Self-Rated Health Status Comparing Pacific Islanders to Asians

Disease reporting for Asians/Pacific Islanders often conflicts and is, many cases, inaccurate because of the aggregation of Asians and Pacific Islanders. An analysis of 2005 Behavior Risk Factor Surveillance System data was performed to examine health status of Asians compared to Native Hawaiian or Other Pacific Islanders. Findings show a significant difference between Asians and Native Hawaiian or Other Pacific Islanders, with a greater likelihood for Native Hawaiians or Other Pacific Islanders to rate their health as poor. Conclusion: Asians and Native Hawaiians or Other Pacific Islanders do not have the same health status. By aggregating these two distinctly different populations, Native Hawaiians or Other Pacific Islanders are silenced. The aggregate disease reporting, which is limited and inaccurate, precludes advocacy efforts and the political power to intervene, and stifles the ability to create change and improvement for these populations

“It’s Always a Part of You”: The Connection Between Sacred Spaces and Indigenous/Aboriginal Health

Since colonization, Indigenous/Aboriginal Peoples (IAP) have fought for their inherent rights to follow their ways of life on their traditional territories. One continuing battle is the protection of sacred spaces. Sacred spaces are places recognized by IAP as deeply spiritually and powerful. Relationships to sacred spaces sustain spiritual connections integral to our concepts of holistic health/well-being and are vital for cultural integrity. Though all of the natural world is sacred to IAP, the particular cultural and spiritual significance of sacred spaces and impact on health merits attention. Drawing from qualitative research, this article investigates IAP’s perspectives and experiences regarding the connection between Indigenous/Aboriginal and sacred spaces, and we conclude that the desecration of sacred spaces has negative impacts on IAP’s health

Understanding disparities in clinical trials for Native Hawaiian men

Understanding low rates of participation by minority populations in clinical trials is critical for reducing and eliminating disparities. We examined beliefs and attitudes of Native Hawaiian men related to illness and cancer to better understand their rates of participation in clinical trials. We conducted face-to-face interviews with Native Hawaiian key informants throughout the State of Hawai‘i using quota sampling methods to obtain a range of perspectives about attitudes towards health care seeking to provide insight into low clinical trials participation. Interviews were audio-taped, transcribed, and independently coded by researchers. Thematic analysis guided the extraction of relevant data from the discussions. Key informants (N=16) suggested the following beliefs and attitudes regarding clinical trials participation: 1) mistrust in the healthcare system, 2) external locus of control, 3) gender norms, and 4) the customary pono (righteousness, to make right) practice towards family/community to model and maintain good health, including participation in cancer clinical trials. Native Hawaiian men in this study expressed hesitation in the benefits of formalized health care. Many men described experiences of racism, inequity, and injustice associated their interactions with health care providers. These encounters were factors that influenced their healthcare practices and beliefs towards maintaining health and longevity

Integrating Viral Hepatitis Screening and Prevention Services into an Urban Chemical Dependency Treatment Facility for American Indians and Alaska Natives

American Indian/Alaska Natives (AI/AN) patients at an urban residential chemical dependency treatment center participated in a viral hepatitis prevention project. Project activities integrated into patients’ treatment programs included viral hepatitis and human immunodeficiency virus (HIV) risk factor screening, education and counseling, laboratory testing, and hepatitis A and B vaccination. Of 928 AI/AN admissions, 585 (63%) completed risk factor screening assessment. Of these, 436 (75%) received at least one vaccination, viral hepatitis testing, or both. Of 322 patients tested, 91 (28%) were hepatitis C virus (HCV) antibody positive. Lack of pre-existing immunity to vaccine-preventable viral hepatitis infection was common: 132 (45%) were susceptible to hepatitis A and 224 (70%) were susceptible to hepatitis B infection. Chemical dependency treatment centers serving urban AI/AN provide important opportunities for implementing viral hepatitis prevention programs for high-risk populations and for improving ongoing efforts to reduce the disparate impact of chronic liver disease in AI/ AN people

Health Impact Assessment of the Proposed Moʻomomi Community-Based Subsistence Fishing Area

Hawai‘i State law provides pathways for island communities to apply for the designation of Community-Based Subsistence Fishing Areas (CBSFAs), allowing for comanagement of culturally significant and/or cologically vulnerable nearshore fisheries by the state and local communities. In the early 1990s residents of the Island of Moloka‘i expressed concern about Native Hawaiians’ rights to exercise traditional cultural fishing practices in nearshore environments. A task force report, commissioned in 1994 by then- Governor John Waihe‘e, recommended that the Mo‘omomi fishery area along the northwest coast of Moloka‘i serve as a demonstration area, in which fishing activities would be managed by the Ho‘olehua Homestead community primarily for subsistence rather than commercial use. The Hawai‘i State Legislature passed Hawai‘i Revised Statute §188-22.6 that same year, authorizing the Department of Land and Natural Resources (DLNR) to designate CBSFAs and implement management strategies “for the purpose of reaffirming and protecting fishing practices customarily and traditionally exercised for the purposes of [N]ative Hawaiian subsistence, culture, and religion.” Fish and other marine life are prominent staples of traditional Hawaiian diets, and overfishing, commercial harvesting methods, and a gradual movement away from the Hawaiian mahele system of sharing and other ancestral practices were identified as threats to community and cultural food security. Despite the passage of legislation more than 20 years ago, the proposed Mo‘omomi CBSFA remained a pilot project. Currently Hui Mālama O Mo‘omomi, a community organization based on Moloka‘i, is in the process of advancing a formal proposal to make traditional subsistence harvesting practices legally enforceable in the designated area of Moloka‘i’s north shore. This Health Impact Assessment seeks to provide information that will help evaluate the CBSFA proposal by taking into consideration potential effects of CBSFA status on community well-being. The authors also hope that the findings and recommendations of an HIA particular to the Mo‘omomi area may also prove relevant to CBSFA proposals from other regions of the state where such co-management strategies are being considered

Views on clinical trial recruitment, biospecimen collection, and cancer research: population science from landscapes of the Haudenosaunee (People of the Longhouse).

Biomedical research in culturally distinct communities is often a challenge. Potential barriers to participation occur because science is presented in a format that lacks cultural acknowledgement. Investigations may also fail to showcase beneficial relevance to the communities or include them in true partnership. The history of biomedical research within Native American societies has been complicated by these issues. Historical trauma among many Native groups sometimes transcends into contemporary challenges in both recruitment to and participation particularly in biobanking research. The participants for this study included members of the Haudenosaunee, the People of the Longhouse. Native Americans, including the Haudenosaunee, endure some of the worst health disparities in the country. These include high rates of cancer, obesity, and diabetes which may be linked at least partially to genetic predisposition. Results from a Haudenosaunee urban population shared response on ways to improve recruitment strategies for biospecimen, cancer, and other health-related clinical trials. Mixed methods approaches were used, and community responses indicated the importance of creating trust through respectful partnership; promoting culturally appropriate recruitment materials; the need for a greater understanding of consenting and signature processes; the necessity for concise summary sheets; and a desire to have information that community member understand. Discussion items also include international Indigenous perspectives to biobanking and genetic-related health disparity research

Adaptation of a Smoking Cessation and Prevention Website for Urban American Indian/Alaska Native Youth

Tobacco use among American Indian youth is a disproportionately significant problem. We adapted and modified an existing web-based and youth-focused tobacco control program to make it appropriate for young urban American Indian/Alaska Natives (AI/ANs). The results of the focus group indicate that AI/AN youth were very receptive to the use of a web-based Zine-style intervention tool. They wanted the look and feel of the website to be more oriented toward their cultural images. Future research should examine if successful programs for reducing non-ceremonial tobacco use among urban AI/AN youth can keep young irregular smokers from becoming adult smokers

A Comparative Analysis of Indigenous Research Guidelines to Inform Genomic Research in Indigenous Communities

BACKGROUND: Genetic research has potential benefits for improving health, such as identifying molecular characteristics of a disease, understanding disease prevalence and treatment, and developing treatments tailored to patients based on individual genetic characteristics of their disease. Indigenous people are often targeted for genetic research because genes are easier to study in communities that practice endogamy. Therefore, populations perceived to be more homogenous, such as Indigenous peoples, are ideal for genetic studies. While Indigenous communities remain the focal point of many genomic studies, some result in harm and unethical practice. Unfortunately, the harms of poorly formulated and unethical research involving Indigenous people have created barriers to participation that prevent critical and lifesaving research. These harms have led a number of Indigenous communities to develop guidelines for engaging with researchers to assist in safely bridging the gap between genetic research and Indigenous peoples. SPECIFIC AIMS: The specific aims of this study were: (1) to conduct an international review and comparison of Indigenous research guidelines that highlight topics regarding genetics and use of biological samples and identify commonalities and differences among ethical principles of concern to Indigenous peoples; and (2) develop policy recommendations for Indigenous populations interested in creating formal policies around the use of genetic information and protection of biological samples using data from specific aim 1. METHODS: A comparative analysis was performed to identify best research practices and recommendations for Indigenous groups from four countries: Canada, New Zealand, Australia, and the United States. The analysis examined commonalities in political relationships, which support self-determination among these Indigenous communities to control their data. Current international Indigenous guidelines were analyzed to review processes of how genetic research is conducted and the use of biological samples is handled with Indigenous peoples. RESULTS: Results suggest the need for genetic and genomic research policies for the world’s Indigenous people. Indigenous groups are most vulnerable to research exploitation and harm; therefore, identifying principles that work for Indigenous people will lead to best practices for all populations. CONCLUSIONS: Development and implementation of best practices informed by research guidelines in Canada, New Zealand, Australia, and the U.S. may be helpful to advise Indigenous leaders, policy makers, and researchers to the proper conduction of genetic research within Indigenous communities. Comparative analyses are a useful tool for identifying areas for further work in developing genetic research policy for Indigenous communities. OUTCOME: The outcomes of this analysis are relevant and useful to Indigenous communities and inform the development of community-based genetic research guidelines. The recommendations can be used in designing appropriate policies for future genomic research with Indigenous peoples

Liberating Data: Accessing Native Hawaiian and Other Pacific Islander Data from National Data Sets

Using data from the National Center for Health Statistics, an assessment was performed on the quality of death reporting in accordance with standards, a working definition was developed, death counts and rates for several racial categories were analyzed, and data was modeled for use in data structures optimized for analysis and reporting with simple client tools. Most states were still not compliant with the 1997 Office of Management and Budget racial categories by 2005. Comparing the mortality experience of NHOPI to whites revealed many differences. Mortality was higher in NHOPI males and occurred at younger ages for both males and females. The place of death differed between NHOPI and whites, while place of injury (where applicable) was similar. Causes also varied after the top two causes of death

A Nationwide Population-Based Study Identifying Health Disparities Between American Indians/Alaska Natives and the General Populations Living in Select Urban Counties

Objectives. Despite their increasing numbers, little is known about the health of American Indians/Alaska Natives living in urban areas. We examined the health status of American Indian/Alaska Native populations served by 34 federally funded urban Indian health organizations. Methods. We analyzed US census data and vital statistics data for the period 1990 to 2000. Results. Disparities were revealed in socioeconomic, maternal and child health, and mortality indicators between American Indians/Alaska Natives and the general populations in urban Indian health organization service areas and nationwide. American Indians/Alaska Natives were approximately twice as likely as these general populations to be poor, to be unemployed, and to not have a college degree. Similar differences were observed in births among mothers who received late or no prenatal care or consumed alcohol and in mortality attributed to sudden infant death syndrome, chronic liver disease, and alcohol consumption. Conclusions. We found health disparities between American Indians/Alaska Natives and the general populations living in selected urban areas and nationwide. Such disparities can be addressed through improvements in health care access, high-quality data collection, and policy initiatives designed to provide sufficient resources and a more unified vision of the health of urban American Indians/Alaska Natives