Search

Colorectal cancer (CRC) rates among many American Indian populations are high. Screening by fecal occult blood test (FOBT) and endoscopy is effective for reducing CRC mortality, but little research has examined the extent of such screening in reservation populations. Further, nothing is known of how American Indians' cultural characteristics may be related to screening receipt.We examined data from participants recruited from 2 Northern Plains and 1 Southwest reservation for the Education and Research Toward Health (EARTH) study. All participants agedor = 51 years were eligible for inclusion.After calculating screening rates, we examined bivariate relationships between screening and participant characteristics, including measures of cultural characteristics including ethnic identity and use of traditional healing practices. We applied multivariate regression to relate these cultural variables to odds of lifetime screening by FOBT or endoscopy.Of 751 American Indians sampled, 35% reported lifetime CRC screening by at least one modality. Multivariate analyses did not reveal significant relationships or trends relating FOBT to respondents' cultural characteristics. By contrast, odds of endoscopy were significantly lower among persons who spoke a tribal language at home (OR .6, 95% C.I. .4-.9), and trend analysis revealed an inverse relationship between endoscopy and number of identity measures endorsed (Ptrend.1).The sampled population exhibits disparities in CRC compared to the general population, and cultural characteristics are related to odds of endoscopy. Findings warrant culturally tailored CRC screening initiatives for American Indians.

Perceived risk of disease plays a key role in health behaviors, making it an important issue for cancer-prevention research. We investigate associations between perceived cancer risk and selected cancer risk factors in a population-based sample of American Indians. STUDY DESIGN AND POPULATION: Data for this cross-sectional study come from a random sample of 182 American Indian adults, agedor = 40 years, residing on the Hopi Reservation in northeastern Arizona.Perception of cancer risk was ascertained with the 5-point Likert scale question, "How likely do you think it is that you will develop cancer in the future?" dichotomized into low perceived risk and high perceived risk.Participants reporting a family member with cancer were more likely, by greater than five times, to report the perception that they would get cancer (OR = 5.3; 95% CI: 2.3, 12.3). After controlling for age and family history of cancer, knowledge of cancer risk factors and attitude about cancer prevention were not significantly associated with risk perception.Perceived cancer risk was significantly associated with self-reported family history of cancer, supporting the importance of personal knowledge of cancer among American Indians. Further research is needed to obtain a more complete picture of the factors associated with perceptions of cancer risk among American Indians in order to develop effective interventions.

American Indians/Alaska Natives are underrepresented in clinical trials. Therefore, they must participate in large-scale cancer clinical trials to ensure the generalizability of trial results and improve their access to high-quality treatment. Our goal was to identify factors that influenced participation in cancer clinical trials among American Indians/Alaska Natives.An anonymous survey that assessed willingness to participate in a hypothetical cancer clinical trial and how 37 factors influenced their willingness to participate was administered to 112 older American Indian/Alaska Native adults at an annual social event honoring elders. Responses ranged from one (definitely would not participate) to five (definitely would participate). Data were analyzed with ordinal logistic regression.Factors that most strongly increased willingness to participate were having a lead researcher of Native descent, having a study physician with experience treating American Indians/Alaska Natives, personal experience with the cancer being studied, family support for participation, and belief/hope that the study would result in new treatments. Factors that decreased willingness to participate most strongly were living far from the study site and a high risk that confidentiality could be breached.Our results identify conventional and culturally unique barriers to research participation among older American Indians/Alaska Natives. These data emphasize the need to establish partnerships with Native communities and include American Indian/Alaska Native and culturally competent professionals in research efforts. Of equal importance are disseminating information about clinical trials and recognizing the role of family in decisionmaking in this group.

We compared the prevalence of, and reasons for, perceived discrimination in health care among American Indian/Alaska Natives (AI/ANs) and persons of AI/AN + White heritage to African Americans, Asian Americans, and Whites.Data on perceived discrimination were collected by the 2001 California Health Interview Survey (CHIS). We used chi-square tests to evaluate the prevalence of perceived discrimination and the reasons for perceived discrimination across racial groups.The 2001 CHIS, a telephone survey, one of the largest cross-sectional surveys ever conducted in the United States.Participants in this analysis were adultsor = 18 years of age, interviewed from 55,000 households that took part in the survey.Participants in the 2001 CHIS were asked "Thinking of your experiences with receiving health care in the past 12 months, have you felt you were discriminated against for any reason?" Respondents who endorsed this item were asked about possible reasons for the discrimination.1) Does the prevalence of perceived discrimination in health care differ between AI/ANs, AI/AN + Whites, African Americans, Asian Americans, and Whites? and 2) Do the reasons for perceived discrimination in health care vary by race or ethnicity?Discrimination was perceived by 7.1% of the AI/AN alone group, 8.8% of AI/AN + White respondents, 5.6% of African Americans, 4.3% of Whites, and 2.6% of Asian Americans. After adjusting for covariates, the odds of perceived discrimination were different for AI/AN + White (odds ratio [OR] =2.0, 95% confidence interval [CI] 1.5-2.5) and Asian American (OR = .5, 95% CI .4-.7) when compared to Whites.AI/ANs, and especially those who identify as AI/AN + White, were the most likely among racial groups to report discrimination in health care.

To assess the prevalence of, and quality of care for, diabetes mellitus among the understudied, yet growing, population of older, urban American Indians and Alaska Natives (AI/ANs).Medical record review.Urban Indian primary care clinic in Seattle, Washington.All (N = 550) AI/AN patientsor = 50 years of age.Provider-documented medical diagnoses and indicators of quality of care of diabetes.Diabetes mellitus was documented in 113 (21%) of the medical records. Persons with diabetes were more likely than those without (Por = .05) to be obese, and to have hypertension, coronary artery disease, and depression. Most patients with diabetes were treated with either insulin (43%) or oral hypoglycemic medication (39%), but 16% received neither. Screening rates within 12 months were high for glycosylated hemoglobin (72%), lipid profile (84%), and foot examination (72%), but were low for urinalysis (23%), ophthalmology referral (23%), and influenza vaccination (46%). Only 46% of patients had ever received pneumococcal vaccination, and even fewer (26%) had received tuberculin skin testing (24%). Although 65% of patients had ever been referred to a dietitian, only 40% had received exercise counseling. The total number of health problems was the factor most often associated with quality of care indicators.The prevalence rate of diabetes among this urban clinic population of older AI/ANs was high. Although performance of quality indicators was suboptimal, it was comparable to, or better than, that found in other older populations for many measures.