Native Hawaiian Research Articles

Standardizing Fetal Movement Monitoring using Count the Kicks.

Stillbirth affects 1 in 175 pregnancies in the United States. There are significant racial and ethnic disparities in rates of stillbirth. Rates of stillbirth are highest among non-Hispanic Native Hawaiian or Other Pacific Islander and non-Hispanic Black women, more than twice the rate of non-Hispanic White women. Stillbirth is a public health crisis that warrants attention as it has significant physical, psychosocial, and economic effects on women and their family. Many stillbirths occur due to placental insufficiency, causing a lack of oxygenation of the fetus, which can result in decreased movement. Pregnant patients who experience stillbirth often observe decreased fetal movement days before birth. Daily fetal movement monitoring has the potential to identify pregnancies at risk so providers can intervene. Count the Kicks is a fetal movement monitoring program that provides standardized education and resources for expectant parents. Increased awareness of providers and childbearing families about the importance of fetal movement monitoring, standardized provision of education on fetal movement counting, and what to do if a baby's normal movement patterns change can be helpful in promoting healthy pregnancy outcomes.

Estimating dementia incidence in insured older Asian Americans and Pacific Islanders in California: an application of inverse odds of selection weights.

Literature shows heterogeneous age-standardized dementia incidence rates across US Asian American, Native Hawaiian, and Pacific Islanders (AANHPI), but no estimates of population-representative dementia incidence exist due to lack of AANHPI longitudinal probability samples. We compared harmonized characteristics between AANHPI Kaiser Permanente Northern California members (KPNC cohort) and the target population of AANHPI 60+ with private or Medicare insurance using the California Health Interview Survey. We used stabilized inverse odds of selection weights (sIOSW) to estimate ethnicity-specific crude and age-standardized dementia incidence rates and cumulative risk by age 90 in the target population. Differences between the KPNC cohort and target population varied by ethnicity. sIOSW eliminated most differences in larger ethnic groups; some differences remained in smaller groups. Estimated crude dementia incidence rates using sIOSW (versus unweighted) were similar in Chinese, Filipinos, Pacific Islanders and Vietnamese, and higher in Japanese, Koreans, and South Asians. Unweighted and weighted age-standardized incidence rates differed for South Asians. Unweighted and weighted cumulative risk were similar for all groups. We estimated the first population-representative dementia incidence rates and cumulative risk in AANHPI ethnic groups. We encountered some estimation problems and weighted estimates were imprecise, highlighting challenges using weighting to extend inferences to target populations.

Do Medicare Inpatient Rehabilitation Facility Patients' Self-Care and Mobility Outcomes Vary by Dual Eligibility Status, Race and Ethnicity, Rural Residence, Socioeconomic Status, and Living Alone?

To examine whether inpatient rehabilitation facility (IRF) patients' risk-adjusted functional outcomes varied with five social drivers of health: Medicare-Medicaid dual eligibility status, race and ethnicity, rural residence, socioeconomic status (SES), and living alone. This cohort study examined unadjusted and adjusted mobility and self-care change scores during IRF stays for 428,710 Medicare patients with and without social drivers of health. Regression models isolated the mean marginal effect of each of the five social factors on mobility and self-care change scores after adjusting for covariates. Patients with full dual status had slightly lower risk-adjusted mobility and self-care improvement (-4.5% and -3.3%, respectively) compared to patients without dual status. Patients who identified as Black, Asian and Native Hawaiian had self-care marginal effects that were slightly lower (-4.8%, -4.1% and -3.7%, respectively) than patients who were White. Patients living in lower SES neighborhoods and patients who lived alone had slightly higher mobility and self-care improvement scores. Risk-adjusted marginal differences in improvement scores for patients with and without these social factors were small and did not meet the meaningfully different criteria. Overall, IRF patients' risk-adjusted functional outcomes did not vary meaningfully by dual eligibility status, race or ethnicity, rural residence, SES or living alone.

Disaggregation of Asian American, Native Hawaiian, and Pacific Islander populations in postmastectomy breast reconstruction

PurposeAsian American, Native Hawaiian, and Pacific Islander (AANHPI) patient populations are often defined as one monolithic group in medical research despite cultural, socioeconomic, and clinical heterogeneity. Although the general AANHPI population is underrepresented in reception of postmastectomy breast reconstruction, existing literature has not characterized the disaggregation of such rates for AANHPI ethnic subgroups. MethodsPatients who underwent mastectomy were identified in the 2007 to 2020 registries within the Surveillance, Epidemiology and End Results database. Patients were stratified by race and ethnicity, and additional demographic and oncologic variables were collected. Multivariate binary logistic regression was conducted to assess for reception of postmastectomy immediate breast reconstruction (p < 0.05). ResultsAmong 33,422 AANHPI patients who underwent mastectomy, South Asian patients were associated with the highest breast reconstruction rates (33%) and Melanesians with the lowest (15%). Overall, AANHPI patients were associated with a lower breast reconstruction rate than non-Hispanic Whites (27% vs. 35%; p < 0.001). This difference increased from 6.4% in 2007 to 10% in 2020. After controlling for demographic and oncologic covariates, all AANHPI ethnic subgroups predicted a lower likelihood of breast reconstruction than non-Hispanic Whites (p < 0.001). Odds ratios for reconstruction ranged from 0.17 [95% confidence interval (95% CI), 0.11–0.27] for Melanesian patients to 0.45 (95% CI, 0.42–0.48) for South Asian patients. ConclusionsDisparities in the receipt of immediate breast reconstruction exist within the AANHPI patient population in the United States. This analysis supported the need for disaggregation in plastic surgery research for improved knowledge and targeted interventions.

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.

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).

Suicidal ideation, suicide attempt, and self-injury among American Indian, Alaskan Native, and Native Hawaiian college students in the United States from 2015 to 2019.

Suicide is a major driver of mortality among college students and is the leading cause of death among American Indian, Alaska Native, and Native Hawaiian (AI/AN/NH) young adults. Data on suicidal ideation, suicide attempt, and self-injury among AI/AN/NH college students (n = 8103) were analyzed via multivariable logistic regressions employing the American College Health Association National College Health Assessment survey from 2015 to 2019. Adjusted odds ratios (aORs) were used to assess how opioid misuse may act as a risk or protective factor for suicidality and self-injury. Between 2015 and 2019, suicidal ideation was the most prevalent dimension of suicidality affecting AI/AN/NH college students (ranges from 12.69% to 18.35%), followed by self-injury (7.83%-11.41%) and suicide attempt (2.40%-4.10%). AI/AN/NH college students who reported opioid misuse were significantly more likely to experience suicidal ideation (aOR: 1.417; 95% confidence interval [CI]: 1.154-1.740) and self-injury (aOR: 1.684; 95% CI: 1.341-2.116) than those who did not engage in such behavior. We identified opioid misuse as a potential risk factor for suicidal ideation and intentional self-injury among populations of AI/AN/NH college students. Programs seeking to reduce suicide prevalence among Indigenous college students may benefit from the inclusion of evidence-based interventions that prevent and treat issues related to opioid use.

“It Matters Who Defines It”—Defining Nutrition through American Indian, Alaska Native, and Native Hawaiian Worldviews

BackgroundAdequately assessing nutrition is deeply important for understanding and addressing health inequities, especially for American Indian, Alaska Native, and Native Hawaiian (AI/AN/NH) peoples who have been subjected to the malnourishing effects of settler colonialism. Mainstream approaches to nutrition rely heavily on indicators of physical diet consumption, while ignoring the contributions of food to spiritual, social, and emotional health. Considering only physical aspects of dietary consumption paints a narrow picture of AI/AN/NH foodways and nutritional health further contributing to deficit-based narratives about AI/AN/NH peoples. To adequately understand and address the nutritional health of AI/AN/NHs, strengths-based approaches to nutrition that are rooted in Indigenous ways of knowing are urgently needed. ObjectiveThe objective of this study was to define nutrition through AI/AN/NH worldviews. MethodsThree focus group discussions (n = 3) and in-depth interviews (n = 6) were conducted with 26 purposively identified AI/AN/NH food sovereignty experts and knowledge holders. Data collection and analysis were conducted iteratively. Through a process of open, focused, and axial coding, primary themes and supporting subthemes were established and refined, and a conceptual framework (the Indigenous Nourishment Framework) was developed to reflect the relationships between primary themes, subthemes, and the overall meaning of nourishment for AI/AN/NHs. ResultsThe Indigenous Nourishment Model contains 4 main domains of nourishment (physical, spiritual, emotional, and relational), and 8 subthemes representing concepts, practices, and beliefs, which contribute to overall nourishment. ConclusionsDespite the importance of physical aspects of nutrition, our findings assert that spiritual, emotional, and relational well-being are inseparable and integral to the overall goal of nourishment for AI/AN/NHs. The resulting Indigenous Nourishment Framework developed with a diverse group of AI/AN/NH food knowledge holders reflects the strengths of AI/AN/NH foodways and builds upon existing approaches to nutrition by offering new directions for approaching and measuring nutrition.

One Health, many perspectives: Exploring Indigenous and Western epistemologies

Abstract The One Health approach, which assesses the interconnectedness of animal, human, and environmental health, fails to include and amplify Indigenous knowledge and Indigenous scientists. To effectively center Indigenous knowledge next to and within the One Health approach, which is historically based in Western science, the similarities and differences between Indigenous science, specifically Traditional Ecological Knowledge (TEK), and One Health must be explored. The objective of this project is to identify values in Indigenous science that are unsupported or underrepresented in Western science and then collaboratively ideate recommendations that Western allies can take to center and support Indigenous scientists and elevate Indigenous knowledge. From January to March 2023, the study team conducted semi-structured interviews with Indigenous knowledge keepers via Zoom video calls. American Indian, Alaska Native, Native Hawaiian (Kānaka Maoli), and other Indigenous participants from the global diaspora residing in the continental United States and Hawaiian Islands were recruited through social media and referrals from Indigenous leaders who had participated in formative (phase 1) interviews completed in 2022. In those formative interviews, four themes emerged and called for further exploration of Indigenous perspectives on (1) the natural world, (2) cultural heritage, (3) value expression, and (4) reflection. These ideas were reframed into questions asked in subsequent (phase 2) interviews in 2023. Thematic identification methods were used to highlight key ideas throughout the interviews. Participants noted gaps between their Indigenous worldviews and the One Health model, particularly relating to contrasts with Western culture, holistic expression, power in action, identity and belonging, maintaining community and cultural practices, and sharing information/education. It was also noted that One Health must do more than just uplift Indigenous values to support Indigenous scientists and should instead collaborate with TEK keepers and foster practices that are inclusive and validating of other knowledge systems. Phase 2 interview responses highlighted Indigenous principles that are underrepresented in One Health practice. These principles were transformed into considerations specifically for Western-rooted scientists to improve allyship to Indigenous science and scientists. Adoption of the considerations would strengthen partnership between One Health practitioners and Indigenous scientists and promote collaboration across many ways of knowing. One Health impact statement The One Health theory encourages transdisciplinary collaboration to break down siloing and innovate solutions. Yet, One Health practice, and the Western scientific approach it takes, often excludes involvement with Indigenous ways of knowing and disclaims Indigenous knowledge keepers who have been conducting “One Health” work since time immemorial. Indigenous knowledge keepers who self-identified as cultural bridges between Native communities and Western communities were interviewed and asked to speak to values found in Indigenous science and research. The featured principles highlight some of the similarities and differences between Indigenous and Western scientific approaches. The identified values informed recommendations for Western scientists to be better allies to Indigenous scientists and to amplify Indigenous voices and science. One Health practitioners will benefit from these guidelines by navigating research in a more equitable way and by creating sustainable reciprocal partnerships with Indigenous scientists. This makes One Health more open and accessible to Indigenous and Western ways of knowing.

Socioeconomic status as a potential mediator of arterial aging in marginalized ethnic and racial groups: current understandings and future directions.

Cardiovascular diseases (CVDs) are the leading cause of death in the United States. However, disparities in CVD-related morbidity and mortality exist as marginalized racial and ethnic groups are generally at higher risk for CVDs (Black Americans, Indigenous People, South and Southeast Asians, Native Hawaiians, and Pacific Islanders) and/or development of traditional CVD risk factors (groups above plus Hispanics/Latinos) relative to non-Hispanic Whites (NHW). In this comprehensive review, we outline emerging evidence suggesting these groups experience accelerated arterial dysfunction, including vascular endothelial dysfunction and large elastic artery stiffening, a nontraditional CVD risk factor that may predict risk of CVDs in these groups with advancing age. Adverse exposures to social determinants of health (SDOH), specifically lower socioeconomic status (SES), are exacerbated in most of these groups (except South Asians-higher SES) and may be a potential mediator of accelerated arterial aging. SES negatively influences the ability of marginalized racial and ethnic groups to meet aerobic exercise guidelines, the first-line strategy to improve arterial function, due to increased barriers, such as time and financial constraints, lack of motivation, facility access, and health education, to performing conventional aerobic exercise. Thus, identifying alternative interventions to conventional aerobic exercise that 1) overcome these common barriers and 2) target the biological mechanisms of aging to improve arterial function may be an effective, alternative method to aerobic exercise to ameliorate accelerated arterial aging and reduce CVD risk. Importantly, dedicated efforts are needed to assess these strategies in randomized-controlled clinical trials in these marginalized racial and ethnic groups.

Incident diabetes among older Asian, Native Hawaiian, and Pacific Islander women with breast cancer.

The risk of diabetes among Asian, Native Hawaiian, and Pacific Islander (ANHPI) women after breast cancer is unclear. This study estimated the risk of incident type II diabetes in older ANHPI and older non-Hispanic White (NHW) women with breast cancer from the US National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Medicare linked claims. A matched cohort of 7122 older ANHPI and 21 365 older NHW women with breast cancer were identified from SEER-Medicare between 2000 and 2017. To assess the risk of incident type II diabetes after breast cancer, hazard ratios (HRs) and 95% confidence intervals (95% CI) were estimated using the Cox proportional-hazards regression model. During the mean 8 years of follow-up, 9.3% of older women with breast cancer developed incident type II diabetes. In comparison with older NHW women, older ANHPI women without a known history of diabetes had an elevated risk of diabetes after breast cancer, with strong associations observed for Pacific Islander (HR = 3.09, 95% CI = 1.43 to 6.67), Vietnamese (HR = 2.12, 95% CI = 1.33 to 2.36), and Filipino (HR = 2.02, 95% CI = 1.57 to 2.59) women with breast cancer, adjusting for potential confounders. Among ANHPI women with breast cancer, more baseline comorbidities and obesity were risk factors for developing incident type II diabetes. ANHPI women diagnosed with breast cancer had an elevated risk of type II diabetes compared with older NHW women with breast cancer. Routine monitoring and management of diabetes are warranted in older ANHPI women with breast cancer.

Discrimination and hypertension among a diverse sample of racial and sexual minority men living with HIV: baseline findings of a longitudinal cohort study

Racial and sexual orientation discrimination may exacerbate the double epidemic of hypertension (HTN) and HIV that affects men of color who have sex with men (MSM). This was a cross-sectional analysis of African American, Asian American, Native Hawaiian, or Pacific Islander (NHPI) MSM living with HIV (PLWH) cohort in Honolulu and Philadelphia. Racial and sexual orientation discrimination, stress, anxiety, and depression were measured with computer-assisted self-interview questionnaires (CASI). We examined the associations between racial and sexual orientation discrimination with hypertension measured both in the office and by 24-h ambulatory blood pressure monitoring (ABPM) using multivariable logistic regression. Sixty participants (60% African American, 18% Asian, and 22% NHPI) completed CASIs and 24-h ABPM. African American participants (80%) reported a higher rate of daily racial discrimination than Asian American (36%) and NHPI participants (17%, p < 0.001). Many participants (51%) reported daily sexual orientation discrimination. Sixty-six percent of participants had HTN by office measurement and 59% had HTN by 24-h ABPM measurement. Participants who experienced racial discrimination had greater odds of having office-measured HTN than those who did not, even after adjustment (Odds Ratio 5.0 (95% Confidence Interval [1.2–20.8], p = 0.03)). This association was not seen with 24-h ABPM. Hypertension was not associated with sexual orientation discrimination. In this cohort, MSM of color PLWH experience significant amounts of discrimination and HTN. Those who experienced racial discrimination had higher in-office blood pressure. This difference was not observed in 24-h APBM and future research is necessary to examine the long-term cardiovascular effects.

Diet Quality and Risk of Bladder Cancer in the Multiethnic Cohort Study.

This study analyzed the overall quality of the diet using predefined indices, including the Healthy Eating Index-2015 (HEI-2015), the Alternative Healthy Eating Index-2010 (AHEI-2010), the alternate Mediterranean Diet (aMED) score, the Dietary Approaches to Stop Hypertension (DASH) score, and the Dietary Inflammatory Index (DII®), to explore their association with the risk of bladder cancer in the Multiethnic Cohort Study. Data were taken from 186,979 African American, Japanese American, Latino, Native Hawaiian, and non-Hispanic White participants aged 45-75 years, with 1152 incident cases of invasive bladder cancer during a mean follow-up period of 19.2 ± 6.6 years. Cox models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) with comprehensive adjustment for smoking. Comparing the highest vs. lowest diet quality score quintile, HRs (95% CIs) in men was 1.08 (0.86-1.36) for HEI-2015, 1.05 (0.84-1.30) for AHEI-2010, 1.01 (0.80-1.27) for aMED, 1.13 (0.90-1.41) for DASH, and 0.96 (0.76-1.21) for DII®, whereas the corresponding HRs for women were 0.75 (0.53-1.07), 0.64 (0.45-0.92), 0.60 (0.40-0.88), 0.66 (0.46-0.95), and 0.63 (0.43-0.90) with all p values for trend <0.05. The inverse association found in women did not vary by smoking status or race and ethnicity. Our findings suggest that adopting high-quality diets may reduce the risk of invasive bladder cancer among women in a multiethnic population.

Differential effects of a social work staffing intervention on social work access among rural and highly rural Veterans: A cohort study.

To evaluate the impact on rural Veterans' access to social work services of a Department of Veterans Affairs (VA) national program to increase social work staffing, by Veterans' rurality, race, and complex care needs. Data obtained from VA Corporate Data Warehouse, including sites that participated in the social work program between October 1, 2016 and September 30, 2021. The study outcome was monthly number of Veterans per 1000 individuals with 1+ social work encounters. We used difference-in-differences to estimate the program effect on urban, rural, and highly rural Veterans. Among rural and highly rural Veterans, we stratified by race (American Indian or Alaskan Native, Asian, Black, Native Hawaiian or Other Pacific Islander, and White) and complex care needs (homelessness, high hospitalization risk, and dementia). We defined a cohort of 740,669 Veterans (32,434,001 monthly observations) who received primary care at a participating site. Average monthly social work use was 8.7 Veterans per 1000 individuals. The program increased access by 49% (4.3 per 1000; 95% confidence interval, 2.2-6.3). Rural Veterans' social work access increased by 57% (5.0; 3.6-6.3). Among rural/highly rural Veterans, the program increased social work access for those with high hospitalization risk by 63% (24.5; 18.2-30.9), and for Veterans experiencing homelessness, 35% (13.4; 5.2-21.7). By race, the program increased access for Black Veterans by 53% (6.1; 2.1-10.2) and for Asian Veterans by 82% (5.1; 2.2-7.9). At rural VA primary care sites with social work staffing below recommended levels, Black and Asian Veterans and those experiencing homelessness and high hospitalization risk may have unmet needs warranting social work services.

Impact of CYP3A5 Polymorphisms on Pediatric Asthma Outcomes.

Genetic variation among inhaled corticosteroid (ICS)-metabolizing enzymes may affect asthma control, but evidence is limited. This study tested the hypothesis that single-nucleotide polymorphisms (SNPs) in Cytochrome P450 3A5 (CYP3A5) would affect asthma outcomes. Patients aged 2-18 years with persistent asthma were recruited to use the electronic AsthmaTracker (e-AT), a self-monitoring tool that records weekly asthma control, medication use, and asthma outcomes. A subset of patients provided saliva samples for SNP analysis and participated in a pharmacokinetic study. Multivariable regression analysis adjusted for age, sex, race, and ethnicity was used to evaluate the impact of CYP3A5 SNPs on asthma outcomes, including asthma control (measured using the asthma symptom tracker, a modified version of the asthma control test or ACT), exacerbations, and hospital admissions. Plasma corticosteroid and cortisol concentrations post-ICS dosing were also assayed using liquid chromatography-tandem mass spectrometry. Of the 751 patients using the e-AT, 166 (22.1%) provided saliva samples and 16 completed the PK study. The e-AT cohort was 65.1% male, and 89.6% White, 6.0% Native Hawaiian, 1.2% Black, 1.2% Native American, 1.8% of unknown race, and 15.7% Hispanic/Latino; the median age was 8.35 (IQR: 5.51-11.3) years. CYP3A5*3/*3 frequency was 75.8% in White subjects, 50% in Native Hawaiians and 76.9% in Hispanic/Latino subjects. Compared with CYP3A5*3/*3, the CYP3A5*1/*x genotype was associated with reduced weekly asthma control (OR: 0.98; 95% CI: 0.97-0.98; p < 0.001), increased exacerbations (OR: 6.43; 95% CI: 4.56-9.07; p < 0.001), and increased asthma hospitalizations (OR: 1.66; 95% CI: 1.43-1.93; p < 0.001); analysis of 3/*3, *1/*1 and *1/*3 separately showed an allelic copy effect. Finally, PK analysis post-ICS dosing suggested muted changes in cortisol concentrations for patients with the CYP3A5*3/*3 genotype, as opposed to an effect on ICS PK. Detection of CYP3A5*3/3, CYPA35*1/*3, and CYP3A5*1/*1 could impact inhaled steroid treatment strategies for asthma in the future.

Disaggregating U.S. Asian and Pacific Islanders: Colorectal cancer

BackgroundColorectal cancer remains a public health concern as the 4th most common cancer in the US. Incidence and mortality have been observed to differ between races; however, Asian and Pacific Islander ethnicities are often documented in aggregate. Recognizing that these groups are heterogeneous, this study seeks to disaggregate Native Hawaiian from the broader “Asian/Pacific Islander” group and examine disparate outcomes in colorectal cancer. MethodsDe-identified data from the Hawaii Tumor Registry was queried to evaluate colorectal cancer in the state of Hawaii. Primary outcomes were cancer stage at diagnosis, first course of therapies received, and duration of survival from diagnosis. Chi-square analyses were performed for differences in categorical variables. Results7943 Hawaii residents were diagnosed with colorectal cancer in 2008–2018 with 1151 (14.5 %) patients identifying as Native Hawaiian. Native Hawaiians were less likely to present with localized cancer (36.7 % vs. 41.7 %; p = 0.002) and more likely to be diagnosed with distant stage cancer compared to non-Native Hawaiians (25.2 % vs. 17.67 %; p < 0.0001) and, among those with distant metastases, more likely to receive chemotherapy (68.3 % vs. 61.1 %; p = 0.029). No significant differences were observed between races on analysis of CRC-specific mortality. ConclusionSignificant differences exist between disaggregated Asian and Pacific Islander ethnic groups. Native Hawaiians are observed to present with more advanced cancer at the time of diagnosis in comparison to ethnicities. Disaggregating these groups reveals racial and ethnic disparities that may inform public health measures. SynopsisDisaggregating Asian and Native Hawaiian and Pacific Islander groups reveals disparities in colorectal cancer. Native Hawaiians presented with more advanced disease across all studied ethnic groups. No significant differences were observed in colorectal cancer specific mortality across groups.

Early Uses by Ancient Hawaiians, and Environmental, Geographical, and Ecological History, of Haleakalā Crater, East Maui

This research assesses the environmental uses of Haleakalā Crater, and adjoining east Maui areas, by native Hawaiians during recent centuries, and evaluates the modern utilization of this volcanic depression. The study methods examine, and focus on, numerous historical and modern accounts and reports. Three historical periods were identified as follows: (1). A phase, from the ~1400s until contact with foreigners in 1778, characterized by the development of settlements, population expansion, the intensification of traditional agriculture, and the political consolidation of Maui. The construction of the Kiha-a-Pi‘i-lani trail across the crater enhanced travel between distant island areas. (2). Following the collapse of Maui’s human populations during the late 1700s, and until the 20th century, came a period distinguished by scientific exploration of the crater, and intentional or accidental introductions of animals, including goats, horses, cattle, and wild dogs. (3). After Haleakalā became a National Park in 1916, efforts to eradicate introduced animals and to encourage the reproduction of silverswords and other plants were initiated. Unfortunately, in retrospect, construction of a modern paved road, improvement of hiking trails, and building of facilities allowed swift access to the Park and substantially increased tourist numbers, up to ~2 million yearly visitors. Faced with such crowds, the long-term planning of Park resources appears to be a formidable task.

Racial disparities among triple negative breast cancer clinical trial enrollees between 2010-2023.

1093 Background: Despite the social construct of race lacking biological significance, it plays a significant role in health disparities and necessitates examination to address social stratification and health inequities. Not reporting race in medical research neglects the reality of social stratification, injustices, and implications for population health. Additionally, excluding racial demographic data from research publications may conceal health disparities. This study focuses on Triple Negative Breast Cancer (TNBC) clinical trials, aiming to meta-analyze the inclusion of racial data and assess racial representation. Methods: A meta-analysis of 81 completed TNBC trials (2011-2023) from ClinicalTrials.gov was conducted. Demographic data on race and sex were extracted and analyzed using Microsoft Excel. Two independent reviewers extracted study-level data for a random-effects analysis. The primary outcome was identifying the prevalence of studies lacking racial data. The secondary outcomes are the prevalence of each racial category (White, Black, Asian, Hispanic/Latino, and Combined Other) among all TNBC clinical trials that reported demographic information. The Combined Other category includes American Indian, Native Hawaiian, more than one race, and unknown/unreported. Results: Of 81 trials, 29.63% did not report racial data. The remaining 57 trials (8,196 participants) revealed 73.98% White, 10.29% Asian, 7.85% Black, 8.02% Hispanic/Latino, and 4.12% "combined other" participants. U.S.-based trials (36 studies, 3,348 participants) showed 77.96% White, 12.03% Black, 4.51% Asian, and 4.96% Hispanic/Latino participants. Moreover, we conducted a comparative analysis between the racial distribution in U.S. clinical trials and the prevalence of TNBC in the U.S. population, utilizing the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Public Use Datasets (2010-2019). The analysis revealed a significant discrepancy with White (p&lt;.001) participants being overrepresented, and Black (p&lt;.001), Asian (p&lt;.001), Hispanic/Latino (p&lt;.001), American Indian (p&lt;.001), more than one race (p&lt;.02), and Other/Unknown (p&lt;.001) populations being underrepresented. Conclusions: Globally, 29.63% of TNBC trials did not report racial data, raising concerns about generalizability. U.S.-based studies exhibited overrepresentation of White participants and underrepresentation of Black, Asian, Hispanic/Latino, American Indian, Native Hawaiian, and other categories. Notably, Black and Hispanic/Latino individuals, comprising a substantial portion of TNBC patients, were underrepresented. These findings underscore racial/ethnic disparities in breast cancer trial participation, warranting further investigation into recruitment barriers for equitable participation.

Underrepresentation of Asian Americans, Native Hawaiians, and other Pacific Islanders (AA &amp; NHPI) in cancer clinical trials that led to FDA approvals in 2010-2022.

11026 Background: About 6% and 0.3% of the total United States (US) population identify as Asian or NHPI alone, respectively. The most commonly diagnosed cancers among AA &amp; NHPI in the US are breast, prostate, lung, thyroid, and colorectal. Liver, gastric, and head and neck cancers occur in higher rates in AA &amp; NHPI vs. non-Hispanic White. Enrollment of Asian &amp; NHPI patients in multiregional cancer clinical trials may provide additional data regarding intrinsic and extrinsic factors (e.g., diet, infections, environmental exposures) impacting the etiology of cancer. We investigated enrollment trends of NHPI and Asian (within and outside of US) patients in cancer clinical trials that led to an FDA approval from 2010-2022. Methods: We analyzed data from ~98,000 patients in 171 cancer therapeutic clinical trials that led to FDA approvals for breast, prostate, lung, thyroid, colorectal, liver, gastric, and head and neck cancer indications from 2010-2022. Separate race categories of Asian and Native Hawaiian and other Pacific Islander were used. Results: Descriptive statistics of NHPI and Asians within and outside of US enrollment in breast, prostate, lung, thyroid, colorectal, liver, gastric, and head and neck cancer trials that led to an FDA approval from 2010-2022 are summarized in the table. Enrollment of Asian patients in the US was &lt;1% (except for liver cancer) and NHPI patients was &lt;0.2%. Conclusions: Although cancer is the leading cause of death for AA &amp; NHPI, AA &amp; NHPI are under-represented in cancer clinical trials, especially when data are further disaggregated into enrollment of NHPI and Asians within and outside of the US. Cancer etiology may vary in Asians in the US vs. Asia due to different intrinsic/extrinsic risk factors, underscoring the importance of enrolling more AA &amp; NHPI into clinical trials to expand the evidence supporting drug approvals in the US and to advance health equity through clinical trial diversity. [Table: see text]

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]