Is Personal Protective Equipment Worth the Hassle? Annual Risk of Cryptosporidiosis to Dairy Farmers and How Personal Protective Equipment and Handwashing Can Mitigate It.

Cows are known carriers of Cryptosporidium parvum (C. parvum), a protozoa that can cause the gastrointestinal illness cryptosporidiosis in humans. Despite this potential exposure, dairy farmers tend to wear personal protective equipment (PPE) to protect the milk from contamination, rather than to protect themselves from zoonotic diseases, such as cryptosporidiosis. In this study, cow feces were collected from individual cattle on dairy farms and analyzed for C. parvum using qPCR. Quantitative microbial risk assessment (QMRA) was used to determine the risk of cryptosporidiosis to the dairy farmer with and without the use of handwashing and PPE (gloves and masks). The annualized risk of cryptosporidiosis to dairy farmers was 29.08% but was reduced significantly in each of the three interventions. Among the individual interventions, glove use provided the greatest reduction in risk, bringing the annual risk of cryptosporidiosis to 4.82%. Implementing regular handwashing, the use of gloves and a mask brought the annual risk of cryptosporidiosis to 1.29%. This study provides evidence that handwashing and PPE use can significantly reduce the risk of cryptosporidiosis to farmers and is worth implementing despite potential barriers such as discomfort and cost.

An Examination of US COVID-19 Vaccine Distribution in New Jersey, Pennsylvania, and New York.

COVID-19 quickly spread across the United States (US) while communications and policies at all government levels suffered from inconsistency, misinformation, and lack of coordination. In order to explain the discrepancy between availability and population uptake, a case study was conducted analyzing vaccine rollout plans, social media, and Health Officer/Other Key Informant interviews in New Jersey, New York, and Pennsylvania. Key research questions included, "What were the barriers and facilitators of early COVID vaccine distribution?" and "What mechanisms in the community emerged to alleviate strains in early vaccination?" Findings from this study revealed that pre-existing emergency preparedness infrastructures and plans developed since the 9/11 tragedy were seemingly abandoned. This caused health departments at all levels of government to make impromptu, non-uniform decisions leading to confusion, vaccine hesitancy, and ultimately low uptake. The results indicate that future vaccine rollout best practices must include evidence-based decision-making, coordinated communications, and outreach to high-priority and vulnerable communities.

The Evaluation of IDEAL-REACH Program to Improve Nutrition among Asian American Community Members in the Philadelphia Metropolitan Area.

Objective Asian Americans' food purchasing, cooking, and eating patterns are not well understood. Greater insight into these behaviors is urgently needed to guide public health interventions of dietary behaviors in this population. The present study aims to examine the effects of a community-level intervention on food purchasing and preparation, nutrition knowledge, and health awareness in Asian Americans. Methods From 2015 to 2017, we conducted the Improving Diets with an Ecological Approach for Lifestyle (IDEAL-REACH) intervention to increase access to healthy food or beverage options for the Asian-American population in the Philadelphia metropolitan area. Participants (1110 at pre- and 1098 at post-assessment) were recruited from 31 community-based organizations (CBOs). We assessed Asian Americans' dietary behaviors, nutrition knowledge, and awareness of heart health. Results The results of pre-post intervention comparisons showed that the IDEAL-REACH intervention was successful in promoting whole grains consumption, reducing sodium consumption, and raising knowledge and awareness related to nutrition and heart health. Conclusions To our knowledge, this is one of the first initiatives in the U.S. to engage CBOs to promote healthier dietary behaviors. The findings show that CBOs serve as a powerful platform for community-level interventions to improve healthy nutrition behaviors in Asian-American communities.

A Community-Based Randomized Trial of Hepatitis B Screening Among High-Risk Vietnamese Americans.

OBJECTIVES: To evaluate the effectiveness of a community-based liver cancer prevention program on hepatitis B virus (HBV) screening among low-income, underserved Vietnamese Americans at high risk. METHODS: We conducted a cluster randomized trial involving 36 Vietnamese community-based organizations and 2337 participants in Pennsylvania, New Jersey, and New York City between 2009 and 2014. We randomly assigned 18 community-based organizations to a community-based multilevel HBV screening intervention (n = 1131). We randomly assigned the remaining 18 community-based organizations to a general cancer education program (n = 1206), which included information about HBV-related liver cancer prevention. We assessed HBV screening rates at 6-month follow-up. RESULTS: Intervention participants were significantly more likely to have undergone HBV screening (88.1%) than were control group participants (4.6%). In a Cochran-Mantel-Haenszel analysis, the intervention effect on screening outcomes remained statistically significant after adjustment for demographic and health care access variables, including income, having health insurance, having a regular health provider, and English proficiency. CONCLUSIONS: A community-based, culturally appropriate, multilevel HBV screening intervention effectively increases screening rates in a high-risk, hard-to-reach Vietnamese American population.

Addressing the Health Needs of High-Risk Filipino Americans in the Greater Philadelphia Region.

Filipino Americans represent one of the largest and most diverse immigrant populations in the United States. It has been established that chronic diseases are a significant public health issue affecting this population. We conducted a health needs assessment of 200 Filipino Americans aged 18 years or older residing in the greater Philadelphia region. Study participants were recruited from eight Filipino community-based organizations in the region. Information about demographic and acculturative characteristics, health behaviors, self-reported chronic health conditions, and chronic disease perception were collected. Participants were older and highly acculturated. With regards to health behaviors, several did not meet dietary fruit and vegetables intake and physical activity guidelines. The top five health conditions were high blood pressure (67.5 %), high blood cholesterol (57.1 %), arthritis (28.9 %), diabetes (21.8 %), and cancer (14.7 %). Majority of participants perceived high blood pressure, high blood cholesterol, and diabetes to be a concern in their community, and had high awareness of the risk factors associated with these diseases. Reported rates of hypertension, high cholesterol, and diabetes suggest that lifestyle interventions targeting diet and physical activity, in addition to health education, are needed in this population.

Psychosocial correlates of benefit finding in breast cancer survivors in China.

Breast cancer is number one in incidence and sixth in mortality among all cancers of women in China. Prior work identified positive consequences following diagnosis and treatment, including benefit finding among breast cancer survivors from Western countries. This study evaluated psychosocial correlates of benefit finding in breast cancer survivors in China. A total of 148 participants completed measures of coping, perceived stress, depressive symptoms, social support, and benefit finding. Results indicated that benefit finding was positively related to active coping and negatively related to depression. Future research may evaluate whether interventions to enhance active coping will improve outcomes among Chinese breast cancer survivors.

Factors Associated with Hepatitis C Knowledge Before and After an Educational Intervention among Vietnamese Americans.

BACKGROUND: Hepatitis C virus (HCV) is a major cause of chronic liver disease and cancer. Vietnamese Americans are at high risk of HCV infection, with men having the highest US incidence of liver cancer. This study examines an intervention to improve HCV knowledge among Vietnamese Americans. STUDY: Seven Vietnamese community-based organizations in Pennsylvania and New Jersey recruited a total of 306 Vietnamese participants from 2010 to 2011. RESULTS: Average knowledge scores for pretest and posttest were 3.32 and 5.88, respectively (maximum 10). After adjusting for confounding variables, age and higher education were positively associated with higher pretest scores and having a physician who spoke English or Vietnamese was negatively associated with higher pretest scores. Additionally, after adjusting for confounding variables, household income, education, and having an HCV-infected family member significantly increased knowledge scores. CONCLUSIONS: Promotion and development of HCV educational programs can increase HCV knowledge among race and ethnic groups, such as Vietnamese Americans. Giving timely information to at-risk groups provides the opportunity to correct misconceptions, decrease HCV risk behaviors, and encourage testing that might improve timely HCV diagnosis and treatment.

Increasing Asian American participation in clinical trials by addressing community concerns.

Background Asian Americans are underrepresented in clinical trials, but little is known about the factors that contribute to clinical trial participation in this population. Purpose The purpose of this study was to identify knowledge, barriers, facilitators, and cultural influences on participating in clinical trials among three Asian American ethnic groups. Concurrently, we sought to identify mechanisms and messages to facilitate dissemination of information and to identify strategies to promote clinical trial participation in this population. Methods Eight focus groups were conducted (n = 103) with Chinese (four groups), Korean (two groups), and Vietnamese (two groups) Americans. Each group was conducted with a moderator and a translator using a standardized guide. Results Participants discuss the benefits of contributing to science, future generations, and their families by being in clinical trials. Some participants think clinical trials would give hope to those with terminal illnesses. A doctor's recommendation, being sick, and needing more options for treatment are motivators for Asian Americans. Having some guarantee of treatment effectiveness and lack of side effects facilitates participation. Cultural or religious beliefs are not believed to prevent clinical trial participation. Limitations This qualitative, two-site study included three Asian American ethnic groups and is not meant to establish prevalence of beliefs. Conclusion Asian Americans need more information about clinical trials and their benefits to science and the larger community. Health-care providers can play pivotal roles in enhancing recruitment of Asian Americans. Basing recruitment goals on percentage representation in most US geographic areas does not provide sufficient numbers to allow for analysis of minorities like Asian American groups. The discovery of important group-specific harms and benefits depends on greater participation of racial/ethnic subgroups.

Using Mixed Methods to Examine Perceptions and Willingness to Participate in Bio-specimen Banking in Diverse Asian Americans.

BACKGROUND: On a large scale, bio-specimen banking offers researchers the ability to newly understand areas like community genetics and to apply new sampling technologies to housed samples. Understanding cultural differences in knowledge and perceptions of bio-specimen banking allows for addressing community concerns and facilitates dissemination of culturally relevant health education. METHODS: Community-based participatory approaches (CBPA) provide opportunities to solicit community input and to build mechanisms for maximizing outcomes of potential interventions. As part of a larger CBPA project, Chinese, Korean, and Vietnamese community members participated in eight focus groups on bio-specimen banking. Demographics and qualitative text were analyzed. RESULTS: The study results indicate that education and English proficiency were the most important predictors of knowledge of bio-specimen banking. Ethnic and age differences also were identified as predictors of knowledge in bivariate analyses. Participants discussed safety in bio-specimen sample collection procedures; processes of tissue removal, including spinal and blood draws; privacy protection; trust in healthcare providers; concerns about genetic research; importance of contributing to science; and family concerns. CONCLUSION: The diversity of Asian American populations requires that, to increase participation in bio-specimen banking, understanding and addressing community concerns requires health education efforts that improve knowledge of innovations in sampling and cultural tailoring of health education messages. Promotion messages should highlight scientific benefits including possibilities for tailoring medical treatment and new diagnoses. Issues of health information privacy and stigma for communities at risk for certain diseases remain community worries.

The impact of a community-based clinical trial educational intervention among underrepresented Chinese Americans.

BACKGROUND: Clinical trials are a critical resource for the discovery of new prevention, diagnostic, and treatment methods for cancer. The most effective prevention and treatment modalities are based on previous clinical trial results. However, participation in clinical trials is underrepresented by racial/ethnic minority populations, Asian Americans in particular. Asian Americans are the least represented of any ethnic groups in clinical trials. The purpose of this study is to develop and evaluate a culturally and linguistically appropriate community-based educational intervention to increase knowledge of and intent to participate in cancer clinical trials among underrepresented Chinese Americans. METHODS: Community-Based Participatory Research approach was used to guide the development, cultural tailoring, implementation, and evaluation of clinical trial intervention. First, 22 Asian community representatives were recruited as community health educators (CHE) who received 12-hour training on clinical trial education. Second, 262 members were recruited from 11 Chinese community organizations. Of those recruited, a total of 247 eligible Chinese enrolled and participated in the clinical trial education delivered by trained CHEs. Participants completed pretest before and posttest after the intervention. RESULTS: Fifteen of 21 measures of clinical trial knowledge showed significant changes post the intervention (P < 0.05). Education remained the sole demographic factor increasing clinical trial knowledge in multivariate analysis. CONCLUSION: Clinical trial education should emphasize both benefits to science and the larger Asian community. This community-based clinical trial intervention demonstrated promising results and has potential to enhance recruitment and participation in clinical trial research among the underrepresented Asian Americans. IMPACT: Improving clinical trial participation in the fast-growing Asian American population is key to dissemination of health innovations targeted to diminish health disparities.

Clinical practice guideline: improving voice outcomes after thyroid surgery.

OBJECTIVE: Thyroidectomy may be performed for clinical indications that include malignancy, benign nodules or cysts, suspicious findings on fine needle aspiration biopsy, dysphagia from cervical esophageal compression, or dyspnea from airway compression. About 1 in 10 patients experience temporary laryngeal nerve injury after surgery, with longer lasting voice problems in up to 1 in 25. Reduced quality of life after thyroid surgery is multifactorial and may include the need for lifelong medication, thyroid suppression, radioactive scanning/treatment, temporary and permanent hypoparathyroidism, temporary or permanent dysphonia postoperatively, and dysphagia. This clinical practice guideline provides evidence-based recommendations for management of the patient's voice when undergoing thyroid surgery during the preoperative, intraoperative, and postoperative period. PURPOSE: The purpose of this guideline is to optimize voice outcomes for adult patients aged 18 years or older after thyroid surgery. The target audience is any clinician involved in managing such patients, which includes but may not be limited to otolaryngologists, general surgeons, endocrinologists, internists, speech-language pathologists, family physicians and other primary care providers, anesthesiologists, nurses, and others who manage patients with thyroid/voice issues. The guideline applies to any setting in which clinicians may interact with patients before, during, or after thyroid surgery. Children under age 18 years are specifically excluded from the target population; however, the panel understands that many of the findings may be applicable to this population. Also excluded are patients undergoing concurrent laryngectomy. Although this guideline is limited to thyroidectomy, some of the recommendations may extrapolate to parathyroidectomy as well. RESULTS: The guideline development group made a strong recommendation that the surgeon should identify the recurrent laryngeal nerve(s) during thyroid surgery. The group made recommendations that the clinician or surgeon should (1) document assessment of the patient's voice once a decision has been made to proceed with thyroid surgery; (2) examine vocal fold mobility, or refer the patient to a clinician who can examine vocal fold mobility, if the patient's voice is impaired and a decision has been made to proceed with thyroid surgery; (3) examine vocal fold mobility, or refer the patient to a clinician who can examine vocal fold mobility, once a decision has been made to proceed with thyroid surgery if the patient's voice is normal and the patient has (a) thyroid cancer with suspected extrathyroidal extension, or (b) prior neck surgery that increases the risk of laryngeal nerve injury (carotid endarterectomy, anterior approach to the cervical spine, cervical esophagectomy, and prior thyroid or parathyroid surgery), or (c) both; (4) educate the patient about the potential impact of thyroid surgery on voice once a decision has been made to proceed with thyroid surgery; (5) inform the anesthesiologist of the results of abnormal preoperative laryngeal assessment in patients who have had laryngoscopy prior to thyroid surgery; (6) take steps to preserve the external branch of the surperior laryngeal nerve(s) when performing thyroid surgery; (7) document whether there has been a change in voice between 2 weeks and 2 months following thyroid surgery; (8) examine vocal fold mobility or refer the patient for examination of vocal fold mobility in patients with a change in voice following thyroid surgery; (9) refer a patient to an otolaryngologist when abnormal vocal fold mobility is identified after thyroid surgery; (10) counsel patients with voice change or abnormal vocal fold mobility after thyroid surgery on options for voice rehabilitation. The group made an option that the surgeon or his or her designee may monitor laryngeal electromyography during thyroid surgery. The group made no recommendation regarding the impact of a single intraoperative dose of intravenous corticosteroid on voice outcomes in patients undergoing thyroid surgery.

Cancer patient navigator tasks across the cancer care continuum.

Cancer patient navigation (PN) programs have been shown to increase access to and utilization of cancer care for poor and underserved individuals. Despite mounting evidence of its value, cancer patient navigation is not universally understood or provided. We describe five PN programs and the range of tasks their navigators provide across the cancer care continuum (education and outreach, screening, diagnosis and staging, treatment, survivorship, and end-of-life). Tasks are organized by their potential to make cancer services understandable, available, accessible, affordable, appropriate, and accountable. Although navigators perform similar tasks across the five programs, their specific approaches reflect differences in community culture, context, program setting, and funding. Task lists can inform the development of programs, job descriptions, training, and evaluation. They also may be useful in the move to certify navigators and establish mechanisms for reimbursement for navigation services.

Native American breast cancer survivors' physical conditions and quality of life.

BACKGROUND: Based on Survivors' Guidance, an interactive, Web-based, culturally relevant Native American cancer survivorship program, Native American Cancer Education for Survivors (NACES), was developed. The focus of the program is to improve quality of life (QOL) for Native American breast cancer survivors. METHODS: NACES is a community-driven research and education project, based on the Social Cognitive Theoretical Model. Participants complete a QOL survey that includes physical, psychosocial, spiritual, and social components. This publication focuses on the physical component of the survey collected by trained Native American patient advocates, and compares physical conditions among Native American breast cancer survivors who were diagnosed within 1 year, those diagnosed between 1 and 4 years, and those who are long-term survivors (diagnosed > or = 5 years ago). RESULTS: For the first time, survivorship issues are reported specifically for Native American breast cancer patients (n = 266). Selected access issues document situations that contribute to disparities. Comorbidities such as high blood pressure and arthritis are common in the survivors, with more than a third having diabetes, in addition to breast cancer. Numerous side effects from cancer treatments are experienced by these survivors. CONCLUSIONS: These data describe what Native American breast cancer patients are experiencing based on self-reported information. Clearly there is need for much more work and long-term tracking of Native American patients to begin to document if or how the severity of physical symptoms lessens over time and if their experiences are significantly different from non-Native Americans.

Gastric cancer among American Indians and Alaska Natives in the United States, 1999-2004.

BACKGROUND: Gastric cancer incidence rates for American Indians and Alaska Natives (AI/ANs) historically have exceeded those for non-Hispanic whites (NHWs). Previous reports may have underestimated the true burden of gastric cancer in AI/AN populations because of misclassification of AI/AN race in cancer registries. METHODS: Population-based cancer registry data from 1999 through 2004 were used to describe gastric cancer incidence in AI/ANs and NHWs in the US. To address misclassification of race, registry data were linked with Indian Health Service administrative records, and analyses were restricted to residents of Contract Health Service Delivery Areas (CHSDA). Disease patterns were assessed for 6 geographic regions and for all regions combined. Rates were expressed per 100,000 population and were age-adjusted to the 2000 US standard population. RESULTS: In CHSDA counties, gastric cancer incidence rates for AI/ANs were higher than the rates for NHWs across most regions. For both sexes combined, AI/AN rates ranged from 6.1 in the East region to 24.5 in Alaska; there was relatively little regional variation in NHW rates. Most patients with gastric cancer were diagnosed with late-stage disease, regardless of race, age, or sex. In some regions, cancer rates in the central/distal portions of the stomach were higher among AI/ANs than among NHWs, whereas rates in the proximal stomach were similar between the 2 populations. CONCLUSIONS: AI/ANs are generally at greater risk for gastric cancer than NHWs. Relatively high rates of cancer in the central/distal portions of the stomach among AI/ANs in some geographic regions may indicate a disproportional burden of Helicobacter pylori-associated disease.

Osteoprotective knowledge in a multiethnic epilepsy population.

Antiepileptic drugs (AEDs) are known to cause bone loss. People with epilepsy have twice the fracture rate of nonepilepsy populations. Osteoprotective knowledge related to calcium and exercise has not been assessed in people with epilepsy. The Osteoporosis Knowledge Test (OKT), a validated, 24-item test, was administered to 94 epilepsy patients (28 males and 66 females) to measure knowledge of risk factors for osteoporosis and strategies for prevention related to calcium and exercise. The mean age of participants was 45 years with an average AED exposure of 20 years. Fifty participants were Caucasian and 44 were non-Caucasian. No significant differences related to age or gender for the OKT were found. One-way analysis of variance (ANOVA) of ethnicity showed that non-Caucasians had much lower calcium (F = 8.15, p = .005) and exercise (F = 7.71, p = .007) knowledge. The total mean OKT score was 11.71 (4.92), reflecting a correct response rate of 49%. In previous studies of nonepilepsy populations, the mean OKT score ranged from 7.83 to 21.8, with a correct response ranging from 32.9% to 90.8%. Independent t tests of the individual OKT questions revealed specific knowledge deficiencies in the areas of risk factors, exercise, and reasons for calcium supplementation for non-Caucasians. Results of this study reveal that people with epilepsy, who are at greater risk for metabolic bone loss, have lower knowledge scores for calcium and exercise than nonepilepsy populations of various ages and genders. Culturally relevantepilepsy materials and programs may improve knowledge and adoption of preventative behavior.

Use of the Precaution Adoption Process Model to examine predictors of osteoprotective behavior in epilepsy.

In the neurology literature it is well established that anti-epileptic drugs (AEDs) lead to bone loss (osteopenia and osteoporosis). Several large epidemiologic studies have found twice the fracture rate in persons with epilepsy compared to the non-epilepsy population. While an increasing level of awareness for preventative measures and screening by neurologists and primary care physicians are recommended, so far no one has attempted to address how knowledge related to calcium and exercise, health beliefs (based on the Health Belief Model) and self-efficacy (confidence in abilities) impact osteoprotective behaviors in epilepsy, based on the Precaution Adoption Process Model (PAPM). The seven-stage PAPM, unlike other health behavior theories where a person is either practicing or not practicing the behavior, conceptualizes behavior change as dynamic and occurring over time. Validated instruments were used to assess knowledge, health beliefs, self-efficacy and stages of the precaution adoption process for four osteoprotective behaviors. For dietary calcium; exercise knowledge and calcium self-efficacy predicted higher stages of precaution adoption. For calcium supplements; age perceived susceptibility for osteoporosis and perceived benefits of calcium predicted higher stages. Exercise adoption stage was most predicted by exercise knowledge and health motivation. For DEXA screening adoption; age and perceived susceptibility predicted higher stages. This study provides hints how persons with epilepsy could be influenced to move from the unaware/unengaged positions into to the stages of adoption and maintenance for osteoprotective behaviors.

California American Indian and Alaska natives tribal groups' care access and utilization of care: policy implications.

Background. We used the 2001 California Health Interview Survey (CHIS) to examine differences in cancer care access and utilization by subgroups of American Indian and Alaskan Natives (AIAN). Methods. The CHIS 2001 includes over 55,000 Californian households, with an oversampling of California American Indian, non-California AIAN, and unknown AIAN tribal groups. Results. We found significant differences among the 3 tribal subgroups for various measures of health care coverage and utilization. Conclusions. AIAN must be disaggregated to provide appropriate data for public health and policy making.

Self-efficacy, knowledge, health beliefs, quality of life, and stigma in relation to osteoprotective behaviors in epilepsy.

It is well reported in the epilepsy literature that use of antiepileptic drugs (AEDs) leads to bone loss. Validated instruments were administered to assess knowledge, health behavior, quality of life, and stigma, to determine their effects on self-efficacy for osteoprotective and self-management behaviors. This adult epilepsy population had a mean age of 45, with 20 years of AED exposure. Fifty subjects were Caucasian and 44 were non-Caucasian. By one-way ANOVA, there were significant differences in self-efficacy based on ethnicity, medical assistance, status, and seizure frequency. Differences in knowledge based on ethnicity, education, and income were also noted. Regression analysis revealed that the factors that most predict self-efficacy for calcium, exercise, and self-management do not parallel each other. Age and ethnicity were predictive of self-efficacy for epilepsy self-management only. Medical management factors varied among the models. Overall quality of life was a positive predictor for both calcium and exercise self-efficacy.

Breast cancer early detection among Chinese women in the Philadelphia area.

BACKGROUND: Breast cancer is the most frequently diagnosed cancer and the second leading cause of cancer death among Chinese American women. Previous studies identified disparities in breast cancer screening between Asian and Caucasian women. This study describes breast cancer awareness, attitudes, and knowledge, as well as barriers and facilitators of early detection among Chinese women in Philadelphia. METHODS: A cross-sectional, translated survey was conducted among a convenience sample of 111 Chinese women from the greater Philadelphia area. Data were analyzed using descriptive statistics to describe participant experiences and attitudes, and Pearson correlation coefficients, chi-square tests, and multiple regressions were used to identify significant predictors of breast cancer screenings. RESULTS: Of respondents, 53.2% had ever performed breast self-examination (BSE). Among women aged >or=40, 53.6% had ever had clinical breast examination (CBE), and 71.1% had ever had mammogram. Knowledge (p < 0.001) and self-efficacy (p = 0.001) predicted BSE ever performance. Having a doctor as information source of CBE (p = 0.001) and belief in family history as a risk factor of breast cancer (p = 0.002) were significant predictors of having ever had a CBE. Having a doctor as information source of mammogram (p = 0.002) was the only significant predictor of having ever had mammogram screening. CONCLUSIONS: This study laid a foundation for developing culturally sensitive breast cancer education and screening programs for Chinese women in the Philadelphia area. Recommendations include a call for physician education to improve breast cancer screening rates in this population.

American Indians and Alaska Natives in California: women's cancer screening and results.

BACKGROUND AND METHODS: The purpose of this article was to examine differences in demographics, general health status, and utilization of breast and cervical cancer screening for subgroups of American Indians and Alaska Natives (AIAN) using the 2001 California Health Interview Survey. RESULTS: The statewide distribution of California American Indians, non-California AIANs, and unknown AIANs are 10%, 51%, and 39%, respectively. Significant differences exist among the 3 tribal subgroups. CONCLUSIONS: Overall, AIAN women aged 40+ years are close to the Healthy People 2010 goals for receipt of a mammogram in the past 2 years and for receipt of a Pap test ever and in the past 3 years. Less than 5% of AIAN in California report Indian Health Service coverage.