Health Disparities Investigator Development through a Team-Science Pilot Projects Program.

Profound health disparities are widespread among Native Hawaiians, other Pacific Islanders, and Filipinos in Hawai'i. Efforts to reduce and eliminate health disparities are limited by a shortage of investigators trained in addressing the genetic, socio economic, and environmental factors that contribute to disparities. In this conference proceedings report from the 2022 RCMI Consortium National Conference, we describe our mentoring program, with an emphasis on community-engaged research. Elements include our encouragement of a team-science, customized Pilot Projects Program (PPP), a Mentoring Bootcamp, and a mentoring support network. During 2017-2022, we received 102 PPP preproposals. Of these, 45 (48%) were invited to submit full proposals, and 22 (19%) were awarded (8 basic biomedical, 7 clinical, 7 behavioral). Eighty-three percent of awards were made to early-career faculty (31% ethnic minority, 72% women). These 22 awards generated 77 related publications; 84 new grants were submitted, of which 31 were awarded with a resultant return on investment of 5.9. From 5 to 11 investigators were supported by PPP awards each year. A robust usage of core services was observed. Our descriptive report (as part of a scientific conference session on RCMI specialized centers) focuses on a mentoring vehicle and shows how it can support early-stage investigators in pursuing careers in health disparities research.

Developing a culturally responsive dementia storybook with Native Hawaiian youth.

Similar to the nation's majority and racial/ethnic minority populations, Native Hawaiian families provide the bulk of care to loved ones with dementia. Limited research has focused on youth caregivers, who are largely invisible to the eldercare service system. This knowledge gap is especially critical for Native Hawaiians who place a high value on eldercare, often provided in multigenerational homes. To address this gap, we describe the process by which a university-community center developed a culturally responsive storybook on dementia targeted to Native Hawaiian youth. The development process honored community-based participatory research principles grounded in the cultural values and practices of Native Hawaiians, active collaboration of an advisory council, and face-to-face engagement with Native Hawaiian youth. Future directions are shared about culture-based programming and evaluation in dementia care that may be useful in work with other racial/ethnic youth and families.

Physical Activity and Health Among Native Hawaiian and other Pacific Islander Older Adults.

Objectives: Native Hawaiian and other Pacific Islander (NHPI) older adults often experience social disadvantages and poor health outcomes. Physical activity has been associated with better health in other racial groups, but limited studies have examined these associations in NHPI older adults. Methods: Using data from the 2014 Native Hawaiian and Pacific Islander National Health Interview Survey (n = 1,045), logistic regression models examined associations between physical activity and memory/psychological distress/self-rated health. Results: Sufficient levels of physical activity were associated with lower odds of memory problems, serious psychological distress, and poor/fair self-rated health. Unfortunately, only half of the sample reported sufficient physical activity and approximately 30% reported none. Also, 78% of the sample was estimated to be overweight/obese, and 29% had diabetes. Discussion: Culturally-appropriate interventions are recommended to increase physical activity in this population, which could also help reduce high rates of overweight/obesity and diabetes.

Examining Long-Term Service and Support Needs and Preferences of Native Hawaiian Elders: A Mixed-Method Approach.

Objective: The Native Hawaiian population experiences numerous disparities in health and income. Using a mixed-method research (MMR) design, we summarize findings from three phases of an MMR approach used to uncover kupuna (elder) long-term service and support (LTSS) needs and care preferences. Methods: Key informants in Hawaiian health were interviewed, secondary analyses of large state data sets were conducted, and kupuna and "ohana (family) caregivers were engaged in listening sessions. Results: Quantitative data confirmed numerous health disparities experienced by older Native Hawaiians, whereas qualitative data exposed their limited knowledge of this poor health profile and revealed their historical and contemporary experiences with discrimination in education, employment, and health care. Hawaiian culture was identified as a continued source of resilience in support of elders and family caregiving regardless of geographic setting. Discussion: We suggest three practice, policy, and research directions that offer the potential to respond to and improve kupuna health and service use.

The Research Centers in Minority Institutions (RCMI) Translational Research Network: Building and Sustaining Capacity for Multi-Site Basic Biomedical, Clinical and Behavioral Research.

The Research Centers in Minority Institutions (RCMI) program was established by the US Congress to support the development of biomedical research infrastructure at minority-serving institutions granting doctoral degrees in the health professions or in a health-related science. RCMI institutions also conduct research on diseases that disproportionately affect racial and ethnic minorities (ie, African Americans/Blacks, American Indians and Alaska Natives, Hispanics, Native Hawaiians and Other Pacific Islanders), those of low socioeconomic status, and rural persons. Quantitative metrics, including the numbers of doctoral science degrees granted to underrepresented students, NIH peer-reviewed research funding, peer-reviewed publications, and numbers of racial and ethnic minorities participating in sponsored research, demonstrate that RCMI grantee institutions have made substantial progress toward the intent of the Congressional legislation, as well as the NIH/NIMHD-linked goals of addressing workforce diversity and health disparities. Despite this progress, nationally, many challenges remain, including persistent disparities in research and career development awards to minority investigators. The continuing underrepresentation of minority investigators in NIH-sponsored research across multiple disease areas is of concern, in the face of unrelenting national health inequities. With the collaborative network support by the RCMI Translational Research Network (RTRN), the RCMI community is uniquely positioned to address these challenges through its community engagement and strategic partnerships with non-RCMI institutions. Funding agencies can play an important role by incentivizing such collaborations, and incorporating metrics for research funding that address underrepresented populations, workforce diversity and health equity.

Transnational Pacific Islanders: Implications for Social Work.

The Pacific Islander American racial group is smaller in terms of numbers relative to other racial groups and yet one of the fastest-growing in the United States. The complexity of their lives exceeds the implications of such small numbers, yet it reflects the contribution of their transnational ties and relationships in the Pacific and increasing multiple cultural identities as Pacific Islander Americans. Although this identity provides potential opportunities, challenges and struggles in navigating dual cultures and systems is a reality. Thus, commitment to culturally relevant social work practice with transnational Pacific Islander Americans is imperative. Social work practices that acknowledge and integrate indigenous ways of knowing and doing with consideration to the duality of their transnational identities will produce better outcomes. Emphasis on Pacific Islander cultural strengths is fundamental to generating positive health and mental health outcomes as these strengths have sustained Pacific Islanders through experiences of colonization, immigration, and historical trauma. This article discusses the multiple dimensions of the transnational experiences of Pacific Islander Americans and the implications for culturally relevant social work practice, policy, and research.

Insights in Public Health: Ke A'o Mau: Strengthening Cultural Competency in Interdisciplinary Education.

In order to successfully address social determinants of health and to achieve social justice for kanaka and all the people of Hawai'i, we must broaden our understanding of and approach to healing/health through interdisciplinary, culturally-informed education. Strengthening cultural competence within an Interprofessional Education framework, has potential in meeting important challenges in patient and population health, including meeting the increased demand for culturally trained professionals, increasing access to providers, and reducing health inequities in kanaka (Native Hawaiians). We present a model of course design and delivery, Ke A'o Mau (Learning Preserved), intended to provide haumana (students) with a unique body of culturally-anchored and community-based knowledge, skills and values that facilitate work with kanaka. Ke A'o Mau was implemented in the 2017-2018 academic year at University of Hawai'i (UH) at Manoa and optimized the authenticity of cultural learning through the engagement of kumu loea (expert teachers) to instruct in their area of expertise. Design and delivery of the course began with the understanding and honoring of kanaka worldviews, knowledge, and practices. Appraisal of haumana learning showed strong evaluative scores, of knowledge development, skills training, and instructional materials. This course not only seeks to resolve critical challenges in patient and population health but also provides a model to support the UH Manoa strategic priority of "striving to be a foremost indigenous-serving institution."

Leading by Success: Impact of a Clinical and Translational Research Infrastructure Program to Address Health Inequities.

Building research infrastructure capacity to address clinical and translational gaps has been a focus of funding agencies and foundations. Clinical and Translational Sciences Awards, Research Centers in Minority Institutions Infrastructure for Clinical and Translational Research (RCTR), and the Institutional Development Award Infrastructure for Clinical and Translational Research funded by the US government to fund clinical translational research programs have existed for over a decade to address racial and ethnic health disparities across the USA. While the impact on the nation's health cannot be made in a short period, assessment of a program's impact could be a litmus test to gauge its effectiveness at the institution and communities. We report the success of a Pilot Project Program in the University of Hawaii RCTR Award in advancing careers of emerging investigators and community collaborators. Our findings demonstrated that the investment has a far-reaching impact on engagement with community-based research collaborators, career advancement of health disparity investigators, and favorable impacts on health policy.

Native Hawaiian and Pacific Islander Elders: What Gerontologists Should Know.

Native Hawaiian and other Pacific Islanders (NHOPI) experience significant health disparities compared with other racial groups in the United States. Lower life expectancy has resulted in small proportions of elders in the population distribution of NHOPI, yet the number of NHOPI elders is growing. This article presents data on NHOPI elders and discusses possible reasons for continuing health disparities, including historical trauma, discrimination, changing lifestyle, and cultural values. We outline promising interventions with NHOPI and make suggestions for future research.

Listening to the voices of native Hawaiian elders and 'ohana caregivers: discussions on aging, health, and care preferences.

Native Hawaiians, the indigenous people of Hawai'i, are affected by varying social and health disparities that result in high prevalence of chronic disease, early onset of disability, and shorter life expectancy compared to other ethnic groups in Hawai'i. Six listening meetings were conducted, involving 41 community-dwelling kupuna (Native Hawaiian elders) and 'ohana (family) caregivers to investigate health and care preferences that offer the potential for improving well-being in later life for Native Hawaiian elders. As background, we provide three explanatory perspectives and theories­life course perspective, minority stress theory, and historical trauma­that guided the design of this study and provided the study's context. A number of overarching themes and subthemes were identified, some of which point to universal concerns with age and caregiving (such as challenges and costs associated with growing old and caregiving) and others that are culturally specific (such as influence of culture and social stressors, including discrimination, on health needs and care preferences). Results give further support to the urgency of affordable, accessible, and acceptable programs and policies that can respond to the growing health and care needs of native elders and family caregivers.

Research on indigenous elders: from positivistic to decolonizing methodologies.

Although indigenous peoples have lower life expectancies than the social majority populations in their countries, increasing numbers of indigenous people are living into old age. Research on indigenous elders is informed by a number of research traditions. Researchers have mined existing data sets to compare characteristics of indigenous populations with non-indigenous groups, and these findings have revealed significant disparities experienced by indigenous elders. Some investigators have attempted to validate standardized research tools for use in indigenous populations. Findings from these studies have furthered our knowledge about indigenous elders and have highlighted the ways in which tools may need to be adapted to better fit indigenous views of the constructs being measured. Qualitative approaches are popular, as they allow indigenous elders to tell their stories and challenge non-indigenous investigators to acknowledge values and worldviews different from their own. Recently, efforts have extended to participatory and decolonizing research methods, which aim to empower indigenous elders as researchers. Research approaches are discussed in light of the negative experiences many indigenous peoples have had with Eurocentric research. Acknowledgment of historical trauma, life-course perspectives, phenomenology, and critical gerontology should frame future research with, rather than on, indigenous elders.

Factors affecting healthy eating and physical activity behaviors among multiethnic blue- and white-collar workers: a case study of one healthcare institution.

Worksite health promotion programs can reduce prevalence of chronic disease among employees, but little research has been done to discern whether they meet the needs and incorporate the preferences of workers of different occupational types. The objective of this study is to examine differences in influences to healthy eating and physical activity and preferences for programs among multiethnic blue- and white-collar workers in Hawai'i. A total of 57 employees from a major health care corporation in Hawai'i participated. A mixed-methods approach was employed, in which findings from focus groups with white-collar workers (WCW) (n=18) were used to inform development of a questionnaire with closed and open-ended items for use with blue-collar workers (BCW) (n=39), whose jobs did not provide adequate time to participate in focus groups. Focus groups with WCW revealed that onsite availability of healthy food and fitness opportunities provided the most support for healthy eating and physical activity at work; work demands, easy access to unhealthy foods, and lack of onsite fitness opportunities were barriers; and lifestyle management was a topic of substantial interest. BCW cited the ability to bring home lunch and their (physically active) jobs as being supportive of healthy behaviors; not having enough time to eat and personal illness/injury were barriers; and chronic disease topics were of greatest interest. Knowing differences in influences to healthy eating and physical activity, as well as preferences for worksite wellness programming, among BCW and WCW, is important when planning and implementing worksite health promotion programs.

Building family capacity for Native Hawaiian women with breast cancer.

Native Hawaiian women have the highest breast cancer incidence and mortality rates when compared with other large ethnic groups in Hawai'i. Like other women, they rely on the support of their families as co-survivors. This project explored the feasibility and effects of a culturally tailored educational intervention designed to build family capacity by improving the knowledge and skills of the woman and her family in dealing with breast cancer, particularly in the latter stage of recovery care. Twenty-nine Native Hawaiian women with breast cancer, along with a close family member, were randomly assigned to the intervention (n = 15) or a wait-list control group (n = 14). The authors assessed the knowledge, self-efficacy, and coping skills of women and their family members and the recovery care behaviors of the women at baseline and at four months (after the intervention or control period). The intervention group made significant improvements in self-efficacy and coping; the wait-list control group did not. Evaluation of the intervention suggests that it was well received by participants. This work has relevance for social workers wanting to design and test culturally appropriate interventions for minority groups.

Why Are Native Hawaiians Underrepresented in Hawai'i's Older Adult Population? Exploring Social and Behavioral Factors of Longevity.

Native Hawaiians comprise 24.3% of Hawai'i's population, but only 12.6% of the state's older adults. Few published studies have compared health indicators across ethnicities for the state's older adult population or focused on disparities of Native Hawaiian elders. The current study examines data from two state surveillance programs, with attention to cause of death and social-behavioral factors relevant to elders. Findings reveal that Native Hawaiians have the largest years of productive life lost and the lowest life expectancy, when compared to the state's other major ethnic groups. Heart disease and cancer are leading causes of premature mortality. Native Hawaiian elders are more likely to report behavioral health risks such as smoking and obesity, live within/below 100-199% of the poverty level, and find cost a barrier to seeking care. Indicated is the need for affordable care across the lifespan and health services continuum. Future research might explain behavioral factors as influenced by social determinants, including historical trauma on Native Hawaiian longevity.

Caregiving and older Japanese adults: lessons learned from the periodical literature.

The United States is on the threshold of a substantial growth of older adults that increasingly reflects the cultural diversity inherent in this nation. Culture shapes the experience of aging and caregiving, and thus becomes an important factor when considering social services for older adults. One culturally distinct minority group--Japanese--is reputed to have one of the longest life expectancies in the US population, and, thus, information about their experiences may expand knowledge on aging and culture. A periodical literature review of older Japanese adults was undertaken to assess lessons learned about the association of aging and culture. Two important lessons that emerged emphasized the influence of cultural values on family caregiving, and women as caregivers. Implications for practice with this population are drawn and broad directions for the profession of social work are provided.

Adversity and resiliency in the lives of Native Hawaiian elders.

Native Hawaiians constitute 401,000 or 0.1 percent of the total U.S. population, with approximately 60 percent residing in the state of Hawai'i. In Hawai'i, Native Hawaiian elders (na kapuna) face a number of social and health disparities when compared with their non-Native Hawaiian counterparts: higher rates of poverty, greater disability rates, higher rates of specific life-threatening diseases, shorter life expectancies, and lower utilization rates of some services. Integrating life course literature and resiliency theory, the authors propose a model that provides a context from which to analyze and understand social and health disparities found among older Native Hawaiians. The authors introduce a historical timeline that identifies key cultural and historical markers in the lives of na kapuna and then link this timeline to health and social-health delivery strategies. This model offers a rationale for the development and implementation of culturally based solutions for na kapuna and underscores the need for social workers to intervene at the micro, meso, and macro levels to affect the well-being for this and other ethnic populations.