Culture, Communication, and Cancer Risk Behaviors Among Pacific Islanders in Hawaii

Abstract

Background: A priority of the National Cancer Institute (NCI) is to acquire, aggregate and integrate cancer control data that facilitates collaborations to address health disparities and communication inequalities. To better communicate cancer research to the public, the NCI developed the Health Information National Trends Survey (HINTS). However, as with most national health surveillance systems, HINTS nationally obtained data are not sufficient to address the behaviors of unique demographic and geographic subpopulations. US Pacific Islanders are one of the fastest growing population groups in the US, and cancer is the leading cause of death in this group. Limited knowledge about the cancer communication practices and risk behaviors of US Pacific Islanders drive the poor implementation of effective cancer prevention interventions. Aim: This study aims to document the prevalence and differences in the cancer relevant knowledge, attitudes, and information seeking practices of Pacific Islander populations residing in Hawaii. Specifically, we aim to expand HINTS assessment to native Hawaiians and recent migrant Marshallese and Chuukese populations in Hawaii. Methods: We conducted surveys with 352 native Hawaiians, 282 Chuukese, and 129 Marshallese residing in HI. We used Respondent Driven Sampling method (RDS) to recruit these geographically diffuse populations in HI. The survey included questions about basic knowledge, attitude and behavior about various cancers, detailed communication behaviors about health information, and cultural beliefs and practices. Results: Data show there are clear differences among the three ethnic groups across a variety of cancer-related attitudes, knowledge, behaviors and risk factors. For example, a larger proportion of Chuukese have BMIs that can be described as obese or morbidly obese compared with native Hawaiians. On the other hand, native Hawaiians are significantly more likely to smoke than Marshallese and Chuukese. These groups also differ significantly regarding the level of acculturation, religiosity, fatalism about cancer, and trust in medical professionals. Regarding communication, cell phone use was common with 75% of native Hawaiians, 80% of Marshallese and 88% of Chuukese having cell phones. This use of cellphone technology was in stark contrast to Internet use with only 45% of native Hawaiians, 49% of Marshallese and 27% of Chuukese reporting access to the Web. Conclusion: There is a need for cancer prevention programs for Pacific Islanders in Hawaii. An effective health program has to address their unique cultural beliefs and practices, and fit their unique communication ecology. This study provides new knowledge concerning the use of nonprobability based study sampling methods, and the role of culture in cancer-related communications in influencing cancer risk behaviors that may be generalizable to the growing number of migrant Pacific Islander populations living in the US.