal fibrosis, the in vivo effects of leptin on cardiac ECM remodeling remain unclear. Our objective was to define the role of leptin as a key mediator of pro-fibrogenic responses in the heart. In vitro administration of leptin to primary cardiofibroblasts resulted in significant stimulation of pro-collagen Iα ( 1 ) and a decrease in pro-matrix metalloproteinase (MMP)-8, -9 and -13 gene expressions at 24 h. To study the in vivo pro-fibrotic effect, leptin was administrated to C57BL/6 and leptin-deficient ob/ob mice for 8 weeks. With exogenous leptin ob/ob mice displayed passive diastolic filling dysfunction, coincided with significant increase in myocardial collagen compared with ob/ob controls. We also observed a marked stimulation of pro-collagen IIIα ( 1 ) and suppression of pro-MMP-8, TIMP-1 and -3 gene expressions in leptin-treated ob/ob mice. Our findings suggest pro-fibrotic effects of leptin in the heart, primarily through the predominance of collagen synthesis over degradation.

Presentations

• Cordova, F. M., & Carroll, S. R. (2021). Connecting with Data and Community Through an Indigenous Lens. Molecular Epidemiology & the Environment SIG” for the ASPO American Society of Preventive Oncology 45TH Annual Meeting: Health Equity, Culture, & Cancer.
• Hendrickson, B., Cordova, F. M., Abecassis, M. M., & Wilkinson-Lee, A. M. (2021, October). Panel – Health, Culture, and Religion on the Arizona Border. 2021 Fred and Barbara Borga Lecture, Tucson Humanities Festival, College of Humanities, University of Arizona. Tucson, Arizona: College of Humanities, University of Arizona.