Northwest Portland Area Indian Health Board: Indian Leadership for Indian Health

Comprehensive Cancer Tribal BRFSS Project

Background:
American Indians/Alaska Natives (AI/AN) are a diverse population representing hundreds of tribes with a variety of cultural beliefs and customs.  Regional cancer incidence rates vary among the AI/AN population.  Incidence rates for colorectal, lung, and breast cancer are substantially higher in Alaska Natives and Northern Plains Indians, while American Indians living in the southwestern United States have lower incidence rates for these cancer sites AI/ANs generally have higher rates of habitual tobacco use, diabetes, and obesity and lower rates of physical activity compared to non-Hispanic whites. However, there is regional variation among the AI/AN population in these cancer-related risk factors as well. Tribe-specific data on behavioral risk factors are usually not available. State-level Behavioral Risk Factor Surveillance System (BRFSS) data for AI/AN populations is often hampered by small numbers leading to unstable estimates. In addition, the BRFSS core module does not collect data on tribal affiliation.  AI/ANs in general have lower rates of household phone coverage than the general U.S. population, making this population harder to reach with traditional phone survey methods.  In one AI/AN community, lack of landline telephone coverage was associated with lower educational attainment, unemployment, and unhealthful lifestyle practices. 

The Comprehensive Cancer Control Branch (CCCB) in the Division of Cancer Prevention and Control at CDC funds four tribal organizations and three tribal nations for comprehensive cancer control activities through the National Comprehensive Cancer Control Program (NCCCP). The tribal organizations include Alaska Native Tribal Health Consortium, Northwest Portland Area Indian Health Board (OR, WA, ID), South Puget Intertribal Planning Agency, and Aberdeen Area Tribal Chairman’s Health Board (South Dakota, North Dakota, Iowa, Nebraska).  The three tribes are Cherokee Nation, Fond du Lac Reservation, and Tohono O’odham Nation. 

Through an interagency agreement with IHS, the Northwest Portland Area Indian Health Board’s Tribal Epidemiology Center (TEC) will be funded to perform developmental work with up to three NCCCP tribal programs for the purpose of conducting either in-person BRFSS type health surveys (using the BRFSS core or optional modules or other OMB approved health surveys) or working with state BRFSS programs for an oversample or enhanced sample through the traditional BRFSS. 

The NPAIHB’s TEC will work with CDC’s Division of Cancer Prevention and Control (DCPC) and IHS’s Division of Epidemiology and Disease Prevention (DEDP) to finalize the identification of NCCCP-funded tribal programs with BRFSS-type data needs and secure their interest in this project.  The TEC will assist the NCCCP--funded tribal programs with securing institutional review board (IRB) approval and tribal council approvals.  The TEC, along with input from the NCCCP tribal programs and DCPC, will determine the best strategy for survey data collection, including determining the statistical sampling approach and sample size requirements, and will develop a project implementation plan for each identified NCCCP tribal program.

Goals:
These activities include building coalitions and partnering with other organizations to address cancer in their communities, assessing the burden of cancer including risk factors, developing cancer plans that encompass the cancer control continuum, and implementing cancer plans with stated goals/objectives/strategies to ultimately reduce the burden of cancer. 

Objectives:

  • By the end of 2011, developmental work will begin on the tribal BRFSS surveys to include securing tribal support and IRB approval, and determining statistical sampling approach.
  • By the end of 2011, any modification of survey questions will be completed and tested for the tribal BRFSS surveys, interviewers will be trained, and databases will be setup.
  • By the end of 2012, the tribal BRFSS surveys will be completed.
  • By the end of 2013, results of the tribal BRFSS surveys will be disseminated and a tribe-specific and aggregate report completed. 

Data:
The BRFSS is one of four datasets recommended by CCCB to assess the burden of cancer and data on alcohol and tobacco use, obesity, physical activity, and cancer screening (breast, cervical, colorectal, and prostate cancer screening) are collected through self-report by telephone surveys administered through state health departments. Most NCCCP tribal programs have cancer registry and vital statistics data for their populations, but gaps exist with the BRFSS and YRBS, as reported through the NCCCP Performance Measures. As the NCCCP evolves and emphasis is placed on measuring changes in population-based measures and showing progress toward cancer control objectives, having timely, adequate data will become increasingly important. 

Funding & Program Contacts:
The Comprehensive Cancer Tribal BRFSS Project is funded through the Centers of Disease Control and Prevention through a contract with the Indian Health Service.
Project Director: Birdie K. Wermy, B.S. (Southern Cheyenne)
Principle Investigator: Julie Townsend, MS.
Comprehensive Cancer Control Branch Division of Cancer Prevention and Control Centers for Disease Control and Prevention