Understanding determinants of lung cancer preventive care in at-risk urban American Indians and Alaska Natives: A mixed-methods study.

Introduction: Lung cancer is the leading cause of cancer death among American Indian and Alaska Native (AI/AN) people, and AI/AN people have the highest rate of smoking of any racial or ethnic group in the US. There is limited research to inform culturally-relevant strategies for lung cancer prevention inclusive of lung cancer screening (LCS). The objective of this study was to understand determinants of LCS and tobacco cessation care in at-risk urban-dwelling AI/ANs. Materials and Methods: This was a mixed-methods community-based participatory research study including complimentary qualitative discussions and surveys conducted in Seattle, Washington, USA from 2022 to 2023. The study measures and analytic approach integrated the Consolidated Framework for Implementation Research and Tribal Critical Race Theory and qualitative transcripts were analyzed using thematic analysis. Participants were self-identified AI/AN people who were age ≥ 40 and had ≥ 10-year history of commercial cigarette smoking. Results: Forty-five participants completed surveys and participated in discussions, 48% were female, the median age was 58 and median smoking history was 24 pack-years of commercial cigarette use. Themes revealed prominent barriers to LCS care including access, costs, awareness, and fear. Many reported previous negative and discriminatory encounters within and outside the health system which may also serve as barriers. Most participants endorsed cancer screening and increased education, recommending Indigenous-centered, delivered, and tailored programs, as well barrier-directed support. Conclusions: In a broad sample of at-risk urban-dwelling AI/AN people, our findings suggest enthusiasm for preventive care but several complex barriers. Participants endorsed culturally-tailored programs which could provide relevant education and address barriers.

Impact of Breastfeeding Barriers on Racial/Ethnic Disparities in Breastfeeding Outcomes in North Dakota.

OBJECTIVE: Exclusive breastfeeding is recommended for the first 6 months of life, but there are racial/ethnic disparities in meeting this recommendation. METHODS: 2017-2020 North Dakota Pregnancy Risk Assessment Monitoring System (weighted N = 11,754) data were used to examine racial/ethnic differences in the association between self-reported breastfeeding barriers and breastfeeding duration. Breastfeeding duration was self-reported breastfeeding at 2 and 4 months, and number of weeks until breastfeeding cessation. Self-reported breastfeeding barriers were yes/no responses to 13 barriers (e.g., "difficulty latching," "household duties"). Logistic regression estimated odds ratios and 95% confidence intervals to determine if barriers accounted for breastfeeding disparities by race/ethnicity. Cox proportional hazard models estimated hazard ratios for stopping breastfeeding for American Indian and other race/ethnicity individuals, compared to White individuals. Models were adjusted for birthing parents' demographic and medical factors. RESULTS: Logistic regression results suggest American Indian birthing parents had similar odds for breastfeeding duration (2-month duration: OR 0.94 (95%CI 0.50, 1.77); 4-month duration: OR 1.24 (95%CI 0.43, 3.62)) compared to White birthing parents, after accounting for breastfeeding barriers. Cox proportional hazard models suggest American Indian birthing parents had a lower hazard of stopping breastfeeding (HR 0.76 (95%CI 0.57, 0.99)) than White parents, after accounting for breastfeeding barriers. CONCLUSIONS: Accounting for breastfeeding barriers eliminated observed disparities in breastfeeding outcomes between American Indian and White birthing parents. Targeted and culturally safe efforts to reduce barriers to breastfeeding are warranted to reduce racial/ethnic disparities in breastfeeding.

Knowledge, beliefs, and behaviors regarding organ and tissue donation in selected tribal college communities.

American Indians and Alaska Natives (AI/ANs) suffer a disproportionate burden of diabetes and kidney failure. For those with chronic kidney disease, transplantation may be the most effective treatment option. However, low rates of organ donation and transplantation are reported for AI/ANs, who face significant barriers in accessing the transplant waiting list. They are also less likely than Whites to consent to become organ donors. We partnered with five tribal colleges and universities to conduct focus groups to assess knowledge, cultural beliefs, and behaviors related to organ donation and transplantation among AI/AN college students. Focus group data were used to develop a culturally targeted media campaign and outreach strategy aimed at increasing rates of consent to donate organs. Community knowledge typically drew from direct family experience with chronic illness. Study findings confirmed that attitudes about organ donation were influenced by cultural beliefs. Nevertheless, many participants supported organ donation even when it conflicted with cultural and spiritual beliefs about keeping the body intact for burial. Participants also expressed mistrust of the local health care system, suggesting that trust issues might interfere with health messaging on this topic. This is the first study to examine sociocultural beliefs about organ donation among AI/AN college students. Through focus group findings, study staff were better positioned to develop culturally relevant outreach materials. Rising rates of chronic illness among AI/ANs ensure that organ donation and transplantation will be a long-term feature of the health landscape in AI/AN communities. Targeted health messaging must be part of the strategy to reduce donor shortages.

Patterns of tobacco use in a sample of American Indians in Minneapolis-St. Paul.

The purpose of this study was to identify patterns of tobacco initiation, current use, and smoking cessation and their correlates in the adult American Indian population in the Twin Cities, using community-based participatory research methods. A total of 300 American Indians aged 18 years or older participated in in-person interviews. Participants were recruited to fill age-gender quotas that reflect the demographic distribution of American Indians in Minnesota. Almost everyone in this sample had smoked cigarettes recreationally: Only 12% had smoked fewer than 100 cigarettes, and nearly two-thirds (62%) reported that they were current smokers. Only 29% of ever-smokers had quit smoking. More than two-thirds (68%) of current smokers would like to quit, and most of them (53% of all smokers) had tried unsuccessfully to quit in the previous 12 months. Our results show a level of current smoking and low cessation rates among American Indians in the Twin Cities area that reflect a crisis for public health and for the Indian community.