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Correlates of Receipt of Colorectal Cancer Screening among American Indians in the Northern Plains
Abstract
Research has consistently documented lower colorectal cancer (CRC) screening rates for racial and ethnic minority populations,
with the lowest screening rates among American Indians (AIs). Given the low CRC screening rates among AIs residing in the
Northern Plains region, the objective of this research was to identify CRC screening correlates for Northern Plains AIs. With
a sample of 181 AIs age 50 years or older, the authors used Andersen’s behavioral model to examine the following factors related
to receipt of CRC screening: (a) predisposing factors—age, education, marital status, and gender; (b) need factors—personal
and family history of cancer; and (c) enabling factors—having a particular place to receive medical care, annual health checkup,
awareness of the availability of CRC screening, knowledge of CRC, and self-efficacy of CRC. Nested logistic regression identified
the following correlates of receipt of CRC screening: (a) predisposing factors—older age; (b) need factors—having a personal
history of cancer; and (c) enabling factors—having an annual health checkup, greater awareness of CRC screening, and greater
self-efficacy of CRC. Given the findings, prevention and intervention strategies, including public awareness and education
about CRC screening, are promising avenues to reduce cancer screening disparities among AIs.
... These advances have also led to improvements in cervical cancer incidence and mortality for most US women, although cervical cancer disparities exist across a number of factors [1,11]. Race is a persistent determinant of cancer outcomes, and in New Mexico (NM) and across the Southwestern US, American Indians (AI) experience a range of inequities [16,17,25,26]. ...
... While most population science examines AI/AN health disparities by grouping all AI/AN Tribes together, the AI/ AN population is not a monolith and Tribal differences need to be acknowledged and accounted for in cancer prevention plans [11,[16][17][18]25]. In this study, we contribute to the evidence base of cervical cancer screening knowledge among the Zuni people, who may have distinctly different, culturally derived knowledge of cervical cancer, which may be different from other AI Tribes. ...
... Cervical cancer risk factor knowledge is measured by the sum of correct answers to 18 questions focused on knowledge of specific cervical cancer risk factors (see Table 1 for the individual items). Our measures are modeled after prior work on cancer screening awareness and knowledge [16,17]. ...
American Indian women experience cervical cancer disparities, including later-stage diagnosis and a higher cervical cancer mortality rate. These disparities are interconnected and linked to cervical cancer screening disparities. Cervical cancer when identified early is highly treatable. Individual- and health system-level factors often contribute to gaps in cervical cancer screening. To better understand the source of these inequities experienced by American Indian women, specifically Zuni women, this paper examines how knowledge about cervical cancer and related risk factors is linked to cervical cancer screening for Zuni women using primary data gathered by the Zuni Health Initiative in 2020 and 2021. We find that of the women who completed the survey ( n = 171), women with greater cervical cancer knowledge are statistically significantly more likely to have received cervical cancer screening. Closer examination of knowledge on the specific risk factors for cervical cancer provides evidence upon which to develop a cervical cancer education intervention.
... Fortunately, our summaries of respondents' preferences for Community Guide-recommended interventions or strategies can help inform Zuni health program development to target these very individuals. For example, having flexible clinic hours, offering childcare services, creating home visits for age and receipt of CRC screening has been found by others in studies of American Indian communities [32][33][34][35][36]. Similarly, not having a regular provider and thus, having fewer chances to be recommended for CRC screening has also been found in other AI CRC studies [29,33,34,36]. ...
... Fortunately, our summaries of respondents' preferences for Community Guide-recommended interventions or strategies can help inform Zuni health program development to target these very individuals. For example, having flexible clinic hours, offering childcare services, creating home visits for age and receipt of CRC screening has been found by others in studies of American Indian communities [32][33][34][35][36]. Similarly, not having a regular provider and thus, having fewer chances to be recommended for CRC screening has also been found in other AI CRC studies [29,33,34,36]. As highlighted in Fig. 1, younger individuals without a regular provider are among the least likely to have ever completed colonoscopy or FOBT. ...
... For example, in a study on repeat FOBT completion, out of 69 patients with zero clinic visits in the year after completing an FOBT, zero of those 69 participants completed their second FOBT within a year education, and having community health representatives (CHRs) help obtain screening, were all highly preferred evidence-based interventions or strategies that may be particularly well-suited for younger individuals with family All of the aforementioned factors, and strategies to address these factors, confirm the need for multilevel, multicomponent interventions [3]. Patients who lack a regular source of care are unlikely to receive preventive and routine care where CRC screening recommendations are most often made [29,34] and where negative perceptions can be addressed by providers. Therefore, provider education or EHR alerts alone are not likely to improve [41]. ...
Although strategies to mitigate barriers to colorectal cancer (CRC) screening have proven successful in some parts of the US, few of these strategies have been studied in rural, American Indian communities that may exhibit unique culturally driven attitudes toward and knowledge of colorectal cancer and experience increased barriers to healthcare access. In this study, we describe the results of a survey among CRC screen-eligible members of Zuni Pueblo (N = 218) on an array of questions regarding CRC screening behaviors, knowledge, satisfaction with and access to healthcare services, social support for CRC screening, perceptions toward FOBT, and preference for evidence-based interventions or strategies for improving CRC screening rates. Results from the multivariable model suggest age, having a regular healthcare provider, and harboring fewer negative perceptions toward FOBT are key drivers of ever completing CRC screening. Respondents reported strong support for Community Guide-recommended interventions and strategies for increasing CRC screening for nearly all proposed interventions. Results confirm the need for multilevel, multicomponent interventions, with a particular focus on improving Zuni Pueblo community members’ access to a regular source of care, improving knowledge of CRC risk factor, and addressing negative perceptions toward CRC screening. These results provide critical, community-specific insight into better understanding the drivers of low guideline-adherent screening rates and inform local healthcare providers and community leaders of context-specific strategies to improve CRC screening in Zuni Pueblo.
... We used Andersen's (1973Andersen's ( , 1995 behavioral model of health service utilization as our theoretical framework. Andersen's model has been widely used as a guideline for examining health service use and extensively applied to studies of diverse racial/ethnic populations, including Indigenous populations (e.g., Lee et al., 2015;Roh, Burnette, Lee, Lee, & Goins, 2016). The model posits that people's use of health services (e.g., cancer screening) is a function of three influential factors for service use: (1) predisposing factors (i.e., predisposition to use health services), (2) need factors (i.e., need for care), and (3) enabling factors. ...
... Some studies indicated that participants with a positive family history of breast cancer were more likely to receive mammography (Gonzales, Ton, Garroutte, Goldberg, & Buchwald, 2010;Tolma et al., 2014). In addition, a personal history of cancer was correlated with receipt of cancer screening (Roh et al., 2016). Having a personal history of cancer would understandably increase one's cancer screening awareness and the importance of early detection to prevent future occurrences. ...
This study examined predictive models of utilization of mammograms among Indigenous women adapting Andersen’s behavioral model. Using a sample of 285 Indigenous women residing in South Dakota, nested logistic regression analyses were conducted to assess predisposing (age and marital status), need (personal and family cancer history), and enabling factors (education, monthly household income, mammogram screening awareness, breast cancer knowledge, self-rated health, and cultural practice to breast cancer screening). Results indicated that only 55.5% of participants reported having had a breast cancer screening within the past 2 years. After controlling for predisposing and need factors, higher education, greater awareness of mammogram, and higher utilization of traditional Native American approaches were significant predictors of mammogram uptake. The results provide important implications for intervention strategies aimed at improving breast cancer screening and service use among Indigenous women.
... Andersen's Behavioural Model has been broadly used in studies as a guide to examine health service use in different racial or ethnic populations [26,27]. However, no studies with this theoretical framework in relation with Chagas diagnosis in non-endemic countries have been found. ...
Background
Chagas disease has become a challenge for non-endemic countries since population mobility has increased in recent years and it has spread to these regions. In order to prevent vertical transmission and improve the prognosis of the disease, it is important to make an early diagnosis. And to develop strategies that improve access to diagnosis, it is important to know the factors that most influence the decision of the population to know their serological status. For this reason, this study uses Andersen’s Behavioural Model and its proposed strategies to explore the health behaviours of Bolivian population.
Methods
Twenty-three interviews, two focus groups, and two triangular groups were performed with Bolivian men and women, involving a total of 39 participants. In addition, four interviews were conducted with key informants in contact with Bolivian population to delve into possible strategies to improve the Chagas diagnosis.
Results
The most relevant facts for the decision to being diagnosed pointed out by participants were having relatives who were sick or deceased from Chagas disease or, for men, having their pregnant wife with a positive result. After living in Spain more than ten years, population at risk no longer feels identified with their former rural origin and the vector. Moreover, their knowledge and awareness about diagnosis and treatment still remains low, especially in younger people. Limitations on access to healthcare professionals and services were also mentioned, and proposed strategies focused on eliminating these barriers and educating the population in preventive behaviours.
Conclusions
Based on Andersen’s Behavioural Model, the results obtained regarding the factors that most influence the decision to carry out Chagas diagnosis provide information that could help to develop strategies to improve access to health services and modify health behaviours related to Chagas screening.
... This is inconsistent with the findings of a previous study by Roh et al wherein the level of education did not affect CRC screening participation between men and women. 26 Only a few studies have compared the effect of gender-specific differences in education status on CRC screening participation, thus limiting the possible discussion on the topic. Nevertheless, gender-specific educational programs that focus on improving the knowledge of CRC and screening could be used to target poorly educated older women, who are at a particularly high risk. ...
The rate of and factors influencing colorectal cancer screening differs by gender. We aimed to determine the behaviors for and predict the factors influencing self-reported colorectal cancer screening in Korean adults. Secondary analysis was performed with data from the cross-sectional 2012 Community Health Survey. We examined the relationship between gender and self-reported screening using data for 115 045 adults aged ≥50 years; 62.4% of men and 65.5% of women underwent colorectal cancer screening. In the multivariate logistic regression analysis, men with private insurance and who attended regular health checkups were more likely to undergo screening; men who were employed, ate salty food, were older, or smoked were less likely. Women with private insurance, who lived with a spouse, were more educated, were housewives, or attended regular health checkups were more likely, and older women were less likely to undergo screening. Therefore, gender-specific interventions are needed to encourage colorectal cancer screening.
... The current study was a secondary data analysis using data from the 2013 General Well-Being Among Native American Study, a study designed to explore cancer screening literacy among Native Americans in the Midwest (for more information, please see Roh, 2015). After receiving approval by University of South Dakota Institutional Review Board, data were collected from Native American women (aged 18 years or older) and men (aged 40 years or older) in rural areas of South Dakota. ...
This study examined the association between childhood maltreatment and intimate partner violence (IPV) victimization among Native American adults. Based on Riggs's theoretical model of the long-term effects of childhood abuse, we also examined the mediating roles of insecure attachment patterns and depressive symptoms. The current study was a secondary data analysis using the 2013 General Well-Being Among Native Americans dataset (N = 479). Structural equation modeling was used to examine the hypothesized relationships among key constructs. Consistent with existing literature of revictimization, our findings showed that the experience of childhood maltreatment was positively associated with IPV victimization. Mediation analyses indicated that depression was a significant mediator in the association between childhood maltreatment and IPV victimization. In addition, all the paths linking childhood maltreatment, fearful attachment, depressive symptoms, and IPV victimization were statistically significant, although the overall mediation effect was not significant. The results of this study suggest that Riggs's model can serve as a useful theoretical framework for understanding the long-term effects of childhood maltreatment among Native American adults. Practitioners in the area of IPV should include maltreatment history and current attachment patterns in client assessments, which could help address conflict and violence within intimate relationships.
Cancer screening rates remain low among American Indian men, and cancer screening behaviors and barriers to cancer screening among American Indian men are not well understood. This study evaluated cancer screening behaviors in 102 Hopi men who were 50 years of age or older from the Hopi Survey of Cancer and Chronic Disease. Reported cancer screening frequencies were 15.7%, 45.1%, and 35.3% for fecal occult blood test (FOBT), colonoscopy, and prostate-specific antigen (PSA) test, respectively. Among men who reported having had a FOBT, 81.2% had the test more than 1 year ago. Among men who reported a colonoscopy, 60.8% had colonoscopy within the past 3 years. Similarly, among men who reported having had PSA, 72.3% had PSA within the past 3 years. “No one told me” was the most common answer for not undergoing FOBT (33.7%), colonoscopy (48.2%), and PSA (39.4%). Men who reported having had a PSA or digital rectal exam were three times as likely to also report having a FOBT or colonoscopy (odds ratio [OR] 3.19, 95% confidence interval [CI]: 1.21–8.46). Younger age (< 65) was associated with reduced odds of ever having prostate cancer screening (OR 0.28, 95% CI: 0.10–0.77). Ever having colorectal cancer screening and previous diagnosis of cancer increased odds of ever having prostate cancer screening (OR 3.15, 95% CI: 1.13–8.81 and OR 5.28, 95% CI: 1.15–24.18 respectively). This study illustrates the importance of community cancer education for men to improve cancer screening participation.
Although violence against Indigenous women is a global human rights and social justice issue, it must be examined within the local context. This article focuses on Indigenous women’s experiences with intimate partner violence (IPV). These women reside in an Indigenous community in the United States that is traditionally matrilineal. The article explores how the power and status of women have been constrained to the extent that many women now experience epidemic rates of IPV. Through the use of the theoretical framework of Paulo Freire, this critical ethnography examined how IPV is situated within a broader context of historical oppression, filling a gap in the literature with respect to understanding Indigenous women’s experiences of IPV in the United States by understanding IPV from the voices of women themselves and connecting IPV experiences to a framework of historical oppression. As part of a critical ethnography, reconstructive analysis of 29 life history interviews with Indigenous women revealed an intergenerational cycle of violence, dehumanizing tactics, and women breaking free from violent relationships. The importance of social work practitioners and researchers examining the challenges experienced by Indigenous peoples within the broader historical context of historical oppression, as well as implementing policies that enable greater self-determination for Indigenous peoples are highlighted.
American Indian (AI) older adults are vulnerable to mental health disparities, yet very little is known about the factors associated with help-seeking for mental health services among them. The purpose of this study was to investigate the utility of Andersen’s Behavioral Model in explaining AI older adults’ help-seeking attitudes toward professional mental health services. Hierarchical regression analysis was used to examine predisposing, enabling, and need variables as predictors of help-seeking attitudes toward mental health services in a sample of 233 AI older adults from the Midwest. The model was found to have limited utility in the context of older AI help-seeking attitudes, as the proportion of explained variance was low. Gender, perceived stigma, social support, and physical health were significant predictors, whereas age, perceived mental health, and health insurance were not.
Context:
Colorectal cancer (CRC) is the second leading cause of cancer death among cancers affecting both men and women in the United States. The Centers for Disease Control and Prevention's Colorectal Cancer Control Program (CRCCP) supports both direct clinical screening services (screening provision) and activities to promote screening at the population level (screening promotion).
Objective:
The purpose of this study was to characterize patient navigation (PN) programs for screening provision and promotion for the first 1 to 2 years of program funding.
Participants:
We conducted a cross-sectional survey of the 29 CRCCP grantees (25 states and 4 tribal organizations) and 14 in-depth interviews to assess program implementation.
Main outcome measures:
The survey and interview guide collected information on CRC screening provision and promotion activities and PN, including the structure of the PN program, characteristics of the navigators, funding mechanism, and navigators' activities.
Results:
Twenty-four of 28 CRCCP grantees of the survey used PN for screening provision whereas 18 grantees used navigation for screening promotion. Navigators were often trained in nursing or public health. Navigation activities were similar for both screening provision and promotion, and common tasks included assessing and responding to patient barriers to screening, providing patient education, and scheduling appointments. For screening provision, activities centered on making reminder calls, educating patients on bowel preparation for colonoscopies, and tracking patients for completion of the tests. Navigation may influence screening quality by improving patients' bowel preparation for colonoscopies.
Conclusions:
Our study provides insights into PN across a federally funded CRC program. Results suggest that PN activities may be instrumental in recruiting people into cancer screening and ensuring completed screening and follow-up.
BACKGROUND
The objectives of this study were to describe, examine, and compare prevalence estimates of colorectal cancer (CRC) screening practices and to determine whether disparities exist for American Indians/Alaska Natives (AIANs) and blacks compared with whites.METHODS
Behavioral Risk Factor Surveillance System (2001-2010) data from respondents aged ≥50 years (n = 356,073) were used. The primary outcome was self-reported CRC screening according to US Preventive Services Task Force guidelines for endoscopy (colonoscopy or sigmoidoscopy), fecal occult blood test (FOBT), or mixed screening (endoscopy or FOBT).RESULTSFrom 2001 to 2010, endoscopy screening increased in the AIAN population by 44.8% (P < .001) compared with black respondents (51.7%) and white respondents (26.5%). AIANs were less likely to report endoscopy screening (45%) compared with both blacks (56%) and whites (55%). For mixed CRC screenings, AIAN rates increased by 34.5%, compared with 29.7% for blacks and 15% for whites. In 2010, AIANs (51%) had the lowest prevalence of mixed CRC screening compared with blacks (61%) and whites (60%; P < .001). Factors that enabled health care attenuated the lowered likelihood of CRC screenings, but disparities remained for AIAN CRC screening. In contrast, once enabling factors were controlled, the odds ratios of CRC screening among blacks were higher compared with whites.CONCLUSIONS
Between 2001 and 2010, AIANs had the lowest CRC screening rates in the United States compared with blacks and whites, presenting a CRC disparity, as rigorously defined. The current findings indicate that, although considerable progress has been made to increase CRC screening for blacks and whites, progress for AIANs continues to lag behind in the first decade of 21st century. Cancer 2014 © 2014 American Cancer Society.
Objectives:
We used improved data on American Indian and Alaska Native (AI/AN) ancestry to provide an updated and comprehensive description of cancer mortality and incidence among AI/AN populations from 1990 to 2009.
Methods:
We linked the National Death Index and central cancer registry records independently to the Indian Health Service (IHS) patient registration database to improve identification of AI/AN persons in cancer mortality and incidence data, respectively. Analyses were restricted to non-Hispanic persons residing in Contract Health Service Delivery Area counties in 6 geographic regions of the United States. We compared age-adjusted mortality and incidence rates for AI/AN populations with White populations using rate ratios and mortality-to-incidence ratios. Trends were described using joinpoint analysis.
Results:
Cancer mortality and incidence rates for AI/AN persons compared with Whites varied by region and type of cancer. Trends in death rates showed that greater progress in cancer control was achieved for White populations compared with AI/AN populations over the last 2 decades.
Conclusions:
Spatial variations in mortality and incidence by type of cancer demonstrated both persistent and emerging challenges for cancer control in AI/AN populations.
Colorectal cancer (CRC) is a leading cause of cancer mortality worldwide. CRC incidence and mortality can be reduced through screening. However, in the United States, screening participation remains suboptimal, particularly among underserved populations such as the uninsured, recent immigrants, and racial/ethnic minority groups. Increasing screening rates among underserved populations will reduce the US burden of CRC. In this commentary focusing on underserved populations, we highlight the public health impact of CRC screening, list key challenges to screening the underserved, and review promising approaches to boost screening rates. We identify four key policy and research priorities to increase screening among underserved populations: 1) actively promote the message, "the best test is the one that gets done"; 2) develop and implement methods to identify unscreened individuals within underserved population groups for screening interventions; 3) develop and implement approaches for organized screening delivery; and 4) fund and enhance programs and policies that provide access to screening, diagnostic follow-up, and CRC treatment for underserved populations. This commentary represents the consensus of a diverse group of experts in cancer control and prevention, epidemiology, gastroenterology, and primary care from across the country who formed the Coalition to Boost Screening among the Underserved in the United States. The group was organized and held its first annual working group meeting in conjunction with the World Endoscopy Organization's annual Colorectal Cancer Screening Committee meeting during Digestive Disease Week 2012 in San Diego, California.
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.
Objective: This systematic review aims to assess the use and implementation of the Behavioral Model of Health Services Use developed by Ronald M. Andersen in recent studies explicity using this model.
Methods: A systematic search was conducted using PubMed in April 2011. The search strategy aimed to identify all articles in which the Andersen model had been applied and which had been published between 1998 and March 2011 in English or German. The search yielded a total of 328 articles. Two researchers independently reviewed the retrieved articles for possible inclusion using a three-step selection process (1. title/author, 2. abstract, 3. full text) with pre-defined inclusion and exclusion criteria for each step. 16 studies met all of the inclusion criteria and were used for analysis. A data extraction form was developed to collect information from articles on 17 categories including author, title, population description, aim of the study, methodological approach, use of the Andersen model, applied model version, and main results. The data collected were collated into six main categories and are presented accordingly.
Results: Andersen’s Behavioral Model (BM) has been used extensively in studies investigating the use of health services. The studies identified for this review showed that the model has been used in several areas of the health care system and in relation to very different diseases. The 1995 version of the BM was the version most frequently applied in the studies. However, the studies showed substantial differences in the variables used. The majority of the reviewed studies included age (N=15), marital status (N=13), gender/sex (N=12), education (N=11), and ethnicity (N=10) as predisposing factors and income/financial situation (N=10), health insurance (N=9), and having a usual source of care/family doctor (N=9) as enabling factors. As need factors, most of the studies included evaluated health status (N=13) and self-reported/perceived health (N=9) as well as a very wide variety of diseases. Although associations were found between the main factors examined in the studies and the utilization of health care, there was a lack of consistency in these findings. The context of the studies reviewed and the characteristics of the study populations seemed to have a strong impact on the existence, strength and direction of these associations.
Conclusions: Although the frequently used BM was explicitly employed as the theoretical background for the reviewed studies, their operationalizations of the model revealed that only a small common set of variables was used and that there were huge variations in the way these variables were categorized, especially as it concerns predisposing and enabling factors. This may stem from the secondary data sets used in the majority of the studies, which limited the variables available for study. Primary studies are urgently needed to enrich our understanding of health care utilization and the complexity of the processes shown in the BM.
Colorectal cancer (CRC) is the most frequently diagnosed cancer among Alaska Native (AN) people, and the second leading cause of cancer death. The incidence rate for the combined years 1999 through 2003 was 30% higher than the rate among U.S. whites (USWs) for the same period. Current incidence rates may serve to monitor the impact of screening programs in reducing CRC in the AN population.
Incidence data are from the Alaska Native Tumor Registry and the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) Program. We compared AN CRC incidence, survival rates, and stage at diagnosis with rates in USWs for cases diagnosed from 2005 through 2009. Relative survival calculations were produced in SEER*Stat by the actuarial method.
The CRC age-adjusted incidence rate among AN men and women combined was higher than those in USW men and women (84 vs. 43/100,000; P < .05; AN:USW rate ratio [RR] = 2.0). The greatest differences between rates in AN people and USWs were for tumors in the hepatic flexure (RR = 3.1) and in the transverse (RR = 2.9) and sigmoid (RR = 2.5) regions of the colon. Rectal cancer rates among AN people were significantly higher than rates in USWs (21 vs.12/100,000). Five-year relative survival proportions by stage at diagnosis indicate that the CRC 5-year relative survival was similar in AN people and USWs for the period 2004 through 2009.
The high rate of CRC in AN people emphasizes the need for screening programs and interventions to reduce known modifiable risks. Research in methods to promote healthy behaviors among AN people is greatly needed.
Facing severe mental health disparities rooted in a complex history of cultural oppression, members of many urban American Indian (AI) communities are reaching out for indigenous traditional healing to augment their use of standard Western mental health services. Because detailed descriptions of approaches for making traditional healing available for urban AI communities do not exist in the literature, this community-based project convened 4 focus groups consisting of 26 members of a midwestern urban AI community to better understand traditional healing practices of interest and how they might be integrated into the mental health and substance abuse treatment services in an Urban Indian Health Organization (UIHO). Qualitative content analysis of focus group transcripts revealed that ceremonial participation, traditional education, culture keepers, and community cohesion were thought to be key components of a successful traditional healing program. Potential incorporation of these components into an urban environment, however, yielded 4 marked tensions: traditional healing protocols versus the realities of impoverished urban living, multitribal representation in traditional healing services versus relational consistency with the culture keepers who would provide them, enthusiasm for traditional healing versus uncertainty about who is trustworthy, and the integrity of traditional healing versus the appeal of alternative medicine. Although these tensions would likely arise in most urban AI clinical contexts, the way in which each is resolved will likely depend on tailored community needs, conditions, and mental health objectives. (PsycINFO Database Record (c) 2012 APA, all rights reserved).
As descendants of the indigenous peoples of the United States, American Indians and Alaska Natives (AI/ANs) have experienced a resurgence in population and prospects since the beginning of the twentieth century. Today, tribally affiliated individuals number over two million, distributed across 565 federally recognized tribal communities and countless metropolitan and nonreservation rural areas. Although relatively little evidence is available, the existing data suggest that AI/AN adults and youth suffer a disproportionate burden of mental health problems compared with other Americans. Specifically, clear disparities have emerged for AI/AN substance abuse, posttraumatic stress, violence, and suicide. The rapid expansion of mental health services to AI/AN communities has, however, frequently preceded careful consideration of a variety of questions about critical components of such care, such as the service delivery structure itself, clinical treatment processes, and preventive and rehabilitative program evaluation. As a consequence, the mental health needs of these communities have easily outpaced and overwhelmed the federally funded agency designed to serve these populations, with the Indian Health Service remaining chronically understaffed and underfunded such that elimination of AI/AN mental health disparities is only a distant dream. Although research published during the past decade has substantially improved knowledge about AI/AN mental health problems, far fewer investigations have explored treatment efficacy and outcomes among these culturally diverse peoples. In addition to routine calls for greater clinical and research resources, however, AI/AN community members themselves are increasingly advocating for culturally alternative approaches and opportunities to address their mental health needs on their own terms.
According to the World Health Organization, quality of life (QOL) includes physical and mental health, emotional well-being, and social functioning. Using an adaptation of Andersen's behavioral model, we examined the associations between the three dimensions of QOL and needs and health behaviors in a nationally representative sample of adults 65 years and older.
A representative sample from the 2005-2006 National Health and Nutrition Examination Survey (NHANES) was used. NHANES over-samples persons 60 years and older, African Americans, and Hispanics. Frequencies and distribution patterns were assessed, followed by bivariate and multiple regression analyses.
These older adults reported high levels of QOL. However, associations between needs and health behaviors and QOL varied across dimensions. Activities of daily living (ADL) were associated with all three dimensions. Depression was associated with two dimensions and memory problems with one dimension. Physical activity was linked to social functioning, and health care utilization was linked to emotional well-being.
The differences in associations with different dimensions of QOL confirm that this is a multidimensional concept. Since depression, memory problems, and ADL function were all associated with some dimension of QOL, future interventions to improve QOL in older adults should include screening and treatment for these problems.
South Asians are the largest visible minority group in Canada, but little research is available, particularly on the older adults and their use of Western health services. This study examined the effects of the predisposing, enabling, need, and cultural factors on the use of Western health services by older South Asian immigrants.
Using a modified version of the Andersen-Newman service utilization model, the specific effects of cultural factors on use of Western health services were examined. A random sample of 220 South Asians 55 years and older were interviewed in Calgary using a structured telephone survey.
Hierarchical regression analysis showed that the cultural factors were as important as the need factors in explaining the proportion of variance in the use of Western health services. Being a Hindu, immigrated to Canada for a longer period of time, fewer access barriers related to cultural incompatibility, a lower level of agreement with traditional South Asian health beliefs, and a stronger South Asian ethnic identity were significantly related to the use of more types of Western health services.
The findings signify the importance of developing strategies for providing culturally competent health promotion, prevention, and intervention, and health care services.
Although self-efficacy, a construct from social cognitive theory, has been shown to influence other screening behaviors, few measures currently exist for measuring Papanicolaou test self-efficacy. This article describes the development and psychometric testing of such a measure for Mexican American women. Data from two separate samples of Mexican American women ages>or=50 years, obtained as part of a study to develop and evaluate a breast and cervical cancer screening educational program, were used in the current study. Exploratory factor analysis indicated a single-factor solution and all item loadings were >0.73. Confirmatory analysis confirmed a single-factor structure with all standardized loadings>0.40 as hypothesized. The eight-item self-efficacy scale showed high internal consistency (Cronbach's alpha=0.95). As hypothesized, self-efficacy was correlated with knowledge, prior experience, and screening intention. Logistic regression supported the theoretical relationship that women with higher self-efficacy were more likely to have had a recent Papanicolaou test. Findings showed a significant increase in self-efficacy following the intervention, indicating that the measure has good sensitivity to change over time.
The American Indian Service Utilization, Psychiatric Epidemiology, Risk and Protective Factors Project (AI-SUPERPFP) estimated the mental health burden and associated help-seeking in select American Indian reservation communities.
To determine the lifetime and 12-month prevalence of common DSM-IV disorders, their demographic correlates, and patterns of help-seeking in 2 culturally distinct American Indian reservation communities in the Southwest and Northern Plains.
Completed between 1997 and 2000, a cross-sectional probability sample survey.
General community.
Three thousand eighty-four (Southwest = 1446 and Northern Plains = 1638) members, aged 15-54 years, of 2 tribal groups living on or near their home reservations were randomly sampled from the tribal rolls. Response rates were 73.7% and 76.8% for the Southwest and Northern Plains tribes, respectively.Main Outcomes Measures The AI-SUPERPFP Composite International Diagnostic Interview, a culturally adapted version of the University of Michigan version of the Composite International Diagnostic Interview, to assess DSM-IV diagnoses and help-seeking.
Overall lifetime prevalence of AI-SUPERPFP DSM-IV disorders ranged from 35.7% for Southwest women to near 50% for both groups of men. Alcohol abuse and dependence were the most common disorders for men, with posttraumatic stress disorder most prevalent for women. Many of those with lifetime alcohol problems or posttraumatic stress disorder no longer met criteria for 12-month diagnoses. Significant levels of comorbidity were found between those with depressive and/or anxiety and substance disorders. Demographic correlates other than tribe, sex, and age were generally unrelated to disorder status. A majority of participants with lifetime disorders had sought help from mental health professionals, other medical personnel, or culturally traditional sources.
Alcohol disorders and posttraumatic stress disorder were more common in these American Indian populations than in other populations using comparable methods. Substantial comorbidity between depressive and/or anxiety and substance disorders suggests the need for greater coordination of treatment for comorbid disorders.
The aim of this paper is to describe and compare components of diagnostic delay (patient, primary care, referral, secondary care) for six cancers (breast, colorectal, lung, ovarian, prostate and non-Hodgkin's lymphoma), and to compare delays in patients who saw their GP prior to diagnosis with those who did not. Secondary data analysis of The National Survey of NHS Patients: Cancer was undertaken (65 192 patients). Breast cancer patients experienced the shortest total delays (mean 55.2 days), followed by lung (88.5), ovarian (90.3), non-Hodgkin's lymphoma (102.8), colorectal (125.7) and prostate (148.5). Trends were similar for all components of delay. Compared with patient and primary care delays, referral delays and secondary care delays were much shorter. Patients who saw their GP prior to diagnosis experienced considerably longer total diagnostic delays than those who did not. There were significant differences in all components of delay between the six cancers. Reducing diagnostic delays with the intention of increasing the proportion of early stage cancers may improve cancer survival in the UK, which is poorer than most other European countries. Interventions aimed at reducing patient and primary care delays need to be developed and their effect on diagnostic stage and psychological distress evaluated.
We examined cancer screening and risk factor patterns in California using 4 different statistical tabulations of American Indian and Alaska Native (AIAN) populations.
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.
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.
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.
Although white women have the highest incidence of breast cancer, African American, followed by Hispanic, American Indian/Alaskan Native, and Asian American or Pacific Islander, women have higher death rates from the disease. Timely initiation of treatment has been shown to improve survival, and may help to lessen the mortality differences among racial/ethnic groups.
The purpose of this study was to describe time delays in the initial diagnosis and treatment of primary breast carcinoma across diverse ethnic/racial groups. Data are from the Surveillance, Epidemiology, and End Results-Medicare database. Women in this study were diagnosed as having breast cancer between January 1, 1992, and December 31, 1999. Billing claims from outpatient and inpatient visits were used. A total of 49 865 female Medicare recipients 65 years and older were enrolled in the study. Racial/ethnic groups were compared in their diagnostic, treatment, and clinical delay (ie, women with a diagnostic and treatment delay).
African American women experienced the greatest diagnostic, treatment, and clinical delay. After controlling for other predictors, compared with white women, African American women had a 1.39-fold odds (95% confidence interval, 1.18-1.63) of diagnostic delay beyond 2 months, a 1.64-fold odds (95% confidence interval, 1.40-1.91) of treatment delay beyond 1 month, and a 2.24-fold odds (95% confidence interval, 1.75-2.86) of having a combined clinical delay.
In a population-based study, African American women experienced the most delays in initial diagnosis and initiation of breast cancer treatment, relative to women of other racial/ethnic subgroups. Despite the limitations of a claims database, the magnitude and direction of the findings are consistent across the research, suggesting the critical importance of reducing these delays.
As high-profile reviews have appeared and international interest has grown, sophisticated studies of the U.S. population continue to document racial and ethnic disparities in initiation of mental health care and in continuity of care. Many explanations focus on cultural factors: trust and treatment receptiveness, stigma, culturally distinctive beliefs about mental illness and mental health, culturally sanctioned ways of expressing mental health-related suffering and coping styles, and client preferences for alternative interventions and treatment-seeking pathways, as well as unresponsive programs and providers. The research itself has become more rigorous and informative, but it continues to lack theoretical focus and does not yet yield cumulative findings. Too few studies have addressed community and regional differences or differences between mental health treatment programs and systems, or considered mental health-related policies that are very likely linked to disparities. Theoretically well-formulated studies on representative samples can provide a comprehensive explanation of access disparities in cultural and culture-related terms that inform a broad-based plan of remedial intervention.
A common concern when faced with multivariate data with missing values is whether the missing data are missing completely at random (MCAR); that is, whether missingness depends on the variables in the data set. One way of assessing this is to compare the means of recorded values of each variable between groups defined by whether other variables in the data set are missing or not. Although informative, this procedure yields potentially many correlated statistics for testing MCAR, resulting in multiple-comparison problems. This article proposes a single global test statistic for MCAR that uses all of the available data. The asymptotic null distribution is given, and the small-sample null distribution is derived for multivariate normal data with a monotone pattern of missing data. The test reduces to a standard t test when the data are bivariate with missing data confined to a single variable. A limited simulation study of empirical sizes for the test applied to normal and nonnormal data suggests that the test is conservative for small samples.
Cancer mortality among indigenous peoples is increasing, but these populations commonly under use cancer-screening services. This systematic review explores knowledge, attitudes, and behaviours towards cancer screening among indigenous peoples worldwide. Searches of major bibliographic databases identified primary studies published in English up to March, 2014; of 33 eligible studies, three were cohort studies, 27 cross-sectional, and three case-control. Knowledge of and participation in screening was greater for breast cancer than for other cancers. Indigenous peoples tended to have less knowledge, less favourable attitudes, and a higher propensity to refuse screening than non-indigenous populations. The most common factors affecting knowledge, attitudes, and behaviours towards cancer screening included access to screening, knowledge about cancer and screening, educational attainment, perceived necessity of screening, and age. Greater understanding of knowledge, attitudes, and behaviours towards cancer screening in diverse indigenous cultures is needed so that culturally appropriate cancer prevention programmes can be provided.
From the reviews of the First Edition."An interesting, useful, and well-written book on logistic regression models . . . Hosmer and Lemeshow have used very little mathematics, have presented difficult concepts heuristically and through illustrative examples, and have included references."—Choice"Well written, clearly organized, and comprehensive . . . the authors carefully walk the reader through the estimation of interpretation of coefficients from a wide variety of logistic regression models . . . their careful explication of the quantitative re-expression of coefficients from these various models is excellent."—Contemporary Sociology"An extremely well-written book that will certainly prove an invaluable acquisition to the practicing statistician who finds other literature on analysis of discrete data hard to follow or heavily theoretical."—The StatisticianIn this revised and updated edition of their popular book, David Hosmer and Stanley Lemeshow continue to provide an amazingly accessible introduction to the logistic regression model while incorporating advances of the last decade, including a variety of software packages for the analysis of data sets. Hosmer and Lemeshow extend the discussion from biostatistics and epidemiology to cutting-edge applications in data mining and machine learning, guiding readers step-by-step through the use of modeling techniques for dichotomous data in diverse fields. Ample new topics and expanded discussions of existing material are accompanied by a wealth of real-world examples-with extensive data sets available over the Internet.
Objective:
To assess colorectal cancer screening (CRCS) prevalence and psychosocial correlates of CRCS among Latinos in South Texas.
Method:
Using multivariable analyses, we examined the association of perceived susceptibility, self-efficacy, pros and cons, subjective norms, knowledge and fatalism on CRCS among 544 Latinos (50 years and older).
Results:
In this socioeconomically disadvantaged population, 40% had never heard of any CRCS test, only 34% reported ever completing any type of CRCS, and only 25% were adherent to CRCS guidelines. Insurance status, gender, perceived cons, CRCS self-efficacy, and CRCS norms were significantly associated with CRCS.
Conclusion:
CRCS interventions in this population should focus on improving access, increasing self-efficacy and perceived norms, and decreasing negative perceptions of CRCS.
A common concern when faced with multivariate data with missing values is whether the missing data are missing completely at random (MCAR); that is, whether missingness depends on the variables in the data set. One way of assessing this is to compare the means of recorded values of each variable between groups defined by whether other variables in the data set are missing or not. Although informative, this procedure yields potentially many correlated statistics for testing MCAR, resulting in multiple-comparison problems. This article proposes a single global test statistic for MCAR that uses all of the available data. The asymptotic null distribution is given, and the small-sample null distribution is derived for multivariate normal data with a monotone pattern of missing data. The test reduces to a standard t test when the data are bivariate with missing data confined to a single variable. A limited simulation study of empirical sizes for the test applied to normal and nonnormal data suggests that the test is conservative for small samples.
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.
BACKGROUND
Based on the lack of published information regarding Native Americans and cancer and the success of previous meetings, the Network for Cancer Control Research among American Indian and Alaska Native Populations (NCCR-AIANP) and the Native Hawaiian and American Samoan Cancer Research Network determined there was sufficient need to have annual national Native American cancer conferences.METHODS
The NCCR-AIANP, the Native Hawaiian and American Samoan Cancer Research Network, and the AMC Native American Cancer Research Program collaborated to organize the third national Native American cancer conference, “Native American Cancer Conference III: Risk Factors, Outreach and Intervention Strategies.”RESULTSThe conference was held in Seattle, Washington, June 16–19, 1995. It provided a forum for scientific discussion and dissemination of information related to cancer prevention and control.CONCLUSIONS
Conference participants benefited from the topics presented and the diversity of the audience members. There continues to be a need to share what is happening in cancer research with this unique population and to address new issues of concern. A cancer conference seems to be a useful mechanism to provide such an opportunity. Cancer 1996;78:1527-32.
BACKGROUND. The American Cancer Society, the Centers for Disease Control and Prevention, the National Cancer Institute, and the North American Association of Central Cancer Registries collaborate annually to provide updated information on cancer occurrence and trends in the U.S. The 2007 report features a comprehensive compilation of cancer information for American Indians and Alaska Natives (AI/AN).
METHODS. Cancer incidence data were available for up to 82% of the U.S. population. Cancer deaths were available for the entire U.S. population. Long-term (1975 through 2004) and fixed-interval (1995 through 2004) incidence and mortality trends were evaluated by annual percent change using regression analyses (2-sided P <.05). Cancer screening, risk factors, socioeconomic characteristics, incidence data, and stage were compiled for non-Hispanic whites (NHW) and AI/AN across 6 regions of the U.S.
RESULTS. Overall cancer death rates decreased by 2.1% per year from 2002 through 2004, nearly twice the annual decrease of 1.1% per year from 1993 through 2002. Among men and women, death rates declined for most cancers. Among women, lung cancer incidence rates no longer were increasing and death rates, although they still were increasing slightly, were increasing at a much slower rate than in the past. Breast cancer incidence rates in women decreased 3.5% per year from 2001 to 2004, the first decrease observed in 20 years. Colorectal cancer incidence and death rates and prostate cancer death rates declined, with colorectal cancer death rates dropping more sharply from 2002 through 2004. Overall, rates for AI/AN were lower than for NHW from 1999 through 2004 for most cancers, but they were higher for cancers of the stomach, liver, cervix, kidney, and gallbladder. Regional analyses, however, revealed high rates for AI/ AN in the Northern and Southern Plains and Alaska. For cancers of the breast, colon and rectum, prostate, and cervix, AI/AN were less likely than NHW to be diagnosed at localized stages.
CONCLUSIONS. For all races/ethnicities combined in the U.S., favorable trends in incidence and mortality were noted for lung and colorectal cancer in men and women and for breast cancer in women. For the AI/AN population, lower overall cancer incidence and death rates obscured important variations by geographic regions and less favorable healthcare access and socioeconomic status. Enhanced tobacco control and cancer screening, especially in the Northern and Southern Plains and Alaska, emerged as clear priorities. Cancer 2007;110:2119–52. Published 2007 by the American Cancer Society.
Colorectal cancer (CRC) is a significant cause of mortality among Asian Americans and Pacific Islanders (AAPIs), yet studies have consistently reported lower CRC screening rates among AAPIs than among non-Latino Whites and African Americans. Moreover, existing research tends to aggregate AAPIs as one group when reporting CRC screening, masking the disproportionate burden in cancer screening that exists across AAPI groups.
This study examines differences in CRC screening rates in both aggregated and disaggregated AAPI groups as compared with non-Latino Whites in order to identify the most vulnerable AAPI subgroups in terms of obtaining CRC screening. This study utilizes merged data from the 2001, 2003, and 2005 California Health Interview Survey (CHIS), specifically the data pertaining to adults aged 50 and older (n = 52,491) from seven AAPI groups (Chinese, Japanese, Korean, Filipino, South Asian, Vietnamese, and Pacific Islander) and non-Latino Whites. Andersen's Behavioral Model of Health Services Use was utilized to select potential confounders to racial/ethnic differences in CRC screening.
When AAPI groups were considered as an aggregate, their CRC screening rate (46.8%) was lower than that of non-Latino Whites (57.7%). When AAPI groups were disaggregated, further disparity was noted: Koreans (32.7%) showed the lowest CRC screening rate, whereas Japanese (59.8%) had the highest. When the influence of potential predisposing, enabling, and need confounders was adjusted, Koreans, Filipinos, and South Asians were found to have a lower likelihood than non-Latino Whites to undergo CRC screening. Comparisons among AAPI subgroups further revealed that Filipinos, Koreans, Pacific Islanders, and South Asians were less likely than Chinese, Japanese, and Vietnamese to receive CRC screening.
These results highlight the importance of identifying differences in CRC screening behavior among disaggregated AAPI subgroups in order to help health professionals and policy-makers prioritize which AAPI subgroups need the most urgent interventions in terms of CRC screening promotion.
Native Americans from the Northern Plains have the highest age-adjusted cancer mortality compared to Native Americans from any other region in the U.S.
This study examined the utilization and determinants of cancer screening in a large sample of Native Americans from the Northern Plains.
A survey was administered orally to 975 individuals in 2004-2006 from three reservations and among the urban Native-American community in the service region of the Rapid City Regional Hospital. Data analysis was conducted in 2007-2008.
Forty-four percent of individuals reported ever receiving any cancer screening. Particularly low levels were found for breast, cervical, prostate, and colon cancer screening. In multivariate analyses, the strongest determinant of receiving cancer screening overall or cancer screening for a specific cancer site was recommendation for screening by a doctor or nurse. Other determinants associated with increased likelihood of ever having cancer screening included older age, female gender, and receiving physical exams more than once a year. Increased age was a determinant of breast cancer screening, and receiving physical exams was associated with cervical cancer screening.
Cancer screening was markedly underutilized in this sample of Native Americans from the Northern Plains. Future research should evaluate the potential for improving cancer screening.
Little progress has been made over the last 40 years to eliminate the racial/ethnic differences in incidence, morbidity, avoidable suffering, and mortality from cancer that result from factors beyond genetic differences. More effective strategies to promote equity in access and quality care are urgently needed because the changing demographics of the United States portend that this disparity will not only persist but significantly increase. Such suffering is avoidable. The authors posit that culture is a prime factor in the persistence of health disparities. However, this concept of culture is still poorly understood, inconsistently defined, and ineffectively used in practice and research. The role of culture in the causal pathway of disparities and the potential impact of culturally competent cancer care on improving cancer outcomes in ethnic minorities has, thus, been underestimated. In this article, the authors provide a comprehensive definition of culture and demonstrate how it can be used at each stage of the cancer care continuum to help reduce the unequal burden of cancer. The authors conclude with suggestions for clinical practice to eliminate the disconnection between evidence-based, quality, cancer care and its delivery to diverse population groups.
The American Cancer Society, the Centers for Disease Control and Prevention (CDC), the National Cancer Institute (NCI), and the North American Association of Central Cancer Registries (NAACCR) collaborate annually to provide updated information regarding cancer occurrence and trends in the United States. This year's report includes trends in colorectal cancer (CRC) incidence and death rates and highlights the use of microsimulation modeling as a tool for interpreting past trends and projecting future trends to assist in cancer control planning and policy decisions.
Based on the lack of published information regarding Native Americans and cancer and the success of previous meetings, the Network for Cancer Control Research among American Indian and Alaska Native Populations (NCCR-AIANP) and the Native Hawaiian and American Samoan Cancer Research Network determined there was sufficient need to have annual national Native American cancer conferences.
The NCCR-AIANP, the Native Hawaiian and American Samoan Cancer Research Network, and the AMC Native American Cancer Research Program collaborated to organize the third national Native American cancer conference, "Native American Cancer Conference III: Risk Factors, Outreach and Intervention Strategies."
The conference was held in Seattle, Washington, June 16-19, 1995. It provided a forum for scientific discussion and dissemination of information related to cancer prevention and control.
Conference participants benefited from the topics presented and the diversity of the audience members. There continues to be a need to share what is happening in cancer research with this unique population and to address new issues of concern. A cancer conference seems to be a useful mechanism to provide such an opportunity.
Key findings on cancer incidence and mortality are presented for five racial and ethnic groups in the United States--African Americans, American Indians, Asians and Pacific Islanders, Hispanics, and whites. Information on the prevalence of cancer risk factors and screening examinations among these racial and ethnic groups is also included.
Cancer is a major public health concern in American Indian and Alaska Native (AI/AN) communities. However, information on the incidence of cancer is lacking for this group. The purpose of this study is to report cancer incidence patterns for the U.S. AI/AN population.
Age-adjusted annual cancer incidence rates for 1992 through 1999 were calculated for 12 Surveillance, Epidemiology and End Results (SEER) areas, representing a sample (42%) of the U.S. AI/AN population. Trends in cancer incidence rates for the AI/AN sample were determined using standard linear regression of log-transformed rates and were compared to those of the U.S. white population.
The top five incident cancers (from highest to lowest) among AI/AN males were prostate, lung and bronchus, colon and rectum, kidney and renal pelvis, and stomach cancers. Among AI/AN women, cancers of the breast, colon and rectum, lung and bronchus, endometrium, and ovary ranked highest. Four sites where cancer incidence rates are greater for AI/ANs than for whites include gallbladder (the AI/AN rate was 4.1 times the rate for white males and 2.6 times the rate for white females), liver and intrahepatic bile duct cancers (1.3 times for males and 2.3 times for females), stomach (1.2 times for males and 1.5 times for females), and kidney and renal pelvis (1.03 times for males and 1.07 times for females). The data show increasing trends for AI/AN males and females and declining trends for white males and females for colorectal, stomach, and pancreatic cancers and leukemia. Similar differences between AI/AN rates and white rates were found for urinary bladder cancers in males and gallbladder cancer in females.
Analysis of SEER data allowed for the determination of disparities in cancer incidence between a sample of the U.S. AI/AN population and the white population. The findings of this study provide baseline information necessary for developing cancer prevention and intervention strategies specific to the AI/AN population to address these cancer disparities.
National estimates of cancer mortality indicate relatively low rates for American Indians (AIs) and Alaska Natives (ANs). However, these rates are derived from state vital records in which racial misclassification is known to exist.
In this cross-sectional study of cancer mortality among AIs and ANs living in counties on or near reservations, the authors used death records and census population estimates to calculate annualized, age-adjusted mortality rates for key cancer types for the period 1996-2001 for 5 geographic regions: East (E), Northern Plains (NP), Southwest (SW), Pacific Coast (PC), and Alaska (AK). Mortality rate ratios (MRRs) and 95% confidence intervals (95% CIs) also were calculated to compare rates with those in the general United States population (USG) for the same period. To examine temporal trends, MRRs for 1996-2001 were compared with MMRs for 1990-1995.
The overall cancer mortality rate was lower in AIs and ANs (165.6 per 100,000 population; 95% CI, 161.7-169.5) than in the USG (200.9 per 100,000 population; 95% CI, 200.7-201.2). In the regional analysis, however, cancer mortality was higher in AK (MRR=1.26; 95% CI, 1.17-1.36) and in the NP (MMR=1.37; 95% CI, 1.31-1.44) than in the USG. In both regions, the excess mortality was attributed to cancer of the lung, colorectum, liver, stomach, and kidney. In the SW, the mortality rate for cancer of the liver and stomach was higher than the rate in the USG, in contrast with that region's nearly 4-fold lower mortality rate for lung cancer (MRR=0.23; 95% CI, 0.19-0.27). Rates of cervical cancer mortality were higher among AIs and ANs (MRR=1.35; 95% CI, 1.13-1.62), notably in the NP and SW. Rates of breast cancer mortality generally were lower (MRR=0.60; 95% CI, 0.55-0.66), notably in the PC, SW, and E. Cancer mortality increased by 5% in AIs and ANs (MRR for 1996-2001 compared with 1990-1995: 1.05; 95% CI, 1.01-1.08), whereas it decreased by 6% in the USG (MMR=0.94; 95% CI, 0.94-0.94).
Regional data should guide local cancer prevention and control activities in AIs and ANs. The disparity in temporal trends in cancer mortality between AIs and ANs and the USG gives urgency to improving cancer control in this population.
This commentary summarizes quality of life (QOL) research priorities gleaned from three sources: (1) Native survivors who are participating as working group members to develop QOL education modules, (2) enrolled members of the "National Native American Cancer Survivors' Support Network," and (3) participants of the "1st National Native American Cancer Survivors'/Thrivers' Conference."
Criteria for including issues within this summary are that the issue was raised by 8 or more different survivors from at least 2 of the data collection sources.
The research priorities identified insufficient or lack of access to quality care and resources.
Nine research issues were prioritized by Native cancer survivors.
The purpose of this research was to understand the cultural meanings of cancer among American Indian women from Northern Plains tribes living in western South Dakota and their experiential view of breast and cervical cancer screening.
Using an exploratory design, a purposive sample of 28 women, 35-75 years of age, were recruited into three Talking Circles.
Talking Circle and focus group methodology, combined with Affonso's Focus Groups Analytic Schema, were used to generate contextual data sets including thematic findings.
Ten themes emerged indicating interrelationships between cultural traditions and health structures of care. The themes provided a unique perspective for conceptualizing women's experiences with breast and cervical cancer screening.
Incorporating women's cultural experiences into screening services is necessary to address clinical and policy challenges for reducing breast and cervical cancer mortality among American Indian women. Findings from this research will be used to guide a future study investigating breast-screening patterns related to mammography adherence and development of interventions specific to American Indian women.
This study adapts Andersen's Behavioral Model to determine if health sector market conditions affect vulnerable subgroups' use of alcohol, drug, and mental health services (ADM) differently than the general population, focusing specifically on community-level predisposing and enabling characteristics.
Wave 2 data (2000-2001) from the Health Care for Communities study, supplemented with cases from wave 1 (1997-1998), were merged with area characteristics taken from Census, Area Resource File (ARF), and other data sources.
The study used four-level hierarchical logistic regression to examine access to ADM care from any provider and specialty ADM access. Interactions between community-level predisposing and enabling vulnerability characteristics with individual race/ethnicity, age, income category, and insurance type were explored.
Nonwhites, the poor, uninsured, and elderly had lower likelihoods of service use, but interactions between race/ethnicity, income, age and insurance status with community-level vulnerability factors were not statistically significant for any service use. For ADM specialty care, those with Medicare, Medicaid, private fully managed, and private partially managed insurance, the likelihood of utilization was higher in areas with higher HMO penetration. However, for those with other insurance or no insurance plan, the likelihood of utilization was lower in areas with higher HMO penetration.
Community-level enabling factors explain part of the effect of disadvantaged status but, with the exception of the effect of HMO penetration on the relationship between insurance and specialty care use, do not modify any of the residual individual-level effects of disadvantage. Interventions targeting both structural and individual levels may be necessary to address the problem of health disparities. More research with longitudinal data is necessary to sort out the causal direction of social context and ADM access outcomes, and whether policy interventions to change health sector market conditions can shift ADM treatment utilization.
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