Type 2 diabetes mellitus, a disease that previously was characterized with an onset in the fourth decade of life or later, is now being diagnosed in children, particularly children from minority groups, including American Indians. Because children with the disease are frequently asymptomatic, they tend to ignore recommendations from their health care providers about appropriate self-management behaviors, thus increasing their risk for early onset of secondary complications, including retinopathy and end-stage renal disease. This problem with self-management can in part be attributed to a lack of knowledge as well as to denial about their disease. This article describes an intervention that encourages and motivates American Indian youth with type 2 diabetes to improve their diabetes self-management. The Medical Wellness Camp is a partnership program hosted by several Arizona tribes and the University of Arizona. The camp provided these youth with the education and the skills needed to prevent or delay diabetes-related complications that will negatively impact their quality of life. This camp is unique because it builds on and integrates an intertribal "cultural capital" model to help them learn how to adopt the lifestyle changes necessary to live with this chronic disease. The program emphasis is on education, not research. This position honors the wishes of tribal partners whose communities have been reluctant to involve their children in research, a reluctance fueled by reports about unethical research practices that have harmed other tribal communities.

INTRODUCTION Today slightly over half of the 1.5 million American Indians and Alaska Natives live in towns, cities, and other off-reservation communities in the United States. This migration to the urban areas has increased dramatically during the last two decades. The increase began during the 1950s and 1960s with the relocation of Indians to the cities, and was partially financed by the federal government. Indian families were encouraged to leave the reservations and migrate to the cities to obtain jobs and to avail themselves of other economic opportunities. In many instances, leaving the reservation meant also leaving behind the support of kin and access to free medical care. Once in the cities, most Indian families found themselves living in urban ghettos with few resources to cope with the new environment and its foreign institutions and rules. In time of sickness, many Indian relocatees found themselves denied, declared ineligible for, and/or unable to afford medical care in the cities. As more and more Indians migrated to the cities, their health problems increased, and concerns over their access to health care escalated. Fortunately, with the advent of consumer health movements in the 1960s, a number of “store front” free clinics serving Indian clients sprang up in cities across the country. Over a period of time, many of these initial “store front” clinic operations became eligible for federal funding as part of a network of urban-based Indian health clinic.