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Community Cancer Screening:Reducing Health Disparities among Native Americans in Rural, Tribal Communities
Full text linkNative Americans have higher cancer morbidity and mortality rates than non-Native Americans and cancer screening rates are lower. This qualitative case study used community-based participatory research principles to identify individual, family, community, and environmental factors that positively influenced screening rates in a rural, Native American community. Over a two-year period, 90 people participated in 11 focus groups to inform the evaluation of the Standing Rock Reservation Men’s and Women’s Health Days Program.
Focus group interviews were digitally recorded, transcribed, and saved into NVivo for analysis. Categories and themes were developed using a modified grounded theory approach, leading to a comprehensive model that allowed coding of all comments.
The evaluation confirmed that many components of the screening were valuable, such as the advantages of holistic, culturally appropriate approaches within a social setting. Individual experience with cancer and other chronic diseases, family experience with cancer and family support, and friends and exposure to toxins in the community influenced participation in cancer screening. Collaboration between organizations, intensive outreach and recruitment, multiple services provided in one location, consistency of staff, incentives, and the opportunity to socialize and share a meal increased participation. Barriers to screening, such as transportation, changing funding and criteria for screenings, reductions in other services, and unpleasant screening procedures, have required ongoing patience and problem solving on the part of the community team to ensure that high rate of screenings continue. These findings led to recommendations for program development in the target community and other similar communities nationally
Introduction to Special Issue on Cancer Health Disparities in Native Americans
Full text linkI am very pleased to serve as the Guest Editor for this special edition of Cancer Health Disparities focussing on American Indian and Alaska Native (AIAN) populations. The majority of these articles were presented initially as part of our Spirit of Eagles Community Networks Program at our national conference held at Niagara Falls, New York in September 2017. This conference was co-sponsored by the Mayo Clinic Comprehensive Cancer Center and Roswell Park Cancer Institute. Over 300 community members, providers, survivors, researchers and policy makers from across the country attended as well as colleagues from Canada, Australia and New Zealand
Potentially Preventable Cancers Among Alaska Native People
No full textCancer is the leading cause of death among Alaska Native (AN) people, and the third leading cause of years of potential life lost. AN tribal health leaders and researchers want to understand the cancer burden attributable to modifiable risk factors among AN people, to inform the design of cancer prevention strategies that may reduce the burden of these diseases. To address this question, we estimated the population attributable risk (PAR) associated with modifiable risk factors for cancer including obesity, smoking, physical inactivity, and alcohol use, among AN people. We observed that PAR varied by cancer site and risk factor, but was highest for lung cancer and smoking, with an estimated 78.8% of cancers among males, and 69.8% among females attributable to this risk factor. A smaller, but still substantial proportion of cancers were associated with obesity (up to 37% for endometrial cancer among females), physical inactivity (up to 18% for endometrial cancer among females), and alcohol use (up to 34% for breast cancers among heavy drinking females). These results demonstrate the importance of smoking as a primary prevention target to reduce the burden of cancer and other chronic diseases among AN people. However, they also indicate that obesity, physical activity, and alcohol use may also account for a varying, but substantial proportion of cancers in this population. Given the high burden of cancer among AN people, a comprehensive approach to primary prevention is warranted
Breast Cancer Disparities Among American Indian Women
Full text linkHealth disparities in breast cancer among American Indian women include historically higher stage at diagnosis, younger age at diagnosis, higher ratios of rates of mortality vs incidence, geographic variability of incidence and mortality rates, more difficult access to breast imaging and cancer treatment, and racial misclassification in medical records resulting in underestimation of breast cancer data. This population is understudied as well as underserved and more research is needed to reveal specific causes and interventions for these breast cancer disparities. Proactive efforts may include improving access to regular screening, diagnosis and treatment, identifying high risk women for intervention, and continuing community based research and educational programs. After a cancer diagnosis, patient navigators and prompt access to up to date breast cancer therapy treatment may improve outcomes
Indigenous Writing Retreats: Native American Community Members and Scholars in action!
Full text linkWriting retreats provide time away from distractions to write manuscripts, grant applications, books, or dissertations. A unique characteristic of writing retreats is that they form a “community of scholars,” which is culturally congruent with Indigenous intellectuals, who are familiar with community as an essential way of life. This article presents two case studies and data about the experiences from a national Native American scholars’ cohort (n=6) and an Indigenous writing retreat from mainly Haudenosaunee writers in Mohawk Country (n=22). Evaluative feedback from aggregated writing retreats endorses the feasibility, growth, and advocacy of future writing retreats. Results shared that protective writing times increased meaningful productivity. Core values related to a community-based participatory research framework learned from a confederacy of tribes and their urban partners were also shared
A Southwestern Tribal Perspective on Traditional and Commercial Tobacco
Full text linkAmerican Indian or Alaska Natives have the highest rates of current cigarette (36.5%) and smokeless tobacco use (5.3%), and tobacco product (40.1%) and the second highest rate of current cigar use (6.1%) compared to all other racial-ethnic groups in the U.S. rates of American Indian or Alaska Native tobacco use vary by gender. Few studies examine perceptions of tobacco use among tribal members residing on and off the reservation. This study fills a gap in the literature by reporting the perceptions of 34 enrolled members of a southwestern tribe who reside on and off a tribal land using a Community-Based Participatory Research (CBPR) design through a collaboration between a university and a tribal health program. Researchers conducted seven focus groups; four on the southwest reservation and three within an urban community. The discussions were audio-recorded, transcribed, and analyzed using a multi-investigator consensus model. The use of tobacco (commercial or traditional) in southwest tribes is essential to cultural practices. Results depicted different views on cultural meaning and health impacts of commercial and traditional tobacco. Findings suggest the importance of local research to understand dimensions of tobacco use before moving forward with tobacco cessation programmin
Is Men’s Health a Priority for Tribal Health Directors? Results From a Survey Study
Full text linkPrograms and initiatives addressing American Indian and Alaska Native (AI/AN) health disparities have recently shifted to better understanding, identifying and promoting successful programs designed to improve the health of AI/AN men. We sought to describe the priorities of front-line leadership of Indian Health Service, Tribal, and Urban (ITU) health programs, especially in relation to men’s health. We also sought to ascertain how potential future partners in men’s health research perceive the priorities established by the Indian Health Care Improvement Act (IHCIA). We surveyed directors of Indian Health Service, tribally operated facilities/programs, and Urban Indian clinics (I/T/U’s) on the relative importance of a range of health topics and issues and whether gender-based strategies were crucial to implementation. I/T/U directors identified diabetes (68%), alcohol and substance abuse (61%), mental/behavioral health (56%), obesity (53%) and addiction (40%) as the highest priority issues affecting both men and women. Only seven directors (6%) selected “men’s health” as a stand-alone priority. However, 80% said gender-tailored implementation was at least somewhat important for three or more of the priorities they selected. While neither men’s nor women’s health was identified as a standalone concern, health directors identified gender tailoring as a useful strategy for addressing many health issues
The Evolution of Palliative Care within the American Indian Health System
Full text linkPalliative care is now considered an important quality component within cancer care and essential to the continuum of cancer care programs nationwide. American Indian and Alaska Native patients have significant differences in mortality from various cancers, and therefore palliative care is very important while working in parallel towards improved survival overall. In fact, palliative care has in some circumstances even contributed to improved survival (Annual report to the Nation on the status of cancer 1975-2009. DOI:10.1093/jnci/djs491). This article recounts the efforts made over many years to institute quality palliative care programs that are culturally acceptable to Native populations and outlines “next steps”.
 
First Strike: The Voice of a Prostate Cancer Survivor: The voice of a survivor
No full textThe voice of survivors is crucial to improving cancer awareness, early detection and successful treatment for Native cancer patients. Bill Ward\u27s message is to seek out the best information and choose a treatment that fits your personal situation and goals. His choice may not be every man’s nor every Native man’s choice but the story is supportive of doing what is necessary to become a survivo
Editorial
Full text linkIn today’s world, understanding, preventing and curing cancer remains the top most challenge. Over the past several decades, there has been a substantial advancement in screening, diagnosis, prevention, and treatment of cancer. Nevertheless, disparities in the incidence, penetrance, social factors, genetic background, and environmental influence all affect the time of diagnosis, the course of prognosis and successful treatment of cancer. A Recent study reports the higher incidence of prostate cancer in American populations, which is relatively much lesser in Asian populations. Among Americans, its incidence is higher in African-Americans in comparison to Caucasians. Similarly, cancer chemotherapy success varies widely across different ethnic populations. These observations make cancer health disparities research an important field of investigation. Disparities research would give way to personalized medicine for treatment of cancer in different populations.
The goal of the Cancer Health Disparities is to cover all aspects of disparities including social, cultural, environmental, and genetic determinants contributing to differences in cancer incidence, prevalence, death, survivorship, and burden of cancer that exist among different population around the world. The overall aim is to publish high quality, high impact, and innovative research articles in all areas related to cancer health disparities.
Cancer Health Disparities will publish case report, multidisciplinary editorial, commentary, hypothesis, short and full-length reviews, full-length original, clinical or basic science research articles and short articles of immediate scientific or clinical significance. These include disparities at the population, epidemiological, metabolic, molecular, genetic, physiological, clinical, diagnostic and therapeutic levels.
Cancer Health Disparities would provide a common dedicated platform to clinicians, epidemiologists, population and prevention scientists, molecular biologists, physician scientists and others for publishing multidisciplinary research on cancer disparities that would accelerate research in this important field. This would pave the way to efficient and targeted personalized cancer care for diverse ethnic populations.
The editorial team is excited about the launch of this journal and looking forward to your participation.
Keshav K Singh, Ph.D.
Editor-in-Chie