Native Hawaiians And Pacific Islanders Research Articles

Inequities in Access to Mental Health Services Among Asian American, Native Hawaiian, and Pacific Islander Medicaid Enrollees.

Asian American (AA) and Native Hawaiian and Pacific Islander (NHPI) people are often aggregated into a monolithic group, but when they are disaggregated into ethnic groups (e.g., Chinese), inequities can be identified. Using a representative sample of adult Medicaid enrollees (N=55,215), the authors assessed inequities in self-reported access to mental or behavioral health services between non-Hispanic AA and NHPI Medicaid enrollees and non-Hispanic White Medicaid enrollees, both by racial group and across 10 disaggregated ethnic groups. AA and NHPI enrollees, by race and all 10 ethnicities, reported significantly worse mental health care access than did White enrollees. The magnitude of disparities also differed between ethnic groups, ranging from -14.6 percentage points for Native Hawaiian enrollees to -43.6 percentage points for Vietnamese enrollees.

Disparities in Breast Cancer Treatment and Reconstruction Among Native Hawaiian and Pacific Islander Women: Systematic Review and Meta-Analysis.

Native Hawaiian and Pacific Islander (NHPI) women experience significant disparities in breast cancer treatment and outcomes, including lower rates of postmastectomy reconstruction, higher refusal rates of radiation therapy, and delays in surgical care. These disparities contribute to poorer survival and increased complications compared to other racial/ethnic groups. This systematic review and meta-analysis aim to quantify these disparities and assess their impact on breast cancer outcomes in NHPI women. A comprehensive search of PubMed, Scopus, and Embase databases was conducted to identify studies reporting on breast cancer surgery, reconstruction, radiation therapy refusal, and surgical delays for NHPI women. Thirteen studies, encompassing a total of 5 546 918 patients, were included, and meta-analyses were performed to pool odds ratios (OR) and hazard ratios (HR) for key outcomes using random-effects models. Heterogeneity was assessed using I² statistics. Thematic analysis was also conducted to explore cultural and structural factors influencing treatment disparities. NHPI women had significantly lower odds of receiving postmastectomy reconstruction compared to non-Hispanic White women (pooled OR = 2.02, 95% confidence interval [CI]: 1.96-2.08, I² = 99%). Delays in surgical care were more frequent, with NHPI women being 4.51 times more likely to experience delays (OR = 4.51, 95% CI: 3.82-5.32, I² = 99%). Radiation therapy refusal was notably higher, with a pooled hazard ratio of 3.28 (95% CI: 2.99-3.58, I² = 77%) indicating that NHPI women who refused radiation therapy had more than three times the risk of mortality compared to those who accepted it. Thematic analysis revealed that geographic isolation, limited access to specialized care, and cultural perceptions surrounding cancer treatments, including fear of radiation due to historical trauma, contributed significantly to treatment disparities. Native Hawaiian and Pacific Islander women face considerable barriers to receiving equitable breast cancer treatment and reconstruction, resulting in worse outcomes compared to other racial/ethnic groups. Efforts to address these disparities must focus on improving access to care, reducing treatment delays, and implementing culturally sensitive interventions. Targeted policies and healthcare system improvements, especially in geographically isolated areas, are critical to improving survival and treatment outcomes for NHPI women.

Abstract 4112952: Developing culturally informed materials to enhance Native Hawaiians' and Pacific Islanders’ participation in clinical trials

Background: Native Hawaiians and Pacific Islanders (NHPI) suffer disproportionately from cardiometabolic disorders and are underrepresented in related clinical trials, limiting our ability to control these disorders for this population. We identified recruitment and retention barriers (complicated clinical language) and facilitators (relationship-building opportunities). Addressing recruitment and retention barriers and facilitators can increase NHPI representation in clinical trials. Goal: To develop culturally informed, educational videos and infographics to improve NHPI trust and attitudes toward research and recruitment and retention in clinical trials. Methods: The videos and infographics are based on focus group data with NHPI past clinical trial participants or staff. The videos focus on recruitment. The infographics focus on recruitment and retention. The videos address the complicated clinical language and hesitancy in disclosing information while leveraging trial outcomes relevant to NHPI health concerns and cultural inclusiveness. The infographics build on the video content. Facilitators include relationship-building opportunities, seeking healthier outcomes for future generations, relationship-building opportunities, and sharing and learning opportunities provided in clinical trials. Results: The Co-Principal Investigators, NHPI clinical trial participants, and NHPI researchers and clinicians contributed to the videos. We created a 5-minute and a 10-minute video. The videos provide 1) an overview of clinical research, 2) considerations for participating in clinical trials, and 3) reasons to participate. Researchers present the first 2 topics, while past participants provide testimonials for the third topic. The 8 infographics include 1) an overview of clinical research, 2) the importance of randomization, 3) research benefits from NHPI participation, 4) the importance of a control group, 5) clinical trial outcomes, 6) individual benefits from research participation, 7) community benefits from research participation, and 8) trust in research. Discussion: We will test the impact of these materials on trust and attitudes towards research and recruitment and retention among NHPI in a randomized clinical trial (RCT). Half of the participants (n=104) will be recruited using traditional strategies and half (n=104) using our novel strategy. Rigorous qualitative (interviews with participants) and quantitative (retention rates) analysis will be conducted.

Exploring Youths' Offers to Use E-Cigarettes in Rural Hawai'i: A Test Development and Validation Study.

The purpose of this study is to describe the development and initial validation of a survey focused on problematic situations involving e-cigarette use by rural Native Hawaiian and Pacific Islander (NHPI) youths. A 5-phase approach to test development and validation was used. In Phase 1 (Item Generation), survey items were created from a series of focus groups with middle school youths on Hawai'i Island (N = 69). In Phase 2 (Item Refinement and Selection), situational items were reduced to 40 e-cigarette offer situations that were selected for inclusion in the survey. In Phase 3 (Item Reduction), items were administered to 257 youths from 11 middle, intermediate, or multi-level public or public-charter schools on Hawai'i Island. Exploratory factor analysis indicated the presence of three factors accounting for 50% of the variance: E-Cigarette Offers from Friends (24%), E-Cigarette Offers from Non-Friends (16%), and Coercive Pressure to Use E-Cigarettes (10%). Hypothesized relationships between offer situations and e-cigarette use were partially confirmed, supporting the construct validity of the survey. This survey helps to fill the scientific and practice gap in measuring ecodevelopmental risk and protection for e-cigarette use and has implications for e-cigarette use prevention with rural, NHPI, and/or Indigenous youth populations.

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

Native Hawaiian and Pacific Islander (NHPI) adults have historically been grouped with Asian adults in U.S. mortality surveillance. Starting in 2018, the 1997 race and ethnicity standards from the U.S. Office of Management and Budget were adopted by all states on death certificates, enabling national-level estimates of cardiovascular disease (CVD) mortality for NHPI adults independent of Asian adults. To describe CVD mortality among NHPI adults. Race-stratified age-standardized mortality rates (ASMRs) and rate ratios were calculated using final mortality data from the National Vital Statistics System for 2018 to 2022. Fifty states and the District of Columbia. Adults aged 35 years or older at the time of death. CVD deaths were identified from International Classification of Diseases, 10th Revision codes indicating CVD (I00 to I99) as the underlying cause of death. From 2018 to 2022, 10 870 CVD deaths (72.6% from heart disease; 19.0% from cerebrovascular disease) occurred among NHPI adults. The CVD ASMR for NHPI adults (369.6 deaths per 100 000 persons [95% CI, 362.4 to 376.7]) was 1.5 times higher than for Asian adults (243.9 deaths per 100 000 persons [CI, 242.6 to 245.2]). The CVD ASMR for NHPI adults was the third highest in the country, after Black adults (558.8 deaths per 100 000 persons [CI, 557.4 to 560.3]) and White adults (423.6 deaths per 100 000 persons [CI, 423.2 to 424.1]). Potential misclassification of underlying cause of death or race group. NHPI adults have a high rate of CVD mortality, which was previously masked by aggregation of the NHPI population with the Asian population. The results of this study support the need for continued disaggregation of the NHPI population in public health research and surveillance to identify opportunities for intervention. National Institute of General Medical Sciences, National Institutes of Health.

Health and Well-being of Family ('Ohana) Caregivers of Native Hawaiian and Pacific Islander Adults Living with Alzheimer's Disease and Related Dementias.

We aimed to describe the health and well-being of family caregivers of Native Hawaiian and Pacific Islander (NHPI) adults living with Alzheimer's disease and related dementias (ADRD), explore cultural values related to caregiving, and characterize barriers and facilitators to their health and well-being. Caregivers of NHPIs living with ADRD were recruited from across the United States to complete a multimethod study including a survey followed by an interview about their health and well-being. Eleven participants completed surveys, six of whom completed an interview. Themes included caring as a community, lōkahi (balance), and the importance of sleep, food, and physical activity. Cultural values included connection to cultural practices, kūpuna (elders) as cultural knowledge holders, and the kuleana (responsibility) of caregiving. Caregiving for an NHPI adult living with ADRD occurs beyond the dyad, and is a matter of family and community. Culturally-based interventions offered through community and healthcare organizations may be critical to promoting caregiver health.

Abstract PR012: Social and Structural Influences of Preventive Cancer Screenings for Native Hawaiian and Pacific Islander Adults in Hawaiʻi

Abstract Background: Native Hawaiians and Pacific Islanders (NHPI) are hindered by sociocultural, geographic, and environmental factors that contribute to cancer health disparities, often masked by aggregated data with Asian Americans. An average of 7,393 Hawai‘i residents are diagnosed with invasive cancer yearly, and rates are disproportionate ethnically; . Native Hawaiians and Micronesians suffer higher mortality rates for breast cancer (24.9 and 21.6 per 100,000) than White women (17.0). This study aims to investigate social drivers of health behaviors among NHPI in Hawaiʻi by examining social factors that influence cancer screenings through mixed methods. Methods: This mixed methods study is a follow-up to a cross-sectional survey administered in 2018 to 3 Pacific Islander ethnic subgroups: Native Hawaiians, Chuukese, and Marshallese in Hawaiʻi using Respondent Driven Sampling within public housing (N=1,010 NHPI). Disparate cancer screening practices were uncovered within these groups when compared to Hawaiʻi state data. Logistic regression was used to analyze predictors of colon, breast, and cervical cancer screenings. The Gelberg Behavioral Model for Vulnerable Populations and socio-ecological model served as the theoretical models. To triangulate the findings, 16 semi-structured interviews with adults living within the communities first surveyed were conducted in 2023 to uncover any additional drivers of health behaviors that the regression missed. Results: Quantitative findings include cultural/linguistic misunderstandings between NHPI and healthcare providers. Participants who indicated difficulty understanding a provider’s instructions because of language were 51% less likely to be screened for cervical cancer (p = .04). Individuals who hold neutral acculturation to both their ethnic and American culture are less likely to be screened for cancer. Those whose responses fell in a neutral category were 40% less likely than those with a high ethnic identity to have had a colon cancer screening (p = .02). Qualitative findings demonstrate differing views among Pacific Islander groups including competition for resources between groups within public housing. All of the interviewees highlight the role of God and faith in decision making. Informational exchanges take place mainly within the family and cohabitants. From triangulating the findings, there is a lack of strong social ties/networks that could facilitate health-based resources and knowledge. Families are not discussing self-care or family histories of disease, which are instrumental in the early detection of cancers and missed within the regression. Conclusion: This study provides insight into the social drivers of cancer screenings for NHPI communities in Hawaiʻi. Novel insights for the fields of medical sociology and public health are highlighted by influential social processes to NHPI cancer screening behaviors. Recommendations include further research and programs that focus on and foster social dynamics of these communities in relation to cancer screenings. Citation Format: Mark L. Willingham Jr., Kevin Cassel, Wei Zhang, Tressa P. Diaz, Angela Sy, Ian Pagano, Munirih R. Ta'afaki, Angelina G. Mummert. Social and Structural Influences of Preventive Cancer Screenings for Native Hawaiian and Pacific Islander Adults in Hawaiʻi [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr PR012.

Multigenerational Native Hawaiian and Pacific Islander Families’ Perspectives on Health and Well-Being

Native Hawaiians and Pacific Islanders (NHPIs) are peoples diverse in culture and history who are too often represented as a monolithic entity, a tendency that undermines efforts to ameliorate health inequities. The current study represents a partnership between academic researchers and a community organization serving NHPIs, in which space was held for five multigenerational NHPI families ( N = 15 family members) to share their experiences with educational and healthcare systems, including issues of discrimination and barriers to accessing services. Qualitative analysis of the interviews identified four themes: Cultural Values and Strengths; Mental Health—Past, Present, and Future Directions; Systemic Racism and Discrimination; and Need for Culturally Informed and Linguistically Accessible Healthcare. These results, including the importance of family systems within NHPI cultures, positive intergenerational shifts in mental health, and the pervasive impacts of colonization on health, are discussed in terms of implications for the health of NHPI communities.

Adult Familial Influences on Rural Native Hawaiian and Pacific Islander Youths’ E-Cigarette Use

Background: Over the past decade, youth e-cigarette use has grown into a national epidemic, with Native Hawaiian and Pacific Islander (NHPI) youths’ rates among some of the highest in the nation. Family factors significantly contribute to NHPI youths’ decisions to engage in or resist substance use, yet few studies have specifically examined familial influences on NHPI youths’ substance use decision-making and behaviors. Objective: The objective of this study is to examine adult familial influences on rural NHPI youths’ decisions to engage in e-cigarette use. Method: Seventeen gender-specific focus groups with NHPI youths (N = 69) from eight public schools on Hawai’i Island were conducted. Results: Two family-related themes emerged from the data: 1) parental substance use permissiveness, and 2) family normalization of e-cigarette use. Conclusions: Examining adult familial contributors to NHPI youths’ e-cigarette use needs to be part of a comprehensive effort to address NHPI health and substance use disparities. Prevention interventions should be explicit in addressing the family and relational context of NHPI youths’ substance use.

Building the NHPI Data Policy Platform to Identify the Most Pressing SDOH Policy Domains for the NHPI Community

Abstract: Access to accurate Native Hawaiian and Pacific Islander (NHPI) social drivers of health (SDOH) data is crucial for understanding health needs and shaping effective public health strategies. However, this data often gets obscured within broader racial and ethnic categories making NHPI issues invisible. Moreover, NHPI communities face barriers when published data formats are inaccessible to community-based organization staff. To tackle these challenges, we initiated the Assessing Social Determinants of Health Data Through Local Data Intermediaries Initiative (AHEAD), supported by the federal Office of Minority Health. We developed two community-centered resources: 1. The NH PI Data Policy Platform, shaped by 138 NHPI community leaders from 13 states and Washington, D.C., representing nine NHPI subgroups. This platform highlights NHPI priority issues and provides equitable data policy recommendations for advocates and policymakers. 2. An NHP I SDOH Dashboard for California Counties, tailored to offer accessible data for community-based organization staff, ensuring better-informed interventions and support.

Kū Like Kākou: Utilizing a Community-led Model of Collaboration to Respond to the COVID-19 Pandemic.

The outbreak of COVID-19 in 2020 brought significant challenges for Native Hawaiians (NH), Pacific Islanders (PI), and other communities of color worldwide. Rapidly increasing rates of infection and transmission of the virus in Native Hawaiian and Pacific Islander (NHPI) communities and incomplete or unavailable data signaled to Hawai'i's leaders that advocacy and action needed to take place to minimize the impact of COVID-19. The Native Hawaiian and Pacific Islander Response, Recovery, and Resilience team (NHPI 3R Team) emerged from an effort to lead and fill gaps in response to COVID-19. Through the swift, intentional, and collaborative work of the team and its partners, NHPI communities and the entities that serve them were better equipped to navigate the pandemic, improve health outcomes, and contribute to a reduction in the number of infections, a rise in vaccination uptake, and an increase in NH and PI representation on various levels of government agencies. As the world shifts its focus from COVID-19 to broader health topics, the NHPI 3R Team will continue to serve as a hub for the exchange of resources and a model of community-led work that can be used to tackle issues like COVID-19 and beyond.

Ka Malu a Waʻahila: Cultivating cultural safety for Native Hawaiian students in university behavioral health

Ka Malu a Waʻahila, an Indigenous-centered and student-informed program, was established in 2022 to meet the growing behavioral health needs of Native Hawaiian college students at the University of Hawaiʻi at Mānoa. Utilizing a cultural safety foundation and relying on the wisdom of community voices articulated by the Pilinahā framework, clinicians provide prevention, direct intervention, and outreach services. As the program continues to evolve, future plans include expanding to other Pacific Islanders and developing an additional layer of systemic change through building an Indigenous behavioral health training pathway and training curriculum for clinicians serving Native Hawaiian and Pacific Islander (NHPI) communities.

Genomic analysis of the tumor microenvironment in Asian and Native Hawaiian and Pacific Islander patients with triple negative breast cancer.

e12644 Background: Triple negative breast cancer (TNBC) accounts for approximately 10- 20% of breast cancer cases and has the worst overall survival and prognosis compared to other subtypes. Unlike other subtypes, patients with TNBC are responsive to neoadjuvant therapy. A higher percent of stromal tumor infiltrating lymophocytes (sTILs) in the tumor microenvironment of TNBC correlates with an improved prognosis. Previous studies demonstrate that Native Hawaiians and Pacific Islanders (NHPIs) and Asians have equivocal percent of sTILs. Yet NHPIs have a higher mortality rate at 24.9% compared to Asians at 11%. Our study aims to molecularly characterize the tumor microenvironment in a diverse population of patients with TNBC who received neoadjuvant therapy. Methods: Retrospective chart review was conducted on 12 Asians and 12 NHPI patients with early stage TNBC from 2015 to 2022 from a medical oncology clinic within the Hawai’i Pacific Health system. Patient data collected include age at diagnosis of breast cancer, histology, BMI, clinical stage, sTILs, residual cancer burden, neoadjuvant treatment, and pathologic complete response. Core biopsy samples were processed and analyzed using the nCounter Breast Cancer 360 Panel. Further analysis was obtained using the nSolver Advanced Analysis Module. Results: Patient characteristics are listed in the table. Most patients had the basal-like immunosuppressed TNBC subtype. Among differentially expressed genes between races, 31 genes were statistically significant. NHPIs expressed more IL12RB2 and MYC, and Asians expressed more FGFR4 and MLPH. Among responders compared to non-responders, 5 genes were statistically significant. Responders expressed more STC1 and PTGER3, and non-responders expressed more CRAYAB, TMPRSS2, and CHAD. Among old and young patients, 132 genes were statistically significant. Older patients expressed more FUT3 and CKMT1, and younger patients expressed more MMP7 and MIA. Conclusions: In this pilot study, the molecular and genetic differences suggest that the tumor microenvironment may play a role in treatment outcomes between NHPIs and Asians. Further analysis will be conducted to determine the differences in immune cell infiltration. [Table: see text]

Disparities in telemedicine use among Native Hawaiian and Pacific Islander individuals insured through Medicaid.

States have implemented policy changes to increase access to telemedicine services for individuals receiving Medicaid benefits. Native Hawaiian and Pacific Islander (NHPI) individuals experienced disproportionate harms from COVID-19 and have long experienced disparities in health care access compared with other racial and ethnic groups, making the issue of telemedicine access particularly salient for NHPI individuals on Medicaid. Utilizing 100% 2020-2021 Medicaid claims, we compared trends in telemedicine use between NHPI and non-Hispanic White individuals on Medicaid in Washington State and conducted a decomposition analysis to identify drivers of underlying disparities. In both years, NHPI individuals were 38%-39% less likely to use any telemedicine than White individuals after adjusting for patient- and area-level characteristics. Decomposition analysis revealed that most of this difference was due to differential effects of characteristics, rather than group differences in characteristics. Namely, several characteristics that were associated with increased telemedicine use had more muted associations for NHPI vs White individuals, such as English as the primary spoken language and female sex. These findings suggest the presence of limited acceptability of or group-specific barriers to telemedicine for NHPI individuals, including potential discrimination in being offered telemedicine visits. These issues should be understood and mitigated through close collaboration between health care leaders and NHPI communities.

Exploring Native Hawaiian and Pacific Islander Youths' E-Cigarette Resistance Strategies: Implications for Tobacco Product Use Prevention

Abstract: This study examined the e-cigarette and vaping resistance strategies used by Native Hawaiian and Pacific Islander (NHPI) youths in rural Hawai'i. Focus groups ( N = 17) were conducted in eight geographically dispersed elementary, middle/intermediate, and multilevel schools in low-income communities on Hawai'i Island. Sixty-nine youths (67% NHPI, Mage = 12.5 years) participated in this study. The resistance strategies discussed across the greatest number of groups were "refuse" (saying no), "explain" (providing reasons for vaping refusal), "avoid" (avoiding people or places where e-cigarettes were used), and "leave" (walking away from a situation where e-cigarettes were being used). Participants described the challenges in using these strategies within contexts characterized by widespread peer and family vaping and strong social demands to use e-cigarettes. The findings suggest the need for multi-level interventions based on youths' resistance strategies to meaningfully reduce youth vaping use in rural and/or NHPI communities.

Abstract P447: Heart Disease Health Disparities Among Native Hawaiian and Pacific Islander Communities in the United States: A Systematic Review

Background: Heart disease is a leading cause of death among Native Hawaiian and Pacific Islander (NH/PI) communities. However, the nature of disease development and risk factors is not well characterized due to poor availability of disaggregated data, hampering efforts towards the design and implementation of culturally-relevant interventions. The purpose of our review is examine known gaps in heart disease prevention measures and programs for NH/PI populations to identify opportunities to mitigate health disparities through structural- and provider-level factors. Methods: We conducted a systematic search of PubMed, Embase, and CINAHL databases to identify peer-reviewed articles focused on heart disease (coronary artery disease, heart attack, heart failure) in NH/PI populations. Eligible studies were assessed for their relevance to NH/PI populations living in the US, US territories and Freely Associated States and their coverage of topics such as prevalence, risk factors, cultural determinants, prevention, and management. Results: Of the 1,440 articles initially identified (3 duplicates removed), 1,437 article titles and abstracts were screened, 585 full-text articles were screened for eligibility and 68 articles were included for analysis. The main reasons for exclusion were the absence of NH/PI individuals, lack of focus on heart disease, grouping NH/PI people with Asian American and other racial groups, and studies conducted outside the US (e.g., Australia, New Zealand). Many of the included articles examined prevalence, risk factors, health behaviors, knowledge, and healthcare utilization, from sources such as the Multiethnic Cohort Study, Behavioral Risk Factor Surveillance Systems, National and Hawaii Vital Statistics and claims data. Culturally-grounded interventions, community-based programs, and initiatives (e.g., Native Hawaiian Health Research Project, Ohana Heart Project, Pacific Islander Health Care Project, Wahine Heart Wellness Program), which incorporate traditional practices, were identified as showing promise in reducing risk and improving heart health among NH/PI adults. Conclusion: The review unveiled a disproportionate burden of heart disease and high prevalence of obesity, diabetes, and hypertension among NH/PI communities, often attributable to lifestyle behaviors, socioeconomic factors, and limited access to healthcare. These disparities are compounded by the underrepresentation of NH/PI populations in national health surveys and the scarcity of comprehensive epidemiological studies featuring robust NH/PI samples. It is evident that further research and policy initiatives are crucial to increase research investments and promote data equity and disaggregation for this population.

Abstract P109: HDL Cholesterol Confers Exceptionally Strong Cardioprotective and Metabolic Effects in Native Hawaiian and Pacific Islander Populations

Relative to the general population, Native Hawaiian and Pacific Islander (NHPI) communities are significantly more prone to obesity, diabetes, and heart disease. Our population-based longitudinal study focuses on HDL cholesterol levels and cardiovascular risk among NHPI and other (comparison) populations. Given the importance of health disparities in cardiovascular disease among the people of Hawai'i, this study holds considerable importance for establishing more diverse, equitable, and inclusive healthcare and precision medicine approaches. Specifically, we communicate a novel data-driven finding, revealed from a statistical and machine learning analysis of epidemiological data from the NIH All of Us Research Program, showing that the cardioprotective effect of high-density lipoprotein (HDL) cholesterol is significantly stronger in NHPI populations relative to other racial/ethnic demographics (including White, Black, and Hispanic/Latinx communities). Our results indicate that: 1) the cardioprotective effect of HDL against coronary artery disease (CAD), acute myocardial infarction (MI), and major adverse cardiovascular events (MACE), is much more powerful in NHPI populations compared to any other racial/ethnic groups currently represented in All of Us . 2) HDL has an exceptionally strong negative relationship with Type II diabetes (T2D) incidence in NHPI populations, which is also significantly stronger than in other ethnicities. In NHPI populations, these results suggest that an additional emphasis ought to be placed on the cardiac and metabolic-protective effect of HDL level as a key biomarker/risk factor in physicians’ assessment of cardiometabolic disease risk. These cardiovascular health equity findings highlight the importance of more and improved diversity, equity, and inclusion efforts to adequately serve growing subpopulations of historically underrepresented groups such as NHPIs within the US healthcare system.

The social drivers of health for Native Hawaiian and Pacific Islander youth in the United States

ObjectivesTo describe the social drivers of health and health status of Native Hawaiian and Pacific Islander (NHPI) youth in the US. MethodsThis is a cross-sectional analysis of the 2014 NHPI National Health Interview Survey (NHIS) which surveyed about 3,000 NHPI households, including 1,428 NHPI youth (884 0–12 yo, 421 13–17 yo, and 123 18–21 yo). We described domains of social drivers of health (SDoH), health conditions, and associations of income and food insecurity with body mass index (BMI) for NHPI youth. ResultsNHPI youth come from households with a wide range in income. Approximately 20% of the cohort were food insecure. Among 18–21 yo, 10% report chronic medical conditions (5% with prediabetes). 33% of 13–17 yo and 52% of 18–21 yo were overweight/ obese. For 13–17 yo, lower income was associated with higher BMI. There was no association between food insecurity and BMI for any age group. ConclusionsOverweight/ obesity are highly prevalent among NHPI youth which is concerning for development of diabetes, hypertension, cardiovascular and kidney disease. Health efforts should focus on SDoH, obesity prevention and management for NHPI youth.

Comorbid Conditions Are Associated With Cognitive Impairment in Native Hawaiians and Pacific Islanders.

We examined the association between comorbid conditions and mild cognitive impairment (MCI) in Native Hawaiians and Pacific Islanders (NHPI) (n = 54). Cross-sectional, self-reported questionnaires were utilized to collect demographic, comorbid conditions, and MCI (via the AD8 index) data. Separate logistic regression models were conducted to investigate the relationship between comorbid conditions and MCI, adjusting for other covariates. We found significantly increased odds of MCI in those reporting high blood pressure (OR = 5.27; 95% CI: [1.36, 20.46]; p = 0.016), high cholesterol (OR = 7.30; 95% CI: [1.90, 28.14], p = 0.004), and prediabetes or borderline diabetes (OR = 4.53; 95% CI: [1.27, 16.16], p = 0.02) compared with those not reporting these respective conditions. These data show that hypertension, hypercholesterolemia, and prediabetes are associated with MCI in the NHPI community, suggesting that preventive strategies to reduce chronic conditions may also potentially slow cognitive decline in underrepresented/understudied NHPI.

Daily Moderate-to-Vigorous Activity of Native Hawaiians and Pacific Islanders and Seven Asian Subgroups by Types of Activities, American Time Use Survey, 2010-2019.

The study used the American Time Use Survey data from 2010 to 2019 to compare the daily moderate-to-vigorous activity of Native Hawaiians and Pacific Islanders (NHPI) and seven Asian ethnic subgroups. Adults aged 24 years and older were included. The study analyzed activities from sports and recreation, household activities, and all activities carried out during the day. Outcomes were determined by the completion of 30 min or more of moderate-to-vigorous activity and the type of activity carried out in the day. Significant ethnic differences were observed for sports and recreation but not for household activities and not for all activities carried out during the day. Of the ethnic populations, NHPI were the least active, and Asian Indians and Chinese were the most active. A majority achieved 30 min or more of moderate-to-vigorous activity during the day from all their activities. Physical activity from household activities exceeded physical activity from sports and recreation. The most physically active group was adults over the age of 65 years, perhaps reflecting more time to exercise or greater concerns about their health. For sports and recreation, exercising with someone doubled the minutes of moderate-to-vigorous activity. The results emphasize the importance of activities performed around the household in addition to sports and recreation and the benefit of exercising with someone. Ethnic populations may be receptive to interventions that emphasize activities they are performing in their daily lives.