Faculty Bibliography

Non-communicable diseases (NCD) have been identified as a health emergency in the US-associated Pacific Islands (USAPI).1 This assessment, funded by the National Institutes of Health, was conducted in the Republic of the Marshall Islands, Majuro Atoll and describes the burdens due to selected NCD (diabetes, heart disease, hypertension, stroke, chronic kidney disease); and assesses the system of service capacity and current activities for service delivery, data collection and reporting as well as identifying the issues that need to be addressed. Findings reveal that the risk factors of poor diet, lack of physical activity, and risky lifestyle behaviors are associated with overweight and obesity and subsequent NCD that are significant factors in the morbidity and mortality of the population. The leading causes of death include sepsis, cancer, diabetes-related deaths, pneumonia, and hypertension. Population-based survey for the RMI show that 62.5% of the adults are overweight or obese and the prevalence of diabetes stands at 19.6%. Other findings show significant gaps in the system of administrative, clinical, data, and support services to address these NCD. There is no policy and procedure manual for the hospital or public health diabetes clinics and there is little communication, coordination, or collaboration between the medical and public health staff. There is no functional data system that allows for the identification, registry, or tracking of patients with diabetes or other NCDs. Based on these findings, priority issues and problems to be addressed for the administrative, clinical, and data systems were identified.

Non-communicable diseases (NCD) have been identified as a health emergency in the US-affiliated Pacific Islands (USAPI).1 This assessment, funded by the National Institutes of Health, was conducted in the Republic of Palau and describes the burden due to selected NCD (diabetes, heart disease, hypertension, stroke, chronic kidney disease); and assesses the system of service capacity and current activities for service delivery, data collection, and reporting as well as identifying the issues that need to be addressed. There has been a 7.1% increase in the population between 2000 and 2010. Significant shifts in the age groups show declines among children and young adults under 34 years of age and increases among adult residents over 45 years of age. Findings reveal that the risk factors of poor diet, lack of physical activity, and lifestyle behaviors are associated with overweight and obesity and subsequent NCD that play a significant role in the morbidity and mortality of the population. The leading causes of death include heart disease and cancer. A 2003 community household survey was conducted and 22.4% of them reported a history of diabetes in the household. A survey among Ministry of Health employees showed that 44% of the men and 47% of the women were overweight and 46% of the men and 42% of the women were obese. Other findings show significant gaps in the system of administrative, clinical, and support services to address these NCD. Priority issues and needs for the administrative and clinical systems were identified.

Non-communicable diseases (NCD) have been recognized as a major health threat in the US-affiliated Pacific Islands (USAPI) and health officials declared it an emergency.1 In an effort to address this emergent pandemic, the Pacific Chronic Disease Council (PCDC) conducted an assessment in all six USAPI jurisdictions which include American Samoa, Commonwealth of the Northern Mariana Islands (CNMI), Federated States of Micronesia (FSM), Guam, the Republic of the Marshall Islands (RMI) and the Republic of Palau to assess the capacity of the administrative, clinical, support, and data systems to address the problems of NCD. Findings reveal significant gaps in addressing NCDs across all jurisdictions and the negative impact of lifestyle behaviors, overweight, and obesity on the morbidity and mortality of the population. In addition, stakeholders from each site identified and prioritized administrative and clinical systems of service needs.

Non-communicable diseases (NCD) have been identified as a health emergency in the US-affiliated Pacific Islands (USAPI). This assessment, funded by the National Institutes of Health, was conducted in the Federated States of Micronesia, State of Kosrae and describes the burdens due to NCDs, including diabetes, and assesses the system of service capacity and current activities for service delivery, data collection and reporting as well as identifying the issues that need to be addressed. There has been a 13.9% decline in the population between 2000 and 2010. Findings reveal that the risk factors of poor diet, lack of physical activity, and lifestyle behaviors lead to overweight and obesity and subsequent NCD that are a significant factor in the morbidity and mortality of the population. Leading causes of death were due to nutrition and metabolic diseases followed by diseases of the circulatory system. Data from selected community programs show that the prevalence of overweight and obese participants ranged between 82% and 95% and the rate of reported diabetes ranged from 13% to 14%. Other findings show significant gaps in the system of administrative, clinical, data, and support services to address these NCD. There is no functional data system that is able to identify, register, or track patients with diabetes. Priority administrative and clinical issues were identified that need to be addressed to begin to mitigate the burdens of NCDs among the residents of Kosrae State.

BACKGROUND: In 2005, approximately 26% of Micronesian women aged 40 or older in Hawai'i used mammography for breast cancer screening. We describe an 18-month project to increase screening participation in this population by tailoring educational materials and using a lay educator approach. COMMUNITY CONTEXT: New immigrants to Hawai'i are Marshallese from the Republic of the Marshall Islands and Chuukese, Pohnpeians, and Kosraeans from the Federated States of Micronesia. In Hawai'i, these 4 groups refer to themselves collectively as Micronesians, although each group has its own distinct culture and language. METHODS: From 2006 through 2007, we applied principles of community-based participatory research--trust building, joint assessment, cultural tailoring of materials, and skills transfer--to develop and track the reach of Micronesian women lay educators in implementing a cancer awareness program among Micronesian women living in Hawai'i. OUTCOME: Using our tailored in-language materials, 11 lay educators (5 Chuukese, 3 Marshallese, 2 Pohnpeians, and 1 Kosraean) provided one-on-one and small group in-language cancer information sessions to 567 Micronesian women (aged 18-75 years). Among the 202 women aged 40 or older eligible for mammography screening, 166 (82%) had never had a mammogram and were assisted to screening appointments. After 6 months, 146 (88%) of the 166 had received a mammogram, increasing compliance from 18% to 90%. Lay educators reported increases in their skills and their self-esteem and want to extend their skills to other health issues, including diabetes management and immunization. INTERPRETATION: Tailoring materials and using the lay educator model successfully increased participation in breast cancer screening. This model may work in other communities that aim to reduce disparities in access to cancer screening.

The Hawai'i Breast and Cervical Cancer Control Program (BCCCP) offers free mammograms and Pap smears to women who are uninsured or underinsured through a statewide provider network. Native Hawaiians, Pacific Islanders and Filipinas are priority populations for this program, and BCCCP providers are required through contract with the Hawai'i Department of Health to utilize half of their allotted mammograms and Pap smears for eligible women from these groups. To identify strategies for increasing use by these groups of mammographyand Pap smear screening services through BCCCP, we held focus groups with women who could potentially use BCCCP services, and we conducted key informant interviews with 9 of Hawai'i's 11 BCCCP providers and 9 non-BCCCP outreach workers serving these populations. Findings led to recommendations for promoting awareness of BCCCP and enhancing outreach to Native Hawaiian, Pacific Islander and Filipina communities in Hawai'i.

BACKGROUND: The prevalence of diabetes is unusually high among the indigenous peoples of Hawaii and the US-associated Pacific Islands. Although diabetes programs developed elsewhere have been tried in these Pacific Islander communities, they have not been sustained. Research suggests that program sustainability is enhanced by the presence of a champion, the fit of the program in an organization, and assistance from stakeholders. CONTEXT: In 1998, the Pacific Diabetes Today Resource Center, funded by the Centers for Disease Control and Prevention, applied a community-empowerment approach to diabetes programming, providing training and technical assistance to coalitions in 11 US-associated Pacific Islands communities. When funding ended in 2004, many of the diabetes programs continued. In 2008, we revisited the 11 communities to examine the vitality of their diabetes coalitions and factors that were known to sustain the programs. METHODS: We interviewed coalition representatives in each of the 11 communities about diabetes-related programming developed from 1999 through 2003 and factors influencing sustainability of diabetes-related activities. CONSEQUENCES: Coalitions that continued the diabetes programming they developed for or adapted to their communities had community leaders (or champions), found supportive organizational homes for the programs, and had assistance. Four case studies show how these factors affected successful coalitions. INTERPRETATION: Freedom to adapt programs to new cultural contexts was a key factor in sustaining diabetes programs in the region.

BACKGROUND: The type 2 diabetes epidemic is a global health issue, particularly in the US Associated Pacific Islands (USAPI). Population health approaches targeting policy development and environmental transformations can help prevent or delay diabetes and related complications. CONTEXT: Since 1986, the Centers for Disease Control and Prevention, Division of Diabetes Translation has provided financial support to 6 USAPI jurisdictions for diabetes prevention and control programs. Geographic isolation, shortages of health care professionals, dependence on US and international aid, and persistent health care funding challenges are constant concerns in these jurisdictions. METHODS: In September 2007, representatives from USAPI diabetes prevention and control programs, the Papa Ola Lokahi Pacific Diabetes Education Program, and the Division of Diabetes Translation met to collectively assess program goals within the Essential Public Health Services framework. Participants shared examples of integrated approaches to health promotion and diabetes prevention. CONSEQUENCES: Despite persistent health care funding challenges, the assessment showed the resourcefulness of the islands' diabetes programs in leveraging resources, creating policy and environmental interventions, and strengthening connections in the traditional cultural systems. INTERPRETATION: Population health approaches used in island jurisdictions reflect the resilience of the islands' cultures in navigating between traditional and Western ways of life. Attention to the interface of cultural knowledge and Western science provides the USAPI diabetes prevention and control programs with opportunities to create strong, sustained partnerships with the shared vision of transforming social and environmental conditions so that they can support healthy people living in healthy island communities.

OBJECTIVES: We examined receptivity to developing church-based cancer programs with Samoans. Cancer is a leading cause of death for Samoans, and investigators who have found spiritually linked beliefs about health and illness in this population have suggested the Samoan church as a good venue for health-related interventions. DESIGN: We interviewed 12 pastors and their wives, held focus groups with 66 Samoan church members, and engaged a panel of pastors to interpret data. All data collection was conducted in culturally appropriate ways. For example, interviews and meetings started and ended with prayer, recitation of ancestry, and an apology for using words usually not spoken in group setting (such as words for body parts), and focus groups were scheduled to last five hours, conferring value to the topic and allowing time to ensure that cancer concepts were understood (increasing the validity of the data collected). RESULTS: We found unfamiliarity with the benefits of timely cancer screening, but an eagerness to learn more. Church-based programs were welcome, if they incorporated fa'aSamoa (the Samoan way of life) -- including a strong belief in the spiritual, a hierarchical group orientation, the importance of relationships and obligations, and traditional Samoan lifestyle. This included training pastors to present cancer as a palagi (White man) illness versus a Samoan (spiritual) illness, about which nothing can be done, supporting respected laity to serve as role models for screening and witnesses to cancer survivorship, incorporating health messages into sermons, and sponsoring group education and screening events. CONCLUSION: Our findings inform programming, and our consumer-oriented process serves as a model for others working with minority churches to reduce cancer health disparities.

The people of the U.S.- Associated Pacific Islands (USAPI) suffer significant health disparities when compared with industrialized countries. One explanation for this is lack of an adequate supply of skilled healthcare workers. The current research examines the factors that current health professionals from the region describe as helping and hindering them in their pursuit of health careers, as well as the barriers seen by students, educators and health professionals. METHODS: Two separate interview studies were conducted with a convenience sample of individuals in the five USAPI jurisdictions in the Northern Pacific. The first study utilized the responses of 15 individuals regarding the barriers to the pursuit of health careers in order to develop a logic model map of the most common problems in the pursuit of health careers. The second study involved in-depth questions of 32 health professionals regarding barriers to and facilitation of health career training. Results were analyzed using constant comparative analysis. RESULTS: Interview results indicate that facilitators of students pursing health careers included having a family member working in healthcare, the desire to help people, available training opportunities and personal experiences. Facilitators of completion of training included family support, financial support, personal commitment and social support during school. Barriers to pursuit and completion of training included:limited academic preparation, exposure and guidance; family obligations, and other careers seen as being more desirable. DISCUSSION: Efforts to improve successful pursuit of health careers should start at the family level and must give a clear message to students that their goal is supported. Furthermore, there should be significant effort given to: improving the academic preparation provided for students, making career information available to students, and providing financial support, mentoring and guidance. Homesickness was a significant barrier that could be decreased by regional programs or a support system at locations with concentrated pockets of students from a given area.