Health Outcomes & Population Research

The Center for Health Outcomes and Population Research (CHOPR) specializes in population, translational, prevention, and clinical research, as well as in the design and methodology surrounding such studies. We have three branches located in Sioux Falls, Pine Ridge, and Rapid City, SD. Our primary research involves many different areas including infant mortality, childhood obesity, fetal alcohol spectrum disorders, childhood bullying, and teen pregnancy prevention. Our faculty have a broad range of expertise, specializing in public health, medicine, psychology, reproductive endocrinology, pediatrics, epidemiology, nutrition, and biostatistics. A number of our research studies involve engagement and partnerships with American Indian communities and community-based organizations. As a center, we are committed to improving health through education and research in prevention and health outcomes in our local communities and the population at large.

There is an Evaluation Core where staff are available to advise and manage evaluation requirements for research and service projects. This includes conducting process and outcome evaluations via qualitative and quantitative methods. There is a Sanford Data Collaborative which looks to provide leading researchers with the opportunity to access real-life, timely healthcare data. This includes partnerships with academic institutions across the region, who are anxious to collaborate with Sanford in this way.


Collaborative Research Center for American Indian Health

The Collaborative Research Center for American Indian Health (CRCAIH) is designed to create a platform to bring together Tribal communities and health researchers, from multiple disciplines, to work together in the development of cutting-edge transdisciplinary research that will address the significant health disparities experienced by American Indians in South Dakota, North Dakota and Minnesota. All projects within the CRCAIH will embrace a “social determinants of health” theme. This theme was selected because of the needs of the region, the immediate applicability of many social determinants of health to public health intervention programming, and the existing strengths within the consortium of partners.

Project Descriptions

Childhood Cancer Etiology

  • Generational analysis of genetics in AML (GAGE-AML study): This study will assess the impact of maternal genetic variation on the development of childhood AML. We hypothesize that genes affecting the gestational milieu may influence the development of cancer. Childhood AML in particular has been linked to risk factors such as maternal alcohol use and birth weight that may have strong maternal genetic components. (Puumala-PI, funded through NIGMS as a pilot study for P2OGM103548 “Center for Cancer Biology Research” (Miskimins-PI)
Conquering Chronic Disease
Over half of all Americans have been diagnosed with a chronic or long-lasting disease. This can affect anyone, even an Olympic champion like Billy Mills. Learn more about his journey here.

Collaborative Research Center for American Indian Health

  • The Collaborative Research Center for American Indian Health (CRCAIH) was formed in September 2012 up on receipt of a grant from the National Institute for Minority Health and Health Disparities. This five-year grant creates a communication and infrastructure platform that brings together Tribal communities and health researchers, from multiple disciplines, to work in the development of cutting-edge transdisciplinary research that will address the significant health disparities experienced by American Indians in South Dakota, North Dakota and Minnesota. A central component of CRCAIH is the Community Engagement and Innovation Division. This division works directly with tribally-employed community liaisons to develop each tribe’s research infrastructure according to specifications and requirements set forth by each Tribal nation.

    The CRCAIH is a transdisciplinary center that embraces a “social determinants of health” theme and serves to advance research through three research projects in pediatric asthma self-management, kidney transplant donation education, and emergency room utilization. In conjunction, the Center offers pilot grants and other resources/curriculum or education in research culture/bioethics, regulation and methodology. These studies, along with the pilot projects, will serve as models and demonstrations of the high quality research that is possible through the partnerships of the CRCAIH. The CRCAIH was created through the vision and collective expertise of numerous partners. Collaborators on the grant include: Cheyenne River Sioux Tribe, Oglala Sioux Tribe (Pine Ridge), South Dakota State University, University of South Dakota, University of North Dakota, North Dakota State University, Turtle Mountain Community College, Missouri Breaks Industries Research, Medicine Wheel Inc., Rapid City Regional, Children’s Hospitals and Clinics of Minnesota and KAT Communications. (Elliott – PI – funded by NIMHD)

Diabetes and Obesity Prevention

  • Sanford has been involved in a series of community needs assessment and health promotion activities related to health promotion and prevention of childhood obesity. Using a community-based participatory research model, where communities are involved in each step of the development, implementation and analysis of projects, three Tribal communities completed needs assessments involving 90 participants. The health promotion and prevention activities included separate interventions with two tribal partners and included 93 children plus parents. This model will be used with 4 additional Tribal communities in the upcoming years. (Grey Owl, PI - funded through NIMHD)
  • A project for the prevention of childhood obesity using the community-based participatory research model involving a community needs assessment and an intervention will be involved with two tribes over the next five years to implement interventions and health promotion activities to their respective communities on their reservation. This intervention project is funded by the CDC Community Transformation Grant through the SD Department of Health to the Great Plains Tribal Chairmen’s Health Board and Sanford Research (Grey Owl, Co Project Director)
  • Pilot Study: Fit-Care Curriculum’s impact on Children’s and Parent’s Health Habits: Sanford Children’s Health and Fitness Initiative and Sanford Research are partnering to conduct a year-long pilot study to measure the impact of the Fit-Care curriculum and the Fit-Care website (alone and in combination) on the health behaviors of children and their parents. (Hanson-PI, funded internally through Sanford Health)
  • Rosebud Native American Diabetes Initiative with Novo Nordisk The Sanford Research Center for Health Outcomes and Prevention Research will provide evaluation services for Novo Nordisk during the implementation of their Native American Diabetes Initiative. Novo Nordisk is partnering with the Rosebud Sioux Tribe to establish a diabetes awareness and education program, build a new wellness center, provide diabetes education to community health representatives and medical providers, and implement a mobile health unit. Sanford Research was awarded a subcontract to monitor and evaluate the process, implementation, and effectiveness of the diabetes initiative program. (Hanson/Baete, funded through Novo Nordisk)

Fetal Alcohol Spectrum Disorders

  • Fetal Alcohol Syndrome Epidemiological Research (FASER): FASER is a study of the prevalence of Fetal Alcohol Spectrum Disorders (FASD) among first graders in Sioux Falls. All public and private elementary schools in Sioux Falls are participating. Data includes growth parameters, dysmorphology evaluation, psychological testing and maternal interviews. FASER also supports ancillary studies in DNA mythelation (PI - Puumala) and microarrays. In Phase I (cohort selected by growth parameters), 1433 participants completed at least one component of the project. Wave II is currently underway and 697 participants have completed at least one component of the project (cohort selected randomly). (May/Hoyme/Elliott – Co-PI, funded by NIAAA)
  • Oglala Sioux Tribe (OST) Project CHOICES: The purpose of this project is to implement and evaluate a pilot program to prevent alcohol-exposed pregnancies (AEP) in non-pregnant American Indian women using the Project CHOICES (Changing High-risk alcohOl use and Increasing Contraception Effectiveness Study) model. This includes utilizing motivational interviewing to decrease binge drinking for women at-risk for an unintended pregnancy and/or decreasing unintended pregnancy by encouraging utilization of contraception among sexually active women. (Dillon – PI, Hanson/Elliott — Evaluators, funded through Indian Health Service)
  • Tribal Collaborations in the Prevention of Alcohol-Exposed Pregnancies: The goal of this study is to utilize a community-based participatory research approach to support partnerships with tribes in the Northern Plains who have an interest in an alcohol-exposed pregnancy (AEP) prevention program. We will implement a community needs assessment to establish effective input from the community on the importance of AEP prevention efforts; what an AEP prevention project would ideally look like; and, if desired, how to best modify current AEP prevention projects to make appropriate for individual tribal communities. Based on results from the community needs assessment, AEP prevention pilot projects, similar or identical to Project CHOICES, will be implemented. (Hanson, PI, funded through NIMHD)
  • Reliability and Validity in a Prevention Program with American Indian Women: The long-term objective of this project is to enrich an existing tribal program, the OST CHOICES Program, which aims to prevent alcohol-exposed pregnancies in non-pregnant American Indian women. The goal of the proposed study is to establish validity and reliability of the CHOICES measurements with American Indian women. This will be accomplished by: 1) establishing content validity by soliciting input on the CHOICES measures from community members and content experts; 2) further establishing validity by implementing a “think aloud” methodology with non-pregnant American Indian women; and 3) determining reliability of the CHOICES measurements by conducting a test-retest, comparing the reliability of modified CHOICES measures— based on input from SA 1 and 2—with the original CHOICES measures (Hanson, PI of pilot project, funded through NIMHD, Elliott PI).
  • WI aSBI/CHOICES Tribal Initiative: The proposed project will fill a gap in services by partnering with Wisconsin tribal clinics that are traditionally underserved in alcohol screening and brief intervention (aSBI) services. The proposed project will develop a training and technical assistance model to move partner clinics forward in the provision of aSBI services and reduce risky drinking and alcohol-related harms, including the risk of alcohol-exposed pregnancies. (Hanson, Consultant, funded through CDC)
  • Epidemiology of Substance-Exposed Pregnancies in the Bemidji Area: Via retrospective chart abstractions at the Sanford Health-North hospital in Bemidji, MN, the specific aims of this project are to 1) determine the prevalence of substance-exposed pregnancies in the Bemidji area; and 2) establish significant demographic characteristics in women who present for delivery and are subsequently given a substance use-specific code. (Hanson-PI, funded internally through Sanford Research).
  • Use of Technology to Collect Data on Risk Behaviors in College Women This collaborative research project will partner faculty in Bemidji State University with researchers at Sanford Research. The project will utilize electronic diaries to collect data on alcohol, sexual activity, and contraception in female college undergraduates. The goal of this proposed project is to determine if electronic diaries produce more consistent output for college-age women when comparing it to traditional paper diaries. In addition, educational programs and student outreach strategies will be developed. (Hanson-PI, funded through BSU Faculty Mini-Grant)
  • DNA methylation as a biomarker in fetal alcohol spectrum disorders: Blood samples will be collected from participants in the FASER study. Differences in DNA methylation will be assessed in those diagnosed with FAS and a group of controls. This study will help us determine if it may be possible to use DNA methylation as a marker of FAS. (Puumala/Wick-Co-PI., funded by T. Denny Sanford Pediatric Collaborative Research Fund)

Fetal/Infant Mortality and Morbidity

  • Safe Passage Study: In a prospective study to investigate the role of prenatal alcohol exposure in stillbirth and sudden infant death syndrome, the Northern Plains collaborates with two American Indian Tribal communities and two urban locations. In total, over 12,000 women and infant pairs from South Africa and the Northern Plains will be enrolled in this study. (Elliott – PI, funded by NICHD)
    • Validation of the Northern Plains Diet Screener: This ancillary study to the Safe Passage Study protocol is designed to determine the relative validity of the PASS Northern Plains Diet Screener to multiple 24-hour dietary recalls in pregnant American Indian women. (funded by NIAAA)
    • 3-D Imaging of Facial Characteristics in the South African PASS cohort: This ancillary study to the Safe Passage Study protocol is designed to improve understanding of the dysmorphic features in Fetal Alcohol Syndrome through collection of 3D facial imaging data and analysis of the 3D facial images using novel analytic techniques to test whether there are unique facial features in infancy that best discriminate alcohol exposed from control subjects.
  • Effects of Prenatal Environment on Brain Development: A longitudinal study in preterm infants. The project involves EEG studies in premature infants and is looking at how prenatal alcohol exposure affects brain development. The overall goal of the study is to determine early in life which exposed infants are at risk for developing cognitive defects. (Fifer/Myers – PI; Elliott – Co-PI, funded by NICHD)

Pediatric Health Disparities

  • Emergency Department Use and Care in American Indian Children: This study will assess use and care patterns of pediatric patients presenting to the emergency department. To study these patterns we will collect data from multiple sources including medical records, community engagement, and emergency room providers. Once we obtain the data, we will work on possible interventions to improve emergency room care specifically for American Indian Children. (Puumala-PI, funded through NIMHD as a component of 1U54MD008164 “Collaborative Research Center for American Indian Health” (Elliott-PI)
  • Understanding the Context of Northern Plains American Indian Teen Pregnancy: The purpose of this project is to better understand the context in which American Indian teen pregnancy occurs in the Northern Plains. Bronfenbrenner’s Ecological Framework informs the study’s methodology and analysis. The needs assessment aims to uncover social norms and unique cultural factors that which account for the high rates of teenage pregnancy in Northern Plains American Indian communities. We will also examine how factors may differ for reservation and urban youth. Using Community-Based Participatory Research methodology, we are using the data collected to develop culturally-based curricula for middle school youth. Finally, we will implement and evaluate a multisite, culturally-sensitive teen pregnancy prevention program for reservation and urban Northern Plains American Indian teens. (Kenyon, PI – funded through NIMHD)
  • STI and Teen Pregnancy Prevention Initiative: The purpose of this project is to implement an evidence-based STI/teen pregnancy prevention curriculum that also promotes adulthood preparation. A qualitative and quantitative needs assessment was implemented to help modify existing curriculum being implemented in three tribal communities in SD, NE, and IA. (Kenyon, Co-PI – funded through DHHS)

Student Training

  • Healthcare Career Day: Approximately 100-150 middle and high school students surrounding a Tribal community participate in an educational day focused on healthcare careers in partnership with a Tribal college. (Yutrzenka/Kenyon, Co-PI’s – funded through NIMHD)
  • Summer Undergraduate Research Experience: Across three summers, 24 American Indian undergraduate students have worked with research mentors at Sanford Research, USD, and the VA to receive hands on experience in public health, applied and basic science projects. (Kenyon, Program Director – funded through NIMHD)