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Cancer Control Research

Abstract

DESCRIPTION (provided by applicant): American Indian/Alaska Native (AI/AN) populations are generally considered to suffer from the most dramatic disease and behavior health disparities of any non-White racial/ethnic group in the US. Few interventions to accomplish these goals have been tested. One potential point of intervention in AI/AN communities is through the workplace because workplaces provide access to AI/AN people, supported by communications and financial infrastructures. In 2003, the Department of Health and Human Services issued a call to action to the nation's employers to implement workplace health promotion interventions aimed at chronic diseases. We have created and piloted a package for the general population that is specifically designed to be implemented in the workplace. Our comprehensive package builds on the evidence collected by 2 federal task forces, the U.S. Preventive Services Task Force and the Task Force on Community Preventive Services. It recommends 15 practices that employers should implement in the workplace that fall into the broad domains of health insurance benefits, policies, programs, and communication and tracking systems. The 15 practices are aimed at helping employees increase the following 7 specific behaviors: 1) colon cancer screening, 2) healthy eating, 3) influenza immunization, 4) mammography use, 5) Pap smear use, 6) physical activity, and 6) tobacco cessation treatment. The working environments, needs, and structures of the lives of AI/AN people, in conjunction with the health disparities they suffer from, call for formative research to create and test such an intervention. Thus, the specific aims of this proposal are to create a package of proven health promotion interventions that is culturally appropriate in AI/AN workplace settings; test the feasibility of implementing this package in 4 different types of AI/AN workplaces; and evaluate its acceptability and usability. Our findings from the pilot study employers and their responsiveness to our approach and recommendations suggested that we are serving a largely unmet need - a need that will be even greater in Indian Country. Critical to the success of the proposed study, we have also found that the intervention developed in the pilot study could be successfully delivered by project interventionists from a community partner, with oversight from the academic partners. Community participation is critical to the success of research efforts involving Indian communities and to the acceptance and dissemination of new approaches. This project will be important to public health in several ways. It targets a disparities population, Native American people. It uses a public health channel for the implementation of proven interventions, workplaces. Finally, it will further develop an intervention model that can be used in multiple settings, and used to change multiple risk factors for chronic disease.