The COVID-19 pandemic has profoundly altered nearly every facet of daily life. Although social and physical distancing constraints appear to be slowing the spread of the disease, they may be adversely affecting cancer- related preventive behaviors and accessibility to medical services, including cancer treatment. The impact of such COVID-19 restrictions must be quantified to understand and mitigate short- and long-term effects across the cancer continuum, especially among vulnerable populations, including American Indian adults. The goal of this study is to explore how differences in demographics (e.g., age, sex, educational attainment) may impact engagement in cancer preventive behaviors (e.g., tobacco cessation, cancer screening) and cancer management/survivorship behaviors (e.g., access to cancer treatment services) in the context of COVID-19 restrictions (e.g., social distancing, alterations in work arrangements) by surveying a sample of 1,000 American Indian adults, including those who have never had cancer, cancer patients and cancer survivors. This study will be conducted by the Stephenson Cancer Center Community Outreach and Engagement (COE) program in close coordination with three American Indian tribal nations, Choctaw Nation of Oklahoma, Chickasaw Nation, and Cherokee Nation, and the Oklahoma Area Tribal Epidemiology Center. This goal will be achieved by completing three specific aims: (1) to develop and administer a survey exploring the impact of COVID-19 restrictions on cancer prevention and control behaviors. This survey will include a core set of common data elements that will be administered by several NCI-designated Cancer Centers to increase the depth and generalizability of findings; (2) to develop an accurate and robust data integration method using novel machine learning and propensity score weighting approaches to improve the representativeness of the sample of American Indian adults that will be drawn in Oklahoma; and (3) to analyze data to inform tribes, healthcare delivery systems serving American Indian patients, and Stephenson Cancer Center research program members and clinicians regarding how American Indian adults are being impacted by the COVID-19 pandemic. Findings will be used to inform interventions and policies aimed at mitigating the cancer-relevant effects of COVID-19 restrictions in a highly vulnerable group residing within the Stephenson Cancer Center catchment area of Oklahoma. Future iterations of the survey to monitor trends over time are planned. A timeline of COVID-19 related guidance, restrictions or regulatory mandates that have been enacted at the national, state and tribal levels will be constructed to form a context that will allow for meaningful interpretation of findings by tribal community leaders and researchers.
The impact of COVID-19 social and physical distancing restrictions on cancer preventive behaviors and access to healthcare, including cancer treatment, must be quantified to understand and mitigate effects of these restrictions on vulnerable groups. The exclusive focus of this study on American Indian adults with and without cancer will provide needed information in a population that may be especially vulnerable to the effects of the COVID-19 pandemic.
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