Circle Of Life Initiative: The use of community health representatives to address cancer disparities in American Indians and Alaska Natives through cancer education and wellness across the lifespan

More than 4 million American Indians and Alaska Natives (AIAN) reside in the United States, representing more than 500 tribes. Cancer is the second leading cause of death among AIAN's over age 45. A wealth of evidence exists regarding the efficacy of health information delivered by community health representatives (CHRs). The Circle Of Life (COL) utilizes existing CHRs employed by tribes and the Indian Health Service. The COL Initiative provides CHRs with a culturally appropriate and comprehensive cancer education curriculum and resources. The curriculum begins with prevention and spans the cancer continuum to end of life issues.

The COL has been shared in 30 communities across the nation over the course of two years. CHRs are a proven and culturally appropriate mechanism for addressing the diverse cancer needs of AIAN communities at the local level. The COL has been delivered to various audiences including youth, elders and adults. Initial analysis has shown that, while COL materials focus on adults over 40, through AIAN beliefs and traditions, it can be successful in diverse populations regardless of age. The initiative's success stems from the adaptability of the curriculum and resources.