[Show abstract][Hide abstract] ABSTRACT: We discuss a mixed methodology for analyzing pile sorting data. We created a list of 14 barriers to colon cancer screening and recruited 18, 13, and 14 participants from three American Indian (AI) communities to perform pile sorting. Quantitative data were analyzed by cluster analysis and multidimensional scaling. Differences across sites were compared using permutation bootstrapping. Qualitative data collected during sorting were compiled by AI staff members who determined names for the clusters found in quantitative analysis. Results showed five clusters of barriers in each site although barriers in the clusters varied slightly across sites. Simulation demonstrated type I error rates around the nominal 0.05 level whereas power depended on the numbers of clusters, and between and within cluster variability.
Quality and Quantity 09/2014; · 0.76 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To adapt a daily hassles measure for a low-income population and assess the relationship between hassles and health seeking behavior.
The mixed methods approach used cognitive interviews (N = 23) to inform an adapted measure of daily hassles. The adapted scale was then tested via surveys (N = 144) in community health centers; multivariate logistic regression models were used to assess relationships among variables.
Hassle concerning having enough money for emergencies (76.5%) and worrying about personal health (68.8%) were among the most common. Increased health-related hassles were associated with an increased likelihood to delay needed care.
Findings suggest daily hassles are unique among low-income populations and should be considered in health behavior interventions.
American journal of health behavior 03/2014; 38(2):297-306. · 1.31 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Texts and software that we are currently using for teaching multivariate analysis to non-statisticians lack in the delivery of confirmatory factor analysis (CFA). The purpose of this paper is to provide educators with a complement to these resources that includes CFA and its computation. We focus on how to use CFA to estimate a "composite reliability" of a psychometric instrument. This paper provides guidance for introducing, via a case-study, the non-statistician to CFA. As a complement to our instruction about the more traditional SPSS, we successfully piloted the software R for estimating CFA on nine non-statisticians. This approach can be used with healthcare graduate students taking a multivariate course, as well as modified for community stakeholders of our Center for American Indian Community Health (e.g. community advisory boards, summer interns, & research team members). The placement of CFA at the end of the class is strategic and gives us an opportunity to do some innovative teaching: (1) build ideas for understanding the case study using previous course work (such as ANOVA); (2) incorporate multi-dimensional scaling (that students already learned) into the selection of a factor structure (new concept); (3) use interactive data from the students (active learning); (4) review matrix algebra and its importance to psychometric evaluation; (5) show students how to do the calculation on their own; and (6) give students access to an actual recent research project.
Case studies in business, industry and government statistics : CSBIGS. 01/2014; 5(2):88-101.
[Show abstract][Hide abstract] ABSTRACT: The popularity and usage of social media networks among American internet users age 50 and over doubled from 22% in 2009 to 42% in 2010. Today, 50% of internet users age 50-64 use social-networking sites and 31% do so on a typical day. This increase may be due to the likelihood that many older adults are living with a chronic disease and are more likely to reach out for support online. The growth of aging populations has increased the concern for colorectal cancer risk. This study investigates health related factors associated with current social media use among adults 50 and older. The 2012 Health Information National Trends Survey data (N=3, 959) was analyzed using SAS survey procedures. Individuals 50 and older (N= 2,234) were included in the analysis. In addition to bivariate statistics of selected variables, logistic regression was conducted to identify predictors of social media usage to seek out cancer information. Preliminary results show that age (50>) is a strong predictor of seeking cancer information via social media (OR= 0.95; p= 0.02); the likelihood of visiting a social-networking site to seek cancer information decreased by 5% with each year in age after controlling for race and talking with a doctor about a CRC screening. Further analysis will show at what age (50>) this decrease occurs. Social media networks have the potential to give health promoters and communicators novel ways to engage, inform and educate older Americans about colorectal cancer risk and prevention.
141st APHA Annual Meeting and Exposition 2013; 11/2013
[Show abstract][Hide abstract] ABSTRACT: American Indians (AIs) have some of the poorest documented health outcomes of any racial/ethnic group. Research plays a vital role in addressing these health disparities. Historical and recent instances of unethical research, specifically the Havasupai diabetes project, have generated mistrust in AI communities. To address the concerns about unethical research held by some AIs in the Heartland (Midwest), the Center for American Indian Community Health (CAICH) has launched a series of efforts to inform AIs about research participants' rights. CAICH educates health researchers about the importance of learning and respecting a community's history, culture, values, and wishes when engaging in research with that community. Through community-based participatory research, CAICH is also empowering AIs to assert their rights as research participants. (Am J Public Health. Published online ahead of print October 17, 2013: e1-e8. doi:10.2105/AJPH.2013.301480).
American Journal of Public Health 10/2013; · 3.93 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: American Indians (AI) have the highest smoking rates of any racial/ethnic group in the U.S. and have more difficulty quitting smoking. Little is known about the smoking characteristics of AI smokers. The present study compared the demographic and smoking characteristics of light (≤10 cigarettes per day; N=206) and moderate/heavy (11+ cigarettes per day; N=86) AI smokers participating in a cross-sectional survey about smoking and health.
Multiple methods were used to recruit participants in attendance at powwows, health and career fairs, and conferences. A total of 998 AI (76% cooperation rate) completed a survey assessing general health, sociodemographics, traditional and commercial tobacco use, knowledge and attitudes related to cancer, source of health information and care and other health-related behaviors.
AI light smokers were younger and less likely to be married or living with a partner compared to moderate/heavy smokers. AI light smokers were less dependent on smoking and more likely to have home smoking restrictions. There were no differences with respect to number of quit attempts in the past year or the average length of their most recent quit attempt by light vs. moderate/heavy smoking. In addition, a similar proportion of light and heavy smokers reported using tobacco for traditional purposes such as ceremonial, spiritual and prayer.
These findings highlight important differences between AI light and heavier smokers. Differences related to smoking characteristics such as level of dependence and home smoking restrictions have important implications for the treatment of AI smokers.
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVE . Although colorectal cancer (CRC) mortality rates in the US population have shown a decline, American Indian (AI) CRC mortality rates appear to be increasing. CRC screening rates of AIs remain low when compared with other ethnic groups. The research team explored women's perceptions toward CRC screening, existing barriers, and suggestions to promote education and screening among AI women in Kansas and Missouri. METHODS . Using a community-based participatory research approach, the authors conducted 7 focus groups with AI women older than 50 years (N = 52) to better understand their perceptions of and attitudes toward CRC screening. RESULTS . Women recognized barriers to screening, such as embarrassment, privacy issues, fear, insurance, and cost. They countered perceived barriers through inventive suggestions for education and awareness via social support systems and intergenerational relationships. DISCUSSION . CRC screening interventions for AI must be culturally tailored.
Journal of primary care & community health. 07/2013; 4(3):160-166.
[Show abstract][Hide abstract] ABSTRACT: Breast cancer mortality rates are the second leading cause of cancer death in American Indian (AI) women. AI breast cancer screening rates have been decreasing, and AI women have some of the lowest screening rates compared to other racial/ethnic groups. Our research team investigated breast cancer and breast cancer screening education prior to recommended age for screening. It is imperative to examine the perspectives of young AI women toward breast cancer screening to better understand screening perceptions among AI women. Following a community-based participatory research approach, we conducted five focus groups and four interviews with AI women aged 25-39 (N = 48) in Kansas and Missouri. Nine themes emerged from the focus groups and relate to topics such as the following: knowledge of breast cancer and breast cancer screening, barriers to screening and treatment, suggestions to improve access, and perceptions and use of health-care systems. Specifically, we found that AI women lacked knowledge of details about screenings and their risks for getting breast cancer, cost was cited as a primary barrier to screening, additional education was needed (particularly materials that were AI focused), breast health was generally not discussed with others, and more instruction was requested for techniques used to identify bodily changes or abnormalities. Understanding attitudes of AI women not of recommended screening age may provide an insight into low screening rates among AI women. Furthermore, the results may inform outreach strategies to improve current and future screening rates.
Journal of Cancer Education 06/2013; · 0.88 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: American Indian (AI) men have some of the highest rates of colorectal cancer (CRC) in the United States but among the lowest screening rates. Our goal was to better understand awareness and discourse about colorectal cancer in a heterogeneous group of AI men in the Midwestern United States. Focus groups were conducted with AI men (N = 29); data were analyzed using a community-participatory approach to qualitative text analysis. Several themes were identified regarding knowledge, knowledge sources, and barriers to and facilitators of screening. Men in the study felt that awareness about colorectal cancer was low, and people were interested in learning more. Education strategies need to be culturally relevant and specific.
[Show abstract][Hide abstract] ABSTRACT: Information concerning American Indian/Alaska Native (AI/AN) Internet use and health information needs is dearth. Our research team explored Internet use among AI/AN college students to determine Internet use in relation to health information seeking behaviors. We used a tobacco site example for participants to describe what they desired in a health site designed specifically for AI/AN. Using a community-based participatory research approach, we conducted 14 focus groups with AI/AN college students (N = 108), to better understand their perceptions of and attitudes toward Internet use and health information needs. Daily Internet use was reported across strata yet health topics investigated differed among groups. Participants in all strata desired a health website that was easy to navigate and interactive. Respectful representation of Native culture was a concern, yet no consensus was reached for a multi-tribal audience. Participants felt a website should use caution with cultural depictions due to the possible misinterpretation. Overall, participants agreed that recreational and traditional tobacco use should be differentiated and the variation of traditional use among tribes acknowledged. Data concerning Internet use for health information among AI/AN college students are needed to establish baseline indicators to effectively address disparities.
Journal of Community Health 11/2012; · 1.28 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: African immigrant and refugee communities remain medically underserved in the United States. Formative efforts are being directed to address the local needs of communities by researchers, community agencies, and local populations. However, there is a paucity of data and sparse documentation regarding these efforts. The objectives for this pilot study were to identify the health priorities of the Kansas City Somali community and to establish a working relationship between an academic medical university and the local Somali community. Our team used community-based participatory research principles and interviewed Somali community members (n = 11). Participants stated that chronic and mental health conditions were of primary concern. Medical system navigation and literacy struggles were identified as barriers. Participants offered possible solutions to some health issues, e.g., using community health workers and Qur'anic readers. Preliminary findings will help guide future research and inform strategies to improve the health and well-being of this community.
Journal of Immigrant and Minority Health 11/2012; · 1.16 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background: High levels of non-adherence to antiretroviral (ART) therapy persist despite ART's ability to extend a young person's life expectancy 40 years beyond medication initiation. This non-adherence is compounded by the fact that drug use and risky sexual behaviors typically occur during youth. Furthermore, compared to their HIV negative counterparts, behaviorally and perinatally infected adolescents and young adults have higher rates of cognitive impairments and mental health issues.
Purpose: This qualitative study illuminates unique factors that influence medication adherence and risky behavior among young, HIV + African American women.
Methods: Twenty semi-structured in-depth interviews were conducted with HIV+ young women (mean age =28.8, 95% African American, 50% on ART) receiving HIV care in an urban clinic. A thematic analysis of interviews was conducted independently by two study team members before reaching consensus on emergent themes.
Results: Participants experienced various tensions in their life causing them to oscillate along a continuum of medication adherence and risk taking behaviors. Factors influencing this oscillation were organized into the following themes: 1.Mental health issues (depression, anxiety, past trauma due to abuse), 2. Stigma (leading to selective/lack of disclosure, sexual/social isolation), 3. Coping mechanisms (positive reappraisal and cognitive avoidance) and 5. Future aspirations (desire to have a child, desire for independence).
Conclusion: Understanding the unique factors that cause young people to oscillate along the continuum of adherence and risk taking behavior allows us to implement strategies that can be used to move youth towards consistent medication adherence and safe behaviors.
140st APHA Annual Meeting and Exposition 2012; 10/2012
[Show abstract][Hide abstract] ABSTRACT: Introduction: American Indian (AI) women have shown greater risk of being diagnosed with breast cancer at a late-stage leading to lower survival rates compared to Non-Hispanic Whites. The Center for American Indian Community Health (CAICH) conducted focus groups to better understand screening attitudes and behaviors concerning breast cancer among AI living in Kansas and Missouri. Participants requested brochures that target AI needs and highlight local resources. CAICH's Susan G. Komen for the Cure scholars and community team members developed a series of brochures about breast cancer knowledge and screening barriers to meet community needs. Methods: Using CBPR, our diverse team created a set of culturally tailored brochures for local AI communities. CAICH incorporated suggestions from focus groups (n=45) and used resources at local health centers. Each scholar was assigned a specific brochure (i.e., facts, screening, what to do if you have a positive screen, and what to do if someone you love is diagnosed). Team members came to a consensus concerning appropriate information, local resources, images, and literacy levels to include in the brochures. Results: Four informational breast cancer brochures have been created for local AI communities. Our Community Advisory Board members and the AIHREA Health and Wellness Powwow attendees reviewed drafts of the brochures. CAICH is in the process of refining the brochures based on community input. Conclusion: CAICH plans to distribute these brochures after additional tailoring. CAICH plans to use the breast cancer brochures as a model for other pertinent health concerns in our AI communities.
140st APHA Annual Meeting and Exposition 2012; 10/2012
[Show abstract][Hide abstract] ABSTRACT: Colorectal cancer (CRC) mortality rates have decreased in the general US population; however, CRC mortality rates are increasing among American Indians (AI). AI CRC screening rates remain low when compared to other ethnic groups. Our team investigated CRC screening education prior to recommended age for screening to better understand screening perceptions among AI community members. Our research team conducted 11 focus groups with AI men and women aged 30-49 (N = 39 men and N = 31 women) in Kansas and Missouri. The results revealed that community members (1) have little knowledge of CRC, (2) do not openly discuss CRC, and (3) want additional CRC education. Variations existed among men and women's groups, but they agreed that preventive measures need to be appropriate for AI communities. Thus, AI CRC screening interventions should be culturally tailored to better meet the needs of the population.
Journal of Cancer Education 10/2012; · 0.88 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Colorectal cancer (CRC) screening is underutilized, especially in low income, high minority populations. We examined the effect test-specific barriers have on colonoscopy and fecal immunochemical test (FIT) completion, what rationales are given for non-completion, and what "switch" patterns exist when participants are allowed to switch from one test to another. Low income adults who were not up-to-date with CRC screening guidelines were recruited from safety-net clinics and offered colonoscopy or FIT (n = 418). Follow up telephone surveys assessed test-specific barriers. Test completion was determined from patient medical records. For subjects who desired colonoscopy at baseline, finding a time to come in and transportation applied more to non-completers than completers (p = 0.001 and p < 0.001, respectively). For participants who initially wanted FIT, keeping track of cards, never putting stool on cards, and not remembering to mail cards back applied more to non-completers than completers (p = 0.003, p = 0.006, and p < 0.001, respectively). The most common rationale given for not completing screening was a desire for the other screening modality: 7 % of patients who initially preferred screening by FIT completed colonoscopy, while 8 % of patients who initially preferred screening by colonoscopy completed FIT. We conclude that test-specific barriers apply more to subjects who did not complete CRC screening. As a common rationale for test non-completion is a desire to receive a different screening modality, our findings suggest screening rates could be increased by giving patients the opportunity to switch tests after an initial choice is made.
Journal of Community Health 09/2012; · 1.28 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: According to the Office of Minority Health, an estimated 4.9 million people living in the United States consider themselves American Indian or Alaska Native, either alone or in combination with one or more races/ethnicities. American Indians or Alaska Natives comprise a racial/ethnic group experiencing serious health disparities, with little if any improvement in health outcomes over the past several decades. This study was designed to explore use of the Internet as a health information source among American Indians in the Central Plains region of the United States. The authors recruited 998 Natives in the region from May 2008 to December 2009 at powwows, health fairs, focus groups, career fairs and conferences, and other social and cultural events, and asked them to complete a self-administered survey. Although compared with data from the general population, American Indians or Alaska Natives in this sample may seem to be more frequent Internet users, their use of modern wireless devices is limited, and their use of the Internet to access health information is lower in comparison with the adult U.S. population. Natives living in the Central Plains region face generational differences in general and health-related use of the Internet. Inadequate availability of culturally appropriate health information websites may drive American Indians or Alaska Natives toward search engines and general information websites.
Journal of Health Communication 05/2012; 17(7):820-35. · 1.61 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: American Indians and Alaska Natives suffer significant health disparities for many infectious and chronic diseases as compared to the general population. Providing accurate and culturally tailored health information to underserved groups has been shown to influence health behaviors and health outcomes. Little prior research has explored American Indians health information use and preferences. National representative sample surveys such as the Health Information National Trends Survey provide some data on minority groups but are underpowered to provide useful information on American Indians. The present study analyzes data from a survey of over 900 American Indians from the Midwest United States and explores their sources of health information, their preferences for information presentation, and their use of health information prior to and during medical encounters. We conclude that campaigns targeting Natives should be narrowly focused and be community driven or employing community resources. American Indians use a diversity of media sources to obtain health information, with the Internet being underutilized compared to the general population. Partnership with Indian Health Service providers and pharmacists, as well as traditional healers, in the development and dissemination of new health information for Natives may provide the "expert" tone needed to promote health improvements in American Indians.
Journal of Community Health 04/2012; · 1.28 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: American Indian women have rising incidence and disproportionate mortality rates due to breast cancer. Using a community-based participatory research approach, we conducted ten focus groups with American Indian women in Kansas and Missouri to understand their barriers to mammography and identify ways to intervene to improve screening rates. Focus groups were stratified by screening status, including women who were up to date with current screening mammography recommendations (mammogram within the last 2 years, N = 7 groups, 66 participants) and women who were not (N = 3 groups, 18 participants). While many similarities were identified across strata, some differences emerged, particularly descriptions of prior negative experiences with the health care system among women who were not up to date with screening recommendations. Primary areas identified by participants for intervention included culturally appropriate educational materials and interventions directed specifically at improving American Indian women's trust in Western medicine and alleviating feelings of discrimination.
Journal of Cancer Education 02/2012; 27 Suppl 1:S32-40. · 0.88 Impact Factor