Committee (under reference numbers T28 and SHS641) and institutional review boards (IRB) from all participating tribes and each Indian Health Service (IHS) region serving the participating tribes, including the Phoenix Area IHS IRB, Great Plains Area IHS IRB, and Oklahoma City Area IHS IRB. This study was not considered human subjects research by the University of Washington IRB because the authors exclusively used deidentified, secondary **data** from the Strong Heart Family Study and did not have access to any identifying information.