Iowa Consortium for Comprehensive Cancer Control
Community Conversations on Cancer in Storm Lake, Iowa
Final Report
June 2007
Project Team:
Carlos Gallego
Intercultural Cancer Council
gallegocarlos@district112.org
Sarah Kitchell
NCI’s Cancer Information Service
Iowa Comprehensive Cancer Control Program
sarah-kitchell@uiowa.edu
Funding for this project came from the Iowa Comprehensive Cancer Control Program at the
Iowa Department of Public Health.
Special Thanks:
Janice Edmunds-Wells
Office of Multicultural Health, Iowa Department of Public Health
Holly Smith
Iowa Comprehensive Cancer Control Program, Iowa Department of Public Health
Jill Myers Geadelmann
Iowa Comprehensive Cancer Control Program, Iowa Department of Public Health
Kellee Mc Crory
Iowa Center for Evaluation Research
National Resource Center for Family-Centered Practice
University of Iowa, School of Social Work
Pastor Barry Thongvanh
Southeast Asian Community Christian Church
Renea Seagren
United Community Health Center
Michele Yehieli
Project EXPORT at the University of Northern Iowa
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 Background/Rationale for Project: According to the National Cancer Institute, research has
shown that people from underserved populations are more likely than the general U.S.
population to be diagnosed and die from preventable cancers. Underserved populations are also
less likely to receive treatment that meets currently accepted standards of care. The Iowa
Consortium for Comprehensive Cancer Control (ICCCC) is committed to eliminating these
disparities. With these facts in mind, the ICCCC funded a project to assess the awareness of
cancer and perceived need for cancer education and services in two disparate communities in
Iowa. This project, Community Conversations on Cancer, addresses a specific strategy within
the state’s Comprehensive Cancer Control Plan:
Decrease language and cultural belief-related barriers that prevent individuals from
accessing early detection screening services. This can be accomplished by increasing the
ability of health care providers to deliver care that is sensitive to various belief systems
and that is understood in the many languages spoken by the increasingly diverse Iowa
population. (Goal #2, Problem #2)
This assessment gathered baseline information on each community’s awareness of cancer
and perceived needs through a series of facilitated conversations. The project team worked with
local partners to develop questions, recruit participants, and organize meeting logistics. This
community-based approach engaged community members, employed local knowledge in the
understanding of health problems, and created new partnerships in the communities served. The
development of relationships within these communities will increase communication, improve
intervention strategies, and in the end lead to better health outcomes to reduce cancer health
disparities.
 Community Information: The community that was selected for this project was Storm Lake,
a small town of about 10,000 people in northwest Iowa (US Census). This community and the
county in which it resides, Buena Vista, has unique aspects that led to its selection as the
intervention site. First, it has a relatively high percentage of minority racial and ethnic
populations, in particular the Tai Dam/Lao and Hispanic communities. Secondly, it is
considered a rural county, with only 35 people per square mile. It is also a county with a high
poverty rate and low educational attainment in comparison to the rest of the state, with 11% of
the community below the poverty line and 19% of adults without a high school diploma
(Northwest Area Foundation). Additionally, it is designated as a Medically Underserved Area,
with only 0.65 physicians per 1,000 people (Northwest Area Foundation). These figures are
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evidence of major barriers to health and are often considered the roots of healthcare disparities.
Indeed, data from the National Cancer Institute shows that there are differences in incidence and
death due to cancer for this county. For example, the county’s death rate from colorectal cancer
is higher than the state rate; the incidence of 34.6 per 100,000 is the highest in the state.
The Tai Dam Community in Storm Lake: The Tai Dam reside in Laos, Thailand, Burma, and
North Vietnam as well as along the valley of the Himalayan Mountains and southern China.
Historically, the Tai Dam’s origins are in China. In 1250 BC, invasions by the Mongols under
Kubila Khan destroyed their kingdom known as Nan Chao.
More recently, the Tai Dam people come from the northwest part of North Vietnam. In 1952,
political tensions increased as the French with whom they were aligned began to lose their
colonies. This forced families of the Tai Dam government and military officials to evacuate from
their homeland. This was the start of a 20-year journey through refugee camps in South Vietnam,
Laos, or Thailand before the Tai Dam fled to Europe, Australia, and Iowa. In 1975, under the
leadership of former Governor Robert Ray, the state of Iowa undertook a state initiative to accept
this ethnic refugee group from the Vietnam War. Consequently, 95 percent of Tai Dam in the
United States live in Iowa.
There were two Community Conversations conducted in the Tai Dam community—one male
group and one female group. The two groups were separated in order to provide a comfortable
setting in which to discuss health topics. There were six participants in the male group and seven
participants in the female group. The average age of the men was 52, with the youngest at 38
and the oldest at 68. The female group was a younger group - the average age was 37.
However, there was one female participant who was 65. Overall, most worked in the meat
packing plant in Storm Lake and had limited education. Yet, there were some exceptions; one
male participant explained that he had a graduate degree in Laos and taught at a university there.
The men and women had been in Iowa for an average of 14.5 years. Please see the attached
spreadsheets for further information.
The Hispanic Community in Storm Lake: Buena Vista County has the highest percentage of
Hispanics by population in the state, with 17.9% of its total population considered Hispanic (US
Census). Until 1992, Mexican/Latino migration was minimal; however, local meatpacking
plants increased recruitment efforts in the mid-1990s and the Hispanic population grew 1500%
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from 1990-2000 (Project EXPORT). According to local estimates by the Storm Lake schools,
Latinos make up 40% of the population and nearly 63% of public school enrollment.
There were two Community Conversations conducted in the Hispanic community of Storm
Lake. These groups were separated by gender with twelve men and twelve women participating
in the groups. The country of origin for majority of participants was Mexico (82%) but there
were two from El Salvador and two from Honduras. Most considered themselves as “poor” and
worked in production/factory jobs or in housekeeping. Age was not asked, but the men had been
in Iowa for an average of 10 years and the women an average of 6 years. Slightly less than half
of the participants had more than an elementary level of education. See attached sheets for more
information.
 Results:
Tai Dam Groups
Culturally Specific Barriers and Issues
- Cancer rates in their ethnic group, especially with liver cancer
- Lack of materials in Laotian or Tai Dam languages
- Cancer risks due to conditions in Laos, refugee camps. They included exposure to
Yellow Rain ( A chemical/toxic substance heavily, most commonly ‘air dropped’
used in the country of Laos and other disputed areas of Southeast Asia by the United
States against the Viet Kong. Unfortunately, many innocent civilians included women
and children and even American allies were subject to exposure. Exposure led to
death or adverse life-long health effects for those whom were exposed.) Another
major concern mentioned by participants was poor hygiene in the camps.
- Tobacco use in Laos seemed to be a healthy habit to some since it was widespread
- Patient advocacy issues, not wanting to call healthcare provider’s authority into
question even if felt they lost trust him/her or feel he/she does not listen
- Concerns over liver diseases, medication use (aspirins) and cancer—what causes
damage, can you prevent cancer from occurring?
Gender Specific Barriers and Issues
- Women’s modesty issues and aversion to discussing “female issues” with a male
health care provider
- Basic health literacy questions concerning many conditions (women’s health,
diabetes, cardiovascular health)
- Women were concerned about personal relationships and how they change based on
cancer experience
General/Overarching Barriers & Issues
- Frustration with navigating healthcare system in an underserved community,
especially getting specialist care
- Inability to get test results/biopsies quickly—anxiety produced
- Cost/benefit to screening if there is no money to pay for treatment
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- Anxiety over knowing if you have cancer—how can you tell for sure? It often
seemed “too late” to some participants by the time others found out.
- Environmental causes of cancer—workplace issues (especially ammonia and other
chemicals used at meat packing plant), pollution
- Sense of inevitability of cancer due to family history, “death sentence”
- Lifestyle & causes of cancer
Hispanic Groups:
Culturally Specific Barriers and Issues
- Concern/anxiety over undocumented status, inability to receive care
- Language, inability to find materials at an appropriate reading level (pamphlets were
often written at too high of a reading level). This was the case regardless of the
materials were in English or their primary language.
- There seemed to be a higher awareness and familiarity with cancer among this group
- Skin blemishes and skin cancer/melanoma were a particular concern
- Cancer prevention and moderating lifestyle factors was an issue (especially eating
fried foods, red meat)
- Some mentioned their desire to return to Mexico to receive treatment, however,
others said the treatment options were better here (due to better technology). One
participant mentioned that all of their celebrities come to the US to get healthcare.
- There were many positive comments about the United Community Health Clinic and
its care
- Smoking projects in this community seem to have made a large impact; there were
several comments about quitting smoking, having a smoke-free environment
- Hispanics mentioned that they like pictures or visuals to tell the message
- Hispanics are more likely to react positively to ‘scare tactics than is the mainstream
population. This is substantiated in various studies in Minnesota and California
surrounding the topic of tobacco.
Gender Specific Barriers and Issues
- Women seem to have higher baseline health knowledge; however, sometimes this
was incorrect/confused information
- Men complained that while there is much information on women’s cancer screening
tests (Pap, mammogram) there is little information for men
- Discomfort with mammography, pain with rectal exams
General/Overarching Barriers & Issues
- Paying for treatment as a cancer patient (especially prostate cancer) when you have
no insurance
- Getting a second opinion, getting enough time with your physician
- How do you “know” you have cancer, anxiety about having cancer and not being
aware of it
- Concern with recurrence
- Concern over “mistakes” and being told they have cancer mistakenly
- Navigating healthcare services in an underserved community
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- Environmental causes of cancer—housekeeping chemicals, chemicals at meat
packing plant
- People who “feel healthy” don’t see the benefit of getting checked, esp. since it costs
money and is uncomfortable
 Partnerships Developed: Through contacts in the Iowa Department of Public Health’s Office
of Multicultural Health, the project team identified key contacts in the Storm Lake community
and contacted them to solicit their support for the project. In particular, two organizations were
instrumental in their assistance with this project. The United Community Health Center
(UCHC), a federally-funded Community Health Clinic in Storm Lake, offered help with the
Hispanic community conversations. The Executive Director, Renea Seagren, was enthusiastic
about this project and gave her full support. Staff from the UCHC provided technical assistance,
meeting space, food for the meeting, an interpreter, and advertisements for the sessions, as well
as facilitating communications with three churches that primarily serve Hispanics, [Iglesia
Cuadrangular Centro de Vida, St. Mary’s Catholic Church and Assembly of God Church]. A
representative from each church helped recruit participants for the conversations and provided a
note-taker for each session. The United Community Health Clinic is very interested in
partnering with the ICCCC for future projects.
The Southeast Asian Community Christian Church in Storm Lake, and in particular Pastor
Barry Thongvanh, was essential in the organization of the Tai Dam community conversations.
Pastor Thongvanh is a Commissioner on the Governor’s Commission on the Status of Asian and
Pacific Islanders (CAPI) and is a leader in his community. He assisted with the project by
recruiting participants, translating forms, interpreting and facilitating the conversations,
arranging for a note-taker, offering meeting space and food, and providing his input on questions
and topics for discussion. Pastor Thongvanh is also interested in future partnerships.
 Recommendations:

Provide health information that is accessible and appropriate for the population. These
characteristics are especially important:
- In their preferred language (especially Laotian)
- At an appropriate reading level (especially Spanish language materials)
- Culturally appropriate
- Available at convenient locations (churches, schools, newspapers, Laundromats,
stores, worksites)
- Delivered by an “information broker” (key people in the community are seen as
“go-tos” for health information)
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
Train key contacts in the community about basic cancer information and available
resources. Ensure that “information brokers” in the community are up to date with
accurate cancer information and are not spreading incorrect and/or faulty information.

Organize a “Resource Fair” to introduce cancer education and resources to these
populations, with the focus on prevention, screening, and treatment

Educate physicians about these findings, help improve communication between
provider and patient

Encourage culturally competent health care delivery—i.e. in native language, with a
provider they feel comfortable with (shortage of female providers), enough time to
discuss health concerns, accessible at convenient times, allowing for family interaction.

Encourage and provide support to individuals from underserved communities so they
will participate on cancer committees at both the local and state level.

Provide underserved communities with updates using strategies, which will effectively
reach their communities.

Communicate findings surrounding preference of female health providers by some
minority females to the various health organizations providing services in the
community (i.e. health plans, St. Luke’s Methodist Hospital and others.)

There is some evidence certain behaviors including tobacco usage and seat belt usage
have been positively impacted by providing information to children in schools. Children
share information with their parents. This potentially could be a way to provide
information to the community. (This was suggested by several of the Hispanic
community conversations participants.)

Use faith communities and worksites as places to provide information and initiate
campaigns for the Tai Dam/Lao and Hispanic communities

Promote ongoing campaigns that return to the community often and sustain ties. Oneshot efforts will fall flat—an investment in a lasting relationship with the community
and its people will be more successful.

Provide basic health literacy and encourage patient advocacy to help community
members become an active member of their health care team. Help community
members to understand they can have a second opinion and they can change providers if
they lose trust in their providers.

Connect with other programs (Diabetes, Cardiovascular, etc) to provide health literacy
information in languages preferred by these communities
 Evaluation/Lessons Learned:

Background Research: It was important to select the best community for the
intervention, given that we had limited funds and time for the project. This was
accomplished through careful research into communities across Iowa as well as
conversations with experts in the field. Since few studies have been done in this area
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focusing on our target populations, informal discussions with people who work with
these populations was our best source of information for the project.

Community Partnerships: This project hinged on community involvement. In order to
gain access to the target population, it was important to approach organizations that
those populations trust. Without the participation of key community organizations such
as the United Community Health Clinic and churches like the Southeast Asian
Community Christian Church, this project would have been more difficult. Their
involvement early on helped assure that the questions used were appropriate and the
setting was convenient and comfortable. Additionally, the community partners helped
plan logistics for the event and provided connections to translators and note takers.

Testing Materials: Due to time constraints, there was not an opportunity to try the
questions and data collection sheets on a test audience. In future projects, it would be
beneficial to build this into the project design. Also, the script used for the
conversations was somewhat restrictive, since there were so many questions. In future,
it would be better to use a more flexible guide that allows discussion to flow naturally.
Again, this approach could be tested if it is built into the project design at the outset.

Sharing Materials: Since this was a project focused on gathering information and
opinions from our target audience, the project team was not prepared to share a lot of
information with the participants. However, the participants desired a lot of information
and resources that the project team was not prepared to supply immediately.
Unfortunately, this is due to the fact that many of these materials are not currently
available (especially in languages other than English). Outcomes from this project will
hopefully develop those materials, which can be shared back with the communities
targeted in this project. Also, naming a concrete date when the project team will return
with those materials and/or ideas for future projects would be beneficial. Sharing this
concrete information will go a long way towards building trust with the community.

Capturing and Analyzing Data: Due to time and funding constraints, it was difficult to
analyze the information collected by the project. There are not a lot of resources to help
translate and transcribe the materials, especially in Lao.
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