1. Northwest Tribal Comprehensive Cancer Program
October Quarterly Board Meeting 2016
Kerri Lopez

2. NTCCP Trainings/Activities
Clinical Cancer Update
29 participants (2016)
CEU accreditation
Tribal Tobacco Summit
50 participants (2016)
Tobacco Cessation
Basic Tobacco Intervention Skills for AI/AN
18 participants (2015)
Tribal BRFSS
Inflatable Colon "Kiki”
Supporting NW Tribal CRC Education Activities
Tribal Cancer Plan Implementation Funding
Tribal site visits
Cancer 101
Development tribal action plan
Participation in tribal prevention, screening and education activity
Technical assistance
Dissemination of resources

3. Tribal BRFSS– 6 tribes Complete Two Washington In progress One Oregon
Two Oregon
Randomized phone
Census phone
Two Washington
Door to door
In progress
One Oregon
Census phone
Tribal resolution
Development of survey materials and IRB application
Cowlitz about the be published: brfss cancer screening rates as good as WA state non Hispanic whites even though higher level of poverty
Conclusion: screening successful ; tribal operated clinic ; relationship with clinic, community, and tribal leaders
Additional project on access to fresh fruits and vegetables
2/28/2018

4. Northwest Portland Area Indian Health Board
Tobacco Cessation
Basic Tobacco Intervention Skills Training (BTIST) for Native Communities
5A’s model
6 Modules topics
The curriculum was adapted from the standard 5A’s training by IHS Tobacco Control Task Force and the HealthCare Partnership at the University of Arizona. It is designed to be implemented by medical, dental, pharmacy, behavioral health, nursing, and health education professionals within IHS, Tribal, and Urban Indian health programs. The six modules include:
Ask, Advise, Assess, Assist, Arrange
Module 1: Health Consequences of Commercial Tobacco
Module 2: Tobacco Dependence & Treatment
Module 3: Tobacco and Culture
Module 4: Intervention Essentials
Module 5: Putting Your Skills Into ACTION
Module 6: Follow-up Interventions
2/28/2018
Northwest Portland Area Indian Health Board

5. Tribal Implementation
Clinic Integration
Results
From train - trainers
3 month time
50 clinic/admin staff were trained in the 5A’s BTIST
Of 50 staff participants 31 staff formed 4 teams
With the goal to increase referrals
41 web-base referrals to the quit-line, 366% increase
51 commercial tobacco users agreed to stop smoking
26 clinical staff members level of knowledge increased
Brainstormed how to get more referrals – poster boards in the north and south clinic, mailer sent out to one specific provider's patient list who used tobacco related products, article in Tribal newsletter, word of mouth, Tribal facebook page and Tribal TPEP facebook page
2/28/2018
Northwest Portland Area Indian Health Board

6. Northwest Portland Area Indian Health Board
Other Implementation
1 on 1 cessation counseling
Group classes
Referrals to another resource for tobacco cessation
All clinic staff training (from receptionist to the IT person)
2/28/2018
Northwest Portland Area Indian Health Board

7. NTCCP Coalition Meeting Navigation and Communication
Topics
Communication with patients
Resources for Survivors
Tobacco Cessation
Lung cancer screening
Other resources:
Housing
Financial assistance
Transportation
Resource Fair:
Organizations sharing information with tribes
(6)
2/28/2018
Northwest Portland Area Indian Health Board

8. Youth tobacco training
Tobacco Facts
Tobacco 101 presentation
Tobacco vs. Candy
Environmental Scan Tool
Group discussion
Tobacco 101- what is tobacco, History: Traditions to profits, SHS, Dip chew snuff, e-cigarettes, sales, marketing, targeting AI/AN, and concerns
2/28/2018
Northwest Portland Area Indian Health Board

9. Northwest Portland Area Indian Health Board
YIKES
2/28/2018
Northwest Portland Area Indian Health Board

11. Northwest Portland Area Indian Health Board
Rates AI/AN Women
32.5% of AI/AN women smoke
18% of AI/AN women smoke during pregnancy nationally. **** 2003 data
26% of AI/AN women smoke during their last 3 months of pregnancy.
22.3% of AI/AN women in Oregon smoke during pregnancy, in the last 3 months of pregnancy 16.2%
2/28/2018
Northwest Portland Area Indian Health Board

12. Tobacco Use in Adults Group Use Year Source AI/AN Adults N/A
N/A Idaho BRFSS
All Adults
15.9%
2014
Idaho BRFSS
35.3%
2013
Oregon BRFSS
NHW Adults
21.4%
AI/AN Pregnant Women
35.7%
2009 Oregon PRAMS Analysis
NHW Pregnant Women
18.5%
36.6%
Washington BRFSS
16.6%

13. Tobacco Use in Youth Group Use Year Source AI/AN 11th Grade Students
N/A
N/A Idaho High School YBRS
All 11th Grade Students
10.4%
2015
Idaho High School YBRS
AI/AN 8th Grade Students
21.9%
Oregon Healthy Teens Survey
NHW 8th Grade Students
11.3%
40.2%
NHW 11th Grade Students
24.8%
AI/AN 10th Grade Students
14.1%
2014
Washington Healthy Youth Survey
NHW 10th Grade Students
7.7%

14. Tobacco Related Cancer Disparities Oregon Incidence 2007-2012
Cancer Site
AI/AN
Age adjusted rate per 100,000
(95% CI)
NHW
Lung & Bronchus*
84.561
(71.694, )
60.6
(59.2, 62.0)
Esophagus
8.8
(5.0, 14.9)
5.248
(4.8, 5.7)
Colorectal
45.7
(36.7, 56.7)
37.8
(36.7, 38.9)
Liver & IBD*
12.7
(8.8,18.4)
6.7
(6.3, 7.2)
Stomach
6.5
(3.4, 11.8)
4.9
(4.5, 5.2)
Pancreas
13.1
(8.4, 20)
11.7
(11.0, 12.3)
Kidney & Renal Pelvis
16.3
(11.7, 22.7)
14.6
(13.9, 15.3)
Liver & Intrahepatic Bile Duct

15. Colorectal Cancer Disparities
CRC Screening 2012 (ID, OR, WA)1
AI/AN 36.0% (50-75 yo)
CRC Distant Staging (ID, OR, WA)2
AI/AN 23.9%
NHW 18.1%
CRC 5 yr Survival (ID, OR, WA)3
AI/AN (0.4190, )
NHW (0.5627,
1 Indian Health Service: 2012 GPRA results
2 Northwest Portland Area Indian Health Board. Cancer Among Northwest American Indians and Alaska Natives. Portland, OR: Northwest Tribal Epidemiology Center, 2011.
3 Petersen, P. S. Colorectal Cancer Survival Among American Indian and Alaska Native People in the Pacific Northwest: A Thesis. Oregon Health & Science University, Portland, OR, 2011.

16. Northwest Portland Area Indian Health Board
E-cigarettes
Facts
No FDA approved
Currently no sufficient evidence to conclude that e-cigarettes are an effective smoking cessation tool.
E-cigarette aerosol can contain heavy metals and cancer causing agents
E-liquid contains insufficient amount of nicotine levels
Most adults who use e-cigarettes also smoke conventional cigarettes, referred as “dual use”
Marketing to youth using Big Tobacco tactics and fun flavors
Gateway to smoking or using other tobacco products
Myths
Safe than conventional cigarettes
Healthy alternative
Does not cause death
E-cigarette aerosol is harmless “water vapor” and is as safe as clean air
No second hand smoke
Little to no nicotine in e-liquid
Fun, Cool, Sexy
Cannot overdose on nicotine from e-liquids
2/28/2018
Northwest Portland Area Indian Health Board
CDC.gov/tobacco

17. Northwest Portland Area Indian Health Board
Youth E-Cigarette use
Current use in Oregon 2015
NHW
AI/AN
8th grade
8.6%
13.0%
11th Grade
17.9%
27.0%
From: Oregon Health Authority, Public Health Division, Health Promotion and Chronic Disease Prevention section. Current tobacco use and related topics among 8th and 11th graders by race and ethnicity, Oregon
2/28/2018
Northwest Portland Area Indian Health Board

18. Northwest Portland Area Indian Health Board
Adult E-Cigarette use
Current use in USA 2014
NHW
AI/AN
ever tried
14.8%
20.2%
currently use
4.6%
10.7%
From: Nguyen KH, Marshall L, Brown S, Neff L. State-Specific Prevalence of Current Cigarette Smoking and Smokeless Tobacco Use Among Adults — United States, MMWR Morb Mortal Wkly Rep 2016;65:1045–1051. DOI:
2/28/2018
Northwest Portland Area Indian Health Board

19. Current Policy Work in Tribal Communities
Tribal Admin-Community Campus
Health Clinic
Education
Gathering Space
Events & Gatherings
Tribally Run Businesses
Tribal Housing
External Partners
2/28/2018
Northwest Portland Area Indian Health Board

20. Cancer Challenges - Multifaceted
High need for Cancer Resources in AI/AN communities
Geographic Isolation
Independent Healthcare Systems
Low Health Literacy
Patient ― Provider Communication
Screening – referrals
Screening rates for paps and mams going down
After care for cancer survivors in tribal community
Economic Impact
$2,701/person vs $5,841/person (2010 IHS vs 2008 Medicaid)
2/28/2018
Northwest Portland Area Indian Health Board

21. NTCCP Tools and Resources
Twenty Year Northwest Tribal Comprehensive Cancer Control Plan
Northwest Tribal Cancer Resource Guide
Cancer 101
Cancer Fact Sheets
Appointment Companion
Tribal Cancer Action Planning
Evaluation of Cancer 101: An Educational Program for Native Settings. Hill TG, Briant KJ, Bowen D, Boerner V, Vu T, Lopez K, Vinson E. J Cancer Educ Feb 10.
 The past, present, and future of comprehensive cancer control from the state and tribal perspective. Miller SE, Hager P, Lopez K, Salinas J, Shepherd WL. Prev Chronic Dis Oct;6(4):A112.
 Cancer Care of American Indians and Alaska Natives and Other Racial Groups Enrolled in Public and Private Insurance Plans. Ramsey S, Zeliadt S, Blough D, Lopez K, Buchwald D. Poverty & Public Policy Vol. 2: Iss. 1, Article 3.

22. Tools and Resources Cont.
Tribal Tobacco Policy Workbook
Northwest Tribal Colorectal Cancer Screening Toolkit
Second Wind Curriculum
NPAIHB Tribal Profiles
State level
Multiple Presentations
E-Cigarettes, Pregnancy & smoking, Cancer Resources, Cancer Survivor support group support and Cancer Action Planning
Multiple factsheets
HPV, Tobacco, SHS, E-cigarettes, Smoke-free Homes, etc.
2/28/2018
Northwest Portland Area Indian Health Board

23. Northwest Portland Area Indian Health Board
NTCCP Staff
Kerri Lopez;
NTCCP Project Director
Eric Vinson;
NCCP Coordinator
Antoinette Aguirre;
Cancer Prevention Coordinator
Ryan Sealy;
WEAVE NW Tobacco Specialist
2/28/2018
Northwest Portland Area Indian Health Board