Advancing Liver Cancer Prevention for Arizona American Indian Communities

Co-leaders: David Garcia, PhD, FACSM (UACC); Timian M. Godfrey, DNP, APRN, FNP-BC, CPH (UACC); Priscilla Sanderson, PhD, MS, CRC (NAU)

There are several aspects of the proposed research that will directly benefit American Indian communities in Arizona. American Indian groups are largely underrepresented in liver cancer research and scientific literature, particularly when considering modifiable risk factors. Among these risk factors, lifestyle behaviors influencing obesity and type 2 diabetes mellitus (T2DM) also impact the risk for developing liver cancer. In fact, individuals with T2DM have a 2-3 fold increased risk for developing liver cancer compared to those who do not have diabetes. The disproportionate burden of obesity and T2DM experienced by American Indian populations are often interrelated with lifestyle choices and social determinants of health. To have culturally informed evidence addressing these health disparities, adequate representation in research processes is important because these outcomes guide the development of health policy and clinical guidelines that ultimately impact American Indian people. To the best of our knowledge, there are no NACP studies that have focused on behavioral, social, and cultural factors to promote community member engagement in early screening and detection for liver disease in American Indian communities. The proposed study uniquely benefits the community in that it not only addresses this need, but also helps participants simultaneously understand their risk for multiple comorbid conditions through the integration of an on-site telehealth assessment and consultation into study methods. Further, when considering the American Indian community, several barriers to equitable health care access exist. Barriers may include scheduling conflicts, unreliable or no transportation, lack of health insurance, and the availability of child or family care services. The use of a portable, non-invasive liver disease screening tool in community settings combined with a telehealth-based approach may eliminate many of these barriers and permit individuals to engage in their healthcare understanding and decision-making in a manner best-suited to their personal situation. This pilot proposal is a needed step to reduce considerable public health burden associated with liver disease and liver cancer for American Indian communities in Arizona.

Early engagement with tribal community constituents has already informed the development of this proposal. Community stakeholders on the Navajo Nation and Tohono O’odham Nation have each expressed a need and interest in the work proposed. We will continue to work with community stakeholders, community advisory committees (CACs), and NACP investigators to conduct community outreach and recruitment efforts within priority areas of the Navajo Nation and Tohono O’odham Nation. These collaborative partnerships will ensure the proposed study is focused on community engaged principles and building tribal and community capacity for implementing sustainable cancer outreach and research initiatives that will provide longstanding benefit to the community.

Given the focus of prevention in obesity-related cancers, this study creates a unique opportunity to prioritize community needs, partner with local Indian and tribal healthcare systems, and collaboratively develop and implement outreach efforts with tribal communities. In partnership with the Navajo Nation and Tohono O’odham Nation, findings from this study will be shared through both community-based and scholarly activities. These approaches will not only enhance the overall goals of the project but also culturally inform institutional capacities to design sustainable, relevant cancer research and prevention programs for American Indian communities in Arizona. In addition, the sharing of ideas across investigators and working with communities will provide a complementary framework about best practices for engaging in research with tribal communities.

Lastly, the investigative team is committed to fostering professional education and development for American Indian students, faculty, and collaborators throughout the research process. We will directly engage American

Indian students from tribal community colleges (e.g., Tohono O’odham Community College) and universities (e.g., the University of Arizona and Northern Arizona University) to provide research training in lifestyle and health outcomes and community engagement. This will serve as a catalyst for training our American Indian students in interdisciplinary and translational research, a “gap” area in which greater representation is essential to building the evidence toward reduced health disparities for American Indian populations. This gap extends to American Indian faculty and post-doctoral fellows. As such, this proposal contributes to the mentorship and training of Dr. Timian Godfrey (Diné; Co-Leader) as she pursues a PhD degree in Nursing and Healthcare Innovation from Arizona State University. Ultimately, the proposed study directly benefits the community by 1) creating representative scientific evidence that can inform health policy and clinical guidelines, 2) increasing access to health services (e.g., telehealth and liver disease screening) that improve understanding of risk factors related to liver cancer, 3) building culturally relevant research capacity within American Indian communities that experience a disproportionate burden of obesity-related health disparities, and 4) providing valuable research training to American Indian health science students and early-career faculty.