Trends in Tuberculosis Mortality Across India: Improvements Despite the COVID-19 Pandemic.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic has had significant health implications across the globe. India is a country that has faced a double burden of COVID-19 and tuberculosis (TB) since 2020. There is a need to understand the impacts of COVID-19 on tuberculosis control programs in India. Therefore, our study aimed to determine the changes in TB mortality across India between 2019 and 2021. METHODS: In our study, we described trends in TB and COVID-19 cases reported across India. Next, we compared death totals for TB between 2019, 2020, and 2021 in India at the national and state level. We considered total TB deaths, as well as deaths by TB for tribal populations, and for those living with human immunodeficiency virus (HIV). Percent changes were calculated. RESULTS: In 2020, compared to 2019, there was a 15.4% decrease in TB death totals, with 28 out of India's 36 states showing a decrease during this time period. While total deaths increased in 2021 compared to 2020, decreases did occur in 2021 compared to 2019. Deaths by TB for individuals living with HIV decreased by 16.0% across India. At a national level, there was a notable rise in TB deaths among tribal populations, though this was not universal across states. CONCLUSION: While the majority of the world has seen an increase in new TB cases and TB deaths annually since the start of the COVID-19 pandemic, there have instead been decreases in India during this time period. More research is required to understand the factors that have led to this decrease in TB deaths. Furthermore, additional allocation of resources is required to better support vulnerable populations in states where TB death totals have increased, especially among tribal populations.

Evaluation of the Health and Nutritional Status of Discharged Children From Malnutrition Treatment Centres Using Mobile Phone Calls During the COVID-19 Lockdown in Jharkhand, India.

Background The Indian state of Jharkhand has the highest rate of wasting (29%) among young children. Mobile audio call follow-up can be used to assess such children with severe acute malnutrition (SAM). Aim This study evaluated SAM children during the COVID-19 outbreak and learn more about the status of their home/community care, and caregivers' awareness of integrated child development services (ICDS) and COVID-19 prevention. Methods Contact numbers of caregivers for discharged children were obtained from 54 malnutrition treatment centers (MTCs). In April and June 2020, mentors conducted follow-up interviews using mobile phone calls. Results Seven children (1.72%) were reported dead and 400 were alive, mostly girls (59.5%). Only a few caregivers observed post-discharge ailments (15.4%) and weight loss (7.7%) in their children. Children aged six to 24 months were characterized by continued breastfeeding (88.0%) at most five to six times a day (45.8%). Most of the children were not fed as per maternal infant and young child feeding protocols. Age in months with an adjusted odds ratio (OR) of 0.55 (1.00-1.11) as a 95% confidence interval (CI), age category, with an adjusted OR of 4.32 (1.71- 10.94) as 95% CI, and breastfeeding with adjusted OR 1.85 (1.07- 3.21) as 95% CI were three major predictors for a well-fed child. Conclusion Community involvement is crucial in the follow-up of children with SAM for effective rehabilitation. Mobile phone audio call follow-up is a relatively cost-effective approach to tackle geographic barriers and COVID-19 lockdown-induced situations. There are major gaps mainly in informing caregivers on how to manage COVID-19 with breastfeeding.

The lived experiences of indigenous youth during the transition to emergency remote learning: A qualitative study

This qualitative study was conducted to learn about the lived experiences of Indigenous youth during the transition to emergency remote learning due to the COVID-19 pandemic. Eight students at two schools in the Western part of Robeson County, North Carolina, told their stories. Tribal Critical Race Theory was used in this study as a lens to analyze the stories told by these Indigenous students and five themes emerged from the data collected from their stories: students had significant issues with the internet, remote learning was challenging, the support of teachers was vital, students wanted to return to school, and school is better now that students are back in class face to face. Findings showed the lack of access to high-speed internet often impeded students' ability to connect with their teachers consistently. Students found remote learning was much more challenging than being in the classroom face to face and returning to school was important to them. Once students returned to school, Indigenous students reported how much better they felt and how much easier it was to learn and retain new information. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

The Mashpee Wampanoag Tribe COVID-19 Pandemic Response: A Case Study.

During the COVID-19 pandemic, the Mashpee Wampanoag Tribe of southeastern Massachusetts requested US federal government assistance. The tribe collaborated successfully with many partners in response to the COVID-19 pandemic. In this case study, the authors describe the tribe's collaboration with a team from the Centers for Disease Control and Prevention who assisted with epidemiology, case investigation and contact tracing, infection prevention and control, community prevention measures, and vaccination. Collaborative efforts resulted in over 200 public service announcements and videos produced, 55 tribal staff trained, 222 people followed up for contact tracing, 80% of tribal members vaccinated, and 5 COVID-19 response plans written. Deployment response teams learned elements essential to partnering with a Native American tribe. This successful partnership during a rapidly evolving pandemic suggests the US federal government and tribal nations can work together effectively to build response capacity for future infectious disease threats.

Effects of wild medicinal edible plant to prevent COVID-19: a survey by neutrosophic statistics in tribal people of Kokrajhar, Assam, India

The research for treatments and vaccines for novel coronavirus disease (COVID-19) is still going on. Desperation in the community, particularly among middle- and low-income groups who have been hit hard by the economic effects of forced lockdowns, has sparked a surge in interest in alternative medical plant-based therapies. This article attempts to provide evidence summaries examining the potential of complementary therapies in COVID-19 management by studying the findings of some wild medicinal edible plants that have been reported to have antiviral, anti-inflammatory, and immunomodulatory activities. We examine and compare the current growth pattern of COVID-19 between tribal and non-tribal people in different regions of Kokrajhar, Assam, India, where during the COVID-19 pandemic tribes have increased their use of wild medicinal edible herbs, and the recovery rate of COVID-19 is high in comparison to non-tribal people of the same area to describe the current state of wild medicinal edible plant use and provide critical recommendations to the relevant authorities. In addition, this study presents a multi-criteria decision-making procedure based on the neutrosophic VIKOR method to survey the region where most wild medicinal edible plants are used and found. Also, with the help of the neutrosophic VIKOR method, we can identify the regions where most people of the Kokrajhar district are affected and recovered. © 2023 Elsevier Inc. All rights reserved.

COVID vaccine hesitancy among the tribal population and its determinants: A community-based study at berhampore block of Murshidabad District, West Bengal.

Background: On January 16, 2021, India rolled out the COVID vaccination drive. A successful and effective vaccination campaign requires much more than the availability of a safe and effective vaccine. This includes identifying vulnerable populations with lower vaccine confidence and identifying the drivers of vaccine hesitancy. Objective: This study aims to find out vaccine hesitancy among the tribal population regarding COVID-19 vaccination. Methods: It was an observational descriptive cross-sectional study, conducted at Manindranagar and Hatinagar gram panchayat of Berhampore Block of Murshidabad district, West Bengal, from June 2021-November 2021, among tribal people aged >18 years. A total of 198 tribal people were selected by applying the probability proportional to size sampling method. Participants were interviewed using predesigned, pretested, and semi-structured schedules. Potential predictors of hesitancy were investigated using the multivariate logistic regression model. Results: Vaccine hesitancy was present among 36.9% of the study participants. Fear of side effects (78.1%) was the most common reason of vaccine hesitancy. Only 30.8% of them received at least one dose of vaccine. Vaccine hesitancy was associated with decreased family income in the last 1 year (adjusted odds ratio [AOR] = 8.23), knowledge regarding vaccine (AOR = 0.41), adherence to COVID-appropriate behavior (AOR = 0.45), and trust on the local health-care worker (AOR = 0.32). Conclusion: Vaccine hesitancy among the tribal population is driven by a lack of knowledge and awareness. Their economic status, attitudes toward the health system, and accessibility factors may also play a major role in vaccine hesitancy. Extensive information, education, and communication activity, more involvement of health-care workers in the awareness campaign, and establishment of vaccination centers in tribal villages may be helpful.

Hepatitis B virus infection among the tribal and particularly vulnerable tribal population from an eastern state of India: Findings from the serosurvey in seven tribal dominated districts, 2021-2022.

The Global Health Sector Strategy on viral hepatitis (2016-2021) endorsed by the World Health Assembly in 2016, called for the elimination of viral hepatitis as a public health threat by 2030. Odisha, an eastern state of India, has the third-highest percentage of tribal population in the country and limited information is available regarding the prevalence of HBsAg among them. The present study was undertaken to estimate the seroprevalence of hepatitis B surface antigen as well as HBV DNA almost after 12 years of the first prevalence study of HBsAg among the tribal community of Odisha. The present study attempted to estimate the prevalence of HBsAg among the 35 Scheduled tribal (ST) communities and 5 Particularly Vulnerable Tribal Group (PVTG) using the 2,737 number of sera collected as part of a statewide COVID-19 serosurvey, among the tribal populations of Odisha (residing in 7 districts) aged 6-75 years. HBsAg positivity ranged between 1.79 and 2.94% across various age groups. 42.9% of HBsAg positive individuals showed the presence of HBV DNA and the high viral load was 0.10 × 102-6.84 × 108 IU/mL, indicating a high potential to transmit the virus. The HBsAg positivity was 14.18 and 6.06% among the PVTGs, Kutia Khond and Paudi Bhuyan, who were first time surveyed for HBsAg prevalence. The present study documents the prevalence of HBsAg among the major tribal population residing in the eastern state of the country and highlights the need for a statewide survey of Hepatitis B infection and risk factors, coverage and impact of the Hepatitis B vaccination program introduced in 2010-2011 in Odisha among the ST and PVTG population of the state.

COVID-19 Messaging on Social Media for American Indian and Alaska Native Communities: Thematic Analysis of Audience Reach and Web Behavior.

Background: During the COVID-19 pandemic, tribal and health organizations used social media to rapidly disseminate public health guidance highlighting protective behaviors such as masking and vaccination to mitigate the pandemic's disproportionate burden on American Indian and Alaska Native (AI/AN) communities. Objective: Seeking to provide guidance for future communication campaigns prioritizing AI/AN audiences, this study aimed to identify Twitter post characteristics associated with higher performance, measured by audience reach (impressions) and web behavior (engagement rate). Methods: We analyzed Twitter posts published by a campaign by the Johns Hopkins Center for Indigenous Health from July 2020 to June 2021. Qualitative analysis was informed by in-depth interviews with members of a Tribal Advisory Board and thematically organized according to the Health Belief Model. A general linearized model was used to analyze associations between Twitter post themes, impressions, and engagement rates. Results: The campaign published 162 Twitter messages, which organically generated 425,834 impressions and 6016 engagements. Iterative analysis of these Twitter posts identified 10 unique themes under theory- and culture-related categories of framing knowledge, cultural messaging, normalizing mitigation strategies, and interactive opportunities, which were corroborated by interviews with Tribal Advisory Board members. Statistical analysis of Twitter impressions and engagement rate by theme demonstrated that posts featuring culturally resonant community role models (P=.02), promoting web-based events (P=.002), and with messaging as part of Twitter Chats (P<.001) were likely to generate higher impressions. In the adjusted analysis controlling for the date of posting, only the promotion of web-based events (P=.003) and Twitter Chat messaging (P=.01) remained significant. Visual, explanatory posts promoting self-efficacy (P=.01; P=.01) and humorous posts (P=.02; P=.01) were the most likely to generate high-engagement rates in both the adjusted and unadjusted analysis. Conclusions: Results from the 1-year Twitter campaign provide lessons to inform organizations designing social media messages to reach and engage AI/AN social media audiences. The use of interactive events, instructional graphics, and Indigenous humor are promising practices to engage community members, potentially opening audiences to receiving important and time-sensitive guidance.

Introduction to the special section: Tribal marketing after Covid

This article introduces the special section, "Tribal Marketing After Covid: Consuming Together in an Age of Social Distance.” The authors trace the history of tribal marketing theory up until the present, ‘post-Covid' era, outlining each wave and some trajectories for future research. © The Author(s) 2023.

Effect of lock down due to COVID-19 pandemic on the alcohol use and abuse among a tribal community in South India.

Background: Alcohol consumption in the tribal communities is found to be rising, as Indian-made foreign liquor (IMFL) is easily accessible through state-run outlets. During the first coronavirus disease (COVID-19) lockdown, despite IMFL being non-available, there were not any reports of alcohol withdrawal among the tribal men who were enrolled in our substance abuse clinic. Methodology: This is a community-based, mixed-method study to document the changes during the lockdown in the drinking pattern and behavior of families and communities of men who consume alcohol. The quantitative part of the study was done by interviewing 45 alcohol-dependent men and documenting their alcohol use disorders identification test (AUDIT) scores during the lockdown. The qualitative part captured the changes in familial and social behavior. Focused group discussions (FGDs) were conducted among community members and leaders. In-depth interviews (IDs) were done among men with harmful drinking patterns and their spouses. Results: There was a significant reduction in the consumption of IMFL among the men interviewed as depicted by the low mean AUDIT score (16.42, P < 0.001). Trivial withdrawal symptoms were found among them (67%). Around 73.3% could access arrack. The community perceived that arrack was brewed and sold at a higher cost within days of lockdown. Familial conflicts reduced. Certain community leaders and members could proactively curb the brewing and selling of arrack. Conclusion: The study uniquely brought out in depth the information at the individual, familial, and community contexts. It is imperative to develop policies to protect indigenous populations by different rules governing the sales of alcohol.

Clinical features, management, and mortality because of COVID-19 in an intensive care unit in Surguja, a tribal district in Central India: A single-centre descriptive study.

Background: The clinical features and management of severe coronavirus disease 2019 (COVID-19) have been well documented in urban India. However, little data exist on the management and outcomes of severe COVID-19 in rural and tribal areas. Methods: This was a retrospective chart review of the patients admitted in a 20-bedded COVID-19 intensive care unit (ICU) set up at the Government District Hospital, Ambikapur, Chhattisgarh, between 17 May and 17 July 2021 during the second wave of COVID-19 in India. The ICU was managed by a team of primary care providers, family physicians, and nurses under the supervision of three specialists. Data related to socio-demographic, clinical, laboratory, and treatment profiles were extracted using a data extraction tool and analysed. Results: A total of 55 of the 63 (87.3%) patients admitted in the ICU during the study period were eligible for the study. The mean age of the patients was 50.95 [standard deviation (SD) 15.76] years; 66% were < 60 years of age, and 63.6% were men. The mean duration of symptoms before ICU admission was 7.52 (SD 4.16) days. Breathlessness (63.6%), fever (58.2%), cough (52.7%), and altered sensorium (38.2%) were the most common presenting symptoms. 67% of the patients had any co-morbidity, and 43% had two or more co-morbidities. 32.7% patients needed non-invasive (14 out of 55) or invasive ventilation (4 out of 55). 12.7% of the patients (7 out of 55) needed dialysis. The intra-ICU mortality was 47%. Patients who died had higher prevalence of heart disease, hypoxia, and altered sensorium. Conclusion: Our study highlights the need for critical care services in Government District Hospitals in India and the feasibility of providing such care by primary care providers through specialist mentoring.

Facilitating the Urgent Public Health Need to Improve Data Sharing With Tribal Epidemiology Centers.

Tribal epidemiology centers (TECs) are an essential and unique part of the public health system and an important part of federal efforts to improve the health status of American Indian and Alaska Native people. Pursuant to federal statute, TECs serve the 574 federally recognized tribes (hereinafter, "tribes") and their members across the United States, as well as American Indian and Alaska Native people in general. The COVID-19 pandemic has highlighted the need for timely, complete, and accurate public health data, particularly for American Indian and Alaska Native communities and others who may have been disproportionately impacted by COVID-19. This article reviews the history and importance of TECs and federal statutes governing TECs' ability to access and use protected health information for public health purposes. TECs and tribes often encounter difficulty receiving public health data from state and federal agencies despite their designation as "public health authorities" under the Health Insurance Portability and Accountability Act and associated regulations. Limited access to this information hinders the statutory mission of TECs as well as tribal monitoring of and response to public health threats such as SARS-CoV-2. Agency acknowledgment and compliance with current federal law regarding data sharing with TECs are essential to improve data access and the fragile public health of tribal communities.

"When people see me, they know me; they trust what I say": characterizing the role of trusted sources for smoke risk communication in the Okanogan River Airshed Emphasis Area.

INTRODUCTION: As wildfire smoke events increase in intensity and frequency in the Pacific Northwest, there is a growing need for effective communication on the health risks of smoke exposure. Delivery through a trusted source or intermediary has been shown to improve reception of risk communication messages. This is especially salient in rural and tribal communities who may be hesitant to trust information from state and federal agency sources. This study aims to identify and characterize trusted sources for smoke risk information in the Okanogan River Airshed Emphasis Area (ORAEA), a rural region of North Central Washington state that is heavily impacted by smoke from wildfires and prescribed fire. METHODS: The research team conducted a qualitative study using data collected through key informant interviews and focus groups to assess the role of various sources and intermediaries in disseminating smoke risk information. We used a consensual coding approach in NVivo Qualitative Analysis Software to sort data into preliminary categories, which were grouped into themes using a thematic analysis approach. We used member checking and iterative feedback processes with local project partners throughout the project to ensure credibility of results. RESULTS: Through the analysis, we identified three themes characterizing trusted sources for smoke risk communication in the ORAEA. These themes were: (1) local and tribal sources of information are perceived as more trustworthy than state and federal government sources, (2) trustworthiness is determined by an evaluation of multiple factors, in particular, perceived credibility, quality of information, and relationship with the source, and (3) conservative political ideology and perceived parallels with COVID-19 communication influence perception of trust. Within each theme, we identified several sub-themes, which contributed additional nuance to our analysis. CONCLUSION: This study provides insights into which sources of information are trusted by rural and tribal community members in the ORAEA and why. Results from our study emphasize the importance of relationships and collaboration with local and tribal partners in smoke risk communication. In this paper, we discuss implications for state and federal agency practitioners and present recommendations for how to work with local and tribal partners on smoke risk communication.

COVID-19 and Street Vending in Tribal Areas: A Qualitative Analysis From Ground Zero—Aizawl, Mizoram, Northeast India

This study explores the impact of the COVID-19-induced economic crisis on tribal street vendors in Aizawl, India, using the framework of resilience theory. The paper uses a case-study approach to examine how street vendors recouped their economic losses after the relaxed lockdown phase during the region's most celebrated Christmas and New Year festivals. A total of 74 street vendors were interviewed for this study using a semi-structured questionnaire. The study discusses that despite the relaxation of lockdowns, vendors faced extreme challenges in earning their daily wages, causing an inability to satisfy basic requirements like food, paying rent, and experiencing harsher workplace conditions. We observe that street vendors had heterogeneous motives toward street vending and were not driven by a single theoretical perspective. We present that most street vendors during the lockdowns reflect resilience in their businesses, socioeconomic, and workplace conditions through their indigenous coping mechanisms and social networking. We find that street vendors displayed entrepreneurial qualities during the lockdowns by either changing the goods they sold or how they were sold before the pandemic. The study recommends different economic and financial policies for street vendors at the ground level such as improving basic workplace amenities, safety, and awareness among street vendors and consumers. [ FROM AUTHOR]

Serological survey for SARS-CoV-2 antibodies among tribal communities of Odisha post-second wave.

Background & objectives: Serial national level serosurveys in India have provided valuable information regarding the spread of COVID-19 pandemic in the general population, but the impact of the ongoing pandemic on the tribal population in India is not well understood. In this study, we evaluated the seroprevalence of COVID-19 antibodies in the tribal population of Odisha post-second wave (September 2021). Methods: A population-based, age-stratified, cross-sectional study design was adopted for the survey, carried out in seven tribal districts of Odisha from 30th August to 16th September 2021. A multistage random sampling method was used where serum samples were tested for antibodies against the SARS-CoV-2 nucleocapsid (N) protein in each district, and a weighted seroprevalence with 95 per cent confidence interval (CI) was estimated for each district. Results: A total of 2855 study participants were included from the seven tribal districts of Odisha in the final analysis. The overall weighted seroprevalence was 72.8 per cent (95% CI: 70.1-75.3). Serological prevalence was the highest among 18-44 yr (74.4%, 95% CI: 71.3-77.3) and from Sambalpur district [75.90% (66.90-83.10)]. Among participants, 41.93 per cent had received at least one dose of any COVID-19 vaccine. Kandhamal district had the highest number of fully immunized participants (24.78%), and in Sundergarh district, most of the study participants (58.1%) were unimmunized. Interpretation & conclusions: This study found high seroprevalence against SARS-CoV-2 in the tribal population of Odisha. The vaccination coverage is at par with the general population, and efforts to address some knowledge gaps may be needed to improve the coverage in the future.

Trend in seroprevalence of SARS-CoV-2 (IgG antibody) among tribal-dominated population: Findings from Jharkhand, India.

Background & objectives: Serosurvey of COVID-19 provides a better estimation of people who have developed antibodies against the infection. Undertaking such a serosurvey in certain districts of India which are densely populated with prominent tribes can provide valuable information regarding seropravelance of SARS-CoV-2 antibodies among such indigenous populations. In this context, two rounds of population-based, cross-sectional serosurveys for SARS-CoV-2 IgG antibody were carried out in Jharkhand, a tribal-dominated State of India, to compare the seroprevalence of SARS-CoV-2 infection and to determine the associated demographic risk factors. Methods: The surveys were carried out in June 2020 and February 2021 in ten districts of the State of Jharkhand. Blood samples were collected from the residents of the selected districts by random sampling and tested for anti-SARS-CoV-2 antibodies using an automated chemiluminescence immunoassay platform. A total of 4761 and 3855 eligible participants were included in round 1 and round 2, respectively. Results: The age- and gender-standardized seroprevalence for COVID-19 during round 1 was 0.54 per cent (0.36-0.80) that increased to 41.69 per cent (40.16-43.22) during round 2 with a gap of eight months in between. The seropositivity among male and female participants was 0.73 and 0.45 per cent, respectively, during the first round and 51.35 and 33.70 per cent, respectively, during the second round. During the first round, 17.37 per cent of the participants were tribal with seropositivity of 0.24 per cent (0.02-0.87), and during the second round, 21.14 per cent were tribal with seropositivity of 39.14 per cent (35.77-42.59). Compared to tribal group, non-tribal participants had an adjusted odds of 1.24 (95% confidence interval=1.04-1.48) for SARS-CoV-2 seropositivity. Interpretation & conclusions: COVID-19 seroprevalence was found to be low during the first round (0.54%) of the survey, possibly due to the travel restrictions during lockdown better adherence to social distancing and wearing of face masks among the people. Understanding the dynamics of SARS-CoV-2 transmission and the susceptibility to infection at the individual as well as community level will inform decision and help policy makers to design and implement effective public health strategies to mitigate the pandemic in this State.

Caring Texts, a strength-based, suicide prevention trial in 5 native communities: Research design and methods.

BACKGROUND: Despite their intrinsic strengths and resilience, some American Indian and Alaska Native (AI/AN) communities experience among the highest rates of suicide of any racial and ethnic group. Caring Contacts is one of the only interventions shown to reduce suicide in clinical trials, but it has not been tested in AI/AN settings. OBJECTIVE: To compare the effectiveness of Enhanced Usual Care (control) to Enhanced Usual Care augmented with a culturally adapted version of Caring Contacts (intervention) for reducing suicidal ideation, suicide attempts, and suicide-related hospitalizations. METHODS: We are implementing a single blind randomized controlled trial of Caring Contacts in five AI/AN communities across the country (South Dakota, Montana, Oklahoma, and Alaska). Eligible participants have to be (1) actively suicidal or have made a suicide attempt within the past year; (2) at least 18 years of age; (3) AI/AN; (4) able to speak and read English; (5) able to participate voluntarily; (6) willing to be contacted by text, email or postal mail; and (7) able to provide consent. Following consent and baseline assessment, participants are randomized to receive either Enhanced Usual Care alone, or Enhanced Usual Care with 12 months (25 messages) of culturally adapted Caring Contacts. Follow-up assessments are conducted at 12 and 18 months. CONCLUSIONS: If effective, this study of Caring Contacts will inform programs to reduce suicide in the study communities as well as inform future research on Caring Contacts in other tribal settings. Modifications to continue the trial during the COVID-19 pandemic are discussed. CLINICAL TRIALS REGISTRATION: NCT02825771.

A Native American Perspective on Sustainable and Resilient Infrastructure in Southern California

Although the needs for sustainable urban infrastructure systems are increasingly being recognized and addressed, the same is not true for Native American communities, where existence, condition, and access to a collection of infrastructure systems is often lagging behind urban and non-native communities. To date, there has been a quite limited number of studies exploring Native American perspectives on infrastructure challenges and how to build sustainable and resilient infrastructure systems in their communities. Thus, the purpose of this study is to identify the challenges and opportunities for building sustainable infrastructure systems for Native American communities in Southern California and investigate how those communities experience, understand, and apply engineering practice in the context of their community and culture. Drawing from six group interviews, our study highlights challenges and opportunities for building sustainable and resilient infrastructure systems on tribal reservations in San Diego County, California, from the perspectives offered by Native Americans themselves. We focus on infrastructure systems fundamental to well-being: built environment, water/wastewater, telecommunications, transportation, energy, human capital, and education. Our research participants emphasized the importance of their cultures, sovereignty, and care for the welfare of their communities in innovating sustainable and resilient infrastructure. To accomplish this, a key priority should be to train native engineers, who are best positioned to understand the infrastructure needs and opportunities in their own communities.

Whose Concerns? It's Time to Adjust the Lens of Research on Police-Involved Overdose Response

(p. 1326) creatively use body-worn camera footage- a previously unused data source-to support the following findings of previous research: (1) police can administer naloxone during an overdose, (2) combativeness toward first responders by overdose survivors is rare, (3) drug exposure is nota risk to police officers, and (4) arrests do occur at the scene of overdose emergencies as the result of police presence.1,2 Although we recognize this article's contribution to the growing literature on law enforcement involvement in overdose response, we would caution policymakers about using the findings of this study to bolster (or worse, solely rely on) the role of police in overdose response. White et al. document that arrest- of both overdose victims and other bystanders-does indeed occur. [...]their conclusion that concerns about police-administered naloxone are "overstated" is dismissive of the most problematic and disruptive concern examined in the study. The disproportionate risk of violence at the hands of police is a powerful deterrent to inviting law enforcement interaction (specifically by calling 911)-one that cannot be resolved by the limited protections provided by most 911 Good Samaritan laws.10 Furthermore, druginduced homicide investigations not only directly undermine the protective mechanisms of 911 Good Samaritan laws5 but are also disproportionately used against non-White persons-and almost exclusively in response to the preventable overdose deaths of White persons.11 Disproportionate policing, police violence, and incarceration of Black and Indigenous persons affect these groups' access to overdose prevention interventions, broadly, and to naloxone, specifically, especially in cases when the nearest available naloxone rests in the hands of police. Black and Indigenous people have the highest fatal overdose rates and are least served by resource allocations that further support police involvement in overdose response. [...]methodologically sound and Black and Indigenous PWUD-informed research indicates otherwise, policymakers and resource allocation decision-makers should consider any life-saving gains via police-involved overdose response to be disproportionately unavailable and inaccessible to Black and Indigenous people.

Respectful Tribal Partnership: What Philanthropy Can Learn From the Navajo Nation’s Collaborative Response to the COVID-19 Crisis

The gravity of the COVID-19 pandemic and its disparately harsh impact on Indigenous peoples, including the stark reality of a historical lack of access to essential services and health care, are now well known. COVID-19 death rates, aggregated through May 4, 2022, and normalized by population, show there have been far more Native American than white American deaths: 454 per 100,000 versus 327 per 100,000, respectively (APM Research Lab, 2022). © 2022. Foundation Review.All Rights Reserved