US-affiliated Pacific Islands Research Articles

Human Papillomavirus Vaccination Coverage Among Adolescent Girls Aged 13-17 Years - U.S.-Affiliated Pacific Islands, 2013-2023.

Worldwide, cervical cancer is the fourth most common cancer among women, and the World Health Organization (WHO) Western Pacific Region, where the U.S.-affiliated Pacific Islands (USAPI) are located, accounts for one quarter of all estimated cases. Human papillomavirus (HPV) vaccines are recommended at age 11-12 years to prevent most cervical cancers. HPV vaccines were introduced across USAPI during 2007-2016, predominantly provided through school-located vaccination programs. Retrospective analysis using data from jurisdictional immunization information systems was used to estimate vaccination coverage among adolescent girls as of the last day of each calendar year during 2013-2023. This analysis measured progress toward the WHO 2030 vaccination coverage goal of ≥90% completion of the HPV vaccination series among girls by age 15 years. As of December 2023, initiation of the HPV vaccination series among adolescent girls aged 13-17 years ranged from 58.0% in Palau to 97.2% in the Northern Mariana Islands, and HPV vaccination series completion coverage ranged from 43.4% in Palau to 91.8% in the Northern Mariana Islands. HPV vaccination series completion coverage is >90% in the Northern Mariana Islands and is on track to meet WHO goals by 2030 in American Samoa. Assessment of adolescent vaccination coverage can help immunization programs monitor progress toward regional goals and identify populations and areas with low coverage. Implementing evidence-based strategies to increase vaccine access and coverage would benefit jurisdictions with lagging coverage.

Breast cancer incidence and stage at diagnosis in the six US-Affiliated Pacific Islands

BackgroundBreast cancer is the most common cancer diagnosed among women globally and in the United States (US); however, its incidence in the six US-Affiliated Pacific Islands (USAPI) remains less characterized. MethodsWe analyzed data from a population-based cancer registry using different population estimates to calculate incidence rates for breast cancer among women aged >20 years in the USAPI. Rate ratios and 95 % confidence intervals (CI) were calculated to compare incidence rates between the USAPI and the US (50 states and the District of Columbia). ResultsFrom 2007–2020, 1118 new cases of breast cancer were diagnosed in the USAPI, with 66.3 % (n = 741) of cases reported in Guam. Age-standardized incidence rates ranged from 66.4 to 68.7 per 100,000 women in USAPI and 101.1–110.5 per 100,000 women in Guam. Compared to the US, incidence rates were lower in USAPI, with rate ratios ranging from 0.38 (95 % CI: 0.36, 0.40) to 0.39 (95 % CI: 0.37, 0.42). The proportion of late-stage cancer was significantly higher in the USAPI (48.7 %) than in the US (34.0 %), particularly in the Federated States of Micronesia (78.7 %) and Palau (73.1 %). ConclusionsBreast cancer incidence rates were lower in the USAPI than in the US; however, late-stage diagnoses were disproportionately higher. Low incidence and late-stage cancers may signal challenges in screening, cancer surveillance, and health care access and resources. Expanding access to timely breast cancer screening, diagnosis, and treatment could reduce the proportion of late-stage cancers and improve survival in the USAPI.

Building Capacity for Cervical Cancer Prevention in U.S.-Affiliated Pacific Islands: The Pacific Against Cervical Cancer Project.

The U.S.-affiliated Pacific Islands (USAPI) have higher cervical cancer incidence and mortality rates and lower screening coverage compared with the United States. This is likely because of economic, geographical, health care delivery, and cultural barriers for women living in these resource-constrained, isolated regions. The most recent U.S. and World Health Organization cervical cancer screening guidelines recommended primary human papillomavirus (HPV) testing as one screening option or the preferred screening modality. Primary HPV screening-based strategies offer several advantages over current screening methods in the USAPI. However, adoption of this newer screening modality has been slow in the United States and not yet incorporated into USAPI screening programs. The U.S. Centers for Disease Control and Prevention and partners initiated the Pacific Against Cervical Cancer (PACe) project in 2019 to evaluate the feasibility, acceptability, and cost-effectiveness of primary HPV testing-based strategies in Guam and in Yap, Federated States of Micronesia. This report provides an overview of the PACe project and outlines the approaches we took in implementing primary HPV testing as a new cervical cancer screening strategy (including the option of self-sampling in Yap), encompassing four core components: (1) community engagement and education, (2) medical and laboratory capacity building, (3) health information and system improvement, and (4) modeling and cost-effectiveness analysis. The PACe project provides examples of systematic implementation and resource appropriate technologies to the USAPI, with broader implications for never screened and under-screened populations in the United States and Pacific as they face similar barriers to accessing cervical cancer screening services.

Acculturation and Health Status in the Children's Healthy Living Program in the Pacific Region.

Acculturation/enculturation has been found to impact childhood health and obesity status. The objective of this study is to use cross-sectional data to examine the association between proxies of adult/caregiver acculturation/enculturation and child health status (Body Mass Index [BMI], waist circumference [WC], and acanthosis nigricans [AN]) in the U.S.-Affiliated Pacific Islands (USAPI), Alaska, and Hawai'i. Study participants were from the Children's Healthy Living (CHL) Program, an environmental intervention trial and obesity prevalence survey. Anthropometric data from 2-8 year olds and parent/caregiver questionnaires were used in this analysis. The results of this study (n = 4121) saw that those parents/caregivers who identified as traditional had children who were protected against overweight/obesity (OWOB) status and WC > 75th percentile (compared to the integrated culture identity) when adjusted for significant variables from the descriptive analysis. AN did not have a significant association with cultural classification. Future interventions in the USAPI, Alaska, and Hawai'i may want to focus efforts on parents/caregivers who associated with an integrated cultural group as an opportunity to improve health and reduce child OWOB prevalence.

Abstract 3472: Tailored cancer outreach efforts of a community outreach core working with Native Hawaiian and Pacific Islanders in Hawaiʻi

Abstract Background The Community Outreach Core (COC) of the Pacific Island Partnership for Cancer Health Equity (PIPCHE) aims to improve health equity for historically underserved populations including Native Hawaiians and other Pacific Islanders (NHOPIs), and Filipinos. PIPCHE is a partnership between the University of Hawai’i Cancer Center and the University of Guam whose efforts are focused in Hawaiʻi, Guam and the U.S. Affiliated Pacific Islands (USAPI). The COC directly addresses the disproportionately high rates of health disparities and cancer incidence and mortality found within NHOPIs often due to multiple complex historical, social, cultural, and environmental factors. Cancer is the second leading cause of death in Hawai’i between 2014-2018, as well as the second most common cause of death in nearly all USAPI jurisdictions. The COC uses research-tested, community-engaged approaches to modify determinants of cancer in these groups. Methods Outreach efforts have addressed NHOPI cancer inequities by raising awareness of high cancer burdens experienced by these underserved communities. Efforts include resource sharing and data collection at various venues in Hawaiʻi such as health/wellness fairs, public housing, and Pacific Islander churches. Outreach Advisory Council meetings were held biannually with community health leaders to discuss ongoing and future initiatives/resource sharing. The COC provided health providers and students with cultural competency training on more efficient strategies to work with these unique NHOPI groups. The COC provided presentations and short talks across the U.S, including a Health Providers Symposium on lung cancer across the Pacific. Outreach efforts have included tailored NCI-based Screen to Save (S2S) colorectal cancer education to NHOPIs. Results Forty-seven major outreach events were conducted from 2021 to November 2023. These include: 1 Health Providers’ Cancer Symposium, 5 Outreach Advisory Council meetings, 5 Cultural Competency trainings and class lectures, 11 conference/community and short talk presentations, and 25 community outreach events. There were 1,900 attendees reached during these regional and national outreach activities. The COC works with professional audiences at the national level to inform these groups about cancer and the health burdens of NHOPIs. A total of 97 Pacific Islanders received the S2S education and completed a pre-posttest with positive increases in means found for all 14 questions. Conclusion The PIPCHE COC has been able to reach NHOPIs though community partnerships to deliver culturally tailored cancer prevention education and efforts within Hawaiʻi, as well as shed light nationally of the cancer burdens these populations face. The S2S education has been able to raise awareness of cancer screenings and holds promise as a potential strategy to address cancer burdens of NHOPI communities. Citation Format: Mark Lee Willingham Jr., Kevin D. Cassel, Angela Sy, Munirih Taafaki, Tressa P. Diaz, Antoinette Kleiner, Angelina Mummert. Tailored cancer outreach efforts of a community outreach core working with Native Hawaiian and Pacific Islanders in Hawaiʻi [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 3472.

Ethnic Disparities in Betel Nut Use

Abstract: Adolescent substance use has been extensively studied in Western countries. However, knowledge of substance use, particularly betel nut use, among adolescents in the Pacific Islands, remains limited. The present study examined ethnic differences in betel nut use and intention to use, and factors explaining such ethnic differences, in Guam, a US-Affiliated Pacific Islands in the Western Pacific. Participants were 674 ethnically diverse students (49% female; Mage = 12.7, SD = 0.89) from eight local public middle schools. Self-report questionnaires were used to assess study variables. The results indicated that although the majority of participants did not use betel nut, there were significant differences in rates of betel nut use and intentions to use between ethnic groups. Compared with adolescents from other ethnic groups represented in the study, adolescents from the Freely Associated States (FAS) of Micronesia, or non-CHamoru Micronesians were more likely to use betel nut in the past 30 days and in their lifetime and to expect to use betel nut in the near future. These ethnic differences were partially mediated by proposed factors such as observation or familiarity with and access to betel nut and approval by parents, peers, and the community. In other words, FAS ethnicity was a significant predictor of higher levels of familiarity with betel nut; FAS ethnicity also predicted lower levels of difficulty in accessing betel nut and perceived disapproval of betel nut use from parents, peers, and the community. These, in turn, predicted more betel nut use and intention as reported by FAS adolescents. These findings can be used to inform the design and implementation of intervention and prevention programs to reduce ethnic disparities among at-risk youth vulnerable to betel nut use in the Pacific.

How can early COVID-19 vaccine campaigns in the US-affiliated Pacific Islands inform future vaccine efforts: a cross-sectional analysis

IntroductionThe US-affiliated Pacific Islands (USAPI) are six geographically isolated and culturally distinct Pacific Island jurisdictions with special relationships with the USA; the USAPI were included in the US COVID-19 vaccination...

COVID-19 in the US-affiliated Pacific Islands: A timeline of events and lessons learned from March 2020-November 2022.

The US-Affiliated Pacific Islands (USAPIs) experience many health disparities, including high rates of non-communicable disease and limited health resources, making them particularly vulnerable when SARS-CoV-2 began circulating globally in early 2020. Therefore, many USAPIs closed their borders early during the COVID-19 pandemic to give them more time to prepare for community transmission. Routine virtual meetings were established and maintained throughout the pandemic to support preparedness and response efforts and to share information among USAPIs and support partners. Data collected from these regular virtual meetings were gathered and disseminated through routine regional situational reports. These situational reports from March 27, 2020 to November 25, 2022 were reviewed to develop a quantitative dataset with qualitative notes that were used to summarize the COVID-19 response in the USAPIs. The initial surges of COVID-19 in the USAPIs ranged from August 2020 in Guam to August 2022 in the Federated States of Micronesia. This prolonged time between initial surges in the region was due to varying approaches regarding travel requirements, including fully closed borders, repatriation efforts requiring pre-travel quarantine and testing, quarantine requirements upon arrival only, and vaccine mandates. Delaying community transmission allowed USAPIs to establish testing capacity, immunize large proportions of their populations, and use novel COVID-19 therapeutics to reduce severe disease and mortality. Other essential components to support the USAPI regional COVID-19 response efforts included strong partnership and collaboration, regional information sharing and communication efforts, and trust in health leadership among community members. Valuable lessons learned from the USAPIs during the COVID-19 pandemic can be used to continue to strengthen systems within the region and better prepare for future public health emergencies.

Guam Adolescents’ Use of Strategies to Resist Cigarette, e-Cigarette, and Betel Nut Offers: Findings from a Focus Group Study

Background : This study examined resistance strategies used by predominantly Pacific Islander young adolescents in response to offers of tobacco, e-cigarettes, and betel [areca] nuts. This study was intended to inform the development of a prevention curriculum focused on training young adolescents from the U.S.-Affiliated Pacific Islands (USAPI) on culturally appropriate strategies to resist substance use offers. Currently, very little is understood in terms of how Pacific Islander youths deal with tobacco and other substance use offers, although the use of tobacco products among Pacific Islander youths is high. Specifically, given the collectivist sociocultural orientation of the Pacific Islander communities, it is unclear whether the direct (overt) confrontational style of resistance is a viable mode of resistance for youths to practice when faced with a substance use offer. Methods : We conducted 10 focus groups with public middle school students (N = 34) from Guam, which is part of the USAPI. Results : Results suggested that, as with other communities in the U.S., the resistance strategies fall into two categories—overt/confrontational and non-confrontational resistance strategies. Overt/confrontational strategies included (a) saying “no” and (b) verbally confronting the offeror. Non-confrontational strategies included (a) avoiding or leaving the situation and (b) telling an adult. Conclusions : Our findings have implications for the development of culturally grounded interventions aimed at preventing youth tobacco and other substance use in Guam, the USAPI, and the Pacific region.

Global prevalence of preterm birth among Pacific Islanders: A systematic review and meta-analysis.

The epidemiology of preterm birth among Pacific Islanders is minimally understood. The purpose of this study was to estimate pooled prevalence of preterm birth among Pacific Islanders and to estimate their risk of preterm birth compared to White/European women. We searched MEDLINE, EMBASE, Web of Science Core Collection, Cochrane Library, CINAHL, Global Health, and two regional journals in March 2023. Observational studies were included if they reported preterm birth-related outcomes among Pacific Islanders. Random-effects models were used to estimate the pooled prevalence of preterm birth with 95% confidence interval (CI). Bayes meta-analysis was conducted to estimate pooled odds ratios (OR) with 95% highest posterior density intervals (HPDI). The Joanna Briggs Institute checklists were used for risk of bias assessment. We estimated preterm birth prevalence among Pacific Islanders in the United States (US, 11.8%, sample size [SS] = 209,930, 95% CI 10.8%-12.8%), the US-Affiliated Pacific Islands (USAPI, SS = 29,036, 6.7%, 95% CI 4.9%-9.0%), New Zealand (SS = 252,162, 7.7%, 95% CI 7.1%-8.3%), Australia (SS = 20,225, 6.1%, 95% CI 4.2%-8.7%), and Papua New Guinea (SS = 2,647, 7.0%, 95% CI 5.6%-8.8%). Pacific Islanders resident in the US were more likely to experience preterm birth compared to White women (OR = 1.45, 95% HPDI 1.32-1.58), but in New Zealand their risk was similar (OR = 1.00, 95% HPDI 0.83-1.16) to European women. Existing literature indicates that Pacific Islanders in the US had a higher prevalence of preterm birth and experienced health inequities. Learning from New Zealand's culturally-sensitive approach to health care provision may provide a starting point for addressing disparities. The limited number of studies identified may contribute to higher risk of bias and the heterogeneity in our estimates; more data is needed to understand the true burden of preterm birth in the Pacific region.

Strategies to Operationalize Health Equity in Island Area Health Departments.

Strategies to Operationalize Health Equity in Island Area Health Departments.

Preterm birth among Pacific Islanders in the United States and the US-affiliated Pacific Islands: A systematic review and meta-analysis.

To better understand the epidemiology of preterm birth among Pacific Islanders in the United States and the US-Affiliated Pacific Islands. Systematic searches of MEDLINE, Embase, CINAHL, PsycINFO, two nonindexed regional journals, and gray literature were conducted and finalized in September 2021. Observational studies published since January 2010 that documented preterm birth outcomes among Pacific Islanders in the United States and the US-Affiliated Pacific Islands were eligible for inclusion. Outcomes of interest included preterm birth prevalence, risk compared with white women, and risk factors for preterm birth among Pacific Islanders. Fourteen of the 3183 screened articles were included in meta-analyses. Random-effects models were used for pooled estimates with 95% confidence intervals. The pooled prevalence of preterm birth among Pacific Islanders was 11.2%, 95% CI: 9.3%-13.6%. Marshallese women had the highest pooled prevalence (20.7%, 95% CI 18.6%-23.0%) among Pacific Islander subgroups. Compared with white women, Pacific Islander women had higher odds of experiencing preterm birth (OR=1.40, 95% CI: 1.28-1.53). Four risk factors for preterm birth could be explored with the data available: hypertension, diabetes, smoking, and pre-pregnancy body mass index; hypertension and diabetes significantly increased the odds of preterm birth. Existing literature suggests that United States Pacific Islanders were more likely to experience preterm birth than white women, although the pooled prevalence varied by Pacific Islander subgroup. Data support the need for disaggregation of Pacific Islanders in future research and argue for examination of subgroup-specific outcomes to address perinatal health disparities.

Oral Cancer Disparities in the Outer US-affiliated Pacific Islands.

Oral cancers in the US-affiliated Pacific Islands are poorly described despite disproportionately higher incidences in certain jurisdictions. This study attempts to better characterize the incidence, staging, and management of oral cancers in this region. Retrospective Epidemiological Study. A retrospective review was conducted across the US-affiliated Pacific Islands between 2007 and 2019. Patient data were obtained for individuals with primary head and neck cancers from the Pacific Regional Central Cancer Registry database. All cohorts were age-adjusted to the 2000 US Standard Population. Further analysis was performed on oral cavity cancers due to their clear predominance within the sample. A total of 585 patients with primary head and neck cancers were included. The average age was 54.5 ± 12.9 years, and most patients were male (76.8%). Oral cancer subsite analysis revealed the proportional incidence of buccal mucosa was higher in 5 of 9 jurisdictions when compared with the United States (p < 0.001). Tongue and lip cancers were not found to have significantly higher incidence proportions. Patients in the Pacific Islander group were less likely to be detected at earlier stages for cancers of the cheek and other mouth (p < 0.001), tongue (p < 0.001), and lips (p < 0.001) compared with the United States. Many Pacific Island populations are burdened with higher incidences of oral cancer with later staging. Further investigation is recommended to evaluate oral cancer-related outcomes and mortality in this region. 3 Laryngoscope, 133:1899-1905, 2023.

Pacific Islands Cohort on Cardiometabolic Health Study: rationale and design

BackgroundPacific Islanders, including those residing in the US Affiliated Pacific Islands (USAPI), experience some of the highest mortality rates resulting from non-communicable diseases (NCDs) worldwide. The Pacific Island Health Officers’ Association declared a Regional State of Health Emergency in 2010 due to the epidemic of NCDs in the USAPI. Obesity, a known risk factor for NCDs, has become an epidemic among both children and adults in Micronesia and other parts of the USAPI. There is some recent information about overweight and obesity (OWOB) among young children in the USAPI, but there is no data looking at the relationship between children and their biological parents. The Pacific Islands Cohort on Cardiometabolic Health (PICCAH) Study aims to collect data on NCD lifestyle factors from two generations of families (n = 600 child-parent dyads or 1,200 participants) living in Guam, Pohnpei, and Palau.MethodsThe PICCAH Study is an epidemiological study using community-based convenience sampling to recruit participants in USAPI of Guam, Palau, and Pohnpei. The goal is to recruit participant dyads consisting of 1 child plus their biological parent in Guam (500 dyads or 1,000 participants), Pohnpei (50 dyads or 100 participants), and Palau (50 dyads or 100 participants). All participants are having the following information collected: demographic, health, and lifestyle information; anthropometry; diet; physical activity; sleep; acanthosis nigricans; blood pressure; and serum levels of fasting plasma glucose, fasting insulin, glycated hemoglobin, total cholesterol, triglycerides, LDL, and HDL.DiscussionThe PICCAH Study is designed to establish the baseline of a generational epidemiologic cohort with an emphasis on cardiometabolic risk, and to better understand the extent of DM and CVD conditions and related risk factors of those living in the USAPI jurisdictions of Guam, Pohnpei, and Palau. This study also serves to further build research capacity in the underserved USAPI Region.

Consumption of Traditional Fruits and Vegetables among Children in the US-Affiliated Pacific Region

ABSTRACTBackgroundTraditional Pacific diets have many health benefits, including maintenance of a healthy weight and prevention of various diseases. Few studies have evaluated the frequency at which traditional diets are consumed in the Pacific, especially among children.ObjectivesThis study examined the frequency of traditional and acculturated fruit and vegetable (F&V) intake among children in the US-affiliated Pacific (USAP) region.MethodsDiet records of 3319 children ages 2 to 8 y old were analyzed for frequency of traditional or acculturated F&V intake within USAP jurisdictions of American Samoa, Commonwealth of the Northern Mariana Islands (CNMI), Federated States of Micronesia (FSM; FSM island states include Chuuk, Kosrae, Pohnpei, and Yap), Guam, Hawaii, Republic of the Marshall Islands (RMI), and Republic of Palau.ResultsOf the 95,304 food items recorded among participating children in the USAP jurisdictions, 15.2% were F&Vs. Of the 10 jurisdictions, children in the islands of Chuuk, Kosrae, Yap, and Pohnpei recorded the highest frequencies of traditional F&V intake relative to their total F&V intake (67.8%, 64.8%, 56.7%, and 52.5%, respectively). American Samoa and RMI recorded moderate frequency of traditional F&V intake (38.9% and 46.4%, respectively), whereas children in Hawaii, Guam, and CNMI recorded the lowest frequencies of traditional F&V intake relative to their total F&V intake (10.4%, 12.4%, and 15.3%, respectively). Children in Hawaii, Guam, Palau, and CNMI recorded high frequencies of acculturated F&V intake (37.8%, 31.2%, 34.5%, and 27.9%, respectively).ConclusionsOverall, children in the USAP jurisdictions participating in this study recorded a low frequency of F&V intake. The differences in traditional F&V intake found between the USAP islands may be due to variation in economic income level and external influences on social and cultural norms among the island populations and variations of cost, accessibility, and convenience of each category of food to each island's population.

Accelerating Climate Change Adaptive Capacity Through Regional Sustained Assessment and Evaluation in Hawai‘i and the U.S. Affiliated Pacific Islands

As the impacts and risks from climate change increase, the climate assessment landscape has expanded in scope and application, resulting in the desire for more information relevant to local decision-making. Some regions lack detailed climate projections and a body of consensus findings about sector-specific impacts, and there is a need for actionable, culturally cognizant, translated climate information suitable for integration into operations and management, budgeting, funding proposals, and domestic and international policy. The Pacific Islands Regional Climate Assessment, or PIRCA, is the subject of this decade-long case study illustrating the need, development, and benefit of creating and sustaining a nuanced, collaborative, and deliberately inclusive climate assessment effort among researchers and practitioners in Hawai‘i and the US-Affiliated Pacific Islands (USAPI). Using external evaluations done in 2013 and 2021, and our observations as participants in the process, we describe regional adaptive capacity challenges—an important component of the decision context for PIRCA stakeholders—and analyze the role of the PIRCA network in accelerating climate adaptation. We also examine how regional and national assessments complement each other, and how assessment processes can aid in translation to sub-national decision making across the climate science-policy interface. Results reveal components of the PIRCA that are foundational to its effectiveness: framing climate information in human and decision-centric ways; use of inclusive and non-extractive methods; willingness to shift approaches to meet stakeholder objectives; leveraging the resources of the Pacific Regional Integrated Sciences and Assessments (RISA) and other boundary organizations; taking the time to build relationships; and creating a dedicated position to sustain collaborations and relationships within the region and at larger assessment scales. Our experience and the feedback received through the evaluation suggest that these lessons are transferable to other regions and scales, and that sustained and collaborative regional climate assessments can serve a key function in complementing major national and international assessments, by translating and more effectively targeting information to meet local needs in support of regional climate adaptation and policymaking.

Tuberculosis Among Native Hawaiian and Other Pacific Islander Persons: United States and U.S.-Affiliated Pacific Islands, 2010-2019.

Background:In recent years, tuberculosis (TB) incidence in the United States has declined overall but remained high among Native Hawaiian and Other Pacific Islander (NH/PI) persons. Few studies have examined the epidemiology of TB among NH/PI persons, particularly in the U.S.-Affiliated Pacific Islands (USAPI). We describe TB incidence and characteristics of NH/PI patients during 2010–2019.Methods:We used data from the National Tuberculosis Surveillance System to characterize TB cases reported among NH/PI persons born in the 50 U.S. states (defined to include District of Columbia) and the USAPI. We calculated annual TB incidence among NH/PI patients, stratified by place of birth (U.S. states or USAPI). Using Asian persons born outside the United States—persons historically grouped with NH/PI persons as one racial category—as the reference, we compared demographic, clinical, and socio-behavioral characteristics of NH/PI TB patients.Results:During 2010–2019, 4359 TB cases were reported among NH/PI patients born in the U.S. states (n=205) or the USAPI (n=4154). Median annual incidence per 100,000 persons was 6.5 cases (persons born in the U.S. states) and 150.7 cases (persons born in the USAPI). The proportion of TB patients aged <15 years was higher among NH/PI persons (U.S. states: 54%, USAPI: 24%) than among Asian persons born outside the United States (1%).Conclusions:TB incidence among NH/PI persons is high, particularly among persons born in the USAPI, emphasizing the need to enhance TB prevention strategies in these communities. Interventions should be tailored toward those who experience the highest risk, including NH/PI children and adolescents.

Description of novel microsatellite markers for the giant mud crab Scylla serrata (Forskål, 1775) (Decapoda: Brachyura: Portunidae), with an evaluation for applications in stock structure and parentage assignment

Abstract The giant mud crab, Scylla serrata (Forskål, 1775), is a targeted fishery along its geographic distribution, both for domestic and international markets. Population genetic data, evaluated with genetic markers such as microsatellites, can be used to identify management units (stocks) based on genetic dissimilarities between locations, informing localized management decisions for targeted fisheries. Additionally, microsatellite loci can be used to identify released individuals from stock enhancement programs, while simultaneously monitoring genetic impacts of hatchery-releases on wild populations. We isolated and characterized 16 novel microsatellite markers; fourteen of the markers were further evaluated for population structure among three localities in the US-Affiliated Pacific Islands: Palau, Pohnpei, and Kosrae. The significant genetic differentiation observed between Palau and Kosrae/Pohnpei suggests the newly described markers would be capable of elucidating structure across the broader scope of the geographic distribution of the species. Given the international trade for live mud crab, the evaluation of structure would highlight potential issues regarding the transport of live animals between locations with genetically differentiated stocks. Additionally, a multilocus exclusion probability of 0.999, with as few as three markers, suggests the novel microsatellite markers would be capable of identifying hatchery-sourced individuals as part of a stock enhancement program.

Brand inequity in access to COVID-19 vaccines

Brand inequity in access to COVID-19 vaccines

Evaluation of Sputum-Culture Results for Tuberculosis Patients in the United States-Affiliated Pacific Islands.

Sputum-culture confirmation guides tuberculosis (TB) diagnosis and patient management but has previously been reported to be low in the US-Affiliated Pacific Islands (USAPI). We evaluated factors associated with positive sputum-culture results by analyzing TB case surveillance and laboratory data, including sputa quality and quantity for diagnostic specimens from the USAPI. A lower proportion of sputum specimens were reported as culture positive from the USAPI (42%), compared with Hawaii (58%) and the United States (55%). Few (3%) sputa collected from TB patients in the USAPI had both optimal quality and quantity; 40% had optimal quality (mucoid), and 7% had optimal quantity (&gt;5 mL). Suboptimal sputum specimen quality and quantity contributed to fewer sputum-culture positive results in the USAPI. Improving sputum collection and handling might lead to more culture positive results and ultimately improve patient care and TB control in USAPI.