Pacific Island Communities Research Articles

“Jia you (Add oil, let’s go!)”: A Speech’s Critical Discourse Analysis on the Use of Metaphors to Empower the Asian Community Against Hate Amid Covid-19

Following Fairclough’s three-dimensional model, this paper presents a critical discourse analysis of the speech “We are GOLDEN” delivered at a Stop Asian Hate rally held in the U.S. in 2021.The analysis focuses on the use of adjectives and metaphors at the text, discursive practice and social practice levels, which demonstrate the speaker’s strong criticism and opposition to violence, systemic racism, hegemony, and the power of white supremacy that became evermore present amid COVID-19. The results unveil the use of cultural and historical intertextuality from a resilient perspective to empower the Asian American and Pacific Islander community to promote social change and stand against hate.

Making it real: Actioning the mental health strategy with Pacific Island communities.

This paper explores the practical implications of the World Health Organization strategy of focussing on community-based mental health and wellbeing ecosystems in the context of the Pacific Island Countries. It draws on the expertise of the participants of a collaborative workshop held during the Creating Futures conference in 2023 to discuss successes, challenges, barriers, opportunities in the implementation of the framework and to examine potential future actions. Some of the significant factors that make for effective and sustained community-based mental health systems include appropriate central coordination and oversight of community-based services, adequate frameworks for quality assurance, meaningful data collection and sustained long-term funding, as well as a range of workforce factors. Flexible and place-based approaches also need to be considered in effective implementation, moving away from Western diagnostic 'labels' to communication that is effective at the local level. Positive community resources as well as the relative youth of the mental health sector in the Pacific Island Nations are huge opportunities to develop affective and appropriate community mental health systems.

(Re)Development of pain target competencies in a contemporary, multi-centre undergraduate medical curriculum: The importance of local cultural requirements

Pain is the most common reason to seek healthcare, however pain teaching is often not prominent in medical school curricula. This project reviewed an existing medical curriculum to develop a comprehensive pain curriculum that consolidated pain learning across a medical degree delivered on geographically-distinct campuses, looking to provide contemporary pain learning that was culturally appropriate in a local context. A cross-campus, interdisciplinary pain working group (PWG) was established to work across the two program stages (pre-clinical, clinical) and three clinical campuses. The PWG undertook a three-phase project to i) develop a range of potential target competencies based on expert input and international pain curricula, ii) identify and review existing pain competencies, and iii) undertake iterative review of information, consult with stakeholders, and propose revised competencies. Eight pain competencies were identified within the extant curriculum. Recommendations included two existing competencies remained unchanged, four be modified, two merged, and 26 new competencies adopted including some specific to local Indigenous Māori and Pacific Island communities. The 33 pain target competencies were structured across different teaching domains: science, research, and scholarship (n = 5); population health and epidemiology (n = 3); clinical skills (n = 5); and diagnostics and therapeutics (n = 20). Contemporary pain learning, including around Indigenous health, was not adequately represented. New target competencies were adopted to ensure pain learning is appropriate for medical practice in Aotearoa New Zealand, containing competencies specific to Māori and Pacific Island communities. Curricula review needs to consider local cultural requirements while integrating international best practice to ensure pain learning is appropriate. PerspectiveA comprehensive pain curriculum was developed across a multi-campus medical school setting. Through a three-phase project, existing pain competencies were reviewed and new target competencies developed, including those specific to local Indigenous communities. Findings highlight the importance of ensuring contemporary curricula include pain learning that is culturally focused and relevant.

Family model diabetes self-management education and support in faith-based organizations in the Republic of the Marshall Islands: A study protocol

IntroductionThe Republic of the Marshall Islands (RMI) is an independent nation and a member of the United States (US) Affiliated Pacific Islands through a Compact of Free Association. Health disparities in the RMI are striking, with high rates of type 2 diabetes mellitus (T2DM). The International Diabetes Federation has documented age-adjusted prevalence of T2DM at 23.0 %, compared to the US (13.2 %) and globally (9.8 %). T2DM has a devastating impact on patients and their families. MethodsThe purpose of this article is to present the study protocol for the fully powered two-arm cluster randomized controlled trial using a wait-list control to evaluate the effectiveness of a Family Diabetes Self-Management Education and Support (Family DSMES) program when delivered in a group setting by community health workers (CHWs) in faith-based organizations (FBOs) in the RMI. The study used a community engaged approach, and the study protocol includes adaptations based on the results of our one-arm pilot study. SummaryThis study will provide new and innovative information on the effectiveness of Family DSMES delivered in a group setting by CHWs in FBOs in the RMI. The knowledge gained from this research will inform DSMES interventions conducted with Marshallese and other Pacific Islander communities, as well as DSMES interventions conducted in other low-resource countries.

Leveraging deep learning and computer vision technologies to enhance management of coastal fisheries in the Pacific region

This paper presents the design and development of a coastal fisheries monitoring system that harnesses artificial intelligence technologies. Application of the system across the Pacific region promises to revolutionize coastal fisheries management. The program is built on a centralized, cloud-based monitoring system to automate data extraction and analysis processes. The system leverages YoloV4, OpenCV, and ResNet101 to extract information from images of fish and invertebrates collected as part of in-country monitoring programs overseen by national fisheries authorities. As of December 2023, the system has facilitated automated identification of over six hundred nearshore finfish species, and automated length and weight measurements of more than 80,000 specimens across the Pacific. The system integrates other key fisheries monitoring data such as catch rates, fishing locations and habitats, volumes, pricing, and market characteristics. The collection of these metrics supports much needed rapid fishery assessments. The system’s co-development with national fisheries authorities and the geographic extent of its application enables capacity development and broader local inclusion of fishing communities in fisheries management. In doing so, the system empowers fishers to work with fisheries authorities to enable data-informed decision-making for more effective adaptive fisheries management. The system overcomes historically entrenched technical and financial barriers in fisheries management in many Pacific island communities.

Navigating identity and mental health on Instagram: Edu‐fluencers in the Asian American Pacific Islander Community

AbstractCounselors and other mental health professionals use Instagram for brand‐building and disseminating information on mental health and counseling resources. This study was an exploratory mixed‐methods analysis of Asian American/Pacific Islander mental health edu‐fluencers to understand their post content and user engagement over the first year of the COVID‐19 pandemic. We describe post content and present analyses of variance results to compare user engagement. Implications of social media use are discussed for mental health professionals and researchers.

News Literacy and Critical Thinking in the Pacific: Evidence from Guam and the Northern Mariana Islands

ABSTRACT This study analyzes data from surveys conducted in two Pacific Island communities—Guam and the Commonwealth of the Northern Mariana Islands—to assess relationships among news literacy, news literacy efficacy, critical thinking about content, and news credibility. Results, on the one hand, show that news literacy is positively associated with both critical thinking about content and news literacy efficacy. On the other hand, news literacy is negatively related to news credibility. Also, the positive association between news literacy and critical thinking about content is mediated by news literacy efficacy. Results support the role of news literacy in facilitating critical thinking about news messages across the two sociocultural settings. We discuss theoretical implications of findings.

Acculturating to multiculturalism: a new dimension of dietary acculturation among Asian American, Native Hawaiian, and Pacific Islander women in the San Francisco Bay Area, USA

BackgroundDietary acculturation is the process by which diet and dietary practises from the environment of origin are retained or changed and/or those prevalent in a new environment are adopted. Despite rapid population growth the U.S., knowledge gaps exist on characterising dietary acculturation among Asian American, Native Hawaiian, and Pacific Islander communities (AANHPI). This study characterise dietary patterns in a sample representative of AANHPI on key demographic characteristics.MethodsData were from a 2013–2014 population-based case-control study in the San Francisco Bay Area, U.S. Survey items were adapted from dietary acculturation scales developed for AANHPI populations. Validated measures assessed social capital, social standing, discrimination and immigration experiences. A principal components factor analysis was conducted to characterise dietary patterns of acculturation.ResultsThree dietary patterns were identified: “Asian,” “Western,” and a distinct “Multicultural” factor. Respondents reporting a high-Asian diet tended to also report smaller social networks, higher levels of stress, and, among those born outside of the U.S., an educational standing that was better before immigration. Respondents reporting a high-Western diet tended to also report the highest level of discrimination. Those reporting a high-Multicultural diet tended to report higher neighbourhood collective efficacy.ConclusionsThe finding of a distinct “Multicultural” factor beyond the typical “Asian” and “Western” factors may reflect the multidirectional relationships between culture, diet, and dietary behavior, in which origin and destination cultures interact in complex ways and where foods from multiple ethnicities intermix.

Exploring the Radical Potential of Queer AZN and Pasifika CRT for Clinical Social Work Praxis

ABSTRACT In the wake of the COVID-19 pandemic, the crisis in Palestine, and the continued rise in hate crimes against Asian American and Pacific Islander (AAPI) communities, clinical social work praxis centering on the intersectional identities of queer and transgender AAPI communities has never been more vital. Through the visioning of an approach that addresses these intersecting identities and our own experiences with racism, cisheterosexism, and transphobia, we propose a theoretical framework, Queer AZN and Pasifika Critical Race Theory (CRT), for clinical social work praxis. Specifically, we describe six tenets of a Queer AZN and Pasifika CRT approach, which include (1) Queer, Brown Asianization; (2) Challenging mainstream ideologies about Asians, Pacific Islanders, Queer and Transgender Pacific Islanders, and Queer and Transgender Asian Americans; (3) Global, decolonial perspectives; (4) Re-constructive histories; (5) Multidisciplinary story, practice, praxis, and voice; and (6) a Social Justice perspective. We present cases as an opportunity to explore and reflect on clinical social work practice with queer and trans AAPI people through the lens of Queer AZN and Pasifika CRT.

Disaster preparedness among Asian, Pacific Islander, and Desi American communities.

Disaster experiences and explorations of preparedness among Asian, Pacific Islander, and Desi Americans (APIDA) in the United States are often overlooked owing to their relatively smaller population share. APIDA are not homogenous, and their disaster experiences warrant further examination. This paper does so by investigating disaster preparedness using disaggregated information about APIDA. The study utilises nationally representative data from the 2017 American Housing Survey, analysing sociodemographic covariates. The disaster preparedness score among APIDA communities was approximately 4.81 on a zero to nine scale. APIDA renters and non-US citizens were less prepared than homeowners and US citizens. Among subgroups, Korean, Chinese, and Vietnamese respondents who were non-US citizens were less prepared than those who were US citizens. Marital status was significantly and positively associated with preparedness among Indians, Japanese, Vietnamese, and multiracial respondents. The findings underscore the importance of data disaggregation and tailored preparedness information and resources to address specific challenges APIDA communities face instead of a one-size-fits-all approach.

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

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

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.

Honoring Inágofli’e’ and Alofa: Developing a Culturally Grounded Health Promotion Model for Queer and Transgender Pacific Islanders

(1) Background: Although culturally grounded health interventions (CGHI) have shown efficacy in improving Indigenous health, few CGHI for Queer and Transgender Pacific Islander (QTPI) communities exist to address their health promotion. This study explores QTPI experiences of health for cultural mechanisms to develop CGHI for QTPI health promotion. (2) Methods: Using Indigenist community-engaged research methodologies, we collaborated with the United Territories of Pacific Islanders Alliance of Washington and Guma’ Gela’ to conduct 11 exploratory semi-structured interviews with QTPI community members living in the Puget Sound area of Washington state. These interviews were analyzed using thematic analysis. (3) Results: QTPI well-being was greatly influenced by how settler colonialism impacted their connectedness to their families, communities, and cultures. We also found that inágofli’e’ and alofa, relational values in CHamoru and Sāmoan culture, played essential roles in facilitating QTPI health. Many participants fostered these values through chosen family, community care, and Indigenous mobilities. (4) Conclusions: Our findings indicate a need for CGHI that facilitate inágofli’e’ and alofa for QTPI to combat settler colonialism’s impacts on QTPI well-being. Finally, we present a community-centered conceptual model for culturally grounded health promotion in QTPI communities.

The Role of Culturally Appropriate Mediated Communication Strategies to Reduce Hepatitis B and Liver Cancer Disparities

Asian, Pacific Islander, African, and Caribbean communities in the U.S. are heavily impacted by chronic hepatitis B (HBV) and hepatocellular carcinoma (HCC). Educating these groups about the link between the two diseases is imperative to improve screening rates and health outcomes. This study aims to identify and incorporate preferred mediated communication methods into community-specific educational campaigns which emphasize the connection between the conditions, to promote uptake of prevention and management behaviors for HBV and HCC. Fifteen focus groups and two key informant interviews were conducted with Micronesian, Chinese, Hmong, Nigerian, Ghanaian, Vietnamese, Korean, Somali, Ethiopian, Filipino, Haitian, and Francophone West African communities. Data were analyzed using thematic coding and analysis. Findings demonstrate that all communities preferred materials be offered in both English and native languages and requested that materials highlight the connection between HBV and HCC. Delivery channel preferences and messaging themes varied by group. This study provides insight into community-specific preferences for learning about HBV and HCC. The findings can be used to design culturally and linguistically tailored, multi-platform, health education campaigns to facilitate improved HBV screening and vaccination rates and increase knowledge about HCC risk among highly impacted communities in the U.S.

Existing knowledge, myths, and perceptions about hepatitis B and liver cancer within highly impacted immigrant communities

BackgroundImmigrant groups from Southeast Asia, the Pacific Islands, sub-Saharan Africa, and the Caribbean bear the heaviest burden of chronic hepatitis B and primary liver cancer in the United States. Educational campaigns to increase knowledge about these diseases and their connection are necessary to promote protective health behaviors within these communities, to ultimately reduce the burden of disease, lessen stigma, and eliminate health disparities. ObjectivesThis project sought to engage groups within highly impacted communities to identify existing gaps in hepatitis B- and liver cancer-related knowledge, in order to inform future health education programming that will aim to reduce stigma and promote liver cancer prevention and early detection behaviors within and across groups. MethodsFifteen focus groups and two key informant interviews were conducted virtually with participants from Micronesian, Chinese, Hmong, Nigerian, Ghanaian, Vietnamese, Korean, Somali, Ethiopian, Filipino, Haitian, and Francophone West African communities. Qualitative data were analyzed using thematic coding. ResultsThere are large gaps in knowledge and awareness of hepatitis B and liver cancer, and the link between these two diseases among Asian, Pacific Islander, African and Haitian immigrant communities. This limited knowledge and misinformation, exacerbated by stigma, hinder these groups’ utilization of hepatitis B and liver cancer diagnostic and preventative healthcare services. ConclusionTo reduce hepatitis B and liver cancer health disparities within heavily burdened groups, health education needs to be community-informed, culturally sensitive, and actionable. Study results can guide the development of culturally and linguistically appropriate education programs that focus on the link between hepatitis B and liver cancer and the need for vaccination and routine screening, and that are responsive to the knowledge gaps and misperceptions of diverse communities. The results also provide valuable insights for healthcare providers to improve the knowledge gaps of the diverse patient populations that they serve.

Expansion of outreach to native Hawaii and Pacific Islander communities to increase breast cancer screening and clinical trial awareness in underserved and rural Oahu.

e13725 Background: Multiple barriers exist in the enrollment of racial and ethnic minority groups into breast cancer screening and clinical trials. Such barriers include the lack of knowledge, mistrust, and access. To increase participation of rural-dwelling Native Hawaiian/Pacific Islanders (NHPI) and other underserved minority groups in breast cancer screening and clinical trials, a pilot project was developed to augment community engagement, provide education, and gain insights into the cancer screening/clinical trial process. Our objective was to engage rural Oahu's underserved communities in breast cancer screening and facilitate enrollment into the Digital Tomosynthesis Mammography and Digital Mammography in Screening Patients of Breast Cancer Trial (TMIST) utilizing a team comprising of a cultural congruent and gender concordant Community Health Educator (CHE) and medical oncology health care provider. Methods: We reviewed the community activities over the course of a year. The CHE facilitated outreach by speaking at numerous church events and other community gatherings. Results: Participants did not respond favorably to surveys on social determinants of health. Common reasons for their reluctance included lack of perceived importance and medical mistrust. When discussing verbiage that was intimidating or confusing such as clinical trial protocol consent language, TMIST study participants conveyed a strong sense of dehumanization. Conclusions: A total of 93 women were screened for the TMIST clinical trial. Of those, 13 were enrolled in TMIST and 31 participants received mammograms. Participant insight highlighted the importance of education using culturally sensitive language and community engagement to combat the lack of knowledge and mistrust. Continued development of education materials centered around community involvement will improve the accrual of NHPI participation in breast cancer screening/clinical trials. We hope this project established a basis for equity in communities with low breast cancer screening and clinical trial participation rates. We intend to build upon the community partnerships forged during this pilot project.

Editors’ Introduction: Honoring Asian American and Pacific Islander (AAPI) Communities, Voices, and Experiences

Editors’ Introduction: Honoring Asian American and Pacific Islander (AAPI) Communities, Voices, and Experiences

Disparities in Overall Survival Within AANHPI Subpopulations With Cervical Cancer [ID 2683427

INTRODUCTION: The Asian American, Native Hawaiian, and Pacific Islander (AANHPI) community is a diverse group, including over 21 ethnic groups, but is often misrepresented as one cohort. Differences in human papillomavirus prevalence and access to care lead to varying cervical cancer incidences and outcomes within the AANHPI community. Here, we compare overall survival (OS) of cervical cancer patients within the AANHPI subpopulations. METHODS: The National Cancer Database identified 84,395 women with cervical squamous cell carcinoma (ICD-O-3-code 8070). Races listed as “unknown/other” or “Other Asian” were excluded. Kaplan–Meier and Cox regression model were performed. RESULTS: This study identified 985 East Asian (EA), 395 South Asian (SA), 1,073 Southeast Asian (SEA), and 290 NHPI patients with cervical cancer. Mean OS was 144.0 months for EA, 137.0 months for SA, 132.6 months for SEA, and 116.1 months for NHPI. Kaplan–Meier revealed worse OS for SEA and NHPI compared to SA (P=.011, P<.001, respectively) and EA (P=.002, P<.001, respectively). EA (hazard ratio [HR] 0.522; P<.001), SA (HR 0.490; P<.001), and SEA (HR 0.633; P<.001) had lower survival hazard ratios compared to NHPI. CONCLUSION: Survival disparities exist among AANHPI subgroups with cervical cancer. Disaggregation of AANHPI subpopulations revealed that SEA and NHPI patients had worse OS. Native Hawaiian and Pacific Islander patients had greater survival hazard ratios after controlling for socioeconomic variables. This study highlights the need to disaggregate AANHPI data so that disparities among subpopulations can be identified, investigated, and addressed.

Climate Change and its Effects on Pacific Islander Communities: Are Climate Changes and its Effects a Danger to Pacific Islander Communities?

Climate Change and its Effects on Pacific Islander Communities: Are Climate Changes and its Effects a Danger to Pacific Islander Communities?

Discrimination is associated with depression, anxiety, and loneliness symptoms among Asian and Pacific Islander adults during COVID-19 Pandemic

In the United States, Asian and Pacific Islander (A/PI) communities have faced significant discrimination and stigma during the COVID-19 pandemic. We assessed the association between discrimination and depression, anxiety, and loneliness symptoms among Asian or Pacific Islander adults (n = 543) using data from a 116-item nationally distributed online survey of adults (≥ 18 years old) in the United States conducted between 5/2021–1/2022. Discrimination was assessed using the 5-item Everyday Discrimination Scale. Anxiety, depression, and loneliness symptoms were assessed using the 2-item Generalized Anxiety Disorder, 2-item Patient Health Questionnaire, and UCLA Loneliness Scale—Short form, respectively. We used multivariable logistic regression to estimate the association between discrimination and mental health. Overall, 42.7% of participants reported experiencing discrimination once a month or more. Compared with no discrimination, experiencing discrimination once a month was associated with increased odds of anxiety (Adjusted Odds Ratio [aOR] = 2.60, 95% CI = 1.38–4.77), depression (aOR = 2.58, 95% CI = 1.46–4.56), and loneliness (aOR = 2.86, 95% CI = 1.75–4.67). Experiencing discrimination once a week or more was associated with even higher odds of anxiety (aOR = 6.90, 95% CI = 3.71–12.83), depression, (aOR = 6.96, 95% CI = 3.80–12.74), and loneliness (aOR = 6.91, 95% CI = 3.38–13.00). Discrimination is detrimental to mental health, even at relatively low frequencies; however, more frequent discrimination was associated with worse mental health symptoms. Public health interventions and programs targeting anti-A/PI hate and reducing A/PI mental health burden are urgently needed.