OBJECTIVES: To characterize the leading causes of death for the urban American Indian/Alaska Native (AI/AN) population and compare with urban White and rural AI/AN populations. METHODS: We linked Indian Health Service patient registration records with the National Death Index to reduce racial misclassification in death certificate data. We calculated age-adjusted urban AI/AN death rates for the period 1999-2009 and compared those with corresponding urban White and rural AI/AN death rates. RESULTS: The top-5 leading causes of death among urban AI/AN persons were heart disease, cancer, unintentional injury, diabetes, and chronic liver disease and cirrhosis. Compared with urban White persons, urban AI/AN persons experienced significantly higher death rates for all top-5 leading causes. The largest disparities were for diabetes and chronic liver disease and cirrhosis. In general, urban and rural AI/AN persons had the same leading causes of death, although urban AI/AN persons had lower death rates for most conditions. CONCLUSIONS: Urban AI/AN persons experience significant disparities in death rates compared with their White counterparts. Public health and clinical interventions should target urban AI/AN persons to address behaviors and conditions contributing to health disparities. (Am J Public Health. Published online ahead of print February 18, 2016: e1-e9. doi:10.2105/AJPH.2015.303033).

Previous studies have shown an association between cervical cancer screening and racial/ethnic minority status, no usual source of care, and lower socioeconomic status. This study describes the demographics and health beliefs of women who report never being screened for cervical cancer by area of residence. Data from the 2010 Behavioral Risk Factor Surveillance System were used to study women aged 21-65 years who reported never being screened for cervical cancer. Multivariate logistic regression modeling was used to calculate predicted marginals to examine associations between never being screened and demographic characteristics and health belief model (HBM) constructs by metropolitan statistical area (MSA). After adjusting for all demographics and HBM constructs, prevalence of never being screened was higher for the following women: non-Hispanic Asians/Native Hawaiians/Pacific Islanders (16.5 %, 95 % CI = 13.7 %, 19.8 %) who live in MSAs; those with only a high school diploma who live in MSAs (5.5 %, 95 % CI = 4.7 %, 6.5 %); those living in non-MSAs who reported "fair or poor" general health (4.1 %, 95 % CI = 3.1 %, 5.4 %); and those living in either MSAs and non-MSAs unable to see a doctor within the past 12 months because of cost (MSA: 4.4 %, 95 % CI = 4.0 %, 4.8 %; non-MSA: 3.4 %, 95 % CI = 2.9 %, 3.9 %). The Affordable Care Act will expand access to insurance coverage for cervical cancer screening, without cost sharing for millions of women, essentially eliminating insurance costs as a barrier. Future interventions for women who have never been screened should focus on promoting the importance of screening and reaching non-Hispanic Asians/Native Hawaiians/Pacific Islanders who live in MSAs.

Colorectal cancer (CRC) screening is underused in the United States, and non-adherence with screening recommendations is high in some populations. This study describes the characteristics of people who have never been screened for CRC. In addition, we use the health belief model to examine the constructs associated with screening behavior. We used data from the 2010 Behavioral Risk Factor Surveillance System (BRFSS) to create three study outcomes: people who have been screened for CRC and are up-to-date with current recommendations, people who have been screened but are not up-to-date, and people who have never been screened. We used multivariate logistic regression modeling to calculate predicted marginal estimates examining the associations between the screening outcomes and demographic and Health Belief Model (HBM) characteristics. Overall 29 % of respondents had never been screened for CRC. In the adjusted model, 36.6 % of US adults age 50-59 years and 29.1 % of US men reported never being screened for CRC. More Asian/Native Hawaiian/Pacific Islander, non-Hispanics (38.2 %) reported never being screened than members of other racial and ethnic groups. Nearly 37 % of people with less than a high school diploma reported never being screened. We found statistically significant differences among screening outcomes for all demographics and HBM constructs except could not see a doctor because of costs in the last 12 months, where approximately 29 % reported no CRC screening. New interventions should focus on those subpopulations that have never been screened for CRC.