Sela V. Panapasa

Mortality Patterns of Native Hawaiians Across Their Lifespan: 1990–2000

OBJECTIVES We examined mortality patterns across the lifespan of Native Hawaiians and compared mortality disparities across races. METHODS We determined the age-specific and age-adjusted mortality rates of Native Hawaiians from 1990 to 2000 by using national census and vital registration data. RESULTS Among Native Hawaiians aged younger than 1 year, expected deaths were 15% lower than for Blacks and 50% higher than for Whites. Among older adults, Native Hawaiians had higher rates of mortality compared with the general population, particularly in 1990 and 1995. Crude death rates for Native Hawaiians were similar to those for Blacks in 1990 and 1995 but were 20% lower than those for Blacks by 2000. Crude death rates for Native Hawaiians were 30% higher than for Whites in 1990 and 1995 and more than 40% higher than for Whites in 2000. CONCLUSIONS Compared with Whites, Native Hawaiians and Blacks face similar challenges regarding infant and early-life mortality and increasing risks of mortality in mid-life and early old age. Our analyses document a need for renewed efforts to identify the determinants of ill health and commitment to address them.

Community-Based Participatory Research Approach to Evidence-Based Research: Lessons From the Pacific Islander American Health Study

Objectives: Reports on the challenges and lessons learned from the Pacific Island American Health Study engagement with community-based organizations (CBOs) and faith-based organizations (FBOs) in Pacific Islander (PI) communities and mechanisms to facilitate the collection of robust data. Methods: Academic–community partnership building was achieved with PI CBOs and FBOs. Focus group meetings were organized to plan various aspects of the study, develop questionnaire themes and protocols for survey, assist with the interviewer recruitment process, and strategize data dissemination plan. Lessons Learned: The PIA-HS represents a model for overcoming challenges in data collection among small understudied populations. FBOs represent a valuable resource for community-based participatory research (CBPR) data collection and for effective interventions. Conclusion: The study methodology can be replicated for other racial/ethnic groups with high levels of religiosity combined with concentrated levels of residential clustering. Expansion of the Pacific Islander American Health Study (PIA-HS) to include other PI subgroups is encouraged.

Disability Among Older Women and Men in Fiji: Concerns for the Future

SUMMARY This study examines the composition of elderly population at risk of disability and speculates the impact of disability on the quality of their lives and their longevity. Using census and survey data collected in Fiji, life table estimates of unimpaired life expectancy across time are presented for older people and the potential costs of disability, in terms of productive years of life lost. From a planning perspective, the study discusses medical and support services that may be needed to support older individuals in Fiji. The study also describes policy implications of the findings, focusing on the older women, and considers the implications for older women of other developing countries.

Improving Asian American, Native Hawaiian, and Pacific Islander health: national organizations leading community research initiatives.

Background: Functionally, many CBPR projects operate through a model of academic partners providing research expertise and community partners playing a supporting role. Objectives: To demonstrate how national umbrella organizations deeply rooted in communities, cognizant of community needs, and drawing on the insights and assets of community partners, can lead efforts to address health disparities affecting their constituents through research. Methods: Case studies of two Asian American, Native Hawaiian, and Pacific Islander national organizations Results: Strategically engaging a diverse range of partners and securing flexible funding mechanisms that support research were important facilitators. Main challenges included limited interest of local community organizations whose primary missions as service or health care providers may deprioritize research. Conclusions: Efforts to make research relevant to the work of community partners and to instill the value of research in community partners, as well as flexible funding mechanisms, may help to promote community-driven research.

Impacts of Long-Term Obesity on the Health Status of Samoan and Tongan Men in the United States: Results from the Pacific Islander Health Study.

OBJECTIVE To examine the impacts of long-standing obesity (BMIs ≥ 30.0 kg/m(2)) on health outcomes among Samoan and Tongan men (aged ≥ 18 years) in California using a life course perspective. DESIGN Cross-sectional analysis of 103 males from the Pacific Islander Health Study (PIHS), a probability sample modeled after the National Health Interview Survey (NHIS). SETTING Urban residential neighborhoods in San Mateo and Los Angeles counties using a multistage, cluster sample design. MAIN OUTCOME MEASURES BMI, diabetes, hypertension, total cholesterol, smoking, drinking, arthritis, gout and migraines. RESULTS Bivariate analysis shows high rates of poor health outcomes distributed throughout the obese and non-obese sample. Logistic analysis finds that being obese does not significantly increase observed negative health outcomes. After controlling for socio-demographic characteristics, the presence of obesity results in non-significant findings for hypertension (OR=1.02; CI: .21, 4.91), and high cholesterol (OR=.52; CI: .10, 2.73), while obesity significantly reduces the risk of diabetes by 60% (OR=.40; CI: .14, 1.17). When applying disease counts, obese men have a significantly lower risk of reporting multiple health conditions (OR=.72; CI: .52, 1.00). CONCLUSION Overall, the health of Samoan and Tongan males in California is uniformly poor and obesity alone does not significantly increase risks of poor health outcomes. Using a life course perspective, the analysis offers new insights on the basic health of this understudied population.

Abstract A2: The efficacy of administrative and large-scale databases for measuring cancer health disparities among micro-minorities: The case of native Hawaiians and Pacific Islanders

This study examines the effectiveness of administrative databases and national-level health surveys to increase our understanding of cancer health disparities among U.S. Pacific Islanders, a racially and ethnically diverse population that is medically underserved both in terms of screening and treatment. The study provides a systematic analysis of four data sources: 1) National Hospital Discharge Survey (NHDS), 2) Mortality Detail Files (MDF), 3) Surveillance, Epidemiology, and End Results (SEER) and 4) National Health Interview Survey (NHIS). These studies are examined to determine their efficacy in the statistical representation of Native Hawaiian and Pacific Islanders (NHPIs) in the United States. The paper presents a systematic and comparative evaluation of population coverage or sample attributes for each of the studies. The paper also evaluates the ability to obtain statistically robust measures of cancer incidence across select socioeconomic characteristics among the NHPIs in each study. The paper concludes with a summary of the strengths and limitations of these large-scale databases in advancing our understanding of cancer risks, prevalence, incidence, and mortality among NHPIs. Study findings will also examine the various ways that census data has been used in association with health data to provide detailed demographic, social, economic and geographic information on NHPIs. The strategic use of census data can allow us to in some ways overcome the lack of robust microdata on cancer patterns across NHPI subgroups and within geographic areas of specific concern for this population. The paper also discusses and evaluates some of the key barriers using administrative data and large-scale surveys to better understand cancer risks among NHPIs. Among these barriers, the lack of detailed information on NHPI subpopulations is particularly troublesome. While useful for establishing incidence, studies such as NHDS and MDFs continue to report only on Native Hawaiian, Samoan, and Guamanian/Chamorro subgroups and summarize the other NHPI populations in a residual other “Asian or Pacific Islander” category. In contrast, the SEER data base provides tremendous detail on NHPI subpopulations but does not attempt to estimate the annual population denominator estimates needed for the calculation of cancer rates. The paper concludes with a discussion of research methods and suggested approaches that may help overcome these kinds of data limitations and expand our understanding of cancer risks among this diverse and poorly understood population. Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A2.