Angela A. Gonzales, Ph.D. (Hopi)Angela A. Gonzales, Ph.D. (Hopi)Assistant ProfessorAssistant Professor

Department of Development SociologyDepartment of Development SociologyCornell UniversityCornell University

Native Investigator ProgramNative Investigator Program

ActivitiesActivities Secondary Data AnalysisSecondary Data Analysis

Influence of Cultural Factors on Mammography among American Indian Women

Pilot StudyPilot StudyIs Social Capital Related to Colorectal Cancer

Knowledge and Attitudes? A Pilot Study of American Indians in the Southwest

K01 ProjectK01 ProjectWhat is the Association between Social Capital and

Blood Pressure? A Study of American Indians in the Southwest

BackgroundBackground

In 2005, breast cancer was the second leading cause of cancer death among American women

American Indian WomenAmerican 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

Specific AimsSpecific 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

SampleSample

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

MeasuresMeasures

OutcomeOutcomeSelf-reported lifetime receipt of mammography

Predictors of InterestPredictors of InterestTraditional 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 CovariatesAdjustment CovariatesAge, education, employment, single caregiver status, access to mammography, current driver status

Statistical MethodsStatistical Methods

Specific Aim 1Specific Aim 1 Calculated frequencies and proportions of sociodemographic, ecological,

and cultural factors both overall and by mammography receipt group

Specific Aim 2Specific 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 3Specific 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

ResultsResults

73% of our female participants reported having a mammogram sometime in their lives

Prevalence of lifetime mammography receipt differed by reservation (P < 0.001)

Reservation Prevalence 95% CIPine 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)

ConclusionsConclusions

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

Pilot StudyPilot Study

Is Social Capital Related to Colorectal Cancer Knowledge and Attitudes?

A Pilot Study of American Indians in the Southwest

SettingSetting

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.

BackgroundBackground

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

Social CapitalSocial 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 capitalBonding – relations within a communityBridging – horizontal links with other communitiesLinking – vertical links with outside institutions (e.g. federal and state governments, public/private corporations)

Specific AimsSpecific 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

SampleSample

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

MeasuresMeasures

OutcomeOutcomeTwo multi-item measures of CRC knowledge and CRC attitudes

Predictors of InterestPredictors 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

K01 ProjectK01 Project

What is the Association between Social Capital and Blood Pressure? A Study of

American Indians in the Southwest

Askawali!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, SDHopi Tribe• Tribal Council, Hopi Health Advisory Committee, and the Hopi

Health and Human Services DepartmentNative People for Cancer ControlResource Centers for Minority Aging Research Native Investigator

Program