Today we’re sharing the experience of Christina Haswood who completed an internship from by MPHTC in the spring of 2020. In the fall of 2020, she was elected to the Kansas House of Representatives. Representative Haswood is one of the youngest members of the Kansas Legislature and the third Native American member in history.
by Christina Haswood
The Center for American Indian Community Health (CAICH) here at the University of Kansas Medical Center (KUMC), goes far back to my middle school days. Back when I didn’t even know I wanted to become a public health professional let alone attend graduate school. Our sister organization, American Indian Health Research & Education Alliance (AIHREA), puts on an annual powwow at Johnson County Community College (JCCC) where I used to dance. Their approach to bringing health education and awareness at a powwow2 was a new concept I hadn’t seen before but they always gave away free tshirts. I first interned for CAICH as an undergraduate summer intern then came back as a grad student where I am currently a Graduate Research Assistant with the privilege of having the Alternative Tobacco project as my internship and capstone. Being a Navajo woman who was born and raised in Lawrence, KS, I will gladly take any opportunity to give back to my community.
The CAICH3 was founded in 2010 with a mission to “improve the physical, mental, spiritual, and cultural health of American Indian (AI) communities and individuals throughout Kansas, the region, and the nation through collaborative research, education, and service.”1 They conduct community-based participatory research (CBPR) to Native communities, bring awareness to Native health issues, assist Native students into the health field, and provide services (i.e. health literacy & education) to communities. Many CAICH projects are on and off the reservation and programs such as the All Nations Breath of Life (ANBL) provide culturally tailored tobacco cessation programs that have the highest quit rates in the country.
My capstone project is on the Understanding Knowledge, Attitudes, Beliefs, and Behaviors Surrounding Alternative Tobacco Product Use in American Indian College Students. I have seen this project go from the ground up as I’ve worked on it last semester (Fall 2019) for my internship class. The main objective for the capstone is to perform a qualitative analysis on the focus group transcriptions to see if there is a need for an American Indian (AI) alternative tobacco prevention program.
There is no current published research or prevention programs that are culturally tailored to American Indians to combat the growing concerns of vape and other alternative tobacco devices. This will also give the students the opportunity to voice out their concerns and share their opinions. They are a part of the solution that will be designed for them and their peers.
The halfway point was around the first week of April where we were coming back from Spring Break. This year, we were all faced with COVID-19 and following social distancing, self-quarantine from traveling, and stay at home orders. Fortunately, this project was not heavily impacted by the COVID-19 pandemic, but our indigenous communities were. American Indian (AI) tribal nations have some of the highest mortality and rate of cases in the United States. Currently, tribes have not received their COVID-19 relief funds from the government.
What affected our alternative tobacco (AT) project was our plan to recruit more survey participants as we hoped to capture about 200 more tribal college students. With COVID-19, our partnering university had sent their students home by the end of March. My team looked into the options of putting the survey online but we all respectfully agreed that sending a survey this early into the pandemic would be inappropriate.
The AT project used a mixed-methods approach which was qualitatively focused. Last semester we ran focus groups where AI students self-identified into three groups (1) current/former AT users, (2) current/former smoker, and (3) non-user. They were then stratified into their self-identified gender that followed a nested sampling approach. Participants took a de-identified survey that captured their knowledge, attitudes, beliefs, and behaviors (KABB) surrounding AT product use.
We completed 20 focus groups then transcribed the audio for qualitative analysis. Once transcriptions were completed an audit was performed by the transcribers. A codebook was then created with primary, secondary, and tertiary codes. Coders were trained to follow coding procedures by the Center for American Indian Community Health (CAICH). The objective of coding was to identify themes to be reviewed by the PI.
A qualitative focused study can be difficult as we needed to reach saturation with the focus groups in order to begin analysis. Reaching saturation, there is no perfect number to groups we could have calculated, and the risk of declaring saturation too early can produce inconsistent results. This was done by frequent team meetings and post focus group briefings. Working and being a student during COVID-19 has provided challenges that I am thankful to have a wonderful team, family, and friends who all uplift each other. My sincere thoughts go out to those impacted by COVID-19 and Indian Country. We are resilient peoples and we will get through this.
The last few months at my placement site was dedicated to finishing up this project to present as my capstone project, Knowledge, Attitudes, Beliefs and Behaviors (KABB) Surrounding Alternative Tobacco Us in American Indian (AI) college students’. Once us three coders sent in our themes to the PI, we got to compare each other’s submission for themes. It was interesting to see what themes we all agreed, disagreed, or wanted to add. This part was research unique as two of the coders (including myself) were Native American and the other was not. The other Native coder comes from the Northern Plains area while I am Navajo from the Southwest region. At times, we would both catch on “Native humor” and slang that we could translate to fit a theme. This shows the importance of having members of the community you are doing research with, trained in the research that is being done. This value is one of the Center for American Indian Community Health (CAICH) goals is to train and provide education for Native American students in public health and community-based participatory research (CBPR) methods.
Putting together my capstone paper and defending it were my last deliverables to my Masters of Public Health (MPH) degree. Reflecting on eight months working on the AT KABB project, I am thankful to be a part of an organization addressing the vaping issue. The CAICH is producing first of its kind research that focuses on the AI college student and their prevalence to using electronic nicotine delivery systems (ENDS). This brings concerns as AI in the midwest region where we are located, have a high use of nicotine use with traditional cigarettes. Non-Native communities such as Johnson County, were working hard in tackling the vaping issue in their middle and high schools. This project also gave an opportunity to AI students an opportunity to be a part of the solution while being rightfully compensated for their time. Installing trust in research and AIs is a relationship that was severely damaged by unethical and moral practices that we must always involve the community at every step of the way.