Receipt of Employment Interest

							Native Investigator Program

  Angela A. Gonzales, Ph.D. (Hopi)
        Assistant Professor
Department of Development Sociology
         Cornell University
Activities
 Secondary Data Analysis
   Influence of Cultural Factors on Mammography
    among American Indian Women
 Pilot Study
   Is Social Capital Related to Colorectal Cancer
    Knowledge and Attitudes? A Pilot Study of American
    Indians in the Southwest
 K01 Project
   What is the Association between Social Capital and
    Blood Pressure? A Study of American Indians in the
    Southwest
Background

    In 2005, breast cancer was the second leading
     cause of cancer death among American women

    American Indian Women

     – Are less likely to receive screening mammography
       than other women
     – Present with breast cancer at later disease stages
       than other women, contributing to poorer survival
     – Have higher case mortality than other women
Specific Aims

    Estimate the prevalence of self-reported
     mammography among American Indian women aged
     41 and over residing on a Southwest or one of two
     Northern Plains reservations

    Estimate association between measures of traditional
     healing practices or measures of cultural identity with
     lifetime mammography receipt, adjusting for
     sociodemographic and ecological factors

    Assess whether the relationships between
     mammography receipt and cultural factors and
     traditional healing differ by reservation
Sample

 832 female participants in the NCI funded
 Education and Research Towards Health Study
 (EARTH) who met the following eligibility
 criteria:

 – Were at least 41 years of age at the time of the
   interview

 – Provided valid data on lifetime mammography and all
   traditional healing use, cultural identity, and
   adjustment covariates
Measures
Outcome
   Self-reported lifetime receipt of mammography

Predictors of Interest
   Traditional Medicine Use
       • Lifetime use of a traditional Native healer
       • Use of traditional Native remedies or practices to prevent illness
       • Use of traditional Native remedies or practices when ill
  Cultural Identity
       • Use of an American Indian language at home
       • Degree of identification with Native culture
       • Active participation in Native community activities
Adjustment Covariates
      Age, education, employment, single caregiver status, access to
      mammography, current driver status
Statistical Methods

 Specific Aim 1
  Calculated frequencies and proportions of sociodemographic, ecological,
   and cultural factors both overall and by mammography receipt group

 Specific Aim 2
  Modeled the unadjusted log-odds of mammography receipt using separate
   logistic regression models for each traditional healing and cultural identity
   predictor of interest
  Refit logistic models, adjusting for covariates that may confound the
   associations between the predictors of interest and mammography receipt
  Calculated unadjusted and adjusted odds ratios and their 95% confidence
   intervals

 Specific Aim 3
  Fit adjusted logistic regression models of mammography receipt, allowing
   for an interaction between reservation and each predictor of interest
  Calculated reservation-specific odds ratios and 95% confidence intervals
Results

   73% of our female participants reported having a mammogram sometime
    in their lives
   Prevalence of lifetime mammography receipt differed by reservation (P <
    0.001)

     Reservation           Prevalence       95% CI
     Pine Ridge            65%              (60, 70)
     Cheyenne River        87%              (84, 91)
     Gila River            66%              (60, 71)

 Mammography receipt was associated with higher annual household
  income (P < 0.001), more years of education (P<0.001), a higher rate of
  employment, and greater access to mammography equipment
 The adjusted odds of mammography receipt were not significantly
  associated with any measures of traditional medicine use or cultural
  identity
 The relationship between use of traditional remedies and practices to
  prevent disease differed by reservation (P=0.03)
Conclusions

 Neither traditional medicine use nor
  identification with Native culture appear to
  impede the lifetime receipt of mammography
  for women resembling those in our sample
 Our results challenge the notions that the use
  of traditional healing practices and allopathic
  medicine are incompatible, and that use of
  traditional healing practices might deter
  women from screening mammography
            Pilot Study


Is Social Capital Related to Colorectal Cancer
          Knowledge and Attitudes?
   A Pilot Study of American Indians in the
                  Southwest
Setting

    Hopi reservation is located in
     the northeastern part of
     Arizona and encompasses
     approximately 1.5 million
     acres.
    Hopi tribal enrollment records
     identify nearly 8,500 enrolled
     tribal members.
    Reside on part of their tutsqua,
     their ancestral and sacred
     homelands, in 12 villages
     strung along Arizona State
     Highway 264.
Background

  Colorectal Cancer (CRC) is the second leading cause of
   cancer-related deaths in the United States
  CRC screening rates are lower than for any other
   cancer screening test, with only half of persons aged 50
   years and older having received any of the available
   methods.

  American Indians

    – CRC is the second leading cause of cancer death for men and
      the third leading cause for women.
    – Have low CRC screening rates
    – Higher CRC mortality rates
Social Capital

  Refers to features of the human environment – including
   the quantity and quality of social relationships, levels of
   interpersonal trust, and norms of reciprocity – that
   influence health behaviors and outcomes.

  Dimensions of social capital
      Bonding – relations within a community
      Bridging – horizontal links with other communities
      Linking – vertical links with outside institutions (e.g. federal and
      state governments, public/private corporations)
Specific Aims
    Hypothesis:
     – That higher community-level measures of social capital will have
       a positive impact on individual CRC knowledge and attitudes.

    Specific Aims
     – Identify and measure the different forms of social capital
       characterizing the 2 villages in our sample
     – Describe individuals’ knowledge of CRC and attitudes towards
       screening and its efficacy
     – Estimate the association between specific forms of social capital
       with knowledge and attitudes about CRC in each village,
       adjusting for sociodemographic and health factors
Sample

 200 randomly-selected individuals who
 meet the following eligibility criteria:

  – Enrolled tribal members
  – Reside in the villages of Shungopavi or Kykotsmovi
  – 18 years of age or older at the time of the interview
Measures
Outcome
     Two multi-item measures of CRC knowledge and CRC attitudes

Predictors of Interest
     –   Bonding Social Capital
     –   Bridging Social Capital
     –   Linking Social Capital

   Based on a culturally appropriate assessment instrument
    developed by the Canadian Population Health Initiative and Centre
    for Aboriginal Health Research to assess social capital in First
    Nations.
   The instrument includes 15, 5-point Likert scale items that address
    each dimension of social capital
           K01 Project

What is the Association between Social
Capital and Blood Pressure? A Study of
  American Indians in the Southwest
Askawali!

NERC mentors:
• Dedra Buchwald, MD, Department of Medicine, University of
  Washington, Seattle, WA
• Eva Garroutte, PhD, Department of Sociology, Boston College,
  Boston, MA
• Andy Bogart, MS, Center for Clinical and Epidemiological
  Research, University of Washington, Seattle, WA
EARTH Study
• Jeffrey A. Henderson, MD, MPH, Black Hills Center for American
  Indian Health, Rapid City, SD
Hopi Tribe
• Tribal Council, Hopi Health Advisory Committee, and the Hopi
  Health and Human Services Department
Native People for Cancer Control
Resource Centers for Minority Aging Research Native Investigator
  Program