Northwest Tribal Comprehensive Cancer Program

1. Northwest Tribal Comprehensive Cancer Program October Quarterly Board Meeting 2016 Kerri Lopez

2. Clinical Cancer Update 29 participants (2016) CEU accreditation Tribal Tobacco Summit 50 participants (2016) Tobacco Cessation Basic Tobacco Intervention Skills for AI/AN 18 participants (2015) NTCCP Trainings/Activities • Tribal BRFSS • Inflatable Colon "Kiki” • Supporting NW Tribal CRC Education Activities • Tribal Cancer Plan Implementation Funding • Tribal site visits Cancer 101 Development tribal action plan Participation in tribal prevention, screening and education activity • Technical assistance • Dissemination of resources

3. Tribal BRFSS– 6 tribes In progress One Oregon Census phone One Oregon Tribal resolution Development of survey materials and IRB application Complete • TwoOregon • Randomized phone • Census phone • Two Washington • Door to door

4. Tobacco Cessation • Basic Tobacco Intervention Skills Training (BTIST) for Native Communities • 5A’s model • 6 Modules topics Northwest Portland Area Indian Health Board

5. Tribal Implementation Clinic Integration Results 41 web-base referrals to the quit-line, 366% increase 51 commercial tobacco users agreed to stop smoking 26 clinical staff members level of knowledge increased • From train - trainers • 3 month time • 50 clinic/admin staff were trained in the 5A’s BTIST • Of 50 staff participants 31 staff formed 4 teams • With the goal to increase referrals Northwest Portland Area Indian Health Board

6. Other Implementation • 1 on 1 cessation counseling • Group classes • Referrals to another resource for tobacco cessation • All clinic staff training (from receptionist to the IT person) Northwest Portland Area Indian Health Board

7. NTCCP Coalition Meeting Navigation and Communication • Topics • Communication with patients • Resources for Survivors • Tobacco Cessation • Lung cancer screening • Other resources: • Housing • Financial assistance • Transportation • Resource Fair: • Organizations sharing information with tribes (6) Northwest Portland Area Indian Health Board

8. Youth tobacco training • Tobacco Facts • Tobacco 101 presentation • Tobacco vs. Candy • Environmental Scan Tool • Group discussion Northwest Portland Area Indian Health Board

9. YIKES Northwest Portland Area Indian Health Board

11. Rates AI/AN Women • 32.5% of AI/AN women smoke • 18% of AI/AN women smoke during pregnancy nationally. **** 2003 data • 26% of AI/AN women smoke during their last 3 months of pregnancy. • 22.3% of AI/AN womenin Oregonsmoke during pregnancy, in the last 3 months of pregnancy 16.2% Northwest Portland Area Indian Health Board

12. Tobacco Use in Adults

13. Tobacco Use in Youth

14. Tobacco Related Cancer Disparities Oregon Incidence 2007-2012

15. Colorectal Cancer Disparities CRC Screening 2012 (ID, OR, WA)1 • AI/AN 36.0% (50-75 yo) CRC Distant Staging 2003-2007 (ID, OR, WA)2 • AI/AN 23.9% • NHW 18.1% CRC 5 yr Survival 1998-2007 (ID, OR, WA)3 • AI/AN 0.4727 (0.4190, 0.5338) • NHW 0.5627 (0.5627, 0.5825 1 Indian Health Service: 2012 GPRA results 2 Northwest Portland Area Indian Health Board. Cancer Among Northwest American Indians and Alaska Natives. Portland, OR: Northwest Tribal Epidemiology Center, 2011. 3 Petersen, P. S. Colorectal Cancer Survival Among American Indian and Alaska Native People in the Pacific Northwest: A Thesis. Oregon Health & Science University, Portland, OR, 2011.

16. E-cigarettes Myths • Safe than conventional cigarettes • Healthy alternative • Does not cause death • E-cigarette aerosol is harmless “water vapor” and is as safe as clean air • No second hand smoke • Little to no nicotine in e-liquid • Fun, Cool, Sexy • Cannot overdose on nicotine from e-liquids Facts • No FDA approved • Currently no sufficient evidence to conclude that e-cigarettes are an effective smoking cessation tool. • E-cigarette aerosol can contain heavy metals and cancer causing agents • E-liquid contains insufficient amount of nicotine levels • Most adults who use e-cigarettes also smoke conventional cigarettes, referred as “dual use” • Marketing to youth using Big Tobacco tactics and fun flavors • Gateway to smoking or using other tobacco products Northwest Portland Area Indian Health Board CDC.gov/tobacco

17. Youth E-Cigarette use Current use in Oregon 2015 From: Oregon Health Authority, Public Health Division, Health Promotion and Chronic Disease Prevention section. Current tobacco use and related topics among 8th and 11th graders by race and ethnicity, Oregon 2015. https://public.health.oregon.gov/DiseasesConditions/ChronicDisease/DataReports/Pages/YouthData.aspx. Northwest Portland Area Indian Health Board

18. Adult E-Cigarette use Current use in USA 2014 From: Nguyen KH, Marshall L, Brown S, Neff L. State-Specific Prevalence of Current Cigarette Smoking and Smokeless Tobacco Use Among Adults — United States, 2014. MMWR Morb Mortal Wkly Rep 2016;65:1045–1051. DOI: http://dx.doi.org/10.15585/mmwr.mm6539a1 Northwest Portland Area Indian Health Board

19. Current Policy Work in Tribal Communities • Tribal Admin-Community Campus • Health Clinic • Education • Gathering Space • Events & Gatherings • Tribally Run Businesses • Tribal Housing • External Partners Northwest Portland Area Indian Health Board

20. Cancer Challenges - Multifaceted • High need for Cancer Resources in AI/AN communities • Geographic Isolation • Independent Healthcare Systems • Low Health Literacy • Patient ― Provider Communication • Screening – referrals • Screening rates for paps and mams going down • After care for cancer survivors in tribal community • Economic Impact Northwest Portland Area Indian Health Board

21. Twenty Year Northwest Tribal Comprehensive Cancer Control Plan Northwest Tribal Cancer Resource Guide Cancer 101 Cancer Fact Sheets Appointment Companion Tribal Cancer Action Planning NTCCP Tools and Resources Evaluation of Cancer 101: An Educational Program for Native Settings. Hill TG, Briant KJ, Bowen D, Boerner V, Vu T, Lopez K, Vinson E. J Cancer Educ. 2010 Feb 10. The past, present, and future of comprehensive cancer control from the state and tribal perspective. Miller SE, Hager P, Lopez K, Salinas J, Shepherd WL. Prev Chronic Dis. 2009 Oct;6(4):A112. Cancer Care of American Indians and Alaska Natives and Other Racial Groups Enrolled in Public and Private Insurance Plans. Ramsey S, Zeliadt S, Blough D, Lopez K, Buchwald D. Poverty & Public Policy. 2010 Vol. 2: Iss. 1, Article 3.

22. Tools and Resources Cont. • Tribal Tobacco Policy Workbook • Northwest Tribal Colorectal Cancer Screening Toolkit • Second Wind Curriculum • NPAIHB Tribal Profiles • State level • Multiple Presentations • E-Cigarettes, Pregnancy & smoking, Cancer Resources, Cancer Survivor support group support and Cancer Action Planning • Multiple factsheets • HPV, Tobacco, SHS, E-cigarettes, Smoke-free Homes, etc. Northwest Portland Area Indian Health Board

23. NTCCP Staff • Kerri Lopez; • NTCCP Project Director • Eric Vinson; • NCCP Coordinator • Antoinette Aguirre; • Cancer Prevention Coordinator • Ryan Sealy; • WEAVE NW Tobacco Specialist Northwest Portland Area Indian Health Board