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    Awarded Grants
    American Indian Breast Cancer Prevention: Turning Knowledge into Action

    Scientific Abstract:
    American Indian Breast Cancer Prevention: Turning Knowledge into Action Background. The American Indian and Alaska Native (AIAN) population is increasing at about 1.8% a year. According to the 2000 US Census, 4.1 million US residents reported being AIAN alone or in combination with one or more races, with 2.2 million reporting AIAN alone. More AIAN reside in California (CA) than any other single state in the US with 627,600 people. There are 107 federally recognized tribes in CA more than any other state, except Alaska. In addition, the majority of AIAN living in California are from tribes outside of California, all with diverse breast cancer morbidity and mortality. Although cancer incidence is decreasing among white ethnic groups, cancer continues to increase among AIAN and is an understudied issue among Native populations. Native cancer patients continue to have the poorest survivorship from cancer five years after diagnosis when compared with other minority, poor, and medically underserved populations. Accurate statistical and epidemiologic data is needed for professional public health action, such as program planning and resource allocation. The growing cancer dilemma is often missed by AIAN communities unlike alcohol, violence, diabetes and other well promoted and widely-dispersed conditions. Although the five-year relative survival from cancer continues to be among the poorest for AIAN in comparison to all other ethnic and racial groups in the U.S, cancer still has not been set as a priority at the community level. If we want to turn around the problem of early diagnosis and treatment in the early stages, then community mobilization (i.e. tribal government, state, county, grassroots) must take place. Objective. The study proposes to provide to tribes, and tribal and urban Indian organizations, current breast cancer epidemiologic data through user-friendly mechanisms and support local level breast health infrastructure and capacities. Specific Aims. The study will: (a) examine breast cancer epidemiologic data, categorized into two sub-groups: urban and rural AIAN who live in California; (b) implement and evaluate five training workshops with ongoing technical assistance, tailored to the AIAN community: (b1) Introduction to Breast Cancer Health Data, (b2) Performing Community-based Breast Cancer Needs Assessment, (b3) Breast Cancer Media Advocacy, (b4) On-line internet based data query systems; (b5) develop and test a training module on breast cancer social marketing; and (c) support the development of communications tools developed by a cohort of community scholars (e.g. fact sheets). The outcomes of this study will be a scientific report, a journal article, and scientific presentations. Design. A secondary analysis of CHIS, the largest state-level health survey ever conducted, will provide urban and rural breast cancer information that will be used to develop and provide Popular Education theory-based training workshops. In 2000/2001 the CHIS randomly surveyed by telephone over 55,000 households throughout the state, focusing on public health and access to health care, and due to the National Cancer Institute supplement, the data is particularly strong in cancer. For the purposes of this project, the CHIS is unique in its ability to provide information about AIAN because the survey instrument underwent an AIAN cultural and linguistic review and because it has the largest sample of AIAN in the history of the US, an unweighted total of over 3,000. Advanced social marketing technical assistance will be provided to the community scholars program to assist them in their local efforts, for example, to promote mammography screening in their community or to increase awareness of the need for tribes to provide access to treatment for breast cancer. We will provide baseline assessment of participants and do periodic follow- up assessments in all phases of the program. Benefits. CA AIAN communities have never had access to quality data on breast cancer from which to build health programming. Unfortunately, past data has been problematic. Even the limited data available were fraught with error, particularly racial misclassification. This essential study is positioned to provide very recent never before available breast health data, analyzed by a Native American team poised to work directly with interested local communities, tailoring the data to the community and mobilizing the communities toward breast health programming. This level of technical assistance is critical to address the increasing health disparities that we see among Native American women. This program democratizes access to breast health data, especially analytic data, with the intention of providing health advocates with the information they need to make change in their local communities.

    Lay Abstract:
    American Indian Breast Cancer Prevention: Turning Knowledge into Action Background. According to the 2000 US Census, 4.1 million US residents reported being American Indian and Alaska Native (AIAN). More AIAN reside in California (CA) than any other state in the US with 627,600 people. There are 107 federally recognized tribes in CA. The majority of AIAN living in California are from tribes outside of California, all with diverse breast cancer morbidity and mortality. Although cancer incidence is decreasing among white ethnic groups, cancer continues to increase among AIAN and is an understudied issue among Native populations. Native cancer patients continue to have the poorest survivorship from cancer five years after diagnosis when compared with other minority, poor, and medically underserved populations. Accurate statistical data is needed for public health action, such as program planning and resource allocation. Although the five-year relative survival from cancer continues to be among the poorest for AIAN in comparison to all other ethnic and racial groups in the U.S, cancer still has not been set as a priority at the community level. If we want to turn around the problem of early diagnosis and treatment in the early stages, then community mobilization must take place. Objective. The study proposes to provide to tribes, and tribal and urban Indian organizations, user-friendly breast cancer information and to support local level breast health infrastructure. Specific Aims. The study will: (a) examine breast cancer epidemiologic data, for urban and rural AIAN who live in California; (b) implement and evaluate five training workshops with ongoing technical assistance, tailored to the AIAN community: (b1) Introduction to Breast Cancer Health Data, (b2) Performing Community-based Breast Cancer Needs Assessment, (b3) Breast Cancer Media Advocacy, (b4) On-line internet based data query systems; (b5) develop and test a training module on breast cancer social marketing; and (c) support the development of communications tools developed by a cohort of community scholars (e.g. fact sheets). The outcomes of this study will be a scientific report, a journal article, and scientific presentations. Design. A data analysis of CHIS, the largest state-level health survey ever conducted, will provide urban and rural breast cancer information that will be used to develop and provide theory-based training workshops. Advanced social marketing technical assistance will be provided to the community scholars to assist them in their local efforts, for example, to promote mammography screening in their community or to increase awareness of their tribal councils of the need to pursue funding for breast cancer prevention. We will provide baseline assessment/evaluation of trainees and do periodic follow- up assessments/evaluation in all phases of the program. Benefits. CA AIAN communities have never had access to quality data on breast cancer from which to build health programming. This essential study is positioned to provide very recent never before available breast health data. The data will be analyzed by a Native American research and public service team poised to work directly with interested local communities, tailoring the data to the community and mobilizing the communities toward breast health programming. This level of technical assistance is critical to address the increasing health disparities that we see among Native American women. This program democratizes access to breast health data, especially research data, with the intention of providing health advocates with the information they need to make change in their local communities.