Building Relationships with Native American Populations

1
Building Relationships with Native American
Populations

• American Indian / Alaska Native (AIAN) Cultural
  Workshop for Public Health Professionals CDC
  U57 DP001138

Brenda Seals, PhD (Eastern Band Cherokee) Linda
Burhansstipanov, DrPH (Cherokee Nation of
Oklahoma) Native American Cancer Research 393
South Harlan Street, suite 125 Lakewood, CO
80226-3571 303-325-3377 fax
303-495-3040 http//www.NatAmCancer.org
2
Please turn off your cell phones or switch them
to vibrate mode
3
Acknowledgments

• Selected segments of these slides were created or
  used with permission from the following Natives

• Lydia Hubbard-Pourier
• Lisa Kerfoot
• Noel Pingatore
• Lauren Tancona
• Dean Seneca
• Pamela Iron
• Roberta Paisano
• and non Native friend and colleague, David Espey

• Carolee Dodge Francis
• Phyllis Pettit Nassi
• Arlene Wahwasuck
• Celeste Whitewolf
• Delight Satter
• Nellie Sandoval
• Tinka Duran
• DeAnna Fay Finifrock
• Carmelita Wamego Skeeter

4
Audience Response System (ARS)

• (the keypads)

5
(No Transcript)
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Audience Response System (ARS) keypads

• This is how we vote on different items and issues
• The keypads are anonymous (we dont know who
  uses which keypad) but we would like you to
  write down the number of the keypad you are using
  so that you use the same one throughout the
  workshop
• The keypads work best if placed on your desk so
  that you can press your choice/answer firmly
• You do not need to point the keypad (like a TV
  remote control)

7
Audience Response System (ARS) keypads

• You will see a counter in the bottom left-hand
  corner of the slide to see how many people have
  voted on any item
• You can change your vote up until the final vote
  has been collected and the slide advances to show
  the total
• A summary of bar graphs appears on the screen
  after the votes are completed for most items so
  that everyone can see the total tallies
• The summary bar graph will not appear for
  pre-workshop knowledge items or workshop
  satisfaction

8
Demographic items4 items
9
Are you ___?

1. Male
2. Female
3. Dont want to answer

gender
0 / 175
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About how old are you?

1. 81 and older
2. 65-80
3. 50-64
4. 41-49
5. 31-40
6. 21-30
7. 13-20
8. Under 12
9. Dont want to answer

brthyr5
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What is your primary race or ethnicity?

1. American Indian / Alaska Native
2. Canadian Aboriginal
3. New Zealand Maori
4. Pacific Islander
5. Asian
6. South Asian
7. African-American
8. Non-Hispanic white (Caucasian)
9. Hispanic / Latino / Chicano
10. Dont know / Dont want to answer

race_eth2
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How much schooling have you had?

1. Elementary (kindergarten through grade 6 / grade
   school)
2. 7th , 8th , or 9th grade (middle school)
3. 10, 11, or 12th grade (no degree)
4. High school graduate / GED
5. Technical school /apprentice training
6. Some college (no degree)
7. College AA degree
8. College BA, BS degree
9. Masters degree
10. Doctorate or more

Educ3
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Pre-Training Knowledge10 Items
14
What region of Indian Country has the highest
deaths for Native women from breast cancer?

1. Alaska
2. East
3. Northern Plains
4. Southern Plains
5. Southwest
6. Pacific Coast
7. Dont know / Not sure

b1_BC_NDN
0 / 175
15
What is the most significant factor contributing
to racial misclassification for AIAN data?

1. AIAN is a response category for too many
   healthcare facilities
2. Tribal enrollment blood quantum changes
3. Lack of tribal identification
4. Use of Spanish surnames
5. Dont know / not sure

d1_misclas
0 / 175
16
Which of the following is the most important
factor that affects the success of your Native
health program?

1. Administrative Director advocates for the program
2. Reservations supporting screening for tribal
   members who live in urban areas
3. Large numbers of urban American Indians living
   throughout the county
4. Urban American Indians reliance on traditional
   Indian medicine in place of western medicine
5. Dont know / not sure

st1_factor
0 / 175
17
What is one example of a message that is
effective in upper middle class white community,
but less effective with Native Americans?

1. Have a mammogram to show your daughters how a
   well woman behaves
2. Have a mammogram so that you can live to enjoy
   your grandchildren
3. Have a mammogram to be a well woman for your
   family
4. You need to get a mammogram every year
5. Dont know / not sure

st1_Mess-3
0 / 175
18
Which of the following was the most effective
Native recruitment strategy to screening?

1. Colorectal screening held on separate days than
   other cancer tests
2. Native-specific Public Service Announcements
   published in the Times newspaper
3. One-on-one delivery with culturally specific
   education
4. Native celebrities promoting CRC screening over
   the radio
5. Dont know / not sure

st1_recruit
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19
Which of the following is a FALSE statement about
Native messages?

1. Non-native verbal patterns frequently include
   talking on top of one anothers words.
2. Native rate of speech is comparable to middle
   class white womans rate of speech
3. Needs to address all wellness, not just limited
   to cancer
4. Use of the phrase, breast cancer in outreach
   messages can usually be effectively replaced with
   breast health
5. Dont know / not sure

st1_Mess-2
0 / 175
20
Which of the following is a criterion for
successful tribal education materials?

1. Includes Indian-specific jargon
2. Has been pretested for local tribal relevance
3. Excludes storytelling
4. Uses 6 different types of characters on the page
   (font style, bold)
5. Dont know / not sure

st1_Mat-2
0 / 175
21
Which of the following is a lesson learned from
the NACR Navigator (Native Sisters) program since
1994?

1. The Native Sisters were asking the patient the
   wrong questions when interacting with the doctor
2. Only women with high school education or less
   make effective navigators
3. On average, about 30 hours of training was
   necessary for the navigators to feel comfortable
   working with the community
4. Navigation programs only work if they are based
   out of a healthcare clinic
5. Dont know / not sure

nv1_lesson
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22
Which of the following helped make the NACR
Navigator (Native Sisters) program successful?

1. The Navigators were all cancer survivors who
   volunteered their time to work for the program
2. Male Navigators (Native Brothers) helped the male
   family members understand and support their
   partners
3. Providing supplemental auto insurance coverage
   allowed the Native Sisters to transport the
   patients to screenings
4. Once the poverty barriers to the woman taking
   part in screening were addressed, the other
   issues were easily resolved
5. Dont know / not sure

nv1_succ-1
0 / 175
23
Which of the following is the best source of
Native-specific cancer information?

1. Association for American Indian Physicians
2. National Indian Health Board
3. The Native CIRCLE (Mayo Clinic)
4. The EARTH Study (Black Hills)
5. American Indian Science and Engineering Society
   (AISES)
6. Dont know / not sure

st1_resou1
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Workshop Objectives By the end of the session,
the participant will be able to

1. Summarize the need for culturally appropriate
   actions based on the historical perspective of
   Native American populations
2. Identify health service systems and delivery
   methods available to Native American populations
   (includes effective messaging, materials
   development and literacy issues

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Workshop Objectives By the end of the session,
the participant will be able to

1. Identify culturally sensitive communication
   methods and techniques for Native American
   outreach efforts.
2. Identify culturally sensitive communication
   methods and techniques for Native American
   outreach efforts.

NOTE some issues will be repeated throughout the
day to emphasize their importance
26
Overarching Objectives, At the end of this
workshop, participants will be able to

1. Summarize the need for culturally appropriate
   actions based on the historical perspective of
   Native American populations.
2. Identify heath service systems and delivery
   methods available to Native American populations.
3. Identify culturally sensitive communication
   methods and techniques for Native American
   outreach efforts.
4. Apply effective strategies and messaging for
   working with Native American populations.

27
Objective 1 by the end of this session, the
participant will be able to

1. Summarize the need for culturally appropriate
   actions based on the historical perspective of
   Native American populations

28
2000 U.S. Census Numbers of AIAN

• American Indian and Alaska Native (AIAN)
  population is increasing at about 1.8 a year
• 2.2 million reported AIAN Race alone (4.1
  million AIAN alone or in combination with other
  race(s)

28 increase in AIAN alone since 1990 Census
29
2000 U.S. Census Where AIAN Live
Note the areas of elevated number of AIANs
Places unequal burden on states that have high
numbers of AIANs

• 43 of AIAN lived in the West
• 31 lived in the South
• 17 lived in the Midwest
• 9 in the Northeast
• Approximately 64 live in urban areas

30
Without looking at your handout, which American
Indian Tribe has more than 50,000 enrolled
members?

1. Sioux
2. Choctaw
3. Hopi
4. Seminoles
5. Dont know / Not sure

gt50,000 AIAN
0 / 175
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2000 U.S. Census Largest Tribal Nations

• American Indian tribes with 50,000 or more
  individuals

• Cherokee
• Navajo
• Choctaw
• Blackfeet
• Chippewa
• Muscogee
• Apache
• Lumbee

32
Without looking at your handout, which State has
the highest number of American Indians and Alaska
Natives?

1. California
2. Alaska
3. Arizona
4. New Mexico
5. Dont know / Not sure

State AIAN
0 / 175
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2000 U.S. Census States with gt100,000

• States with more than 100,000 AIAN residents.

• New York
• Washington
• North Carolina
• Michigan
• Alaska
• Florida

• California (628,000)
• Oklahoma (392,000)
• Arizona
• Texas
• New Mexico

Combined, these states have 62 of the total
AIAN population
34
2000 U.S. Census States with 1.5

• Number of states where the AIAN population as a
  proportion of the total population exceeded the
  national average of 1.5

• Alaska (19 percent)
• Oklahoma (11 percent) Note Racial
  misclassification
• New Mexico (10 percent)
• The other 16 states AZ, CA, CO, ID, MT, NV, HI,
  OR, UT, WA, WY, KS, MN, ND, SD, NC

35
2000 U.S. Census Age, Income, Poverty,
Education
Thank you, Dean Seneca, MPH, Office of Tribal
Affairs, ATSDR, CDC, for sharing this slide
36
Census 2000 Federally and State Recognized
Tribal Nations

• More than 560 federally recognized tribal Nations
  
• In addition, several hundred more are state
  recognized, but not federally recognized
• State recognized tribes are not eligible for IHS,
  most federally supported education programs, etc.

37
2000 Census Health Insurance

• Less than half of AIANs living in urban areas
  have private health insurance
• Most AIANs (as well as non-Natives) erroneously
  call IHS health insurance, but it is NOT
• AIANs self-report having health insurance on
  surveys based on error of calling IHS health
  insurance

38
Urban Indian Health Organizations Nationwide (34)
2 of the total IHS budget is for urbans half of
this is for mental health/drugs

Seattle Indian Health Board Urban Indian Health
Institute Director--Ralph Forquera
39
Uniqueness of AIAN History
All or almost all cultures throughout history
experience some form of

• Violence
• Domination
• Slavery
• Annihilation

• These cultures all have something unique about
  their experiences and survival

Todays training is to explain what some of
those unique events are within the Natives
story
40
Interactive ActivityCoyote and Bear
41
Coyote / Bear Activity (6 items)
The Oglala Lakota (Sioux) are among the tribal
Nations with 50,000 or more individuals
Coyote
US 2000 Census documents about 2.2 million AIAN
alone (i.e., not mixed heritage).
Bear
42
Coyote / Bear Activity (6 items)
The state with the highest proportion of AIANs is
Alaska
Bear
Twice as many AIANs live below the poverty rate
than do people from other races
Bear
43
Coyote / Bear Activity (6 items)
Because most urban Indians have private health
insurance, they are usually able to get cancer
treatment in the city.
Coyote
The state with the highest number of AIANs is
Arizona
Coyote
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Introduction
What is an Indian and how do we differ from
other medically under-served communities? American
Indian AI Alaska Native AN
45
Tribal Sovereignty

• Tribes are governments that have authority with
  regard to their members
• Tribes existed prior to the U.S.
• Tribal Nations made treaties with colonial
  powers, states, and the U.S.
• Nations within a nation

46
Government-to-Government Relationship

• Tribes are treated as governments by the federal
  government.
• Approval Protocols
• Tribal consultation means federal agency must
  meet with all 564 federally recognized tribal
  Nations

• Cannot meet with selected Nations or groups and
  meet the legal definition of consultation

47
Federal Definition of AIAN

• The term Indian as used in secs. 461-466,
  470-473, and 475, 476-479 of this title shall
  include all persons of Indian descent who are
  members of any recognized Indian Tribe now under
  Federal jurisdiction and all persons who are
  descendents of such members who were, on June 1,
  1934, residing within the present boundaries of
  any Indian reservation, and shall further include
  all other persons of one-half or more Indian
  bloodEskimos and other aboriginal peoples of
  Alaska shall be considered Indians. Indian
  Reorganization Act, June 18, 1934, c. 576, 19,
  48 Stat. 988.

48
Opinion Which terminology is correct?

1. American Indian
2. Native American
3. Indigenous People
4. First Nations
5. First Peoples
6. Dont know / not sure

Politically Correct
0 / 175
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How does the Federal Government Identify AIANs?

• Tribes establish criteria for membership
• ¼ tribal blood is the Bureau of Indian Affairs
  (BIA) Standard
• A descendant of a tribal member
• Or a person recognized by the tribal members as a
  member.
• Alaska Native The term collectively refers to
  Eskimos, Aleuts, and American Indians who are
  indigenous to Alaska.

50
Self-Identified Data Sources

• American Indian This includes enrolled
  members of Federal and/or State recognized tribes
  as well as people who are identify themselves as
  American Indian. Includes surveys such as
• U.S. Census
• Behavioral Risk Factor Surveillance Survey
  (BRFSS) and Youth Risk Behavior Survey (YRBS)
• National Health Interview Survey

51
What are the differences in the American Indians
history?

• Since the formation of the union, the U.S. has
  recognized Tribal governments as sovereign
  nations
• The federal government has enacted numerous
  statutes and regulations that establish and
  define who an Indian is and their relationship to
  the federal government

Thank you, Lauren Tancona, CDC for the use of the
slide
52
Indians are not just . . .

• . . . a minority

. . . a special interest group
. . . a political party
Thank you, Lauren Tancona, CDC for the use of the
slide
53
Brief overview of AIAN Historical Events as Basis
of Distrust of Government and its Programs
54
Early DiseasesAfter European Contact
55
Manifest Destiny Adopted as Federal Policy

• ".... It is the right of our manifest destiny to
  over spread and to possess the whole of the
  continent which Providence has given us for the
  development of the great experiment of liberty
  and federative development of self government
  entrusted to us. It is right such as that of the
  tree to the space of air and the earth suitable
  for the full expansion of its principle and
  destiny of growth."

56
Federal Indian Policy

• 1608-1830 Treaty Making
• 1830-1850 Removal Policy
• 1850-1871 Establishment of Reservations
• 1871-1928 Assimilation and Allotment Era
• Indian Reorganization Act of 1934
• 1943 1968 Termination
• 1968 Present Self Determination

57
Removal Policy Eastern Tribes
How many tribal Nations were included in the
Trail of Tears?
58
Which US state originally comprised Indian
Country?

1. South Dakota
2. Alaska
3. Oklahoma
4. Texas
5. Arizona
6. Georgia

NDN Country
0 / 175
59
Removal Policy Nez Perce
60
Indian Lands within the U.S. 1492 to ?
61
Indian Lands within the U.S. 1492 to ?
62
Indian Lands within the U.S. 1492 to ?
63
Indian Lands 1492 to Present
64
First They Took Our LandThen They Took Our
Children
65
Indian Boarding School System

• Existed between 1870 - PRESENT
• Movement attributed to Manifest Destiny
  philosophy
• Mission to educate Indian children and
  assimilate them into the European language and
  culture.

Thank you, Dean Seneca, MPH, MCURP, Office of
Tribal Affairs ATSDR, CDC, for sharing this slide
66
Apache Children at Carlisle Indian School
67
Characteristics of the Boarding School Experience

• Forced separation of children from communities
• Physical, sexual, emotional abuse by caretakers
• Exposure to infectious diseases, resulting in
  illness and death

68
Characteristics of the Boarding School Experience
(cont.)

• Extreme diet changes.
• Children who didnt go home, took on the
  characteristics of their caretakers.

69
Key Points In Indian History

• 1802 - War Department
• 1824 - Bureau of Indian Affairs (BIA)
• 1849 - BIA moved under Department of Interior
• 1887-The General Allotment or Dawes Act
• 1924 - Indian Citizenship Act of 1924 (41 Stat.
  408)
• 1934 - Indian Reorganization Act
• 1940s 1980s Indians fought for the right to
  vote
• 1953 - Termination Act
• 1968 Self-Determination (PL 93 -638)

70
Many Contemporary (within last 35 years) Events

• 1968 American Indian Movement and Alcatraz Island
  reclaiming disserted federal lands as per
  federal law
• 1970s sterilization of American Indian women
  without informed consent
• Many other events (NY / Canada Mohawk siege
  Rosebud Wounded Knee (recent event, not the
  original event)

71
Culture-wide Multiple Traumas
Post Traumatic Stress Disorders
Boarding Schools
Racism/Poverty
Addiction
Children never parented so never learned to parent
Neglect/Abuse of Children Inadequate Mirroring
Depression
Unresolved Grief
Coping Unhealthy Behaviors
Long histories of subjugation, historical trauma,
unresolved grief and the challenges of changing
cultures, poor economics, and lack of
opportunities are negative and destructive
72
How May Historical Trauma Affect AIANs Use Of The
Healthcare System?

• Example distrust avoid Western medicine
• What are specific examples related to cancer?
• Cancer clinical trials (especially treatment
  trials)
• Cancer genetic studies

73
Sub-ObjectiveDistinguish among factors
affecting AIAN racial misclassification.Note
Results in under-counting of AIAN health / cancer
issues that subsequently results in under-funding
of AIAN programs
74
Cancer
75
Statistics are merely aggregations of numbers
with the tears wiped away.
Dr. Irving Selikoff
76
Cancer Data Issues

• Collapsing the diverse smaller population groups
  into an other racial category ... Other
  racial data
• Lose all racially specific information and
  cultural relevance
• Are of no use when attempting to develop,
  assess, and monitor public health programs and
  services LB

77
Most Common Reasons for Racial Misclassification
The Department of Finance Racial Definition is
based on Spanish surnames. This results in
statistically significant under-counting of AIANs.

1. Use of Spanish surnames to determine race /
   ethnicity
2. Subjective use of personal observation by the
   data collector
3. AIAN not a response category in medical records
   (e.g., hospital, health clinic)

78
Most Common Reasons for Racial Misclassification

1. Imprecise and inconsistent definitions of AI
2. Changing self-identification
3. Tribe formerly unrecognized

79
Most Common Reasons for Racial Misclassification

1. Tribal enrollment blood ordinances changing
2. Tribal enrollment ordinances re Paternal or
   Maternal lineage

80
First documented misclassification of American
Indians
Thank you Chuck Wiggins, PhD, UNM SEER!
81
Every time an elder dies ...
a library burns Patricia Cochran, MS, Inupiaq,
Executive Director Alaska Native Science
Commission
82
Sub-ObjectiveDelineate AIAN regional cancer
incidence and mortality differences.
83
(No Transcript)
84
AIAN Cancer Incidence Data (finally) THANK YOU!

• CHSDA Counties IHS Contract Health Service
  Deliver Areas

85
Incidence Rates (1999-2004)
US US So. Plains So. Plains No Plains No Plains
AIAN NHW AIAN NHW AIAN NHW
All 368.4 475.9 492.6 461.2 538.1 464.8
Breast 85.3 134.4 115.7 129.6 115.9 130.3
Cervix 9.4 7.4 14.1 9.1 12.5 7.4
Colon 46.3 50.8 60.2 51.8 72.5 52.3
Kidney 17.9 11.8 21.3 12.4 23.7 12.1
Lung 48.5 58.6 87.1 82.2 104.3 65.5
Prostate 105.4 154.4 156.7 146.5 174.5 162.2
Source Cancer registries in Centers for Disease
Control and Prevention's (CDC) National Program
of Cancer Registries (NPCR) and National Cancer
Institute's (NCI) Surveillance, Epidemiology, and
End Results Program (SEER) D. Espey, Monograph
Group.
86
2007 Annual Report to the Nation

• Cancer incidence among AI/ANs, though generally
  lower than for the Non-Hispanic White (NHW)
  population, is rising rapidly
• In 3 of the twelve regions of the Indian Health
  Service, cancer incidence rates are equal to that
  of the dominant white population
• Alaska
• Northern Plains (IL, IN, IA, MI, MN, MT, NE, ND,
  SD, WI, WY)
• Southern Plains (OK, TX, KS)

87
IHS Health Risk Factor Data (BRFSS, 2000-2006)

• Current Smoker
• US
• 22.8 NHW
• 31 AIAN
• Southern Plains Region
• 33.2
• Northern Plains Region
• 40.1

Steele CB, Cardinez CJ, Richardson LC, Tom-Orme
L, Shaw K. Surveillance for Health Behaviors of
American Indians and Alaska NativesFindings from
the Behavioral Risk Factor Surveillance System,
2000-2006, CANCER 2008, in press
88
IHS Health Risk Factor Data (BRFSS, 2000-2006)

• Current Smoker
• US
• 22.8 NHW
• 31 AIAN
• Southern Plains Region
• 33.2
• Northern Plains Region
• 40.1

Steele CB, Cardinez CJ, Richardson LC, Tom-Orme
L, Shaw K. Surveillance for Health Behaviors of
American Indians and Alaska NativesFindings from
the Behavioral Risk Factor Surveillance System,
2000-2006, CANCER 2008, in press
89
IHS Health Risk Factor Data (BRFSS, 2000-2006)

• Ever told have diabetes
• US
• 6.0 NHW
• 12.4 AIAN
• Southern Plains
• 12.6
• No. Plains
• 13.0

What is the relationship between diabetes and
cancer?
Steele CB, Cardinez CJ, Richardson LC, Tom-Orme
L, Shaw K. Surveillance for Health Behaviors of
American Indians and Alaska NativesFindings from
the Behavioral Risk Factor Surveillance System,
2000-2006, CANCER 2008, in press
90
IHS Health Risk Factor Data (BRFSS, 2000-2006)

• Obese (CDC defn. BMI gt 30.0 kg/m2)
• US
• 20.8 NHW
• 29.0 AIAN
• Southern Plains
• 30.9
• Northern Plains
• 31.0

What is the relationship between obesity and
cancer?
Steele CB, Cardinez CJ, Richardson LC, Tom-Orme
L, Shaw K. Surveillance for Health Behaviors of
American Indians and Alaska NativesFindings from
the Behavioral Risk Factor Surveillance System,
2000-2006, CANCER 2008, in press
91
IHS Health Risk Factor Data (BRFSS, 2000-2006)

• Health care coverage
• US
• 88.3 NHW
• 75.6 AIAN
• Southern Plains
• 71.8
• Northern Plains
• 77.2

The BRFSS data over-estimates insurance for
AIANs Inquiring Minds want to know, Why?
Steele CB, Cardinez CJ, Richardson LC, Tom-Orme
L, Shaw K. Surveillance for Health Behaviors of
American Indians and Alaska NativesFindings from
the Behavioral Risk Factor Surveillance System,
2000-2006, CANCER 2008, in press
92
IHS Health Risk Factor Data (BRFSS, 2000-2006)

• Pap Screening with past 3 years, All women 18
  (w/o hysterectomy)
• US
• 84 NHW
• 78 AIAN
• S. Plains 74
• N. Plains 80.4

What was the Pap percentage prior to the
screening guidelines changing?
Steele CB, Cardinez CJ, Richardson LC, Tom-Orme
L, Shaw K. Surveillance for Health Behaviors of
American Indians and Alaska NativesFindings from
the Behavioral Risk Factor Surveillance System,
2000-2006, CANCER 2008, in press
93
IHS Health Risk Factor Data (BRFSS, 2000-2006)

• Mammogram within past 2 years among women aged
  40
• US
• 76 NHW
• 69.4 AIAN
• S. Plains 66.4
• N. Plains 67.9

Steele CB, Cardinez CJ, Richardson LC, Tom-Orme
L, Shaw K. Surveillance for Health Behaviors of
American Indians and Alaska NativesFindings from
the Behavioral Risk Factor Surveillance System,
2000-2006, CANCER 2008, in press
94
IHS Cancer Mortality

• Note cancers other than breast, cervix, colon,
  lung and prostate
• This is why AIAN comprehensive cancer plans
  cannot be limited to only those sites!

95
Haverkamp et al, Cancer Mortality among AIAN
Regional Differences, 199-2003, IHS, Rockville,
MD 2008
96
IHS Mortality Data (best of any federal database,
but still has limitations)

• Note the of AIANs summarized in report is
  extreme overestimate
• 64 live in urban areas and those data are not
  included in the reports
• limited to AIANs WHO USE IHS CLINICAL FACILITIES
  WITH PREVIOUS 3 YEARS
• Note the horizontal scale fluctuates for each
  cancer site and can be misleading

97
Omissions

• Note both childhood and adult leukemia
  increasing among AIAN
• Childhood under-reported due to children not
  admitted to a Childrens Hospital and symptoms
  misdiagnosed as diabetes
• Brain cancer increasing among all races

98
Haverkamp et al, Cancer Mortality among AIAN
Regional Differences, 199-2003, IHS, Rockville,
MD 2008
99
Barriers that affect AIAN ability to create,
access or use cancer prevention and control
programs
100
Which of the following cancer outreach and
screening barriers with AIAN communities is one
of the only issues that has changed significantly
in the last 20 years?

1. Transportation issues
2. Language issues
3. Healthcare system issues
4. Provider issues
5. Dont know / not sure

b1_issues1
0 / 175
101
Linda Bs Barriers Research Tirade

• LB Pet Peeve wasting limited cancer monies on
  creating yet another study to list barriers that
  are documented in more than 100 reports and
  studies
• The only barriers than have changed in last 20
  years are
• Internet (access to info and resources)
• Healthcare System (or lack of insurance)

102
Linda Bs Barriers Tirade

• Public Health Professionals AND COMMUNITY MEMBERS
  KNOW the barriers
• We do NOT know how to address the barriers in
  culturally respectful strategies
• The strategies vary for each local community and
  require local tailoring of the interventions to
  address the barriers
• Please do not waste limited tax dollars to fund
  any more studies of barriers that are already
  well documented

103
Linda Bs Barriers Tirade (continued)

• For those who feel the need to see SOME of the
  barriers research findings, they are listed on
  the NACR website.
• Because these findings are incredibly old and
  over-reported, we will not spend any time
  discussing these unless a participant needs
  clarification of what the finding means related
  in Indian Country issues

104
(No Transcript)
105
Give Yourself a Hand!
106
Obj 1. Tic-Tac-Toe True False

• 1. CDC consultation with tribal Nations may be
  implemented with only the 10 largest Nations.

False / Coyote
107
Obj 1. Tic-Tac-Toe True False

• 2. Alaska Natives includes Siberian Yupik Eskimos

True / Bear
108
Obj 1. Tic-Tac-Toe True False

• 3. Sovereign Tribal Nations have legal agreements
  and treaties through the US Congress

True / Bear
109
Obj 1. Tic-Tac-Toe True False

• 4. The Trail of Tears was limited to the 5
  Civilized Tribes

False / Coyote
110
Obj 1. Tic-Tac-Toe True False

• 5. Boarding Schools from 1870s to about World War
  II resulted in loss of identity (students began
  to act like caretakers)

True / Bear
111
Obj 1. Tic-Tac-Toe True False

• 6. 1970s American Indian sterilization without
  informed consent is comparable to Tuskeegee for
  African-Americans.

True / Bear
112
Obj 1. Tic-Tac-Toe True False

• 7. Department of Finance Racial Definition is
  based on Spanish surnames.

True / Bear
113
Obj 1. Tic-Tac-Toe True False

• 8. Southern and Northern Plains Tribal Nations
  have higher age-adjusted colorectal cancer
  incidence rates in comparison with Non-Hispanic
  Whites.

True / Bear
114
Obj 1. Tic-Tac-Toe True False

• 9. IHS Cancer Databases accurately reflect the
  cancer mortality among AIANs.

False / Coyote