BACKGROUND: Breast cancer incidence and mortality have been increasing among American Indian and Alaska Native (AI/AN) women, and their survival rate is the lowest of all racial/ethnic groups. Nevertheless, knowledge of AI/AN women's breast cancer screening practices and their correlates is limited. METHODS: Using the 2003 California Health Interview Survey, we 1) compared the breast cancer screening practices of AI/AN women to other groups and 2) explored the association of several factors known or thought to influence AI/AN women's breast cancer screening practices. FINDINGS: Compared with other races, AI/AN women had the lowest rate of mammogram screening (ever and within the past 2 years). For clinical breast examination receipt, Asian women had the lowest rate, followed by AI/AN women. Factors associated with AI/AN women's breast cancer screening practices included older age, having a high school diploma or some college education, receipt of a Pap test within the past 3 years, and having visited a doctor within the past year. CONCLUSION: Significant differences in breast cancer screening practices were noted between races, with AI/AN women often having significantly lower rates. Integrating these epidemiologic findings into effective policy and practice requires additional applied research initiatives.
Nationally, a greater proportion of American Indians and Alaska Natives (AI/ANs) are diagnosed with advanced-stage cancers compared with non-Hispanic whites. The reasons for observed differences in stage at diagnosis between AI/ANs and non-Hispanic whites remain unclear.
Medicaid, Indian Health Service Care Systems, and state cancer registry data for California, Oregon, and Washington (2001-2008, analyzed in 2014-2015) were linked to identify AI/ANs and non-Hispanic whites diagnosed with invasive breast, cervical, colorectal, lung, or prostate cancer. Logistic regression was used to estimate ORs and 95% CIs for distant disease versus local or regional disease, in AI/ANs compared with non-Hispanic white case patients.
A similar proportion of AI/AN (31.2%) and non-Hispanic white (35.5%) patients were diagnosed with distant-stage cancer in this population (AOR=1.03, 95% CI=0.88, 1.20). No significant differences in stage at diagnosis were found for any individual cancer site. Among AI/ANs, Indian Health Service Care Systems eligibility was not associated with stage at diagnosis.
In contrast to the general population of the U.S., among Medicaid enrollees, AI/AN race is not associated with later stage at diagnosis. Cancer survival disparities associated with AI/AN race that have been observed in the broader population may be driven by factors associated with income and health insurance that are also associated with race, as income and insurance status are more homogenous within the Medicaid population than within the broader population.
The accuracy of infant mortality rates and other indices of the health of populations depends on the consistency of information collected from separate sources (e.g., birth and death certificates). Inconsistent recording of basic information such as race and ethnicity has resulted in underestimation of mortality among minority populations, particularly minority populations other than blacks. This report summarizes studies in California and Montana that describe and measure the magnitude of differences in the recording of race for American Indians/Alaskan Natives (AI/ANs) on birth and infant death certificates.
Age-specific incidence rates for cancers of the colon and rectum are presented for Chinese in the western United States and Canada (high risk area), and in Shanghai, the People's Republic of China (low risk area). These rates are compared to those among North American whites. Among Chinese, rate differences between high and low risk areas are greater for colon cancer than rectal cancer, are greater for men than women, and increase with age. The most striking finding is the high colon cancer incidence among older Chinese-American men, compared to Chinese-American women. Colon cancer rates among elderly Chinese-American men equal those of whites, which are seven times the corresponding rates in China. By contrast, colon cancer rates among older Chinese-American women are intermediate between those of whites and those in China, and are only three to four times the rates in China. Rectal cancer rate differences for Chinese men also exceed those for Chinese women. However, they are less dramatic than for colon cancer, with elderly Chinese-American men having roughly double the rates in China, and with women exhibiting little variation between continents or ethnic groups. Male:female (M:F) rate ratios increase with age for both continents, both ethnic groups, and both colon and rectum. The colon cancer M:F ratios among Chinese-Americans exceed the others, reaching two in the older age groups. These observations suggest sex-specific aetiological exposures, or sex-specific susceptibilities to common exposures, among Chinese-Americans.(ABSTRACT TRUNCATED AT 250 WORDS)
The cost of smoking has been explored for residents of the U.S. living in several states. Recent evidence has indicated that the prevalence and cost of smoking are associated with racial and ethnic groups. This study provides information on tobacco prevention and control for American Indians (AI) (American Indians refers to American Indians and Alaska Natives throughout this article. Where we use the term California tribe we specifically mean persons who are members of Indigenous tribes geographically located in the geographic area now known as the state of California.) and examines the relative impact of smoking by using behavioral and demographic characteristics in order to predict the economic cost on AIs. The analysis suggests that AIs smoke more frequently than other Californians, which results in higher health care costs, as well as morbidity and mortality due to high levels of tobacco related chronic disease. Based on these factors we urge tribes to exercise their sovereignty as governments and implement local tobacco control policy strategies. We call for public health action by community leaders in Indian country and nationwide. We must act now to protect future generations.
A human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) intervention using indigenous outreach workers was implemented with Hispanic injection drug users (IDUs) and their sexual partners in three locations: Laredo, Texas; San Diego, California; and San Juan, Puerto Rico. A total of 2,169 subjects were contacted, given health education, HIV antibody testing, and follow-up counseling. This article reports on the 1,616 IDUs (75%) who completed the initial and follow-up interviews. The results indicated significant increases in health knowledge on AIDS, decreases in needle risk drug taking behaviors, some decreases in sex risk behaviors, and more realistic perceptions of personal AIDS risk. Using multivariate analyses, gender (male) and increasing age (older than age 25 years) were the strongest predictors of behavior change. Surprisingly, the identification of a positive HIV serostatus was not a significant predictor of behavior change. Although intended as a comparison study between contrasting levels of intervention, logistical and administrative problems undermined the use of a true quasi-experimental design. Nonetheless, the results from this research suggest that the use of indigenous outreach workers is an effective means of combatting the spread of HIV in this difficult to reach population. Some programmatic recommendations are provided for future efforts of this kind, particularly in relation to role conflicts experienced by outreach workers.
Men with higher endogenous 5alpha-reductase activity may have higher prostate cancer risk. This hypothesis raises two questions: (a) Could racial differences in 5alpha-reductase activity explain the observed racial differences in prostate cancer risk? and (b) Could a man reduce his activity level by modifying his lifestyle? To address these questions, we measured two hormonal indices of 5alpha-reductase activity [serum levels of androstane-3alpha-17beta-diol glucuronide (3alpha-diol G) and androsterone glucuronide (AG)] in healthy, older African-American, white, and Asian-American men, who are at high, intermediate, and low prostate cancer risk, respectively. We also examined associations between these metabolite levels and such lifestyle characteristics as body size and physical activity as well as select aspects of medical history and family history of prostate cancer. Men included in this cross-sectional analysis (n = 1054) had served as control subjects in a population-based case-control study of prostate cancer we conducted in California, Hawaii, and Vancouver, Canada and provided information on certain personal attributes and donated blood between March 1990 and March 1992. In this study, concentrations of 3alpha-diol G declined significantly with age and increased significantly with body mass index. Mean levels of 3alpha-diol G, adjusted for age and body mass index, were 6.1 ng/ml in African-Americans, 6.9 ng/ml in whites and 4.8 ng/ml in Asian-Americans. These differences were statistically significant (African-Americans versus whites: P
OBJECTIVES: To examine the effects of proposed methods of redistributing multiple-race mothers to single-race categories when computing trend data from birth certificates. METHODS: Low birthweight and multiple (twin and higher-order) birth rates for California were calculated for non-Hispanic mothers from birth certificate data for 2000. Births to the 1.9% of mothers identified as multiple-race were reassigned to single-race groups according to 12 "bridging" methods. Bridge methods utilized population-based whole allocation, fractional allocation, and other methods, primarily depending on first race listed. RESULTS: For large race groups, there was little difference in low birthweight and multiple birth rates regardless of the bridge method employed. For smaller groups such as Native Hawaiians and other Pacific Islanders and American Indians/Alaska Natives, there was substantial variation by bridge method in observed rates. CONCLUSIONS: Tracking trends in birth outcomes across the change in data collection will challenge public health researchers. This paper outlines advantages and disadvantages of various bridge methods.
In some problems in survival analysis there may be more than one plausible measure of time for each individual. For example mileage may be a better indication of the age of a car than months. This paper considers the possibility of combining two (or more) time scales measured on each individual into a single scale. A collapsibility condition is proposed for regarding the combined scale as fully informative regarding survival. The resulting model may be regarded as a generalization of the usual accelerated life model that allows time-dependent covariates. Parametric methods for the choice of time scale, for testing the validity of the collapsibility assumption and for parametric inference about the failure distribution along the new scale are discussed. Two examples are used to illustrate the methods, namely Hyde's (1980) Channing House data and a large cohort mortality study of asbestos workers in Quebec.
The authors present analyses of data from three independent clinical series and controls indicating an association between working in occupations with probable medium to high exposure to extremely low frequency ( 10 mG intermittently) to high (> 10 mG or > 100 mG intermittently) exposed cases were seamstress, dressmaker, and tailor. The results appear to be independent of education, and the sex-combined odds ratios for the three series are quite homogeneous: 2.9, 3.1, and 3.0. The odds ratio for the three series analyzed together is 3.0 (p