Invited Commentary: Mental health services utilization disparities at the intersection of Asian ethnoracial identity and limited English proficiency.

Nguyen et al. (Am J Epidemiol. 2024;XXX(XX):XXX-XXX) analyzed data from the U.S. National Survey of Drug Use and Health (NSDUH) to show that Asian American Native Hawaiian/Pacific Islander (AANHPI) adults with limited English proficiency have substantially lower levels of mental health services utilization compared with White adults without limited English proficiency. The findings add to the growing literature using an intersectionality framework to understand health and healthcare disparities. We comment on the authors' notable examination of intersecting minoritized identities in mental health services utilization and the welcome emphasis on AANHPI health. We discuss the limitations of the NSDUH data, which is administered in English and Spanish only, and its limited ability to support analyses disaggregated by ethnoracial subgroups. We conclude by identifying gaps related to funding, training, and data disaggregation, and highlight the role of mixed methods approaches to advance our understanding of intersectionality and health disparities research.

Prehospital Assaults Against Asian Americans, Native Hawaiians, and Pacific Islanders During COVID-19.

INTRODUCTION: Anti-Asian sentiment increased when the SARS-CoV-2 virus reached the United States in 2020. Trends in national assaults occurring during the COVID-19 pandemic in the Asian American, Native Hawaiian, and Pacific Islander (AANHPI) community were evaluated. METHODS: Patients treated for assaults by emergency medical services between January 2019 and December 2021 were extracted from ImageTrend Collaborate, a national database. Multivariable logistic regression models, adjusting for age, sex, and urbanicity, were used to compare assault rates overall and in the AANHPI population. RESULTS: There were 84,825 assaults (8.5% of injury incidents) in 2019; 96,314 (9.2%) in 2020; and 97,841 (8.4%) in 2021. Assaults against AANHPI increased from 870 (7.1 assaults per 100 injuries) to 987 (8.3) and 1150 (7.9) between 2019 and 2021, respectively. Compared to 2019, risk of assaults in 2020 in all races increased (OR 1.08; 1.07, 1.10) but decreased in 2021 (OR 0.97; 0.96, 0.98). However, among AANHPI, risk of assaults increased in both 2020 (OR 1.22; 1.10, 1.35) and 2021 (OR 1.13; 1.03, 1.25). Most AANHPI assault victims were between 25 and 34 y old (11.8% in 2019) with an increase in 2020 (15.6%) and 2021 (14.4%). Assaults against AANHPI with blunt and sharp objects increased annually from 2019 to 2021. CONCLUSIONS: Despite national decreases of assaults in 2021 to pre-COVID baseline, the rate of assaults treated by emergency medical services for the AANHPI population remained elevated. Further studies analyzing in-hospital assault trends will allow for better understanding and will quantify the impact the pandemic and surrounding social influences had on minorities across the United States.

Differences Among Native Hawaiian, Asian, and White Patients with Progressive Supranuclear Palsy.

BACKGROUND: Most studies of progressive supranuclear palsy (PSP) have been conducted in White populations. OBJECTIVE: The objective of this study was to identify whether differences exist for patients with PSP among Whites, East Asians (EAs), and Native Hawaiians/Pacific Islanders (NHPIs) in Hawaii. METHODS: We conducted a single-center, retrospective study of patients meeting Movement Disorder Society probable PSP criteria (2006-2021). Data variables included age of onset and diagnosis, comorbidities, and survival rate. Variables were compared across groups using Fisher's exact test, Kruskal-Wallis rank sum test, and log-rank tests. RESULTS: A total of 94 (59 EAs, 9 NHPIs, 16 Whites, and 10 Others) patients were identified. Mean age ± standard deviation (in years) of symptom onset/diagnosis were both youngest in NHPIs (64.0 ± 7.2/66.3 ± 8.0) followed by Whites (70.8 ± 7.6/73.9 ± 7.8), then EAs (75.9 ± 8.2/79.2 ± 8.3) (P < 0.001). Median survival from diagnosis was significantly lower (P < 0.05) in NHPIs (2 years) compared with EAs (4 years) and Whites (6 years). CONCLUSIONS: There may be racial disparities for PSP, and studies are needed to identify genetic, environmental, and socioeconomic contributions. © 2023 International Parkinson and Movement Disorder Society.

Disparities and Risk Factors for Surgical Complication in American Indians and Native Hawaiians.

INTRODUCTION: American Indian and Alaskan Natives (AIAN) and Native Hawaiian and Pacific Islanders (NHPI) research is limited, particularly in postoperative surgical outcomes. This study analyzes disparities in AIAN and NHPI surgical complications across all surgical types and identifies factors that contribute to postoperative complications. METHODS: This retrospective cohort study examined all surgeries from 2011 to 2020 in the National Surgical Quality Improvement Program, queried by race. Multivariable models analyzed the association of race and ethnicity and 30-day postoperative complication. Next, multivariable models were used to identify preoperative variables associated with postoperative complications, specifically in AIAN and NHPI patients. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were calculated. RESULTS: AIAN patients were associated with higher odds of postoperative complication (AOR: 1.008 [CI: 1.005-1.011], P < 0.001) compared to non-Hispanic white patients. The comorbidities that were of higher incidence in AIAN patients, which also adversely contributed to postoperative complication, included dependent functional status, diabetes, congestive heart failure (CHF), open wounds, preoperative weight loss, bleeding disorders, preoperative transfusion, sepsis, hypoalbuminemia, along with an active smoking status and ASA ≥3. In NHPI patients, dependent functional status, CHF, renal failure, preoperative transfusion, open wounds, and sepsis were of higher incidence and significantly contributed to postoperative complication. CONCLUSIONS: Surgical outcome disparities exist particularly in AIAN patients. Identification of modifiable patient risk factors may benefit perioperative care for AIAN and NHPI patients, which are historically understudied racial groups.

The Mental Health, Substance Use, Physical Health, and Mental Health Treatment Need of Community Individuals Experiencing Homelessness in Hawai'i.

Limited research has examined the mental health of individuals experiencing homelessness in Hawai'i, which bears the nation's second highest homelessness rate. Mental health, substance use, treatment need, and health data were collected from 162 unhoused individuals in Hawai'i County by visiting community locations where they congregate (e.g., beaches, vacant buildings). 77% of participants were Native Hawaiian/Pacific Islander (NH/PI) with participants demonstrating severe rates of mental and substance use disorders including 57% experiencing major depressive disorder (MDD), 56% experiencing generalized anxiety disorder (GAD), and 64%, 74%, and 12% experiencing alcohol, methamphetamine, and opioid use disorders, respectively-heightening overdose risk. Treatment need was high (62%) but health was poor (85% reporting fair/poor health), with MDD and GAD predicting reduced general health (p < 0.05). Study findings indicate Hawai'i unhoused individuals are disproportionately Indigenous NH/PI, enduring striking mental and physical health disparities that may be reduced by increasing access/utilization of community mental health programs/services.

Racial and ethnic disparities in readmission risk following the surgical management of endometrial cancer.

OBJECTIVE: Most women diagnosed with endometrial cancer undergo primary surgical management with hysterectomy. Although racial disparities in readmission risk following hysterectomy for non-cancerous conditions have been reported, data among women with endometrial cancer are absent. This study evaluates racial differences in readmission risk among women undergoing endometrial cancer-related hysterectomy. METHODS: In the National Cancer Database, women who underwent surgical management for endometrial cancer from 2004 to 2018 were identified. Readmission and minimally invasive hysterectomy (MIH) proportions were plotted according to year of diagnosis and race/ethnicity. Multivariable logistic regression models were used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for associations between readmission risk and epidemiological, facility, tumor, and surgical characteristics. A base model was sequentially adjusted to incorporate significant covariates. RESULTS: There were 350,631 patients included in the study. The proportion of MIH increased among all race/ethnicities over the study period; however, MIH rates were lower among Black women. Readmission proportions were 2.7% among White, 4.2% among Black, 2.9% among Hispanic, 2.4% among Asian, 2.1% among American Indian/Alaska Native, and 3.1% among Native Hawaiian/Pacific Islander women. In the fully adjusted model incorporating surgical approach, Black women (OR: 1.20, 95% CI = 1.13, 1.28) and Native Hawaiian/Pacific Islander women (OR: 1.54, 95% CI = 1.09, 2.18) were more commonly readmitted compared to White women. CONCLUSIONS: In this study, Black and Native Hawaiian/Pacific Islander women with endometrial cancer had significantly higher readmission risk than White women. Optimizing perioperative care for minority women is an essential component of overcoming racially disparate endometrial cancer outcomes.

Association of cultural affinity and island food consumption in the Pacific Islander health study.

Objectives: The dietary patterns of Pacific Islander Americans are partially influenced by a rich cultural heritage. There is little known about how cultural affinity affects the dietary choices of this small, but quickly growing population. This analysis attempts to understand how the association of cultural affinity on island foods consumption (IFC) varies by key demographic characteristics.Design: A sample of 240 Samoan and Tongan adults in California from the Pacific Islander Health Study (PIHS) was used. Psychometric properties of a novel 11-item cultural affinity scale were assessed. Univariate and bivariate analyses of the cultural affinity scale were completed to understand the distribution of cultural affinity score. Separate multivariable Poisson regression was used to assess the effect of interactions between cultural affinity and five key demographic factors on IFC.Results: Psychometric analysis of the PIHS cultural affinity scale revealed two unique factors. Significant interactions were found between cultural affinity and ethnicity and birthplace: the association between cultural affinity and IFC was larger among Samoans compared to Tongans and Samoan or Tongan birthplace was found to have a weaker association between cultural affinity and IFC. Interactions between cultural affinity and age, financial insecurity, and educational attainment were not significant.Conclusion: Understanding how cultural affinity varies in its effect on IFC is a part of understanding overall dietary patterns in this population.

Sociodemographic factors influencing island foods consumption in the Pacific Islander Health Study.

Objectives: Pacific Islander Americans are a small, but quickly growing population that experiences alarming disparities in obesity and obesity-related chronic illnesses influenced by dietary patterns. This population also has a unique culinary heritage including traditional foods and more contemporary imports such as tinned meats and refined carbohydrates. This analysis is a novel attempt to understand the sociodemographic factors influencing island foods consumption.Design: A sample of 240 Samoan and Tongan adults in California from the Pacific Islander Health Study was used. Following univariate and bivariate analyses, a series of four multivariable regression models were created to predict past week frequency of island foods consumption after sequential adjustment for demographic, socioeconomic, and cultural covariates.Results: Participants reported consuming island foods an average of 2.93 times in the previous week, with the largest proportion of participants (20.42%) reporting eating island foods 6 or more times. Age and Samoan ethnicity were initially significant, positive predictors of island foods consumption, but their effect was attenuated after addition of cultural covariates. With the third model that adjusted for birthplace, financial insecurity and Tongan birthplace were positive predictors. Both lost significance in the fourth and final model upon addition of cultural affinity, which was positively associated with island foods.Conclusion: Understanding how sociodemographic factors are associated with island foods consumption is a first step in understanding the broad way in which an ethnically specific dietary pattern may be associated with obesity-related chronic illness risk among Pacific Islander Americans.

Anti-Asian American, Native Hawaiian, and Pacific Islander Racism in Academic Pediatrics: Recommendations for Training, Research, and Clinical Practice.

This paper discusses how anti-Asian American, Native Hawaiian, and Pacific Islander (AANHPI) racism affects pediatric training, research, and clinical practice. Extant research shows that racism and discrimination are social determinants of health that impact AANHPI populations, including youth. AANHPI youth face significant health disparities and a wide range of barriers to health care access. However, AANHPIs tend to be seen by clinicians and depicted in training as monolithic, high achieving, and a relatively low priority in terms of pediatric workforce recruitment and training and pediatric research. After a brief discussion of US policies that have explicitly aimed to exclude, punish, or imprison AANHPIs, the paper explains AANHPI racism and its consequences. The paper then describes evidence of anti-AANHPI racism in pediatrics and offers recommendations for training, research, and clinical practice.

Ku Like Kakou: Utilizing a Community-led Model of Collaboration to Respond to the COVID-19 Pandemic.

The outbreak of COVID-19 in 2020 brought significant challenges for Native Hawaiians (NH), Pacific Islanders (PI), and other communities of color worldwide. Rapidly increasing rates of infection and transmission of the virus in Native Hawaiian and Pacific Islander (NHPI) communities and incomplete or unavailable data signaled to Hawai'i's leaders that advocacy and action needed to take place to minimize the impact of COVID-19. The Native Hawaiian and Pacific Islander Response, Recovery, and Resilience team (NHPI 3R Team) emerged from an effort to lead and fill gaps in response to COVID-19. Through the swift, intentional, and collaborative work of the team and its partners, NHPI communities and the entities that serve them were better equipped to navigate the pandemic, improve health outcomes, and contribute to a reduction in the number of infections, a rise in vaccination uptake, and an increase in NH and PI representation on various levels of government agencies. As the world shifts its focus from COVID-19 to broader health topics, the NHPI 3R Team will continue to serve as a hub for the exchange of resources and a model of community-led work that can be used to tackle issues like COVID-19 and beyond.

Risk factors of undiagnosed and uncontrolled hypertension in primary care patients with hypertension: a cross-sectional study.

BACKGROUND: Hypertension is a common heart condition in the United States (US) and severely impacts racial and ethnic minority populations. While the understanding of hypertension has grown considerably, there remain gaps in US healthcare research. Specifically, there is a lack of focus on undiagnosed and uncontrolled hypertension in primary care settings. AIM: The present study investigates factors associated with undiagnosed and uncontrolled hypertension in primary care patients with hypertension. The study also examines whether Black/African Americans are at higher odds of undiagnosed and uncontrolled hypertension compared to White patients. METHODS: A cross-sectional study was conducted using electronic health records (EHR) data from the University of Utah primary care health system. The study included for analysis 24,915 patients with hypertension who had a primary care visit from January 2020 to December 2020. Multivariate logistic regression assessed the odds of undiagnosed and uncontrolled hypertension. RESULTS: Among 24,915 patients with hypertension, 28.6% (n = 7,124) were undiagnosed and 37.4% (n = 9,319) were uncontrolled. Factors associated with higher odds of undiagnosed hypertension included age 18-44 (2.05 [1.90-2.21]), Hispanic/Latino ethnicity (1.13 [1.03-1.23]),  Medicaid (1.43 [1.29-1.58]) or self-pay  (1.32 [1.13-1.53]) insurance, CCI 1-2 (1.79 [1.67-1.92]), and LDL-c ≥ 190 mg/dl (3.05 [1.41-6.59]). For uncontrolled hypertension, risk factors included age 65+ (1.11 [1.08-1.34]), male (1.24 [1.17-1.31]), Native-Hawaiian/Pacific Islander (1.32 [1.05-1.62])  or Black/African American race (1.24 [1.11-1.57]) , and self-pay insurance (1.11 [1.03-1.22]). CONCLUSION: The results of this study suggest that undiagnosed and uncontrolled hypertension is prevalent in primary care. Critical risk factors for undiagnosed hypertension include younger age, Hispanic/Latino ethnicity, very high LDL-c, low comorbidity scores, and self-pay or medicaid insurance. For uncontrolled hypertension, geriatric populations, males, Native Hawaiian/Pacific Islanders, and Black/African Americans, continue to experience greater burdens than their counterparts. Substantial efforts are needed to strengthen hypertension diagnosis and to develop tailored hypertension management programs in primary care, focusing on these populations.

Racial and Ethnic Disparities in Cervical Insufficiency, Cervical Cerclage, and Preterm Birth.

Background: The frequency of cervical insufficiency differs among the major racial and ethnic groups, with limited data specific to Asian American and Native Hawaiian/Pacific Islander (AANHPI) subpopulations. We assessed cervical insufficiency diagnoses and related outcomes across 10 racial and ethnic groups, including disaggregated AANHPI subgroups, in a large population-based cohort. Study Design: We performed a retrospective cohort study of all singleton births between 20-42 weeks' gestation in California from 2007 to 2018. Logistic regression models were performed to estimate the odds of cervical insufficiency and, among people with cervical insufficiency, the odds of cerclage and preterm birth according to self-reported race and ethnicity. Results: Among 5,114,470 births, 38,605 (0.8%) had a diagnosis code for cervical insufficiency. Compared with non-Hispanic White people, non-Hispanic Black people had the highest odds of cervical insufficiency (adjusted odds ratio [aOR] 3.07; 95% confidence interval [CI], 2.97, 3.18), for cerclage placement and higher odds for preterm birth. Disaggregating AANHPI subgroups showed that Indian people had the highest odds (aOR 1.94; 95% CI, 1.82, 2.07) of cervical insufficiency and had significantly higher odds of cerclage without increased odds of preterm birth; Southeast Asian people had the highest odds of preterm birth. Conclusion: Within a large, diverse population-based cohort, non-Hispanic Black people experienced the highest rates of cervical insufficiency, and among those with cervical insufficiency, had among the highest rates of cerclage and preterm birth. Among AANHPI subgroups specifically, Indian people had the highest rates of cervical insufficiency and cerclage placement, without increased rates of preterm birth; Southeast Asian people had the highest rates of preterm birth, without increased rates of cerclage. Disaggregating AANHPI subgroups identifies important differences in obstetric risk factors and outcomes.

Assessing the Impact of COVID-19 on the Health of Native Hawaiian/Pacific Islander People in the United States, 2021.

OBJECTIVES: Minimal research has assessed COVID-19's unique impact on the Native Hawaiian/Pacific Islander (NH/PI) population-an Indigenous-colonized racial group with social and health disparities that increase their risk for COVID-19 morbidity and mortality. To address this gap, we explored the scope of COVID-19 outcomes, vaccination status, and health in diverse NH/PI communities. METHODS: NH/PI staff at partner organizations collected survey data from April through November 2021 from 319 community-dwelling NH/PI adults in 5 states with large NH/PI populations: Arkansas, California, Oregon, Utah, and Washington. Data were analyzed with descriptive statistics, Pearson χ2 tests, independent and paired t tests, and linear and logistic regression analyses. RESULTS: During the COVID-19 pandemic, 30% of survey participants had contracted COVID-19, 16% had a close family member who died of the disease, and 64% reported COVID-19 vaccine uptake. Thirty percent reported fair/poor health, 21% currently smoked cigarettes, and 58% reported obesity. Survey participants reported heightened COVID-19-related psychosocial distress (mean score = 4.9 on 10-point scale), which was more likely when health outcomes (general health, sleep, obesity) were poor or a family member had died of COVID-19. Logistic regression indicated that age, experiencing COVID-19 distress, and past-year use of influenza vaccines were associated with higher odds of COVID-19 vaccine uptake (1.06, 1.18, and 7.58 times, respectively). CONCLUSIONS: Our empirical findings highlight the acute and understudied negative impact of COVID-19 on NH/PI communities in the United States and suggest new avenues for improving NH/PI community health, vaccination, and recovery from COVID-19.

Severity, comorbidities, and adherence to therapy in Native Hawaiians/Pacific Islanders with obstructive sleep apnea.

STUDY OBJECTIVES: Considerable disparities in the prevalence, diagnosis, and management of obstructive sleep apnea (OSA) exist for minority groups in the United States. However, the impact of OSA on Native Hawaiian/Pacific Islanders (NHPIs) has not been evaluated. METHODS: We performed a retrospective review of patient records of NHPIs who underwent sleep apnea testing between 2014 and 2021 at a single center in Utah to characterize the distribution of comorbidities, disease severity, and treatment adherence. RESULTS: 140 of 141 NHPI patients who underwent sleep testing had OSA. High rates of obesity (94%) and other relevant comorbidities were found. OSA was mostly severe (57%), particularly in males with higher obesity. Adherence to continuous positive airway pressure was low (41% using for 4 or more hours on 70% of nights), and medical factors predicted whether adherence targets were met with modest accuracy (area under the curve 0.699). CONCLUSIONS: NHPIs at a single sleep center had a high prevalence of comorbidities in association with OSA, a skewed distribution toward severe disease suggestive of barriers to care or unique disease characteristics, and low adherence to continuous positive airway pressure. These findings suggest a high burden of OSA in this population, and further work to characterize barriers to identifying and treating OSA in NHPIs can improve chronic disease outcomes in NHPIs. CITATION: Locke BW, Sundar DJ, Ryujin D. Severity, comorbidities, and adherence to therapy in Native Hawaiians/Pacific Islanders with obstructive sleep apnea. J Clin Sleep Med. 2023;19(5):967-974.

Depression Symptoms, Perceived Stress, and Loneliness During the COVID-19 Pandemic Among Diverse US Racial-Ethnic Groups.

Introduction: Studies have reported increases in psychological distress during the COVID-19 pandemic. This study aimed to estimate associations between race-ethnicity and psychological distress during the COVID-19 pandemic among nationally representative samples of all major racial-ethnic groups in the United States. Methods: We conducted a nationally representative cross-sectional survey between December 2020 and February 2021 of Asian, black/African American, Latino (English and Spanish speaking), American Indian/Alaska Native, Native Hawaiian/Pacific Islander, white, and multiracial adults (n=5500). Distress measures included: anxiety-depression (Patient Health Questionnaire-4 [PHQ-4]), stress (modified Perceived Stress Scale), and loneliness-isolation (frequency felt lonely and isolated). Multinomial logistic regression models estimated associations between race-ethnicity and psychological distress, adjusting for demographic and health characteristics. Results: Overall, 23.7% reported moderate/severe anxiety-depression symptoms, 34.3% reported moderate/severe stress, and 21.3% reported feeling lonely-isolated fairly/very often. Compared with white adults and adjusting for covariates, the prevalence of moderate/severe anxiety-depression was significantly lower among Asian (adjusted odds ratio [aOR]=0.44, 95% confidence interval [CI]=0.34-0.58), black (aOR=0.49, 95% CI=0.38-0.63), English-speaking Latino (aOR=0.62, 95% CI=0.45-0.85), Spanish-speaking Latino (aOR=0.31, 95% CI=0.22-0.44), and Native Hawaiian/Pacific Islander (aOR=0.66, 95% CI=0.49-0.90) adults. Similar trends were seen for moderate/severe stress and feeling lonely-isolated fairly/very often. Worse distress profiles of American Indian/Alaska Native and multiracial adults were attenuated after adjustment. Conclusions: Minoritized groups tended to have less distress than white adults. Collective experiences of cumulative disadvantage could engender shared resiliency/normalization among these groups.

Next Gen Hawai'i: Collaborative COVID-19 Social Media Initiative to Engage Native Hawaiian, Other Pacific Islander, and Filipino Youth.

The Next Gen Hawai'i social media project was initiated in the fall of 2020 to address ongoing public health concerns and the need for accessible and reliable information across Hawai'i's diverse communities by strategically amplifying the voices of Hawai'i's youth in their Native languages. The collaborative effort arose from conversations within the Hawai'i's Native Hawaiian & Pacific Islander COVID-19 Response, Recovery, and Resilience Team, composed of diverse public and private organizations involved in statewide COVID-19 response efforts for Native Hawaiian and Pacific Islander communities. Next Gen Hawai'i's focus was on Native Hawaiian, Pacific Islander, Filipino, and other populations disproportionately suffering from COVID-19. Five social media platforms were developed to spread messaging to youth and young adults about COVID-19. Public Health Ambassadors (from high school to young adults) were recruited and engaged to create culturally and linguistically rooted messaging to promote public health and prevention-based social norms. This strength-based approach recognized youth as important community leaders and ambassadors for change and empowered them to create content for dissemination on platforms with national and global reach. Messaging was designed to build individual, community, and digital health literacy while integrating core cultural values and strengths of Native Hawaiian, Pacific Islander, and Filipino communities. Over 250 messages have been delivered across Next Gen Hawai'i social media channels on topics including vaccine information, mask-wearing, staying together over distances, mental health, and in-languages resources in Chuukese, Chamorro, Marshallese, Samoan, Hawaiian, Ilocano, Tagalog, and other Pacific-basin languages. Reach has included more than 75 000 views from various social media channels, media features, successful webinars, and relevant conference presentations. This Public Health Insights article provides an overview of Next Gen Hawai'i's activities and achievements as well as lessons learned for other youth-focused public health social media campaigns and organizations.

Health care utilization among women of reproductive age living in public housing: Associations across six public housing sites in San Francisco.

Housing is a key social determinant of health and health care utilization. Although stigmatized due to poor quality, public housing may provide stability and affordability needed for individuals to engage in health care utilization behaviors. For low-income women of reproductive age (15-44 y), this has implications for long-term reproductive health trajectories. In a sample of 5,075 women, we used electronic health records (EHR) data from 2006 to 2011 to assess outpatient and emergency department (ED) visits across six public housing sites in San Francisco, CA. Non-publicly housed counterparts were selected from census tracts surrounding public housing sites. Multivariable regression models adjusted for age and insurance status estimated incidence rate ratios (IRR) for outpatient visits (count) and odds ratios (OR) for ED visit (any/none). We obtained race/ethnicity-specific associations overall and by public housing site. Analyses were completed in December 2020. Public housing was consistently associated with health care utilization among the combined Asian, Alaskan Native/Native American, Native Hawaiian/Pacific Islander, and Other (AANHPI/Other) group. Public housing residents had fewer outpatient visits (IRR: 0.86; 95% Confidence Interval [CI]: 0.81, 0.93) and higher odds of an ED visit (OR: 1.81; 95% CI: 1.32, 2.48). Black women had higher odds of an ED visits (OR: 1.32; 95% CI: 1.07, 1.63), but this was driven by one public housing site (site-specific OR: 2.34; 95% CI: 1.12, 4.88). Variations by race/ethnicity and public housing site are integral to understanding patterns of health care utilization among women of reproductive age to potentially improve women's long-term health trajectories.

Racial/ethnic disparities in intent to obtain a COVID-19 vaccine: A nationally representative United States survey.

Black, Latino, Pacific Islander, and American Indian/Alaska Native adults are more likely than White adults to experience SARS-CoV-2-related infections, hospitalizations, and mortality. We assessed intent to be vaccinated and concerns among 7 U.S. racial/ethnic groups (1,000 Black/African American, 500 American Indian/Alaska Native, 1,000 Asian, 1,000 Latino (500 English- and 500 Spanish-speaking), 500 Pacific Islander, 500 multiracial, and 1,000 White adults) in a cross-sectional online survey conducted December 2020-February 2021, weighted to be nationally representative within groups. Intent to be vaccinated was ascertained with: "If a COVID-19 vaccine becomes available, how likely are you to get vaccinated?" (not at all/slightly/moderately/very/extremely likely). Respondents identified which concerns would keep them from being vaccinated: cost, not knowing where, safety, effectiveness, side-effects, and other. Multinomial logistic regression models assessed associations of race/ethnicity with odds of being extremely/very/moderately, slightly likely to be vaccinated (ref = not at all), controlling for demographics and health. Overall, 30% were extremely likely, 22% not at all likely, and 48% unsure. Compared to White respondents, American Indian/Alaska Native (Adjusted Odds Ratio (AOR) = 0.66, 95% CI, 0.47-0.92) and Black/African American (AOR = 0.54, 95% CI, 0.41-0.72) respondents were less likely, and Asian (AOR = 2.21, 95% CI, 1.61-3.02) and Spanish-speaking Latino respondents (AOR = 3.74, 95% CI, 2.51-5.55) were more likely to report being extremely likely to be vaccinated. Side-effects (52%) and safety (45%) were overriding concerns. Intent and vaccination rates are changing rapidly; these results constitute a comprehensive baseline for ongoing vaccination efforts among U.S. racial and ethnic groups.

Hawai'i's multiethnic adolescent and young adult survivors of childhood cancer: are their health behavior risks similar to state and national samples?

Due to toxicities associated with their malignancies and treatments, adolescent and young adult survivors of childhood cancer (AYASCC) are at high risk for developing chronic diseases. This can be compounded by a greater prevalence of unhealthy behaviors relative to similarly aged non-cancer peers. Disparities in health behaviors have been noted for Black and Hispanic AYASCC, but data on Asian American (AA) or Native Hawaiian and Other Pacific Islander (NHOPI) minorities are lacking. The purpose of this study was to help bridge these information gaps by gathering data from Hawai'i AA and NHOPI AYSCC. Telephone surveys were used to collect health behavior data from survivors 13-24 years of age (N=64); 55% of the sample was female, 77% AA or NHOPI, 63% leukemia/lymphoma survivors, and 32% overweight/obese. These were compared to state/national survey data for similarly aged individuals (Youth Risk Behavior Surveillance System data for 13-17 year olds, and Behavioral Risk Factor Surveillance System data for 18-24 year olds). While Hawai'i AYASCC had significantly lower rates of tobacco/alcohol use, a higher proportion did not eat five fruits/vegetables a day (96%) compared to state (83%) and national (78%) samples (P < .001). Although many met age-specific physical activity recommendations, 44% of <18 year olds and 29% of ≥18 year olds still failed to meet national guidelines. Low intake of fruits/vegetables and suboptimal levels of physical activity place these vulnerable, ethnic minority cancer survivors at higher risk for chronic disease. These findings underscore the need to assess and advise survivors about their diet and exercise habits as part of post-treatment care.