ORIGINAL REPORTS:CANCER PERCEIVED CANCER RISK AMONG AMERICAN INDIANS: IMPLICATIONS FOR INTERVENTION RESEARCH Angela A. Gonzales, PhD; Thanh G.N. Ton, MPH, PhD; Eva Marie Garroutte, PhD; Jack Goldberg, PhD; Dedra Buchwald, MD Objective: Perceived risk of disease plays a key role in health behaviors, making it an important issue for cancer-prevention re- search. We investigate associations between perceived cancer risk and selected cancer risk factors in a population-based sample of American Indians. Study Design and Population: Data for this cross-sectional study come from a random sample of 182 American Indian adults, aged $40 years, residing on the Hopi Reservation in northeastern Arizona. Outcome Measures: Perception of cancer risk was ascertained with the 5-point Likert scale question, ‘‘How likely do you think it is that you will develop cancer in the future?’’ dichotomized into low perceived risk and high perceived risk. Results: Participants reporting a family mem- ber with cancer were more likely, by greater than five times, to report the perception that they would get cancer (OR55.3; 95% CI: 2.3, 12.3). After controlling for age and family history of cancer, knowledge of cancer risk factors and attitude about cancer prevention were not significantly associated with risk perception. Conclusions: Perceived cancer risk was signif- icantly associated with self-reported family history of cancer, supporting the importance of personal knowledge of cancer among American Indians. Further research is needed to obtain a more complete picture of the factors associated with perceptions of cancer risk among American Indians in order to develop effective interventions. (Ethn Dis. 2010;20:458–462) Key Words: Indians, North America, Cancer, Health Belief Model, Risk Perception, Atti- tudes and Beliefs, Cancer Knowledge, Family History INTRODUCTION Cancer is the second leading cause of death among American Indians. 1 The number of deaths associated with cancer among American Indians aged $45 years exceeds the next three leading causes combined (diabetes, unintention- al injuries, chronic liver disease/cirrho- sis). 2 While overall cancer incidence and mortality rates in the United States have been decreasing, the age-adjusted inci- dence and mortality rates for many cancers have been increasing among American Indians. 1,3,4 The American Cancer Society estimates that more than half of all cancer deaths could be prevented by adopting health-protective behaviors and preventive screening. 5 However, according to the Health Belief Model, 6 an individual’s perception of risk plays a significant role in adopting preventive health behaviors. 7,8 Perceived risk of cancer – the subjective estimation of likelihood that one might be diagnosed with cancer in the future – has been used to predict cancer screening behaviors as well as to evaluate the effectiveness of interven- tions to promote screening and other health-protective behaviors. 9–12 Perceptions of cancer risk vary widely among populations. 2,13–18 A study of risk perception in a nationally representative sample of Whites, Blacks, Hispanics, and Asians found that non- Whites reported lower perceptions of cancer risk than Whites. 16 A study of perceived risk for breast, cervical, and colon cancer found striking racial/ethnic differences, with Asian women report- ing the lowest perception of risk for all three cancers and Latinas reporting the highest. 15 Studies have also found distinctive attributions of perceived risk in racial/ethnic minority popula- tions. 19,20 One study using a predom- inantly African-American sample found that respondents more often attributed their risk to psychological causes, such as ‘‘just feeling like you could get it,’’ than to medically established factors such as heredity or environmental causes. 21 Variations in perception of cancer risk among racial/ethnic groups suggest that social and cultural characteristics may be significantly related to risk perception, and thus may pose a From Department of Development Sociology, Cornell University (AAG); De- partment of Neurology, University of Wash- ington (TGNT); Department of Sociology, Boston College (EMG); Department of Medicine, University of Washington (JG, DB). Address correspondence to Angela Gonzales, PhD; Department of Develop- ment Sociology; Cornell University; 322 Warren Hall; Ithaca, NY 14853; 607-255- 1795; 607-254-2896 (fax); aag27@cornell. edu The number of deaths associated with cancer among American Indians aged $45 years exceeds the next three leading causes combined (diabetes, unintentional injuries, chronic liver disease/ cirrhosis). 2 458 Ethnicity & Disease, Volume 20, Autumn 2010