1. Angela A. Gonzales, Ph.D. (Hopi) Assistant Professor Department of Development Sociology Cornell University Native Investigator Program

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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) ReservationPrevalence95% 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)

9. 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

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

11. 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.

14. 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

15. 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)

16. 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

17. 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

18. 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

19. K01 Project What is the Association between Social Capital and Blood Pressure? A Study of American Indians in the Southwest

21. 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