ASSESSING DIET CANCER ASSOCIATION IN NATIVE AMERICANS

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Accurate assessment of usual dietary intake is critical to understanding the relationship between diet and cancer epidemiology, biology, control and prevention. For Native Americans, such quantitative information is limited. The application of dietary data that does exist for Native Americans to cancer studies is restricted by several factors: (1) most reports are based on short-term intake; (2) cultural differences in portion sizes has not been considered a significant variable; (3) micronutrient intake is not reported; (4) micronutrient content of some seasonally consumed wild foods is unknown; and (5) inter-reservation diet diversity limits the validity of extending results from one population to another. Within some communities, cultural and economic differences in food choices, availability, preparation, processing techniques, appropriate portion sizes, and food classification systems impair the applicability and validity of food frequency questionnaires (FFQs) used in nationwide surveys. The Native American diet is changing and cancer is rapidly becoming a significant health problem for this minority population; incidence and age-adjusted mortality rates of cervical, stomach and gallbladder cancer among Native Americans are two to twenty times higher than that reported for US all races. FFQ-based epidemiologic studies of diet-cancer associations in Native American populations are crippled by the absence of culturally appropriate dietary assessment tools. The goal of this project is to improve our understanding of diet-cancer associations as observed among Native Americans, by developing a dietary assessment technique which allows Native Americans to accurately report their usual food intake. Working with tribes in the Southwest, project aims are (1) to use qualitative (focus groups) and quantitative techniques (multiple 24hr recalls) to develop valid, reliable and culturally competent FFQ templates that can be "culture specific" adapted, (2) to design and test a manual which outlines steps for culturally adapting the FFQ templates, and (3) to develop supportive computer analyses programs to assess nutrient intake relative to cancer risks. These tools promise to improve FFQ-based epidemiologic studies of diet-cancer associations and will assist in the design, implementation, monitoring and evaluation of preventive oncology interventions among Native Americans. This proposal for research will be the major component of a five-year Academic Award. As a faculty member in the UA College of Medicine and the Arizona Graduate Program in Public Health, the investigator will incorporate information and perspectives developed from this experience, into preexisting and newly developed courses and internships for medical and public health students. The investigator will enhance her own education with continued course work in advanced epidemiology, biology of cancer and ethnobotany.