Comic books have long been used among U.S. youth as an educational tool to improve and protect public health. A notable deficit of prior efforts was the absence of direct youth involvement in producing the educational comics. In 2008, Native People for Cancer Control launched the Native Comic Book Project (NCBP) as a youth-focused community education effort. By combining American Indian and Alaska Native (AI/AN) storytelling traditions with a successful school-based comics curriculum and instruction in decision-making skills, the NCBP involved Native youth in participatory health promotion and primary prevention activities related to tobacco use. In this Pilot Project, Native People for Cancer Control will expand and test the ability of the intervention to increase knowledge and encourage adoption of cancer risk reduction habits related to smoking, obesity, and human papillomavirus infection. Our study population will be school-age AI/AN youth at 4 sites in Washington State. Four established partners have requested the NCBP; the Seattle School District Indian Education Program;the Lummi Nation, a tribe of 4,219 Coastal Salish people in Bellingham;and 2 non-profit, multi-service community health centers, namely, the Seattle Indian Health Board and the Spokane Native Project. Thus, the Specific Aims of the NCBP are to;1) develop up to 3 new curricula on cancer risk factors pertinent to youth and ascertain their comprehensibility, acceptability, and relevance at our 4 partner sites;2) perform pre- and post-intervention measures of knowledge, habits, and decision-making regarding tobacco use, healthy eating, exercise, and human papillomavirus among youth participants;3) determine the intervention's sustained effect by conducting 2-month post-Intervention follow-up interviews with youth to assess knowledge and habits regarding the outcomes of interest;4) assess dissemination into local communities by conducting 2-month post-intervention follow-up interviews on the steps taken by youth to share their finished comic books with family, friends, and community members. The primary outcomes of this study will be an increase in knowledge of cancer risk factors most pertinent to youth and enhanced decision-making skills that are transferable to diverse health conditions and situations. This is the first educational intervention study using comic books with Al/ANs, and the first in any minority group to target cancer risk factors relevant to youth. Our focus on youth addresses cancer and its risk factors at the most fundamental level by encouraging good choices early in life. Our community-based participatory methods will inform efforts to encourage healthy behaviors in a particularly at-risk and hard-to-reach minority population.

Public Health Relevance

This innovative community-based participatory research project has a unique focus on decision-making, a key concept in understanding, encouraging, and increasing healthy behaviors among AI/AN youth. Intervening with a group of youth holds far more promise than intervening with a single individual, reinforcing research findings that peers play a pivotal role in shaping adolescents'health behavior. The NCBP Pilot Project will be led by promising new investigators, thus contributing to NPCC's training mission and increasing the pool of Native researchers conducting investigations on cancer and cancer risk factors.

National Institute of Health (NIH)
National Cancer Institute (NCI)
Specialized Center--Cooperative Agreements (U54)
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Special Emphasis Panel (ZCA1-PCRB-G)
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University of Washington
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