Cancer Risk Factors and Screening Behaviors of the Hopi Tribe
Priscilla R. Sanderson, PhD
Sylvia Brown, PhD, MPH
Hopi Health Department
Lorencita Joshweseoma, MPH
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 addressed these issues with the development of a tribal-specific, cancer-focused behavioral risk factor survey for the Hopi Tribe. This research is a collaborative effort between the Hopi Office of Health Services and Hopi Cancer Support Services and researchers from the Arizona Cancer Center at the University of Arizona (UA) and Northern Arizona University(NAU) The team evaluated the prevalence of Hopi cancers, such as colorectal cancer and examined the hypothesis 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 three-year pilot project will end August 31, 2013. It has been a community based project which includes partners from the Hopi Tribe, UA and NAU. In year one, the project focused on 1) the development of a culturally appropriate cancer and chronic disease survey instrument and research protocols suitable for Hopi tribal members age 18 and older living on the reservation, and 2) training Hopi team members in survey methodology and NAU students on qualitative analyses. Survey items were selected from national survey tools, including the BRFSS, HINTS and First Nations Regional Health Survey, and were refined by the joint research team to be culturally appropriate to the Hopi people. Input from four focus groups aided in this effort. In Year 1, the team received funding from the Arizona Biomedical Research Commission (ABRC) to expand the project to cover all chronic diseases and to include a survey and focus groups of Hopi tribal members living off the reservation. In Years 2-3, the team implemented both surveys. The on-reservation survey achieved a 62% participation rate. Both surveys allow for an assessment of all Hopi tribal members, jointly and by residence, and facilitate an examination of the differences in knowledge, attitudes and behaviors, as well as health status, between Hopi living on versus off the reservation.