Breast cancer screening beliefs and behaviors among American Indian women in Kansas and Missouri: a qualitative inquiry.

American Indian women have rising incidence and disproportionate mortality rates due to breast cancer. Using a community-based participatory research approach, we conducted ten focus groups with American Indian women in Kansas and Missouri to understand their barriers to mammography and identify ways to intervene to improve screening rates. Focus groups were stratified by screening status, including women who were up to date with current screening mammography recommendations (mammogram within the last 2 years, N = 7 groups, 66 participants) and women who were not (N = 3 groups, 18 participants). While many similarities were identified across strata, some differences emerged, particularly descriptions of prior negative experiences with the health care system among women who were not up to date with screening recommendations. Primary areas identified by participants for intervention included culturally appropriate educational materials and interventions directed specifically at improving American Indian women's trust in Western medicine and alleviating feelings of discrimination.

Sorting it Out: Pile Sorting as a Mixed Methodology for Exploring Barriers to Cancer Screening.

We discuss a mixed methodology for analyzing pile sorting data. We created a list of 14 barriers to colon cancer screening and recruited 18, 13, and 14 participants from three American Indian (AI) communities to perform pile sorting. Quantitative data were analyzed by cluster analysis and multidimensional scaling. Differences across sites were compared using permutation bootstrapping. Qualitative data collected during sorting were compiled by AI staff members who determined names for the clusters found in quantitative analysis. Results showed 5 clusters of barriers in each site although barriers in the clusters varied slightly across sites. Simulation demonstrated type I error rates around the nominal 0.05 level whereas power depended on the numbers of clusters, and between and within cluster variability.

Smoke-Free Policies in the Workplace and in the Home among American Indians.

OBJECTIVES: American Indians are more likely to smoke, less likely to have smoke-free homes, and potentially less likely to have worksite smoke-free policies. We examined correlates of smoke-free policies at home and work among a community-based sample of American Indians in the Midwest. METHODS: We examined correlates of smoke-free policies at home and work in a sample of American Indians in the Midwest using a community-based participatory research approach. RESULTS: 66.7% were nonsmokers, 15.6% smoked on some days, and 17.6% smoked every day. The majority (72.4%) had complete smoke-free home policies, 13.1% had partial restrictions, and 14.5% had no rules. Moreover, 62.7% had complete smoke-free worksite policies, 27.9% had partial policies, and 9.4% had no worksite smoke-free policies. Factors associated with having a complete smoke-free home policy included being a college graduate (p=.005) and a nonsmoker versus a nondaily (p=.006) or a daily smoker (p<.001). Correlates of having a complete smoke-free worksite policy included being female (p=.005) and a nonsmoker versus a nondaily (p=.03) or a daily smoker (p<.001). Having complete worksite policies was associated with having smoke-free homes (p<.001). CONCLUSIONS: Having complete worksite policies was related to having smoke-free home policies; both were associated with being a nonsmoker.

Smoke-Free Policies in the Workplace and in the Home among American Indians.

OBJECTIVES: American Indians are more likely to smoke, less likely to have smoke-free homes, and potentially less likely to have worksite smoke-free policies. We examined correlates of smoke-free policies at home and work among a community-based sample of American Indians in the Midwest. METHODS: We examined correlates of smoke-free policies at home and work in a sample of American Indians in the Midwest using a community-based participatory research approach. RESULTS: 66.7% were nonsmokers, 15.6% smoked on some days, and 17.6% smoked every day. The majority (72.4%) had complete smoke-free home policies, 13.1% had partial restrictions, and 14.5% had no rules. Moreover, 62.7% had complete smoke-free worksite policies, 27.9% had partial policies, and 9.4% had no worksite smoke-free policies. Factors associated with having a complete smoke-free home policy included being a college graduate (p=.005) and a nonsmoker versus a nondaily (p=.006) or a daily smoker (p<.001). Correlates of having a complete smoke-free worksite policy included being female (p=.005) and a nonsmoker versus a nondaily (p=.03) or a daily smoker (p<.001). Having complete worksite policies was associated with having smoke-free homes (p<.001). CONCLUSIONS: Having complete worksite policies was related to having smoke-free home policies; both were associated with being a nonsmoker.