title: Cancer-related disparities and opportunities for intervention in Northern Plains American Indian communities.
abstract: OBJECTIVE
  We examined behavioral trends associated with cancer risk and cancer screening use from 1997 through 2006 among American Indians/Alaska Natives (AI/ANs) in the Northern Plains region (North Dakota, South Dakota, Nebraska, and Iowa) of the United States. We also examined disparities between that population and non-Hispanic white (NHW) people in the Northern Plains and AI/ANs in other regions.
  
  
  METHODS
  We analyzed Behavioral Risk Factor Surveillance System data from the Centers for Disease Control and Prevention for 1997-2000 and 2003-2006. We used age-adjusted Wald Chi-square tests to test the difference between these two periods for AI/ANs and the difference between AI/ANs and NHW people during 2003-2006.
  
  
  RESULTS
  There was no statistically significant improvement among AI/ANs in the Northern Plains region for behaviors associated with cancer risk or cancer screening use, and there was a significant increase in the obesity rate. The prevalence of binge drinking, obesity, and smoking among AI/ANs in the Northern Plains was significantly higher than among NHW people in the same region and among AI/AN populations in other regions. Although the percentage of cancer screening use was similar for all three groups, the use of sigmoidoscopy/colonoscopy was significantly lower among the Northern Plains AI/ANs than among NHW people.
  
  
  CONCLUSIONS
  These results indicate a need for increased efforts to close the gaps in cancer health disparities between AI/ANs and the general population. Future efforts should focus not only on individual-level changes, but also on system-level changes to build infrastructure to promote healthy living and to increase access to cancer screening.
authors.affiliation: Northern Plains Tribal Epidemiology Center, Great Plains Tribal Chairmen's Health Board, Rapid City, SD 68198-4395, USA. swatanabe@unmc.edu
authors.forename: Shinobu
authors.initials: S
authors.lastname: Watanabe-Galloway
authors.forename: Nicole
authors.initials: N
authors.lastname: Flom
authors.forename: Liyan
authors.initials: L
authors.lastname: Xu
authors.forename: Tinka
authors.initials: T
authors.lastname: Duran
authors.forename: Leah
authors.initials: L
authors.lastname: Frerichs
authors.forename: Favian
authors.initials: F
authors.lastname: Kennedy
authors.forename: Corey B
authors.initials: CB
authors.lastname: Smith
authors.forename: Adeola O
authors.initials: AO
authors.lastname: Jaiyeola
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D005260:Female; D015438:Health Behavior; D054625:Healthcare Disparities; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data*; D007484:Iowa / Q000453:epidemiology; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009329:Nebraska / Q000453:epidemiology; D009369:Neoplasms / Q000208:ethnology*; D009658:North Dakota / Q000453:epidemiology; D012307:Risk Factors; D012959:Socioeconomic Factors; D013023:South Dakota / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data