Health Education and Chronic Disease

Health Education and Chronic Disease

REACH – Journey to Wellness

REACH – Racial and Ethnic Approaches to Community Health is part of the U.S. Department of Health and Human Services initiative to support public health efforts to reduce chronic diseases, promote healthier lifestyles, reduce health disparities, and control health care spending.

The ITCM’s REACH Journey to Wellness Project is a three year initiative and is focused on cardiovascular disease prevention in seven Tribal Agencies:  The Saginaw Chippewa Indian Tribe, the Nottawaseppi Band of Huron Potawatomi, the Little Traverse Bay Bands of Odawa and Chippewa Indians, the Keweenaw Bay Indian Community, the Hannahville Indian Community, the Bay Mills Indian Community and the American Indian Health and Family Services Agency in Detroit.

Goal: To improve the health and quality of life for Native Americans in Michigan who suffer from exceedingly high rates of morbidity and mortality.

Objectives:   1) Increase access to prevention, risk reduction and chronic disease management opportunities, 2) Increase access to environments with healthy food or beverage options, 3) Increase access to physical activity opportunities, and 4) Increase access to tobacco-free and smoke-free environments

Overview:  The Journey to Wellness project builds upon work started through the Healthy Native People Coalition which encompasses all Native American Tribes in Michigan along with sub-sets of local coalitions within each Tribe.  Each Tribal coalition includes representatives from tribal health clinics, tribal human resources, tribal elder’s center, tribal schools, tribal casinos, tribal work sites, and tribal community members.    The Healthy Native People Coalition also includes collaborations with multiple partners at the State and Federal level.

The Journey to Wellness Project provides each participating tribe with a sub-contract to support one full time Tribal REACH Coordinator.   These seven coordinators follow the Journey to Wellness Project  Logic Model in order to implement locally tailored community action plans (CAPs).  The culturally appropriate CAPS emphasize evidence-based policy, systems, and environmental changes designed to address four risk factors for chronic disease: physical inactivity, poor nutrition, commercial tobacco use, and lack of quality of care.


Tribe to Tribe Walking Challenge







New and Improved Nutrition Facts Label

Angie Johnston

Billi Jo Head

Brianne Kraii

Brandon Schultz

Chantel Henry

Elizabeth Mayo

Mary Dee Shanahan

Health Education and Chronic Disease Staff

PTP_0494 Mike Willette
Noel Pingatore, Department Director Mike Willette, Communications Specialist
Cathy Edgerly, REACH Program Manager Joshua Hudson, Program Manager
Josh Mayo, Public Health Specialist Chris Sams, Administrative Support Specialist

Tobacco Screening Policy

Commercial tobacco use is a well known problem among Native American communities in Michigan. To help address this issue the Inter-Tribal Council of Michigan has worked to help address this problem in a number of ways including addressing tribal clinical policies.

Please see the following resources to learn more about efforts of work done at the clinical policy level in tribal sites in Michigan. These resources cover policy, signage, youth screening, using the CHANGE tool and communication campaigns.

Tobacco Screening Policy Resources


The American Indian Commercial Tobacco Program

The American Indian Commercial Tobacco Program (AICTP) is LIVE and ready to use!

Call today to receive free, culturally-tailored help, including:

  • Up to 10 coaching calls per quit attempt with a dedicated Native coach.
  • 8 weeks of nicotine replacement therapy with combination medication as an option.
  • Focus on commercial tobacco use.
  • Open to men, women, and elders of all ages and tribal nations.
  • AICTP Website:

For our future generations, call today!


Sereina:  11:00 A.M. – 7:30 P.M. Tuesday – Saturday

Kim:  12:30 P.M. – 9:00 P.M. Sunday – Thursday


Can I call if I am pregnant? Yes

Can youth under 18 call the quitline? Yes

Can I call for help with smokeless tobacco?  Yes

Learn more about commercial and traditional tobacco:

Breast and Cervical Cancer Control Support Program

Inter-Tribal Council of Michigan, Inc. Institutional #671
Health Education and Chronic Disease Department
Breast and Cervical Cancer Outreach and Education

Statement of Work


A. To support and enhance working partnerships between local health departments and twelve federally recognized Michigan tribes.

Coordinate meetings between local tribal health directors/staff and LCA BCCCP Coordinators

Facilitate discussion and implementation of collaborative activities and services.

Support local tribal participation in BCCCP and women’s health coalitions, including local and state wide meetings.

B. To assist twelve federally recognized tribes and local coordinating agencies in establishing effective outreach and recruitment strategies to promote access to breast and cervical cancer screening follow up services for Native American women.

Coordinate meetings with tribal BCCCP staff for the purpose of providing technical assistance in the development of specific outreach and recruitment activities.

Facilitate and support the development and use of strategies to promote and secure follow up services for tribal women.

C. To build capacity within twelve federally recognized tribes to support and provide direct BCCCP service and effective outreach and recruitment activities through training and education.

Coordinate an annual statewide training and education session for tribal staff focusing on education and skill development.

Facilitate opportunities for collaboration and sharing of successful outreach and recruitment activities targeting Native American women among the tribal staff.

Develop and provide effective and appropriate educational materials and resources to the tribes.

Get screened today!  Click here to find your local tribal health center.

Digital Stories


Cancer Prevention and Control

Native Navigators and the Cancer Continuum

The NNACC Project provides two Navigators – Amanda Leonard at Sault Tribe and Leah Markel at Saginaw Chippewa Indian Tribe. The Navigators provide 12 – 2 hour cancer education sessions to selected community groups, i.e. elders, parents. The intent is that by increasing knowledge on the cancer continuum – prevention, detection, diagnosis, treatment, survivorship we’ll see improved health behaviors and screenings among the target population.

The Navigators use an Audience Responses System (ARS) during each of their education sessions.  This allows us to gather pre and post knowledge scores as well as demographics and track our progress. Individual session reports and entered into an online evaluation system and analyzed by Native American Cancer Research, along with other partnering agencies across the country.   We see average increases in knowledge at about 35 to 75%, given the topic area.

Noel Pingatore

Brief Summary of Tribe-Registry Cancer Data Linkages

The Problem

  1. American Indian communities and Tribes do not have adequate cancer statistics to plan appropriately & allocate cancer prevention, screening, or treatment funds where they are most needed. Tribes need Tribe-specific cancer incidence data, not statewide or regional data.
  2. Cancer registries around the nation realize that their cancer statistics for American Indians under-estimate the burden of cancer in these communities. This is because American Indian individuals with cancer are reported as white by their doctors.

One Solution

Data linkages aim to identify two records in two datasets that represent the same person. A data linkage between the state cancer registry and a Tribe’s enrollment roster looks for records in both files that are the same person; in short, we identify all Tribal members who are diagnosed with cancer in the state. This information is used to provide the Tribe with Tribe-specific cancer statistics and to correct the state’s cancer registry so that American Indian individuals are counted.

The Process

The IHS and the CDC worked together to create a free software program (Registry PlusTM Link Plus) to conduct these linkages. Ideally, the Tribe would have the following information on their members in electronic form: Social Security Number; Date of Birth; First, Last, & Middle Name; Sex; and Street Address. We can conduct the linkage on the Tribe’s computer, accessing the registry’s dataset from an external hard drive. Once this is done, a team of State and Tribe staff to go over all the possible matches to make sure they make sense. Next, we pull cancer information for all individuals who linked and then delete all the identified fields (all those fields listed above, except sex), producing a de-identified Tribe-specific dataset that includes cancer site, stage at diagnosis, histology, laterality, age at diagnosis, and year of diagnosis for all tribe members diagnosed from 1985-2005 in the state.

All in, this process takes about 2 full days. From there, we can do statistical analyses on the de-identified dataset using SAS or SPSS. To some degree, we are limited by the size of the dataset – i.e. of only 3 people have stomach cancer from 1985-2005, we can’t calculate a very good incidence estimate for stomach cancer. Once we see how many links there are, we can discuss what statistics would be informative. At the very least, we should be able to calculate annual cancer incidence for the tribe and compare that rate to the all-races rate forMichigan and the Nation. This is useful for cancer planning and for grant applications for funding of cancer programs.

Family Health History Education

The American Cancer Society provided funding to develop and implement culturally specific Family Health History Materials.

Family History of cancer is a risk factor for many Native Americans in Michigan.

Tracking and sharing your health history with your health care provider is important to assess the need for early or more frequent screening.

Native American Family Health History Project

Health Education and Chronic Disease Department FY 2012

Cardiovascular Health and Diabetes

The ITCM’s past REACH US project was a national, multilevel program that served as the cornerstone of the CDC’s efforts to eliminate racial and ethnic disparities in health. The ITCM’s REACH US program worked with three Tribes over five years in order for each diverse community to design, implement, and evaluate community-driven strategies to eliminate health disparities related to cardiovascular disease and diabetes mellitus.

Bay Mills Indian Community REACH US – Success Story

Hannahville Indian Community REACH US Success Story

Saginaw Chippewa Indian Community REACH US Success Story

For more information about the ITCM REACH project, please contact REACH Program Manager, Cathy Edgerly at (906) 632-6896 ext. 111 or

 ITCM Tribal 4 X 4 Program

Goal:  The ITCM 4 X 4 Program is funded through the Michigan Department of Community Health in order to create a Tribal Coalition which works to encourage 4 healthy behaviors: (1) Take part in a healthy diet, (2) Engage in regular exercise, (3) Avoid all commercial tobacco use, and (4) Take part in an annual clinical exam which includes these 4 clinical measures: Body Mass Index, Blood Glucose, Blood Pressure, and Cholesterol.  All 12 Federally Recognized Tribes along with the American Indian Health and Family Services Agency participate.

Objectives:  Each Tribe selects from a menu of objectives which include: 1) Promote the MI Healthier Tomorrow 4 x 4 media message and Take the Pledge to Lose 10%; 2) Adopt system guidelines/to screen all adults for Body Mass Index, Glucose, Cholesterol, and Blood Pressure; 3) Improve Healthy Work Environments; and 4) Increase healthier food choices and encouraging physical activity in tribal venues.

The project will create increased opportunities for improved nutrition and physical activity, resulting in reduced obesity rates and associated chronic disease.


SEMA Project

FY 2012 objectives are aimed at:

  • Increasing Smoke Free Policies among Michigan Tribal Communities; including assessment education and awareness to protect people from the dangers of secondhand smoke
  • Adapting Prenatal Quit Line materials and promotions to be culturally appropriate and effective
  • Educating State Representatives and Tribal Leaders on Commercial Tobacco
  • Provide technical assistance and training to Tribal Health Educators specific to commercial tobacco use prevention and control

Tribal Tobacco Control Programs to Reduce Commercial Tobacco use Among American Indians and Alaska Natives

CDC/OSH: Five Year Grant  9/30/10-9/29/15

SEMA: Strengthening and Educating Michigan’s Anishinabe

The long-term program goal is to reduce disparities in morbidity and mortality related to commercial tobacco abuse and exposure among American Indian people in Michigan.

SEMA Project will utilize funding from the CDC to implement and evaluate evidence-based strategies and interventions in seven federally recognized tribal communities in Michigan.

Proposal will target 4 of the CDC’s MPOWER framework strategies.  The MPOWER framework is a package of six tobacco-control strategies to reduce and reverse tobacco-related disease and death.  ITCM will work on the following strategies:

  1. Monitor commercial tobacco use and prevention policies
  2. Protect people from secondhand smoke
  3. Offer help to quit commercial tobacco use
  4. Warn about dangers of commercial tobacco

Project Outcomes:

  1. Increase the proportion of tribal leaders and members participating in local tribal tobacco coalitions within the funded tribal communities.
  2. Increase the proportion of tribes in Michigan implementing and enforcing comprehensive smoke-free policies in workplaces, public places, bars and restaurants.
  3. Increase the number of tribes in Michigan with access to representative, tribal-specific surveillance data for commercial tobacco use and exposure.
  4. Increase the number of sustainable tribal tobacco control programs in Michigan by seven.
  5. Creating, implementing, and sustaining tobacco surveillance and evaluation strategies through the AI ATS (American Indian Adult Tobacco Survey) and the CHANGE (Community Health Assessment and Group Evaluation) Tool.
  6. Providing funding for tribes to develop tribal coalitions to raise awareness and provide education within each respective tribal community related to the 4 MPOWER strategies listed.
  7. Creating a surveillance and evaluation system for Tribes using clinic data from the IHS RPMS, tribal AI ATS, CHANGE tool assessment, and recording of tobacco coalition activities.
  8. Provide training, technical assistance, and materials with culturally appropriate messages and imagery to all 12 tribes in Michigan for local population focused educational activities designed to increase awareness of the dangers of commercial tobacco use and exposure.

At the end of the five year grant those involved in the SEMA Project will have received the assistance and guidance to continue sustaining the tribal tobacco coalition and continue providing education and raising awareness of the dangers of commercial tobacco use.

Anishinaabe Smoking Cessation


Anishinaabe Smoking Cessation Curriculum



UP Breast Health Coalition Project

Time Frame: October 1, 2013 to September 30, 2018
Includes: Sault Ste. Marie Tribe of Chippewa Indians, Bay Mills Indian Community, Keweenaw Bay Indian Community and the Hannahville Indian Community

Using the Learning Collaborative Model, Year One focuses on capacity building and training; In years two and three, the Sault Tribe and Keweenaw Bay will implement Breast Health QI projects; In years four and five the Bay Mills and Hannahville Indian Communities will implement Breast Health QI projects.

Project Abstract Summary

The Inter-Tribal Council of Michigan’s Upper Peninsula Tribal Breast Health Project will focus on Priority Area 1 – Tribal Public Health Capacity Building and Quality Improvement. This project will utilize a Learning Collaborative Model to implement Quality Improvement projects which will integrate evidence-based population interventions into the tribal public health system within four federally-recognized tribes in Michigan’s rural Upper Peninsula.
Tribal capacity building needs will be addressed through the implementation of Quality Improvement projects designed to: 1) increase breast health screening rates among the women in the targeted population ages 40 to 49 by 20%; and 2) decrease the time span between breast cancer screening, diagnosis, and treatment for women within the target population. The accomplishment of these objectives will lead to improved health outcomes and lower rates of morbidity and mortality due to breast cancer for AI women.

Training Materials and Resources:


Focused Conversation Demonstration_FINAL

Focused Conversation Worksheet

ITCM Tribal QI 3 26 14_FINAL

ITCM Tribal QI 3 27 14_FINAL

Sample Focused Conversation Questions Handout_FINAL

The Focused Conversation Method Handout1_FINAL

Tribal QI Training Scenario March 2014

Typical QI Team Member Roles_FINAL

Embracing Quality in Public Health: A Practitioner’s Quality Improvement Guidebook

Public Health Quality Improvement Exchange (PHQIX)