Reducing Cancer Health Disparities among Pacific Islanders in the U.S.

Abstract

Cancer mortality is on the decline in the U.S. (Jemal, Siegel, Xu, & Ward, 2010), but like so many other health conditions this is not enjoyed by all Americans. Among the most underserved are Pacific Islanders (PIs), who in 2000 numbered 874,414 (alone or in combination with one or more other races). California is second only to Hawai’i in the number of PIs, with half of the state’s 221,458 PIs living in Southern California (APALC, 2005). Pacific Islanders (PIs) represent a wide diversity of ethnic populations, with over 19 census defined groups that each have their own culture, language, traditions, world and health perspectives, and political and migration history. Some of these PI populations have close ties to the U.S. territories and jurisdictions in the Pacific, including American Samoa, Guam, the Federated States of Micronesia, the Republic of the Marshall Islands, and the Commonwealth Nations of the Mariana Islands. Other groups such as Tongans, have migrated from their small island nations in search of higher earnings to support families back home (Small, 1997). Despite their differences in nationalities, PIs generally face high socioeconomic barriers to health and other care (US Census Bureau, 2004). For instance, educational attainment is low: 14-40% of PIs have less than a high school degree compared to the California average of only 10% (APALC, 2005). While only 8% of Californians were at or below the poverty line, this was true for 10-20% of PIs. Compared to nearly all other ethnic groups, PIs suffer from higher prevalence of the leading health disparity indicators, including cigarette smoking, hypertension, obesity, diabetes, infant mortality, tuberculosis, hepatitis B, and asthma (CDC, 2002). PIs face critical cancer health disparity needs and barriers to care. With regards to cancer prevention, Native Hawaiians, American Samoans, Chuukese and Palauans have been found to have rates of tobacco use between 4258% among men, and between 11-67% among women (Lew & Tanjasiri, 2003). A 2004 study for the California Departments of Justice and Education found that among 12th graders, heaviest daily smoking was observed for Hawaiians (35%) and Samoans (30%), compared with 19% Koreans, 16% Filipinos, 12% Japanese, and 5% Chinese youth (Austin & Chorpita, 2004). Similarly, a 2003 study found PI 9th graders in California have the highest smoking rate (19.7%) compared to whites (16.3%). Obesity has also been implicated as a causal factor in the onset of cancer (including breast, colon, endometrium, esophagus, and kidney cancers), and rates of obesity are high in PI populations (Shabbir, Kwan, Wang, Shih, & Simon, 2010). A 2008 needs assessment of PI young adults in Southern California found that 76% of Samoans and 84% of Tongans were overweight (defined as greater than 85th percentile), and levels of nutritional intake and physical activity identified many areas of need.