Purpose: Native Navigators and the Cancer Continuum (NNACC) is a community based participatory research project based on partnerships among three American Indian (AI) communities in: (1) Colorado (2) South Dakota; and (3) Michigan. The goal is for the Partners to collaborate, refine, expand and adapt various navigator/community education programs to address the Native American communities' and patients' needs throughout the continuum of cancer care. The intended population is a total 600 AI adults, both genders (200 each setting).

Methods/Strategies: This community-based participatory research (CBPR) study is based on the Social Cognitive Theory. The research question is, "Can a Native specific comprehensive Navigator-initiated community cancer education intervention improve health behaviors among Native American community members?" Each NNACC setting creates partnerships with two local AI organizations. These local organizations coordinate Family Fun Events (FFE), series of 24-hours of community education workshops per year as well as track the use of audience response system keypads for their respective participants. The Navigators serve as teaching faculty to implement and evaluate the AI community workshops. Through such exposure within the community, the Navigators become more visibility and subsequently more accessible for AI community members to help them schedule early detection appointments, follow-through for all abnormal screening tests, support for those diagnosed with cancer and for their family members and loved ones.

Evaluation/Results/Findings: By the middle of year 03, all three partners implemented baseline and follow-up FFE and at least three series of AI community workshops that cover the full continuum of cancer in all three settings with more than 300 Native community members.

Conclusions: The Navigators documented data showing an increase from pre- to post-workshop knowledge evaluation that averaged >25% for all three settings.

This 2.5 year Supplement is designed to increase Muscogee (Creek) Nation American Indian awareness of cancer, potential causes and available resources through community cancer education. This is implemented by providing technical assistance, educational materials, partnerships and financial support for Muscogee (Creek) Nation staff to work with community members who live with disparities. Muscogee (Creek) Nation will be an additional site to the NNACC study.

Purpose: The purpose of "Native American Cancer Education for Survivors" (NACES) is to improve the quality of life (QOL) of cancer patients by increasing knowledge and informed choice using innovative, tailored web-based technology.

Methods/Strategies: The intervention is based on the Social Cognitive Theory. The primary research question is, "Does a culturally relevant cancer intervention that can be adapted by the individual Native American cancer patient to address personal needs, increase access to and utilization of resources that improve the Native American cancer survivor's QOL? The intervention uses the Medicine Wheel (body, mind, emotions, spirits) for its layout and includes the following components: spirituality, communication, treatment, clinical trials, side effects, palliative care, other health problems, supportive care and resources. Trained Native Patient Advocates implement a four-part QOL survey and the intervention.

Evaluation/Results/Findings: By spring 2010, more than 600 Native American cancer survivors from diverse regions of the US completed the QOL survey. 81.8% (n=446) of the participants self-reported their health as okay or excellent and almost all (n=519; 93.7%) said their life was satisfying. The majority (n=491. 71.5%) felt they had fair to good control over their cancer. However, almost two-thirds (n=358; 65.3%) reported their lives as very or fairly stressful. Also, disconcertingly, a large proportion (n=239; 43.9%) reported their lives served little to no usefulness.

Conclusions: Although the survivors documented many challenges, more importantly, they reported a message of hope and most (87.1%) said they were mentally able to do most or everything they wanted or needed to do daily.

Native American Cancer Research Corporation (NACR) has two primary roles during this five-year CNP. The first is to partner with two American Indian (AI) communities based in Nebraska and Florida to implement local health / cancer needs assessments (NA) during years 01-02. Based upon the findings from the local NA, each community will prioritize their health / cancer needs and pilot test an excerpt of an intervention. The pilot intervention will be implemented and evaluated during years 03-05. Each community will also collect knowledge, attitude and behavior (KAB) measures during the pilot intervention. Each community will continue to refine the intervention or for those pilots that are working well, the community may expand their intervention to address other priorities based on their local NA. Throughout the five years, the communities will continue to collect NA and KAB data. Throughout these NA and pilot intervention efforts, NACR staff will provide technical assistance, training, access to online evaluation tracking programs, and cancer education and awareness. They will partner with the communities through one face-to-face meetings annually as well as through conference calls using webinars to allow the sharing of documents among the partners. The two communities will include an AI rural community based in FL, and an urban setting in NE. The goal for task 1 is improve two AI communities' skills to collect and analyze NA and KAB measures to assist with the implementation and assessment of culturally appropriate health / cancer interventions in their local AI communities. The research question is, "How can local AI NA and KAB findings be used to create culturally appropriate health / cancer pilot interventions?"

NACR's second role is to continue implementation and analyses of the "Native American Cancer Education for Survivors" (NACES) support education intervention. Through Mayo Clinic's SoE-CNP-II support, one Native Patient Advocate (NPA) will work in the Northern Plains to collect baseline quality of life (QOL) online surveys and implement the education intervention with AI cancer survivors. They will also follow-up with the patients about six months later to collect the follow-up QOL survey and administer additional components of the education intervention. The goal for task 2 is to improve informed decision-making among Native American cancer survivors through culturally and literacy appropriate health information. The primary research question is, "How does culturally relevant and easy-to-understand information intervention improve the Native American cancer survivor's QOL?

NACR's specific aims follow:
• Aim 1. By month 24, collect and analyze AI community health and cancer needs and resources from two geographically diverse regions.
• Aim 2. By month 60 and based on the documented, local needs assessment findings, implement and evaluate via measured changes in participants' KAB for two AI community health / cancer pilot interventions.
• Aim 3. Throughout the five years, implement and assess NACES survivors' survey and education intervention within Northern Plains AI communities.
• Outcome measures for Aim 1 include NA findings and priorities for two geographically diverse AI communities summarized during months 24, 36, 48 and 54.
• Outcome measures for Aim 2 are culturally appropriate pilot interventions for two geographically diverse AI communities.
• Outcome measures for Aim 3 is at least 50 QOL surveys and 25 follow-up surveys from Northern Plains AI cancer survivors and tracking data documenting in which components of the NACES education intervention the survivors took part.

On October 1, 2010, NACR was awarded a 5-year grant from the Centers for Disease Control and Prevention called, "Collaborative Partnerships in Cancer Prevention and Control Programs for American Indians" (PI: Seals; 1U57 DP003084). There are 4 tasks associated with this grant.

1. Implementing and evaluating 10 Regional Planning Conferences in collaboration with local public health professionals and organizations that actively work with American Indian or Alaska Native (AIAN) organizations and communities. The conferences will be 2.5 days with one day being optional cultural awareness training. The Map on this page highlights the locations of the Regional Conferences and the years for implementation (year 01=2011; year 02=2012, etc.);



2. Addressing gaps in AIAN cultural awareness materials (includes designing developing and distributing AIAN cultural appropriate public education and awareness materials in partnerships with the Regional Planning conferences; also includes one Native Wellness booklet annually and one case study annually);



3. Providing Technical Assistance as approved by the CDC, to states, Indian Health Service, Tribal and urban programs and others; and,



4. Implementing and evaluating cultural awareness trainings (1 with CDC and the remaining ones in conjunction with the regional conferences)

"Breast Health for Native Americans," Susan G. Komen for the Cure, Local Denver Affiliate

The purpose of this grant is to increase breast cancer screening and quality services for Native American women in the Denver metropolitan area.

NACR is funded to:

1. Coordinate with Native American organizations and other Komen affiliates to recruit Native American women for breast cancer screenings;



2. Refer for breast cancer screening at least 30 women who meet eligibility including those aged 40-49 and older women who are not eligible for WWC (no US documentation) or younger women who are younger and have some clinical or family background to indicate a need for cancer screening;



3. host cancer support groups; and



4. offer 4 cultural awareness trainings to Komen affiliates and other organizations serving women for breast screening and treatment.