Native Hawaiian Population Research Articles

Prenatal intention to human milk feed in the native Hawaiian population: predictors of any human milk feeding from birth to six months postpartum

BackgroundRates of non-communicable diseases are disproportionately high among Native Hawaiian (NH) people, and the proportion of NH infants being fed human milk (HM) is the lowest among all ethnicities within the state of Hawaiʻi. The aim of this study was to explore biological, socio-economic, and psychosocial determinants of the initiation and duration of human milk feeding (HMF) among a study of NH mothers and infants.MethodsA sample of 85 NH mother-infant dyads who were participating in a larger prospective study were involved in this research. Recruitment for the parent was delayed due to the COVID-19 pandemic. Recruitment started in November 2020 and continued until April 2022. Questionnaires were distributed at birth, two-months, four-months, and six-months postpartum. Questionnaires addressed topics relating to maternal and infant characteristics and infant feeding practices. Descriptive statistics, comparative analysis, and multivariate logistic regression tests were conducted.ResultsThe majority of participating mothers were aged between 31 and 35 years, had some college education or more, were employed, and multiparous. The majority of infants were receiving HM at each timepoint (94% at birth, 78% at two-months postpartum, and 76% at four and six-months postpartum). Factors found to be significantly associated with HMF initiation and duration were prenatal intention to HMF, maternal educational attainment, Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participation, and Supplemental Nutrition Assistance Program (SNAP) recipiency. A prenatal intention to HMF was found to be a strong predictor of HMF at birth (aOR = 64.18, 95% CI 2.94, 1400.28) and at two-months postpartum (aOR = 231.55, 95% CI 2.18, 2418.3). Participants not involved with WIC were more likely to be HMF at four-months postpartum (aOR = 6.83, 95% CI 1.01, 46.23).ConclusionThis research supports existing evidence that prenatal intention to HMF and higher maternal educational attainment are positive predictors of HMF. WIC participation and being a SNAP recipient were found to be negatively associated with HMF which suggests a need for more culturally tailored support. Further research is required to reduce the gap in knowledge related to the determinants of HMF in NH.

Abstract PO5-08-12: Ethnic Admixture Affects Breast Cancer Incidence in Native Hawaiians: The Multiethnic Cohort

Abstract Background Native Hawaiians (NH) have the highest breast cancer incidence and the poorest survival of any ethnic group in Hawaii [1]. Since it has been shown that different ethnic groups have disparate risk of breast cancer in Hawaii and NHs are commonly of mixed ancestry, it is possible that the specific ethnic admixture may present an altered risk profile. For example, NH with Asian admixture was associated with higher risk for type 2 diabetes independent of known risk factors [2] compared to those without. The objective of this study was to calculate crude and age-adjusted breast cancer incidences by ethnic admixture group among participants of the Multiethnic Cohort (MEC). Methods: Based on self-reports, 106,525 eligible women were categorized by broad ethnic categories: Native Hawaiian, White, Black, Latino, and Japanese. In total there were 9257 breast cancer cases in the MEC cohort (1996-2019) at time of analysis. The Native Hawaiian population was further categorized into the following subgroups: Native Hawaiian only, Native Hawaiian & White, Native Hawaiian & Chinese, Native Hawaiian & White & Chinese. Crude and age-adjusted incidence rates (per 1000 person-years) were calculated for the various groups. The direct method of age adjustment using the US 2000 Standard population was used. Results: The ethnicity with the highest crude incidence were White=88.46, followed by Black=85.20, Latino=84.27, Japanese=84.90, and Native Hawaiian=81.28. However, after age-adjustment the highest were Japanese=159.1, White=153.8, Latino=148.3, Black=147.4, and Native Hawaiian=139.1. Crude incidence rates for Native Hawaiian ethnic admixture was found to be highest for Native Hawaiian & White=83.5, Native Hawaiian only=82.5, Native Hawaiian & Chinese=80.8, and Native Hawaiian & White & Chinese=80.4. After age adjustment, the highest was Native Hawaiian & Chinese=173.9, followed by Native Hawaiian & White=154.3, Native Hawaiian only=148.7, and finally Native Hawaiian & White & Chinese=120.8. Conclusion: These findings indicate that ethnic admixture in Native Hawaiians may be at elevated age-adjusted breast cancer incidence when compared to Native Hawaiian alone. When a woman was Native Hawaiian and Chinese the incidence was notably higher than any other group at 173.9 when compared to all Native Hawaiian=139.1. Furthermore, the group that had the lowest age-adjusted incidence was the mixed group of Native Hawaiian & White & Chinese=120.8 which seems to account for why the overall Native Hawaiian group=139.1 had one of the lowest incidence rates of the 5 major ethnic groups. 1. Loo, L.W., M. Williams, and B.Y. Hernandez, The high and heterogeneous burden of breast cancer in Hawaii: A unique multiethnic US Population. Cancer epidemiology, 2019. 58: p. 71-76. 2. Maskarinec, G., et al., Ethnic admixture affects diabetes risk in native Hawaiians: the Multiethnic Cohort. Eur J Clin Nutr, 2016. 70(9): p. 1022-7. Citation Format: Dustin Valdez, Arianna Bunnell, David Bogumil, Gertraud Maskarinec, John Shepherd. Ethnic Admixture Affects Breast Cancer Incidence in Native Hawaiians: The Multiethnic Cohort [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-08-12.

Abstract 1017: Characterizing immune cell infiltration in colorectal cancer tumor microenvironment among Native Hawaiians

Abstract Background Colorectal cancer (CRC) is recognized as a heterogeneous disease, ranking third in new cancer diagnoses and second in cancer-related deaths globally and nationally. CRC incidence is higher in the state of Hawaii compared to the U.S. overall. This study focuses on profiling immune cell infiltration in Native Hawaiian(NH)-specific CRC tumor microenvironments. Identifying the race-specific tumor infiltrating microenvironment may uncover potential mechanisms for CRC development in the NH population. Methods Deidentified, archival formalin-fixed paraffin-embedded tumor samples from Native Hawaiian patients diagnosed with primary CRC between 1990 and 2006 were obtained from the Hawaii Tumor Registry. RNA was extracted from tumor and adjacent normal tissues. RNA-seq data from Caucasian American (CA) CRC samples were obtained from The Cancer Genome Atlas (TCGA) and the Gene Expression Omnibus (GEO). Differentially expressed genes for each cohort were identified via DESeq2 with Benjamini-Hochberg multiple testing q-value<0.05 and a cutoff of 2-fold change. From the gene expression profiles, we applied the ESTIMATE algorithm to calculate the overall immune cell infiltration score for each sample. Based on a deconvolution algorithm, known as CIBERSORT to estimate the abundance of 22 immune cell types, we profiled the tumor-infiltrating immune cells present in each cohort’s paired samples, respectively. To improve the accuracy, p-value and root mean squared error were counted for each sample. Data with p<0.05 were filtered and selected for the next analysis. The fraction of immune cell subpopulations was evaluated and compared between paired tumor and adjacent normal tissues in NH and CA cohorts. Results In the NH cohort, we found the overall immune cell infiltration score was significantly lower in cancer tissues than the adjacent normal tissues (p<0.05), and there were significantly higher fractions of activated dendritic cells, resting natural killer (NK), and follicular helper T cells in tumor tissues compared to adjacent non-tumor tissues (p<0.05). Furthermore, the fractions of activated NK cells and plasma cells were significantly lower in tumor tissues than in adjacent non-tumor tissues in NH (p<0.05). Resting NK cells are upregulated in both the NH and the CA cohorts, while plasma cells are the only immune cell type downregulated in either cohort. In the NH cohort, activated dendritic cells and follicular helper T cells are exclusively upregulated, while activated NK cells are downregulated relative to the CA cohort. Conclusion This study demonstrates that the NH cohort displays distinctive immunological variances between tumor and adjacent non-tumor tissues which distinguishes them from the CA cohort. This emphasizes the significance of acknowledging population-specific genetic variations which may help understand race specific difference in CRC. Citation Format: Yuanyuan Fu, Gino Quintal, Masaki Nasu, Mayumi Jijiwa, Sudhir K. Rai, Isam Mohd-Ibrahim, Yu Chen, Hua Yang, Zhanwei Wang, Christina Wai, Owen Chan, Brenda Y. Hernandez, Youping Deng. Characterizing immune cell infiltration in colorectal cancer tumor microenvironment among Native Hawaiians [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 1017.

Abstract TP248: Genetic Predisposition to Diabetes and Risk of Stroke in Native Hawaiians

Background: Diabetes is a highly heritable stroke risk factor with numerous known genetic risk variants. However, the role of these genetic risk variants in the development of cerebrovascular disease in Native Hawaiians remains unknown. We sought to determine whether genetic predisposition to diabetes is associated with higher risk of stroke in a Native Hawaiian population. Methods: We conducted a genetic association case/control study using data from Native Hawaiians enrolled in the Population Architecture using Genomics and Epidemiology (PAGE) study. Stroke cases were ascertained by baseline questionnaires and matched by age and sex in a 1:10 ratio. We modeled genetic predisposition to diabetes through a polygenic risk score that contained independent genetic variants known to associate with diabetes at genome-wide levels (p<5x10 -8 ). This polygenic risk score became the independent variable of logistic regression models for both diabetes and stroke. Results: A total of 440 self-identified Native Hawaiians were included (15% < 50 years of age, 85% ages 50-69, 65% females), including 40 stroke patients and 400 age/sex-matched control subjects. Genetic predisposition to diabetes was associated with a 23% higher risk of diabetes (OR 1.23, CI 1.01-1.51; p=0.04) and with a 45% higher risk of stroke (OR 1.45, CI 1.03-2.05; p=0.04). Conclusions: Among Native Hawaiians, genetic predisposition to diabetes is associated with higher risk of stroke. As research aimed at evaluating the role of polygenic risk data in clinical practice grows rapidly, our results emphasize the importance of including Native Hawaiians in order to avoid health disparities exacerbated by incomplete representation.

Recombination map tailored to Native Hawaiians may improve robustness of genomic scans for positive selection

Recombination events establish the patterns of haplotypic structure in a population and estimates of recombination rates are used in several downstream population and statistical genetic analyses. Using suboptimal maps from distantly related populations may reduce the efficacy of genomic analyses, particularly for underrepresented populations such as the Native Hawaiians. To overcome this challenge, we constructed recombination maps using genome-wide array data from two study samples of Native Hawaiians: one reflecting the current admixed state of Native Hawaiians (NH map) and one based on individuals of enriched Polynesian ancestries (PNS map) with the potential to be used for less admixed Polynesian populations such as the Samoans. We found the recombination landscape to be less correlated with those from other continental populations (e.g. Spearman’s rho = 0.79 between PNS and CEU (Utah residents with Northern and Western European ancestry) compared to 0.92 between YRI (Yoruba in Ibadan, Nigeria) and CEU at 50 kb resolution), likely driven by the unique demographic history of the Native Hawaiians. PNS also shared the fewest recombination hotspots with other populations (e.g. 8% of hotspots shared between PNS and CEU compared to 27% of hotspots shared between YRI and CEU). We found that downstream analyses in the Native Hawaiian population, such as local ancestry inference, imputation, and IBD segment and relatedness detections, would achieve similar efficacy when using the NH map compared to an omnibus map. However, for genome scans of adaptive loci using integrated haplotype scores, we found several loci with apparent genome-wide significant signals (|Z-score|> 4) in Native Hawaiians that would not have been significant when analyzed using NH-specific maps. Population-specific recombination maps may therefore improve the robustness of haplotype-based statistics and help us better characterize the evolutionary history that may underlie Native Hawaiian-specific health conditions that persist today.

I kua na'u "Let me carry out your last wishes" Clinical trial protocol to promote advance care planning among native Hawaiian populations

Advance Care Planning (ACP) is a communication process about serious illness decision making designed to inform patients of possible medical options. Native Hawaiians consistently have low rates of ACP and low use of palliative and hospice care services. Our multidisciplinary community and research group partnered to create I kua na'u “Let Me Carry Out Your Last Wishes,” an ACP intervention featuring culturally tailored videos and are now testing its efficacy. Focus groups and informant interviews were conducted with Native Hawaiian community members to ensure the curriculum honored the history, opinions, and culture of Native Hawaiians. Native Hawaiian culture has traditionally been an oral culture; the spoken word transmitted the moʻolelo, stories, traditions, histories and genealogies, which merges seamlessly with video media. The I kua na'u intervention included multiple educational sessions enhanced with videos (informational and personal). The specific aims are to compare ACP knowledge (primary outcome) and readiness for ACP engagement, ACP preferences, decisional conflict, and ACP completion rates via electronic medical record review (secondary outcomes) in 220 Native Hawaiians over age 55 in: (a) a randomized controlled trial of 110 people recruited from ambulatory clinics, and (b) a pre-post study design among 110 people living on Hawaiian Homestead communities located on lands set aside for Native Hawaiians or assisted living.Our protocol aims to evaluate the efficacy of our video-based educational intervention for Native Hawaiians to support decision making in this community and decrease disparities in serious illness care.Clinical Trial Registration Number: NCT04771208

S112 Implications of Butyrate Kinase and Intestinal Microbiota on Diabetes Risk in a Community Enriched With Native Hawaiians

Introduction: The incidence of type 2 diabetes mellitus (T2DM) within the Native Hawaiian population among the highest of any major ethnic group within the state of Hawaii. Modern research is beginning to mechanistically understand ancient Hawaiian concepts and practices demonstrating the importance of environment to human health. Environmental factors, such as socioeconomic status, toxicants, diet/nutrition, etc, contribute to individual risk of T2DM, where impacts on the gut microbiome may play key roles in inflammatory and metabolic dysregulation characteristic of diabetes. In this study, we focused on understanding the relationship between the gut microbiome and T2DM risk in the Native Hawaiian population. Methods: The study enrolled a cohort of Hawaii residents (16 years or older) in a community enriched with Native Hawaiians. Microbial DNA was isolated from self-collected stool samples of all participants and used for 16S amplicon-based sequencing for metagenomic analyses and for quantifying microbial-specific butyrate kinase (BUK) gene expression levels using qPCR approaches. From each participant, anthropometric measures and blood levels of HbA1c, a diagnostic indicator of T2DM, were taken. Blood was collected by venous puncture from which plasma was isolated to measure inflammatory and metabolic biomarkers. Herein, we identified and describe significant differences between diabetic and non-diabetic microbiome composition and diversity. Results: Consistent with other studies, we observed increased levels of CRP (p< 0.01) and decreased levels of leptin (p=0.04) in the plasma of diabetic compared to non-diabetic participants. Additionally, we observed that BUK levels were negatively correlated with that of HbA1c (R=-0.18, p=0.04), and positively correlated with that of metabolic hormones PYY (R=0.30; p=0.007) and GLP-1 (R=0.19; p=0.04), which were largely attributed to diabetes status. Higher plasma levels of PYY and GLP-1 have previously been associated with reduced T2DM risk. Conclusion: Altogether, our data suggest a role for butyrate-producing gut bacteria in the maintenance of the homeostatic inflammatory and metabolic states that are dysregulated in the progression of T2DM and implicates novel targets for reducing T2DM risk among health disparate populations.

Ethnicities of Patients Presenting with Methamphetamine Associated Cardiomyopathy at a Tertiary Hospital System in Hawaii

<h3>Purpose</h3> Methamphetamine (meth) use is now the second most used illicit substance worldwide. Methamphetamine-associated cardiomyopathy/heart failure (MethHF) is an increasingly recognized disease entity. Previous literature has showed that racial and ethnic minority populations are at higher risk for meth use. We set out to characterize the degree of burden of MethHF through the lens of ethnicity at a major metropolitan, tertiary hospital hospital system in Hawaii. <h3>Methods</h3> A retrospective chart review from 2011 to 2021 including all adult patients (≥18 years old) with positive meth urine drug screen or with prior diagnosis of meth use with and without a diagnosis of cardiomyopathy in the electronic medical record were included for analysis. They were compared to patients with heart failure from any cause as defined by a serum BNP >200, serum NT proBNP >200, or a positive history of cardiomyopathy as defined by ICD codes in the electronic medical record. <h3>Results</h3> The socio-demographics of patients presenting with MethHF are included in Table 1. 46,849 patients were included for analysis. MethHF was seen most commonly in the Native Hawaiian, Caucasian, and Filipino population with the three groups making up for 65% of the total MethHF burden. The prevalence of meth use was highest in the Caucasian population, however MethHF was seen more commonly in the Native Hawaiian population. The prevalence of MethHF in the Native Hawaiian population is more striking when compared to 2020 census data showing that only 5% of the island's population identify as such. <h3>Conclusion</h3> Our results suggest that the burden of meth use and MethHF at our institution is higher in minority populations. This study suggests that greater awareness of psychosocial factors in MethHF patients is needed to better prevent and treat this burgeoning disease.

Increasing Native Research Leadership Through an Early Career Development Program.

Inequities impact American Indian, Alaska Native, and Native Hawaiian populations across various health conditions; in particular, many Native communities bear a disproportionate burden of substance use disorder. Such inequities persist despite concerted efforts of communities and significant research directed toward prevention and intervention. One factor hampering these efforts is the underrepresentation of researchers who are themselves Native and uniquely equipped to respond to the needs of their communities. This paper describes the innovative Native Children's Research Exchange (NCRE) Scholars program, now entering its ninth year of successful career development support for emerging Native scholars. We summarize the history of NCRE Scholars, outline the mentoring and training approaches taken to meet the unique needs of early-career Native scholars, and present key progress of program alumni. The current cohort of Scholars provide first-person perspectives on how four key program elements have supported their career development to date. NCRE Scholars has been an effective approach for supporting the next generation of Native research leaders and for helping to build an essential mass of Native researchers prepared to respond to Native community health priority needs.

Abstract PO-167: Predictive genetic risk factors and prognostic nomogram for colorectal cancer in Native Hawaiian population

Abstract Background While Native Hawaiians (NH) comprise a small portion of the US population, their numbers are expected to increase. Concerningly, NH exhibit disproportionate health issues, and specifically those with colorectal cancer (CRC) present elevated incidence and mortality above the US population. This study aims to identify race-specific genetic factors for CRC early detection and prognosis in this unique population. Methods Paired tumor and adjacent normal biospecimens from NH patients with primary CRC were collected from the Hawaii Tumor Registry (HTR), and RNA sequencing on 41 paired samples were performed to establish the first genome-wide transcriptome profiling dataset specifically for NH with CRC. RNAseq data of 18 paired samples and additional 212 cancer samples were taken from The Cancer Genome Atlas (TCGA) white patients. Differential expressed genes (DEGs) were identified for both NH and TCGA cohorts via DESeq2 with FDR q-value &amp;lt; 0.05 and a cutoff of 2-fold change. A diagnostic model was built by Least Absolute Shrinkage and Selection Operator (LASSO) logistic regression with 10-fold cross validation, and Ingenuity Pathway Analysis (IPA) was processed for canonical pathways and network discovery. Univariate Cox proportional regression was performed to identify DEGs related to NH patient survival; multivariable Cox regression model with stepwise fitting generated a prognostic index (PI): PI=Σbi × expGenei (where expGene defines the gene expression and b equals the regression coefficient), and the prediction value was examined by the Area Under the Receiver Operating Characteristic (ROC) Curve (AUC). A nomogram was developed by integrating PI and clinicopathologic factors; calibration curves were provided to internally validate the performance, and discriminative ability was appraised by concordance index. Results In total, 2096 DEGs were identified between tumor and normal groups, and 1740 transcripts were unique to NH compared to the TCGA Whites cohort. A set of 23 genes including 10 NH specific DEGs was identified as genetic risk factors for detecting NH with CRC, and the AUC was 99.8%. A 9 gene-signature prognostic model including 5 NH specific DEGs was built with high survival prediction capability (AUC=0.99), and Kaplan-Meier curve showed that the low PI group had a better survival than the high PI group in NH with CRC (Logrank P=3.6E-05). After adjustment by age, gender, and tumor grade, the prognostic 9 gene-signature was still significant (P=0.0059). By integrating the above signatures with prognostic clinicopathologic features, a nomogram was constructed to stratified patients with overall survival rates for 3, 10, and 20 years. Conclusion Divergent DEGs and consequential pathways between NH and TCGA cohort reinforced the necessity of NH race specific biomedical research. The prognostic gene signature offered evidence that genomic data provided independent and complementary prognostic information, and the nomogram incorporating genetic and clinicopathological factors refined the prognosis of CRC for this unique population. Citation Format: Yuanyuan Fu, Devin Takahashi, Vedbar Khadka, Masaki Nasu, Mayumi Jijiwa, Yu Chen, Heather Borgard, Youping Deng. Predictive genetic risk factors and prognostic nomogram for colorectal cancer in Native Hawaiian population [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-167.

Native Hawaiian healing to treat substance misuse: history through the looking glass

ABSTRACT Cultural interventions that reflect the history and traditions of Native Hawaiians in therapeutic settings are not a mainstay of standard addiction treatment. In an attempt to address the disproportionately high rates of substance use with comparably low rates of voluntary treatment participation among the Native Hawaiian population, the first Native Hawaiian culturally informed treatment program emerged in the early 1980s to utilize various types of indigenous methods intended to improve treatment response and expected clinical outcomes. This article explores the historical basis and cultural precedence for the contemporary use of Native Hawaiian cultural practices in drug treatment facilities. The history of indigenous healing traditions and the Kingdom of Hawai‘i’s government policy interventions between 1810, when Kamehameha unified the Hawaiian islands under his rule, and 1893, when the U.S. government backed the illegal overthrow of Queen Lili‘uokalani’s constitutional monarchy, are considered in addressing substance misuse.

Lack of Native Hawaiian Neurologists and Disparities in Care for Native Hawaiians in Hawaiʻi

Introduction: In Hawaiʻi, there are 367,000 Native Hawaiian and Pacific Islanders. Native Hawaiians experience health disparities in a variety of conditions, including stroke, diabetes, and cancer. Ethnic minorities are underrepresented among physicians; this lack of physician-patient racial concordance may contribute to the disparities, as recent studies suggest that racial discordance resulted in poorer healthcare quality. This study aims to assess the current status of neurological health disparities in the Native Hawaiian population in Hawaiʻi, with a focus on identifying neurologist ethnic representation, neurological diseases, and healthcare-related challenges disproportionately affecting Native Hawaiians. Methods: An anonymous survey on physician’s attitudes and practice was emailed to all neurologists in the Hawaiʻi Neurological Society from February 2019 to June 2019. Findings: Twenty-three full responses and one partial response was received. No participants self-identified as Native Hawaiian nor did they know of any Native Hawaiian neurologists in Hawaiʻi, yet all who completed the survey reported treating Native Hawaiians in their practice (n = 23), which identifies a gap in Native Hawaiian representation in the field of neurology in Hawaiʻi. In addition, majority of participants perceived that Native Hawaiians are disproportionately affected by neurological diseases and have difficulty accessing neurology services and obtaining quality care. Conclusions: Future focus on creating opportunities to improve racially discordant physician-patient relationships and to increase Native Hawaiian representation in neurology may help narrow the gap in health disparities experienced by Native Hawaiians.

OncotypeDx scores according to race/ethnicity and age in a diverse cohort of breast cancer patients.

e12512 Background: Breast cancer incidence and mortality rate differ across racial/ethnic populations in the US, but little is known about the relationship between Oncotype DX scores and race/ethnicity. Oncotype DX scores are used in early stage, hormone positive breast cancers to estimate the likelihood of breast cancer recurrence and benefit from receiving chemotherapy. Most available literature assesses disparities between race and receipt of an Oncotype DX score, with only some assessing distribution of scores by race. Populations previously studied mainly focus on Black compared to White women, with very few including Asian and Native Hawaiian/Pacific Islander subpopulations. When included, they are often grouped together as Asian/Pacific Islander. Current studies suggest there is a similar distribution of scores among Black and White women, but some studies report that Black women may be more likely to have high-risk scores. Methods: We examined 476 unique breast cancer cases in the Hawaii Pacific Health system diagnosed in 2018-2020. We used univariable and multivariable analyses on all of those cases that received an Oncotype DX score to determine correlation to age and race. Results: In 328 breast cancer cases that received an Oncotype DX score, age of diagnosis ranged from 29 to 84 with race/ethnicity including Japanese (n = 90, 27%), White (n = 78, 24%), Filipino (n = 54, 17%), Native Hawaiian (n = 52, 16%), Chinese (n = 24, 7%), and other (n = 30, 9%) populations. Cases with age at diagnosis between 60-69 (n = 118, 36%) were found to have a mean Oncotype DX score of 13.91 (CI 12.19-15.62, p = 0.04) which was statistically lower than other ages groups on both univariable and multivariable analysis. We found no other significant relationships between Oncotype DX score and race or age at diagnosis on our analyses. Conclusions: These findings contribute more information about Oncotype DX scores within Asian and Native Hawaiian populations to the available literature.

Supporting Native Hawaiian Health With Community‐Based Social and Biomedical Research

PURPOSE Research indicates that Native Hawaiians have the highest rates of diabetes and obesity in the state of Hawaiʻi. Understanding the way epigenetics plays a role in Type 2 Diabetes (T2DM) will help us determine how environmental factors play a role in the risk of T2DM in Native Hawaiian populations. Our objectives with this study are:(1) Understand the relationship between social context and health; (2) Learn about the mechanism through which a community-based program impacted health/wellbeing of Native Hawaiians; (3) Consider a new model of community-engaged research that empowers individuals and organizations to address health disparities. METHODS The study targeted individuals (16 years or older) in the state of Hawaiʻi affiliated with MAʻO organic farms or connected to their social network. Stool sample kits were distributed to participants with oral and written instructions to collect their own samples at home and store them in a freezer until they can be returned via mail or collected by a community research facilitator for analysis. Stool samples were used to metagenomics analysis. Height, weight, blood pressure, pulse and A1C were measured and recorded. RESULTS Results of this study show that main bacteria were dominant in Native Hawaiians (Bacteroidetes, Firmicutes, Proteobacteria, Actinobacteria). Actinobacteria and Proteobacteria were significantly correlated with BMI and A1c in Native Hawaiians. In the overall study population, there is a statistically significant negative correlation between A1c and the abundance of Actinobacteria (ρ= -0.169; CI = 90%) and Proteobacteria (ρ= -0.212; CI=95%). In the same group of participants, BMI is negatively correlated with the abundance of Actinobacteria (ρ= -0.222; CI=95%). DISCUSSION/CONCLUSION Our project integrates social and biomedical research in evaluating a holistic community-based program on the health/wellbeing of Native Hawaiian youth and their social networks. Social networks influence individuals' choices and behaviors that either lead to unhealthy or healthy lifestyles. Recent studies suggest a link between social networks and health conditions that are likely mediated by biological mechanisms influencing glucose homeostasis and gut microbiome composition. Our project will conclude with a description of a new model of community-engaged research that is currently being developed to facilitate the collection and sharing of social and biomedical data driven by community-based organizations to ultimately promote Native Hawaiian health.

Orders from disorder? King Kalākaua’s 1881 global tour and the Hawaiian monarchy’s late nineteenth-century deployment of royal orders and decorations

The history of the late nineteenth-century Hawaiian kingdom is often viewed as an inevitably tragic story. It comprises the rapid decline of the native Hawaiian population through disease, the weakening of Hawaiian monarchs’ political autonomy by pro-American sugar interests, followed by the US-led overthrow of the monarchy in 1893. The story culminates in formal annexation of the kingdom in 1898 and supposedly ends with Hawai’i’s admission as America’s 50th state in 1959. In fact, the history of the late nineteenth-century Hawaiian monarchy, and in particular its active resistance to US imperialism, remains a palpable force within contemporary Hawai’i. It influences the current native Hawaiian independence movement and informs a range of decolonising projects involving current scholars and activists across the Pacific. The following discussion of royal Hawaiian orders and decorations offers some new raw materials for those seeking to recover the agency and global entanglements of Hawai’i’s monarchy both prior to and following US annexation.

Abstract P629: Genome-Wide Association Study of Individuals of Native Hawaiian Ancestry Reveals Unique Genetic Risk Factors for Stroke and Myocardial Infarction

Background: Several genetic susceptibility risk loci for ischemic stroke have been identified. However, the relative dearth of genetic data from populations of non-European ancestry has the potential to create disparities in access to genomics-based precision medicine strategies. Individuals of Native Hawaiian ancestry represent a particularly understudied group in stroke genomics research despite facing high rates of cerebrovascular disease. Hypothesis: Genetic variants associated with stroke differ between Native Hawaiians and previously studied groups of predominantly European ancestry. Methods: We conducted a genome-wide (GW) association study of stroke and myocardial infarction (MI) in an adult population of Native Hawaiian ancestry, using data from the Multiethnic Cohort study (MEC). Genetic information was ascertained via genome-wide array genotyping using the AB OpenArray and TaqMan platforms followed by imputation to 1000 Genomes reference panels. We pursued replication of variants that were GW significant (p&lt;5x10 -8 ) or yielded suggestive associations (p&lt;5x10 -7 ) in the prior stroke GW association study MEGASTROKE. Results: We identified 2,104 individuals (1,089 [51.8%] female) of Native Hawaiian ancestry, including 173 cases and 1,931 controls. We identified one novel susceptibility risk locus at a narrow intronic region located at chromosome q26.2 (top associated SNP 3:169096251, OR 2.48, 95%CI 1.81-3.41; p=1.93x10 -8 ), overlying the MECOM gene. We also identified 9 other suggestive risk loci at p&lt;5x10 -7 . When replicating in MEGASTROKE, q26.2 did not have available counterpart variants to analyze, and 3 out of 9 suggestive signals were associated with ischemic stroke subtypes at p&lt;0.05. Conclusions: We report the first GW association study of ischemic stroke and myocardial infarction in a Native Hawaiian population. We identified one susceptibility risk locus at q26.2, located in a narrow intronic region of MECOM, a gene that codes for a histone-lysine N-methyltransferase that has transcriptional regulation and oncoprotein functions. The lack of available replication data for this locus in the large MEGASTROKE collaboration emphasizes the importance of developing genomic resources across ancestral groups.

Abstract P329: Perceptions of Neighborhood Level Stressors in Native Hawaiian Communities: A Descriptive Study

HTN (HTN) is an important and modifiable risk factor for cardiovascular disease, the leading cause of death. Native Hawaiians, the indigenous people of Hawai‘i, experience a prevalence of HTN (i.e., systolic blood pressure (SBP) of ≥140mmHg or diastolic blood pressure of ≥90mmHg) of over 50%. Factors that contribute to HTN control are multilevel and include neighborhood or community level determinants such as walkability, availability of healthy foods, safety, and social cohesion. However, these factors and their potential relationship to HTN have yet to be examined in Native Hawaiian communities. Identifying important neighborhood factors in Native Hawaiian communities can inform HTN control interventions. The purpose of this study is to describe the perceptions of neighborhood level stressors among Native Hawaiians participating in a randomized controlled trial testing a culturally-grounded, hula-based HTN intervention. This study was comprised of a subset of participants (N=124) from an NIH-funded, randomized controlled trial testing the effectiveness of a hula-based intervention at improving SBP in Native Hawaiians with uncontrolled HTN compared to an education only group. Neighborhood Level Stressors Scale was used to assess seven neighborhood dimensions: walkability, availability of healthy foods, safety, social cohesion, aesthetic quality, violence, and activities with neighbors. Scores ranged from 1 to 5 with lower scores indicating more positive perceptions their neighborhoods (e.g., greater safety). Demographic variables included age, gender, marital status, education. Descriptive and summary statistics are presented. Two-sample t-test was done to compare neighborhood level stressor by intervention group. Mean scores for the seven dimensions were as follows: aesthetic quality 2.54 (SD=0.61) walkability 2.48 (SD=0.72), availability of healthy foods 2.59 (SD=1.10), safety 2.63 (SD=0.97), violence 3.44 (SD=0.54), social cohesion 2.17 (SD=0.76), and activities with neighbors 2.09 (SD=0.75). The hula-based intervention group had a significantly lower (i.e., better) mean neighborhood aesthetic quality score compared to the education only group (p=0.02). The intervention group also had marginally better perceived activities with neighbors (p=0.09). This study describes perceived neighborhood dimensions in a Native Hawaiian population engaged in a HTN control intervention trial. Mean scores on walkability, availability of healthy foods, safety, social cohesion, aesthetic quality, violence, and activities with neighbors were similar to those reported in larger, multiethnic cohort studies. Perceptions of greater walkability, availability of healthy foods, safety, and social cohesion have been associate with HTN in other populations. Analysis to examine the potential associations between neighborhood level stressors and SBP is planned.

MH Care of American Indian, Alaskan Native, and Native Hawaiian Population Has Long History, Uncertain Future

MH Care of American Indian, Alaskan Native, and Native Hawaiian Population Has Long History, Uncertain Future

Examining Long-Term Service and Support Needs and Preferences of Native Hawaiian Elders: A Mixed-Method Approach.

Objective: The Native Hawaiian population experiences numerous disparities in health and income. Using a mixed-method research (MMR) design, we summarize findings from three phases of an MMR approach used to uncover kūpuna (elder) long-term service and support (LTSS) needs and care preferences. Methods: Key informants in Hawaiian health were interviewed, secondary analyses of large state data sets were conducted, and kūpuna and "ohana (family) caregivers were engaged in listening sessions. Results: Quantitative data confirmed numerous health disparities experienced by older Native Hawaiians, whereas qualitative data exposed their limited knowledge of this poor health profile and revealed their historical and contemporary experiences with discrimination in education, employment, and health care. Hawaiian culture was identified as a continued source of resilience in support of elders and family caregiving regardless of geographic setting. Discussion: We suggest three practice, policy, and research directions that offer the potential to respond to and improve kūpuna health and service use.

Lepra e exílio: a biopolítica da monarquia havaiana no século XIX

O presente artigo pretende analisar, sob perspectiva foucaultiana, como a biopolítica se consolidou através da influência ocidental no Havaí durante o século XIX. Para tal, tomamos o Act to prevent the Spread of Leprosy (1865) e suas consequências políticas e sociais como objeto de análise. Primeiramente, fazemos uma breve contextualização do cenário político e social do Havaí durante esse período, assunto pouco discutido na historiografia brasileira. Em seguida, diferenciamos os conceitos de poder soberano e biopoder para indicar como a criminalização da hanseníase (“lepra”) pelo rei Kamehameha V relaciona-se com a teoria de biopoder de Michel Foucault. O Act to Prevent the Spread of Leprosy, como “biopolítica da espécie humana”, afetou profundamente a vida da população nativa havaiana e revelou se parte da influência americana e europeia que minaria a própria autonomia do país.