"There are still broken or fragmented systems": Qualitative assessment of needs to strengthen adolescent mental health services in American Samoa

Mental health challenges appear common among adolescents in American Samoa. There is a community-identified need to better understand the health burden and identify opportunities to strengthen the mental health system to better meet adolescent mental health needs. The goal of this qualitative study was to gather community stakeholders' perceptions of common mental health problems among adolescents in American Samoa, identify existing services for adolescent mental health, and highlight strength-based opportunities to enhance care. Using the Fa'afaletui research framework, semi-structured in-depth interviews (n = 28) were conducted between October 2020 and February 2021 using Zoom. Key informants were adults living in American Samoa, sampled for diversity in profession, age, gender, education, and region of residence. Transcripts were coded in duplicate and analysed using deductive thematic analysis. Participants reported that suicide, depression, anxiety, and post-traumatic stress disorder are the conditions of highest burden. Participants identified an impressive amount of infrastructure and community mobilization, but also limitations in these services in addressing adolescents' health needs. Four themes arose related to the need to: (1) strengthen existing infrastructure; (2) reduce barriers to treatment access; (3) improve sustainability; and (4) encourage collaboration among leaders. Policymakers should prioritize the allocation of resources to strengthen infrastructure, public education, and stakeholder collaboration to improve adolescent mental health in American Samoa.

Research on the changes and predictions of the burden of type 2 diabetes mellitus in Pacific Island countries from 1990 to 2019

AIMS

To assess the burden of type 2 diabetes in Pacific Island countries and predict future trends.

METHODS

We analyzed and processed data using R and Excel software, performed Joinpoint 4.7.0 software analysis to investigate changing trends in disease burden, and used an autoregressive integrated moving average model to forecast future trends.

RESULTS

Our study showed that from 1990 to 2019, the burden of type 2 diabetes in Pacific Island countries continues to increase, with the standardized incidence rate showing the most significant growth. Moreover, there were significant differences in the burden of type 2 diabetes between regions. In 2019, American Samoa had the highest standardized incidence rate, while Fiji had the highest standardized death rate and disability-adjusted life year rate. The standardized incidence rate peaked at ages 65-69 years, while the standardized death rate and disability-adjusted life year rate peaked at ages 95 years and 70-74 years respectively. Type 2 diabetes burden was higher among males than females. Based on our forecasting, from 2020 to 2030, the standardized incidence rate is expected to continue to rise, while the standardized death rate and disability-adjusted life year rate will slowly decline.

CONCLUSIONS

Our study highlights that the burden of type 2 diabetes in Pacific Island countries has been increasing from 1990 to 2019. Therefore, it is imperative to strengthen disease prevention and control measures in the region.

Culturally Competent Interventions for Child Sexual Abuse: A Scoping Review of the Literature and the Implications for American Samoa

Significant stigma regarding child sexual abuse exists in American Samoa. Although cultural interventions may help prevent child sexual abuse, very little is known about such interventions. Therefore, through a scoping review process, this study aimed to gain a broad understanding of past and current culturally tailored interventions to prevent child sexual abuse. Because no studies examine interventions to prevent child sexual abuse in American Samoa specifically, the reviewed literature investigates interventions in different cultures. The literature search initially identified 180 relevant articles. After applying inclusion and exclusion criteria, nine studies met the eligibility criteria for review. Extracted data from these articles included the country or population, sample, study methods, children's age, intervention type, and details about the intervention. Results suggest that culturally tailored interventions for preventing child sexual abuse exist in various countries and cultural contexts. Results highlight that child sexual abuse prevention interventions are effective if translated into the native language. Findings from this study highlight the importance of using a culturally tailored approach to addressing child sexual abuse and can help guide the development of new interventions. Although more research on the prevention of child sexual abuse in American Samoa is needed, the results of this study might inform the development of culturally tailored interventions for the region.

Catchment to sea connection: Impacts of terrestrial run-off on benthic ecosystems in American Samoa

Variation in water quality can directly affect the composition of benthic assemblages on coral reefs. Yet, few studies have directly quantified nutrient and suspended particulate matter (SPM) to examine their potential impacts on benthic community structure, especially around high oceanic islands. We assessed the spatio-temporal variation of nutrients and SPM across six sites in American Samoa over a 12-month period and used exploratory path analysis to relate dissolved inorganic nutrients, land use, and natural and anthropogenic drivers to benthic assemblages on adjacent shallow reefs. Multivariate analyses showed clear gradients in nutrient concentrations, sediment accumulation and composition, and benthic structure across watersheds. Instream nutrients and land uses positively influenced reef flat nutrient concentrations, while benthic assemblages were best predicted by wave exposure, runoff, stream phosphate and dissolved inorganic nitrogen loads. Identifying locality-specific drivers of water quality and benthic condition can support targeted management in American Samoa and in other high islands.

Nutrient thresholds to protect water quality and coral reefs

Establishing nutrient thresholds to protect coral reefs is difficult because water quality is dynamic and shifts with many environmental factors. We examined the contribution of natural and human factors in predicting water quality at the base of 34 streams on a high tropical Pacific island. Mixed regression models revealed that rainfall, sea-surface temperature, and windspeed were fixed factors predicting dissolved inorganic nitrogen (DIN) concentrations at the base of all watersheds. In contrast, human influences were captured as random components of variation associated with site-based differences. The novel modeling approach using temporal and spatial data provided daily-loading simulations that were used to evaluate exceedance criteria, defined as the percent of time each watershed exceeded a suite of DIN thresholds. Exceedance criteria were considered alongside biological data to recommend a 0.1 to 0.15 mg l^-1 benchmark to protect coastal water quality and coral reefs surrounding Tutuila, American Samoa.

Ridge to Reef Management Implications for the Development of an Open-Source Dissolved Inorganic Nitrogen-Loading Model in American Samoa

Excessive nutrient discharge to tropical island coastlines drives eutrophication and algal blooms with significant implications for reef ecosystem condition and provision of ecosystem services. Management actions to address nutrient pollution in coastal ecosystems include setting water-quality standards for surface waters discharging to the coast. However, these standards do not account for the effects of groundwater discharge, variability in flow, or dilution, all of which may influence the assessment of true nutrient impacts on nearshore reef habitats. We developed a method to estimate dissolved inorganic nitrogen (DIN) loads to coastal zones by integrating commonly available datasets within a geospatial modeling framework for Tutuila, American Samoa. The DIN-loading model integrated an open-source water budget model, water-sampling results, and publicly available streamflow data to predict watershed-scale DIN loading to the island's entire coastline. Submarine groundwater discharge (SGD) was found to deliver more terrigenous DIN to the coastal zone than surface water pathways, supporting findings from other tropical islands. On-site wastewater disposal systems were also found to be the primary anthropogenic sources of DIN to coastal waters. Our island-wide DIN-loading model provides a simple and robust metric to define spatially explicit sources and delivery mechanisms of nutrient pollution to nearshore reef habitats. Understanding the sources and primary transport modes of inorganic nitrogen to nearshore reef ecosystems can help coastal resource managers target the most impactful human activities in the most vulnerable locations, thereby increasing the adaptive capacity of unique island ecosystems to environmental variation and disturbances.

Pagoamide A, a Cyclic Depsipeptide Isolated from a Cultured Marine Chlorophyte, Derbesia sp., Using MS/MS-Based Molecular Networking

A thiazole-containing cyclic depsipeptide with 11 amino acid residues, named pagoamide A (1), was isolated from laboratory cultures of a marine Chlorophyte, Derbesia sp. This green algal sample was collected from America Samoa, and pagoamide A was isolated using guidance by MS/MS-based molecular networking. Cultures were grown in a light- and temperature-controlled environment and harvested after several months of growth. The planar structure of pagoamide A (1) was characterized by detailed 1D and 2D NMR experiments along with MS and UV analysis. The absolute configurations of its amino acid residues were determined by advanced Marfey's analysis following chemical hydrolysis and hydrazinolysis reactions. Two of the residues in pagoamide A (1), phenylalanine and serine, each occurred twice in the molecule, once in the d- and once in the l-configuration. The biosynthetic origin of pagoamide A (1) was considered in light of other natural products investigations with coenocytic green algae.

Densities and drivers of sea turtle populations across Pacific coral reef ecosystems

Sea turtle populations are often assessed at the regional to sub-basin scale from discrete indices of nesting abundance. While this may be practical and sometimes effective, widespread in-water surveys may enhance assessments by including additional demographics, locations, and revealing emerging population trends. Here, we describe sea turtle observations from 13 years of towed-diver surveys across 53 coral islands, atolls, and reefs in the Central, West, and South Pacific. These surveys covered more than 7,300 linear km, and observed more than 3,400 green (Chelonia mydas) and hawksbill (Eretmochelys imbricata) sea turtles. From these data, we estimated sea turtle densities, described trends across space and time, and modelled the influence of environmental and anthropogenic drivers. Both species were patchily distributed across spatial scales, and green turtles were 11 times more abundant than hawksbills. The Pacific Remote Island Areas had the highest densities of greens (3.62 turtles km-1, Jarvis Island), while American Samoa had the most hawksbills (0.12 turtles km-1, Ta'u Island). The Hawaiian Islands had the lowest turtle densities (island ave = 0.07 turtles km-1) yet the highest annual population growth (μ = 0.08, σ = 0.22), suggesting extensive management protections can yield positive conservation results. Densities peaked at 27.5°C SST, in areas of high productivity and low human impact, and were consistent with patterns of historic overexploitation. Though such intensive surveys have great value, they are logistically demanding and therefore have an uncertain budget and programmatic future. We hope the methods we described here may be applied to future comparatively low-cost surveys either with autonomous vehicles or with environmental DNA.

Dapsone Resistance in Leprosy Patients Originally from American Samoa, United States, 2010-2012

Skin biopsies from US leprosy patients were tested for mutations associated with drug resistance. Dapsone resistance was found in 4 of 6 biopsies from American Samoa patients. No resistance was observed in patients from other origins. The high rate of dapsone resistance in patients from American Samoa warrants further investigation.

Cost-effectiveness analysis of a cluster-randomized, culturally tailored, community health worker home-visiting diabetes intervention versus standard care in American Samoa

BACKGROUND

Type 2 diabetes mellitus (T2DM) is highly prevalent in American Samoa. Community health worker (CHW) interventions may improve T2DM care and be cost-effective. Current cost-effectiveness analyses (CEA) of CHW interventions have either overlooked important cost considerations or not been based on randomized clinical trials (RCTs). The Diabetes Care in American Samoa (DCAS) intervention which occurred in 2009-2010 was a cluster-randomized, culturally tailored, home-visiting CHW intervention and improved HbA1c levels.

OBJECTIVE

To analyze the cost-effectiveness of the DCAS intervention against standard care using a RCT in a low-resource setting.

METHODS

We collected clinical, utilization, and cost data over 2 years and modeled quality-adjusted life years (QALYs) gained based on the RCT glycated hemoglobin (HbA1c) improvements. We calculated an incremental cost-effectiveness ratio (ICER) from the societal perspective over a 2-year time horizon and reported all costs in 2012 USD ($).

RESULTS

Two hundred sixty-eight American Samoans diagnosed with T2DM were cluster randomized into the CHW (n = 104) or standard care control (n = 164) arms. The CHW arm had a mean reduction of 0.53% in HbA1c, an increase of $594 in cost, and an increase of 0.05 QALYs. The ICER for the CHW arm compared to the control arm was $1121 per percentage point HbA1c reduced and $13 191 per QALY gained.

CONCLUSIONS

Compared to a variety of willingness-to-pay thresholds from $39 000 to $154 353 per QALY gained, this ICER shows that the CHW intervention is highly cost-effective. Future studies of the cost-effectiveness of CHW T2DM interventions in similar settings should model lifetime costs and QALYs gained to better assess long-term cost-effectiveness.

TRIAL REGISTRATION

ClinicalTrials.gov , ID NCT00850824. Registered 9 February 2009, https://clinicaltrials.gov/ct2/show/NCT00850824 .

Rainwater harvesting in American Samoa: current practices and indicative health risks

Roof-harvested rainwater (RHRW) is an important alternative source of water that many island communities can use for drinking and other domestic purposes when groundwater and/or surface water sources are contaminated, limited, or simply not available. The aim of this pilot-scale study was to investigate current RHRW practices in American Samoa (AS) and to evaluate and compare the quality of water from common potable water sources including RHRW stored in tanks, untreated stream water, untreated municipal well water, and treated municipal tap water samples. Samples were analyzed using culture-based methods, quantitative polymerase chain reaction (qPCR), and 16S amplicon sequencing-based methods. Based on indicator bacteria (total coliform and Escherichia coli) concentrations, the quality of RHRW was slightly lower than well and chlorinated tap water but exceeded that of untreated stream water. Although no Giardia or Leptospira spp. were detected in any of the RHRW samples, 86% of the samples were positive for Cryptosporidium spp. All stream water samples tested positive for Cryptosporidium spp. Opportunistic pathogens (Pseudomonas aeruginosa and Mycobacterium intracellulare) were also detected in the RHRW samples (71 and 21% positive samples, respectively). Several potentially pathogenic genera of bacteria were also detected in RHRW by amplicon sequencing. Each RHRW system was characterized by distinct microbial communities, 77% of operational taxonomic units (OTUs) were detected only in a single tank, and no OTU was shared by all the tanks. Risk of water-borne illness increased in the following order: chlorinated tap water/well water < RHRW < stream water. Frequent detection of opportunistic pathogens indicates that RHRW should be treated before use. Stakeholder education on RHRW system design options as well as on importance of regular cleaning and proper management techniques could improve the quality of the RHRW in AS.

Culture, local capacity, and outside aid: a community perspective on disaster response after the 2009 tsunami in American Sāmoa

Research on diverse cultural contexts has indicated that aid organisations often fail to leverage local, culturally-grounded resources and capacities in disaster-affected communities. Case-study methodology was employed to explore the relationship between local and external disaster response efforts in American Sāmoa following the earthquake and tsunami on 29 September 2009 in the southern Pacific Ocean, with a specific focus on the role of culture in defining that relationship. Interview and focus group data from 37 participants, along with observational data, suggested that the local response to the event was swift and grounded in Samoan cultural systems and norms. External aid was viewed as helpful in some respects, although, on the whole, it was seen as a disruption to village hierarchies, social networks, and local response efforts. The study discusses the implications for the role of outside aid in diverse cultural contexts, and makes suggestions for improving the ecological fit of post-disaster interventions.

Integrating Molecular Networking and Biological Assays To Target the Isolation of a Cytotoxic Cyclic Octapeptide, Samoamide A, from an American Samoan Marine Cyanobacterium

Integrating LC-MS/MS molecular networking and bioassay-guided fractionation enabled the targeted isolation of a new and bioactive cyclic octapeptide, samoamide A (1), from a sample of cf. Symploca sp. collected in American Samoa. The structure of 1 was established by detailed 1D and 2D NMR experiments, HRESIMS data, and chemical degradation/chromatographic (e.g., Marfey's analysis) studies. Pure compound 1 was shown to have in vitro cytotoxic activity against several human cancer cell lines in both traditional cell culture and zone inhibition bioassays. Although there was no particular selectivity between the cell lines tested for samoamide A, the most potent activity was observed against H460 human non-small-cell lung cancer cells (IC50 = 1.1 μM). Molecular modeling studies suggested that one possible mechanism of action for 1 is the inhibition of the enzyme dipeptidyl peptidase (CD26, DPP4) at a reported allosteric binding site, which could lead to many downstream pharmacological effects. However, this interaction was moderate when tested in vitro at up to 10 μM and only resulted in about 16% peptidase inhibition. Combining bioassay screening with the cheminformatics strategy of LC-MS/MS molecular networking as a discovery tool expedited the targeted isolation of a natural product possessing both a novel chemical structure and a desired biological activity.

Land-based sources of marine pollution: Pesticides, PAHs and phthalates in coastal stream water, and heavy metals in coastal stream sediments in American Samoa

The island nations and territories of the South Pacific are facing a number of pressing environmental concerns, including solid waste management and coastal pollution. Here we provide baseline information on the presence and concentration of heavy metals and selected organic contaminants (pesticides, PAHs, phthalates) in 7 coastal streams and in surface waters adjacent to the Futiga landfill in American Samoa. All sampled stream sediments contained high concentrations of lead, and some of mercury. Several coastal stream waters showed relatively high concentrations of diethyl phthalate and of organophosphate pesticides, above chronic toxicity values for fish and other aquatic organisms. Parathion, which has been banned by the US Environmental Protection Agency since 2006, was detected in several stream sites. Increased monitoring and initiatives to limit non-point source land-based pollution will greatly improve the state of freshwater and coastal resources, as well as reduce risks to human health in American Samoa.

Variability of Symbiodinium Communities in Waters, Sediments, and Corals of Thermally Distinct Reef Pools in American Samoa

Reef-building corals host assemblages of symbiotic algae (Symbiodinium spp.) whose diversity and abundance may fluctuate under different conditions, potentially facilitating acclimatization to environmental change. The composition of free-living Symbiodinium in reef waters and sediments may also be environmentally labile and may influence symbiotic assemblages by mediating supply and dispersal. The magnitude and spatial scales of environmental influence over Symbiodinium composition in different reef habitat compartments are, however, not well understood. We used pyrosequencing to compare Symbiodinium in sediments, water, and ten coral species between two backreef pools in American Samoa with contrasting thermal environments. We found distinct compartmental assemblages of clades A, C, D, F, and/or G Symbiodinium types, with strong differences between pools in water, sediments, and two coral species. In the pool with higher and more variable temperatures, abundance of various clade A and C types differed compared to the other pool, while abundance of D types was lower in sediments but higher in water and in Pavona venosa, revealing an altered habitat distribution and potential linkages among compartments. The lack of between-pool effects in other coral species was due to either low overall variability (in the case of Porites) or high within-pool variability. Symbiodinium communities in water and sediment also showed within-pool structure, indicating that environmental influences may operate over multiple, small spatial scales. This work suggests that Symbiodinium composition is highly labile in reef waters, sediments, and some corals, but the underlying drivers and functional consequences of this plasticity require further testing with high spatial resolution biological and environmental sampling.

Barriers to adequate prenatal care utilization in American Samoa

The objective of this study is to describe the utilization of prenatal care in American Samoan women and to identify socio-demographic predictors of inadequate prenatal care utilization. Using data from prenatal clinic records, women (n = 692) were categorized according to the adequacy of prenatal care utilization index as having received adequate plus, adequate, intermediate or inadequate prenatal care during their pregnancy. Categorical socio-demographic predictors of the timing of initiation of prenatal care (week of gestation) and the adequacy of received services were identified using one way analysis of variance and independent samples t tests. Between 2001 and 2008 85.4 % of women received inadequate prenatal care. Parity (P = 0.02), maternal unemployment (P = 0.03), and both parents being unemployed (P = 0.03) were negatively associated with the timing of prenatal care initiation. Giving birth in 2007-2008, after a prenatal care incentive scheme had been introduced in the major hospital, was associated with earlier initiation of prenatal care (20.75 vs. 25.12 weeks; P < 0.01) and improved adequacy of received services (95.04 vs. 83.8 %; P = 0.02). The poor prenatal care utilization in American Samoa is a major concern. Improving healthcare accessibility will be key in encouraging women to attend prenatal care. The significant improvements in the adequacy of prenatal care seen in 2007-2008 suggest that the prenatal care incentive program implemented in 2006 may be a very positive step toward addressing issues of prenatal care utilization in this population.

Transcriptome-wide Changes in Coral Gene Expression at Noon and Midnight Under Field Conditions

Reef-building corals experience high daily variation in their environment, food availability, and physiological activities such as calcification and photosynthesis by endosymbionts. On Ofu Island, American Samoa, we investigated day-night differences in gene expression under field conditions of changing pH, temperature, light, and oxygen. Using RNASeq techniques, we compared two replicate transcriptomes from a single coral colony of Acropora hyacinthus over six noons and five midnights. We identified 344 contigs with significant expression differences across 16,800 contigs in the transcriptome, most with small fold-changes. However, there were 21 contigs with fold-changes ranging from 10 to 141. The largest changes were in a set of transcription factors strongly associated with day-night gene regulation in other animals, including cryptochromes, thyrotroph embryonic factor, and D site-binding protein. We also found large daytime increases in a set of genes involved in glucose transport and glycogen storage. We found small expression differences in genes associated with aerobic ATP production and hypoxia response, along with slightly higher expression of most calcification genes at noon. Although >40-fold-changes in expression occur in important transcription factors, downstream gene regulation seems very stable in corals from day to night compared to other animals studied.

Insights in public health: a tale of two polities: health in Independent and American Samoa

Independent and American Samoa have a shared cultural, genetic, ethnolinguistic, and historical background but have been politically separated since 1899. In this essay, we examine the health of these two polities and identify two key health patterns that have emerged even as American Samoa has achieved a higher per capita income than Independent Samoa. Whereas the gender gap in life expectancy at birth has narrowed in Independent Samoa, this gap has not narrowed in American Samoa and its male life expectancy now lags behind that of Independent Samoa. Neonatal mortality rates in American Samoa are slightly higher than in Independent Samoa. These patterns may be linked to the higher rates of obesity and urbanization observed in American Samoa compared to Independent Samoa, as well as the differing political and institutional arrangements of the two polities. Limited data remains a persistent challenge to conducting analysis of public health in the Pacific islands, particularly in American Samoa.

Hepatitis B vaccination for healthcare personnel in American Samoa: pre-implementation survey for policy decision

American Samoa does not have a hepatitis B vaccination policy for healthcare personnel (HCP). Consequently, hepatitis B has remained a health threat to HCP. In this study, we performed a cross-sectional study and examined demographic and risk information and hepatitis B vaccination, testing, and serostatus in hospital employees in American Samoa. Of 604 hospital employees, 231 (38·2%) participated, and of these, 158 (68·4%) were HCP. Of HCP participants, 1·9% had chronic hepatitis B infection, 36·1% were susceptible, and 60·8% were immune. Nearly half of HCP participants reported history of needlestick injury. Overall, participants' knowledge of their hepatitis B infection and vaccination status was low. These data support the adoption of a hepatitis B vaccination policy for HCP by American Samoa, as currently recommended by the World Health Organization and the US Centers for Disease Control and Prevention. Adherence to the policy could be monitored as a way to measure protection.

Translating the semi-structured assessment for drug dependence and alcoholism in the Western Pacific: rationale, study design and reliability of alcohol dependence

AIMS

The aims of this study were to develop a bilingual version of the Semi-Structured Assessment for Drug Dependence and Alcoholism (SSADDA) in English and Samoan and determine the reliability of assessments of alcohol dependence in American Samoa.

METHODS

The study consisted of development and reliability-testing phases. In the development phase, the SSADDA alcohol module was translated and the translation was evaluated through cognitive interviews. In the reliability-testing phase, the bilingual SSADDA was administered to 40 ethnic Samoans, including a sub-sample of 26 individuals who were retested.

RESULTS

Cognitive interviews indicated the initial translation was culturally and linguistically appropriate except items pertaining to alcohol tolerance, which were modified to reflect Samoan concepts. SSADDA reliability testing indicated diagnoses of DSM-III-R and DSM-IV alcohol dependence were reliable. Reliability varied by language of administration.

CONCLUSION

The English/Samoan version of the SSADDA is appropriate for the diagnosis of DSM-III-R alcohol dependence, which may be useful in advancing research and public health efforts to address alcohol problems in American Samoa and the Western Pacific. The translation methods may inform researchers translating diagnostic and assessment tools into different languages and cultures.

Trade-offs among catch, bycatch, and landed value in the American Samoa longline fishery

The interspecific preferences of fishes for different depths and habitats suggest fishers could avoid unwanted catches of some species while still effectively targeting other species. In pelagic longline fisheries, albacore (Thunnus alalunga) are often caught in relatively cooler, deeper water (>100 m) than many species of conservation concern (e.g., sea turtles, billfishes, and some sharks) that are caught in shallower water (<100 m). From 2007 to 2011, we examined the depth distributions of hooks for 1154 longline sets (3,406,946 hooks) and recorded captures by hook position on 2642 sets (7,829,498 hooks) in the American Samoa longline fishery. Twenty-three percent of hooks had a settled depth <100 m. Individuals captured in the 3 shallowest hook positions accounted for 18.3% of all bycatch. We analyzed hypothetical impacts for 25 of the most abundant species caught in the fishery by eliminating the 3 shallowest hook positions under scenarios with and without redistribution of these hooks to deeper depths. Distributions varied by species: 45.5% (n = 10) of green sea turtle (Chelonia mydas), 59.5% (n = 626) of shortbill spearfish (Tetrapturus angustirostris), 37.3% (n = 435) of silky shark (Carcharhinus falciformis), and 42.6% (n = 150) of oceanic whitetip shark (C. longimanus) were caught on the 3 shallowest hooks. Eleven percent (n = 20,435) of all tuna and 8.5% (n = 10,374) of albacore were caught on the 3 shallowest hooks. Hook elimination reduced landed value by 1.6-9.2%, and redistribution of hooks increased average annual landed value relative to the status quo by 5-11.7%. Based on these scenarios, redistribution of hooks to deeper depths may provide an economically feasible modification to longline gear that could substantially reduce bycatch for a suite of vulnerable species. Our results suggest that this method may be applicable to deep-set pelagic longline fisheries worldwide.

Comparative population assessments of Nautilus sp. in the Philippines, Australia, Fiji, and American Samoa using baited remote underwater video systems

The extant species of Nautilus and Allonautilus (Cephalopoda) inhabit fore-reef slope environments across a large geographic area of the tropical western Pacific and eastern Indian Oceans. While many aspects of their biology and behavior are now well-documented, uncertainties concerning their current populations and ecological role in the deeper, fore-reef slope environments remain. Given the historical to current day presence of nautilus fisheries at various locales across the Pacific and Indian Oceans, a comparative assessment of the current state of nautilus populations is critical to determine whether conservation measures are warranted. We used baited remote underwater video systems (BRUVS) to make quantitative photographic records as a means of estimating population abundance of Nautilus sp. at sites in the Philippine Islands, American Samoa, Fiji, and along an approximately 125 km transect on the fore reef slope of the Great Barrier Reef from east of Cairns to east of Lizard Island, Australia. Each site was selected based on its geography, historical abundance, and the presence (Philippines) or absence (other sites) of Nautilus fisheries The results from these observations indicate that there are significantly fewer nautiluses observable with this method in the Philippine Islands site. While there may be multiple possibilities for this difference, the most parsimonious is that the Philippine Islands population has been reduced due to fishing. When compared to historical trap records from the same site the data suggest there have been far more nautiluses at this site in the past. The BRUVS proved to be a valuable tool to measure Nautilus abundance in the deep sea (300–400 m) while reducing our overall footprint on the environment.

Monitoring herbivorous fishes as indicators of coral reef resilience in American Samoa

Resilience-based management aims to promote or protect processes and species that underpin an ecosystem's capacity to withstand and recover from disturbance. The management of ecological processes is a developing field that requires reliable indicators that can be monitored over time. Herbivory is a key ecological process on coral reefs, and pooling herbivorous fishes into functional groups based on their feeding mode is increasingly used as it may quantify herbivory in ways that indicate resilience. Here we evaluate whether the biomass estimates of these herbivore functional groups are good predictors of reef benthic assemblages, using data from 240 sites from five island groups in American Samoa. Using an information theoretic approach, we assembled a candidate set of linear and nonlinear models to identify the relations between benthic cover and total herbivore and non-herbivore biomass and the biomass of the aforementioned functional groups. For each benthic substrate type considered (encrusting algae, fleshy macroalgae, hard coral and turf algae), the biomass of herbivorous fishes were important explanatory variables in predicting benthic cover, whereas biomass of all fishes combined generally was not. Also, in all four cases, variation in cover was best explained by the biomass of specific functional groups rather than by all herbivores combined. Specifically: 1) macroalgal and turf algal cover decreased with increasing biomass of ‘grazers/detritivores’; and 2) cover of encrusting algae increased with increasing biomass of ‘grazers/detritivores’ and browsers. Furthermore, hard coral cover increased with the biomass of large excavators/bio-eroders (made up of large-bodied parrotfishes). Collectively, these findings emphasize the link between herbivorous fishes and the benthic community and demonstrate support for the use of functional groups of herbivores as indicators for resilience-based monitoring.

Factors affecting household adoption of an evacuation plan in American Samoa after the 2009 earthquake and tsunami

American Samoa is still recovering from the debilitating consequences of the September 29, 2009 tsunami. Little is known about current household preparedness in American Samoa for future earthquakes and tsunamis. Thus, this study sought to enumerate the number of households with an earthquake and tsunami evacuation plan and to identify predictors of having a household evacuation plan through a post-tsunami survey conducted in July 2011. Members of 300 households were interviewed in twelve villages spread across regions of the principle island of Tutuila. Multiple logistic regression showed that being male, having lived in one's home for < 30 years, and having a friend who suffered damage to his or her home during the 2009 tsunami event increased the likelihood of having a household evacuation plan. The prevalence of tsunami evacuation planning was 35% indicating that survivors might feel that preparation is not necessary given effective adaptive responses during the 2009 event. Results suggest that emergency planners and public health officials should continue with educational outreach to families to spread awareness around the importance of developing plans for future earthquakes and tsunamis to help mitigate human and structural loss from such natural disasters. Additional research is needed to better understand the linkages between pre-event planning and effective evacuation responses as were observed in the 2009 events.

Swarming behavior of Aedes polynesiensis (Diptera: Culicidae) and characterization of swarm markers in American Samoa

We characterize the swarming behavior of male Aedes polynesiensis (Marks) in American Samoa. Instead of swarming around a blood host, males used the base of certain trees as a marker. Repeated sampling proved nondestructive and allowed us to investigate the impact of static (e.g., tree species) and dynamic (e.g., barometric pressure) characters on the likelihood of swarm presence and intensity. Tree circumference and oviposition activity (number of Ae. polynesiensis reared from oviposition cups) were significant positive predictors of the number of males in a swarm. Tree circumference and diameter were significantly positively associated, and canopy height was significantly negatively associated, with swarm occurrence. Comparisons between males swarming early and late during the swarming period allowed for insight into swarm composition in terms of male size and the amount of putative fluid (e.g., nectar) in the crop, indicators of energetic reserves. Males collected during the late period had significantly larger wings and less crop contents than did males of the early cohort. Because the ecology of male Ae. polynesiensis remains understudied, we consider how the current results could facilitate further studies related to applied autocidal strategies as well as the evolution of host-based mating behavior.

Nurse-community health worker team improves diabetes care in American Samoa: results of a randomized controlled trial

OBJECTIVE

To evaluate the effectiveness of a culturally adapted, primary care-based nurse-community health worker (CHW) team intervention to support diabetes self-management on diabetes control and other biologic measures.

RESEARCH DESIGN AND METHODS

Two hundred sixty-eight Samoan participants with type 2 diabetes were recruited from a community health center in American Samoa and were randomly assigned by village clusters to the nurse-CHW team intervention or to a wait-list control group that received usual care.

RESULTS

Participants had a mean age of 55 years, 62% were female, mean years of education were 12.5 years, 41% were employed, and mean HbA1c was 9.8% at baseline. At 12 months, mean HbA1c was significantly lower among CHW participants, compared with usual care, after adjusting for confounders (b = -0.53; SE = 0.21; P = 0.03). The odds of making a clinically significant improvement in HbA1c of at least 0.5% in the CHW group was twice the odds in the usual care group after controlling for confounders (P = 0.05). There were no significant differences in blood pressure, weight, or waist circumference at 12 months between groups.

CONCLUSIONS

A culturally adapted nurse-CHW team intervention was able to significantly improve diabetes control in the U.S. Territory of American Samoa. This represents an important translation of an evidence-based model to a high-risk population and a resource-poor setting.

Assessing the system of services for chronic diseases prevention and control in the US-affiliated Pacific Islands: introduction and methods

Chronic diseases are among the most costly and, in part, preventable health problems that share common behavioral risk factors. Data related to the prevalence of chronic diseases, such as diabetes, their risk factors, and the description of the capacity of the health and medical care system to address these problems are limited in the US-affiliated Pacific Islands (USAPI). This paper presents the background and methods used in conducting comprehensive assessments of the health care systems in ten sites across the USAPI. The principles used as the basis for conducting these assessments included capacity building and skills training. The methods included identifying the on-site Needs Assessment Team (NAT), developing the conceptual model; archival data collection; key informant interviews; reviewing data and documents to identify the key problems and issues to be prioritized; and reviewing and prioritizing the problems and issues.

Structures and cytotoxic evaluation of new and known acyclic Ene-Ynes from an American Samoa Petrosia sp. Sponge

Four new compounds, (-)-petrosynoic acids A-D (1-4), and five known congeners, pellynols A (5), C (6), D (7), F (8), and I (9), were isolated from a Petrosia sp. marine sponge collected in American Samoa. Isolation work was guided by cytotoxicity against human lung cancer cells (H460). The structures of the C31-C33 polyacetylenes (1-9) were determined on the basis of 1D- and 2D-NMR analysis, mass spectrometry, and comparison of specific rotation values. Compounds 1-9 were found to be broadly cytotoxic with limited selectivity for cancer cells, as they were all moderately active against the A2058 (melanoma), H522-T1 (lung), and H460 (lung) human cancer cell lines as well as IMR-90 quiescent human fibroblast cells.

A descriptive study in American Samoa: services for people with disabilities

State agency service providers of persons with disabilities were surveyed and interviewed in American Samoa to describe and understand the level of services offered within the federal mandates and cultural context. Responses to the survey indicated that a majority of consumers do not request services or complete the application forms themselves. The interviews revealed an important aspect that was overlooked from the initial stages of the study: Many service providers did not have a conceptual understanding of self-determination as defined within a western context. We believe this cultural and contextual difference influenced how they responded to particular questions and perhaps how they engaged in providing services. This preliminary study opens the door for follow up investigations to determine the interplay of culture and federal regulations coinciding within a Pacific Island population.

A case of severe septicemia following traditional Samoan tattooing

Traditional Samoan tattoos, or tatau, are created by master tattooists, or tufuga ta tatau, and their assistants using multi-pointed handmade tools. These tools are used to tap tattoo pigment into the skin, usually over several days. This traditional process is considered an honor to the one receiving the tatau. Unfortunately, as it is typically practiced according to cultural traditions, the sanitary practices are less than ideal. There have been several reported cases of severe infection, sepsis, shock, and even death as a result of traditional Samoan tattoos. Although Hawai'i is the home of the second largest Samoan population in the United States, short of only American Samoa, literature review found no published case reports in this state. Presented is a case of a 46-year-old man, who, after undergoing a modified version of traditional Samoan tattooing for 5 days, was admitted to the intensive care unit with severe septic shock due to poly-microbial bacteremia with Group A Streptococcus and Methicillin-sensitive Staphylococcus Aureus. In addition, we will discuss the previously reported cases, mainly documented in New Zealand, and review some of the mandatory sanitary standards put into place there.

Humpback whale (Megaptera novaeangliae) song occurrence at American Samoa in long-term passive acoustic recordings, 2008-2009

Humpback whales (Megaptera novaeangliae) wintering in American Samoan waters belong to the endangered Oceania subpopulation (IUCN Red List), but survey effort in this region has been relatively limited. Humpback whale seasonal occurrence was assessed using long-term passive acoustic recordings from March 2008 to July 2009 at Tutuila, the most populous island of American Samoa, and October 2008 to September 2009 at the remote Rose Atoll, 240 km to the east. Humpback whale song occurred from mid-July through November at both locations. For days with song, the mean number of recordings per day with song was significantly greater at Tutuila than at Rose Atoll. Song incidence at Rose Atoll peaked at 82% of recordings/day in late September 2008, and at Tutuila 70-100% of recordings contained song in late August through early September 2009, when recording ceased. Song incidence at Rose Atoll decreased at midday and increased at midnight, whereas there was no significant diurnal pattern at Tutuila. The lower overall incidence of song and its episodic nature at Rose Atoll suggest lower densities of whales traveling through the likely smaller detection area there, whereas greater song incidence and longer peak periods at Tutuila suggest greater whale densities and longer residence times.

Secondhand smoke concentrations in hospitality venues in the Pacific Basin: findings from American Samoa, Commonwealth of the Northern Mariana Islands, and Guam

INTRODUCTION

Secondhand smoke (SHS) from burning tobacco products causes disease and premature death among nonsmokers. Although the number of laws prohibiting smoking in indoor public places continues to increase, millions of nonsmokers in the United States (US) and its territories remain exposed to SHS. This study assessed indoor air pollution from SHS in hospitality venues in three US Pacific Basin territories.

METHODS

Air monitors were used to assess PM2.5, an environmental marker for SHS, in 19 smoke-permitted and 18 smoke- free bars and restaurants in American Samoa, Commonwealth of the Northern Mariana Islands (CNMI), and Guam. Observational logs were used to record smoking and other sources of air pollution. Differences in average PM2.5 concentrations were determined using bivariate statistics.

RESULTS

The average PM2.5 level in venues where smoking was always permitted [arithmetic mean (AM)=299.98 μg/m3; geometric mean (GM)=200.39 μg/ m3] was significantly higher (p<0.001) than smoke-free venues [AM=8.33 μg/m3; GM=6.14 μg/m3]. In venues where smoking was allowed only during certain times, the average level outside these times [AM=42.10 μg/m3; GM=41.87 μg/m3] was also significantly higher (p<0.001) than smoke-free venues.

CONCLUSIONS

Employees and patrons of smoke-permitted bars and restaurants are exposed to dangerous levels of air pollution from SHS, even during periods when active smoking is not occurring. Prohibiting smoking in all public indoor areas, irrespective of the venue type or time of day, is the only way to fully protect nonsmokers from SHS exposure in these environments.

Water quality and herbivory interactively drive coral-reef recovery patterns in American Samoa

Background

Compared with a wealth of information regarding coral-reef recovery patterns following major disturbances, less insight exists to explain the cause(s) of spatial variation in the recovery process.

Methodology/Principal Findings

This study quantifies the influence of herbivory and water quality upon coral reef assemblages through space and time in Tutuila, American Samoa, a Pacific high island. Widespread declines in dominant corals (Acropora and Montipora) resulted from cyclone Heta at the end of 2003, shortly after the study began. Four sites that initially had similar coral reef assemblages but differential temporal dynamics four years following the disturbance event were classified by standardized measures of ‘recovery status’, defined by rates of change in ecological measures that are known to be sensitive to localized stressors. Status was best predicted, interactively, by water quality and herbivory. Expanding upon temporal trends, this study examined if similar dependencies existed through space; building multiple regression models to identify linkages between similar status measures and local stressors for 17 localities around Tutuila. The results highlighted consistent, interactive interdependencies for coral reef assemblages residing upon two unique geological reef types. Finally, the predictive regression models produced at the island scale were graphically interpreted with respect to hypothesized site-specific recovery thresholds.

Conclusions/Significance

Cumulatively, our study purports that moving away from describing relatively well-known patterns behind recovery, and focusing upon understanding causes, improves our foundation to predict future ecological dynamics, and thus improves coral reef management.

Perceptions and use of complementary and alternative medicine in American Samoa: a survey of health care providers

PURPOSE

American Samoa health care providers' use and perceptions of common complementary and alternative treatments, with a focus on traditional Samoan healing for women diagnosed with breast cancer or cervical cancer, was investigated to inform the development of the first locally produced women's cancer prevention radio drama and the first cancer patient navigator program in the US Territory.

METHODS

A 10-item self-administered survey was completed by a total of 47 health care providers employed at the Lyndon B. Johnson Tropical Medical Center and the American Samoa Department of Health Breast and Cervical Cancer Early Detection Program.

FINDINGS

Comprehensive health care is limited in American Samoa, especially cancer treatment. Dissatisfaction or disconnection with Western medicine leads some patients to seek complementary or alternative health care from traditional Samoan healers who provide massage and herbal remedies. Health care providers in American Samoa use and recommend many complementary and alternative medicines (CAM) popular in the United States. The most common CAM recommended to patients is exercise (81%), diet modification (81%), prayer (36%), massage (36%), support group participation (26%), and relaxation techniques (19%). Traditional Samoan healing methods are unique CAM that 19% of mainstream health care providers have used, and 17% have recommended these techniques to patients. Most survey respondents believe traditional Samoan healing methods have a harmful effect on patient quality of life and 72% have advised a patient to discontinue using this type of CAM. While most providers feel that the majority of American Samoan patients use traditional healing methods to complement Western healthcare, 55% are aware of a breast cancer or cervical cancer patient utilizing these techniques as an alternative to hospital treatment. A provider's ethnicity, gender, age and years of professional experience appear to be indicators of different CAM method endorsement and patient consultations concerning CAM use.

CONCLUSIONS

CAM use is likely to continue in American Samoa as long as health care deficiencies exist. Most American Samoa health care professionals accept common CAM in the United States, but local providers are more likely to endorse traditional healing methods than their mainland counterparts. Little is known of the impact different CAM have on quality of life, especially amongst cancer patients. The majority of American Samoa health care providers request more information about tradition al healing which would facilitate more comprehensive medical documentation and patient care.

American Samoan women's health: experiences and attitudes toward breast and cervical cancer screening

BACKGROUND

Cancer is the second leading cause of death among Samoan women and, compared to women of other ethnicities in the United States, Samoan women present at earlier ages with advanced stages of both breast and cervical cancers. Our goal was to gain a better understanding of issues that may prevent women in American Samoa from using available cancer screening resources.

METHODS

Following approval from the Office of Samoan Affairs, we conducted four focus group sessions, in which a total of 55 women from urban and rural sites participated. Women were asked about their perceptions regarding barriers, knowledge, and past utilization of available cancer screening services.

RESULTS

Among the participants, professional women were more aware and had higher utilization rates of age-specific screening services. Barriers to health care services included lack of awareness and fears regarding poor confidentiality.

DISCUSSION

Our findings, which have been reviewed by participants, highlight the further need for outreach and education about female cancers. Screening rates could be increased and all services may benefit from increased collaboration between the American Samoa Department of Public Health and Lyndon B. Johnson (LBJ) Tropical Medical Center. Our findings underline a need for additional staff training in professionalism, particularly in the areas of confidentiality and respect for patients.

Xenomonitoring of Wuchereria bancrofti and Dirofilaria immitis infections in mosquitoes from American Samoa: trapping considerations and a comparison of polymerase chain reaction assays with dissection

Entomologic monitoring of filarial infections, xenomonitoring, may have advantages in certain epidemiologic situations to assess the presence of infections in humans. Hemalum staining and dissection and polymerase chain reaction (PCR) were compared to determine the filarial infection status of Aedes (Stegomyia) mosquitoes in American Samoa. The overall prevalences of Wuchereria bancrofti and Dirofilaria immitis infections in Ae. polynesiensis were, respectively, 0.16% and 1.06% by dissection and 0.69% and 1.77% by PCR. Human filarial worm DNA rates in Aedes aegypti and Aedes upolensis were 1.16% and 0.38%, respectively. The results suggest that W. bancrofti transmission to humans may be continuing at low levels in some villages despite recent completion of 5 years of mass drug administration. PCR testing of mosquitoes collected using the BG-Sentinel traps represents a promising alternative to landing catches for assessing the transmission of filariasis in areas where Ae. polynesiensis and related species are the primary vectors.

Susceptibility loci for adiposity phenotypes on 8p, 9p, and 16q in American Samoa and Samoa

Obesity is a complex phenotype affected by genetic and environmental influences such as sociocultural factors and individual behaviors. Previously, we performed two separate genome-wide investigations for adiposity-related traits (BMI, percentage body fat (%BF), abdominal circumference (ABDCIR), and serum leptin and serum adiponectin levels) in families from American Samoa and in families from Samoa. The two polities have a common evolutionary history but have lately been influenced by variations in economic development, leading to differences in income and wealth and in dietary and physical activity patterns. We now present a genome-wide linkage scan of the combined samples from the two polities. We adjust for environmental covariates, including polity of residence, education, cigarette smoking, and farm work, and use variance component methods to calculate univariate and bivariate multipoint lod scores. We identified a region on 9p22 with genome-wide significant linkage for the bivariate phenotypes ABDCIR-%BF (1-d.f. lod 3.30) and BMI-%BF (1-d.f. lod 3.31) and two regions with genome-wide suggestive linkage on 8p12 and 16q23 for adiponectin (lod 2.74) and the bivariate phenotype leptin-ABDCIR (1-d.f. lod 3.17), respectively. These three regions have previously been reported to be linked to adiposity-related phenotypes in independent studies. However, the differences in results between this study and our previous polity-specific studies suggest that environmental effects are of different importance in the samples. These results strongly encourage further genetic studies of adiposity-related phenotypes where extended sets of carefully measured environmental factors are taken into account.

Assessing coastal waters of American Samoa: territory-wide water quality data provide a critical "big-picture" view for this tropical archipelago

The coastal waters of American Samoa's five high islands (Tutuila, Aunu'u, Ofu, Olosega, and Ta'u) were surveyed in 2004 using a probabilistic design. Water quality data were collected from the near-shore coastal habitat, defined as all near-shore coastal waters including embayments, extending out to 1/4 mile off-shore. Hydrography and water column samples were collected, and water quality data were compared to the Territorial water quality standards for pH, dissolved oxygen (DO), Enterococcus, chlorophyll a, water clarity, total nitrogen, and total phosphorus. All station measurements for pH, DO, and Enterococcus satisfied the local water quality standards, although some fraction of the Territory could not be assessed for either DO or Enterococcus. With respect to chlorophyll a, 66 +/- 18% of Territory coastal waters complied with the standard, while 34 +/- 18% failed to comply with the standard. For water clarity, 54 +/- 18% of the Territorial waters complied with the standard while 42 +/- 7% failed to comply. Territorial waters satisfied the standards for total nitrogen and phosphorus 72 +/- 17% and 92 +/- 10%, respectively. These data provide the first "big-picture" view of water quality in the near shore region around the high islands of American Samoa. While the picture is encouraging, these data suggest emerging water quality concerns.

Temporal variability in chlorophyll fluorescence of back-reef corals in Ofu, American Samoa

Change in the yield of chlorophyll a fluorescence is a common indicator of thermal stress in corals. The present study reports temporal variability in quantum yield measurements for 10 coral species in Ofu, American Samoa-a place known to experience elevated and variable seawater temperatures. In winter, the zooxanthellae generally had higher dark-adapted maximum quantum yield (F(v)/F(m)), higher light-adapted effective quantum yield (DeltaF/F'(m)), and lower relative electron transport rates (rETR) than in the summer. Temporal changes appeared unrelated to the expected bleaching sensitivity of corals. All species surveyed, with the exception of Montipora grisea, demonstrated significant temporal changes in the three fluorescence parameters. Fluorescence responses were influenced by the microhabitat-temporal differences in fluorescence parameters were usually observed in the habitat with a more variable temperature regime (pool 300), while differences in F(v)/F(m) between species were observed only in the more environmentally stable habitat (pool 400). Such species-specific responses and microhabitat variability should be considered when attempting to determine whether observed in situ changes are normal seasonal changes or early signs of bleaching.

Evaluation of three traps for sampling Aedes polynesiensis and other mosquito species in American Samoa

The efficacy of the recently developed BG-Sentinel mosquito trap baited with BG-Lure (a combination of lactic acid, ammonia, and caproic acid) was evaluated in American Samoa against the omnidirectional Fay-Prince trap and the Centers for Disease Control and Prevention (CDC) light trap, both baited with carbon dioxide. The BG-Sentinel trap captured the greatest number of the important filariasis and dengue vector Aedes (Stegomyia) polynesiensis at all 3 collection locations; however, its catch rate was not significantly different from that of the Fay-Prince trap at 2 of the 3 trapping locations. The CDC light trap caught very few Ae. polynesiensis. The Fay-Prince trap was more efficient than the other 2 traps for collecting Aedes (Aedimorphus) nocturnus, Aedes (Finlaya) spp., Culex quinquefasciatus, and Culex annulirostris. The efficacy and convenience of the BG-Sentinel suggest further research is warranted to evaluate its potential as a possible efficient and safe alternative to landing catches for sampling Ae. polynesiensis in research and control efforts against filariasis and dengue in the South Pacific.

Arsenic speciation in marine fish and shellfish from American Samoa

We speciated arsenic compounds in marine fish and shellfish from two islands of the United States Territory of American Samoa in the South Pacific, and found that inorganic arsenic occurred as a minor fraction. The proportion of inorganic arsenic was generally far below the levels of prevailing assumptions typically used in human health risk assessments when only total arsenic is analysed. Fish and shellfish were collected from Tutuila and Ofu between May 2001 and March 2002 (n=383 individual specimens, with 117 composites); sites were selected based on habitat type and were representative of those frequented by local fishers. These islands have moderately developed reef fish fisheries among artisanal fishers, are far removed from any industrial or mining sources of arsenic, and presented an opportunity to study arsenic variations in marine biota from un-impacted environments. Target species were from various trophic levels and are among those frequently harvested for human consumption. We found evidence that arsenic concentrated in some marine species, but did not tend to follow classic trophic patterns for biomagnification or bioaccumulation. For the majority of samples, inorganic arsenic was less than 0.5% of total arsenic, with only a few samples in the range of 1-5%, the latter being mollusks which are recognized to have unusually high arsenic levels in general. This work supports the importance of speciation analysis for arsenic, because of the ubiquitous occurrence of arsenic in the environment, and its variable toxicity depending on chemical form.

Composite estimates of physiological stress, age, and diabetes in American Samoans

Composite estimates of physiological stress such as allostatic load (AL) were developed to help assess cumulative impacts of psychosocial and physical stressors on the body. Physiological responses to stress generally accelerate somatic wear-and-tear and chronic degenerative conditions (CDCs). Following McEwen (Neuropsychopharmacology 22 (1999) 108-124) and others, primary physiological mediators of somatic stress responses include glucocorticoids (cortisol), catecholamines (adrenaline and noradrenaline), and serum dihydroepiandosterone-sulfate (DHEA-S). Conversely, blood pressure (BP), serum HDL and total cholesterol, glycated hemoglobin (HbA1c), and waist/hip (w/h) ratio are modulated by such hormones, thereby acting as secondary mediators of stress response. When these risk factors are aggregated into a composite score, higher stress loads are associated with increased risks for days of school/work missed, functional losses, morbidity, and mortality in US samples. To examine stress loads in American Samoans, data on all 6 secondary mediators along with estimates of body habitus (i.e. height, weight, circumferences, skinfolds) and physiology (i.e. fasting insulin, LDLc, triglycerides, fasting glucose) were measured on 273 individuals residing on Tutuila Island in 1992. Four combinations of these physiological factors were used to determine composite estimates of stress. These were then assessed by sex for associations with age and the presence of diabetes. Composite estimates of stress load were higher in Samoan women than men. Associations with age tended to be low and negative in men, but positive in women, appearing to reflect cultural circumstances and population history. Stress load scores also were higher among those with diabetes than those without among both men and women. These results suggest that composite estimates of stress may be useful for assessing future risks of CDC's and the senescent processes that may underlie them in cross-cultural research.

Genome-wide scan for adiposity-related phenotypes in adults from American Samoa

OBJECTIVE

To detect quantitative trait loci influencing adiposity-related phenotypes assessed by body mass index (BMI), abdominal circumference (ABDCIR), percent body fat (%BFAT) and fasting serum leptin and adiponectin using a whole genome linkage scan of families from American Samoa.

DESIGN

Family-based linkage analysis, the probands and family members were unselected for obesity.

SUBJECTS

A total of 583 phenotyped American Samoan adults, of which 578 were genotyped in 34 pedigrees.

MEASUREMENTS

A total of 377 autosomal and 18 X chromosome microsatellite markers were typed at an approximate average spacing of 10 cM spanning the genome. Multipoint LOD (logarithm of the odds) scores were calculated using variance-components approaches and SOLAR/LOKI software. The covariates simultaneously evaluated were age, sex, education, farm work and cigarette smoking, with a significance level of 0.1. Due to the stochastic nature of LOKI, we report the average of maximum LOD scores from 10 runs.

RESULTS

Significant linkage to leptin was found at 6q32.2 with LOD of 3.83. Suggestive linkage to leptin was found at 16q21:LOD=2.98, 1q42.2:LOD=1.97, 5q11.2:LOD=2.08, 12q24.23:LOD=2.00, 19p13.3:LOD=2.05; adiponectin was linked to 13q33.1-q22.1:LOD=2.41; %BFAT was linked to 16q12.2-q21, LOD=2.24; ABDCIR was linked to 16q23.1:LOD=1.95; %BFAT-adjusted leptin to 14q12, LOD=2.01; %BFAT-adjusted ABDCIR to 1q31.1, LOD=2.36, to 3q27.3-q28, LOD=2.10 and to 12p12.3, LOD=2.04.

CONCLUSION

We found strong evidence for a major locus on 6q23.2 influencing serum leptin levels in American Samoans. The 16q21 region appears to harbor a susceptibility locus that has significant pleiotrophic effects on phenotypes BMI, %BFAT, leptin and ABDCIR as shown by bivariate linkage analyses. Several other loci of varying significance were detected across the genome.

Legacy of the Pacific Islander cancer control network

The groundwork for the Pacific Islander cancer control network (PICCN) began in the early 1990s with a study of the cancer control needs of American Samoans. The necessity for similar studies among other Pacific Islander populations led to the development of PICCN. The project's principal objectives were to increase cancer awareness and to enhance cancer control research among American Samoans, Tongans, and Chamorros. PICCN was organized around a steering committee and 6 community advisory boards, 2 from each of the targeted populations. Membership included community leaders, cancer control experts, and various academic and technical organizations involved with cancer control. Through this infrastructure, the investigators developed new culturally sensitive cancer education materials and distributed them in a culturally appropriate manner. They also initiated a cancer control research training program, educated Pacific Islander students in this field, and conducted pilot research projects. PICCN conducted nearly 200 cancer awareness activities in its 6 study sites and developed cancer educational materials on prostate, colorectal, lung, breast, and cervical cancer and tobacco control in the Samoan, Tongan, and Chamorro languages. PICCN trained 9 students who conducted 7 pilot research projects designed to answer important questions regarding the cancer control needs of Pacific Islanders and to inform interventions targeting those needs. The legacy of PICCN lies in its advancement of improving cancer control among Pacific Islanders and setting the stage for interventions that will help to eliminate cancer-related health disparities. Cancer 2006. (c) 2006 American Cancer Society.

A cross-cultural perspective on obesity and health in three groups of women: the Mississippi Choctaw, American Samoans, and African Americans

This study compares obesity as assessed by Body Mass Index (BMI) and the relationship of BMI to hypertension and diabetes in adult females from three populations, the Mississippi Band of Choctaw (N=50), American Samoa (N=155), and an African American community in West Alabama (N=367). These groups were surveyed in the early to mid 1990s. All three groups of women have very high levels of overweight and obesity, with the Samoans being most extreme in this regard. While there are indications that all three groups of women consume a calorically dense diet, low activity appears to be the most likely causal factor in the high rates of obesity. Relaxed negative attitudes toward an overweight/obese body image may also play a role in the high rates. The prevalences of hypertension and diabetes are alarmingly high in all three groups. There are, however, very different associations between BMI, hypertension, and diabetes in the three groups of women. The Samoans are substantially more obese (and older), but they have lower rates of hypertension than the African American women and lower rates of diabetes than the Choctaw women. While the genetic background of the three groups no doubt plays a role, it is also likely that a BMI of 30+, the common cutoff for obesity, means different things in these different populations. These results provide further support for the idea of variation in the relationship of BMI to disease in different populations.

American Samoa assessment for a continuing health care professional development program

In 2003, the University of Hawai'i Department of Family Medicine & Community Health entered a 4-year cooperative agreement with the U.S. Health Resources and Services Administration to establish the "Pacific Association for Clinical Training" (PACT). PACT's goal is to develop effective distance education methods to improve the education and skills of healtcare professionals in the U.S.-Affiliated Pacific Island nations. To determine the situation existing in 2004, one of PACT's first projects was to perform site visits to each jurisdiction, conducting needs assessments through interviews with key healtcare professionals, hospital administrators, and government officials. This article highlights findings of PACT's American Samoa assessment. Meant to establish a baseline for future reference, all data are those collected in 2004/2005 and have not been updated.