risk reduction". strengthening the diabetes data infrastructure is an effort to attain a greater base of health information, specifically for the ihs electronic health record. in addition to the special diabetes program for native americans, the ihs combats diabetes with model diabetes programs and the integrated diabetes education recognition program. there are 19 model diabetes programs which work to "develop effective approaches to diabetes care, provide diabetes education, and translate and develop new approaches to diabetes control". the integrated diabetes education recognition program is an ihs program that works towards high-quality diabetes education programs by utilizing a three-staged accreditation scale. native american programs in healthcare facilities can receive accreditation and guidance to effectively educate the community concerning diabetes self-management. tribal programs many tribes themselves have begun programs to address the diabetes epidemic, which can be specifically designed to address the concerns of the specific tribe. the te-moak tribe of western shoshone have created their diabetes program. with this program, they hope to promote healthy lifestyles with exercise and modified eating and behavior. the means of achieving these ends including "a walking club, 5 a day fruits and vegetable, nutrition teaching, exercise focusing, 28 day to diabetes control, and children's cookbook". additionally, the te-moak tribe has constructed facilities to promote healthy lifestyles, such as a center to house the diabetes program and a park with a playground to promote active living. the meskwaki tribe of the mississippi has also formed diabetes program to provide for the tribe's people. the meskwaki tribe facilitates their program to eliminate diabetes as a health concern through prevention and control of complications. the program has a team mentality, as community, education and clinical services are all involved as well as community organizations and members. there are many facets of this diabetes program, which include the distribution of diabetes information. this is achieved through bi-weekly articles in the meskwaki times educating the population about diabetes prevention and happenings in the program and additional educational materials available about diabetes topics. other educational is spread through nutrition and diabetes classes, such as the diabetes prevention intensive lifestyle curriculum classes, and events like health fairs and walks. medical care is also available. this includes bi-weekly diabetes clinics, screenings for diabetes and related health concerns and basic supplied. hiv-aids programs official seal of the national native hiv/aids awareness day multiple programs exist to address the hiv and aids concerns for native americans. within the indian health service, an hiv/aids principal consultant heads an hiv/aids program. this program involves many different areas to address "treatment, prevention, policy, advocacy, monitoring, evaluation, and research". they work through many social outputs to prevent the masses from the epidemic and enlist the help of many facilities to spread this message. the indian health service also works with minority aids initiative to use funding to establish aids projects. this funding has been used to create testing, chronic care, and quality care initiatives as well as training and camps. the minority aids initiative operates through the ryan white hiv/aids program, under the public health service act. this is in recognition of the disproportionate impact of hiv/aids on racial and ethnic minorities. there has also been a national native hiv/aids awareness day held on march 20 for native americans, alaska natives, and native hawaiians, with 2009 marking its third year. this day is held to: encourage native people to get educated and to learn more about hiv/aids and its impact in their community; work together to encourage testing options and hiv counseling in native communities; and help decrease the stigma associated with hiv/aids. this day takes place across the united states with many groups working in coordination, groups like the cdc and the national native capacity building assistance network. by putting out press releases, displaying posters, and holding community events, these groups hope to raise awareness of the hiv/aids epidemic. heart disease and stroke programs the centers for disease control and prevention contain a division for heart disease and stroke prevention, which collects data and specifically releases information to form policy for native americans. they have identified many areas in which lifestyles of native americans need to be changed in order to greatly decrease the prevalence of heart disease and stroke. one major concern to prevent is diabetes, which directly relates to the presence of heart disease. many general health concerns also need to be addressed, according to the cdc's observations, including moderating alcohol use, eliminating tobacco use, maintaining health body weight, regularizing physical activity, diet, and nutrition, preventing and controlling high blood cholesterol, and preventing and controlling high blood pressure. the indian health service works in collaboration with the university of arizona college of medicine to maintain the native american cardiology program. this is a program that acknowledges the changes in lifestyle and economics in the recent past which have ultimately increased the prevalence of heart attacks, coronary disease, and cardiac deaths. the native american cardiology program prides itself in its cultural understanding, which allows it to tailor health care for its patients. the program has many bases but has placed an emphasis on providing care to remote, rural areas in order for more people to be cared for. the native american cardiology program's telemedicine component allows for health care to be made more accessible to native americans. this includes interpreting medical tests, offering specialist input and providing triage over the phone. the native american cardiology program also has educational programs, such as lectures on cardiovascular disease and its impact, and outreach programs. samhsa's office of tribal affairs and policy the office of tribal affairs and policy (otap) serves as primary point of contact between the substance abuse and mental health services administration (samhsa) and tribal governments, tribal organizations, and federal agencies on behavioral health issues that impact tribal communities. otap supports samhsa's efforts to implement the tribal law and order act (tloa) of 2010 and the national tribal behavioral health agenda. the office of indian alcohol and substance abuse (oiasa), an organizational component of otap, coordinates federal partners and provides tribes with technical assistance and resources to develop and enhance prevention and treatment programs for substance use disorders, including alcohol. indian health services the alcohol and substance abuse program (asap) is a program for american indian and alaska native individuals to reduce the incidence and prevalence of alcohol and substance use disorders. these programs are administered in tribal communities, including emergency, inpatient and outpatient treatment and rehabilitation services for individuals covered under indian health services. it addresses and treats alcohol use disorder from a disease model perspective. tribal action plan the indian alcohol and substance abuse prevention and treatment act of 1986 was updated in 2010 to make requirements that the office of indian alcohol and substance abuse (oiasa), a subdivision of samhsa, is to work with federal agencies to assist native american communities in developing a tribal action plan (tap). the tap coordinates resources and funding required to help mitigate levels of alcohol and substance abuse among the native american population, as specified in the indian alcohol and substance abuse memorandum of agreement of august 2011, and executed by oiasa.