Native Hawaiians And Pacific Islanders Research Articles

404 Sleep-Disordered Breathing In Native Hawaiians/Pacific Islanders With Associated Comorbidities And Adherence To Therapy

Abstract Introduction Sleep-disordered breathing in Native Hawaiians and Pacific Islanders (NHPIs), its relationship to type 2 diabetes mellitus (DM), chronic renal, and heart disease, is not well known. NHPIs comprise only 1.3% of Utah’s population, but have the highest rates of DM and deaths due to diabetic kidney disease in Utah. This study assessed the nature of sleep-disordered breathing, its association with demographic variables, and comorbidities, and adherence patterns to positive airway pressure (PAP) therapy. Methods University of Utah sleep clinics patient databases from 2014 were evaluated to identify NHPIs using first/last names. Electronic medical records were reviewed to confirm patient ethnic origin, demographic data, and comorbidities. The most recent PAP downloads were obtained. Results Of 106 NHPIs were identified, data available for 104 patients (71 males, 33 females) was analyzed. Mean age of males was 47 + 13 years and females 48±13 years. Prevalence rates of obesity were 13% (female 9%, male 15%) with BMI≥30, 33% (female 24%, male 23%) with BMI≥35, and 49% (female 58%, Male 23%) with BMI≥40). Majority of patients had severe OSA (61% males with AHI≥30; 39% females with ≥ 30), with overall mean AHI of 47±38. A high prevalence of comorbidities was noted: 61% hypertension (male 58%; female 67%), diabetes 54% (male 48%, female 67%), renal disease 20% (male 21%, female 18%), coronary artery disease 13% (male 14%, female 9%), and congestive heart failure 13% (male 15%, female 9%). Prevalence of lung disease was low 13% (male 9%, female 18%). Conclusion NHPIs evaluated for sleep-disordered breathing have high rates of obesity, severe OSA, and concerning comorbidities. PAP adherence in this group was poor compared to overall adherence for patients seen in University of Utah sleep clinics (~70%). Further research is required to assess the relationships between OSA, associated comorbidities, and disease outcomes. Addressing low rates of PAP adherence in this population may afford opportunities to improve health outcomes. Support (if any) n/a

The Great Recession and Economic Outcomes for Indigenous Peoples in the United States

This article examines the earnings and employment experience of American Indians and Alaska Natives (AIAN) and Native Hawaiians and Pacific Islanders (NHPI) residing in the United States during and after the Great Recession. I compare these populations to non-Hispanic whites over the same time period with respect to median earnings and inequality, labor force participation rates, earnings by location, educational attainment, and occupational status. I find that the AIAN population has the lowest median earnings and highest level of earnings inequality. NHPI and AIAN experience a sharp increase in earnings inequality over the Great Recession and AIAN have a pronounced drop in labor force participation; these inequality measures remained elevated and stable over the recovery period especially for the AIAN population. Indigenous peoples employed in food services occupations experienced the least amount of earnings decline over the Great Recession, while those employed in construction and sales experienced larger declines. Labor force participation rates dropped most dramatically for the AIAN population over the Great Recession and remained at a new lower level in the recovery period. The analysis shows that there are stark differences across time, space, and occupation for these groups.

679 Associations between race/ethnicity and perinatal outcomes in Hawai‘i

The primary objective was to evaluate for associations between perinatal outcomes and race/ethnicity in an ethnically diverse population in Hawai‘i. This is a retrospective cohort study of pregnant/postpartum women (within 6 weeks of delivery) who delivered in Hawai‘i from 2012-2017. All Patient Refined Diagnosis Related Groups codes were used to identify hospitalizations from the Hawai‘i Health Information Corporation inpatient database. Race/ethnicity was self-reported and categorized as non-Hispanic White, Asian, Filipino, Native Hawaiian and Pacific Islander (NHPI), and Other. Perinatal outcomes were extracted using International Classification of Diseases 9th and 10th Revision codes. Associations between patient characteristics and race/ethnic group were evaluated by chi-square tests with statistical significance set to p<0.05, followed by a post-hoc analysis with adjusted significance level set to p<0.0125 based on Bonferroni correction. Non-Hispanic White was used as the reference group to assess for racial/ethnic disparities. Our study included 90,399 hospitalizations of pregnant/postpartum women age 12-50. There were statistically significant differences between most of the outcomes measured (p<0.01, see Table 1). Asian, Filipino, and NHPI women were more likely to have pre-existing diabetes or gestational diabetes than White women. Asian, Filipino and NHPI women were more likely to have chronic hypertension than White women. Filipino and NHPI women were more likely to have a pregnancy-induced hypertension disorder or placental abruption compared to White women. Our study found that Asian, Filipino and NHPI women had higher rates of adverse perinatal outcomes than White women in Hawai‘i, adding to the limited data available on perinatal outcomes in these race/ethnic groups. At a time when minority health remains a critical issue, our findings re-emphasize the need for higher vigilance when caring for these race/ethnic groups and their associated comorbidities.

Food Insecurity and Chronic Diseases among Native Hawaiians and Pacific Islanders in the US: Results of a Population-based Survey

ABSTRACT Data from the 2014 Native Hawaiian and Pacific Islander (NHPI) National Health Interview Survey were used to examine associations between food security and individual chronic diseases, total number of chronic diseases, and general health status among 637 NHPI adults with income below 200% federal poverty level. Very low food security was associated with hypertension, diabetes, and asthma. Very low food security and marginal food security were associated with having any chronic disease and with having a higher number of chronic diseases. Risk for food insecurity increased as health status decreased. These associations had not previously been documented for NHPI.

Racial/ethnic differences in health-related quality of life among Hawaii adult population

BackgroundThis study examined racial/ethnic differences in health-related quality of life (HRQOL) among adults and identified variables associated with HRQOL by race/ethnicity.MethodsThis study was conducted under a cross-sectional design. We used the 2011–2016 Hawaii Behavioral Risk Factor Surveillance System data. HRQOL were assessed by four measures: self-rated general health, physically unhealthy days, mentally unhealthy days, and days with activity limitation. Distress was defined as fair/poor for general health and 14 days or more for each of the other three HRQOL measures. We conducted multivariable logistic regressions with variables guided by Anderson’s behavioral model on each distress measure by race/ethnicity.ResultsAmong Hawaii adults, 30.4% were White, 20.9% Japanese, 16.8% Filipino, 14.6% Native Hawaiian and Pacific Islander (NHPI), 5.9% Chinese, 5.2% Hispanics, and 6.2% Other. We found significant racial/ethnic differences in the HRQOL measures. Compared to Whites, Filipinos, Japanese, NHPIs, and Hispanics showed higher distress rates in general health, while Filipinos and Japanese showed lower distress rates in the other HRQOL measures. Although no variables were consistently associated with all four HRQOL measures across all racial/ethnic groups, history of diabetes were significantly associated with general health across all racial/ethnic groups and history of depression was associated with at least three of the HRQOL measure across all racial/ethnic groups.ConclusionsThis study contributes to the literature on disparities in HRQOL and its association with other variables among diverse racial/ethnic subgroups. Knowing the common factors for HRQOL across different racial/ethnic groups and factors specific to different racial/ethnic groups will provide valuable information for identifying future public health priorities to improve quality of life and reduce health disparities.

Pūpūkahi i Holomua: A Story of Hawaiian Education and a Theory of Change

The Hawaiian kingdom, prior to the illegal overthrow of its monarchy (1893) and the subsequent English-only Law (1896), had boasted a 91-95% literacy rate. Within that learning environment learners had a clear sense of purpose because Hawaiians had a firm grasp of who they were, where they were, and what they had to contribute. Since the English-only Law and US annexation of Hawai‘i (1898), however, the settler colonialschool system has maintained levels of cultural dissonance that have manifested as inequitable student outcomes for Native Hawaiians and Pacific Islanders (NHPI) across multiple academic and disciplinary student indicators (i.e., proficiency, suspension rates, etc). While western law and US compulsory education severed traditional sources of knowledge production that had provided a sustainable model of a‘o (teaching and learning), the ancestors of the Native Hawaiian community were diligent about preserving the keys to their genealogical legacies within more than 120,000 pages of Hawaiian-language newspapers. This collective repository is a resource that helps the Office of Hawaian Education (OHE) rethread Hawaiian education into the tapestry of traditional sources of knowledge production to improve sustainability (cultural, intellectual, environmental, political, etc.) for all learners. OHE uses a theory of change that engages primary and secondary sources, quantitative and qualitative data, in action research that informs Why contemporary circumstances exist, What those contemporary circumstances are, Where we want Hawaiian education to go, and How we are going to get there.

Adaptions to the National Diabetes Prevention Programme lifestyle change curriculum by Hawai‘i Federally Qualified Health Centers: a qualitative descriptive study

ObjectiveThe objective of this qualitative study was to describe the community-appropriate and culturally appropriate adaptations made by lifestyle change programme (LCP) coaches to the National Diabetes Prevention Programme curriculum for...

Effects of Race and Poverty on Sleep Duration: Analysis of Patterns in the 2014 Native Hawaiian and Pacific Islander National Health Interview Survey and General National Health Interview Survey Data.

There are health concerns associated with unhealthy sleep duration. A growing body of evidence indicates that there are disparities in sleep duration based upon race/ethnicity and socioeconomic status. Prior studies have suffered from inadequate measures of poverty and have not included Native Hawaiians and Pacific Islanders (NHPI). Using the 2014 National Health Interview Survey (NHIS) and the 2014 NHPI-NHIS, the effect of race/ethnicity and poverty was examined for associations with sleep duration. Significant differences among race/ethnicity groups and sleep duration were found in adjusted associations. Compared with Whites, NHPIs and Blacks were twice as likely to experience very short sleep; NHPI, Hispanic, and Blacks were more likely to experience short sleep; Blacks were also more likely to experience long sleep. Asians were less likely to experience unhealthy sleep (very short, short, or long sleep). Persons living in poverty were significantly more likely to experience very short sleep compared with persons not living in poverty. This is the first population-based study that has examined the relationship between sleep duration and poverty with a large sample that included NHPI in relation to other races/ethnicities. The difference in sleep duration between NHPI and Asians provides a strong rationale for not aggregating Asian and NHPI data in population-based studies.

Abstract 3485: Body mass index and mammographic density among Native Hawaiians and Pacific Islanders

Abstract Background: Mammographic density is an important breast cancer risk factor, yet data on mammographic density is limited for some racial/ethnic groups, including Native Hawaiians and Pacific Islanders (NHPI). Obesity is highly prevalent in the NHPI population and prior work, primarily in non-Hispanic White (NHW) women, has reported that high body mass index (BMI) is inversely associated with mammographic density but positively associated with risk of breast cancer. We used data from the Utah Population Database (UPDB) to estimate the association between BMI and mammographic density in Utah's NHPI population and evaluate if the association differs for NHPI women compared to NHW women. Methods: We included women ages 18-79 years with at least one mammogram from 2005-2012 and no history of breast cancer. Data on BMI and race/ethnicity were collected from the UPDB, and mammographic density was evaluated using Breast Imaging Reporting and Data System (BIRADS) scores. We estimated the association between BMI and BIRADS using multinomial logistic regression adjusted for age and stratified at age 55 (a proxy for menopausal status). Heterogeneity by race/ethnicity was evaluated using likelihood ratio tests. Results: Our analyses included data from 102 Native Hawaiian, 112 Samoan, 344 other Pacific Islander, and 143,259 NHW women. High mammographic density (BIRADS=4) was less common among Samoan women (2.7%) and other Pacific Islanders (4.7%) compared to NHW women (5.8%), but more common among Native Hawaiians (11.8%). Age-standardized BMI was highest in Samoan women (mean=32.3, SD=6.3) followed by other Pacific Islander women (mean=31.2, SD=7.1) then Native Hawaiian women (mean=27.8, SD=6.4), and lowest among NHW women (mean=26.1, SD=5.4). Among women younger than age 55, a one-unit increase in BMI was associated with 0.76 (95% CI=0.69-0.84) times lower odds of high (BIRADS=4) versus low (BIRADS=1) breast density in NHPI women. The comparable odds ratio (OR) in NHW women was 0.66 (95% CI=0.65-0.66; p-heterogeneity=6.9 × 10^-10). For women age 55 and older, the association between BMI and mammographic density was stronger among NHPI women, OR=0.62 (95%CI=0.45-0.84), compared to NHW women, OR=0.70 (95%CI=0.69-0.72; p-heterogeneity=0.018). Discussion: Mammographic density differs among racial/ethnic subgroups of the NHPI population with Native Hawaiians having the highest mammographic density. Given the high prevalence of obesity in the NHPI population and evidence that the association between BMI and mammographic density may differ by race/ethnicity, more research is needed to understand how BMI and mammographic density influence risk of breast cancer in understudied racial/ethnic minorities, such as NHPIs. Citation Format: Mollie E. Barnard, Tarun Martheswaran, Jennifer A. Doherty, Karen Curtin. Body mass index and mammographic density among Native Hawaiians and Pacific Islanders [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 3485.

Electronic Cigarette Use and Associated Risk Factors in U.S.-Dwelling Pacific Islander Young Adults

Background: E-cigarette use is rapidly increasing among US young adults, heightening their risk for vaping-related illnesses. Yet, little is known about e-cigarette use among young adult Native Hawaiians and Pacific Islanders (NHPI): an indigenous-colonized US racial group rarely described in research literature. This exploratory study provides the first known data on e-cigarette use and potential risk factors in NHPI young adults. Method: Self-report data were collected from 143 NHPI young adults (age 18–30 years) living in two large NHPI communities: Samoans in urban Los Angeles County and Marshallese in rural Arkansas. We assessed rates of e-cigarette, cigarette, alcohol, and marijuana use, and positive and negative outcome expectancies from e-cigarettes, that is expected outcomes from e-cigarette use. To identify potential risk factors for NHPI e-cigarette use, regressions explored associations between participants’ current e-cigarette use with current cigarette, alcohol, and marijuana use, and e-cigarette outcome expectancies. Results: Among NHPI young adults, lifetime e-cigarette use rate was 53% and current use rate was 39%. Current rate of dual e-cigarette/cigarette, e-cigarette/alcohol, and e-cigarette/marijuana use was 38%, 35%, and 25%, respectively. In our regression models, current marijuana use and positive e-cigarette outcome expectancies were significantly associated with current e-cigarette use. Conclusions: E-cigarette use is common among NHPI young adults, exceeding rates for other at-risk racial groups. Marijuana use and positive expectations about e-cigarette use may represent potential e-cigarette use risk factors. Collectively, findings underscore the need for additional research to further explore the scope of, and risk and protective factors for, e-cigarette use in this understudied high-risk population.

Incidence of ESKD Among Native Hawaiians and Pacific Islanders Living in the 50 US States and Pacific Island Territories

Native Hawaiians and Pacific Islanders (NHPI) have been reported to have the highest rates of incident end-stage kidney disease (ESKD) compared with other races in the United States. However, these estimates were likely biased upward due to the exclusion of nearly half the NHPI population that reports multiple races in the US Census. We sought to estimate the incidence rate of ESKD, including individuals reporting multiple races, and describe the clinical characteristics of incident cases by race and location. Health care database study. US residents of the 50 states and 3 Pacific Island territories of the United States whose ESKD was recorded in the US Renal Data System (USRDS) between 2007 and 2016, as well as US residents recorded in the 2010 Census. Age, sex, race, body mass index, primary cause of ESKD, comorbid conditions, estimated glomerular filtration rate, pre-ESKD nephrology care, and hemoglobin A1c level among ESKD cases. Initiation of maintenance dialysis or transplantation for kidney failure. Crude ESKD incidence rates (cases/person-years) were estimated using both single- and multiple-race reporting. Even after inclusion of multirace reporting, NHPI had the highest ESKD incidence rate among all races in the 50 states (921 [95% CI, 904-938] per million population per year)-2.7 times greater than whites and 1.2 times greater than blacks. Also using multirace reporting, the NHPI ESKD incident rate in the US territories was 941 (95% CI, 895-987) per million population per year. Diabetes was listed as the primary cause of ESKD most frequently for NHPI and American Indians/Alaska Natives. Sensitivity analysis adjusting for age and sex demonstrated greater differences in rates between NHPI and other races. Diabetes was the primary cause of ESKD in 60% of incident NHPI cases. Patients with ESKD living in the territories had received less pre-ESKD nephrology care than had patients living in the 50 states. Different methods of race classification in the USRDS versus the US Census. NHPI living in the 50 US states and Pacific territories had the highest rates of ESKD incidence compared with other races. Further research and efforts are required to understand the reasons for and define how best to address this racial disparity.

Medical financial hardship reported by Native Hawaiian and Pacific Islander cancer survivors compared with non‐Hispanic whites

Although medical financial hardship (MFH) resulting from sequelae of cancer and treatment has been reported in other racial/ethnic populations, little is known about MFH among Native Hawaiian and Pacific Islander (NHPI) cancer survivors. One hundred fifty adult NHPI cancer survivors were identified from the 2014 NHPI National Health Interview Survey (NHIS). Cancer survivors were those with a history of cancer (excluding nonmelanoma/unknown type of skin cancer). MFH was defined by 3 domains: 1) material (problem paying or unable to pay medical bills); 2) psychological (worrying about paying medical bills); and 3) behavioral (delaying or forgoing medical care for financial reasons). For comparison, 2098 non-Hispanic white (NHW) cancer survivors were identified from the 2014 NHIS. Logistic regressions were used to identify sociodemographic and health factors associated with experiencing MFH. Stratified analysis by age (<65 vs ≥65years) and sensitivity analysis using propensity score-matched NHPI and NHW cancer survivors were conducted. Nationally representative estimates were generated using survey weights. Among elderly cancer survivors, more NHPIs reported any MFH (59% vs 32%; P=.001), psychological MFH (36% vs 22%; P=.040), and behavioral MFH (27% vs 9%; P=.004) than NHWs. Among survivors aged <65years, NHPIs reported less MFH (46% vs. 65%; P=.034). Even after propensity score matching, these patterns persisted. Female NHPIs and NHPIs with a college degree were significantly more likely to report MFH, especially material and psychological MFH. A significantly higher proportion of elderly NHPI cancer survivors reported MFH, and this difference persisted even after propensity score matching, which warrants further investigation.

Food Security Status of Native Hawaiians and Pacific Islanders in the US: Analysis of a National Survey

ObjectiveTo document food insecurity prevalence among a nationally representative sample of Native Hawaiian and Pacific Islander (NHPI) adults and compare differences in food security status across races/ethnicities in the US. MethodsUsing 2014 National Health Interview Survey and 2014 NHPI–National Health Interview Survey data, food insecurity among the NHPI population is described and food security status across racial/ethnic groups is compared using Rao-Scott chi-square and multinomial logistic regression. ResultsFood insecurity prevalence was 20.5% among NHPI adults, and NHPI had significantly higher odds of experiencing low and very low food security than white individuals. Food insecurity among Hispanic individuals, black people, and other races/ethnicities was also significantly higher than that among white people. Significant variation in food security status was observed by race/ethnicity (P < .001). Conclusions and ImplicationsThis study provides documentation of food insecurity prevalence among NHPI adults and will inform chronic disease and nutrition research and programs conducted with NHPI communities in the US.

HEALTH-RELATED QUALITY OF LIFE AND CARDIOVASCULAR DISEASE IN ASIAN AMERICAN AND PACIFIC ISLANDER OLDER ADULTS

Cardiovascular disease (CVD) is the leading cause of death for Asian American (AA), Native Hawaiian, and Pacific Islander (NHPI) older adults, and AAs/NHPIs have not enjoyed decreases in CVD mortality rates, as have non-Hispanic whites (NHWs). Heterogeneity exists in the prevalence of traditional CVD risk factors for AAs/NHPIs. Health-related quality of life (HRQOL) reflect physical and mental burdens beyond clinical burdens, which may help explain discrepant CVD rates and risk factors in AAs/NHPIs. We examined HRQOL among NHW and AA/NHPI Medicare Advantage enrollees with and without a CVD (i.e., coronary artery disease, congestive heart failure, myocardial infarction, and stroke) using the Medicare Health Outcomes Survey. The sample included 655,914 older adults who were 65 years or older, self-reported as AA/NHPI or NHW, and were enrolled in Medicare Advantage plans in 2011-2015. HRQOL was measured using the Veterans RAND 12-item survey and is composed of a physical component score (PCS) and mental component score (MCS), where higher scores reflect better physical and mental health, respectively. Multivariable linear regression was used to explore HRQOL and CVD prevalence. Asian Indian, Filipino, Vietnamese, Other Asian, and NHPI subgroups had lower overall PCS, and all AA/NHPI subgroups had lower overall MCS, compared to NHWs. Among those reporting having any CVD, PCS varied by CVD outcomes and subgroups, whereas MCS was lower for all CVD outcomes and for all but one AA/NHPI subgroups (Japanese), compared to NHWs. Attention to mental health for AA/NHPI older adults could be important for the equitable realization of healthy aging.

Prevalence, Health and Resource Utilization, and Unmet Healthcare Needs of Native Hawaiian and Pacific Islander Children With Developmental Disabilities.

Little is known about health limitations and service utilization among the Native Hawaiian and Pacific Islander (NHPI) children with developmental disabilities (DDs) due to limited data. Our study examined the prevalence of DDs, health limitations, services used, and the unmet needs of NHPI children aged 3 to 17 years using cross-sectional data from the 2014 NHPI National Health Interview Survey. Results showed that prevalence of DDs among NHPI children was lower than American children of other races. DDs were negatively associated with health and functioning of NHPI children. There is a need to promote understanding of DDs among NHPI families and to inform public policy makers to identify appropriate intervention services for NHPI children.

398 ESRD Incidence in Native Hawaiians and Pacific Islanders (NHPI) Living in the States and Territories

398 ESRD Incidence in Native Hawaiians and Pacific Islanders (NHPI) Living in the States and Territories

Diabetes Disparities and Promising Interventions to Address Diabetes in Native Hawaiian and Pacific Islander Populations.

The Native Hawaiian and Pacific Islander (NHPI) population is rapidly growing in the USA. NHPIs face significant health disparities and have a high prevalence of diabetes compared to the general US population. Recent culturally-adapted diabetes interventions have shown promise in addressing these disparities among NHPI communities. The interventions showed success by utilizing a community-based approach that honored NHPIs' collectivist culture, addressed social determinants of health that influence disease control and prevention, and utilized NHPI community health workers (CHWs) and peer educators for key roles in implementation of the intervention. To address health disparities in the NHPI community, much can be learned from existing, successful interventions. Promising interventions share several attributes. The interventions were: culturally adapted using a community-based participatory research approach; addressed specific social determinants of health (i.e., cost of healthy food, transportation, access to health care) that influence disease control and prevention; honored the collectivist culture of NHPI communities by integrating social networks and extended family members; and utilized NHPI community members, including peer educators and CHWs, for intervention implementation. Further investment to scale these interventions for regional and national implementation is needed to address the significant diabetes disparities that NHPIs face.

Physical Activity Among Native Hawaiians and Pacific Islanders: A Systematic Review and Meta-Analysis

ObjectiveTo examine the proportion of Native Hawaiian and Pacific Islander (NHPI) meeting recommended physical activity guidelines for Americans (PAG) and determine differences in physical activity (PA) by sex and between NHPI and Asians when data are disaggregated. DesignSystematic review and meta-analysis. SettingArticles identified in CINAHL, The Cochrane Library, Embase, PsychINFO, PubMed, Scopus, SocINDEX, SPORTDiscus, and Web of Science. ParticipantsNHPI children and adults, and Asian adults. InterventionsProportion of NHPI meeting PAG and differences in PA involvement by sex and by ethnicity. MethodsSummary reporting for articles, and meta-analysis using random-effects and inverse-various weighted models. Conclusions and ImplicationsJust over one-third of NHPI children met the PAG (mean = 38.6%, 95% CI [32.43-45.08]), with more males (42.8%) than females (34.7%) meeting the guidelines (t = 6.74, df = 1, P = .02). Less than half met the PAG for combination (mean = 48.7%, 95% CI [34.69-62.97]), moderate (mean = 47.1%, 95% CI [33.62-61.07]), and about one-third met the PAG for vigorous PA (mean = 33.4%, 95% CI [24.55-43.62]). There were no significant differences between Asians and NHPI in PA. Policy, systems, and environmental changes as well as culturally appropriate interventions are needed to increase physical activity among NHPI.

Racial and ethnic differences in mental health service utilization among the Hawaii medicaid population

Background: Racial/ethnic differences have not been adequately addressed in the utilization of mental health services among Medicaid populations.Aim: This study aimed to examine racial/ethnic differences in the utilization of health services for mental disorders in a Medicaid adult population aged between 21 and 64 years.Methods: Racial/ethnic differences in inpatient, outpatient and emergency department services utilization were assessed using 2010 Hawaii Medicaid data. Zero-inflated negative binomial regressions were employed adjusting for age, sex and residential area.Results: Among 73,200 beneficiaries, 29.7% were Whites, 28.5% Asians, 34.7% Native Hawaiians and Pacific Islanders (NHPIs); 60.2% were younger (21–44 years) and 58.6% were females. The patterns of utilization of health services differed across race/ethnicity. Compared to Whites, Asians and NHPIs were less likely to use outpatient services and had lower rates of inpatient visits. NHPIs were also estimated to have lower rates of outpatient and emergency department visits.Conclusion: Variation in the utilization of health services emphasizes the importance of race/ethnicity in mental health management. Various factors, such as language barriers and cultural differences, should be considered in developing clinical interventions or integrative health programs that aim to reduce racial/ethnic disparities among people with mental disorders.

Neighborhood social cohesion and sleep outcomes in the Native Hawaiian and Pacific Islander National Health Interview Survey.

Native Hawaiians and Pacific Islanders (NHPIs) have the lowest attainment of healthy sleep duration among all racial and ethnic groups in the United States. We examined associations of neighborhood social cohesion with sleep duration and quality. Cross-sectional analysis of 2464 adults in the NHPI National Health Interview Survey (2014). Neighborhood social cohesion was categorized as a continuous and categorical variable into low (<12), medium (12-14), and high (>15) according to tertiles of the distribution of responses. We used multinomial logistic regression to examine the adjusted odds ratio of short and long sleep duration relative to intermediate sleep duration. We used binary logistic regression for dichotomous sleep quality outcomes. Sleep outcomes were modeled as categorical variables. Forty percent of the cohort reported short (<7 hours) sleep duration and only 4% reported long (>9 hours) duration. Mean (SE, range) social cohesion score was 12.4 units (0.11, 4-16) and 23% reported low social cohesion. In multivariable models, each 1 SD decrease in neighborhood social cohesion score was associated with higher odds of short sleep duration (odds ratio [OR]: 1.14, 95% confidence interval [CI]: 1.02, 1.29). Additionally, low social cohesion was associated with increased odds of short sleep duration (OR: 1.53, 95% CI: 1.10, 2.13). No associations between neighborhood social cohesion and having trouble falling or staying asleep and feeling well rested were found. Low neighborhood social cohesion is associated with short sleep duration in NHPIs.