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

• Monetathchi, A. R., Carson, W. O., Upshaw, B., Lester, A., Cleary, E., Little, A., Cordova-Marks, F. M., & Erdrich, J. (2026). Colorectal Cancer in the American Indian and Alaska Native Community: A Holistic Review. Journal of cancer education : the official journal of the American Association for Cancer Education.
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  Despite a decline in colorectal cancer (CRC) incidence and mortality for the general United States population, American Indian/Alaska Native (AI/AN) populations have seen an increase in both measures. AI/AN populations have also experienced the largest increase in early-onset colorectal cancer, have the second highest CRC incidence rates, and the AN community has the highest rates of CRC worldwide. AI/AN populations face numerous barriers, including limited access to care and a shift in dietary preferences away from traditional foods, which may contribute to these findings. This review of the literature explored what types of CRC research have been conducted and found that 7.1% is on diet, 8.2% on age, 3.5% on geography, and 64.7% on screening. This review expands the focus beyond screening and highlights research focused on potential underlying causes of CRC in AI/AN communities. A more comprehensive and population-specific fund of knowledge on the totality of the subject is critical to directing more effective prevention, earlier detection, and management. Evaluating different components of CRC honors the holistic approach to health practiced by many AI/AN communities.
• Carson, W. O., Cordova-Marks, F. M., Jennings, L. L., & Carroll, S. R. (2025). Reaffirming Indigenous data sovereignty in New Mexico as a result of COVID-19. Frontiers in public health, 13(Issue). doi:10.3389/fpubh.2025.1302655
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  Despite New Mexico's history of working with and enhancing collaboration with the 23 Tribes in the state, data sharing and collaboration with Tribes was poor during the COVID-19 pandemic. New Mexico's policies of state collaboration with Tribes conflicts with the principles of Indigenous Data Sovereignty and fails to recognize Tribal public health authorities. New Mexico state agencies limited what data Tribes and Tribal Organizations received, resulting in the suppression of Tribes' inherent rights. This policy brief concludes with recommendations for the state of New Mexico to respect Tribal sovereignty, uphold the tenants of Indigenous Data Sovereignty, restore trust with Tribes, and support increased capacity and capability of Tribes.
• Carson, W. O., Little, A., Monetathchi, A., Erdrich, J., & Cordova-Marks, F. M. (2025). Analysis of Urban Indian Organizations’ Promotion of Cancer Services. Cancer Research Communications, 5(Issue 2). doi:10.1158/2767-9764.crc-24-0335
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  The burden of cancer remains elevated for American Indians/Alaska Natives (AI/AN) in the United States, particularly in urban communities. Urban Indian Organizations (UIO) are a part of the Indian healthcare system for urban AI/AN populations to receive culturally competent care; therefore, it is important that UIOs convey the importance of cancer preventive and treatment options through their websites. The purpose of this study was to utilize the Indian Health Service (IHS) Office of Urban Indian Health Programs’ official website to identify, analyze, and describe the IHS-funded UIOs offering cancer-related services. We utilized qualitative content analysis on UIOs with primary care service capabilities. After determination of UIOs, each eligible website was reviewed to determine whether promotion of specific cancer-related services was being done based on the following categories: primary prevention, cancer screening, cancer support, and information/ technology services that focus on the social determinants of health. There is limited, vague, or outdated information on UIO websites regarding the type of cancer-related services and programs provided. We found that whereas 21 of 34 UIOs list any mention of cancer screenings, few mentioned specific testing capabilities for various cancers. In addition, the listing of support and preventative services was also limited, with less than half of UIOs reporting on patient navigation services, among others. There is untapped potential in the utilization of websites for extending the impact of UIOs and their work with urban AI/AN populations in prevention, screening, and support of patients with cancer in a culturally appropriate manner that can improve outcomes.
• Carson, W. O., Valenti, M., Begay, K., Carvajal, S., Carroll, S. R., Yuan, N. P., & Cordova-Marks, F. M. (2025). Evaluating Indigenous Identity and Stress as Potential Barriers to Accessing On-Campus Healthcare for Indigenous Students at a Large Southwestern University. International Journal of Environmental Research and Public Health, 22(Issue 9). doi:10.3390/ijerph22091409
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  Introduction: This study examined the relationship between Indigenous identity, perceived stress, and healthcare utilization for Indigenous students on-campus. Methods: Potential participants included undergraduate and graduate Indigenous students from Tribal Nations within the United States. Participants were recruited through community partnerships and in person communication. This survey included the Perceived Stress Scale (PSS-10), the Multiethnic Identity Measure (MEIM), and university Campus Health Service Health and Wellness Survey. Results: 153 Indigenous students from United States-based Tribal Nations participated in this survey. While there appears to be a relationship between Indigenous identity, perceived stress, and Campus Health utilization, the results were not significant for the second tertile (OR: 1.1 (0.4, 2.7)) or third tertile (1.4 (0.5, 3.3)). Students who reported “Yes” or “Unsure” to questions on if their insurance needed them to go outside of the university were far less likely to use Campus Health (Yes OR: 0.2 (0.08–0.5)); (Unsure OR: 0.09 (0.03–0.3)) and CAPS (Yes OR: 0.2 (0.09–0.6)); (Unsure OR: 0.2 (0.04–0.4)). Discussion: This study saw a complex relationship between Indigenous identity, perceived stress, and campus health utilization; however, the findings are not statistically significant. There are distinctions in on campus health care usage when adjusting for undergraduate or graduate student status and health insurance literacy. Conclusion: The research findings offer many promising avenues for future work around Indigenous identity, affordability of healthcare, and importance of health literacy.
• Crocker, R. M., Yeo, S., Cordova-Marks, F. M., Castro, I., Torres, E., & Carvajal, S. C. (2025). “Don't leave it all to science”: How Mexicans living along the US-Mexico border view health and care seeking. Wellbeing, Space and Society, 9. doi:10.1016/j.wss.2025.100288
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  The geographic and cultural distribution of the health beliefs that inform how people interpret disease etiologies, engage in the clinical arena, utilize traditional remedies, and respond to health promotion programming is an important and understudied topic. The impacts of place-based factors on health concepts may be especially critical among geographically displaced populations, who tend to face a similar and concerning host of barriers to medical care access and societal stressors. In this community-based participatory research study, we use qualitative interviews (n=30) among a sample of binationally mobile Mexicans living near the US-Mexico border in southern Arizona to explore how border residence shapes Mexicans’ health and healing world views and care-seeking practices. Findings centered around 1) participants’ binational mobility which reinforced their connections with Mexican healing practices and medical services and provided an escape valve in the face of US-based barriers to care; 2) their integrated mind-body-soul health concepts that grounded them in their ecological and social surroundings; 3) their commitment to taking a primary role in their own healing including localized health challenges and their views on the role of doctors, and 4) barriers to health management tied to labor conditions, border crossing stressors, and perceived ill effects of biomedical care. In conclusion, proximity to the border and binational mobility are shown here to reinforce Mexicans’ cultural health concepts and facilitate their ability to maintain a more active role in their own care-seeking practices and to circumvent some critical US-based barriers to medical services.
• Upshaw, B. E., Keovorabouth, S. T., & Cordova-Marks, F. M. (2025). Beyond LGBTQ+: Centering QT2S lived experiences in body image research. Social science & medicine (1982), 386, 118640.
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  This critical narrative review examines body image within Queer, Trans, Two-Spirit (QT2S) communities, centering how race, gender, community norms, and dominant beauty ideals shape embodied experience. While body image research has grown in recent decades, it continues to privilege white, cisheteronormative perspectives, leaving critical gaps in understanding QT2S lived realities.
• Erdrich, J., Cordova-Marks, F. M., Carson, W. O., Bea, J. W., Montfort, W. R., & Thomson, C. A. (2024). Health Behavior Change Intervention Preferences Expressed by American Indian Cancer Survivors From a Southwest Tribal Community: Semistructured Interview Study. JMIR Formative Research, 8. doi:10.2196/51669
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  Background: While many factors, including social determinants of health, affect cancer mortality, one modifiable risk factor that may contribute to cancer disparities is obesity. The prevalence of obesity in the American Indian/Alaska Native population is 48.1% per the Centers for Disease Control and Prevention. The overall cancer mortality for the American Indian/Alaska Native population is 18% higher than the White population as reported by the American Cancer Society. Interventions tailored to American Indian/Alaska Native communities that promote healthy lifestyle behaviors after cancer diagnosis and prior to cancer surgery (prehab) might improve cancer outcomes for this population. Objective: The aim of the study is to characterize the lifestyle behaviors of San Carlos Apache cancer survivors and identify preferences for the adaption of a prehab intervention. Methods: Semistructured interviews and validated questionnaires were completed with San Carlos Apache cancer survivors (N=4), exploring their viewpoints on healthy lifestyle and cancer risk and preferences for program development. A thematic content analysis was conducted. Results: Participants had an average BMI of 31 kg/m2 and walked 53 minutes daily. The majority of participants reported a high willingness to change eating habits (n=3, 75%). All 4 reported willingness to participate in a diet and exercise program. Important themes and subthemes were identified: (1) cancer is perceived as a serious health condition in the community (N=4, 100%); (2) environmental exposures are perceived as cancer-causing threats (n=3, 75%); (3) healthy diet, exercise, and avoiding harmful substances are perceived as mitigating cancer risk (n=3, 75%); (4) barriers to healthy habits include distance to affordable groceries (n=3, 75%) and lack of transportation (n=2, 50%); (5) there is high interest in a prehab program geared toward patients with cancer (N=4, 100%); and (6) standard monitoring practiced in published prehab programs showed early acceptability with participants (N=4, 100%). Conclusions: Collaboration with tribal partners provided important insight that can help inform the adaptation of a culturally appropriate prehab program for San Carlos Apache patients diagnosed with cancer.
• Jones, R., Andrews, J., Dalton, A., Dixon, B., Dzomba, B., Fernando, S., Pogreba-Brown, K., Ortiz, M., Sharma, V., Simmons, N., Saydah, S., Thomas, J., Stein, K., Sokol, B., Sewell, E., Pickett, S., Poe, B., Jeddy, Z., Hunt, D., , Harpole, C., et al. (2024). Tracking the burden, distribution, and impact of Post-COVID conditions in diverse populations for children, adolescents, and adults (Track PCC): passive and active surveillance protocols. BMC Public Health, 24(1). doi:10.1186/s12889-024-19772-4
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  Background: Track PCC includes five geographic surveillance sites to conduct standardized population-based surveillance to estimate and track Post-COVID Conditions (PCC) by age, sex, race/ethnicity, geographic area, severity of initial infection, and risk factors among persons with evidence of SARS-CoV-2 infection (based on the Council of State and Territorial Epidemiologist [CSTE] case definitions for confirmed cases or laboratory-confirmed evidence of infection). Methods: The study will estimate the incidence, prevalence, including temporal trends, and duration and severity of PCC symptoms, among children, adolescents, and adults. PCCs include a broad range of symptoms and conditions that continue or develop after acute SARS-CoV-2 infection or COVID-19 illness. Surveillance includes both passive and active components for diverse populations in Arizona, Indiana, and Utah as well as the Bronx Borough, NY, and part of Philadelphia County, PA. Passive surveillance will utilize electronic health records and health information exchanges within each site catchment area to longitudinally follow persons with COVID-19 to estimate PCC occurring at least 30 days after acute COVID-19 illness. Active surveillance will utilize self-report of PCCs from detailed surveys of persons ages 7 years and older with evidence of SARS-CoV-2 infection in the past 3 months. Respondents will complete follow-up surveys at 6-, 12- and 18-months post-infection. Discussion: These data can help identify which groups are most affected by PCC, and what health differences among demographic groups exist, as well as indicate potential barriers to care. These additional levels of granularity can inform public health action and help direct needed clinical care for patients.
• 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, 38(Issue 1). doi:10.1007/s13187-021-02100-4
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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.
• 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.
• 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(Issue 3). doi:10.1080/10911359.2022.2062516
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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. doi:10.3389/frma.2023.1272318
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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.
• 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(Issue). doi:10.3389/frma.2023.1173805
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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.
• 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.
  More info

  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. doi:10.1016/j.jaut.2022.102991
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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., 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.
• 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(Issue 42). doi:10.1016/j.vaccine.2023.08.080
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  Background: 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. Methods: A total of 2196 adult participants from the Arizona CoVHORT, a population-based cohort in the United States established in May 2020, who had received at least one dose of the COVID-19 vaccine, responded to surveys administered between February 13 and March 29, 2023 querying receipt of a bivalent booster and if not, the reasons for not receiving it. Descriptive statistics were employed, including frequencies of responses by participant characteristics, and multivariable logistic regression was used to assess the association between participant characteristics and selected themes for not having received the bivalent booster. Results: The most commonly reported reason for not having been boosted was a prior SARS-CoV-2 infection (39.5%), followed by concern about vaccine side effects (31.5%), believing that the booster would not provide additional protection over the vaccines already received (28.6%), and concern about booster safety (23.4%) or that it would not protect from SARS-CoV-2 infection (23.1%). For themes related to reasons for not having been boosted, those 60 years of age or older were less likely to select items related to knowledge (OR: 0.24; 95% CI: 0.11–0.55) or logistical concerns (OR: 0.09; 95% CI: 0.03–0.30) about the vaccine; while those reporting Hispanic ethnicity were more likely to convey concerns about logistics than those reporting non-Hispanic ethnicity (OR: 2.15; 95% CI: 1.08–4.30). Finally, compared to college graduates, those with some college or technical school were significantly more likely to select items related to the risks and benefits of the bivalent vaccine not being clear as reasons for not having been boosted (OR: 2.41; 95% CI: 1.69–3.43). Conclusions: Improvement in booster uptake is necessary for optimal public health in the United States. The development of vaccines against SARS-CoV-2 occurred at an unprecedented speed, but vaccine uptake remains among the greatest current public health challenges as updated boosters continue to be developed and made available to the public. Interventions to improve vaccination rates require a variety of approaches.
• 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. doi:10.3389/fgene.2022.1052620
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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.
• 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.
• 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(Issue 14). doi:10.3390/ijerph19148399
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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(Issue 2). doi:10.1245/s10434-021-10730-7
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  Background: 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. Methods: Data from the National Program of Cancer Registries of the Centers for Disease Control and Surveillance, Epidemiology, and End Results were used for this cross-sectional study. Female patients with invasive breast cancer diagnosed 2010–2015 were stratified by race/ethnicity, surgical procedure, radiation, and region. Percentage distributions of mastectomy and lumpectomy were compared overall and by region and stage. Results: From 2010 to 2015 there were 3292 NH-AI/AN women and 165,225 NHW women diagnosed with breast cancer. For early stage (AJCC stage 1 and 2), NH-AI/AN women had overall significantly higher percentage of mastectomy (41% vs 34.4%, p < 0.001) and significantly lower percentage of lumpectomy (59% vs 65.6%) compared with NHW women, without significant differences in post-lumpectomy radiation (71% vs 70%). There were regional variations, notably in the Northern Plains, where the percentage of mastectomy for early-stage disease was 48.9% for NH-AI/AN women versus 35.9% for NHW women, and in Alaska with 47% for NH-AI/AN women versus 33.3% for NHW women (p < 0.001). There were no overall significant differences in type of surgery or radiation for late-stage disease between groups. Conclusion: This is the first study to show disparities in surgical management of NH-AI/AN women with breast cancer. For early-stage disease, NH-AI/AN women undergo a higher percentage of mastectomy. Future clinical directions could focus on the factors that drive awareness, decision-making, and access to breast conservation.
• 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(Issue). doi:10.1016/j.ssmph.2022.101040
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  Background: 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. Methods: Participants of the Arizona CoVHORT (COVID-19 Cohort) received a one-time, electronic based cross-sectional questionnaire intended to capture underlying motivations regarding vaccination, as well as hesitations that may prevent people from getting vaccinated. Rasch analysis was conducted among 4703 CoVHORT participants who had completed the vaccine questionnaire to assess questionnaire reliability and validity. Response categories were grouped to optimize scale functioning and to ensure independent probabilities of participant endorsement. Results: A total of 4703 CoVHORT participants completed the questionnaire, of whom 68% were female, and who had a mean age of 48 years. Participants were primarily White (90%), highly educated (63% with a college degree or above, with most respondents (45%) having an income of more than $75,000 per annum. The results indicated the questionnaire has good reliability and construct validity for assessing attitudes and beliefs about the COVID-19 vaccines. In-fit mean-squares for included items ranged from 0.61 to 1.72 and outfit mean-squares ranged from 0.56 to 1.75, and correlation coefficients ranged from 0.25 to 0.75. The person-item map indicated normal distribution of logit scores measuring perceptions about COVID-19 vaccinations. Conclusions: The CoVHORT vaccine questionnaire demonstrated satisfactory reliability and construct validity in assessing attitudes and beliefs about COVID-19 vaccines. Overall results provide a starting point for a reliable and valid tool to assess knowledge and perceptions about COVID-19 vaccination, ultimately providing public health professionals with an instrument to assess the factors that are associated with vaccine acceptance or hesitancy.
• 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(Issue 1). doi:10.1136/bmjopen-2021-053403
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  Objective 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. Setting and design This work was conducted within the framework of the Arizona CoVHORT, a longitudinal prospective cohort study conducted among Arizona residents. Participants Eligible participants were any individual living in Arizona and were recruited from across Arizona via COVID-19 case investigations, participation in testing studies and a postcard mailing effort. Primary and secondary outcome measures The primary outcome measure was a comparison of the type and frequency of symptoms between COVID-19-positive cases, tested but negative individuals and the general untested population who reported experiencing symptoms consistent with COVID-19. Results Of the 1335 laboratory-confirmed COVID-19 cases, 180 (13.5%) reported having no symptoms. Of those that did report symptoms, the most commonly reported were fatigue (82.2%), headache (74.6%), aches, pains or sore muscles (66.3%), loss of taste or smell (62.8) and cough (61.9%). In adjusted logistic regression models, COVID-19-positive participants were more likely than negative participants to experience loss of taste and smell (OR 12.1; 95% CI 9.6 to 15.2), bone or nerve pain (OR 3.0; 95% CI 2.2 to 4.1), headache (OR 2.6; 95% CI 2.2 to 3.2), nausea (OR 2.4; 95% CI 1.9 to 3.1) or diarrhoea (OR 2.1; 95% CI 1.7 to 2.6). Fatigue (82.9) and headache (74.9) had the highest sensitivities among symptoms, while loss of taste or smell (87.2) and bone or nerve pain (92.9) had the high specificities among significant symptoms associated with COVID-19. Conclusion When comparing confirmed COVID-19 cases with either confirmed negative or untested participants, the pattern of symptoms that discriminates SARS-CoV-2 infection from those arising from other potential circulating pathogens may differ from general reports of symptoms among cases alone.
• 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. doi:10.3389/fpubh.2022.945089
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  Introduction: 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. Methods: The study has two primary outcomes: 1) acute and long-term outcomes of COVID-19 illness and 2) symptoms of depression and anxiety. Data is collected using an online survey with plans to integrate qualitative data collection methods. The survey is administered at baseline, 4, and 8 months in year one, and annually in years two through five. This study is informed by Intersectionality Theory, which considers the diverse identities adolescents have that are self and socially defined and the influence they have collectively and simultaneously. To this end, a sample of variables collected is race/ethnicity, language usage, generational status, co-occurring health conditions, and gender. Additional measures capture experiences in social contexts such as home (parent employment, food, and housing security), school (remote learning, type of school), and society (racism). Results: Findings are not presented because the manuscript is a protocol designed to describe the procedure instead of report results. Discussion: The unique contributions of the study is its focus on COVID-19 the illness and COVID-19 the socially experienced pandemic and the impact of both on adolescents.
• 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, 41(Issue 2). doi:10.1377/hlthaff.2021.01419
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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.
• 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., Khan, S. M., Pogreba-brown, K., Garcia-filion, P., Lutrick, K., Catalfamo, C. J., Harris, R. B., Pogreba-brown, K., Farland, L. V., Lutrick, K., Cordova-marks, F. M., 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., Cordova-marks, F. M., Gerald, L. B., & 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.
• Mahadevan, D., Chiorean, E. G., Harris, W. B., Von Hoff, D. D., Stejskal-Barnett, A., Qi, W., Anthony, S. P., Younger, A. E., Rensvold, D. M., Cordova, F., Shelton, C. F., Becker, M. D., Garlich, J. R., Durden, D. L., & Ramanathan, R. K. (2012). Phase i pharmacokinetic and pharmacodynamic study of the pan-PI3K/mTORC vascular targeted pro-drug SF1126 in patients with advanced solid tumours and B-cell malignancies. European Journal of Cancer, 48(Issue 18). doi:10.1016/j.ejca.2012.06.027
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  Background: SF1126 is a peptidic pro-drug inhibitor of pan-PI3K/mTORC. A first-in-human study evaluated safety, dose limiting toxicities (DLT), maximum tolerated dose (MTD), pharmacokinetics (PK), pharmacodynamics (PD) and efficacy of SF1126, in patients with advanced solid and B-cell malignancies. Patients and methods: SF1126 was administered IV days 1 and 4, weekly in 28 day-cycles. Dose escalation utilised modified Fibonacci 3+3. Samples to monitor PK and PD were obtained. Results: Forty four patients were treated at 9 dose levels (90-1110 mg/m2/day). Most toxicity was grade 1 and 2 with a single DLT at180 mg/m2 (diarrhoea). Exposure measured by peak concentration (C max) and area under the time-concentration curve (AUC 0-t) was dose proportional. Stable disease (SD) was the best response in 19 of 33 (58%) evaluable patients. MTD was not reached but the maximum administered dose (MAD) was 1110 mg/m2. The protocol was amended to enrol patients with CD20+ B-cell malignancies at 1110 mg/m 2. A CLL patient who progressed on rituximab [R] achieved SD after 2 months on SF1126 alone but in combination with R achieved a 55% decrease in absolute lymphocyte count and a lymph node response. PD studies of CLL cells demonstrated SF1126 reduced p-AKT and increased apoptosis indicating inhibition of activated PI3K signalling. Conclusion: SF1126 is well tolerated with SD as the best response in patients with advanced malignancies. © 2012 Elsevier Ltd. All rights reserved.
• 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.