Background American Indians (AI) in North Dakota present with higher rates of advanced-stage disease for screening detectable colorectal cancers and have lower overall baseline colorectal cancer screening rates than non-AIs. We sought to identify the perceived barriers and facilitators for the engagement with colorectal cancer prevention within North Dakota tribal communities. Methods Twelve semi-structured interviews were carried out across four tribal reservation communities in the state of North Dakota with American Indian adults between the ages of 30 and 75 years. We utilized purposive sampling to ensure maximum variation in age, sex, and tribal community until data saturation was achieved. The interviews were transcribed, and thematic analysis was carried out to identify consistent themes rooted within the data. Ethical approval was gained for this project from all relevant institutional review boards. Results Four main themes were identified as barriers for the engagement with colorectal cancer prevention, including: colorectal cancer screening barriers, focused on other health problems, lack of colorectal cancer tailored health promotion, and socio-cultural factors affecting colorectal cancer prevention. Three main themes were identified as facilitators for the engagement with colorectal cancer prevention, including: reasons for getting colorectal cancer screening, role of culture, and getting out into the community. Conclusion There is need for more community-rooted, strengths-based approaches to colorectal cancer prevention activities in AI communities in North Dakota. Socio-cultural factors, such as the use of storytelling, and the use of traditional knowledge have been demonstrated to be an important element of consideration for colorectal cancer tribal community engagement and prevention planning in the state.

Objectives: Despite decades of continued commercial tobacco prevention and control efforts, smoking rates in Northern Plains American Indian (AI) communities within the United States continues to be remarkably high. We sought to take a microcosmic view of AI tobacco research in the Northern Plains region to identify the types of tobacco-related research that has been completed, and to critically examine whether the four areas of community importance outlined as best practice for tobacco programming in AI communities has been represented in the literature to date. Design: A systematic search of multiple databases was executed utilizing an established scoping review framework that was adapted to fit within an Indigenous worldview. A consequent title and abstract review of tobacco-related research published with AI Northern Plains communities was completed. Structured deductive content analysis was carried out on each article utilizing a matrix of analysis developed from existing literature on best practices in AI communities. Results: Of the 916 published studies identified, 50 met the inclusion criteria and were represented within five identified categorical themes: (1) commercial tobacco smoking as a risk factor, (2) commercial tobacco-related disease outcomes, (3) tobacco policy, (4) commercial tobacco smoking cessation, and (5) cultural or traditional tobacco use. The matrix analysis identified substantial variation in the number of studies carried out with community-identified best practices in place, including 22 of the 50 (44%) articles containing one or none of the four areas of importance noted as best practice. Conclusions: We identified a substantial lack of community and culturally informed tobacco-related research being carried out in the Northern Plains region. Community-based and culturally grounded efforts that consider colonization, historical trauma, and ACEs when planning research, funding mechanism, and health programming activities in the region are urgently needed to decrease commercial tobacco use and consequent health disparities.