Cancer Risk Factors and Screening Behaviors of the Hopi Tribe

Project Co-Leaders: Priscilla R. Sanderson, NAU; Sylvia Brown, U of A ; and Lorencita Joshweseoma Martin, Director of Hopi Women’s Health Program

Abstract:
Within the past several years, published research has documented disparities in the cancer burden of Native Americans compared to non-Hispanic Whites and many Native Americans perceive cancer as a major health challenge. In order to address community cancer issues and concerns and to develop culturally appropriate intervention programs, Native American Tribes/Nations need to identify the knowledge, attitudes, beliefs and behaviors about cancer of their respective populations. While the Behavioral Risk Factor Surveillance System (BRFSS) and Health Information National Trends Survey (HINTS) have been administered nationwide and in several states, these tools fail to provide the information needed by individual tribes since a) Native Americans are overall a very small sample within any specific survey year, b) Native American tribes/nations are not homogeneous although their data are customarily aggregated for statistical purposes and c) many times these national or state surveys are administered by telephone– a recruitment strategy that is inappropriate in communities where not all households have telephone lines. We propose to address these issues with the development of a tribal-specific, cancer-focused behavioral risk factor survey for the Hopi Tribe. This research will be undertaken as a collaborative effort between the Hopi Office of Health Services and the Hopi Women’s Health Program (HWHP) and researchers from the Arizona Cancer Center at the University of Arizona and Northern Arizona University. The team seeks to evaluate the hypotheses that Hopi men and women are interested in obtaining additional knowledge about cancer in general and specific cancers such as colorectal cancer; that behaviors are related to knowledge and beliefs; that specific attitudes and lack of knowledge can be identified that would form the foundation for Tribal specific interventions; and that the Hopi people look to the Tribe for guidance and support when dealing with cancer.

This overall project is proposed as a three-year study. In this one-year pilot study proposal, we focus on 1) the development of a culturally appropriate cancer risk factor and knowledge survey instrument and research protocol suitable for Hopi men and women age 18 and older, and 2) assurance of appropriate training and faculty experience in survey methodology and qualitative analyses. Survey items will be selected from national survey tools, including the BRFSS, HINTS and First Nations Regional Health Survey, and through refinement with community input via four focus groups. Implementation of the community survey is proposed for years 2 and 3 (which will be proposed as a full project) when we plan to conduct the survey among Hopi tribal members living on the Reservation, using household in-person interviews. This recruitment method achieved an 86% response rate among Hopi women in our previous study. Depending on funding, we will administer the survey to Hopi enrollees living either on or off the reservation and examine differences in knowledge, attitudes and behaviors between those living on and off reservation. Finally, we will evaluate the validity of the traditional telephone methodologies of the BRFSS and HINTS by conducting a subset of the survey using different methodologies, including telephone and mail.

Specific Aims:

1. To develop a culturally appropriate cancer-focused risk factor survey
2. To increase the research capacity of NAU investigators in health-related survey design