Dataset Information

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

ABSTRACT:

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.

SUBMITTER: Tsosie U

PROVIDER: S-EPMC11295622 | biostudies-literature | 2024 Sep

REPOSITORIES: biostudies-literature

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Publications

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

Tsosie Ursula U Anderson Nicolas N Woo Nicholas N Dee Craig C Echo-Hawk Abigail A Baker Lannesse L Rusk Ann M AM Barrington Wendy W Parker Myra M Triplette Matthew M

Preventive medicine reports 20240714

<h4>Introduction</h4>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.<h4>Materials and met ...[more]

PMID: 39100381

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Project description:BackgroundIn the United States, the mortality burden of injury is higher among American Indians and Alaska Natives (AI/AN) than any other racial/ethnic group, and injury contributes to considerable medical costs, years of potential life lost (YPLL), and productivity loss among AI/AN.This study assessed the economic burden of injuries for AI/AN who are eligible for services through Indian Health Service, analyzing direct medical costs of injury for Indian Health Service's users and years of potential life lost (YPLL) and the value of productivity losses from injury deaths for AI/AN in the Indian Health Service population.MethodsInjury-related lifetime medical costs were estimated for Indian Health Service users with medically treated injuries using data from the 2011-2015 National Data Warehouse. Productivity costs and YPLL were estimated using data on injury-related deaths among AI/AN in Indian Health Service's 2008-2010 service population. Costs were reported in 2017 U.S. dollars.ResultsThe total estimated costs of injuries per year, including injuries among Indian Health Service users and productivity losses from injury-related deaths, were estimated at $4.5 billion. Lifetime medical costs to treat annual injuries among Indian Health Service users were estimated at $549 million, with the largest share ($131 million) going toward falls, the most frequent injury cause. Total estimated YPLL from AI/AN injury deaths in Indian Health Service's service population were 106,400. YPLL from injury deaths for men (74,000) were 2.2 times YPLL for women (33,000). Productivity losses from all injury-related deaths were $3.9 billion per year. The highest combined lifetime medical and mortality costs were for motor vehicle/traffic injuries, with an estimated cost of $1.6 billion per year.ConclusionsFindings suggest that targeted injury prevention efforts by Indian Health Service likely contributed to lower rates of injury among AI/AN, particularly for motor vehicle/traffic injuries. However, because of remaining disparities in injury-related outcomes between AI/AN and all races in the United States, Indian Health Service should continue to monitor changes in injury incidence and costs over time, evaluate the impacts of previous injury prevention investments on current incidence and costs, and identify additional injury prevention investment needs.

Project description:BackgroundAmerican Indians/Alaska Natives have the highest commercial tobacco use in the United States, resulting in higher tobacco-caused deaths and diseases than the general population. Some American Indians/Alaska Natives use commercial tobacco for ceremonial as well as recreational uses. Because federally recognized Tribal lands are sovereign, they are not subject to state cigarette taxes and smoke-free laws. This study analyzes tobacco industry promotional efforts specifically targeting American Indians/Alaska Natives and exploiting Tribal lands to understand appropriate policy responses in light of American Indians'/Alaska Natives' unique sovereign status and culture.MethodsWe analyzed previously secret tobacco industry documents available at the Truth Tobacco Documents Library (https://industrydocuments.library.ucsf.edu/tobacco/).ResultsTobacco companies used promotional strategies targeting American Indians/Alaska Natives and exploiting Tribal lands that leveraged the federally recognized Tribes' unique sovereign status exempting them from state cigarette taxes and smoke-free laws, and exploited some Tribes' existing traditional uses of ceremonial tobacco and poverty. Tactics included price reductions, coupons, giveaways, gaming promotions, charitable contributions, and sponsorships. In addition, tobacco companies built alliances with Tribal leaders to help improve their corporate image, advance ineffective Youth Smoking Prevention programs, and defeat tobacco control policies.ConclusionsThe industry's promotional tactics likely contribute to disparities in smoking prevalence and smoking-related diseases among American Indians//Alaska Natives. Proven policy interventions to address these disparities including tobacco price increases, cigarette taxes, comprehensive smoke-free laws, and industry denormalization campaigns to reduce smoking prevalence and smoking-related disease could be considered by Tribal communities. The sovereign status of federally recognized Tribes does not prevent them from adopting these measures.ImplicationsAmerican Indians/Alaska Natives suffer disparities in smoking prevalence and smoking-related diseases as compared with other groups. The tobacco industry has used promotional tactics including price reductions, coupons and giveaways, casino and bingo promotions, charitable contributions and sponsorships, and so-called Youth Smoking Prevention (YSP) programs to specifically target American Indians/Alaska Natives and exploit Tribal sovereignty, which likely contribute to disparities in tobacco use and related diseases and deaths among this population. Tribal and public health policy makers should consider rejecting ineffective YSP programs and instead consider adopting proven policy interventions including tobacco price increases, cigarette and casino taxes, comprehensive smokefree laws, and anti-industry denormalization campaigns to reduce smoking and smoking-related disease.

Dataset Information

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

Introduction

Materials and methods

Results

Conclusions

Publications

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

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