Knowledge of and attitudes about cancer among American Samoans

The objective of this study was to determine cancer-related knowledge and attitudes among American Samoans, a population seldom studied by cancer researchers. Such information is necessary to develop culturally sensitive cancer control interventions. Specially trained personnel conducted face-to-face interviews with randomly selected respondents in the US Territory of American Samoa; Oahu, HI; and Los Angeles, CA, using a survey based on the National Health Interview Survey Cancer Control Supplement and focus group findings. The survey included questions concerning knowledge of risk factors for cancers (breast, cervical, colon, lung, stomach, and prostate), family resources (health insurance coverage, employment status, and family income), and demographic characteristics. Participants could complete the survey in English or Samoan. Analysis of data included the chi-squared test and logistic regression analysis. Participants included 1,834 noninstitutionalized English- or Samoan-speaking women and men (609 from American Samoa, 610 from Hawaii, and 615 from Los Angeles). The majority of residents had some positive attitudes about cancer prevention and treatment but often also had misconceptions about risk factors for cancer. Logistic regression analysis revealed that site of residence was an important predictor of attitudes. For example, being residents of American Samoa or Hawaii predicted that the respondents would rather not know that they had cancer (odds ratio [OR], 1.5, 2.1, respectively); that cancer can be caused by aitu, or spirits (OR, 1.9, 2.1, respectively); that cancer is a punishment from God (OR, 2.0, 2.2, respectively); and that cancer can be cured by fofo, or traditional Samoan healers (OR, 2.0, 3. 1, respectively). This study documented cancer-related knowledge and attitudes among American Samoans and set the stage for culturally sensitive interventions aimed at improving cancer control in this population. It also identified many issues that should be addressed in such interventions.