title: Colorectal cancer screening among American Indians in a Pacific Northwest tribe: Cowlitz Tribal BRFSS Project, 2009-2010.
abstract: OBJECTIVE
  Colorectal cancer (CRC) screening is low among American Indians (AIs). We describe the demographics, health status, prevalence of modifiable CRC risk factors, and use of CRC screening modalities in a Pacific Northwest AI tribe.
  
  
  METHODS
  We conducted a survey among Cowlitz tribal members using a Behavioral Risk Factor Surveillance System (BRFSS) questionnaire. We analyzed demographic, health status, behavioral risk factor, and CRC screening variables. Using the Washington State 2010 BRFSS, we compared tribal members with non-Hispanic white (NHW) people. We used logistic regression to examine factors associated with CRC screening for tribal members.
  
  
  RESULTS
  A greater proportion of tribal members than NHW people reported living below the federal poverty level (12% vs. 7%, p=0.013). A greater proportion of tribal members than NHW people aged≥50 years had poor self-reported health (27% vs. 16%, p=0.006) and were without health insurance (12% vs. 6%, p=0.004). A greater proportion of tribal members than NHW people had a fecal occult blood test within the past year (20% vs. 13%, p=0.006). Being 60-69 years of age (odds ratio [OR]=2.6, 95% confidence interval [CI] 1.4, 4.9), ≥70 years of age (OR=2.2, 95% CI 1.1, 4.5), and having a personal health-care provider (OR=3.7, 95% CI 1.4, 9.6) were associated with increased screening adherence in tribal members.
  
  
  CONCLUSIONS
  Data from the Cowlitz Tribal BRFSS demonstrate that members are receiving CRC screening in the same proportions as NHW people despite lower sociodemographic and health status indicators among members. Unique characteristics of the tribe likely contribute to this finding.
authors.affiliation: Oregon Health and Science University, Department of Public Health and Preventive Medicine, Portland, OR ; Current affiliation: Family Medicine Residence of Idaho, Boise, ID.
authors.forename: Annika G
authors.initials: AG
authors.lastname: Maly
authors.affiliation: Oregon Health and Science University, Department of Public Health and Preventive Medicine, Portland, OR ; Massachusetts General Hospital, Department of Medicine, Boston, MA.
authors.forename: Tessa L
authors.initials: TL
authors.lastname: Steel
authors.affiliation: Oregon Health and Science University, Department of Public Health and Preventive Medicine, Portland, OR ; Oregon Health and Science University, Department of Emergency Medicine, Portland, OR.
authors.forename: Rongwei
authors.initials: R
authors.lastname: Fu
authors.affiliation: Oregon Health and Science University, Department of Gastroenterology, Portland, OR.
authors.forename: David A
authors.initials: DA
authors.lastname: Lieberman
authors.affiliation: Oregon Health and Science University, Department of Public Health and Preventive Medicine, Portland, OR ; Northwest Area Indian Health Board, Northwest Tribal Epidemiology Center, Portland, OR.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Becker
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D040343:Behavioral Risk Factor Surveillance System; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000208:ethnology*; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D005260:Female; D015438:Health Behavior / Q000208:ethnology; D006304:Health Status; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D015205:Northwestern United States / Q000453:epidemiology; D015995:Prevalence; D012307:Risk Factors; D012959:Socioeconomic Factors; D055815:Young Adult