Engaging the American Indian community in North Carolina to assess cancer research and training opportunities

ABSTRACT

Background: American Indians have significant barriers to cancer prevention and control due to a number of social structural factors. North Carolina has the largest American Indian population east of the Mississippi River with eight tribes and four urban Indian centers, yet there have been few coordinated strategies to address cancer disparities in this population. Engagement with tribal communities is vital in successful implementation of research and outreach activities. Methods: The Wake Forest Baptist Comprehensive Cancer Center (WFBCCC) received a supplement to their P30 Cancer Center Support Grant to inform Community Outreach and Engagement initiatives through The Healing Walk project which was designed to determine the most pressing cancer concerns for American Indian communities in North Carolina and identify needs for research training for American Indian students. Feedback was obtained from tribal leaders, educators, and college students through one large and three mini-round table discussions and solicited by email throughout late 2018 and 2019. The final round table occurred two days before the 2020 COVID 19 mitigation mandates. Results: Community interviews produced a wealth of information on the self-reported issues within American Indian populations in North Carolina. Tribal community leaders identified systemic and demographic issues that contribute to health disparities among their people. These issues include lack of trust in the medical community, structural barriers to care leading to late-stage diagnosis, perceptions related to cancer, high rates of cancer risk factors, including obesity and tobacco use, and historical trauma. Students identified factors which contribute to barriers in pursuing careers in cancer research, including a lack of American Indian mentors, financial barriers, mental health challenges that arise in attending majority institutions, and a lack of culturally competent research training. Conclusions: By relying on the viewpoints of tribal leaders, the WFBCCC can accurately address the needs of the communities and develop cancer prevention and control initiatives that are culturally responsible, such as Tribal Health Ambassadors. In accordance with the majority of the requests both students and educators made, the WFBCCC is creating an undergraduate research program for engaging AI students. Focusing on community identified areas of need, students will develop a research question relative to the health concerns of their tribe. The goal of this research program is two fold. First, to enable tribal communities to accurately assess cancer risk, incidence, and mortality, and with that knowledge reduce the current health disparities in AI populations. Second, to provide American Indian students with the opportunity to not only serve their community, but to give them the tools and experience to help understand and eliminate cancer disparities in their tribal communities.