Colorectal cancer (CRC) is one of the leading causes of cancer-related deaths among American Indian and Alaska Native (AI/AN) populations. Further, AI/ANs are twice as likely to be diagnosed with advanced rather than localized CRC compared to non-Hispanic Whites, suggesting that lack of access to adequate cancer screening and treatment may play a role. Yet, few studies have tested culturally appropriate interventions to increase CRC screening among AI/ANs. Our research team has developed and tested a novel intervention package to promote CRC screening in an urban and underserved Asian minority population. This intervention, which involved a health educator, a culturally-tailored video, and a pamphlet, was remarkably successful: 70% of the intervention group were screened compared to 28% of the control group. The goal of the proposed study Is to culturally adapt this successful CRC screening intervention with AI/AN patients. We will modify the media for conveying the screening intervention by using digital stories, a new media methodology that capitalizes on the tradition of Native storytelling. The CRC screening intervention will be implemented in partnership with the only 2 urban clinics in Washington State that serve the AI/AN population: the Seattle Indian Health Board and NATIVE Health of Spokane.
Our specific aims are to: 1) Estimate the effectiveness of digital stories accompanied by an educational pamphlet to improve CRC screening rates in AI/ANs;2) Using qualitative methods, examine the adoption, implementation, and maintenance of our CRC screening intervention at these 2 urban Indian clinics. Today, over 55% of AI/ANs live in urban areas, yet urban AI/AN people have been called the "invisible minority." Because neither the Indian Health Service nor the National Center for Health Statistics systematically collects information on this group, the needs of AI/ANs living off reservation lands are rarely recognized and they are under-represented in research. To our knowledge, this will be the first CRC screening intervention targeting urban AI/ANs.

Public Health Relevance

The proposed research will contribute knowledge towards the adaptation and dissemination of evidencebased inten/entions to American Indians and Alaska Natives, one of the most underserved populations in the US. Specifically, the aim of this study is to increase colorectal cancer screening by American Indians and Alaska Natives and reduce current colorectal cancer disparities experienced by this population.

National Institute of Health (NIH)
National Cancer Institute (NCI)
Specialized Center (P50)
Project #
Application #
Study Section
Special Emphasis Panel (ZCA1-SRLB-3)
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of Washington
United States
Zip Code
Hoffman, Richard M; Li, Jun; Henderson, Jeffrey A et al. (2014) Prostate cancer deaths and incident cases among American Indian/Alaska Native men, 1999-2009. Am J Public Health 104 Suppl 3:S439-45
Javid, Sara H; Varghese, Thomas K; Morris, Arden M et al. (2014) Guideline-concordant cancer care and survival among American Indian/Alaskan Native patients. Cancer 120:2183-90
Veazie, Mark; Ayala, Carma; Schieb, Linda et al. (2014) Trends and disparities in heart disease mortality among American Indians/Alaska Natives, 1990-2009. Am J Public Health 104 Suppl 3:S359-67