Asian American, Native Hawaiian, And Pacific Islander Research Articles

Disparities in stage at presentation for disaggregated Asian American, Native Hawaiian, and Pacific Islander (AANHPI) groups with breast cancer.

1119 Background: Cancer is the leading cause of death for AANHPI populations, who represent one of the most diverse and fastest-growing racial/ethnic groups in the US. Prior research has shown that AANHPI patients in aggregate have a lower risk of breast cancer than Non-Hispanic White (NHW) peers. However, within-group disparities in stage at presentation remain largely unexplored and are important given disparate access to primary care and cancer screening in certain populations. Methods: Data from 2004 to 2020 were extracted from the National Cancer Database (NCDB) for women newly diagnosed with breast cancer. Patients were disaggregated into AANHPI subgroups based on indigenous history or country of origin. Ordinal logistic regression, adjusting for clinical and sociodemographic factors, was used to calculate adjusted odds ratios (AORs), with higher AORs signifying more advanced stage diagnoses, from Stage 0 to IV. Results: Out of 2,563,180 patients with breast cancer, 83,315 (3.25%) identified as AANHPI. Compared to NHW patients, AANHPI patients were younger (median age, NHW: 63 years vs. AANHPI: 58 years, χ2 P<0.001) and more likely to be uninsured or on Medicaid (NHW: 51% vs. AANHPI: 58%, χ2 P<0.001). The largest AANHPI subgroups were Chinese (n=18,708), Filipino (n=18,429), Indian/Pakistani (n=16,424), Korean (n=6,548), and Vietnamese (n=5,345). Stage 3 or 4 disease was more common among NHW than AANHPI patients (11.3% vs 10.7%, χ2 p<0.001). In aggregate, AANHPI patients were less likely to present with later-stage disease (AOR: 0.88, 95% CI 0.87-0.90, p < 0.001). AANHPI disaggregation revealed that Hawaiian (AOR 1.13, 95% CI 1.07–1.21, p < 0.001), Hmong (AOR 1.86, 95% CI 1.34–2.60, p < 0.001), Laotian (AOR 1.46, 95% CI 1.23–1.74, p < 0.001), and Pacific Islander patients (AOR 1.25, 95% CI 1.16–1.34, p < 0.001) were more likely to present at a more advanced stage relative to NHW patients. Relative to Chinese Americans (the largest AANHPI subgroup), all AANHPI patients were significantly more likely to be diagnosed at a later stage of disease. The largest odds were observed in Hmong (AOR = 2.60, 95% CI 1.87–3.62, p < 0.001), Laotian (AOR = 2.00, 95% CI 1.68–2.39, p < 0.001), Pacific Islander (AOR = 1.71, 95% CI 1.59–1.84, p < 0.001), Hawaiian (AOR = 1.54, 95% CI 1.44–1.65, p < 0.001), and Kampuchean (AOR = 1.42, 95% CI 1.20–1.68, p < 0.001) patients. Conclusions: This disaggregation study finds disparities in the stage of breast cancer at presentation across AANHPI groups, with patients of Hawaiian, Hmong, Laotian, and Pacific Islander descent more likely to be diagnosed at advanced stages when treatments are more intense and cure less likely. Research which considers AANHPI patients as a monolith masks poor outcomes from disparate subgroups that could benefit from targeted, culturally tailored interventions that involve community leaders and leverage cultural norms.

Anti-Asian biases in federal grant reviews: Commentary on Yip et al. (2021).

Prior to the 2021 American Psychologist special issue "Rendered Invisible: Are Asian Americans a Model or a Marginalized Minority?" (Yip et al., 2021), only seven articles on Asian American, Native Hawaiian, and Pacific Islander (AANHPI) populations were published in the journal in 3 decades. The special issue interrogated sources of invisibility and marginalization of AANHPIs not only in the field of psychology but also in the broader national landscape. The current commentary provides a deeper dive into one of the primary drivers of AANHPI invisibility, anti-Asian biases encountered during the federal grant review process, which contributes to low funding rates and insufficient research on AANHPI communities. Despite comprising over 6% of the U.S. population, less than 1% of the National Institutes of Health's funding portfolio supports science on AANHPI populations. This qualitative study revealed thematic barriers encountered during National Institutes of Health grant reviews. A one-time survey was circulated to professional scientific networks to obtain open-ended responses regarding applicants' and reviewers' experiences proposing research with AANHPI samples, resulting in data from N = 16 respondents. Respondents were asked to indicate their role in the review process (e.g., investigator, applicant, reviewer, other) and to provide open-ended responses detailing experiences of bias. Thematic coding revealed six principal themes: (1) invalidation, (2) limited reviewer knowledge, (3) oppression Olympics, (4) White comparison groups, (5) model minority myth, and (6) homogeneity of AANHPI groups. Building off these themes, this commentary concludes with five actionable policy and institutional recommendations aimed at achieving a more inclusive national research enterprise for AANHPI investigators and communities. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Disparities in Overall Survival Within AANHPI Subpopulations With Cervical Cancer [ID 2683427

INTRODUCTION: The Asian American, Native Hawaiian, and Pacific Islander (AANHPI) community is a diverse group, including over 21 ethnic groups, but is often misrepresented as one cohort. Differences in human papillomavirus prevalence and access to care lead to varying cervical cancer incidences and outcomes within the AANHPI community. Here, we compare overall survival (OS) of cervical cancer patients within the AANHPI subpopulations. METHODS: The National Cancer Database identified 84,395 women with cervical squamous cell carcinoma (ICD-O-3-code 8070). Races listed as “unknown/other” or “Other Asian” were excluded. Kaplan–Meier and Cox regression model were performed. RESULTS: This study identified 985 East Asian (EA), 395 South Asian (SA), 1,073 Southeast Asian (SEA), and 290 NHPI patients with cervical cancer. Mean OS was 144.0 months for EA, 137.0 months for SA, 132.6 months for SEA, and 116.1 months for NHPI. Kaplan–Meier revealed worse OS for SEA and NHPI compared to SA (P=.011, P<.001, respectively) and EA (P=.002, P<.001, respectively). EA (hazard ratio [HR] 0.522; P<.001), SA (HR 0.490; P<.001), and SEA (HR 0.633; P<.001) had lower survival hazard ratios compared to NHPI. CONCLUSION: Survival disparities exist among AANHPI subgroups with cervical cancer. Disaggregation of AANHPI subpopulations revealed that SEA and NHPI patients had worse OS. Native Hawaiian and Pacific Islander patients had greater survival hazard ratios after controlling for socioeconomic variables. This study highlights the need to disaggregate AANHPI data so that disparities among subpopulations can be identified, investigated, and addressed.

Breaking the Silence: An Epidemiological Report on Asian American and Pacific Islander Youth Mental Health and Suicide (1999-2021).

Limited studies have focused on recent trends in Asian American and Pacific Islander (AAPI) youth suicide. This study aimed to evaluate epidemiological trends in AAPI youth suicide and reports of depressive symptoms among Asian and Pacific Islander youth in the USA. This cross-sectional study analyzed mortality data from the Centers for Disease Control Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) and reports of depressive symptoms from the Youth Risk Behaviour Surveillance System (YRBSS). Data from 1999 to 2021 were analyzed for suicide rates and methods used among AAPI youth aged 5-24 years. YRBSS data from 1991 to 2021 were analyzed for depressive symptoms reported by Asian American (AA) 9th-12th graders. From 1999 to 2021, 4747 AAPI youth died by suicide in the USA. Rates of suicide doubled from 3.6 to 7.1 per 100,000 during 1999-2021, with an increasing trend observed from 2014 onwards. The most common methods of suicide deaths in this population were suffocation, firearms and poisoning. Rates of suicide were higher among AA males than females, although more AA females reported depressive symptoms, including suicidal planning and attempts. This study shows a concerning increase in suicide rates among AAPI youth over 1999-2021. Suffocation, firearms and poisoning were the most common methods used. While more AAPI males died by suicide, AA females reported higher rates of depressive symptoms. These findings highlight the urgent need for targeted prevention strategies and clinical interventions for this vulnerable population. The study also emphasizes the importance of addressing mental health stigma to improve reporting and support for Asian American, Native Hawaiian and Pacific Islander (AANHPI) youth.

Vietnamese American Perspectives on Engagement in an Aging-Focused Research Registry

Introduction: We elicited Vietnamese Americans’ perspectives on culturally appropriate recruitment into a new research registry: Collaborative Approach for Asian Americans, Native Hawaiians, and Pacific Islanders (AANHPIs) Research and Education (CARE). Methods: Three focus groups were conducted with 21 Vietnamese Americans. Topics included knowledge about and experiences with research, outreach and recruitment methods for research participation and registry enrollment, and views about research incentives. Focus group transcripts were analyzed thematically. Results: Mean age of participants was 41 years (range 18–73), 57% were male, 86% were non-US born, and 81% had never participated in a research study. Themes that emerged included (1) motivations to participate in research to gain knowledge: for oneself, for family’s benefit, and for the Vietnamese American community as a whole; (2) necessity of trustworthy and credible individuals/spokespersons to promote the research initiative; (3) recruitment strategies that are age-specific and culturally appropriate, and (4) importance of monetary incentives. Conclusion: Findings from this study will be used to guide recruitment into and engagement with CARE among Vietnamese Americans but are also relevant for other registries aiming to diversify their participants.

Disparities in survival in Asian American, Native Hawaiian, and Pacific Islander patients with gastric adenocarcinoma: An NCDB analysis.

253 Background: Asian American, Native Hawaiian, and Pacific Islander (AANHPI) individuals exhibit stark disparities in gastric cancer mortality rates, with AANHPI men facing a two-fold higher risk of death and AANHPI women encountering a 2.5-fold elevated risk compared to their Non-Hispanic White (NHW) counterparts. However, the AANHPI community is a diverse group, including over 21 ethnic groups. Here, we identify disparities among AANHPI subpopulations with gastric adenocarcinoma. Methods: Using the National Cancer Database, which gathers data from over 1,500 accredited hospitals and facilities across the United States, this retrospective cohort study identified 141,906 patients with gastric adenocarcinoma (ICD code “8140”). Races listed as “unknown/other” or “Other Asian” were excluded. Kaplan Meier and Cox Regression model were performed. Results: This study compared mean overall survival (OS) of NHW (n=111,137), East Asian (EA) (n=3,745), South Asian (SA) (n=760), Southeast Asian (SEA) (n=1,379), and Native Hawaiian or Pacific Islander (NHPI) (n=325) patients with gastric adenocarcinoma. When aggregated, AANHPI had statistically significant improved OS compared to NHW (21.6 months vs 14.1 months, p < 0.001). After disaggregating, the mean OS was 26.9 months for EA; 21.3 months for SA; 14.5 months for SEA; and 14.3 months for NHPI. Only SA and EA had significantly improved OS than NHW (p<0.001 for both). SEA and NHPI had significantly worse outcomes than EA (p<0.001 for both) and SA (p<0.001 for SEA, and p = 0.033 for NHPI). Multivariate analysis accounted for age at diagnosis, insurance status, median income quartile, Charlson-Deyo comorbidity score, facility type, stage at diagnosis, and time to treatment. SA (HR=0.82; 95% CI, 0.726 to 0.925; p<0.001)), EA (HR=0.644; 95% CI, 0.609 to 0.68; p<0.001), and SEA (HR=0.896; 95% CI, 0.821 to 0.978, p=0.014) had lower survival hazard ratios compared to NHW. NHPI (HR=0.931, 95% CI 0.775 to 1.119, p=0.448) did not have a statistically significant relationship compared to NHW. EA (HR = 0.637; 95% CI 0.548 to 0.741, p<0.001) and SA (HR = 0.793; 95% CI 0.667 to 0.943, p=0.007) had significantly lower survival hazard ratios compared to NHPI. Conclusions: Survival disparities exist among AANHPI subgroups with gastric adenocarcinoma. At first glance, OS appeared significantly greater for AANHPI patients compared to NHW. However, disaggregation of AANHPI subpopulations revealed that Southeast Asian and NHPI actually had comparable OS with NHW. After controlling for socioeconomic factors, NHPI had significantly worse hazard ratios compared to South Asian and East Asian. This highlights the need to disaggregate AANHPI data so that disparities among these diverse subpopulations can be identified, investigated and ultimately addressed.

Lessons Learned from Immigrant Health Cohorts: A Review of the Evidence and Implications for Policy and Practice in Addressing Health Inequities among Asian Americans, Native Hawaiians, and Pacific Islanders.

The health of Asian Americans, Native Hawaiians, and Pacific Islanders (AANHPI) is uniquely impacted by structural and social determinants of health (SSDH) shaped by immigration policies and colonization practices, patterns of settlement, and racism. These SSDH also create vast heterogeneity in disease risks across the AANHPI population, with some ethnic groups having high disease burden, often masked with aggregated data. Longitudinal cohort studies are an invaluable tool to identify risk factors of disease, and epidemiologic cohort studies among AANHPI populations have led to seminal discoveries of disease risk factors. This review summarizes the limited but growing literature, with a focus on SSDH factors, from seven longitudinal cohort studies with substantial AANHPI samples. We also discuss key information gaps and recommendations for the next generation of AANHPI cohorts, including oversampling AANHPI ethnic groups; measuring and innovating on measurements of SSDH; emphasizing the involvement of scholars from diverse disciplines; and, most critically, engaging community members to ensure relevancy for public health, policy, and clinical impact.

Abstract B090: Breast cancer incidence rates by neighborhood socioeconomic status and ethnic enclaves among Asian American, Native Hawaiian, and Pacific Islander females in California

Abstract Background—Among Asian American, Native Hawaiian, and Pacific Islander (AANHPI) females in the U.S., breast cancer incidence has steadily increased1. Of note, California has the largest population of AANHPI residents in the United States2. Few studies have examined whether the incidence rates of breast cancer among AANHPI populations differ by the neighborhood social environment. Thus, we examined the incidence of invasive breast cancer by AANHPI ethnic enclave (ethnically distinct neighborhoods) and neighborhood socioeconomic status (nSES) among AANHPI females in California. Methods— With 14,738 AANHPI females diagnosed with invasive breast cancer from 2008 through 2012 from the California Cancer Registry, we calculated the incidence rates of breast cancer. The 2007 to 2011 American Community Survey (ACS) data was used to assess AANHPI ethnic enclave index and nSES at the census tract level. Incidence rate ratios (IRRs) were analyzed by statewide quintiles of AANHPI ethnic enclave index and nSES. For analyses of AANHPI ethnic enclave index and nSES combined, low and high levels were defined as quintiles 1-3 and quintiles 4-5, respectively, and IRRs were calculated for joint AANHPI and nSES as low-low, low-high, high-low, and high-high. IRR associations of ethnic enclave and nSES by stage (localized vs. advanced (regional/distant)) were also assessed. Results— Overall, neighborhoods of lower AANHPI ethnic enclave index had higher incidence rates of breast cancer for AANHPI females in California. The incidence rate of breast cancer among AANHPI living in low ethnic enclave neighborhoods were 1.16 times that of AANHPI females living high ethnic enclave neighborhoods (95% CI 1.12 to 1.20; p<0.001). In addition, AANHPI females living in higher SES neighborhoods had higher incidence rates of breast cancer (IRR = 1.16 comparing highest to lowest nSES quintile, 95% CI 1.12 to 1.20). The incidence rate of breast cancer among AANHPI females living in low ethnic enclave+high SES neighborhoods was 1.32 times that of AANHPI females living in high ethnic enclave+low SES neighborhoods (95% CI 1.25 to 1.39; p<0.001). Similar patterns of associations were observed for localized and advanced stages of the disease. Conclusion—For AANHPI females in California, incidence rates of breast cancer differed by nSES, ethnic enclave, and jointly. Impact— Future studies should examine whether the impact of these neighborhood-level factors on breast cancer incidence rates differ across specific AANHPI ethnic groups and investigate the pathways through which they contribute to breast cancer risk. Citation Format: Alya Truong, Mi-Ok Kim, Meg Mckinley, Scarlett L. Gomez, Salma Shariff-Marco, Iona Cheng. Breast cancer incidence rates by neighborhood socioeconomic status and ethnic enclaves among Asian American, Native Hawaiian, and Pacific Islander females in California [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B090.

Identifying U.S. regions with the highest suicide rates and examining differences in suicide methods among Asian American, Native Hawaiian, and Pacific Islander Veterans.

The suicide rate among Asian American, Native Hawaiian, and Pacific Islander (AANHPI) Veterans increased from 2001 to 2020. Identifying regions where suicide rates are elevated and increasing among AANHPI Veterans would inform targeted prevention efforts for members of this cohort. We conducted a population-based retrospective cohort study of 377,833 AANHPI Veterans to examine suicide rates and methods (2005-2019) by United States (US) region and over time (2005-2009, 2010-2014, 2015-2019), using US Veteran Eligibility Trends and Statistics and Joint DoD/VA Mortality Data Repository data. AANHPI Veterans across most regions experienced increases in suicide rates from the earliest to latest period; however, patterns differed by region. Age-adjusted suicide rates increased across all three periods among those in the Northeast and West, but increased, then declined in the Midwest and South. In 2015-2019, the age-adjusted suicide rate among AANHPI Veterans was highest in the Northeast (42.0 per 100,000) and lowest in the West (27.5). However, the highest percentages of AANHPI Veteran suicide deaths in 2005-2019 occurred in the West (39.5%) and South (34.7%), with lower percentages in the Midwest (15.0%) and Northeast (10.8%). Across regions, those ages 18-34 had the highest suicide rates. Firearms were the most frequently used suicide method across regions (44.4%-60.2%), except the Northeast (35.2%), where suffocation was more common (38.3%). Results suggest particular needs for suicide prevention efforts among AANHPI Veterans in the Northeast and to ensure that lethal means safety initiatives for AANHPI Veterans encompass both firearms and suffocation, with some variations in emphasis across regions.

Disparities in Pancreatic Cancer Outcomes in the Disaggregated Asian American Population.

The Asian American, Native Hawaiian, and Pacific Islander (AANHPI) population is among the fastest-growing population in the USA. However, this is not reflected in scientific research, in which ethnic groups are often combined. We identified trends in treatment and outcomes for pancreatic cancer in a disaggregated AANHPI population. We hypothesize that patients from different AANHPI groups have differences in survival. A retrospective analysis of the National Cancer Database between 2010 and 2019 identified patients treated for pancreatic cancer. We identified demographic factors for patients of Caucasian, African American, and disaggregated Asian subpopulations. Survival curves were generated and multivariate analysis was performed to help determine which factors impacted overall survival. A total of 296,448 patients met the inclusion criteria. Of those, 8568 (3%) patients were Asian. Median survival of AANHPI patients was 11.3 months, as compared with Caucasians (8.9 months) and African Americans (8.1 months) (p<0.0001). Asian Indians had the highest median survival (14.3 months), whereas the Japanese subpopulation had the lowest (7.6 months) (p<0.0001). There were significant differences in median survival between the different AANHPI subpopulations irrespective of stage. Multivariate analysis demonstrated that belonging to an AANHPI racial/ethnic group, excluding Japanese and Filipino, was associated with decreased risk of overall mortality. Significant differences were identified in the overall median survival for patients with pancreatic cancer between AANHPI subpopulations. Disparities in socioeconomic factors may have played a role in overall survival. This study highlights the need to include disaggregated data in future studies to subdue disparities in cancer care for patients.

Disparities in Breast-Conserving Therapy vs. Mastectomy among Asian American and Pacific Islander Women

Multiple randomized trials support the use of breast-conserving therapy (BCT), defined as lumpectomy followed by adjuvant radiotherapy, as an alternative to mastectomy for definitive treatment of early-stage (T1-2N0) breast cancer. However, data suggest that Asian American, Native Hawaiian, and Pacific Islander (AANHPI) may undergo mastectomy at higher rates than BCT and may experience barriers to receipt of BCT. The purpose of this study was to examine BCT utilization by disaggregated AANHPI groups to identify differences in receipt of mastectomy versus BCT. The 2004-2017 National Cancer Database was queried to identify women age ≥18 years old diagnosed with cT1-2N0M0 breast cancer treated with either BCT or mastectomy without post-mastectomy radiation therapy. Women were classified based on self-reported race. Multivariable logistic regression defined adjusted odds ratios (OR) assessing the association between race and receipt of BCT versus mastectomy for all patients and separately by cT1-2 stage. All models were adjusted for relevant sociodemographic and clinical factors. Of 794,403 women with cT1-2N0M0 breast cancer, 239,801 (30%) received mastectomy and 554,602 (70%) received BCT. After adjusting for clinical and sociodemographic factors, AANHPI women had greater odds of receiving mastectomy over BCT, compared to White women (OR [95% CI], 1.35 [1.30-1.39]; p<0.001). In contrast, Black women were less likely than White women to receive mastectomy (0.86 [0.84-0.87]; p<0.001). Upon disaggregation, Chinese, Japanese, Filipino, Korean, Vietnamese, and Asian Indian & Pakistani women were more likely to receive mastectomy over BCT compared to White women (p<0.001 for all). Treatment at academic (1.30 [1.27-1.32]), integrated (1.24 [1.21-1.27]), and comprehensive community cancer centers (1.15 [1.13-1.17]) were all associated with greater odds of mastectomy compared to treatment at community cancer programs (all p<0.001). Greater distance from treatment facility (≥50 mi. vs. 0 to <10 mi. [reference], OR 1.50 [1.47-1.53]) and cT2 disease (1.85 [1.82-1.87]) were also associated with greater odds of receiving mastectomy (all p<0.001). In this evaluation of women with early-stage breast cancer, women from several AANHPI groups were more likely to receive mastectomy (as opposed to BCT) compared to White women. While sociocultural preferences, differences in access to and interest in reconstruction, as well as prevalent tumor-to-breast ratios may partially explain the disparities, collectively our data suggest an ongoing need for greater patient involvement in shared-decision making, particularly in vulnerable and understudied Asian populations.

Suicide Among Asian American, Native Hawaiian, and Pacific Islander Veterans: Rates and Methods, 2005–2019

Knowledge of suicide rates and methods among Asian American, Native Hawaiian, and Pacific Islander (AANHPI) Veterans remains sparse. Age- and sex-specific suicide rates, methods, and trends were examined among AANHPI Veterans and were compared with findings reported for all Veterans. For this population-based retrospective cohort study, average annual suicide rates (2005-2019) were computed in 2023 using population (U.S. Veterans Eligibility Trends and Statistics) and mortality (National Death Index [NDI]) data. The cohort included 416,454 AANHPI Veterans (356,146 males, 60,229 females) separated from military service and alive as of 1/1/2005. Suicide was determined from NDI underlying cause-of-death ICD-10 codes. The age-adjusted average annual suicide rate among AANHPI Veterans increased 36.85% from 2005-2009 to 2015-2019 (2015-2019: 30.97/100,000). Relative to other ages, 2015-2019 suicide rates were highest among AANHPI Veterans 18-34 (overall: 53.52/100,000; males: 58.82/100,000; females: 32.24/100,000) and exceeded those of similarly aged Veterans in the overall Veteran population (overall: 44.71/100,000; males: 50.59/100,000; females: 19.24/100,000). The sex difference in suicide rates was lower among AANHPI Veterans than in Veterans overall (relative risk [males to females]=1.65 and 2.33, among those 18-54). Firearms were used less and suffocation more among AANHPI Veterans, relative to Veterans overall. Suicide among AANHPI Veterans is an increasing public health concern, with younger males and females at particularly elevated risk. Lethal means safety strategies for AANHPI Veterans should consider distinctions in suicide methods compared to the overall Veteran population. Research is warranted to understand the lower magnitude sex difference in suicide rates among AANHPI Veterans.

E-cigarette use behaviors of Asian American, Native Hawaiian, and Pacific Islander youth in the contiguous United States: Insights from the Monitoring the Future Study (2018–2019)

This study examines e-cigarette use behaviors of Asian American, Native Hawaiian, and Pacific Islander (AANHPI) youth, in relation to other racial/ethnic groups in the United States. Data were obtained from the 2018 and 2019 Monitoring the Future surveys, which include a random, probability-based sample of youth in 8th, 10th, and 12th grades surveyed annually across the contiguous United States. Respondents provided information on race/ethnicity and e-cigarette use (n = 42,980). Measures of e-cigarette use included current (1 + of past 30 days) and regular use (10 + of past 30 days). Chi-square tests were used to determine differences in e-cigarette use by race/ethnicity. Associations between race/ethnicity, other sociodemographic factors, and e-cigarette use were explored using logistic regression analyses. Approximately 5.1% (n = 2,410) of the sample identified as AANHPI. A greater proportion of Native Hawaiian and Pacific Islanders reported current e-cigarette use (NHPI, 28.0%), relative to Asian American (AA, 10.3%), Black (9.5%), Hispanic or Latino (15.0%), American Indian or Alaskan Native (AIAN, 16.5%), multiracial (22.3%), and non-Hispanic White (25.2%) youth. Regular e-cigarette use was highest among non-Hispanic White (12.3%), followed by multiracial (10.7%), AIAN (7.8%), Hispanic or Latino (5.0%), AA (4.3%), and Black (3.0%) youth. Associations between race/ethnicity and e-cigarette use remained significant, after controlling for other sociodemographic factors. Continued monitoring of e-cigarette use is needed among AANHPI, a historically underrepresented population in tobacco research. Special attention should be paid to NHPI, who reported the highest rates of e-cigarette use.

Colon Cancer Disparities in Stage at Presentation and Time to Surgery for Asian Americans, Native Hawaiians, and Pacific Islanders: A Study with Disaggregated Ethnic Groups.

Vast differences in barriers to care exist among Asian American, Native Hawaiian, and Pacific Islander (AANHPI) groups and may manifest as disparitiesin stage atpresentation and access totreatment. Thus, we characterized AANHPI patients with stage 0-IV colon cancer and examined differences in (1) stage at presentation and (2) time to surgery relative to white patients. We assessed all patients in the National Cancer Database (NCDB) with stage 0-IV colon cancer from 2004 to 2016 who identified as white, Chinese, Japanese, Filipino, Native Hawaiian, Korean, Vietnamese, Laotian, Hmong, Kampuchean, Thai, Asian Indian or Pakistani, and Pacific Islander. Multivariable ordinal logistic regression defined adjusted odds ratios (AORs), with 95% confidence intervals (CI), of (1) patientspresenting withadvanced stage colon cancer and (2) patients with stage 0-III colon cancerreceiving surgery at ≥60days versus 30-59days versus <30days postdiagnosis, adjusting for sociodemographic/clinical factors. Among 694,876 patients, Japanese [AOR1.08 (95% CI 1.01-1.15), p<0.05], Filipino [AOR1.17 (95% CI 1.09-1.25), p<0.001], Korean [AOR1.09 (95% CI 1.01-1.18), p<0.05], Laotian [AOR1.51 (95% CI 1.17-1.95), p<0.01], Kampuchean [AOR1.33 (95% CI 1.04-1.70), p<0.01], Thai [AOR 1.60 (95% CI 1.22-2.10), p=0.001], and Pacific Islander [AOR1.41 (95% CI 1.20-1.67), p<0.001] patients were more likely to present with more advanced colon cancer compared with white patients. Chinese [AOR1.27 (95% CI 1.17-1.38), p<0.001], Japanese [AOR 1.23 (95% CI 1.10-1.37], p<0.001], Filipino [AOR1.36 (95% CI 1.22-1.52), p<0.001], Korean [AOR1.16 (95% CI 1.02-1.32), p<0.05], and Vietnamese [AOR1.55 (95% CI 1.36-1.77), p<0.001] patients were more likely to experience greater time to surgery than white patients. Disparities persisted when comparing among AANHPI subgroups. Our findings reveal key disparities in stage at presentation and time to surgery by race/ethnicity among AANHPI subgroups. Heterogeneity upon disaggregation underscores the importance of examining and addressing access barriers and clinical disparities.

Non-small cell lung cancer disparities in stage at presentation and treatment for Asian American, Native Hawaiian, and Pacific Islander women.

Asian Americans, Native Hawaiians, and Pacific Islanders (AANHPI) represent the fastest-growing group in the United States. While described in aggregate, great variations exist within the community. We aimed to determine whether there were differences in stage at presentation and treatment status among AANHPI women with non-small cell lung cancer (NSCLC). Between 2004 and 2016, we identified 522 361 female patients with newly diagnosed NSCLC from the National Cancer Database. Multivariable logistic regression models were used to define adjusted odds ratios (aORs) of presenting with stage IV disease and not receiving treatment. AANHPI women were more likely to present with stage IV disease compared to White (54.32% vs. 40.28%, p < 0.001). Aside from Hawaiian, Pakistani, and Hmong women, all other ethnic groups had greater odds of presenting with stage IV disease than White women. AANHPI women <65 years were more likely to present with stage IV disease (p = 0.030). Only Vietnamese women showed a significant difference (aOR = 1.30 [1.06-1.58], p = 0.010) for likelihood of receiving treatment compared to White. Differences in stage at presentation and treatment status in women with NSCLC were observed among AANHPI ethnic groups when populations were disaggregated.

Characterizing breast cancer incidence and trends among Asian American, Native Hawaiian, and non-Hispanic White women in Hawai'i, 1990-2014.

To characterize breast cancer (BC) incidence by age at diagnosis and BC subtype among disaggregated Asian American, Native Hawaiian, and Pacific Islander (AANHPI) women and non-Hispanic White (NHW) women in Hawai'i. Using 1990-2014 data from the Hawai'i tumor registry, we estimated age-adjusted incidence rates (AAIR) of BC and the annual percent change in BC incidence by age (<50 and ≥50 years) and BC subtype (hormone receptor [HR]+/human epidermal growth factor receptor 2 [HER2]-, HR+/HER2+, HR-/HER2+, triple negative BC) for Filipino American (FA), Japanese American (JA), Native Hawaiian (NH), and NHW women. Among young (<50 years) women, annual BC incidence increased 2.9% (1994-2014) among JA and 1.0% (1990-2014) among NHW women. Incidence was highest among young JA women (2010-2014 AAIR 52.0 per 100,000; 95% confidence interval [CI] 45.6, 58.9). HR+/HER2- BC, the major BC subtype, was similarly highest among young JA women (AAIR 39.5; 95% CI 33.9, 45.4). Among older (≥50 years) women, annual BC incidence increased 1.6% (1990-2014) among FA and 4.2% (2006-2014) for JA women. BC incidence was highest among older NH women (AAIR 137.6, 95% CI 128.2, 147.4), who also displayed highest incidence of two subtypes: HR+/HER2- (AAIR 106.9; 95% CI 98.6, 115.5) and HR+/HER2+ (AAIR 12.1; 95% CI 9.4, 15.1). We observed high and increasing BC incidence among JA women ages <50 years and high incidence among NH women ages ≥50 years. These results highlight racial and ethnic differences in BC incidence among disaggregated AANHPI populations in Hawai'i by age and BC subtype.

Fireside Chat on the Asian American, Native Hawaiian, and Pacific Islander Special Edition of the Health Equity Journal Featuring Authors.

Fireside Chat on the Asian American, Native Hawaiian, and Pacific Islander Special Edition of the Health Equity Journal Featuring Authors.

Risk factors and pregnancy outcomes vary among Asian American, Native Hawaiian, and Pacific Islander individuals giving birth in California

To compare frequencies of risk factors and pregnancy outcomes in ethnic groups versus the combined total of Asian American, Native Hawaiian, and Pacific Islander (AANHPI) populations. Using linked birth and fetal death certificate and maternal hospital discharge data (California 2007-2018), we estimated frequencies of 15 clinical and sociodemographic exposures and 11 pregnancy outcomes. Variability across 15 AANHPI groups was compared using a heat map and compared to frequencies for the total group (n=904,232). AANHPI groups varied significantly from each other and the combined total regarding indicators of social disadvantage (e.g., range for high school-level educational or less: 6.4% Korean-55.8% Samoan) and sociodemographic factors (e.g., maternal age <20 years: 0.2% Chinese-8.8% Guamanian) that are related to adverse pregnancy outcomes. Perinatal outcomes varied significantly (e.g., severe maternal morbidity: 1.2% Korean-1.9% Filipino). No single group consistently had risk factors or outcome prevalence at the extremes, i.e., no group was consistently better or worse off across examined factors. Substantial variability in perinatal risk factors and outcomes exists across AANHPI groups. Aggregation into "AANHPI" is not appropriate for outcome reporting.

Strategies for Increasing Asian American, Native Hawaiian, and Pacific Islander Representation in Survey Research

The Asian American, Native Hawaiian, and Pacific Islander (AANHPI) population in the United States is growing rapidly and is geographically dispersed and culturally diverse. Yet, national estimates produced for this population are often limited to a subset, typically those who are English proficient. Meaningful representation of AANHPI communities in survey research requires strategies that account for their diverse linguistic and cultural characteristics. However, translation alone will not suffice to increase representation. More culturally responsive approaches are needed as well. In a joint project, AARP and NORC at the University of Chicago reviewed the literature and conducted semistructured interviews with experts in AANHPI representation in research to examine barriers to AANHPI survey participation and strategies for overcoming these barriers. This article presents findings and recommendations from this research. We discuss three key challenges to AANHPI representation in surveys: Lack of familiarity with surveys and their importance, lack of trust in those conducting surveys, and issues of language and translation. We then present strategies for increasing AANHPI survey participation: Involving trusted leaders of the AANHPI community, at the local or national level as appropriate for the study; focusing on messaging about the survey that is culturally appropriate and tailored to the population; and providing culturally appropriate translations.

Trends in Collection of Disaggregated Asian American, Native Hawaiian, and Pacific Islander Data: Opportunities in Federal Health Surveys.

Collection of data for Asian American, Native Hawaiian, and Pacific Islander (AANHPI) persons that is disaggregated by ethnic subgroup may identify disparities that are not apparent in aggregated data. Using content analysis, we identified national population surveys administered by the US Department of Health and Human Services (HHS) and evaluated trends in the collection of disaggregated AANHPI data between 2011 and 2021. In 2011, 4 of 15 surveys (27%) collected disaggregated data for Asian American, 2 of 15 surveys (13%) collected data on Native Hawaiian, and 2 of 15 surveys (13%) collected disaggregated data for Pacific Islander people. By 2019, 14 of 21 HHS-administered surveys (67%) collected disaggregated data for Asian American (6 subgroups), 67% collected data on Native Hawaiian, and 67% collected disaggregated data on Pacific Islander (3 subgroups) people. Collection of disaggregated AANHPI data in HHS-administered surveys increased from 2011 to 2021, but opportunities to expand collection and reporting remain. Strategies include outreach with community organizations, increased language assistance, and oversampling approaches. Increased availability and reporting of these data can inform health policies and mitigate disparities. (Am J Public Health. 2022;112(10):1429-1435. https://doi.org/10.2105/AJPH.2022.306969).