Culturally responsive approaches to health promotion for Native Hawaiians and Pacific Islanders

Disparities in Stage at Presentation for Disaggregated Asian American, Native Hawaiian, and Pacific Islander Patients with Breast Cancer

INTRODUCTION

Cancer is the leading cause of death among Asian American, Native Hawaiian, and Pacific Islander (AA&NHPI) populations, who are among the most diverse and rapidly growing racial/ethnic groups in the United States. Despite this population's diverse socioeconomic, cultural, and immigration backgrounds, little is known about the within-group disparities in breast cancer stages at diagnosis. This study aims to identify AA&NHPI subgroups at heightened risk for advanced breast cancer by analyzing detailed incidence rates and diagnostic stages across these diverse subgroups.

METHODS

Patient data spanning from 2004 to 2020 were extracted from the National Cancer Database, focusing on individuals newly diagnosed with breast cancer. Individuals were disaggregated into specific AA&NHPI subgroups by self-reported country of origin. Ordinal logistic regression, adjusting for clinical and sociodemographic factors, was used to calculate adjusted odds ratios (AORs). Higher adjusted odds ratios signify more advanced stage diagnoses.

RESULTS

Of 3,001,173 patients with breast cancer, 99,128 (3.30%) identified as AA&NHPI. Compared with NHW patients, AA&NHPI patients were younger (median age, NHW: 62 years versus AA&NHPI: 57 years, p < 0.001) and more likely to be uninsured (NHW: 1.50% vs. AA&NHPI: 2.60%, p < 0.001). The largest AA&NHPI subgroups were Filipino (n = 21,666, 21.9% of AA&NHPI), Chinese (n = 21,303, 21.5%), Indian/Pakistani (n = 20,295, 20.5%), Vietnamese (n = 6680, 6.74%), and Korean (n = 7776, 7.84%). In aggregate, AA&NHPI patients were less likely to present with advanced stage at diagnosis relative to NHW patients (AOR 0.89, 95% confidence interval [CI] 0.88-0.90, p < 0.001). However, AA&NHPI disaggregation demonstrated that Hawaiian (AOR 1.15, 95% CI 1.09-1.22, p < 0.001), Hmong (AOR 1.70, 95% CI 1.28-2.27, p < 0.001), Laotian (AOR 1.37, 95% CI 1.17-1.61, p < 0.001), and Pacific Islander patients (AOR 1.24, 95% CI 1.17-1.32, p < 0.001) were more likely to present at a more advanced stage relative to NHW patients. Relative to Chinese Americans (the reference AA&NHPI group), all AA&NHPI ethnic groups had higher odds of advanced-stage diagnosis with the highest odds in Hmong (AOR 2.41, 95% CI 1.81-3.20, p < 0.001), Laotian (AOR 1.89, 95% CI 1.61-2.20, p < 0.001), Pacific Islander (AOR 1.71, 95% CI 1.60-1.82, p < 0.001), and Hawaiian (AOR 1.57, 95% CI 1.48-1.67, p < 0.001) patients.

CONCLUSIONS

Our study characterizes disparities in the stage of breast cancer at presentation across disaggregated AA&NHPI groups, with notably advanced diagnoses in patients of Hmong, Laotian, Pacific Islander, Hawaiian, and Kampuchean descent. These findings underscore the need for disaggregated research exploring both risk factors and barriers to early diagnosis, as well as culturally tailored interventions that involve community leaders and leverage cultural norms to improve cancer screening and diagnosis.

A Randomized Clinical Trial of a Culturally Tailored Diabetes Education Curriculum With and Without Real-Time Continuous Glucose Monitoring in a Latino Population With Type 2 Diabetes: The CUT-DM With Continuous Glucose Monitoring Study

BACKGROUND

Data on culturally tailored diabetes education with and without real-time continuous glucose monitoring (RT-CGM) in Latinos with type 2 diabetes, who are not on intensive insulin management, is lacking.

RESEARCH DESIGN AND METHODS

This is an open-label randomized control trial of Latinos with uncontrolled (HbA1c > 8.0%) type 2 diabetes conducted in a Federally Qualified Health Center (FQHC). All participants received 12 one-hour culturally tailored education sessions. Patients were randomized (1:1) to education sessions only (blinded CGM) or cyclic (50 days wear: 10 days on, 7 days off) RT-CGM. The primary outcome was a change in HbA1c from baseline to 12 weeks in those with or without CGM. Secondary outcomes included 24-week HbA1c, CGM, and metabolic parameters.

RESULTS

Participants (n = 120) were 46 years old on average, 44% female, 98% preferred Spanish language, 30% with income <$25,000, 68% uninsured and 26% using basal insulin only. Mean 1-hour session attendance and RT-CGM wear was 7.0 (±4.4) and 27.9 (±20.5) days, respectively. Mean baseline HbA1c was 10.5% (±1.8). HbA1c reduced by 1.9% (95% confidence interval [CI]: 1.5-2.3) overall (P < .001). Participants in the RT-CGM group reduced HbA1c at 12 weeks by 2.3% (95% CI: 1.5-3.2) compared to 1.5% (95% CI: 0.6-2.3) in the blinded CGM group (P =.04). At 24 weeks, overall HbA1c reduction was maintained but between-group differences attenuated.

CONCLUSIONS

In a Latino type 2 diabetes population that was primarily noninsulin-requiring, virtually delivered, culturally tailored education improved HbA1c, with RT-CGM conferring greater improvement. RT-CGM should be an adjunctive therapy to diabetes education, irrespective of insulin use but continued cyclic CGM use may be needed for sustained effect.

Love and Tradition of the Grand Design: Exploring Culturally Responsive Qualitative Methods With Intergenerational and Intercultural Teams and Participants

In this reflective article, our research team discusses the lessons, tools, and experiences we gained while conducting culturally responsive qualitative research (CRQR) in the Deep US South. According to researchers, CRQR is a research methodology that includes qualitative designs and centers culture. With CRQR in mind, our team takes a look at four different research projects and a graduate class service-learning trip to explore the impacts of qualitative health research on both the participants and the researchers. Moreover, our intercultural team, which is composed of intergenerational researchers, discusses how to conduct research with participants living in the culturally rich, politically diverse, historically complex region of Gulf South. From the rural communities in North Louisiana to the capital city of Baton Rouge to Cancer Alley near our beloved New Orleans, we identified several tools and lessons we gathered at each pedagogical site. We share those lessons as storied data for other emerging researchers in the field.

Decision-Making Regarding Elective Child and Adolescent Vaccinations Among Native Hawaiian and Pacific Islander Parents in Orange County

Native Hawaiians and Pacific Islanders (NHPIs) in aggregate experience greater health burdens than non-Hispanic Whites, such as a higher incidence of cervical cancer and COVID-19. Given the importance of vaccinations in preventing and reducing the severity of diseases, such as the flu, cervical cancer, and COVID-19, the receipt of vaccines during childhood and adolescence is crucial. Therefore, this qualitative study aimed to explore the factors associated with NHPI parents' decisions regarding vaccinating their children with these elective vaccinations-that is, vaccinations not required for child care, preschool, or K-12 admissions in California but highly recommended. A total of 15 NHPI parents were recruited through a community-based organization. Semi-structured interviews explored parents' reasons for accepting or denying each vaccine for their child(ren). Results demonstrated variable acceptance of each vaccine, though consistent themes included protection and concerns over side effects. This study also found two general types of parents-those who treat vaccines the same and those with varying opinions about each vaccine. Results from this study demonstrate the family- and community-oriented nature of NHPI communities, suggesting that future interventions target not only parents but also their families and communities to cultivate vaccine acceptance through social networks. Furthermore, addressing all three vaccines during well-child visits may benefit parents who view each vaccine as separate entities with individual pros and cons. Such interventions could contribute toward reducing the burdens of particularly chronic health disparities.

Family model diabetes self-management education and support in faith-based organizations in the Republic of the Marshall Islands: A study protocol

INTRODUCTION

The Republic of the Marshall Islands (RMI) is an independent nation and a member of the United States (US) Affiliated Pacific Islands through a Compact of Free Association. Health disparities in the RMI are striking, with high rates of type 2 diabetes mellitus (T2DM). The International Diabetes Federation has documented age-adjusted prevalence of T2DM at 23.0 %, compared to the US (13.2 %) and globally (9.8 %). T2DM has a devastating impact on patients and their families.

METHODS

The purpose of this article is to present the study protocol for the fully powered two-arm cluster randomized controlled trial using a wait-list control to evaluate the effectiveness of a Family Diabetes Self-Management Education and Support (Family DSMES) program when delivered in a group setting by community health workers (CHWs) in faith-based organizations (FBOs) in the RMI. The study used a community engaged approach, and the study protocol includes adaptations based on the results of our one-arm pilot study.

SUMMARY

This study will provide new and innovative information on the effectiveness of Family DSMES delivered in a group setting by CHWs in FBOs in the RMI. The knowledge gained from this research will inform DSMES interventions conducted with Marshallese and other Pacific Islander communities, as well as DSMES interventions conducted in other low-resource countries.

Cardiovascular Disease Mortality Among Native Hawaiian and Pacific Islander Adults Aged 35 Years or Older, 2018 to 2022

BACKGROUND

Native Hawaiian and Pacific Islander (NHPI) adults have historically been grouped with Asian adults in U.S. mortality surveillance. Starting in 2018, the 1997 race and ethnicity standards from the U.S. Office of Management and Budget were adopted by all states on death certificates, enabling national-level estimates of cardiovascular disease (CVD) mortality for NHPI adults independent of Asian adults.

OBJECTIVE

To describe CVD mortality among NHPI adults.

DESIGN

Race-stratified age-standardized mortality rates (ASMRs) and rate ratios were calculated using final mortality data from the National Vital Statistics System for 2018 to 2022.

SETTING

Fifty states and the District of Columbia.

PARTICIPANTS

Adults aged 35 years or older at the time of death.

MEASUREMENTS

CVD deaths were identified from International Classification of Diseases, 10th Revision codes indicating CVD (I00 to I99) as the underlying cause of death.

RESULTS

From 2018 to 2022, 10 870 CVD deaths (72.6% from heart disease; 19.0% from cerebrovascular disease) occurred among NHPI adults. The CVD ASMR for NHPI adults (369.6 deaths per 100 000 persons [95% CI, 362.4 to 376.7]) was 1.5 times higher than for Asian adults (243.9 deaths per 100 000 persons [CI, 242.6 to 245.2]). The CVD ASMR for NHPI adults was the third highest in the country, after Black adults (558.8 deaths per 100 000 persons [CI, 557.4 to 560.3]) and White adults (423.6 deaths per 100 000 persons [CI, 423.2 to 424.1]).

LIMITATION

Potential misclassification of underlying cause of death or race group.

CONCLUSION

NHPI adults have a high rate of CVD mortality, which was previously masked by aggregation of the NHPI population with the Asian population. The results of this study support the need for continued disaggregation of the NHPI population in public health research and surveillance to identify opportunities for intervention.

PRIMARY FUNDING SOURCE

National Institute of General Medical Sciences, National Institutes of Health.

Representation of Native Hawaiian and Pacific Islander Individuals in Clinical Trials

Importance

Having diverse participants in clinical trials ensures new drug products work well across different demographic groups, making health care safer and more effective for everyone. Information on the extent of Native Hawaiian and Pacific Islander participation in clinical trials is limited.

Objective

To examine representation of Native Hawaiian and Pacific Islanders in clinical trials leading to the first US Food and Drug Administration (FDA) approvals for the 10 drug products with the top worldwide sales forecasts in 2024.

Design, Setting, and Participants

Cross-sectional secondary analysis of existing data from clinical trials that took place from 2006 to 2021 in the US. All clinical trials that were included in the FDA first approval application for the 10 drug products were evaluated in this study. Data were analyzed from February to August 2024.

Exposure

Participation in a clinical drug trial.

Main Outcomes and Measures

Comparison of the proportion of Native Hawaiian and Pacific Islander participation in clinical trials for the 10 drug products with top sales forecasts in 2024 to the Native Hawaiian and Pacific Islander population proportion.

Results

In this cross-sectional study of 139 062 individuals, Native Hawaiian and Pacific Islander participation in clinical trials for the 10 drug products with top sales forecasts was either unknown or low. For 6 of the 10 drug products (60%), the number of Native Hawaiian and Pacific Islander participants was not documented. All trials that reported Native Hawaiian and Pacific Islander participation had fewer Native Hawaiian and Pacific Islander participants than would be expected based on their US population proportion, with 2 of the differences being statistically significant. Of the trials that disaggregated Native Hawaiian and Pacific Islander participants from other racial groups, the number of Native Hawaiian and Pacific Islander participants was 8 for risankizumab-rzaa (0.38% of participants vs 0.49% of the population; percentage point difference, -0.11%; 95% CI, -0.37% to -0.15%), 7 for bictegravir/emtricitabine/tenofovir alafenamide (0.38% of participants vs 0.49% of the population; percentage point difference, -0.10%; 95% CI, -0.39% to 0.18%), 27 for 4vHPV/9vHPV (0.15% of participants vs 0.46% of the population; percentage point difference, -0.31%; 95% CI, -0.37% to -0.26%), and 90 for BNT162B2 COVID-19 vaccine (0.20% of participants vs 0.52% of the population; percentage point difference, -0.32; 95% CI, -0.36% to -0.27%).

Conclusions and Relevance

In this cross-sectional study, limited documentation and participation of Native Hawaiian and Pacific Islander individuals in clinical trials for drug products with top sales forecasts was found. This is especially concerning because Native Hawaiian and Pacific Islander individuals have a higher risk than other racial groups for type 2 diabetes, cancer, and several other conditions the products examined in this study treat. Given the importance of enrolling Native Hawaiian and Pacific Islander participants in clinical trials, sites should be established in key geographic regions, such as Hawai'i, and postmarket studies should be conducted within Native Hawaiian and Pacific Islander populations.

Mosques and Public Health Promotion: A Scoping Review of Faith-Driven Health Interventions

BACKGROUND

Religious institutions play a crucial role in health promotion and hold significant influence in the public health field.

AIM

The aim of this review is to examine outcomes of health-promoting interventions involving the use of mosques as the intervention venue, its role in promoting health behavior change, and the role of theory in each intervention.

METHODS

A scoping review was conducted across 17 databases for relevant publications published up to and including August 2023 that involved the use of mosques as the intervention venue. Fourteen articles met inclusion criteria and were reviewed.

RESULTS

The studies featured a wide range of interventions. However, only eight of these studies integrated theoretical frameworks into their approaches, indicating a need for more structured guidance in this field. These theoretical frameworks included Participatory Action Research (PAR), the theory of planned behavior, behavior-change constructs, the patient-centered outcomes research (PCOR) framework, and prolonged exposure techniques within Islamic principles. The review identified three main health-focused intervention categories: mental health, prevention, and communication, each providing valuable insights into initiatives within Muslim communities.

CONCLUSIONS

This review underscores the significance of inclusive and culturally sensitive health interventions, emphasizing the effectiveness of faith-based approaches in improving health outcomes, promoting positive health behaviors, and addressing communication and cultural barriers. The reviews findings stress the need for further research that incorporates theoretical frameworks and tailored interventions to meet the specific cultural needs of these communities, ultimately contributing to enhanced well-being within them.

Assessing the acceptability of a culturally adapted group-based pediatric intervention, Kokajjiriri, for Marshallese mothers and infants to improve nutrition and prevent childhood obesity

BACKGROUND

Marshallese Pacific Islanders experience higher rates of obesity than other racial and/or ethnic communities. Despite the obesity rates experienced in this community, there are currently no childhood obesity prevention interventions designed for Marshallese Pacific Islanders in the United States. The purpose of this study is to assess the acceptability and feasibility of a culturally adapted group-based pediatric intervention, Kokajjiriri, with Marshallese mothers to improve nutrition and reduce childhood obesity.

METHODS

A multi-methods design was used to culturally adapt the Kokajjiriri intervention for Marshallese mothers in Arkansas (n = 17). In phase one, we conducted 24-h dietary recalls with 20 Marshallese mothers to inform the cultural adaptation of the group-based pediatric intervention, and then in phase two, we culturally adapted and piloted three sessions of the intervention to determine the acceptability and feasibility of the intervention.

RESULTS

Participants found the adapted intervention to be acceptable and feasible, found the location to be convenient and found the facilitator to be knowledgeable. Four themes emerged from the qualitative data: (1) Lactation Support; (2) Introducing Healthy Solids; (3) Rice Portion Control; and (4) Finding Resources.

CONCLUSIONS

This is the first study to assess the acceptability and feasibility of a culturally adapted group-based pediatric intervention, Kokajjiriri, with Marshallese mothers to improve nutrition and reduce childhood obesity. The results from this culturally adapted group-based pediatric intervention, Kokajjiriri, will be used to inform future adaptations and implementation of the full intervention for Marshallese women and children.

Physical Pain Among Urban Native American Emerging Adults: Sociocultural Risk and Protective Factors

OBJECTIVE

American Indian/Alaska Native (AI/AN) people have high rates of physical pain. Pain is understudied in urban-dwelling, AI/AN emerging adults, a group with unique sociocultural risk and protective factors. We explore associations between socioeconomic disadvantage, additional sociocultural factors, and pain among urban AI/AN emerging adults.

METHODS

AI/AN participants aged 18-25 years ( N = 417) were recruited via social media. Regression models tested associations between socioeconomic disadvantage (income and ability to afford health care) and pain as well as additional sociocultural factors (discrimination, historical loss, cultural pride and belonging, visiting tribal lands) and pain. Multigroup regression models tested whether associations between sociocultural factors and pain differed between participants who were socioeconomically disadvantaged and those who were less disadvantaged.

RESULTS

In the full sample, lower income ( b = 1.00-1.48, p < .05), inability to afford health care ( b = 1.00, p = .011), discrimination ( b = 0.12, p = .001), and historical loss ( b = 0.24, p = .006) were positively associated with pain, whereas visiting tribal lands was negatively associated with pain ( b = -0.86 to -0.42, p < .05). In the multigroup model, visiting tribal lands 31+ days was negatively associated with pain only among the less socioeconomically disadvantaged group ( b = -1.48, p < .001).

CONCLUSIONS

Socioeconomic disadvantage may, in part, drive pain disparities among AI/AN emerging adults and act as a barrier to benefitting from visiting tribal lands. Results support a biopsychosocial approach to targeting pain in this population, including addressing socioeconomic challenges and developing culturally informed, strengths-based interventions.

Lessons from the COVID-19 Pandemic: Promoting Vaccination and Public Health Resilience, a Narrative Review

The COVID-19 pandemic has underscored the critical importance of adaptable and resilient public health systems capable of rapid response to emerging health crises. This paper synthesizes the lessons learned from the COVID-19 vaccination campaign and explores strategies to enhance vaccine uptake in the post-pandemic era. Key challenges identified include logistical, economic, sociocultural, and policy dimensions that impact vaccination efforts, particularly in low-resource settings. The analysis highlights the need for resilient supply chains, effective communication, community engagement, and equitable access to healthcare resources. The rapid development and deployment of mRNA vaccines exemplify the potential of innovative vaccine technologies, though public trust and acceptance remain crucial. Strategies such as partnerships with local leaders, tailored messaging, and integration of digital tools are essential for combating vaccine hesitancy. By applying these insights, future vaccination campaigns can be more efficient, equitable, and resilient, ultimately improving public health outcomes globally. This paper aims to inform policy and practice, ensuring that public health strategies are evidence based and context specific, thus better preparing for future health challenges.

Nā Kānaka Maoli ma nā 'Āina 'Ē: Exploring Place of Residency as a Native Hawaiian Health Predictor During the COVID-19 Pandemic

Little is known about the impacts of living in diaspora from the Hawaiian Islands on Native Hawaiian health. To address this, the authors conducted an exploratory analysis using cross-sectional data from the 2021 Native American COVID-19 Alliance Needs Assessment. A total of 1418 participants identified as Native Hawaiian (alone or in any combination), of which 1222 reported residency in the continental US and 196 in Hawai'i. Residency status in the continental US vs Hawai'i was evaluated as a predictor of survey outcomes using likelihood ratio tests on linear and logistic regression models for linear and binary outcomes, respectively. Results showed that NH residency in the continental US was significantly associated with increased odds of reporting fair or poor self-rated health; increased odds for screening positive for anxiety, depression, and suicidality; and increased odds of health insurance loss (P's < .05). Residency in the continent was also associated with lower odds of reporting a diagnosed chronic health condition (P < .05). Residency in the continental US had no observed effect on the odds that participants engaged cultural activities or cultural coping strategies. These results support the role of place of residency as an important Native Hawaiian health predictor during and beyond the COVID-19 pandemic.

A psychometric analysis of the adapted historical loss scale and historical loss associated symptoms scale among native Hawaiian adults

Objectives

The Historical Loss Scale (HLS) and Historical Loss Associated Symptoms Scale (HLASS) are standardized measures that have been accepted and previously validated among North American Indigenous communities and allow researchers to measure the impact of Historical Loss. Evidence of the psychometric properties of this instrument have not been assessed for Native Hawaiians, the Indigenous peoples of Hawai'i. The purpose of this study is to investigate the psychometric properties of the adapted HLS (aHLS) and HLASS for adults from multiple Hawaiian Homestead Communities throughout Hawai'i.

Methods

Data are based on cross-sectional surveys administered between 2014 and 2020. The final sample included 491 Native Hawaiian adults who were predominantly female (67.3%) and between the ages of 18-90 years, who were part of the larger study entitled the Hawaiian Homestead Health Survey. Factor analyses were conducted to determine the final model structures of each scale. Reliability and correlation matrices of items are also reported.

Results

The final factor structure of the aHLS model suggested 3 factors: (1) General loss of culture or cultural loss, (2) Intergenerational loss, and (3) Distrust and destruction of traditional foods. The final HLASS model also suggested 3 factors: (1) Depression and Anger, (2) Shame and Anxiety, and (3) Re-experiencing, fear, and avoidance.

Conclusion

These findings have implications for future research, practice, and education that explores the role of Historical Loss and associated symptoms in Native Hawaiians and Indigenous communities at large. In particular, measuring historical loss and associated symptoms in Hawaiian Homestead communities paves the way for quantitative assessments of historical trauma and healing in these communities.

Electronic health record reveals community-level cardiometabolic health benefits associated with 10 years of community-based participatory research

BACKGROUND

While a major goal of community-based participatory research (CBPR) is to improve community health; it is unclear how to measure longstanding success of CBPR.

OBJECTIVE

We sought to determine the impact of ongoing CBPR on cardiometabolic health of participating communities, including in people not directly participating in research.

METHODS

We used linear mixed-effects modelling with electronic medical records from 2002 to 2012 from the Yukon-Kuskokwim Health Corporation, which provides health care to all Alaska Native people in southwestern Alaska, to compare rates of change in cardiometabolic risk factors between communities that did and did not participate in ongoing CBPR beginning in 2003.

RESULTS

We analysed 1,262,035 medical records from 12,402 individuals from 10 study and 38 control communities. Blood pressure declined faster in study than in control communities: systolic blood pressure (0.04 mmHg/year; 95% confidence interval [CI]: 0.01, 0.08); diastolic blood pressure (DBP) (0.07 mmHg/year; 95% CI: 0.04, 0.09). Body mass index increased 0.04 units/year faster in study communities than in control communities (95% CI: 0.03, 0.05). More study visits were associated with faster reduction of DBP and triglyceride levels in study communities.

CONCLUSIONS

Ongoing CBPR may improve overall cardiometabolic health in communities, perhaps by increasing engagement in health and advocacy.

Work and self-rated memory among native Hawaiian and other Pacific Islander older adults

OBJECTIVES

Engagement in work has an important association with cognitive health in later life, yet little is known about this association among Native Hawaiian and other Pacific Islander (NHPI) older adults. This study assesses the associations between various work characteristics and memory problems among this population.

DESIGN

Using data from the 2014 Native Hawaiian and Pacific Islander National Health Interview Survey (NHPI NHIS), the research question was explored among those who were aged 50+.

RESULTS

Engagement in work, certain occupation types (e.g., clerical or professional occupations compared to blue-collar jobs), and the current/most recent job that is also the longest job held were associated with lower odds of having memory problems.

CONCLUSION

The study's results suggest that work characteristics and opportunities to engage in work are important considerations in preventing memory problems in later life. As the NHPI population experiences cognitive health disparities earlier than other groups, timely interventions that focus on work engagement and a culturally relevant environment require further investigation.

The Associations Between Health-Related Knowledge and Health Beliefs Regarding Risk for Gestational Diabetes in American Indian and Alaska Native Female Adolescents and Young Adults at Risk for Gestational Diabetes and Their Female Caregivers: A Cross-Sectional Dyadic Analysis

INTRODUCTION

Research on associations between knowledge and health beliefs for women at risk for gestational diabetes mellitus (GDM) has focused on adults at risk for or having GDM. Gaps also exist in examining interpersonal associations with family members or peers. We examined dyadic associations between knowledge and health beliefs about the risk for GDM between and within American Indian and Alaska Native (AIAN) female adolescents and young adults (FAYAs) at risk for GDM and their mothers or adult female caregivers (FCs).

METHODS

Grounded in the Expanded Health Belief Model, we employed a cross-sectional design using baseline data from 147 dyads of AIAN FAYAs at risk for GDM and their FCs who participated in the Stopping GDM in Daughters and Mothers trial. FAYAs were 12.0 to 24.5 years of age, and 89.1% were students. FCs had a mean (SD) age of 44.0 (9.3) years, 87.0% were AIAN, 44.9% were college educated, 19.7% had ever had GDM, and 81.0% were the FAYA's mother. FAYAs and FCs completed surveys about knowledge and health beliefs (benefits, barriers, severity, susceptibility) regarding GDM risk and prevention. Bivariate correlational analyses were performed to examine associations between and within dyad members. Dyadic associations were investigated using actor-partner interdependence modeling (APIM) assuming distinguishable dyad members.

RESULTS

Compared with their FCs, FAYAs had lower health-related knowledge and perceived benefits of GDM prevention and susceptibility regarding GDM risk. APIM revealed actor and partner effects of health-related knowledge on health beliefs for dyads. In particular, positive actor effects were found for FAYAs and FCs for GDM-related knowledge with perceived benefits (P < .001), and positive partner effects of GDM-related knowledge for FCs were related to perceived susceptibility and severity for FAYAs (P < .05).

DISCUSSION

As shown in these AIAN dyads, FAYAs and their FCs, as members of one another's social network, may influence each other's health beliefs regarding GDM risk and prevention.

O le tagata ma lona aiga, o le tagata ma lona fa'asinomaga (Every person belongs to a family and every family belongs to a person): Development of a parenting framework for adolescent mental wellbeing in American Samoa

American Samoan adolescents experience a high prevalence of mental health problems, including depression, anxiety, substance use, and suicidal thoughts and behaviors. To complement existing health system efforts, family-based interventions may be a feasible, cost-effective, and relevant opportunity to promote mental health. This community-partnered, qualitative study aimed to: (1) identify potential family-related psychosocial protective factors for adolescent mental health and (2) develop a framework for a parenting program to promote adolescent mental health in American Samoa. Applying the fa'afaletui framework developed for research in Samoan communities, which emphasizes the importance of weaving a range of community member perspectives to reach consensus, semi-structured in-depth interviews with adult key informants (n=28) were conducted between October 2020 and February 2021. Results were validated through five focus groups with Samoan adolescents (n=35) between May and June 2022. Adult participants were sampled for diversity in profession, age, gender, education, and region of residence; adolescent participants were sampled for diversity in gender. Participants were recruited using personal networks and snowball sampling; adolescent participants also responded to Facebook advertising. The semi-structured interviews focused on broad topics including common mental health problems, contributors to mental illness, and potential interventions, among others. Transcripts were coded in duplicate and analyzed using deductive thematic analysis. Themes were collaboratively mapped onto an adapted fonofale model, an existing framework for Pacific Island health research. Six themes described key practices: (1) provide emotional safety and security; (2) provide physical safety and security; (3) encourage sense of self; (4) strengthen intergenerational communication skills; (5) prioritize quality time; and (6) cultivate healthy coping strategies. Participants also expressed the importance of a supportive environment grounded in culture, family and community, and caregiver mental health. These results provide an initial step to identify family-focused factors that promote adolescent mental health in American Samoa and categorize them into a framework to inform intervention development. Drawing on a collaborative and community-partnered process, these findings provide the first evidence-based framework to develop a parenting program to promote adolescent mental wellbeing and resilience in Samoan communities.

Native Hawaiians' Views on Depression and Preferred Behavioral Health Treatments: a Preliminary Qualitative Investigation

Behavioral health issues, especially depression, are a major health disparity concern for Native Hawaiians in Hawai'i. Following the cultural safety framework and contextual behavioral science approach to intervention development, the present preliminary qualitative investigation aimed to gather better insight into Native Hawaiians' views of depression and its causes as well as their preferred forms of behavioral health services. Data were initially collected from a 2-hour virtual focus group with three behavioral health service providers working with Native Hawaiians, followed by a total of 38 online one-on-one in-depth interviews with Native Hawaiian clients with depression (n = 19), behavioral health service providers working with Native Hawaiian adults (n = 9), and Native Hawaiian cultural leaders (n = 10). Our qualitative data suggested that Native Hawaiians tend to view depression contextually and socioculturally as the manifestation of one's vital connection to the 'āina (land), 'ohana (family; continuity from ancestry and future generations), community, culture/spirituality, and one's authentic self being disrupted. Our findings also suggested that Native Hawaiians often attribute these disruptions to disparities due to the ongoing impact of colonization, historical trauma, and cultural loss. As a preferred form of treatment for depression, participants recommended various Hawaiian cultural practices to be integrated into existing behavioral health services to nurture the above-mentioned vital connection.

Providers' Perspectives of a Culturally Adapted CenteringPregnancy Intervention for Marshallese Women in Arkansas

OBJECTIVE

To explore health care providers' perspectives on the successes, challenges, and suggestions for future directions regarding the implementation of CenteringPregnancy for Marshallese women in Arkansas.

DESIGN

A descriptive qualitative design was used as an exploratory method.

SETTING/LOCAL PROBLEM

This study took place in northwest Arkansas. Arkansas is home to the largest Marshallese Pacific Islander population in the United States. Marshallese Pacific Islanders residing in the United States have disproportionally high rates of poor maternal and infant health outcomes, even compared to other Pacific Islanders.

PARTICIPANTS

Seven CenteringPregnancy providers from the University of Arkansas for Medical Sciences Northwest.

INTERVENTION/MEASUREMENTS

Individual interviews were conducted from February to March of 2023. Data were managed using MAXQDA12 software. Content analysis was used to analyze the data. Initial coding was completed to identify each data segment with short summations of emergent themes. The focused thematic codes that emerged were used to identify and develop the most salient thematic categories of the data, which became the thematic codes.

RESULTS

Three overarching themes emerged: Implementation Successes, Challenges to Implementation, and Future Suggestions to Improve Implementation and Sustainability. Each theme had representative subthemes.

CONCLUSION

Findings provide insight for future implementation of CenteringPregnancy for Marshallese and other Pacific Islander individuals.

Assessing the acceptability and implementation feasibility of a culturally adapted parenting intervention for Marshallese mothers: A study protocol

Background

Pacific Islanders, including the Marshallese, face higher rates of obesity and obesity-related chronic conditions. Early-life interventions targeting eating patterns during the first 1000 days of life are essential to promote proper nutrition and growth. Marshallese mothers and caregivers are important decision-makers for feeding practices that could affect childhood obesity rates in Marshallese children. However, little is known about dietary patterns and practices of Marshallese families from birth to 12 months. Culturally-adapted approaches using community-based assets and Pacific Islander cultural values/practices have demonstrated effectiveness in reducing obesity but have not been developed for children.

Methods

This article describes the protocol for a study to culturally adapt the Centering Parenting intervention for Marshallese mothers in Arkansas.

Conclusion

This will be the first study to culturally adapt and implement Centering Parenting with Marshallese women in the United States. This study will be an important first step to assess the feasibility and acceptability of an abbreviated parenting intervention to reduce childhood obesity in Marshallese communities.

Neighborhood determinants of sleep and the moderating role of cultural factors among native adolescents

OBJECTIVE

This study examined the association between neighborhood social environment and sleep among urban American Indian and Alaska Native (AI/AN) adolescents as well as the moderating role of cultural factors in this association.

METHOD

The analytic sample included 133 urban AI/AN adolescents (age 12-16, 57.1% female, Mage = 14.03, SDage = 1.35). Perceived neighborhood social environment included safety and cohesion. Cultural factors included AI/AN cultural identification and historical loss. Sleep duration, efficiency, and wake after sleep onset (WASO) were measured via actigraphy. Sleep disturbance was measured via a questionnaire.

RESULTS

Greater neighborhood safety was significantly associated with lower sleep disturbance (b = -2.17, SE = 0.8, p = .008), higher sleep efficiency (b = 1.75, SE = 0.64, p = .006), and lower WASO (b = -8.60, SE = 3.34, p = .01). Neighborhood cohesion was not associated with any sleep outcomes. Cultural factors moderated the association between neighborhood social environment and sleep outcomes (p < .05). Specifically, both neighborhood safety and cohesion were associated with lower sleep disturbance, only among individuals reporting higher levels of AI/AN cultural identification. Further, neighborhood safety was associated with greater sleep efficiency and lower WASO (i.e., better sleep) only among adolescents with higher contemplation of historical loss.

CONCLUSIONS

Findings highlight the importance of considering cultural factors in addressing sleep and health disparities. AI/AN cultural identification and a sense of historical loss may be important targets for identifying adolescents who might benefit the most from policies and interventions focused on improving the social environment in order to improve sleep and other health outcomes. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

"Community 101 for researchers": an online training program to build capacity for ethical community-engaged research with Native Hawaiians and Pacific Islanders

To address the history of unethical research and community distrust in research among Native Hawaiian and Pacific Islander communities, we developed the "Community 101 for Researchers" training program, which was launched in 2014 to enhance the capacity of researchers to engage in ethical community-engaged research. The purpose of this paper is to describe the development of this training program as well as its reach and feedback from participants. The Community 101 training program is a self-paced, 2-h online training program featuring community-engaged researchers from the University of Hawai'i and their longstanding community partners. Throughout the five modules, we highlight the historical context of Native Hawaiians and Pacific Islander populations in Hawai'i related to research ethics and use examples from the community as well as our own research projects that integrate community ethics, relevance, benefits, and input. To determine reach and gather participant feedback on the training, we extracted data from the user accounts. The training has been completed by 697 users to-date since its launch. Despite very little advertisement, an average of nearly 70 users have completed the Community 101 Program each year. The majority of the participants were located in Hawai'i though participants were also from other states and territories in the US, and international locations. The majority of participants were from universities in Hawai'i in 51 different departments demonstrating multidisciplinary relevance of the program's training. The general feedback from the 96 participants who completed an optional anonymous evaluation survey given at the end of the training was positive. The "Community 101 for Researchers" Training program is an accessible and relevant tool that can be used to advance ethical community engaged research, specifically with Native Hawaiian and Pacific Islander communities.

Impacts of COVID-19 on Young Children and Families: A Qualitative Study Using Best Starts for Kids Health Survey Data in King County, WA

OBJECTIVES

To evaluate the impacts of the COVID-19 pandemic on parents and caregivers with young children in King County, Washington using data from a local population-based survey, the Best Starts for Kids Health Survey (BSKHS).

METHODS

7033 parents and caregivers in King County, Washington with children 5th grade and younger participated in the BSKHS in 2021. Three evaluators adopted a framework method approach to thematic analysis for open-ended survey responses regarding the impacts of COVID-19 on families.

RESULTS

Children aged 0-5 years missed important social development opportunities, while elementary-school children missed social interactions and felt isolated during remote schooling. Parents were exhausted by the competing demands of work and schooling/childcare, with mothers bearing the brunt of additional responsibilities. Many families faced financial uncertainty and were unable to meet basic needs. Yet, families were grateful for more quality time with family members.

CONCLUSIONS FOR PRACTICE

Parents expressed that children aged 0-5 years missed out on social development opportunities with both adults and children their own age and elementary-school children and felt isolated while schools were closed to in-person schooling.

Outdoor Time in Childhood: A Mixed Methods Approach to Identify Barriers and Opportunities for Intervention in a Racially and Ethnically Mixed Population

A growing body of literature suggests that outdoor time is beneficial for physical and mental health in childhood. Profound disparities exist in access to outdoor spaces (and the health benefits thereof) for children in communities of color. The objectives of this research were to: (1) identify challenges and solutions to outdoor time for children; (2) assess the importance of outdoor time for children; and (3) evaluate results stratified by race/ethnicity. Using a convergent mixed methods approach, we conducted a thematic analysis from 14 focus groups (n = 50) with outdoor educators, parents with children attending outdoor preschools, and community members with children. In addition, 49 participants completed a survey to identify challenges and solutions, perceived importance, and culturally relevant perspectives of outdoor time. The main challenges identified for outdoor time were safety concerns, inclement weather, lack of access to outdoor spaces, and parent work schedules. The primary proposed solution was integrating outdoor time into the school day. Nearly all participants, independent of racial identity, reported that outdoor time improved physical and mental health. Overall outdoor time was lower in participants from communities of color (~8 h/week) compared to their White counterparts (~10 h/week). While 50% of people of color (POC) reported that outdoor time was an important cultural value, only 18% reported that people in their respective culture spent time outside. This work contributes to accumulating knowledge that unique barriers to outdoor time exist for communities of color, and the children that live, learn, and play in these communities. Increasing outdoor time in school settings offers a potential solution to reduce identified barriers and to promote health equity in childhood.

Prevalence and Risk Factors of Self-reported Vision Impairment among Native Hawaiians and Pacific Islanders in the United States

Racial disparities in vision impairment have been reported among Black, Hispanic, and White Americans. However, there is a paucity of research on vision impairment among Native Hawaiians and Pacific Islanders (NHPIs). The objective of this study was to determine the prevalence of, and risk factors for, self-reported visual impairment in NHPI adults in the United States (US). Data from the NHPI and 2014 National Health Interview Surveys were analyzed using sample weights and variance estimates. Prevalence was calculated for vision impairment and blindness for the NHPI and overall US populations. Sociodemographic and clinical risk factors of vision impairment were explored using descriptive statistics, χ2 tests, and simple and multiple logistic regression. In total, 2 586 NHPIs and 36 673 individuals in the US were included. The prevalence of vision impairment was 8.8% among NHPIs and 9.1% for the overall US population, and the prevalence of blindness was 0.72% for NHPIs and 0.35% for the overall population. Independent risk factors associated with vision impairment were having a Charlson Comorbidity Index over 1 [OR: 2.89, 95% CI: (1.42-5.88)] and having a family income below $35 000 [OR: 2.03, 95% CI: (1.06-3.89)]. In summary, the rate of blindness is higher among NHPIs than the overall US population, especially for older and unemployed individuals with more comorbidities. Higher comorbidity burden, lower family income, and recent eye care were risk factors for vision impairment. More research is necessary to develop targeted and culturally sensitive interventions to promote NHPI eye health.

Indigenous Research Methodologies with Kānaka 'Ōiwi to Address Health Inequities: Two Case Studies

Kānaka 'Ōiwi (Native Hawaiians), the Indigenous Peoples of Hawai'i, have worldviews of health that emphasize the importance of being pono (ie, right and just) and maintaining balance with all our relations. Yet, the literature of health for Native Hawaiians often focuses on the disproportionate health disparities that affect the Native Hawaiian community. The purpose of this paper is to present 2 case studies that integrate Indigenous research methodologies with, for, and by Kānaka 'Ōiwi, moving beyond Community-Based Participatory Research (CBPR) approaches to respond to the health needs identified with, for, and by Native Hawaiian communities. The first case study, Mini Ahupua'a for Lifestyle and Mea'ai through Aquaponics (MALAMA), reports on the processes and outcomes for backyard aquaponics, which started with, for, and by the Waimānalo community and extended to include other Native Hawaiian communities. The second case study, Ke Ola O Ka 'Āina, reports on the development and pilot findings of the 'Āina Connectedness Scale, developed with, for, and by Native Hawaiian communities. Common themes resulting from the processes of these case examples include the importance of establishing relationships, protocols, and procedures for pono research, identifying community-based health priorities and solutions to address health disparities, and "walking in multiple worlds" to address the priorities of multiple stakeholders. Public health recommendations and implications, including lessons learned and academic policies that may counter Indigenous research methodologies, are further described.

Scoping Review of Interventional Studies in Chronic Disease for Native Hawaiian, Pacific Islander, and Filipino Populations in the United States

Native Hawaiians (NHs), Pacific Islanders (PIs), and Filipinos experience health disparities in the United States (US) and need interventions that work for them. The purpose of this paper is to present a review of interventions designed to address chronic disease in Native Hawaiian, Pacific Islander, and Filipino populations in the US that were tested for clinical impact through a randomized controlled trial (RCT). Articles were identified through a search of 4 databases, citation chasing, and colleagues. The 23 included articles reported on 21 interventions addressing 4 chronic conditions-cancer, obesity, cardiovascular disease, and diabetes. All projects were guided by advisory groups, and all interventions were theory-based and tailored to the population, with culturally- and language-appropriate educational materials delivered by same-race individuals in familiar church, club, or home settings. About half were tested through cluster RCT. The majority of the interventions were successful, confirming the value of developing and delivering interventions in partnership with community. Given the growing numbers of NHs, PIs, and Filipinos in the US, more investigational studies are needed to develop and test culturally tailored and grounded interventions that meet the health needs of these populations.

Prioritizing Connection and Centering on Community: Take Your Shoes Off and Don't Put Your Feet on the Furniture

This column describes what it means to be "in" a community and how to create a leading role for community partners in shaping research. It highlights essential components for conducting clinical and translational research in the community, including: (1) invitation to share history and purpose; (2) community-initiated collaboration and engagement; (3) focus on social and cultural determinants of health; (4) community-driven measures and frameworks; (5) application of Indigenous methods and approaches; and (6) implementation of Indigenous and adaptable interventions. Partnering with a community entails building relationships and positioning research around community interests, using methodologies and interventions right for the community.

Systematic Review of Culturally-Based Breast Cancer Health Studies in Hawai'i

Breast cancer disproportionately impacts Native Hawaiian and Pacific Islander communities in Hawai'i, as exemplified by high breast cancer prevalence and mortality rates. Breast cancer disparities are linked to socio-cultural determinants of health, signifying the importance of culturally-based interventions. This paper systematically reviewed breast cancer studies conducted in Hawai'i. The literature search yielded 813 published studies, with a final total of 13 peer-reviewed studies that met this paper's inclusion criteria. All but 1 study incorporated cultural components. By evaluating key intervention components and assessing the quality of each study, the research team aimed to analyze the importance of cultural values in health interventions. Family and spirituality in coping with a cancer diagnosis were key themes in patients' lived experiences. Other culturally-based components in these studies included community-engaged research and cultural training for health professionals. The collective findings suggest that breast cancer health interventions that incorporate cultural strengths, values, and worldviews may play a central role in reducing the overall breast cancer burden among these communities. The present review advocates for future research to take a more culturally-based strategy in addressing breast cancer health disparities among Native Hawaiian and Pacific Islanders in Hawai'i.

Developing culturally-responsive health promotion: insights from cultural experts

Culturally-responsive health promotion initiatives are important to the creation of health equity for Indigenous and minority populations and these initiatives are complex and time-intensive to establish. The knowledge and resources of cultural experts are often pivotal in programs, yet there is minimal research on effective collaborations. The KāHOLO Project demonstrated strong success in the management of uncontrolled hypertension in the high-risk Indigenous population through a 6-month program based on the Hawaiian cultural dance of hula. This program was developed utilizing a community-based participatory research approach and implemented by cultural experts. To better understand the effectiveness of the research endeavor and program, six experienced hula experts and educators who delivered the community-based program were interviewed. As skilled and trusted cultural experts they set a safe supportive learning environment that promoted health and cultural goals. They articulated it was important that the program maintained cultural priorities and integrity. Through the methodical establishment of mutual respect, cooperation on research protocols and requirements was achieved. The development of cultural experts as health allies offers important inroads to the inclusion of minority and Indigenous cultures in health programming.

Ho'oilina Pono A'e: Integrating Native Hawaiian Healing to Create a Just Legacy for the Next Generation

Native healing practitioners have been incorporated into health centers serving large populations of Kānaka 'Ōiwi (Native Hawaiians). However, no studies have examined their impact. A community based participatory research study at Waimanalo Health Center from 2017 to 2019 examined the added value of integrating native healing practices into primary care, including whether there is acceptability of the integration, cultural connectedness due to integration, and empowerment for patients, providers, and staff. Semi-structured interviews were conducted by the research team with 24 patients, providers and staff, and community residents. Through content analysis, 5 themes emerged. The integration of native healing practices provides an alternative to western medicine, recalls ancestral knowledge, focuses on the whole person, generates increased disclosure leading to behavior change, and is central to a decolonizing process. The findings support the integration of native healing practices providing added value in primary care.

Marshallese Mothers' and Marshallese Maternal Healthcare Providers' Perspectives on Contraceptive Use and Reproductive Life Planning Practices and Influences

Pacific Islander communities experience significant maternal and infant health disparities including high maternal and infant mortality. Contraception and reproductive life planning prevent approximately one-third of pregnancy-related deaths and neonatal deaths. We report the results of formative research devoted to understanding Marshallese mothers' as well as their maternal healthcare providers' practices and influences related to contraceptive use and reproductive life planning. This study used an exploratory, descriptive qualitative design to explore Marshallese mothers' and maternal healthcare providers' practices and influences of contraception use and reproductive life planning. Twenty participants were enrolled in the study, 15 Marshallese mothers and five Marshallese maternal healthcare providers. For the Marshallese mothers, two themes emerged: (1) Reproductive Life Planning Practices and Information; and (2) Reproductive Life Planning Influences. For the Marshallese maternal healthcare providers, two themes emerged: (1) Reproductive Life Planning Practices; and (2) Reproductive Life Planning Influences. This is the first study to document Marshallese mothers' and maternal healthcare providers' practices and influences with contraceptive use and reproductive life planning. Study results will inform the development of a culturally-adapted contraception and reproductive life planning tool with an educational program for Marshallese family units and maternal healthcare providers serving Marshallese women.

The frequency of rs2231142 in ABCG2 among Native Hawaiian and Pacific Islander subgroups: implications for personalized rosuvastatin dosing

Statins are among the most commonly prescribed medications worldwide. Rosuvastatin is a moderate- to high-intensity statin depending on the prescribed dose. Statin-associated muscle symptoms are the main side effects, contributing to low adherence to statins. The missense variant rs2231142 in ABCG2 affects the functionality of the ABCG2 transporter, altering the pharmacokinetics and pharmacodynamics of rosuvastatin. This special report aims to accentuate the importance of considering the ABCG2 genotype upon prescribing rosuvastatin in high cardiovascular disease risk subgroups, specifically Native Hawaiian and Pacific Islander populations. Based on the reported frequencies of rs2231142 in ABCG2, it may be justifiable to initiate low-dose rosuvastatin in Samoans relative to Marshallese or Native Hawaiians. Interpopulation differences in pharmacogenetic allele frequencies underscore the need to disaggregate broad population categories to achieve health equity in treatment outcomes.

Neighborhood level facilitators and barriers to hypertension management: A Native Hawaiian perspective

Native Hawaiians have a disproportionately high prevalence of hypertension, which is an important and modifiable risk factor for cardiovascular disease (CVD). To reduce CVD among Native Hawaiians, we must better understand facilitators and barriers to hypertension management (i.e., diet, physical activity, stress reduction) unique to Native Hawaiians. Despite evidence of neighborhood-level facilitators and barriers to hypertension management in other populations, there is limited research in Native Hawaiians. Participants from a randomized controlled trial (n = 40) were recruited for 5 focus groups. All participants were self-reported Native Hawaiians and had uncontrolled hypertension. Discussions elicited experiences and perceptions of neighborhood-level stressors as they relate to participants' hypertension management efforts. Audio recordings were transcribed and analyzed using ATLAS.ti for emergent themes. Five themes were identified: neighborhood description, community resources, neighborhood change, safety, and social connectedness. Novel barriers to hypertension control included loss of culture and loss of respect for elders, change in community feel, and over-development. Facilitators included social cohesion and collective power. These data provide a deeper understanding of how Native Hawaiians experience neighborhood factors and how those factors impact their efforts to improve their diets, physical activity, and stress management. The findings help to inform the development of multilevel CVD prevention programs. Further research is needed to explore the subtheme of social and emotional stress related to neighborhood change and CVD health risk due to cultural and historic trauma references.

Scoping review protocol of multicomponent interventions to address cardiometabolic disease risk among Pacific Islander children

INTRODUCTION

Multicomponent interventions can reduce cardiometabolic disease (CMD) risk factors in childhood; however, little synthesis of the literature has taken place in the Pacific region. Pacific Islanders experience a disproportionately high prevalence of CMD risk factors, yet interventions have been slow to reach many communities. We present this protocol for a scoping review to identify and summarize existing multicomponent interventions to address CMD risk in Pacific Islander children.

MATERIALS AND METHODS

Eligible interventions will (1) address CMD risk factors (including but not limited to obesity, hyperglycemia, dyslipidemia, elevated blood pressure, and/or health behaviors) in 2-to-12-year-old Pacific Islander children, and (2) be multi-component (including at least two lifestyle/behavior change strategies to address CMD risk factors). To investigate existing interventions for adaptation and potential use in Pacific Islander communities, we will search Scopus, MEDLINE ALL (Ovid), EMBASE (Ovid), Yale-licensed Web of Science Core Collection, Cochrane Library, CINAHL (EBSCOhost), ProQuest Dissertations & Theses Global, Global Health (EBSCO), non-indexed Pacific journals, grey literature, government reports, and clinical trial registrations. The Joanna Briggs Institute Manual for Evidence Synthesis and the Preferred Reporting Items for Scoping Reviews will guide data extraction, evidence mapping, synthesis, and reporting of information including study population, intervention components, behavioral changes, health and implementation outcomes, theoretical frameworks, and evaluation measures.

ETHICS AND DISSEMINATION

Formal ethical approval is not required. The dissemination strategy will include peer-reviewed journal publications and presentations. Synthesis of existing multicomponent interventions for Pacific Islander children will help to identify best practices that could be replicated, adapted, or combined.

Sociocultural influences on dietary behavior and meal timing among Native Hawaiian and Pacific Islander women at risk of endometrial cancer: a qualitative investigation

PURPOSE

Determine sociocultural influences on dietary behavior, body image, weight loss, and perceptions of the cultural appropriateness of a meal-timing intervention design and menu among Native Hawaiian and Pacific Islander (NHPI) women at risk of endometrial cancer.

METHODS

Six 90-min videoconference focus groups among NHPI women (n = 35) recruited by a community champion in Utah. Eligible women were aged ≥ 18 years at risk of endometrial cancer (i.e., BMI ≥ 25 kg/m², history of non-insulin-dependent diabetes or complex atypical endometrial hyperplasia) had a working cell phone capable of downloading a phone app, could use their cell phone during the day, and were not night-shift workers. Twelve semi-structured questions were posed during the focus groups. Using inductive qualitative methods based on Hatch's 9-step approach, de-identified transcript data were analyzed.

RESULTS

Overarching themes included economic factors, cultural influences, meal choice and timing, and perceptions of health. Subthemes included affordability, waste avoidance, inundated schedules, and cultural influences. Perceptions of body size and weight loss were influenced by family, community, and social media, whose messages could be conflicting. Important intervention components included satisfying, convenient pre-made meals, while barriers included the need to cook for family members.

CONCLUSIONS

Dietary interventions targeting metabolic health among NHPI women should consider the multitude of sociocultural and economic factors that influence food choices and meal timing in this population, including affordability, hectic schedules, and immigrant adjustment. Promoting the link between physical and mental well-being as opposed to weight loss is a key approach to reaching this population.

Protocol: Implementation and evaluation of an adolescent-mediated intervention to improve glycemic control and diabetes self-management among Samoan adults

BACKGROUND

Diagnoses of Type 2 Diabetes in the United States have more than doubled in the last two decades. One minority group at disproportionate risk are Pacific Islanders who face numerous barriers to prevention and self-care. To address the need for prevention and treatment in this group, and building on the family-centered culture, we will pilot test an adolescent-mediated intervention designed to improve the glycemic control and self-care practices of a paired adult family member with diagnosed diabetes.

METHODS

We will conduct a randomized controlled trial in American Samoa among n = 160 dyads (adolescent without diabetes, adult with diabetes). Adolescents will receive either a six-month diabetes intervention or a leadership and life skills-focused control curriculum. Aside from research assessments we will have no contact with the adults in the dyad who will proceed with their usual care. To test our hypothesis that adolescents will be effective conduits of diabetes knowledge and will support their paired adult in the adoption of self-care strategies, our primary efficacy outcomes will be adult glycemic control and cardiovascular risk factors (BMI, blood pressure, waist circumference). Secondarily, since we believe exposure to the intervention may encourage positive behavior change in the adolescent themselves, we will measure the same outcomes in adolescents. Outcomes will be measured at baseline, after active intervention (six months post-randomization) and at 12-months post-randomization to examine maintenance effects. To determine potential for sustainability and scale up, we will examine intervention acceptability, feasibility, fidelity, reach, and cost.

DISCUSSION

This study will explore Samoan adolescents' ability to act as agents of familial health behavior change. Intervention success would produce a scalable program with potential for replication in other family-centered ethnic minority groups across the US who are the ideal beneficiaries of innovations to reduce chronic disease risk and eliminate health disparities.

Preeclampsia: a report and recommendations of the workshop of the Society for Maternal-Fetal Medicine and the Preeclampsia Foundation

Preeclampsia is a substantial cause of perinatal and maternal morbidity and mortality. The prevalence of this condition has increased over the past several decades. Additional opportunities are needed to foster interdisciplinary collaborations and improve patient care in the setting of preeclampsia. In recognition of the Preeclampsia Foundation's 20th anniversary and its work to advance preeclampsia research and clinical agendas, a 2-day virtual workshop on preeclampsia was cosponsored by the Society for Maternal-Fetal Medicine and the Preeclampsia Foundation and held January 25-26, 2021 in conjunction with the 41st annual pregnancy meeting. Leaders with expertise in preeclampsia research, obstetrical care, primary care medicine, cardiology, endocrinology, global health, and patient advocacy gathered to discuss preeclampsia prediction, prevention, management, and long-term impacts. The goals of the workshop were to review the following issues and create consensus concerning research and clinical recommendations: This report, developed collaboratively between the SMFM and the Preeclampsia Foundation, presents the key findings and consensus-based recommendations from the workshop participants.

Cultural efficacy as a novel component of understanding linkages between culture and mental health in Indigenous communities

We used a novel measure of cultural efficacy to examine empirical pathways between enculturation, efficacy, and two wellbeing outcomes. Cultural factors are not consistently linked to better wellbeing in the academic literature despite widespread understanding of these processes in Indigenous communities. Healing pathways is a community-based participatory study with eight reservations/reserves in the upper Midwest and Canada. This study uses data collected in 2017-2018 (n = 453, 58.1% women, mean age = 26.3 years) and structural equation modeling to test the relationships between enculturation, cultural efficacy, and mental health. The direct effect of enculturation on anxiety was positive. The indirect effect of enculturation via cultural efficacy was negatively associated with anxiety and positively associated with positive mental health. Cultural efficacy is an important linking variable through which the protective effects of culture manifest. The complex nature of culture must be met with innovative measures and deep understanding of Indigenous peoples to fully capture the protective role of culture.

Social networks in patients hospitalized with preventable conditions for heart disease and diabetes in Hawai'i by health literacy

OBJECTIVES

Reducing potentially preventable hospitalizations (PPH) for chronic disease is a research and practice priority. Native Hawaiians and other Pacific Islanders (NHOPI) have disparities in PPH, and are understudied in both health literacy and social network research. Greater inclusion of social and familial networks can help address health disparities among people with chronic illness and enhance culturally relevant healthcare.

METHODS

Adults hospitalized with a heart disease or diabetes-related PHH in Hawai'i (N = 22) were assessed for health literacy and social network membership ("alters").

RESULTS

Sixty-nine percent of respondents were NHOPI. Three respondents (14%) had no alters ("isolates"). Among non-isolates, 79% desired the participation of at least one alter in chronic disease management-related interventions. Fifty-nine percent of respondents had low health literacy. While the mean number of alters did not vary significantly by health literacy, those with lower health literacy had a trend (p = .055) towards less interest in social network engagement.

DISCUSSION

In a sample primarily comprised of NHOPI with chronic disease, many patients wished to include social network members in interventions. Engagement varied by health literacy with implications for health disparities. Not all patients were interested in social network engagement, which must be considered in intervention planning.

Body Fat Distribution, Glucose Metabolism, and Diabetes Status Among Older Adults: The Multiethnic Cohort Adiposity Phenotype Study

BACKGROUND

As the proportion of visceral (VAT) to subcutaneous adipose tissue (SAT) may contribute to type 2 diabetes (T2D) development, we examined this relation in a cross-sectional design within the Multiethnic Cohort that includes Japanese Americans known to have high VAT. The aim was to understand how ectopic fat accumulation differs by glycemic status across ethnic groups with disparate rates of obesity, T2D, and propensity to accumulate VAT.

METHODS

In 2013-2016, 1,746 participants aged 69.2 (standard deviation, 2.7) years from five ethnic groups completed questionnaires, blood collections, and whole-body dual X-ray absorptiometry and abdominal magnetic resonance imaging scans. Participants with self-reported T2D and/or medication were classified as T2D, those with fasting glucose >125 and 100-125 mg/dL as undiagnosed cases (UT2D) and prediabetes (PT2D), respectively. Using linear regression, we estimated adjusted means of adiposity measures by T2D status.

RESULTS

Overall, 315 (18%) participants were classified as T2D, 158 (9%) as UT2D, 518 (30%) as PT2D, and 755 (43%) as normoglycemic (NG), with significant ethnic differences (P < 0.0001). In fully adjusted models, VAT, VAT/SAT, and percent liver fat increased significantly from NG, PT2D, UT2D, to T2D (P < 0.001). Across ethnic groups, the VAT/SAT ratio was lowest for NG participants and highest for T2D cases. Positive trends were observed in all groups except African Americans, with highest VAT/SAT in Japanese Americans.

CONCLUSION

These findings indicate that VAT plays an important role in T2D etiology, in particular among Japanese Americans with high levels of ectopic adipose tissue, which drives the development of T2D to a greater degree than in other ethnic groups.

Head and Neck Cancer Stage at Presentation and Survival Outcomes Among Native Hawaiian and Other Pacific Islander Patients Compared With Asian and White Patients

Importance

Research studies often group Native Hawaiian and Other Pacific Islander individuals together with Asian individuals despite being consistently identified as having worse health outcomes and higher rates of comorbidities and mortality. Native Hawaiian and Other Pacific Islander individuals also have high incidence rates of oral cavity and pharyngeal cancer compared with the general population; however, disparities in clinical presentation and survival outcomes of head and neck cancer squamous cell carcinoma (HNSCC) among this population have not been investigated nor compared with those of other races.

Objective

To determine the association of race with cancer stage at diagnosis and survival outcomes among Native Hawaiian and Other Pacific Islander patients with HNSCC compared with Asian and non-Hispanic White patients.

Design, Setting, and Participants

This was a retrospective population-based cohort study using data from the Surveillance, Epidemiology, and End Results (SEER) 18 database. Asian, Native Hawaiian or Other Pacific Islander, and non-Hispanic White adult patients diagnosed in 1988 through 2015 with HNSCC of the oral cavity, oropharynx, nasopharynx, larynx, and hypopharynx were included; any patient whose record was missing data on disease or demographic information was excluded.

Main Outcomes and Measures

Cancer stage at presentation was compared among Asian, Native Hawaiian and Other Pacific Islander, and non-Hispanic White patients using a multivariable logistic regression model. Survival outcomes were compared among these racial groups using Cox regression models. Data analyses were performed from July 1, 2021, to March 20, 2022.

Results

The total study population comprised 76 473 patients: 4894 Asian (mean [SD] age at presentation, 60.7 [14.6] years), 469 Native Hawaiian and Other Pacific Islander (57.8 [12.3] years), and 71 110 non-Hispanic White (62.2 [12.1] years) individuals. Native Hawaiian and Other Pacific Islander patients were more likely to present with advanced-stage HNSCC (odds ratio [OR], 1.38; 95% CI, 1.12 -1.72) compared with non-Hispanic White patients. Asian patients presented with similar stage disease (OR, 1.04; 95% CI, 0.97-1.11) compared with non-Hispanic White patients. Native Hawaiian and Other Pacific Islander patients had worse disease-specific survival (HR, 1.18; 95% CI, 1.02-1.36) compared with non-Hispanic White patients after adjusting for clinical and demographic factors. In contrast, Asian patients had improved disease-specific survival (HR, 0.93; 95% CI, 0.88-0.98) compared with non-Hispanic White patients.

Conclusions and Relevance

This retrospective population-based cohort study suggests that Native Hawaiian and Other Pacific Islander race was associated with more advanced HNSCC, and worse disease-specific survival compared with non-Hispanic White race, while Asian race was associated with improved survival. This study highlights the importance of disaggregating Asian from Pacific Islander data when assessing health disparities, and the need for culturally sensitive interventions to promote earlier detection of head and neck cancer and improved survival among the Native Hawaiian and Other Pacific Islander population.

Just data representation for Native Hawaiians and Pacific Islanders: A critical review of systemic Indigenous erasure in census and recommendations for psychologists

The decennial Census survey marks the emergence of federal classifications of race and ethnicity by which the U.S. government has historically conflated Native Hawaiians and Pacific Islanders (NHPI, hereafter) as "Asian or Pacific Islander." This conflation amplifies health injustices and inequities of NHPIs through multiple mechanisms because it masks the complex and heterogeneous experiences of NHPIs, whose positions and relations with the settler state are qualitatively and substantially distinct from Asian Americans. This critical review examines federal documents and research to examine how the panethnic categorizations are often sustained through scientific inquiry and methodologies. We found that self-determination and self-identification for NHPIs are impeded by settler-colonial relations between U.S. colonization of parts of Oceania (e.g., Hawai'i, Sāmoa, Fiji, and Guam) and the forcefully imposed categorization that continues to be in use to legitimize the domination of Indigenous Peoples through race misclassification. Specifically, Census data collection fails to capture accurate and reliable data due to serious methodological limitations. These implications for psychological research compel us to make several recommendations for psychologists: (1) engage with NHPI community partners in all research processes; (2) critically examine Census research design and consider oversampling NHPI households to ensure just data representation; (3) meaningfully engage when, whether and how to aggregate Asian Americans with NHPIs; and (4) use Indigeneity as a critical framework.

Indigenous Culture-as-Health: A Systematized Literature Review

This paper has two goals regarding cultural rigor, defined as privileging cultural ways of knowing and being as a means to achieving health and well-being for future generations. First, we move the continuum of health practices beyond cultural grounding to include Indigenous Culture-as-Health. Second, this project expands the concept of Indigenous Culture-as-Health in addiction and recovery to include a broader range of health, inclusive of prevention, to further understand this emerging model. Our review of the literature yielded an expanded cultural continuum that includes Indigenous Culture-as-Health, which appears to rely on four modalities: 1) Indigenous ways of knowing, 2) Indigenous cultural practices, 3) place-based/sacred sites, and 4) Indigenous spirituality. For Indigenous health, standards are defined by centuries of ancestral consciousness among Indigenous people across generations, in spite of settler-colonial systems that do not serve them. In other words, Indigenous Culture-as-Health practices contribute to self-determination, sovereignty, and liberation. Incorporating these strategies also will ameliorate other problems related to White supremacy and health, such as epistemic exploitation. Additional implications for prevention practice and policy are described.

Examining the Relationship Between Physical Activity and Self-Efficacy for Exercise Among Overweight and Obese Marshallese Adults

This study examined associations between physical activity frequency and self-efficacy for exercise (SEE) among Marshallese adults in the United States. Data were collected from overweight and obese Marshallese participants (N = 378) enrolled in a Diabetes Prevention Program trial. Logistic and ordinal logistic regressions were employed to examine associations between physical activity and SEE, adjusting for covariates. SEE was significantly associated with engaging in sufficient total physical activity [odds ratio (OR) = 1.70], moderate physical activity (OR = 2.23), and vigorous physical activity (OR = 2.13). Unemployment was associated with less frequent moderate physical activity (OR = 0.59). Younger age (OR = 0.98), being male (OR = 2.67), and reporting excellent health (OR = 3.14) or good health (OR = 2.06) were associated with more frequent vigorous physical activity. Physical activity is a modifiable lifestyle behavior associated with many chronic disease disparities faced by the Marshallese community, and the study results will be useful for practitioners and researchers working to address these disparities.

“Wherever I Go, I Have It Inside of Me”: Indigenous Cultural Dance Narratives as Substance Abuse and HIV Prevention in an Urban Danza Mexica Community

Introduction

“Mexican American Indian” (MAI) is a large and diverse population for which little empirical research on alcohol and other drug (AOD) use and HIV is available, yet for which there is a disproportionate risk. Indigenous health narratives and participation in place- and settings-based cultural practices can be protective in chronic and co-occurring disease prevention and health promotion for Indigenous people. This study explores the role of participation in cultural dance in generating narratives of prevention and health promotion among a sample of MAIs from an Urban Danza Mexica Community (UDMC), framed within a decolonizing narratives of health (DNOH) model.

Methods

This secondary data analysis (n = 9) is drawn from a qualitative AOD and HIV health needs assessment of UDMC living in the Pacific Northwest and the Rocky Mountain West (n = 21). This study uses a community-based participatory research approach and employs narrative, Indigenized methods to analyze in-depth interviews from adult cisgender females (n = 5) and males (n = 4). The DNOH model is developed as a relational, analytic framework that contextualizes Indigenous stories in relationship to three distinct yet interconnected levels—the personal, the communal, and Indigeneity in the larger world. These levels of narrative analysis function as culturally grounded, relational pathways through which to articulate health education and promotion approaches.

Results

Narratives delve into the complex and nuanced relationships within participants' internal worlds (personal), between themselves and their Danza community (communal), and between themselves and their complex, intersectional Indigenous identities within society (Indigeneity). Stories of ancestral teachings about health and prevention shared within the Danza circle create spaces wherein participants navigate complex conversations that resist oppressive colonial narratives, reconnect with and strengthen their Indigenous identities, and strive toward ancestral visions of health and well-being.

Discussion

This study contributes to Indigenized theoretical and methodological expansion and the development of place/settings-based, narrative, cultural health interventions aimed at preventing chronic and co-occurring disease and promoting wellness among populations similar to the UDMC. Identifying cultural practices as Native Hubs (relational, socially constructed places) that foster decolonizing narratives helps increase understanding of their role in public health education and promotion through recognition of Indigenous knowledge systems and frameworks.