Effect of Tribal Language Use on Colorectal Cancer Screening Among American Indians

American Indians have one of the lowest colorectal cancer (CRC) screening rates for any racial/ethnic group in the U.S., yet reasons for their low screening participation are poorly understood. We examine whether tribal language use is associated with knowledge and use of CRC screening in a community-based sample of American Indians. Using logistic regression to estimate the association between tribal language use and CRC test knowledge and receipt we found participants speaking primarily English were no more aware of CRC screening tests than those speaking primarily a tribal language (OR?=?1.16 [0.29, 4.63]). Participants who spoke only a tribal language at home (OR?=?1.09 [0.30, 4.00]) and those who spoke both a tribal language and English (OR?=?1.74 [0.62, 4.88]) also showed comparable odds of receipt of CRC screening. Study findings failed to support the concept that use of a tribal language is a barrier to CRC screening among American Indians.     

Tribal differences in diabetes: prevalence among American Indians in New Mexico.

The prevalence of diagnosed diabetes among American Indians in New Mexico with varied genetic and cultural backgrounds is reported. Utilizing community-based registries, the prevalence in persons ages 35 years and older ranged from 9.8 percent among Jicarilla Apache Indians to 28.2 percent among Zuni Indians. All rates were significantly higher than the U.S. rate of 5.3 percent for the same age group. In addition, in three of the five tribal groups examined, the rates of diagnosed diabetes in Indians less than 35 years of age (range from 0.5 percent to 1.3 percent) were significantly higher than the U.S. rate of 0.4 percent for the same age group. The prevalence rates of diagnosed diabetes found in this study of American Indians in New Mexico were intermediate between those for the United States as a whole and the Pima Indians of southern Arizona. Reasons for the variations and the relative contribution of obesity, fitness, or genetic risk in the development of diabetes need further study.     

Cancer screening and risk factor rates among American Indians

OBJECTIVES: We examined cancer screening and risk factor patterns in California using 4 different statistical tabulations of American Indian and Alaska Native (AIAN) populations. METHODS: We used the 2001 California Health Interview Survey to compare cancer screening and risk factor data across 4 different tabulation approaches. We calculated weighted prevalence estimates by gender and race/ethnicity for cancer screening and risk factors, sociodemographic characteristics, and access to care variables. We compared AIAN men and women with members of other racial groups and examined outcomes among AIAN men and women using the 4 tabulation methods. RESULTS: Although some differences were small, in general, screening and risk factor rates among American Indians/Alaska Natives were most similar to rates among Whites when the most inclusive multiracial tabulation approach was used and least similar when the more exclusive US census "single-race" approach was used. CONCLUSIONS: Racial misclassification and undercounting are among the most difficult obstacles to obtaining accurate and informative data on the AIAN population. Our analysis suggests some guidelines for overcoming these obstacles.     

Cancer incidence in Montana: rates for American Indians exceed those for whites

OBJECTIVES: Previous studies suggested that the cancer incidence rates in American Indians and Alaska Natives were lower than in other groups. The objective of this study was to compare the cancer incidence rates in American Indians and whites in Montana. METHODS: Age-adjusted 6-year cancer incidence rates were calculated for American-Indian and white men and women in Montana to allow comparison of rates in 1991-1996 to those in 1997-2002. RESULTS: The age-adjusted rates for American-Indian men were significantly higher than those for white men for all cancer sites (755+/-74 [95% confidence interval] per 100,000 vs 544+/-9 per 100,000), lung cancer (167+/-35 per 100,000 vs 83+/-4 per 100,000), and colorectal cancer (115+/-29 per 100,000 vs 61+/-4 per 100,000) from 1997 to 2002. The adjusted rates for American-Indian women were significantly higher than those for white women for all cancer sites (526+/-47 per 100,000 vs 412+/-8 per 100,000) and lung cancer (120+/-24 per 100,000 vs 56+/-3 per 100,000) during this same time period. There was a significant increase in the age-adjusted rates for all cancer sites among white men and women but not for American-Indian men or women between 1991-1996 and 1997-2002. CONCLUSIONS: There is a significant disparity in the cancer incidence rates between American Indians and whites in Montana. Regional or state-level surveillance data will be needed to describe the changing patterns of cancer incidence in many native communities in the United States.     

Racial misclassification of American Indians in Oklahoma State surveillance data for sexually transmitted diseases

The burden of sexually transmitted diseases (STDs) is high in American Indian/Alaska Native (AI/AN) populations. In addition, race is often misclassified in surveillance data. This study examined potential racial misclassification of American Indians in STD surveillance data in Oklahoma. Oklahoma State STD surveillance data for 1995 were matched with the Oklahoma State Indian Health Service Patient Registry to determine the number of AI/AN women who had one of three STDs but were not listed in Oklahoma surveillance data as AI/AN. Accounting for racial misclassification increased the rate of chlamydia for AI/AN women in Oklahoma by 32% (342/100,000 vs. 452/100,000) in the overall population. For gonorrhea, the rate increased by 57% (94/100,000 vs. 148/100,000) and for syphilis by 27% (15/100,000 vs. 19/100,000). Misclassified AI/AN women most often were classified as "White," and the likelihood of misclassification increased with a lower percentage of AI/AN ancestry. These findings indicate that STD rates may be underestimated for AI/AN populations nationwide. Racial misclassification in state surveillance data causes inaccuracies in characterizing the burden of infectious diseases in minorities.     

合肥市2010年肿瘤登记数据分析

目的及时准确地掌握合肥市恶性肿瘤的发病、死亡数据,了解其动态变化趋势,为恶性肿瘤的预防控制提供依据。方法通过定期收集二级以上医疗机构上报的肿瘤卡片,经疾病预防控制机构人员审核编码后,录入肿瘤登记软件。结果 2010年合肥市登记恶性肿瘤发病率男性为53.5/105,女性为31.5/105,男性和女性登记的恶性肿瘤发病顺位与国家登记数据有较大出入。结论合肥市肿瘤登记数据漏报现象严重。     

Knowledge and Screening of Head and Neck Cancer Among American Indians in South Dakota

Objectives. We established the level of awareness of risk factors and early symptoms of head and neck cancer among American Indians in South Dakota and determined whether head and neck cancer screening detected clinical findings in this population.Methods. We used the European About Face survey. We added questions about human papillomavirus, a risk factor for head and neck cancer, and demographics. Surveys were administered at 2 public events in 2011. Participants could partake in a head and neck cancer screening at the time of survey administration.Results. Of the 205 American Indians who completed the survey, 114 participated in the screening. Mean head and neck cancer knowledge scores were 26 out of 44. Level of education was the only factor that predicted higher head and neck cancer knowledge (b = 0.90; P = .01). Nine (8%) people had positive head and neck cancer screening examination results. All abnormal clinical findings were in current or past smokers (P = .06).Conclusions. There are gaps in American Indian knowledge of head and neck cancer risk factors and symptoms. Community-based head and neck cancer screening in this population is feasible and may be a way to identify early abnormal clinical findings in smokers.Head and neck cancer, including cancers of the oral and nasal cavities, oropharynx, hypopharynx, and larynx, affects approximately 50 000 Americans a year.1 American Indians in the Northern Plains (North and South Dakota, Nebraska, Iowa) have significantly elevated incidence rates of head and neck cancer when compared with the US White population. Age-adjusted incidence rates for all head and neck cancer combined are 30% higher in this population, and for some subsites of head and neck cancer, such as tonsil (2.3 vs 1.3), floor of mouth (2.1 vs 1.5), and hypopharynx (1.5 vs 0.7), the rates per 100 000 persons are dramatically higher. These head and neck cancer rates are the second highest among all American Indians in the United States, second only to the Alaska Native population.2The most common risk factors for these cancers are tobacco and alcohol use. Exposure to the human papillomavirus (HPV) is an additional risk factor for oropharyngeal cancer, which includes cancer of the tonsil.3 Smoking is ubiquitous in this community, with 40% of people reporting current smoking compared with 23% for the general US population. Rates of binge drinking for this population are 20% compared with 17% for the general population.4 Studies of HPV infection rates taken from cervical samples of American Indian women in the Northern Plains have shown similar infection rates to those in the general US population.5 However, the rates of infection with high-risk, oncogenic strains of HPV are significantly higher (67% vs 15%).5,6 These high rates of smoking, heavy alcohol consumption, and virulent HPV infection place American Indians in the Northern Plains at marked risk for head and neck cancer.American Indians diagnosed with head and neck cancer also experience poorer survival compared with the general US population. Analysis of the Surveillance Epidemiology and End Result database and tumor registries in South Dakota indicated worse overall survival for American Indian patients with head and neck cancer (hazard ratio = 0.59), even after the study controlled for demographic variables and disease stage.7,8 A significant contributing factor to this disparity is late-stage presentation. Stage at presentation is the most important prognostic factor for head and neck cancer. Early-stage cancer is very curable, with 5-year survival rates around 91%. These survival rates decline dramatically for late-stage cancers to 30%.1Lack of public awareness of early signs and symptoms of certain cancers has been linked to later stage at presentation.9 Therefore, public health campaigns to increase awareness of early signs and symptoms of head and neck cancer may have a role in decreasing late-stage presentation. Critical to implementing successful educational efforts is defining a baseline knowledge level. The About Face survey was conducted by the European Head and Neck Society to gauge public awareness of head and neck cancer in Europe.10 It found that the general public has poor overall awareness of head and neck cancer and its early signs and symptoms. Telephone surveys conducted in the United States also have documented low awareness of head and neck cancer among rural Floridians.11,12 No comparable studies have been done among the American Indian population within the United States.Another potential avenue to decrease late-stage presentation is screening programs. Because of the relatively low incidence of head and neck cancer in the general population, no official recommendations exist for population-based screenings.13 However, community-based screening programs in Maryland and Kerala, India, have shown success in decreasing the rates of some types of head and neck cancer, such as oral cavity cancer.14,15 Furthermore, community-based screenings have been found to be cost-effective and have been successful in identifying positive clinical findings associated with head and neck cancer in at-risk individuals.16–18Given the high incidence of head and neck cancer among American Indians in the Northern Plains and demonstrated patterns of late-stage presentation among this population, our study had 2 goals. The first goal was to establish the level of awareness of risk factors and early symptoms of head and neck cancer among American Indians. The second goal was to determine whether a community-based head and neck cancer screening is a feasible and potentially effective method to detect positive clinical findings associated with head and neck cancer in this population.     

The prevalence of selected risk factors for chronic disease among American Indians in Washington State.

Despite great improvements in recent decades, the health status of American Indians continues to lag behind that of other Americans. Continued health improvement will depend largely on changes in individual behavior. Until recently, however, few data existed on health risk behaviors among American Indians. We conducted personal interviews among the adult population of an Indian Health Service Unit in Washington State to estimate the prevalence of some health risk behaviors. This analysis focuses on three of the many topics covered in the survey: tobacco use, alcohol consumption, and weight. Cigarette smoking was more prevalent among both men and women than it was in the general population in the same area with 43% of men and 54% of women among the American Indians interviewed reported that they currently smoked. However, they tended to smoke much less heavily than smokers in the general population. Smokeless tobacco use was concentrated among young men, with the overall prevalence similar to that found in the general population. Acute heavy drinking was found to be common with 40% of men and 33% of women reporting this behavior for the previous month. The prevalence of substantial overweight was 45% among men and 43% among women, considerably higher than in the general population. Tribal leaders and the Indian Health Service are using the findings to design disease prevention and health promotion activities. In addition to providing valuable information about the surveyed populations, the survey served as a pilot for similar studies of other American Indian groups.     

Barriers to Cancer Clinical Trial Participation Among American Indian and Alaska Native Tribal College Students

Purpose: American Indians and Alaska Natives (AIs/ANs) have some of the highest cancer‐related mortality rates of all US racial and ethnic groups, but they are underrepresented in clinical trials. We sought to identify factors that influence willingness to participate in cancer clinical trials among AI/AN tribal college students, and to compare attitudes toward clinical trial participation among these students with attitudes among older AI/AN adults. Methods: Questionnaire data from 489 AI/AN tribal college students were collected and analyzed along with previously collected data from 112 older AI/AN adults. We examined 10 factors that influenced participation in the tribal college sample, and using chi‐square analysis and these 10 factors, we compared attitudes toward research participation among 3 groups defined by age: students younger than 40, students 40 and older, and nonstudent adults 40 and older. Findings: About 80% of students were willing to participate if the study would lead to new treatments or help others with cancer in their community, the study doctor had experience treating AI/AN patients, and they received payment. Older nonstudent adults were less likely to participate on the basis of the doctor's expertise than were students (73% vs 84%, P = .007), or if the study was conducted 50 miles away (24% vs 41%, P= .001). Conclusions: Finding high rates of willingness to participate is an important first step in increasing participation of AIs/ANs in clinical trials. More information is needed on whether these attitudes influence actual behavior when opportunities to participate become available.     

Cherokee Choices: a diabetes prevention program for American Indians

In 1999, the Centers for Disease Control and Prevention (CDC) provided Racial and Ethnic Approaches to Community Health 2010 (REACH 2010) funds to the Eastern Band of Cherokee Indians to develop a community-based intervention to improve the health of this rural, mountainous community in North Carolina. During the first year of the Cherokee Choices program, team members conducted formative research, formed coalitions, and developed a culturally appropriate community action plan for the prevention of type 2 diabetes, particularly among children. The Eastern Band of Cherokee Indians has higher rates of obesity and type 2 diabetes than the U.S. and North Carolina general populations. The Cherokee Choices program includes three main components: elementary school mentoring, worksite wellness for adults, and church-based health promotion. A social marketing strategy, including television advertisements and a television documentary series, supports the three components. School policy was altered to allow Cherokee Choices to have class time and after-school time devoted to health promotion activities. School staff have shown an interest in improving their health through attendance at fitness sessions. The credibility of the program has been validated through multiple invitations to participate in school events. Participants in the worksite wellness program have met dietary and physical activity goals, had reductions in body fat, and expressed enthusiasm for the program. A subcoalition has been formed to expand the worksite wellness component and link prevention efforts to health care cost reduction. Participants in the church program have walked more than 31,600 miles collectively.     

Cancer mortality among American Indians and Alaska Natives--United States, 1994-1998

In the United States, public health interventions to control infectious diseases, lower infant and maternal mortality, and improve basic sanitation have led to a substantial increase in life expectancy for American Indians and Alaska Natives (AI/ANs). During 1940-1995, average life expectancy among AI/ANs increased 39%, from 51 years in 1940 to 71 years in 1995; however, AI/ANs experienced a parallel increase in mortality rates for chronic diseases, including cancer, which is the second leading cause of death for AI/ANs nationally and the leading cause of death among Alaska Natives. A previous study examining cancer mortality rates during 1989-1993 documented lower cancer mortality rates for AI/ANs than for the overall U.S. population, with regional variation. To understand cancer mortality among AI/ANs subsequent to that period, the Indian Health Service (IHS) and CDC analyzed death certificate data provided by CDC's National Center for Health Statistics for deaths among AI/ANs in five U.S. geographic regions during 1994-1998. This report summarizes the results of that analysis, which indicate that cancer mortality rates among AI/ANs nationally were lower than cancer mortality rates for all U.S. racial/ethnic populations combined. Rates for AI/ANs varied by region, with the highest rates found in the Alaska and the Northern Plains regions. Plans or modifications for cancer prevention and treatment programs should account for regional variation, and programs to discourage smoking initiation, encourage tobacco cessation, and promote colorectal cancer screening among AI/ANs in the Alaska and the Northern Plains regions should be expanded.     

Cancer incidence among American Indians and Alaska Natives, 1980 through 1987.

OBJECTIVES. This study uses Indian Health Service inpatient data to estimate cancer incidence among American Indians and Alaska Natives. METHODS. Hospital discharge data for 1980 through 1987 were used to identify cases of cancer for 21 sites in women and 18 sites in men. Estimates of incidence were directly standardized to data from the Surveillance, Epidemiology, and End Results Program for the same time frame. RESULTS. Cancers of the gallbladder, kidney, stomach, and cervix show generally high rates among many American Indian and Alaska Native communities, and cancers of the liver and nasopharynx are high in Alaska. Of the relatively common cancers in Whites, American Indians and Alaska Natives experience lower rates for cancers of the breast, uterus, ovaries, prostate, lung, colon, rectum, and urinary bladder and for leukemia and melanoma. Variation among geographic areas and among tribal groups is observed for many important cancer sites. CONCLUSIONS. This study demonstrates significant variations of cancer rates among American Indians and Alaska Natives, with important implications for Indian Health Service cancer control programs. The study also supports the potential use of hospital discharge data for estimating chronic disease among diverse American Indian and Alaska Native communities.     

Linkage Methods for Connecting Children with Parents in Electronic Health Record and State Public Health Insurance Data

The objective of this study was to develop methodologies for creating child–parent ‘links’ in two healthcare-related data sources. We linked children and parents who were patients in a network of Oregon clinics with a shared electronic health record (EHR), using data that reported the child’s emergency contact information or the ‘guarantor’ for the child’s visits. We also linked children and parents enrolled in the Oregon Health Plan (OHP; Oregon’s public health insurance programs), using administrative data; here, we defined a ‘child’ as aged <19 years and identified potential ‘parents’ from among adults sharing the same OHP household identification (ID) number. In both data sources, parents had to be 12–55 years older than the child. We used OHP individual client ID and EHR patient ID numbers to assess the quality of our linkages through cross-validation. Of the 249,079 children in the EHR dataset, we identified 62,967 who had a ‘linkable’ parent with patient information in the EHR. In the OHP data, 889,452 household IDs were assigned to at least one child; 525,578 with a household ID had a ‘linkable’ parent (272,578 households). Cross-validation of linkages revealed 99.8 % of EHR links validated in OHP data and 97.7 % of OHP links validated in EHR data. The ability to link children and their parents in healthcare-related datasets will be useful to inform efforts to improve children’s health. Thus, we developed strategies for linking children with their parents in an EHR and a public health insurance administrative dataset.