Current Centers for Population Health and Health Disparities

University of Washington
Center for Native Population Health Disparities

Contact Information
Ursula Tsosie
1730 Minor Ave., Suite 1760
Seattle, WA 98101
(206) 543-7931
utsosie@u.washington.edu
http://depts.washington.edu/uwccer/ccer-about.html

Dedra S. Buchwald, MD – Contact Principal Investigator

Abstract: The University of Washington (UW) and Black Hills Center for American Indian Health (BHCAIH) will support for a Center for Native Population Health Disparities (CNPHD). Our aim is to directly contribute to improved cancer health outcomes and quality of life for American Indian/Alaska Native (AI/AN) populations—populations that are experiencing dramatic health inequities. Although strides have been made in improving health and life expectancy in Native communities, much work remains, as eloquently argued in the Institute of Medicine report, Examining the Heath Disparities Research Plan of the National Institutes of Health: Unfinished Business, and the Surgeon General's report, Mental Health: Culture, Race, and Ethnicity. Our CNPHD will strive to address the gaps identified in these seminal publications. Our research agenda articulates a model for AI/AN health and health disparities that is well-grounded in current theory, consistent with that of the CPHHD, and applicable to all our projects. The many Native people involved in this Center, as well as our Community Action Board and two AI/AN sociologists, will help us critically examine the role of culture in the model. Our investigations reiterate a single leitmotif—the examination of genetic, environmental, biological, psychosocial, and cultural influences on cancer health disparities at multiple levels and across the lifespan. Our projects include children, youth, and adults. The proposed CNPHD will fill a striking research gap, since no previously or currently funded Center examines AI/AN health disparities. Our Center will truly represent our research partner communities, with 11 AI/ANs serving in key roles, for example as Project and Core Leaders or Co-Investigators. As a result, all proposed projects have deep and meaningful ties to their respective communities. The unique connection between our investigators and the tribal communities imbues our work with a special dynamic. Investigators are more fully invested in the communities with which they work, and this commitment goes a long way to ensuring reciprocity and respect among all parties involved in the research. Finally, the CNPHD will truly be transdisciplinary. We bring together scholars from across the full spectrum of biological, social, and behavioral sciences. Of special note, we do not limit "team science" to traditional academic circles, but bring in ideas and Native expertise from community-based leaders and entities. We envision that this approach will eventually move research on AI/AN health disparities beyond the purely descriptive into meaningful action. The CNPHD will pursue an integrated, multifaceted research program that capitalizes on several large, well-organized, existing efforts and databases, as well as numerous well-established and mutually respectful relationships, to address issues in genetics, etiology, epidemiology, primary and secondary prevention, clinical assessment, treatment, and cancer survivorship. Clinical, basic, and social sciences are linked with a community-based participatory perspective to provide a transdisciplinary research program of the highest scientific and programmatic caliber for AI/AN community members, patients, clinicians, researchers, and health decision-makers. Notably, this application follows the overarching requirements for CPHHD to: (1) include scientists from basic, clinical, and social sciences; (2) focus on an underserved population; (3) incorporate principles of community-based participatory research; (4) include interventions directed toward at least two levels; (5) offer career development opportunities; and (6) interact and harmonize with other Centers and National Institutes of Health (NIH) program staff to conduct transdisciplinary, multisite, highly interactive research.

Center Aims

• Contribute directly to improved cancer health outcomes and quality of life for American Indian/Alaska Native (AI/AN) populations;
• Examine the genetic, environmental, biological, psychosocial, and cultural influences on AI/AN cancer health disparities at multiple levels and across the lifespan;
• Address gaps in improved health and life expectancy within the AI/AN community;
• Pursue an integrated, multifaceted research program that incorporates principles of community-based participatory research and that addresses issues in genetics, etiology, epidemiology, primary and secondary prevention, clinical assessment, treatment, and survivorship of cancer.

Project 1 will identify individuals from a large community-based study and collect new data to produce a detailed description of smoking and nicotine dependence and addiction among members of the Lakota Sioux and Pima Maricopa tribal communities, and examine genetic and molecular markers of nicotine metabolism and addiction.

Specific Aims

• Perform candidate-gene association studies between known smoking-related polymorphisms and smoking status;
• Determine the association between smoking-related polymorphisms and nicotine dependence among smoker;
• Examine whether the pattern of association of specific polymorphisms with smoking status and nicotine dependence varies systematically by tribe.

Project 2 will implement, through focus groups, surveys, and clinical examinations, a tailored intervention for prevention of cervical cancer among Hopi women and girls using vaccine education and human papillomavirus (HPV) DNA testing via self-collected vaginal swabs of all age-eligible Hopi women.

Specific Aims

• Compare the number of Hopi girls ages 11–12 receiving HPV vaccination before and after a 2-year implementation of a mother-daughter educational intervention;
• Assess individual predictors of HPV vaccination;
• Compare the prevalence of high-risk HPV types in Hopi women adherent with cervical cancer screening guidelines to those who are non-adherent;
• Compare risk and protective factors for high-risk HPV infection among screening adherent and non-adherent Hopi women.

Project 3 will evaluate an intervention using digital stories to increase colorectal cancer screening among urban AI/ANs.

Specific Aims

• Estimate the effectiveness of digital stories accompanied by an educational pamphlet to improve colorectal cancer (CRC) screening rates in AI/ANs;
• Using qualitative methods, examine the adoption, implementation, and maintenance of CRC screening intervention at two urban Indian clinics.

Project 4 will ascertain urinary cotinine levels in AI/AN young children to document environmental smoke exposure, and then use motivational interviewing with their parents/guardians, in conjunction with the test results, to increase the rate of polices that are instituted to eliminate or reduce exposure to in-home and second-hand smoke.

Specific Aims

• Evaluate the impact of the child urinary toxin biomarker feedback intervention on the adoption of home smoking restrictions and on home air quality;
• Determine the effect of the intervention on health-related quality of life 3 and 6 months after implementation of the educational and biomarker feedback intervention;
• Determine the effect of the intervention on adult smokers' cigarette use, including readiness to quit, quit attempts, and cessation;
• Assess how the intervention changes cultural and social factors that relate to smoking behavior, such as traditional tobacco use and family support.

Project 5 will examine surgical treatment types, delays, and outcomes among AI/AN lung, prostate, breast, and colorectal cancer patients by using data from the Surveillance Epidemiology and End Results Program (SEER) and a comprehensive surgical data collection project in 50 Washington state hospitals. Semi-structured interviews will be conducted with AI/AN cancer patients and caregivers about barriers to care.

Specific Aims

• Describe nationwide variation in processes and outcomes of surgical cancer care between AI/AN and non-Hispanic White cancer patients by using SEER and SEER-Medicare datasets;
• Compare receipt of "best practices" and stage-specific outcomes in the delivery of surgical care between these two groups of patients across Washington state's SCOAP network;
• Describe the perceptions, attitudes, and beliefs of AI/AN patients related to surgical cancer care, and assess surgeons' cultural competence and perceptions about barriers to providing cancer care to AI/AN patients.