title: Reducing cancer risk among Native American adolescents.
abstract: BACKGROUND
  This article discusses the development, implementation, and preliminary testing of an intervention to reduce cancer risks through tobacco use prevention and dietary modification among Native American youth in the Northeastern United States.
  
  
  METHODS
  The intervention outcome study includes a research design and outcome measurement instruments. In collaboration with Native American communities, reservations, and organizations in the Northeastern United States, implementation of the design quantifies the separate and combined effects of a tobacco use prevention and a dietary modification intervention.
  
  
  RESULTS
  Native American youths in the tobacco prevention intervention and in the combined tobacco and dietary intervention increased their knowledge of tobacco facts and their awareness of the motives of tobacco advertising, and showed higher ratings for an ability to resist peer pressure and to refuse offers of tobacco use between pretest and posttest. Youths in the combined intervention were significantly less apt to report smoking of any kind. Youths in the tobacco use prevention-only condition reported significantly less smoking than their counterparts in the dietary modification-only condition and control condition on 4 of 8 measurement items. As for dietary variables, pretest to posttest measurement scores showed that, after receiving the curriculum, youths in the dietary modification intervention and in the combined intervention improved their knowledge of the health implications of consuming dietary fat, fiber, fruits, and vegetables. Youths in the dietary modification and combined intervention also improved their scores of knowledge related to cancer risk-reducing nutritional practices, cultural dietary habits, and healthy food choices available for Native American cultures. Youths in the dietary modification-only condition report significantly increasing their consumption of complex carbohydrates and significantly decreasing their fat intake between pretest and posttest occasions.
  
  
  CONCLUSIONS
  Data from this longitudinal study suggest the value of the FACETS curriculum for helping Native American youth reduce their risks for cancer associated with tobacco use and dietary preference and consumption patterns. In particular, results indicate the enhanced effects of the combined tobacco use prevention and dietary modification intervention for preventing tobacco use and for improving youths' knowledge and attitudes with regard to tobacco use and diet. Further, the study demonstrates the value of collaborating with Native American organizations to design a cancer risk-reducing curriculum and to implement tests of that curriculum.
authors.affiliation: Columbia University School of Social Work, New York, New York 10025, USA.
authors.forename: S P
authors.initials: SP
authors.lastname: Schinke
authors.forename: B
authors.initials: B
authors.lastname: Singer
authors.forename: K
authors.initials: K
authors.lastname: Cole
authors.forename: I R
authors.initials: IR
authors.lastname: Contento
mesh_terms: D000293:Adolescent; D016497:Adolescent Health Services / Q000458:organization & administration*; D004032:Diet / Q000009:adverse effects; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007198:Indians, North American; D008137:Longitudinal Studies; D008297:Male; D009369:Neoplasms / Q000208:ethnology* / Q000517:prevention & control*; D009511:New England; D011322:Primary Prevention / Q000458:organization & administration*; D016730:Program Development; D015397:Program Evaluation; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects