Native Hawaiian Research Articles

Abstract B061: Nonalcoholic fatty liver disease (NAFLD) polygenic risk score and risk of hepatocellular carcinoma in a multiethnic population

Abstract Purpose: Hepatocellular carcinoma (HCC) is the third cause of cancer mortality globally, with 10%-12% of cases attributable to nonalcoholic fatty liver disease (NAFLD). Genetic variants included in NAFLD polygenic risk scores (PRS) have been associated with HCC risk. Since these associations have been studied primarily among European ancestry populations, in the current study we assessed the transportability of a NAFLD PRS associated with HCC risk in a racially/ethnically diverse population. Methods: We conducted a nested case-control study including 275 incident HCC cases and 73,045 controls from the Multiethnic Cohort Study, using a 21-variant PRS for NAFLD created based on prior GWAS and replication studies on MEC participants and other populations. Associations between PRS (per standard deviation) and HCC were estimated using logistic regression adjusting for age, sex, and global ancestry. A stratified analysis was conducted by body mass index (BMI) due to the direct relationship of obesity with NAFLD and HCC. Results: The PRS was associated with HCC risk in the combined sample (ORper SD= 1.84, 95% CI: 1.64-2.06). Signifcant associations were observed in Japanese Americans [ORper SD=2.26 (1.87-2.72)], Latinos [ORper SD=1.89 (1.52-2.35)], Native Hawaiians [ORper SD=1.84 (1.26-2.69)], and with the associations being weaker and non-significant in whites [ORper SD=1.33 (0.92-1.93)] and African Americans [ORper SD=1.25 (0.90-1.75)]. The PRS association was stronger among those with BMI >= 25 kg/m2 for the combined sample (ORper SD :2.46, 95% CI:1.92-3.14), (P heterogeneity <0.0001); and all racial/ethnic groups [Latino: 3.01(1.88-4.81), African American: 2.72 (95% CI: 1.18-6.27), Hawaiian: 2.25 (1.17-4.32), Japanese: 2.13 (1.36-3.36), and White:2.11(1.10-4.04)]. Conclusion: A NAFLD PRS is applicable for HCC risk prediction across racial/ethnic populations. BMI may modifiy this PRS-HCC risk association. Citation Format: Homa Sadeghi, David Bogumil, David V. Conti, Christopher Haiman, Loïc Le Marchand, Veronica Wendy Setiawan. Nonalcoholic fatty liver disease (NAFLD) polygenic risk score and risk of hepatocellular carcinoma in a multiethnic population [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B061.

Native Hawaiians and Pacific Islanders: Is APOE a Biomarker of Disease?

AbstractBackgroundNative Hawaiians and Pacific Islanders (NHPI) are among the least represented racial groups in Alzheimer’s disease (AD) research (for example, there are only 18 samples in the NACC). The prevalence of AD is unknown in NHPIs. Likewise, no large studies have reported disease biomarkers, including assessing APOE genotypes for correlation with AD. In one small study in Guam natives, APOE ε4 was not correlated with AD. We have enrolled 648 NHPIs in our cohort with AD8 and CDR scores, and results of their performance on the NACC neuropsychological battery. We collected APOE genotypes for 234 individuals.MethodBrain health events were held to recruit study participants. Biological samples (saliva or blood) were collected at these events then transported to our lab where DNA was extracted and analyzed to determine APOE genotypes.ResultTable 1 summarizes the cognitive assessments and APOE genotypes for 234 individuals. APOE allele frequencies vary widely based on race. However, in our dataset, the ε4 frequency in NHPI females and males is the same and higher than reported in other races.We are underpowered to detect significant trends in subjects with and without dementia (Table 2). Our preliminary data reveal ε4 allele frequencies in subjects with and without dementia. No trend towards ε4 differences in impaired versus normal subjects.ConclusionWe are augmenting and refining the existing cohort. We are genotyping APOE in 414 additional NHPIs and formally diagnosing each subject. We will have sufficient samples to determine whether or not APOE correlates with AD status. If APOE is not a biomarker of AD in NHPIs, this suggests that the genetic architecture of AD in NHPIs is unique and demonstrates the importance of prioritizing NHPIs in future AD research.

Abstract B138: Examining factors that contribute to racial and ethnic disparities in liver cancer within an EHR-based epidemiologic cohort linked to cancer registries

Abstract Background: Racial and ethnic disparities in HCC risk have been documented, but disparities across detailed racial and ethnic groups and the relative contribution of these factors to HCC risk across those groups has not been assessed. We assembled a pooled, EHR-based cohort linked to cancer registry data to study disparities in HCC risk among detailed racial and ethnic groups and to examine the relative contribution of known and putative HCC risk factors to disparities in risk. Methods: Adults with at least one in-person encounter in 2000-2017 within three healthcare systems, San Francisco Health Network, Sutter Health Northern California, and Kaiser Permanente Hawai’i, were linked to their respective population-based state cancer registries for data on incident HCC. We used EHR data to define 17 detailed racial and ethnic groups and other sociodemographic and clinical factors. We used Cox proportional hazards regression with age as the timescale to examine racial/ethnic disparities in HCC risk with sex-specific models adjusted for length of active follow-up and with underlying stratification by site, birth cohort, baseline year and number of encounters. We calculated sex-specific hazards and population attributable fractions (PAFs) of HCC risk factors among racial/ethnic groups (e.g., smoking, hepatitis infections, metabolic syndrome). Results: The pooled cohort contained data on 4,249,671 adults followed a median of 6.8 years; 55% were female, and 2,916 had incident HCC. Compared to non-Hispanic White males, Vietnamese American males had greater risk of HCC (HR: 7.42; 95% CI: 4.25, 12.96) as did American Indian/Alaska Native, Black, Chinese American, Hispanic, Native Hawaiian, and Pacific Islander males, and those of multiple races or ethnicities. Among females, every group except for American Indian/Alaska Native, Asian Indian American, and Pacific Islander females had greater risk of HCC compared to the non-Hispanic White group; HRs ranged from 1.68 (1.01, 2.78) among Filipino to 6.38 (2.79, 14.55) among Vietnamese American females. Risk of HCC according to clinical risk factors was similar for males and females; however, the PAF of HCC for alcohol disorders was much higher for females (43%) than males (2%). Analyses by racial/ethnic group are ongoing, but variation in factor-specific risk of HCC was observed in preliminary analyses; for example, only non-Hispanic White and Asian American males had greater risk of HCC with metabolic-associated fatty liver disease and ever-smoking. Conclusions: Analysis of a large EHR-based cohort linked with cancer registry data yields additional information on cancer disparities across detailed racial and ethnic groups and may benefit efforts to identify targets for intervention. Our results indicate disparities in HCC risk across detailed racial and ethnic groups traditionally aggregated into larger groups (e.g., Asian American/Pacific Islander). Variation in the PAF of HCC for known risk factors suggest that the most impactful prevention efforts may require tailoring to the target populations. Citation Format: Mindy C. DeRouen, Alison J. Canchola, Janet Chu, Aly Cortella, Pushkar Inamdar, Sixiang Nie, Mai Vu, Ma Somsouk, Michele Tana, Caroline A. Thompson, Scarlett L. Gomez, Hashem El-Serag, Mi-Ok Kim, Mark Segal, Chanda Ho, Yihe G. Daida, Su-Ying Liang, Salma Shariff-Marco. Examining factors that contribute to racial and ethnic disparities in liver cancer within an EHR-based epidemiologic cohort linked to cancer registries [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B138.

Tree-based QTL mapping with expected local genetic relatedness matrices

Understanding the genetic basis of complex phenotypes is a central pursuit of genetics. Genome-wide association studies (GWASs) are a powerful way to find genetic loci associated with phenotypes. GWASs are widely and successfully used, but they face challenges related to the fact that variants are tested for association with a phenotype independently, whereas in reality variants at different sites are correlated because of their shared evolutionary history. One way to model this shared history is through the ancestral recombination graph (ARG), which encodes a series of local coalescent trees. Recent computational and methodological breakthroughs have made it feasible to estimate approximate ARGs from large-scale samples. Here, we explore the potential of an ARG-based approach to quantitative-trait locus (QTL) mapping, echoing existing variance-components approaches. We propose a framework that relies on the conditional expectation of a local genetic relatedness matrix (local eGRM) given the ARG. Simulations show that our method is especially beneficial for finding QTLs in the presence of allelic heterogeneity. By framing QTL mapping in terms of the estimated ARG, we can also facilitate the detection of QTLs in understudied populations. We use local eGRM to analyze two chromosomes containing known body size loci in a sample of Native Hawaiians. Our investigations can provide intuition about the benefits of using estimated ARGs in population- and statistical-genetic methods in general.

Disparities in the Enrollment of Racialized, Ethnic Minority, and Older Adults in Randomized Trials of Acute Myeloid Leukemia: A Systematic Review

Introduction: There are significant racial and ethnic disparities in incidence and survival for patients diagnosed with hematologic malignancies. Understanding discrepancies in enrollment in randomized controlled trials based on race, ethnicity, and age is important to better understand access to care and clinical trial conduct. Objective: To systematically review the literature on enrollment of racialized, ethnic minority, and older adults in randomized controlled trials (RCTs) of acute myeloid leukemia (AML) and to provide enrollment estimates and compare these to population characteristics. Methods: MEDLINE was searched from inception through to June 2023. No restrictions based on language or publication date were used. Pairs of reviewers independently screened titles, abstracts, and full texts of records. Inclusion criteria were phase II and III RCTs of disease modifying therapy for AML in adults (≥18 years) reporting efficacy and safety outcomes. We excluded single arm trials, trials with unpublished results, conference abstracts, follow-up reports, subgroup/post-hoc/exploratory analyses, and supportive care trials, except those evaluating disease-modifying therapies and reporting clinical efficacy. A standardized form was pilot-tested and used to extract data related to trial characteristics. The proportion of trials reporting racial and ethnic subgroups (African American/Black, Asian, American Indian/Alaskan native, Native Hawaiian or other Pacific Islander, White, Hispanic), and age ≥65 were determined. For US trials, we calculated the enrollment incidence ratios (EIRs), the ratio of trial proportions of members of a racial and ethnic subgroup divided by US population-based incidence in the corresponding racial and ethnic subgroup using the Surveillance, Epidemiology, and End Results (SEER 20) database. We conducted a random-effects meta-analysis to pool EIRs. Results: After screening 7,759 titles and abstracts and 157 full texts, we included 90 studies, of which 14 (15%) were US trials. Overall, there were 21 (23.3%) trials that reported race or ethnicity and 26 (28.9%) that reported the enrollment proportion of ≥65 years. Of the trials with data on race or ethnicity, 15 (71.4%) had data on African American/Blacks, 21 (100%) Whites, 14 (66.7%) Asian or Pacific Islanders, 2 (9.52%) American Indian and Alaskan Native, 4 (19.0%) Hispanics. Of trials reporting on race, 176 (3.6%) of participants were African American/Black, 360 (7.2%) Asian or Pacific Islander, 5 (0.1%) American Indian and Alaskan Native, 3,914 (79.6%) White, and 39 (0.8%) Hispanic. Of the 14 US trials, 4 (28.6%) reported race and 4 (28.6%) reported enrolled proportion of older adults. Hispanic patients (EIR 0.20; 95%CI 0.07 to 0.59, I 2=86%), and Asian patients (EIR 0.24; 95%CI 0.07 to 0.86, I 2=77%) were significantly underrepresented while White patients (EIR 1.33, 95%CI 1.07 to 1.66, I 2=99%) were significantly overrepresented. Confidence intervals were wide for EIR of Black patients (EIR 0.96, 95%CI 0.42 to 2.2, I2=91%). Conclusion: Most trials did not report data on race and ethnicity or on enrollment proportion of participants ≥65 years. Only a small proportion of trial participants were from racial and ethnic minority groups. Hispanic and Asian patients were significantly underrepresented while White patients were overrepresented.

Risk Factors Amenable to Primary Prevention of Type 2 Diabetes Among Disaggregated Racial and Ethnic Subgroups in the U.S.

Race and ethnicity data disaggregated into detailed subgroups may reveal pronounced heterogeneity in diabetes risk factors. We therefore used disaggregated data to examine the prevalence of type 2 diabetes risk factors related to lifestyle behaviors and barriers to preventive care among adults in the U.S. We conducted a pooled cross-sectional study of 3,437,640 adults aged ≥18 years in the U.S. without diagnosed diabetes from the Behavioral Risk Factor Surveillance System (2013-2021). For self-reported race and ethnicity, the following categories were included: Hispanic (Cuban, Mexican, Puerto Rican, Other Hispanic), non-Hispanic (NH) American Indian/Alaska Native, NH Asian (Chinese, Filipino, Indian, Japanese, Korean, Vietnamese, Other Asian), NH Black, NH Pacific Islander (Guamanian/Chamorro, Native Hawaiian, Samoan, Other Pacific Islander), NH White, NH Multiracial, NH Other. Risk factors included current smoking, hypertension, overweight or obesity, physical inactivity, being uninsured, not having a primary care doctor, health care cost concerns, and no physical exam in the past 12 months. Prevalence of hypertension, lifestyle factors, and barriers to preventive care showed substantial heterogeneity among both aggregated, self-identified racial and ethnic groups and disaggregated subgroups. For example, the prevalence of overweight or obesity ranged from 50.8% (95% CI 49.1-52.5) among Chinese adults to 79.8% (73.5-84.9) among Samoan adults. Prevalence of being uninsured among Hispanic subgroups ranged from 11.4% (10.9-11.9) among Puerto Rican adults to 33.0% (32.5-33.5) among Mexican adults. These findings underscore the importance of using disaggregated race and ethnicity data to accurately characterize disparities in type 2 diabetes risk factors and access to care.

Addressing Native Hawaiian historical trauma: Opportunities for increased economic, environmental, and social advancement

Many people view Hawaiʻi as a tropical paradise where people can relax on idyllic beaches. However, for many Native Hawaiians, the Indigenous people of Hawaiʻi, the desire to continue to reside in their homelands has become impossible. Native Hawaiians have lower socio-economic status, home ownership, and educational attainment compared to non-Hawaiians. Simultaneously, Native Hawaiians have higher rates of chronic disease, asthma, and mental health issues, which impact their quality of life. Despite efforts to address these stubborn problems, the gap between the Indigenous Native Hawaiian community and those that settled these islands continue to exist. Native Hawaiian scholars have attributed these persistent challenges to the historical trauma that the community has experienced and continues to experience stemming from the mass trauma events of colonization. Although the community acknowledges the heavy impact that historical trauma has had on Native Hawaiians, many policymakers and individuals in position of authority have expressed a need for evidence of this concept. This project seeks to develop a scale to measure Native Hawaiian historical trauma to support evaluation and advocacy efforts. Moreover, healing Native Hawaiian historical trauma would facilitate increased economic mobility, improved environmental policies, and an enriched social advancement.

Communication Between Pregnant People of Color and Prenatal Care Providers in the United States: An Integrative Review.

Racism and discrimination negatively affect patient-provider communication. Yet, pregnant people of color consistently report being discriminated against, disrespected, and ignored. The purpose of this integrated review was to identify studies that examined communication between pregnant people of color and their prenatal care providers and evaluate the factors and outcomes arising from communication. We searched the PubMed, Embase, CINAHL, and PsychINFO databases for studies published between 2001 and 2023. Articles were eligible for inclusion if they reported on primary research conducted in the United States, were written in English, and focused on patient-provider communication with a sample that included pregnant people of color, defined as those who self-identified as Black, African American, Hispanic, Latina/x/e, Indigenous, American Indian, Asian, Asian American, Native Hawaiian, and/or Pacific Islander American. Twenty-six articles were included in the review. Relevant data were extracted and compiled into an evidence table. We then applied the rating scale of the Johns Hopkins Evidence-Based Practice model to assess the level of evidence and quality of the studies. Themes were identified using a memoing technique and organized into 3 a priori categories: factors, outcomes, and recommendations. Two overarching themes emerged from our analysis: racism/discrimination and unmet information needs. Subthemes were then identified as factors, outcomes, or recommendations. Factors included provider behaviors, language barriers, structural barriers, provider type, continuity of care, and fear. Outcome themes were disrespect, trust, decision-making power, missed appointments, and satisfaction with care. Lastly, culturally congruent care, provider training, and workforce development were categorized as recommendations. Inadequate communication between prenatal care providers and pregnant people of color continues to exist. Improving access to midwifery education for people of color can contribute to delivering perinatal care that is culturally and linguistically aligned. Further research about digital prenatal health communication is necessary to ensure equitable prenatal care.

Human Papillomavirus Awareness by Educational Level and by Race and Ethnicity

ImportanceUnderstanding disparities in human papillomavirus (HPV) awareness is crucial, given its association with vaccine uptake.ObjectiveTo investigate differences in HPV awareness by educational attainment, race, ethnicity, and their intersectionality.Design, Setting, and ParticipantsThis cross-sectional study used the Health Information National Trends Survey (HINTS) 5 cycles 1 to 4 data (January 26, 2017, to June 15, 2020). The data were analyzed from December 12, 2022, to June 20, 2023. A sample of the noninstitutionalized civilian US population 18 years or older was included in the analysis.Main Outcomes and MeasuresWeighted prevalence of HPV awareness, HPV vaccine awareness, and knowledge that HPV causes cancer, stratified by educational attainment and by race and ethnicity. Interaction between educational attainment and race and ethnicity was assessed using a Wald test.ResultsA total of 15 637 participants had educational attainment data available; of these, 51.2% were women, and the median age was 58 (IQR, 44-69) years. A total of 14 444 participants had race and ethnicity information available; of these, 4.6% were Asian, 13.9% were Black, 15.3% were Hispanic, 62.6% were White, and 3.6% were of other race or ethnicity (including American Indian or Alaska Native, Native Hawaiian or Other Pacific Islander, and more than 1 race or ethnicity). Awareness of HPV by educational attainment ranged from 40.4% for less than high school to 78.2% for college or higher; awareness by race and ethnicity ranged from 46.9% among Asian individuals to 70.2% among White individuals. Awareness of HPV vaccines across educational attainment ranged from 34.7% among those with less than high school to 74.7% among those with a college degree or higher and by race and ethnicity from 48.4% among Asian individuals to 68.2% among White individuals. Among adults who were aware of HPV, knowledge that HPV causes cervical cancer differed by educational attainment, ranging from 51.7% among those with less than high school to 84.7% among those with a college degree or higher, and by race and ethnicity, ranging from 66.0% among Black individuals to 77.9% among Asian individuals. The interaction between educational attainment and race and ethnicity on HPV awareness and HPV vaccine awareness was not significant; however, within each educational attainment level, awareness differed by race and ethnicity, with the lowest awareness consistently among Asian individuals regardless of educational attainment. Within each racial and ethnic group, HPV awareness and HPV vaccine awareness significantly decreased with decreasing educational attainment.Conclusions and RelevanceDisparities in HPV awareness were evident across social factors, with the lowest awareness among Asian individuals and individuals with lower educational attainment. These results emphasize the importance of considering social factors in HPV awareness campaigns to increase HPV vaccination.

Abstract 13378: Identifiable Differences in Comorbidities and Surgical History Among Asian, Native Hawaiian, and Pacific Islander Stroke Patients With Carotid Artery Disease

Introduction: A detailed characterization of comorbidity prevalence among carotid artery disease patients has not been thoroughly explored in Asian, as well as Native Hawaiian and Pacific Islander (NHPI) populations. Research Question: This study investigated the types of comorbidities and surgical procedures associated with carotid artery disease in Asian and NHPI populations. Methods: This retrospective study utilized data from a stroke treatment center in Hawaii between the years 2020-21. Patients were identified with ICD-10 codes for stroke and only those ≥18 years old with either a completed carotid artery Doppler ultrasound or carotid angiography were included in the study. Collected data included demographics, location of stroke, degree and location of carotid stenosis, comorbidities, and previous surgical history. Wilcoxon rank sum test and Fisher's exact test were used as appropriate. Results: Overall, 117 patients were included with 74 of identifiable race (45% NHPI, 32% Asian, and 23% White). The average age at the time of stroke was 69 years and 40.0% (47/117) of patients were female. Amongst all races, there were no differences in the greatest degree of carotid stenosis (p=.15) or location of stenosis along the right carotid artery (p=.16), but there was a difference in the location of left carotid stenosis (p=.04). Endocrine conditions were the only comorbidity identified at significantly different rates between all racial groups (p=.02). Prior cardiac (p=.03), otolaryngological (0=.007), and orthopedic (p=.01) procedures differed significantly by race among the cohort. The majority of these differences were present when comparing NHPI or Asian patients against White patients, with no significant differences found between Asian and NHPI patients. Conclusions: Asian and NHPI stroke patients were found to have significantly different rates of left carotid stenosis, endocrine conditions, and prior cardiac, otolaryngological, or orthopedic surgeries when compared to White patients. Due to these race-specific differences in patient demographics and history, the implementation and investigation of carotid artery disease risk assessments should be pursued to best improve stroke outcomes among all patients.

Rising From Ruin—Revitalizing Native Hawaiian Health

This Viewpoint offers insight into the health effects of the recent fires in Hawaiʻi and what culturally conscious approaches are needed to ensure the health of Native Hawaiians going forward.

Advanced melanoma presentation and disease-specific survival disparities among disaggregated Asian American, Native Hawaiian, and Pacific Islander populations

Advanced melanoma presentation and disease-specific survival disparities among disaggregated Asian American, Native Hawaiian, and Pacific Islander populations

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

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

Adiposity, Weight Change, and Urinary Melatonin Levels among Men in the Multiethnic Cohort.

Low levels of 6-sulfatoxymelatonin, the primary urinary metabolite of melatonin, have been linked to cancer and cardiometabolic outcomes in White and female populations. We examined the association between adulthood adiposity and 6-sulfatoxymelatonin levels in a racially and ethnically diverse population. Our study included 4,078 men in the Multiethnic Cohort with adiposity measurements at enrollment (1993-1996) and biomarkers measured in urines collected in 1995 and 2005. Multivariable linear regression models were used to estimate the percent change in 6-sulfatoxymelatonin levels and 95% confidence intervals (CI). Associations were examined separately by racial/ethnic group. The prevalence of obesity varied by race and ethnicity, from 10% for Japanese American men to 34% for Native Hawaiian men. Compared with men with normal body mass index (BMI), men who were overweight (-7.8%; 95% CI, -11.9 to -3.5%) and obese (-18.1%; 95% CI, -23.2 to -12.6%) had significantly lower 6-sulfatoxymelatonin levels adjusting for potential confounding factors. Increasing weight gain in adulthood was also associated with lower 6-sulfatoxymelatonin (Ptrend < 0.0001). The inverse associations for BMI and weight change were qualitatively similar across racial and ethnic groups. Obesity is inversely associated with melatonin in a racially diverse population. This finding is relevant given higher rates of obesity among Black, Native Hawaiian, and Latino men, as well as potential racial and ethnic differences in circadian function. Melatonin may be a relevant biomarker among obesity-associated malignancies and could shed light on a potential mechanism of cancer disparities.

Risk of contralateral breast cancer among Asian/Pacific Islander women in the United States.

While breast cancer studies often aggregate Asian/Pacific Islander (API) women, as a single group or exclude them, this population is heterogeneous in terms of genetic background, environmental exposures, and health-related behaviors, potentially resulting in different cancer outcomes. Our purpose was to evaluate risks of contralateral breast cancer (CBC) among subgroups of API women with breast cancer. We conducted a retrospective cohort study of women ages 18 + years diagnosed with stage I-III breast cancer between 2000 and 2016 in the Surveillance, Epidemiology and End Results registries. API subgroups included Chinese, Japanese, Filipina, Native Hawaiian, Korean, Vietnamese, Indian/Pakistani, and other API women. Asynchronous CBC was defined as breast cancer diagnosed in the opposite breast 12 + months after first primary unilateral breast cancer. Multivariable-adjusted subdistribution hazard ratios (SHR) and 95% confidence intervals (CI) were estimated and stratified by API subgroups. From a cohort of 44,362 API women with breast cancer, 25% were Filipina, 18% were Chinese, 14% were Japanese, and 8% were Indian/Pakistani. API women as an aggregate group had increased risk of CBC (SHR 1.15, 95% CI 1.08-1.22) compared to NHW women, among whom Chinese (SHR 1.23, 95% CI 1.08-1.40), Filipina (SHR 1.37, 95% CI 1.23-1.52), and Native Hawaiian (SHR 1.69, 95% CI 1.37-2.08) women had greater risks. Aggregating or excluding API patients from breast cancer studies ignores their heterogeneous health outcomes. To advance cancer healthequity among API women, future research should examine inequities within the API population to design interventions that can adequately address their unique differences.

Risk of Incident Asthma Among Young Asian American, Native Hawaiian, and Pacific Islander Children from Age 3 to 7 Years in a Northern California Healthcare System

Incident childhood asthma risk has not been examined among diverse Asian American, Native Hawaiian, and Pacific Islander subgroups. In a large California healthcare system, incident asthma was higher among young Filipino/a, Native Hawaiian/Pacific Islander, and South Asian children compared with non-Hispanic White children, whereas Chinese and Japanese children were similar.

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

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

Growing Kalo (Taro) in the Continental United States.

As an increasing number of Native Hawaiian and Pacific Islander adults move to the continental United States, the development and implementation of resources that promote access to cultural foods and support food sovereignty on the continent is crucial to perpetuate cultural practice and connection to the 'āina (land that feeds). Kalo (taro) is an important cultural food central to Native Hawaiian identity. Native Hawaiians connect their genealogy as far back to the cultivation of kalo and the creation of kalo itself. In this practice note, we describe the creation of a māla kalo (cultivated field for taro) in Oregon by the Ka'aha Lāhui O 'Olekona Hawaiian Civic Club. An ongoing project over the past 3 years, the creation of a māla kalo exceeded expectations. Not only did the māla allow the cultivation of kalo outside of Hawaii, the māla became a place for the community to unite toward common goals of connecting with the land, promoting mental health, and creating a sense of place in their diaspora. This project indicates that not only is the creation of māla kalo in Oregon feasible, it may also be an important opportunity for the growing number of Native Hawaiians and Pacific Islanders adults living on the continent to improve health outcomes through connections with cultural foods and practices.

The Mauli Ola Study: A Unique Academic-Community Partnership With MA'O Organic Farms to Understand and Address Health Inequities Among Native Hawaiians and Other Pacific Islanders in Hawai'i.

Indigenous peoples, including Native Hawaiians and Pacific Islanders (NHPIs), experience significant cardiometabolic health disparities arising in large part from rapid changes to their diets and food systems. Innovative food sovereignty initiatives led by NHPIs are needed to address these disparities. This article describes a community-based participatory research study that incorporates social and biological measures to examine the impact of an Indigenous-led land-based food sovereignty youth leadership program on health disparities among NHPI youth in Hawai'i. Grounded in the Indigenous knowledge that holistic health and wellbeing of people is inseparable from that of the environment and to counter rampant food insecurity in their community of Wai'anae, O'ahu, MA'O Organic Farms developed a Youth Leadership Training (YLT) program that offers education, nutrition, physical activity, and access to health care. The program also engages YLT interns and their social networks in health education and research in the ongoing Mauli Ola study. Preliminary data from this study affirm the need to address the disproportionately high rates of obesity, type 2 diabetes mellitus (T2D), and poor mental health conditions among young NHPIs in the Wai'anae community, and how the YLT program may provide an effective approach to address this need. Our unique academic-community partnership underscores the importance of social and biomedical research to understand health disparities in the NHPI population, which present novel avenues to enable disease prevention. The outcomes of the Mauli Ola study may serve as a valuable model for health disparities research while leveraging ongoing social programs that support Indigenous food sovereignty.

Framing an Indigenous Food Sovereignty Research Agenda.

Access to healthy and appealing food is essential for individuals to be able to live a healthy and quality life. For decades, food security has been a priority issue for public health professionals. Food sovereignty expands upon the concept of food insecurity (i.e., having access to nutritious and culturally relevant food) by incorporating people's rights to define their own food system. The expanded focus of food sovereignty on food systems prioritizes public health professionals' role in supporting environmental- and systems-level initiatives and evaluating their implications for health, economics, and the natural environment. Food sovereignty is of particular importance for Indigenous peoples (i.e., American Indian, Alaska Native, Native Hawaiian, and Pacific Islander communities). Colonization had demonstrable consequences, with many Indigenous communities being forcibly relocated from traditional lands, alongside the destruction of traditional food sources. Indigenous food sovereignty aligns with the sovereign nation status that American Indian tribes and Alaska Native communities have with the United States. Furthermore, the worldviews that incorporate Indigenous communities' relational responsibilities to care for their food systems, according to their traditional practices and beliefs (Coté, 2016; Morrison, 2011), uniquely positions Indigenous peoples to lead food sovereignty initiatives. In this article, we explore what is currently known regarding food sovereignty and health. We then discuss opportunities to expand the evidence on Indigenous food sovereignty's relationships with (1) health and well being, (2) economics, (3) the natural environment, and (4) programming facilitators and barriers.