American Indian Community Leader and Provider Views of Needs and Barriers to Colorectal Cancer Screening

Colorectal cancer is a great concern for the American Indian/Alaska Native (AI/AN) community, as incidence and mortality rates remain high and screening rates stay low. We conducted interviews with community leaders (n=13) and with providers from the Indian Health Service (IHS), tribal clinics, and urban safety-net clinics (n=17) in Northeast Kansas and the Kansas City Metro Area to determine their understanding of needs and barriers to colorectal cancer screening among American Indians. Using a community-based participatory research (CBPR) approach for this pilot study, community leaders and providers identified similar needs, including: culturally-appropriate education about colorectal cancer and screenings, the potential use of Native elders as patient navigators, and an emphasis on preventive care, particularly through the IHS. Barriers included culturally specific issues such as historic mistrust and gender roles. Other barriers are similar to members of other ethnic groups, such as cost, transportation, fear, and repulsion toward the screening process

Urban Fervor: Los Angeles Literature and Alternative Religion

Using alternative religion and other dynamics within the spiritual life of Los Angeles opens up the city\u27s literary canon; employing religion as a critical lens illuminates the conjunction of history, literature, and urban growth that characterizes Los Angeles culture. This is especially relevant in a setting where, according to a 1941 guide to the city, the multiplicity and diversity of faiths that flourish in the aptly named City of Angels probably cannot be duplicated in any other city on earth. It is apparent, however, that the specific social phenomena of abundant sects in this urban space can provide keys to understanding the region\u27s culture. While religion plays a part in the history of Los Angeles from the city\u27s inception, its role becomes more complex, fragmentary, and pervasive in the twentieth century as the city undergoes rapid development. This project examines the role alternative religion plays in Los Angeles literature written between 1910 and 1960 and provides an overview of the spiritual culture of the city

Colorectal Cancer Screening Behaviors among American Indians in the Midwest

Colorectal cancer is the second most diagnosed cancer among American Indians and is also the second leading cause of cancer death. We used a community-based participatory approach to conduct a mixed methods study to examine colorectal cancer screening behaviors. Here we report on the screening behaviors of our focus group participants (n=153). There were significant gender differences in the colorectal cancer screening rates for FOBT and colonoscopy. Although over 80% of participants reported having health insurance, only 35% of males over 50 years old and 57% of females reported ever having a colonoscopy. More research is needed to identify the causes of gender differences in colorectal cancer screening rates among American Indians. The results of the current study provide new information on the prevalence of colorectal cancer screening among American Indians living in the Midwestern (Kansas and Missouri) portion of the country

Native American Weight Loss Movement: Pilot Test of a Culturally Tailored Weight Loss Program for American Indians

American Indians (AIs) have higher rates of obesity than other racial/ethnic groups, placing them at heightened risk for cardiovascular diseases, diabetes, and certain cancers. Culturally appropriate weight loss interventions may be the key to reducing risk. The most successful program used in AI communities has been the Diabetes Prevention Program (DPP), which limits enrollment to individuals with a clinical diagnosis of pre-diabetes. The purpose of this pilot project was to modify and culturally tailor a weight loss intervention to AI communities in Kansas to improve weight loss related behaviors among those who do not qualify for the DPP. The Native American Weight Loss Movement (NAWLM) was developed from 2012-2014 using an iterative process with 4 sequential modifications to the program. Group 1 received a slightly modified version of the DPP that was originally tailored to African Americans. Each group received an improved program based on modifications from the previous group. Our analysis shows 36.1% (95% CI: 25.7, 47.5) of all participants (n=72) lost weight; a majority (63.9%, 95% CI: 52.8-75.0) maintained weight, gained weight, or dropped out. Among individuals who completed the program (n=34), 76.5% lost weight (95% CI: 61.4, 91.5). These individuals lost an average of 2.98% body weight (95% CI: 1.58, 4.37), with 6 participants losing \u3e7% body weight. While most participants who completed the program lost weight, more research is needed to determine factors that discourage drop-out and promote behavioral changes. NAWLM shows promise as a weight loss program for AIs who do not qualify for the DPP

Internet Use for Health Information among American Indians: Facilitators and Inhibitors

Our research team explored Internet use among a heterogeneous American Indian (AI) population to determine Internet use in relation to health information seeking behaviors. Participants examined an AI culturally-tailored tobacco website as an example to explain what they wanted in an AI Internet health site. Using community-based participatory research, we conducted 10 focus groups with non-college AI men and women (N=96), stratified by age (18-29, 30-49, and 50 and over) to better understand their perceptions of Internet use and health information needs. We found that Internet use varied greatly among all strata. Participants referenced WebMD© more than any other website, but participants were not pleased with the design and navigation. When examining the sample website, participants across strata stressed that recreational and traditional tobacco use should be discussed. Participants in all strata desired a simple website design with easy to read text accompanied by images. In order to gain and maintain cultural respect, participants stated that web designers should be aware that some images hold cultural meaning, particularly tobacco. Baseline data are needed for AI’s use of the Internet to obtain health information; this research is helpful to address health inequalities among AI, particularly access to web-based health information

Internet All Nation Breath of life (I-ANBL) a Tribal College Student Engaged Development of an Internet-based Smoking Cessation Intervention

Background: Compared to non-Hispanic white college students, American Indian (AI) tribal college students have the highest smoking prevalence in the U.S. (~34%). Culturally-tailored smoking cessation programs have proven to be successful in reducing smoking rates but may require new methods to reach college students. Currently, there is little documentation on the development and success of Internet-based smoking interventions for AI tribal college students. Objectives: To develop an Internet-based smoking cessation program (Internet-All Nations Breath of Life or I-ANBL) with tribal college students. Methods: We conducted six focus groups (n=41) at a tribal college. Focus groups included tribal college students who smoked and groups were stratified by sex. Transcripts were analyzed using insider and outsider perspectives. After analysis, an Internet-based smoking cessation program was developed, based on insight gained. Results: Numerous suggestions for creating the program were offered. There was consensus on the need for a variety of visuals including cultural images, videos, and interactive content. The students also suggested the integration of familiar platforms such as FacebookTM. Conclusion: When culturally tailoring a web-based smoking cessation program for tribal college students, it is important to incorporate cultural aspects and recognize gender differences. One important aspect is to recognize that for many AI, tobacco is a sacred plant and images of tobacco should be respectful. Now that this intervention has been developed, next we will test it for efficacy in a randomized controlled trial. Keywords: American Indians, tribal college, tobacco, program development, smoking cessation, community-based participatory researc

Development of a Culturally Appropriate Smokeless Tobacco Cessation Program for American Indians

This study describes a multiphasic approach to the development of a smokeless tobacco cessation program targeted for American Indians (AI) of different tribal nations. The authors gathered formative data from a series of focus groups and interviews to investigate the knowledge, attitudes, and beliefs of AI and smokeless tobacco (SLT) use. Predominant themes emerged from four major topic areas (SLT use, initiation and barriers, policy, and program development) across both studies. This study further assessed educational materials developed for the cessation program for scientific accuracy, readability, and cultural appropriateness. Program materials were scientifically accurate and culturally appropriate. The average corrected reading grade level was 6.3 using the Fry formula and 7.1 using the SMOG formula. Based on this research, a detailed approach to formative research can be used in combination with input from community members to develop health interventions that address health disparities for a specific population

Marketing a Healthy Mind, Body, and Soul: An Analysis of How African American Men View the Church as a Social Marketer and Health Promoter of Colorectal Cancer Risk and Prevention

The Centers for Disease Control and Prevention ranks colorectal cancer (CRC) as the third most commonly diagnosed cancer among men in the United States; African American (AA) men are at even greater risk. The present study was from a larger study that investigates the church's role as a social marketer of CRC risk and prevention messages, and whether religiously targeted and tailored health promotion materials will influence screening outcome. We used an integrated theoretical approach to explore participants' perceptions of CRC risk and prevention and how promotion messages should be developed and socially marketed by the church. Six focus groups were conducted with men from predominately AA churches in the Midwest. Themes from focus group discussions showed participants lacked knowledge about CRC, feared cancer diagnosis, and feared the procedure for screening. Roles of masculinity and the mistrust of physicians were also emergent themes. Participants did perceive the church as a trusted marketer of CRC but believed that promotional materials should be cosponsored and codeveloped by reputable health organizations. Employing the church as a social marketer of CRC screening promotion materials may be useful in guiding health promotions and addressing barriers that are distinct among African American men

Breast cancer screening practices among American Indians and Alaska Natives in the Midwest

American Indian and Alaska Native (AI/AN) women currently have some of the highest mortality rates from breast cancer for any racial/ethnic group in the United States and some of the lowest screening rates. However, current data are not available for regional differences in screening, which can result in dramatically different stage at diagnosis and mortality. We conducted surveys with 120 focus group participants in a needs assessment of mammography among AI/AN in the greater Kansas City metropolitan area and parts of Northeast Kansas. We found that among women under age 40, for whom recommended screenings include only annual clinical breast examination and breast self-examination, more women reported breast self-examination than clinical breast examination (85.3% versus 55.0% in the past year). Among women age 40 and older, more women reported breast self-examination (80.0% in the past year) than either clinical breast examination or mammography (50.8% and 46.9%, respectively, in the past year). These low rates of breast cancer screening are consistent with low rates reported around the country among AI/AN and have strong implications for stage at diagnosis and prognosis for AI/AN breast cancer patients