1. Community Conversations on Cancer Storm Lake, Iowa

2. Carlos Gallego M.Ed. Intercultural Cancer Council Sarah Kitchell B.A. NCI’s Cancer Information Service Iowa Comprehensive Cancer Control Program Project Team

3. Getting Started Worked with CIS to identify target community Researched community: Both culture and needs Connected to community leaders via cold calls Identified key community partners/leaders Developed Interview questions with input from community leaders assisting with project Explained to community how findings will be used and how you will share information community

4. How the Project Came About CIS staff at Mayo requested presentation on Intercultural Cancer Council at Annual Iowa Comprehensive Cancer Consortium (ICCC) Meeting Invited to join ICCC Significant lack of underserved representation on Committee RFP to do Cancer project available through IDPH Partnered with CIS at Holden Comprehensive Cancer Center, Iowa City

5. To collect baseline data around cancer knowledge, perceptions and barriers confronting the Tai Dam and Latino communities of rural Iowa. Purpose

6. Korean, Tai Dam, Latino, Urban African American Iowa Disparity Project Demographic research, cancer data, minority population centers Storm Lake, Tai Dam and Latino communities Identified community leaders

7. Sioux City Storm Lake, population 9,882 Des Moines

8. Data Healthcare Northwest Area Foundation Buena Vista county’s incidence rate for colorectal cancer, 34.6 per 100,000, is the highest in the state. 8

9. Data U.S. Census Bureau Buena Vista County Demographics

10. Iowa 90% of Tai Dam in the United States live in Iowa. Roughly 4,000 Tai Dam live in Iowa with 3,000 concentrated in Des Moines Data

11. Community Experts - access to the community -interpreters -space -recruitment Method

12. Tai Dam History In 1250 BC many Tai Dam moved south to the Chinese border as Mongol leader Kubilai Khan invaded and destroyed their kingdom, Nan Chao. Tai Dam divided into groups. Some went to Laos, others to Thailand and other followed the Black River to North Vietnam and built their town and cities. Tai Dam lived with neighbors, the Vietnamese and Laotians. In the 1900's French colonized Laos, Vietnam and Cambodia. In the early 1950's, the French began losing their colonies. In North Vietnam under the leadership of Ho Chi Minh, the French were defeated at the battle of Dien Bien Phu (a major Tai Dam city called Muong Theng or the city of the God). Many Tai Dam who had been French soldiers, government employees, and top government officials, and fled as political refugees in 1954. Many Tai Dam moved to Laos because of similarities in language and culture. Others move to South Vietnam. In November 1975, under leadership of Governor Robert D. Ray, people of Iowa welcomed this group of refugees from SE Asia known as the Tai Dam. Today 90 percent of the Tai Dam live and work in Iowa. Iowa is called the free capital of the Tai Dam in the world.

13. Conversation Groups Group Design Recruitment Method

14. Findings Latino Community Cost False-positives Environmental issues Cost-benefit of screening Incorrect medical information

15. Findings When should you have your first pap smear? “After you have a baby” “After you get married” “After your 3 rd baby” “If you have a family history, begin exams after age 30” “After 40-45 years of age” Latinas answer:

16. Navigating health care system Inability to pay Inevitability Workplace concerns Findings Tai Dam

17. “First of all, I don’t have any knowledge about cancer. I would like you to explain, what is cancer? Where does it come from?..My mother died of breast cancer, how can I prevent cancer from coming to all the kids?” Findings Tai Dam male conversations participant

18. Quote from Tai Dam females “They call it Women’s Center but I think it is the man who is the doctor... Women’s Center should have women doctors... It would be good to have more female doctor’s some of us are too shy.” “I went to see my family doctor last week and I asked many questions. He said, I worry too much. Yes, I worry, my kids are still young and I am young and I don’t want to die yet...and he laughed at me...”

19. Tai Dam Culture Tai Dam believe in benevolent and malevolent spirits. They believe there are supernatural forces that decide their lives and destiny. The creator of heaven and earth is the "Then Luong." On earth the "Phi" who are the henchman of the "Then" control every affair of man's deeds. Tai Dam hold man to be a part of nature. Man is superior over nature, but man is happiest when is at one with nature. However, Tai Dam are very tolerant of other's beliefs. Also a strong influence of Confucianism. Improve self, family community. Also now a strong influence from Christianity. There are also Buddhist Tai Dam. Tightly Night extended families Child rearing is generally more conservative and stricter than the mainstream. stricter and less permissive than America. Parents, brothers, sisters, & other family members and elders have responsibility to help raise a child. The younger people show respect to parents, grandparents, and deceased ancestors; disrespect is not tolerated. For the Taidam, the aged are society's most respected people.

20. Recommendations Accessible and appropriate healthcare information Provider Education Work in collaboration with faith communities Encourage patient advocacy Develop local health disparities work groups

21. Recommendations Health Professionals: Cultural competency training Information in several preferred languages Information provided at an appropriate literacy level Convenient location and time of services Family involvement

22. Recommendations Health providers and educators should considers the following issues: Poverty Gender Transportation Family Dynamics Education Level Basic Health Literacy

23. Thank You Cyndi Chen Status of Iowans Asian and Pacific Islander Heritage Iowa Department of Human Rights Sara Comstock Iowa Comprehensive Cancer Control Program National Cancer Institute’s Cancer Information Service Janice Edmunds-Wells Office of Multicultural Health, Iowa Department of Public Health Jill Myers Geadelmann Iowa Comprehensive Cancer Control Program, Iowa Department of Public Health Sarah Kitchell Iowa Comprehensive Cancer Control Program National Cancer Institute’s Cancer Information Service Kellee McCrory Iowa Center for Evaluation Research National Resource Center for Family-Centered Practice University of Iowa, School of Social Work Renea Seagren United Community Health Center, Storm Lake, Iowa Holly Smith Iowa Comprehensive Cancer Control Program, Iowa Department of Public Health Pastor Barry Thongvanh Southeast Asian Community Christian Church Michele Yehieli Project EXPORT at the University of Northern Iowa

24. Contact Information Carlos Gallego, M. Ed. Intercultural Cancer Council (651) 225-6085 or 952-361-0586 gallegocarlos@district112.org Sara Comstock, M.S.W. National Cancer Institute’s Cancer Information Service Iowa Consortium for Comprehensive Cancer Control (319) 335-8144 sara-comstock@uiowa.edu

25. Questions?