Family history of later-onset breast cancer, breast healthy behavior and invasive breast cancer among postmenopausal women: a cohort study.

INTRODUCTION: A family history of later-onset breast cancer (FHLBC) may suggest multi-factorial inheritance of breast cancer risk, including unhealthy lifestyle behaviors that may be shared within families. We assessed whether adherence to lifestyle behaviors recommended for breast cancer prevention--including maintaining a healthful body weight, being physically active and limiting alcohol intake--modifies breast cancer risk attributed to FHLBC in postmenopausal women. METHODS: Breast cancer outcomes through August 2003 were analyzed in relationship to lifestyle and risk factors collected by questionnaire during enrollment (between 1993 and 1998) of 85,644 postmenopausal women into the Women's Health Initiative Observational Study. RESULTS: During a mean follow-up of 5.4 years, 1997 women were diagnosed with invasive breast cancer. The rate of invasive breast cancer among women with an FHLBC who participated in all three behaviors was 5.94 per 1,000 woman-years, compared with 6.97 per 1,000 woman-years among women who participated in none of the behaviors. The rate among women with no FHLBC who participated in all three behavioral conditions was 3.51 per 1,000 woman-years compared to 4.67 per 1,000 woman-years for those who participated in none. We did not observe a clinically important departure from additive effects (Interaction Contrast: 0.00014; 95% CI: -0.00359, 0.00388). CONCLUSIONS: Participating in breast healthy behaviours was beneficial to postmenopausal women and the degree of this benefit was the same for women with and without an FHLBC.

Translational leadership: new approaches to team development.

INTRODUCTION: Little is known about how to develop collaborative multidisciplinary research teams. METHODS: Following a comprehensive needs assessment, we developed a curriculum-based, multi-disciplinary, didactic and experiential Translational Leadership training program grounded in adult learning theory. In addition, we constructed collaborative clinical/translational research experiences for trainees to enhance clinical/translational research skills. KEY PROGRAMMATIC ELEMENTS AND PRELIMINARY FINDINGS: This 15-week Translational Leadership program was generated based on the following premises. Academic translational leadership teams should partner and collaborate, customize, make the program relevant to the culture, create a common language, use the best resources, and establish measurable goals for success. Development of effective collaborative research teams is essential to the management of successful translational research teams. Development of these skills in addition to cultural humility will provide the best infrastructure and human capital committed to the resolution of health disparities. Effective translational research teams are more comfortable with the component team members and the communities where they implement their protocols. Our participants highly valued the diverse experiences from this program; several have succeeded in leading community-based research teams. CONCLUSIONS: Our Translational Leadership program offers essential skills using adult learning theory for translational researchers who become capable of leading and participating in translational research teams. We believe including community members in the training of translational research programs is an important asset. The multidisciplinary approach develops skills that are also of significant use to the community and its acceptance of responsibility for its own health.

Changes in antidepressant medications prescribing trends in children and adolescents in Hawai'i following the FDA black box warning.

OBJECTIVES: To study prescribing trends for antidepressants in Hawai'i following the FDA black box warning regarding the possible risk of suicide in children and adolescents. We also explored relationships between changes in prescribing trends and patient and provider characteristics. STUDY DESIGN: Analysis of an existing insurance data set of prescriptions to children and adolescents within the State of Hawai'i. STUDY POPULATION: Children and adolescents under 18-years-old insured through the largest (>60%) third-party insurance company in the state. RESULTS: Our results showed variations in changes in prescribing trends for different selective serotonin reuptake inhibitors (SSRIs) following the FDA black box warning. SSRIs with more evidence-based research supporting their safety and efficacy were least affected as were those that were less implicated by the FDA analysis of the possible link between SSRIs and Suicidality. Trends were apparent for all age groups examined and for both females and males. CONCLUSIONS: Changes in prescribing patterns of psychiatric medications for children and adolescents in Hawai'i were identified. Differing patterns have evolved since 2003 following the series of concerns raised regarding SSRIs and suicidality in children and adolescents.

Novel polymorphisms of the amyloid precursor protein (APP) gene in Chinese/Taiwanese patients with Alzheimer's disease.

We aimed to determine if the amyloid precursor protein (APP) gene polymorphism is present in Chinese/Taiwanese patients with Alzheimer's disease (AD). This is a 3-year prospective assessment of the genotypes of the APP gene among Chinese/Taiwanese patients with AD. The sample consisted of 50 AD patients and 50 unaffected controls. Participants were recruited from the practices of the authors. Controls were comprised of 45 unrelated healthy subjects and 5 unaffected family members of AD patients. Data were collected in a university-based research unit of a tertiary medical center. Sequencing of the APP gene from exon 15 to exon 18 was performed on the peripheral blood of the patients and the unaffected controls after their informed consent was obtained. Among 50 AD subjects, 11 (7 men, 4 women) had APP gene polymorphisms. Mean age of onset was 72 years (range 65-82 years). Polymorphism of APP gene with A to C substitution at nucleotide position (nt) 284490 (A284490C) was found in 8 AD patients, at nt 284493 (A284493C) in 5, T284497C in 3 patients, and T284500C in 1 patient. These single nucleotide substitutions of the APP gene corresponded to the amino acid substitutions I718L, L720S, and V710G. These polymorphisms were not found in the unaffected controls. The mutations were confirmed by StyI restriction enzyme digestion assay using the subclone from polymerase chain reaction (PCR) products of the mutated APP gene. Thus, APP gene polymorphisms at codon 718 (I>L), 720 (L>S), and 710 (V>G) can be found in certain Chinese/Taiwanese patients with Alzheimer's disease.

Prevalence of breastfeeding among a multiethnic population in Hawaii.

INTRODUCTION: The purpose of this study, conducted in a multiethnic population in Hawaii, was to estimate the prevalence of breastfeeding at six months of age, exclusive and otherwise, as well as to identify positively and negatively associated factors. METHODS: A content-valid survey was conducted among a random stratified sample, and a printed questionnaire was sent to mothers of infants aged 7-10 months. A response rate of 70% yielded 701 completed surveys. RESULTS: At six months after birth, some breastfeeding was practiced by 54% of respondents. The rate of exclusive breastfeeding was approximately 16% at six months. Race and ethnicity assessment showed that Whites had the highest rates and Filipinos the lowest. Formula use in the hospital was most significantly associated with lower breastfeeding rates at six months. CONCLUSIONS: Exclusive breastfeeding for six months, even in a state with extremely high initiation rates, is seldom achieved. Formula use in the maternity units should be reduced, and intensive targeted study and education of the Filipino community should be undertaken.

The Relationship of 5-Aminolevulinic Acid on Mood and Coping Ability in Prediabetic Middle Aged and Older Adults.

In 2010, approximately 79 million Americans had prediabetes and about 50 percent of those individuals were 65 years and older. The most effective diabetes prevention method in prediabetic adults is lifestyle modification. However, despite the benefits of lifestyle change, diabetes prevalence continues to increase. Maintaining a regular exercise routine and a healthy eating plan may be difficult because of the negative emotional barriers (i.e., stress, mood) that a prediabetic individual faces. This is particularly evident in older individuals when you combine that with decreases in mobility and geriatric syndromes. A potential treatment for these emotional barriers is a natural supplement called 5-aminolevulinic acid (5-ALA). In the current study, the group included 154 participants, both men and women, ranging between the ages of 41 to 71 years old. The study design was a double-blind, randomized parallel-group study. The Psychosocial Depressive Symptoms Questionnaire (PDS) and the Perceived Stress Scale (PSS) were used to examine the effect of two doses of 5-ALA (15 mg and 50 mg) on various components of mood (i.e., hopefulness, loneliness, and motivation) and coping ability. Using SAS software, an ordered logistic regression model was used to analyze the association between the dose groups (control, 15 mg, and 50 mg) and the responses to the two questionnaires, the PDS and PSS, used in this study. An integrative literature review, using the PubMed database, searched for studies on the relationship between 5-ALA administration and mood and coping ability. Our literature review resulted in zero published articles. Next, we found that the intake of 5-ALA was significantly associated with improved coping ability (p = 0.004) and improved self-perception of effort spent (p = 0.002). Finally, we found a significant dose-dependent relationship for the association of 5-ALA intake on measures of effort (p = 0.003), loneliness (p = 0.006), and coping ability (p = 0.003). The 50 mg dose was more effective than the 15 mg dose in improving these measures. In conclusion, after 12 weeks of taking 5-ALA, we found significant improvements in self-perception of effort spent, loneliness, and coping ability in prediabetic middle age and older adults. Improved mood and coping ability may allow prediabetic individuals to overcome the emotional obstacles preventing them from maintaining a healthy lifestyle and ultimately, help them to avoid the development of diabetes.

Self identity through Ho'oponopono as adjunctive therapy for hypertension management.

OBJECTIVE: Self Identity through Ho'oponopono is a step-by-step problem-solving approach to identify and relieve stress. The objective of this study was to determine if Self Identity through Ho'oponopono along with standard medical therapy might better control hypertension than standard therapy alone. DESIGN, SETTING, PARTICIPANTS: Twenty-three Asian, Hawaiian, and other Pacific Islanders from a local community in Hawaii participated in a longitudinal design comparing pre- and post-intervention measures of blood pressure. INTERVENTION: Participants attended a half-day class on Self Identity through Ho'oponopono to learn ways to create balance and correct stress through an understanding of their own self identity. Participants learned processes to care for themselves through repentance, forgiveness, and transmutation and how to apply the processes in their daily lives. MAIN OUTCOME MEASURES: Repeated blood pressure measurements were compared before and after the intervention using generalized estimating equations; two spirituality questionnaires were administered before and after the intervention and analyzed with paired RESULTS: Systolic blood pressure decreased after the intervention, averaging 11.86 mm Hg below pre-intervention levels. Diastolic blood pressure decreased by 5.44 mm Hg. Spirituality scores significantly increased after the intervention. CONCLUSIONS: Self Identity through Ho'oponopono was associated with a statistically and clinically significant reduction in mean blood pressure. Spirituality scores increased after the intervention. We conclude that Self Identity through Ho'oponopono may be an effective adjunctive therapy for hypertension. Further research is needed to validate these preliminary findings.

Music and cancer pain management.

PROBLEM: When coupled with the often debilitating side-effects of pharmacological interventions, chronic cancer pain may elicit feelings of anxiety and depression and therefore adversely affect patient well-being and quality of life. PURPOSE: This review article is a systematic assessment of the published literature related to music and cancer pain management. METHOD: A comprehensive systematic evaluation of the data based literature was undertaken and analyzed using matrix analysis. RESULTS: As an adjunctive form of pain management, music therapy has been shown to address some of these hardships by providing patients with an alternative effective means by which to reduce their subjective experiences of pain. Studies investigating the efficacy of music therapy during invasive cancer procedures and chemotherapy demonstrated the role that attention states play in distracting patients from, and therefore minimizing their experience of, the pain associated with such treatments. Other studies examining diverse outpatient populations revealed similar findings, illustrating well the cognitive-affective dimensions of pain perception. Although these findings fail to adequately address the ambiguity surrounding music therapy's role in cancer pain management, music therapy has nonetheless been shown to significantly reduce anxiety and, in so doing, indirectly lessen the intensity of pain while improving patient quality of life.

Traumatic brain injury: outcomes from rural and urban locations over a 5-year period (Part 1).

The national death rates from rural trauma are disproportionately higher compared to urban areas. Traumatic brain injury is a major cause of hospital admissions in Hawai'i. This is the first in a two part series to explore this significant public health concern. Data on traumatic brain injuries from 2000-2004 was obtained from 2 sources. Male gender, alcohol use, and lack of protective devices resulted in higher rates of injury. Rates of severe injury were higher in young adults, the elderly, and in rural locations, but rural mortality rates here did not differ compared to urban settings. The greatest potential to reduce morbidity and mortality resides in the formulation and implementation of preventive strategies.

Anti-tumor effects of herbal medicines on endometrial carcinomas via estrogen receptor-alpha-related mechanism.

This study was performed to examine the relationship between the anti-tumor effects of herbal medicine and endometrial carcinoma with ER-related mechanisms. An endometrial cancer cell line (Ishikawa) was used for this study. The cell viability and expression of estrogen receptors (ER) were determined by MTT and RT-PCR. A dose-dependent decrease of viability and apoptosis of the cancer cells was generated by exposure to the herbal medicines, Juzen-taiho-to or Shimotsu-to. The expression of ER-alpha mRNA, but not ER-beta mRNA was suppressed by Juzen-taiho-to or Shimotsu-to in an endometrial cancer cell line. The anti-tumor effect of these herbal medicines against endometrial carcinoma might be correlated to the ER-alpha related mechanism.

Low-fat dietary pattern and risk of colorectal cancer: the Women's Health Initiative Randomized Controlled Dietary Modification Trial.

CONTEXT: Observational studies and polyp recurrence trials are not conclusive regarding the effects of a low-fat dietary pattern on risk of colorectal cancer, necessitating a primary prevention trial. OBJECTIVE: To evaluate the effects of a low-fat eating pattern on risk of colorectal cancer in postmenopausal women. DESIGN, SETTING, AND PARTICIPANTS: The Women's Health Initiative Dietary Modification Trial, a randomized controlled trial conducted in 48,835 postmenopausal women aged 50 to 79 years recruited between 1993 and 1998 from 40 clinical centers throughout the United States. INTERVENTIONS: Participants were randomly assigned to the dietary modification intervention (n = 19,541; 40%) or the comparison group (n = 29,294; 60%). The intensive behavioral modification program aimed to motivate and support reductions in dietary fat, to increase consumption of vegetables and fruits, and to increase grain servings by using group sessions, self-monitoring techniques, and other tailored and targeted strategies. Women in the comparison group continued their usual eating pattern. MAIN OUTCOME MEASURE: Invasive colorectal cancer incidence. RESULTS: A total of 480 incident cases of invasive colorectal cancer occurred during a mean follow-up of 8.1 (SD, 1.7) years. Intervention group participants significantly reduced their percentage of energy from fat by 10.7% more than did the comparison group at 1 year, and this difference between groups was mostly maintained (8.1% at year 6). Statistically significant increases in vegetable, fruit, and grain servings were also made. Despite these dietary changes, there was no evidence that the intervention reduced the risk of invasive colorectal cancer during the follow-up period. There were 201 women with invasive colorectal cancer (0.13% per year) in the intervention group and 279 (0.12% per year) in the comparison group (hazard ratio, 1.08; 95% confidence interval, 0.90-1.29). Secondary analyses suggested potential interactions with baseline aspirin use and combined estrogen-progestin use status (P = .01 for each). Colorectal examination rates, although not protocol defined, were comparable between the intervention and comparison groups. Similar results were seen in analyses adjusting for adherence to the intervention. CONCLUSION: In this study, a low-fat dietary pattern intervention did not reduce the risk of colorectal cancer in postmenopausal women during 8.1 years of follow-up. CLINICAL TRIALS REGISTRATION: ClinicalTrials.gov Identifier: NCT00000611.

A literature review on Complementary and Alternative Medicine for the treatment of breast cancer: Hawai'i.

The purpose of this literature review is to survey the scholarly work done in the field of Complementary and Alternative Medicine (CAM) as it relates to breast cancer treatment, accenting studies done on diverse ethnicities of Hawai'i. This study reviews articles published in biomedical literature from 1999-2005 that report findings related to the themes recognized in this area of study.

The use of Complementary and Alternative Medicine by Asian women of Hawai'i in the treatment of breast cancer.

This qualitative investigation examined complementary and alternative medicine (CAM) by Hawai'i Asian women breast cancer survivors. The majority of participants felt that the conventional treatment they received was adequate in treating their cancer but was impersonal in nature leaving them feeling abandoned. Many sought CAM to improve their quality of life. Additional research on CAM and the patient-physician relationship is urgently needed.

Use of provider delivered complementary and alternative therapies in Hawai'i: results of the Hawai'i Health Survey.

BACKGROUND: Provider delivered complementary and alternative medicine (CAM) is used increasingly as a treatment option. Nevertheless, data related to the prevalence of provider delivered CAM (or PDCAM) use in diverse racial and ethnic populations is limited. The purpose of this investigation was to describe the use of provider delivered CAM in Hawaiian, Asian, and other Pacific Island populations in Hawai'i. The investigation was undertaken to test the hypothesis that a significant difference existed in the use of provider delivered CAM in Hawai'i because of the cultural diversity existing within the population. METHODS: The data were collected through the Hawai'i Health Survey (HHS). The HHS was administered by telephone among 5,000 stratified, randomly selected households, representing each of the Hawaiian Islands. Data were collected on all members of sample households. The sample population was statistically adjusted to represent the population of Hawai'i. RESULTS: Several factors emerged that may indicate increased use of provider delivered CAM. Most provider delivered CAM users are more educated, have incomes 200% or more above the poverty line, and reported either good or very good health status. Among respondents with poor health status, 60.4% have used provider delivered CAM. Those with a body mass index indicating that they were overweight also reported a high level of provider delivered CAM use (51.4%). Similar percentages of both women and men use provider delivered CAM, while the youngest and oldest respondents reported the least use of provider delivered CAM. Whites (60.0%) and Koreans (56.6%) reported the highest percentage of use of provider delivered CAM, while African Americans (35.5%) and Filipinos (37. 1%) reported the lowest percentage. The majority of people without health insurance report provider delivered CAM use (53. 7%). The highest portion of people who have usedanyalternative health care service is found among those whose pain severely interferes with normal work (78.3%). CONCLUSIONS The use of provider delivered CAM was found to be significantly greater in Hawaii compared with the mainland. Our results suggest the need for additional investigation of provider delivered CAM use in specific ethnic subpopulations.

An overview of obesity and diabetes in the diverse populations of the Pacific.

BACKGROUND: Pacific islanders (PI) have some of the highest prevalence of obesity and type 2 diabetes in the world. Data related to PI are often reported as though the group is an aggregate; however, PI are a group of very diverse peoples. OBJECTIVE: To explore the obesity problem in PI by: 1) characterizing the major ethnic groups in the Pacific; 2) describing the most recent US census data on PI and their recent immigration patterns; and 3) synthesizing the literature on obesity in PI and type 2 diabetes mellitus. METHODS: Census information and anthropologic resources on the Pacific Islands and its peoples were obtained through an Internet search. Literature on obesity, diabetes, and body composition in PI were obtained through a systematic analysis of citations listed on Medline. RESULTS: Pacific Islanders (PI) are diverse people, culturally, biologically, and linguistically. Polynesians and some Micronesians have a very high prevalence of obesity and diabetes. Melanesians are among the most diverse ethnic groups in the world. Body mass index (BMI) cut-point values for Polynesians may be inaccurate. CONCLUSIONS AND RECOMMENDATIONS: The cause of obesity and diabetes in PI is unclear. Some factors involved are related to urbanization and migration. Obesity research should distinguish between island ethnicities and not aggregate all PI together. Research is needed to define body fat distribution of Polynesians in relationship to obesity co-morbidities, to determine normal growth of Polynesian children, to determine the relationship between growth abnormalities and adult obesity, and to determine the impact of immigration on PI.

Improving Hawaiian and Filipino involvement in clinical research opportunities: qualitative findings from Hawai'i.

OBJECTIVE: Investigate the barriers to participation in medical research that involves Asian and Pacific Islander (API) populations in Hawai'i. PARTICIPANTS: Fifty people (27 Filipinos, 23 Hawaiian/Pacific Islanders) in five different communities on Oahu. DESIGN: Nine focus groups with an ethnically matched moderator were held to explore people's feelings, problems, and recommendations regarding medical research. Sessions were audiotaped, transcribed, and qualitatively analyzed with the constant comparison method. RESULTS: Only 12% of study participants said that they absolutely would not participate in a clinical study. Most agreed that research is vital. Filipino participants were more optimistic about the safety and value of joining in medical research. Hawaiian groups were more hesitant and fearful. Reasons for nonparticipation included negative feelings about the purpose and intent of clinical trials and language and cultural barriers. Suggestions on how to encourage API populations to participate in research investigations included improving peoples' understanding of the benefits to family and community. Hawaiian and Filipino groups differed only slightly in their assessments of the type of research needed in their communities. CONCLUSIONS: Recruitment campaigns must improve people's awareness of the process of informed consent, research safeguards, and benefits to family and community. Attention should focus on K-12 health education to use members of the younger generations to access and educate elders, involving persons with medical research experience as a recruitment resource, returning results to study participants, and increasing the number of healthcare professionals and researchers that are culturally and linguistically matched to the community.

Addressing oral health disparities in settings without a research-intensive dental school: collaborative strategies.

Research suggests that oral health is linked to systemic health, and those with poor oral health are potentially at greater risk for important diseases, including cardiovascular disease, stroke, diabetes mellitus, and adverse pregnancy outcomes. Asians and Pacific Islanders (APIs) in Hawaii have high rates of many such diseases. Studies in children in Hawaii have revealed disparities in dental health; for example, API children have significantly higher rates of cavities than other groups. Hence, conducting further study is vital in adults, particularly APIs, to assess oral health and its correlation to overall health outcomes. Given the lack of a dental school and the lack of fluoridated water in the state, the University of Hawaii's John A. Burns School of Medicine (ABSOM) has identified the need to assume a leadership role in creating effective community-based oral health research and treatment programs. With the support of the National Institute of Dental and Craniofacial Research, JABSOM fostered a collaborative relationship with the University of North Carolina at Chapel Hill School of Dentistry, a premiere research-intensive dental school, the Waimanalo Health Center, and the Hawaii State Department of Health. This partnership has worked together to implement a community-based approach to performing research designed to illuminate disparities and develop innovative strategies to promote oral health in Hawaii's diverse populations. We hope that this collaborative, culturally competent approach may serve as a model for use in other settings without a research-intensive dental school.

Oral health disparities and periodontal disease in Asian and Pacific Island populations.

INTRODUCTION: While oral health disparities exist in many ethnic groups in Hawaii, the challenge of developing research and intervention programs is hampered by the lack of a dental school and adequate state resources. OBJECTIVE: To use a collaboration model to establish a mentoring relationship with a research-intensive school of dentistry to reduce oral health disparities in Hawaii. METHODS: Collaborative interactions with the University of Hawaii School of Medicine (UH) and the University of North Carolina School of Dentistry at Chapel Hill (UNC) included bimonthly teleconferences, on-site planning and mentoring sessions, yearly conferences in Hawaii open to the community using UNC faculty, and on-site skills training sessions. The community was asked to participate in determining priorities for research through focus-group interactions. Two pilot investigations were also conducted. RESULTS: Both universities have been awarded grants to fund activities to support the combined intellectual and physical resources of multiple private, public, and community organizations to achieve the goal of improving the oral health status of the people of Hawaii. As a result of initial planning, two related grants have been submitted (one approved, one disapproved) to fund pilot studies on the oral health status of mothers and their babies in a rural community. These studies include both UH and UNC investigators. CONCLUSIONS: Health disparities occur among diverse ethnic groups in Hawaii, and links between general health and oral health continue to emerge. In spite of obstacles to designing effective research and intervention programs in Hawaii, UH fostered a collaborative relationship with a premiere dental research institution to develop competence in clinical research, conduct pilot studies, and obtain extramural funding for comprehensive studies. Direct involvement of community representatives in the research process is integral to the success of such studies and will continue to serve as the foundation of our community-based participatory research. The network partners have accomplished their primary goal of developing culturally appropriate methods for assessing determinants of oral health, oral health-related quality of life, and health outcomes in Asians and Pacific Islanders.

Growth in clinical research productivity and funding at the University of Hawaii's John A. Burns School of Medicine: the past 10 years.

Over the last ten years, faculty at the John A. Burns School of Medicine (JABSOM) and the University of Hawaii (UH) have been actively engaged in ongoing efforts to increase the quantity and improve the quality of biomedical research in the State of Hawaii. JABSOM's Clinical Research Center (CRC), funded in 1995 by the National Center for Research Resources (NCRR) and the Research Centers in Minority Institutions (RCMI) of the National Institutes of Health, has provided research infrastructure that has been essential to these efforts. The CRC and other JABSOM departments and affiliated programs have collaborated with public and private entities within the community, particularly in the area of health, related to diverse racial and ethnic populations. This paper sets forth a number of the significant indicators of research progress, as illustrated primarily through CRC support for various research activities conducted at JABSOM.

The relationship between ethnicity and obesity in Asian and Pacific Islander populations: a literature review.

The purpose of this literature review is to explore the potential relationship between ethnicity and obesity, and obesity-related risks, with a particular emphasis on disparities between Asian and Pacific Islander populations. We conducted a comprehensive search of available medical literature related to the rise of obesity in the United States, factors contributing to obesity, evidence-based clinical guidelines, and obesity and related risks as they occur in Hawaii. In conducting this search, we sought to illuminate obesity rates in Asians and Pacific Islanders in connection with various factors, such as diet and lifestyle, acculturation, and body image, as they occur in diverse cultural contexts. We found that the rates of obesity and related risks were highest in Native Hawaiians and Samoans. Based upon our review of the literature, we conclude that further research is necessary to address the relationship between ethnicity and obesity risk factors in Asian and Pacific Islander populations.