摘要：Objectives. We examined cancer screening and risk factor patterns in California using 4 different statistical tabulations of American Indian and Alaska Native (AIAN) populations. Methods. We used the 2001 California Health Interview Survey to compare cancer screening and risk factor data across 4 different tabulation approaches. We calculated weighted prevalence estimates by gender and race/ethnicity for cancer screening and risk factors, sociodemographic characteristics, and access to care variables. We compared AIAN men and women with members of other racial groups and examined outcomes among AIAN men and women using the 4 tabulation methods. Results. Although some differences were small, in general, screening and risk factor rates among American Indians/Alaska Natives were most similar to rates among Whites when the most inclusive multiracial tabulation approach was used and least similar when the more exclusive US census “single-race” approach was used. Conclusions. Racial misclassification and undercounting are among the most difficult obstacles to obtaining accurate and informative data on the AIAN population. Our analysis suggests some guidelines for overcoming these obstacles. Despite declines in mortality from cancer among the overall US population in recent years, mortality rates among American Indians and Alaska Natives have not declined significantly. 1 Moreover, a persistent gap in self-reported health status remains between American Indians/Alaska Natives and non-Hispanic Whites. 2 National health indicators for American Indians/Alaska Natives rank near the bottom among the major racial/ethnic groups, including Whites, Blacks, Asian Americans, Native Hawaiians and other Pacific Islanders, and Latinos. 3 For example, overall cancer mortality rates are rising among American Indians/Alaska Natives who are residents of California, 4 even though their rates of Papanicolaou test and colorectal screening are among the highest of the major racial/ethnic groups. 5 A recent evaluation of REACH 2010 (Racial and Ethnic Approaches to Community Health 2010) showed that American Indians were more likely than other minority groups to use preventive services; at the same time, however, they exhibited higher levels of risk factors such as smoking and obesity. 6 The study also showed that American Indians have reached or are close to reaching the mammography and Papanicolaou test objectives established by Healthy People 2010, 7 an achievement the REACH authors credited to the commitment of communities, tribal corporations, public health authorities, and health care providers. However, as pointed out by the authors, the REACH 2010 study included only 2 American Indian communities and might not have been representative of American Indians/Alaska Natives from other areas. We explored cancer screening and risk factor patterns among American Indian/Alaska Native (AIAN) women and men. Racial misclassification has been one of the most difficult obstacles to accurate and informative data collection and reporting for the AIAN population. The California Health Interview Survey (CHIS) of 2001 is the largest population-based cancer risk factor and screening data source on American Indians/Alaska Natives. The CHIS database offers a unique opportunity to compare several different tabulation methods for documenting the AIAN population surveyed because of the careful and collaborative manner in which the data were collected. To begin to fill the research gap suggested by the REACH 2010 evaluation, we examined whether the same cancer screening and risk factor patterns were evident in California as in the REACH sample and, more specifically, how these data compared when different statistical tabulations of the AIAN population were used.
