american indians in public health - native american...

9
American Indians in Public Health Burhansstipanov, Native American Cancer Research http://www.NatAmCancer.org 1-800-538-8295 1 Linda Burhansstipanov, MSPH, DrPH, CHES President and Grants Director Native American Cancer Research 3022 South Nova Road Pine, CO 80470-7830 Phone: 303-838-9359 1-800-537-8295; fax: 303-838-7629 http://www.NatAmCancer.org American Indians Working in Public Health American Indians in Public Health (Burhansstipanov, Native American Cancer Research; 1-800-537- 8295; http://www.NatAmCancer.org) 2 Objectives for Session By the end of the session, the participant will be able to: 1. Identify at least three public health fields that directly affect cancer health disparities within the American Indian / Alaska Native (AIAN) community. 2. Identify examples of public health, multidisciplinary, collaborative projects implemented with medically underserved communities, such as American Indians. American Indians in Public Health (Burhansstipanov, Native American Cancer Research; 1-800-537- 8295; http://www.NatAmCancer.org) 3 We Stand on the Shoulders of Our Ancestors Being Indian means more than checking a “box” on a survey form It means giving back to others (your community, the next generation of researchers, etc.) American Indians in Public Health (Burhansstipanov, Native American Cancer Research; 1-800-537- 8295; http://www.NatAmCancer.org) 4 Culture as a Strength What are these cultural gifts? How you resolve conflict? How you respond to pressure? How you generate grant ideas? How may your culture give you strength in challenging personal / work / research situations? American Indians in Public Health (Burhansstipanov, Native American Cancer Research; 1-800-537- 8295; http://www.NatAmCancer.org) 5 Culture as a Strength If you were raised in an environment where your culture was “minimized”, how can you learn more about your background to help you gain strengths find a “cultural” peer or mentor American Indians in Public Health (Burhansstipanov, Native American Cancer Research; 1-800-537- 8295; http://www.NatAmCancer.org) 6 Cultures of … Race, including but not limited to American Indian / Alaska Native, Native Hawaiian, African-American, Asian, etc. Ethnicity, such as Hispanic, Chicano, Latino …. Middle Eastern Sexual or Gender Identity, Maleness / Femaleness / Same Sex

Upload: dodien

Post on 25-Apr-2018

219 views

Category:

Documents


2 download

TRANSCRIPT

Page 1: American Indians in Public Health - Native American …natamcancer.org/handouts/ARS_TP_AI_PubHlth_12-04-08a_LB_HND.pdf · 501(c)(3) American Indians in Public Health ... Skill Dev

American Indians in Public Health

Burhansstipanov, Native American Cancer Research http://www.NatAmCancer.org1-800-538-8295 1

Linda Burhansstipanov, MSPH, DrPH, CHESPresident and Grants Director

Native American Cancer Research 3022 South Nova Road Pine, CO 80470-7830

Phone: 303-838-9359 1-800-537-8295; fax: 303-838-7629http://www.NatAmCancer.org

American Indians Working in Public Health

American Indians in Public Health (Burhansstipanov, Native American Cancer Research; 1-800-537-8295; http://www.NatAmCancer.org) 2

Objectives for SessionBy the end of the session, the participant will be

able to:1. Identify at least three public health fields that

directly affect cancer health disparities within the American Indian / Alaska Native (AIAN) community.

2. Identify examples of public health, multidisciplinary, collaborative projects implemented with medically underserved communities, such as American Indians.

American Indians in Public Health (Burhansstipanov, Native American Cancer Research; 1-800-537-8295; http://www.NatAmCancer.org) 3

We Stand on the Shoulders of Our Ancestors

Being Indian means more than checking a “box” on a survey formIt means giving back to others (your community, the next generation of researchers, etc.)

American Indians in Public Health (Burhansstipanov, Native American Cancer Research; 1-800-537-8295; http://www.NatAmCancer.org) 4

Culture as a Strength

What are these cultural gifts? How you resolve conflict? How you respond to pressure? How you generate grant ideas?

How may your culture give you strength in challenging personal / work / research situations?

American Indians in Public Health (Burhansstipanov, Native American Cancer Research; 1-800-537-8295; http://www.NatAmCancer.org) 5

Culture as a Strength

If you were raised in an environment where your culture was “minimized”, how can you learn more about your background to help you gain strengths

find a “cultural” peer or mentor

American Indians in Public Health (Burhansstipanov, Native American Cancer Research; 1-800-537-8295; http://www.NatAmCancer.org) 6

Cultures of …

Race, including but not limited toAmerican Indian / Alaska Native, Native Hawaiian, African-American, Asian, etc.

Ethnicity, such as Hispanic, Chicano, Latino …. Middle EasternSexual or Gender Identity, Maleness / Femaleness / Same Sex

Page 2: American Indians in Public Health - Native American …natamcancer.org/handouts/ARS_TP_AI_PubHlth_12-04-08a_LB_HND.pdf · 501(c)(3) American Indians in Public Health ... Skill Dev

American Indians in Public Health

Burhansstipanov, Native American Cancer Research http://www.NatAmCancer.org1-800-538-8295 2

American Indians in Public Health (Burhansstipanov, Native American Cancer Research; 1-800-537-8295; http://www.NatAmCancer.org) 7

Cultures of …Religions (Muslim, Buddhist, Catholic, Atheist Careers, such as nursing, public health, teachersLiving conditions, such as poverty

Bottom Line: Everyone has multiple cultures that may influence how they behave in different situations

American Indians in Public Health (Burhansstipanov, Native American Cancer Research; 1-800-537-8295; http://www.NatAmCancer.org) 8

Focus on StrengthsAvoid highlighting your weaknesses

“I have such skinny toes”“I always get that statistical formula wrong”“I just can’t get ‘epidemiology’”

versus highlighting how you can improveAvoid whining and blaming

Rotten childhood? How do you turn it into a blessing?

American Indians in Public Health (Burhansstipanov, Native American Cancer Research; 1-800-537-8295; http://www.NatAmCancer.org) 9

Examples of NACR Research Questions

How can a Native-specific Navigator (Native Sister) community based participatory research (CBPR) education intervention influence American Indians health behaviors?

American Indians in Public Health (Burhansstipanov, Native American Cancer Research; 1-800-537-8295; http://www.NatAmCancer.org) 10

Take home messageNo research is perfect

Jennie Joe, RN, PhD (Navajo), “your doctorate dissertation is not the most important work you will ever do”If you already knew the answers or how to do everything involved in your study, it wouldn’t be called “research” Linda B“should have” “would have” “could have”

American Indians in Public Health (Burhansstipanov, Native American Cancer Research; 1-800-537-8295; http://www.NatAmCancer.org) 11

Examples of NACR Research Questions

Why do more Northern Plains American Indian cancer patients experience more toxicity from external beam radiation in comparison to cancer patients of all races from the same geographic region?

I had to quit radiationafter 2 weeks because

I had such a severe rash American Indians in Public Health (Burhansstipanov, Native American Cancer Research; 1-800-537-

8295; http://www.NatAmCancer.org) 12

Examples of NACR Research Questions

Which education intervention has more impact on long-term increase in cancer prevention knowledge and behaviors?

Page 3: American Indians in Public Health - Native American …natamcancer.org/handouts/ARS_TP_AI_PubHlth_12-04-08a_LB_HND.pdf · 501(c)(3) American Indians in Public Health ... Skill Dev

American Indians in Public Health

Burhansstipanov, Native American Cancer Research http://www.NatAmCancer.org1-800-538-8295 3

American Indians in Public Health (Burhansstipanov, Native American Cancer Research; 1-800-537-8295; http://www.NatAmCancer.org) 13

Examples of NACR Research Questions

How can AIAN Students and Community leaders become informed about complex genetic issues to make informed choices about taking part in

1. Genetic-related careers; 2. Cancer genetic clinical

trials; 3. Cancer genetic research

studies (but not clinical trials)?

American Indians in Public Health (Burhansstipanov, Native American Cancer Research; 1-800-537-8295; http://www.NatAmCancer.org) 14

Examples of NACR Research Questions

How can a Native-specific cancer education intervention improve AIAN patients’ survival from cancer?

American Indians in Public Health (Burhansstipanov, Native American Cancer Research; 1-800-537-8295; http://www.NatAmCancer.org) 15

Public HealthPublic health provides many different opportunities to give back to your respective communityPeople find their paths in many different ways

some have their families before they start collegeSome raise their families before they BEGIN their career

American Indians in Public Health (Burhansstipanov, Native American Cancer Research; 1-800-537-8295; http://www.NatAmCancer.org) 16

What is the take-home message?Public health professionals work in many different settings (these are LBs)

University setting for 18 yearsVolunteered at free clinicBoard member, then an employee of urban Indian clinicSchool settingNational Cancer InstituteCancer Center501(c)(3)

American Indians in Public Health (Burhansstipanov, Native American Cancer Research; 1-800-537-8295; http://www.NatAmCancer.org) 17

Where Might you fit within Public Health?

Public health professional settings Let yourself see the opportunities rather than allowing yourself to be limited to in whatever career your mentor finds passion

American Indians in Public Health (Burhansstipanov, Native American Cancer Research; 1-800-537-8295; http://www.NatAmCancer.org) 18

Take home message: Love your work

Where Might you fit within Public Health? What makes you wake up one morning feeling excited about what you will be doing that day as compared to other mornings when you dread school, the lab or the office? Experiment with different internships to find your passion, but find it!

Page 4: American Indians in Public Health - Native American …natamcancer.org/handouts/ARS_TP_AI_PubHlth_12-04-08a_LB_HND.pdf · 501(c)(3) American Indians in Public Health ... Skill Dev

American Indians in Public Health

Burhansstipanov, Native American Cancer Research http://www.NatAmCancer.org1-800-538-8295 4

American Indians in Public Health (Burhansstipanov, Native American Cancer Research; 1-800-537-8295; http://www.NatAmCancer.org) 19

What is the take-home message?Finish your degree(s)

Almost done then realize you don’t really like the field in which you’ve been training in?

Finish the degree anyway and getIn-service trainingTake additional classesSelf-educate yourself

American Indians in Public Health (Burhansstipanov, Native American Cancer Research; 1-800-537-8295; http://www.NatAmCancer.org) 20

Native American Cancer Research (NACR) Studies include:

Working with many different (~25) public health fields:

EpidemiologyMicrobiologyGenetic SciencesHealth Care AdministrationSchool HealthInternational HealthHospital Administration, etc.

American Indians in Public Health (Burhansstipanov, Native American Cancer Research; 1-800-537-8295; http://www.NatAmCancer.org) 21

What types of Tasks are Included?

Improve quality of AIAN cancer dataCreate and assess culturally appropriateness of public health outreach messages, materials, & strategiesMentor other AIAN organizations or those who work with AIAN communities on how to improve their cultural skills to positively influence health outcomes

American Indians in Public Health (Burhansstipanov, Native American Cancer Research; 1-800-537-8295; http://www.NatAmCancer.org) 22

What types of Tasks are Included?Educate federal agencies about what is real outside of the beltwayInform Congress about what are the advantages and disadvantages of supporting selected types of programs

As 501(c)(3) NACR cannot “lobby” per se, but we can “educate” Congress

Help others write grants and provide mentoring to improve the likelihood of their programs being a success

American Indians in Public Health (Burhansstipanov, Native American Cancer Research; 1-800-537-8295; http://www.NatAmCancer.org) 23

What types of Tasks are Included?Collaborate with the community to help them find answers to the questions that are of most interest to them related to the full cancer continuumSkill Dev. Train community, prof, fedsThe NACR “Team” implements programs that address every “tab” on the http://www.natamcancer.org/soe/soe.htmlassessment tool (User name: train; Password: choochoo)

American Indians in Public Health (Burhansstipanov, Native American Cancer Research; 1-800-537-8295; http://www.NatAmCancer.org) 24

Examples of Our PartnersMayo Clinic’s Native American ProgramsRapid City Regional HospitalIntercultural Cancer CouncilNorthwest Portland Area Indian Health BoardIntertribal Council of MichiganNational Tribal Tobacco Prevention NetworkUrban Indian Health CommissionAlaska Native Medical Center

Page 5: American Indians in Public Health - Native American …natamcancer.org/handouts/ARS_TP_AI_PubHlth_12-04-08a_LB_HND.pdf · 501(c)(3) American Indians in Public Health ... Skill Dev

American Indians in Public Health

Burhansstipanov, Native American Cancer Research http://www.NatAmCancer.org1-800-538-8295 5

American Indians in Public Health (Burhansstipanov, Native American Cancer Research; 1-800-537-8295; http://www.NatAmCancer.org) 25

Examples of Our PartnersAlaska Native Tribal Health ConsortiumUniversity of Colorado Health SciencesOncology Nursing SocietyCity of HopeChildren’s HealthCancer Health Disparities (Genetic Research Trainings)Canadian Aboriginal Cancer Care CoalitionNew Zealand Maori Health Coalition~38 different subcontracts / consultants annually

American Indians in Public Health (Burhansstipanov, Native American Cancer Research; 1-800-537-8295; http://www.NatAmCancer.org) 26

Examples of our Outcomes

85% 5 year relative survival from breast cancer as compared to NCI national data of 49% for AIshttp://www.NatAmCancer.org

Shields (risk / health)QOL Tree (survivorship)

2nd Sidebar components

American Indians in Public Health (Burhansstipanov, Native American Cancer Research; 1-800-537-8295; http://www.NatAmCancer.org) 27

The shield in these slides represents your protection (shield of health) against things that may make you more susceptible to cancer (cancer risks)

The larger the holes and the more number of holes in the shield, the less likely it is to protect you from cancer or other health problems

NOTE: the web page version is animated for breast and CRC American Indians in Public Health (Burhansstipanov, Native American Cancer Research; 1-800-537-

8295; http://www.NatAmCancer.org) 28

The woman’s “shield” of protection against cervix cancer may include daily physical activity, healthy, low fat, limit tobacco to ceremonial use only, and so on

What does this shield tell you about this woman’s cancer risks?

Racism/PovertyPost Traumatic

Stress Disorders

Boarding Schools

Addiction

Depression

Children never parented so

never learned to parent

Neglect/Abuse of Children“Inadequate Mirroring”

Unresolved GriefCoping:

Unhealthy Behaviors

Culture-wide Multiple Traumas

Long histories of subjugation, historical trauma, unresolved grief and the

challenges of changing cultures, poor economics, and lack of opportunities are

negative and destructiveAmerican Indians in Public Health (Burhansstipanov, Native American Cancer Research; 1-800-537-

8295; http://www.NatAmCancer.org) 30

How May Historical Trauma Affect AIANs Use Of The Healthcare System?

Example: distrust = avoid Western medicine

Page 6: American Indians in Public Health - Native American …natamcancer.org/handouts/ARS_TP_AI_PubHlth_12-04-08a_LB_HND.pdf · 501(c)(3) American Indians in Public Health ... Skill Dev

American Indians in Public Health

Burhansstipanov, Native American Cancer Research http://www.NatAmCancer.org1-800-538-8295 6

American Indians in Public Health (Burhansstipanov, Native American Cancer Research; 1-800-537-8295; http://www.NatAmCancer.org) 31

AI/AN Public Health: Challenges

Few AI/AN public health professionalsLimited familiarity with AI/AN policiesComplexities /logistics – over 500 tribes

Modified slide with permission from Dean Seneca, MPH, CDC

American Indians in Public Health (Burhansstipanov, Native American Cancer Research; 1-800-537-8295; http://www.NatAmCancer.org) 32

AI/AN Public Health: Challenges

Public health legislation /legal foundations

Lack of public health infrastructure

Funding issues

Thank you, Dean Seneca, MPH, ATSDR, CDC, for sharing the slide

American Indians in Public Health (Burhansstipanov, Native American Cancer Research; 1-800-537-8295; http://www.NatAmCancer.org) 33

Examples Public Health Funding IssuesLack of AI/AN-specific fundsData errors under-count AIAN health problemsLimitations/problems of categorical fundsFunds received by CDC/ATSDR often designated for state health departments

Thank you, Dean Seneca, MPH, CDC, for sharing the slideAmerican Indians in Public Health (Burhansstipanov, Native American Cancer Research; 1-800-537-

8295; http://www.NatAmCancer.org) 34

Examples Public Health Funding Issues

Tribal ineligibility for certain fundsCurrent funding policies/procedures often put states and tribes in competition for same funds Funding agencies do not understand historical context of phrasing AIAN organizations include within grant applications

Modified from slide provided by Dean Seneca, MPH, CDC

American Indians in Public Health (Burhansstipanov, Native American Cancer Research; 1-800-537-8295; http://www.NatAmCancer.org) 36

AIAN Cancer Incidence Data

(finally)THANK YOU!CHSDA Counties = IHS Contract Health Service Deliver AreasNHW = Non-Hispanic White

Page 7: American Indians in Public Health - Native American …natamcancer.org/handouts/ARS_TP_AI_PubHlth_12-04-08a_LB_HND.pdf · 501(c)(3) American Indians in Public Health ... Skill Dev

American Indians in Public Health

Burhansstipanov, Native American Cancer Research http://www.NatAmCancer.org1-800-538-8295 7

Incidence Rates (1999-2004)*

Source: Cancer registries in Centers for Disease Control and Prevention's (CDC) National Program of Cancer Registries (NPCR)

and National Cancer Institute's (NCI) Surveillance, Epidemiology, and End Results Program (SEER) D. Espey, Monograph Group.

162.2174.5146.5156.7154.4105.4Prostate65.5104.382.287.158.648.5Lung12.123.712.421.311.817.9Kidney52.372.551.860.250.846.3Colon7.412.59.114.17.49.4Cervix130.3115.9129.6115.7134.485.3Breast464.8538.1461.2492.6475.9368.4All NHWAIANNHWAIANNHWAIAN

No PlainsSo. PlainsUS

What is the racial group that has the

highest incidence of breast cancer?

How about for prostate cancer?

American Indians in Public Health (Burhansstipanov, Native American Cancer Research; 1-800-537-8295; http://www.NatAmCancer.org) 38

2007 Annual Report to the NationCancer incidence among AI/AN’s, though generally lower than for the Non-Hispanic White (NHW) population, is rising rapidlyIn 3 of the twelve regions of the Indian Health Service, cancer incidence rates are equal to that of the dominant white population

AlaskaNorthern Plains (IL, IN, IA, MI, MN, MT, NE, ND, SD, WI, WY)Southern Plains (OK, TX, KS)

Espey, David K; Wo, Xiao-Chen; Swan Judith; Wiggins, Charles; Jim, Melissa A.; Ward, Elizabeth; Howe, Holly L.; Ries, Lynn A.G.; Miler, Barry A.; Jemal, Ahmedin; Ahmed, Faruque; Cobb, Nathaniel; Kaur, Judith S.; and Edwards, Brenda K. Annual Report to the Nation on the Status of Cancer, 1975-2004, Featuring Cancer in American Indians and Alaska Natives. Cancer [American Cancer Society]: 2007 [11-15-07]; Volume 110: No. 10. GRAPH MODIFIED BY Rick Clark, Native American Cancer Research

Espey, David K; Wo, Xiao-Chen; Swan Judith; Wiggins, Charles; Jim, Melissa A.; Ward, Elizabeth; Howe, Holly L.; Ries, Lynn A.G.; Miler, Barry A.; Jemal, Ahmedin; Ahmed, Faruque; Cobb, Nathaniel; Kaur, Judith S.; and Edwards, Brenda K. Annual Report to the Nation on the Status of Cancer, 1975-2004, Featuring Cancer in American Indians and Alaska Natives. Cancer [American Cancer Society]: 2007 [11-15-07]; Volume 110: No. 10. GRAPH MODIFIED BY Rick Clark, Native American Cancer Research

Espey, David K; Wo, Xiao-Chen; Swan Judith; Wiggins, Charles; Jim, Melissa A.; Ward, Elizabeth; Howe, Holly L.; Ries, Lynn A.G.; Miler, Barry A.; Jemal, Ahmedin; Ahmed, Faruque; Cobb, Nathaniel; Kaur, Judith S.; and Edwards, Brenda K. Annual Report to the Nation on the Status of Cancer, 1975-2004, Featuring Cancer in American Indians and Alaska Natives. Cancer [American Cancer Society]: 2007 [11-15-07]; Volume 110: No. 10. GRAPH MODIFIED BY Rick Clark, Native American Cancer Research

Espey, David K; Wo, Xiao-Chen; Swan Judith; Wiggins, Charles; Jim, Melissa A.; Ward, Elizabeth; Howe, Holly L.; Ries, Lynn A.G.; Miler, Barry A.; Jemal, Ahmedin; Ahmed, Faruque; Cobb, Nathaniel; Kaur, Judith S.; and Edwards, Brenda K. Annual Report to the Nation on the Status of Cancer, 1975-2004, Featuring Cancer in American Indians and Alaska Natives. Cancer [American Cancer Society]: 2007 [11-15-07]; Volume 110: No. 10. GRAPH MODIFIED BY Rick Clark, Native American Cancer Research

Page 8: American Indians in Public Health - Native American …natamcancer.org/handouts/ARS_TP_AI_PubHlth_12-04-08a_LB_HND.pdf · 501(c)(3) American Indians in Public Health ... Skill Dev

American Indians in Public Health

Burhansstipanov, Native American Cancer Research http://www.NatAmCancer.org1-800-538-8295 8

Espey, David K; Wo, Xiao-Chen; Swan Judith; Wiggins, Charles; Jim, Melissa A.; Ward, Elizabeth; Howe, Holly L.; Ries, Lynn A.G.; Miler, Barry A.; Jemal, Ahmedin; Ahmed, Faruque; Cobb, Nathaniel; Kaur, Judith S.; and Edwards, Brenda K. Annual Report to the Nation on the Status of Cancer, 1975-2004, Featuring Cancer in American Indians and Alaska Natives. Cancer [American Cancer Society]: 2007 [11-15-07]; Volume 110: No. 10. GRAPH MODIFIED BY Rick Clark, Native American Cancer Research

Espey, David K; Wo, Xiao-Chen; Swan Judith; Wiggins, Charles; Jim, Melissa A.; Ward, Elizabeth; Howe, Holly L.; Ries, Lynn A.G.; Miler, Barry A.; Jemal, Ahmedin; Ahmed, Faruque; Cobb, Nathaniel; Kaur, Judith S.; and Edwards, Brenda K. Annual Report to the Nation on the Status of Cancer, 1975-2004, Featuring Cancer in American Indians and Alaska Natives. Cancer [American Cancer Society]: 2007 [11-15-07]; Volume 110: No. 10. GRAPH MODIFIED BY Rick Clark, Native American Cancer Research

Espey, David K; Wo, Xiao-Chen; Swan Judith; Wiggins, Charles; Jim, Melissa A.; Ward, Elizabeth; Howe, Holly L.; Ries, Lynn A.G.; Miler, Barry A.; Jemal, Ahmedin; Ahmed, Faruque; Cobb, Nathaniel; Kaur, Judith S.; and Edwards, Brenda K. Annual Report to the Nation on the Status of Cancer, 1975-2004, Featuring Cancer in American Indians and Alaska Natives. Cancer [American Cancer Society]: 2007 [11-15-07]; Volume 110: No. 10. GRAPH MODIFIED BY Rick Clark, Native American Cancer Research

Espey, David K; Wo, Xiao-Chen; Swan Judith; Wiggins, Charles; Jim, Melissa A.; Ward, Elizabeth; Howe, Holly L.; Ries, Lynn A.G.; Miler, Barry A.; Jemal, Ahmedin; Ahmed, Faruque; Cobb, Nathaniel; Kaur, Judith S.; and Edwards, Brenda K. Annual Report to the Nation on the Status of Cancer, 1975-2004, Featuring Cancer in American Indians and Alaska Natives. Cancer [American Cancer Society]: 2007 [11-15-07]; Volume 110: No. 10. GRAPH MODIFIED BY Rick Clark, Native American Cancer Research

Espey, David K; Wo, Xiao-Chen; Swan Judith; Wiggins, Charles; Jim, Melissa A.; Ward, Elizabeth; Howe, Holly L.; Ries, Lynn A.G.; Miler, Barry A.; Jemal, Ahmedin; Ahmed, Faruque; Cobb, Nathaniel; Kaur, Judith S.; and Edwards, Brenda K. Annual Report to the Nation on the Status of Cancer, 1975-2004, Featuring Cancer in American Indians and Alaska Natives. Cancer [American Cancer Society]: 2007 [11-15-07]; Volume 110: No. 10. GRAPH MODIFIED BY Rick Clark, Native American Cancer Research

IHS Cancer MortalityNote cancers other than breast, cervix, colon, lung and prostate This is why AIAN comprehensive cancer plans cannot be limited to only those sites!

Page 9: American Indians in Public Health - Native American …natamcancer.org/handouts/ARS_TP_AI_PubHlth_12-04-08a_LB_HND.pdf · 501(c)(3) American Indians in Public Health ... Skill Dev

American Indians in Public Health

Burhansstipanov, Native American Cancer Research http://www.NatAmCancer.org1-800-538-8295 9

Haverkamp D, Espey D, Paisano R, Cobb N., Cancer Mortality among AIAN: Regional Differences, 1999-2003, IHS, Rockville, MD 2008

Haverkamp D, Espey D, Paisano R, Cobb N. Cancer Mortality Among American Indians and Alaska Natives: Regional Differences, 1999-2003. Indian Health Service, Rockville, MD, February 2008.

GRAPHS MODIFIED BY: Rick Clark, Native American Cancer Research (note horizontal grid)

Haverkamp D, Espey D, Paisano R, Cobb N. Cancer Mortality Among American Indians and Alaska Natives: Regional Differences, 1999-2003. Indian Health Service, Rockville, MD, February 2008.

GRAPHS MODIFIED BY: Rick Clark, Native American Cancer Research (note horizontal grid)

Haverkamp D, Espey D, Paisano R, Cobb N. Cancer Mortality Among American Indians and Alaska Natives: Regional Differences, 1999-2003. Indian Health Service, Rockville, MD, February 2008.

GRAPHS MODIFIED BY: Rick Clark, Native American Cancer Research (note horizontal grid)

Haverkamp D, Espey D, Paisano R, Cobb N. Cancer Mortality Among American Indians and Alaska Natives: Regional Differences, 1999-2003. Indian Health Service, Rockville, MD, February 2008.

GRAPHS MODIFIED BY: Rick Clark, Native American Cancer Research (note horizontal grid)

Haverkamp D, Espey D, Paisano R, Cobb N. Cancer Mortality Among American Indians and Alaska Natives: Regional Differences, 1999-2003. Indian Health Service, Rockville, MD, February 2008.

GRAPHS MODIFIED BY: Rick Clark, Native American Cancer Research (note horizontal grid)