The Epidemiology of Slipped Capital Femoral Epiphysis in American Samoa.

The Maori of New Zealand have been identified as a high-risk population for slipped capital femoral epiphysis (SCFE). This study assessed whether the burden of disease from SCFE in the American Territory of American Samoa is similar to that identified in the Maori. This was a retrospective review of children from American Samoa treated for SCFE at a tertiary care pediatric hospital between 2005-2014. Demographic, clinical, and radiographic information was collected. All patients were followed for at least one year after surgery and prophylactically pinned hips were not included. Data for determining incidence was obtained from the United States Census Bureau. Between 2005-2014, 55 American Samoan youth were treated for 73 SCFE. The incidence in the "at-risk" population 5-14 years of age was 53.1 per 100,000. Patients had a mean BMI of 29.5 (19.4-46.4) and mean weight of 76.7 kg (45.9-139 kg). Southwick angle was a mean 40.6°+/- 20.4° (6-83°). Overall, 82.2% of hips were treated with in-situ cannulated screw fixation. At a minimum one-year after initial surgery, 22 hips (30.1%) required major surgery including intertrochanteric osteotomy, osteochondroplasty, or total hip replacement. The incidence of SCFE in American Samoa is extremely high, 53.1 per 100,000 of "at-risk" population 5-14 years old. The mean weight and BMI in SCFE patients from American Samoa is substantially higher than previously published reports. Furthermore, morbidity from SCFE in this population is substantial with 30.1% requiring major surgery either at the time of physeal stabilization or in subsequent years.

The contribution of feeding mode to obesogenic growth trajectories in American Samoan infants.

UNLABELLED: What is already known about this subject Samoan adults are recognized for their particularly high body mass index and prevalent obesity. While Polynesians are understudied, in other populations infancy is a critical period in the development of obesity. Breastfeeding has been shown to attenuate obesity risk. What this study adds Samoan infants show remarkably rapid gain in weight but not length in early infancy resulting in a prevalence of overweight and obesity far higher than has been previously reported elsewhere. Breastfeeding is associated with slower weight gain in infancy suggesting that its protective benefits for obesity risk are generalizable outside of European-derived populations. BACKGROUND: Samoans are recognized for their particularly high body mass index and prevalent adult obesity but infants are understudied. OBJECTIVE: To examine the prevalence of overweight and obesity and determine the contribution of feeding mode to obesogenic growth trajectories in American Samoan infants. METHODS: Data were extracted from the well baby records of 795 (n = 417 male) Samoan infants aged 0-15 months. Mixed-effects growth models were used to produce individual weight and length curves. Further mixed-effects models were fitted with feeding mode (breastfed, formula- or mixed-fed) as a single observation at age 4 (±2) months. Weight and length values were converted to z-scores according to the Centers for Disease Control 2000 reference. RESULTS: At 15 months, 23.3% of boys and 16.7% of girls were obese (weight-for-length > 95th percentile). Feeding mode had a significant effect on weight and length trajectories. Formula-fed infants gained weight and length faster than breastfed infants. Formula-fed boys were significantly more likely to be obese at 15 months (38.6%) than breastfed boys (23.4%), χ(2) = 8.4, P < 0.01, odds ratio = 2.05, 95% confidence interval (1.04, 4.05). CONCLUSION: Obesity in American Samoans is not confined to adults. Obesity prevention efforts should be targeted at early life and promotion of breastfeeding may be a suitable intervention target.

Cultural translation of interventions: diabetes care in American Samoa.

Translation of research advances into clinical practice for at-risk communities is important to eliminate disease disparities. Adult type 2 diabetes prevalence in the US territory of American Samoa is 21.5%, but little intervention research has been carried out there. We discuss our experience with cultural translation, drawing on an emerging implementation science, which aims to build a knowledge base on adapting interventions to real-world settings. We offer examples from our behavioral intervention study, Diabetes Care in American Samoa, which was adapted from Project Sugar 2, a nurse and community health worker intervention to support diabetes self-management among urban African Americans. The challenges we experienced and solutions we used may inform adaptations of interventions in other settings.

Developing a community-based collaboration to reduce cancer health disparities among Pacific Islanders in California.

Cancer is a leading cause of death for Asians and Pacific Islanders in the United States, but education and research efforts addressing the needs ofPacific Islanders in the continental U.S. is sparse. The purpose of this paper is to describe the development of a community-based participatory research network dedicated to addressing cancer health disparities among Chamorros, Marshallese, Native Hawaiians, Samoans and Tongans in Southern California. Community-based organizations (CBO) comprise the focus of the network, and their efforts have included increasing cancer-related awareness in their communities, developing capacities regarding cancer control, and initiating collaborative research efforts with academic partners. First year processes and outcomes are described, and specific examples are given from two CBO partners.

Prevalence and predictors of smoking behavior among Samoans in three geographical regions.

OBJECTIVES: Provide comprehensive data on smoking behavior among Samoans. DESIGN: Cross-sectional, using systematic random sampling procedures, and in-person interviews. SETTING: US Territory of American Samoa, Hawaii, and Los Angeles, California. PARTICIPANTS: 1834 adult, non-institutionalized Samoans. INTERVENTION: None. MAIN OUTCOME MEASURES: Prevalence and independent predictors of smoking. RESULTS: Approximately one fourth (26.6%) of Samoans were current smokers, with 31.4% of men and 22.5% of women currently smoking. More current smokers were found in American Samoa (28.9%), followed by Hawaii (26.9%) and Los Angeles (24.1%, P<.001). At each site, Samoan men compared with the women were significantly more likely to smoke (P<.001), initiate smoking earlier (P<.05), and smoke more cigarettes (P<.05). Cessation rates for the sample were very low. Predictors of smoking included being younger, male, married, less educated, with lower income, and more acculturated. CONCLUSION: The high smoking and low cessation rates indicate that smoking-related diseases will be significant causes of morbidity and mortality for Samoans for many years. The findings further underscore the importance of documenting smoking patterns and their determinants for subgroups rather than aggregates such as Asian American and Pacific Islanders. If Samoans are to meet the Healthy People 2010 tobacco goals, there is a need to: 1) develop tailored tobacco awareness and cessation programs based on the recommendations made by the Taskforce on Community Preventive Services; 2) understand the complex interactions between social, cultural, and psychological determinants of smoking and cessation behaviors; and 3) develop policies to limit availability of tobacco, environmental exposure from tobacco, and increase cessation efforts.

Exploring beliefs about cancer among American Samoans: focus group findings.

OBJECTIVE: To evaluate answers to the following questions among American Samoans: What is cancer? What causes cancer? And what can you do to prevent cancer? DESIGN: Focus groups (four with women and four with men). SETTINGS: Pago Pago and the Manu'a islands, American Samoa; Honolulu, Hawaii; Los Angeles, California. PARTICIPANTS: 80 self-reported Samoan men and women over the age of 18 years, selected through non-probability purposive sampling with help from Samoan community-based organizations. MEASUREMENT: Qualitative content analysis of focus findings to identify themes. RESULTS: The concepts that cancer was not a Samoan illness, that failure to follow fa'aSamoa (the traditional Samoan way of life) could lead to cancer, and that a return to fa'aSamoa could prevent cancer were the prevalent themes in the focus groups. CONCLUSION: The value that Samoans place on fa'aSamoa, a traditional healthy lifestyle, provides insights into the design of future intervention programs aimed at improving cancer control in this population.

Predictors of papanicolaou smear use among american samoan women.

To explore the rate and predictors of Papanicolaou (Pap) smear use among American Samoans, we conducted a survey of 986 randomly selected adult, self-identified Samoan women in American Samoa (n = 323), Hawaii (n = 325), and Los Angeles (n = 338). Only 46% of the women reported having a Pap smears within the past 3 years. These women were more likely than others to reside in Hawaii (odds ratio [OR], 1.7), be less than 40 years of age (OR, 2.2), be married (OR, 1.9), have more than 12 years of formal education (OR, 2.1), have an income of more than $20,000 per year (OR, 1.6), have health insurance (OR, 1.6), and have higher acculturation levels (OR, 1.9). Knowledge and attitudes about cervical cancer did not predict Pap smear screening. It is likely that the low rate of Pap smear screening contributes to the high site-specific incidence of cervical cancer among American Samoan women.

Knowledge of and attitudes about cancer among American Samoans.

The objective of this study was to determine cancer-related knowledge and attitudes among American Samoans, a population seldom studied by cancer researchers. Such information is necessary to develop culturally sensitive cancer control interventions. Specially trained personnel conducted face-to-face interviews with randomly selected respondents in the US Territory of American Samoa; Oahu, HI; and Los Angeles, CA, using a survey based on the National Health Interview Survey Cancer Control Supplement and focus group findings. The survey included questions concerning knowledge of risk factors for cancers (breast, cervical, colon, lung, stomach, and prostate), family resources (health insurance coverage, employment status, and family income), and demographic characteristics. Participants could complete the survey in English or Samoan. Analysis of data included the chi-squared test and logistic regression analysis. Participants included 1,834 noninstitutionalized English- or Samoan-speaking women and men (609 from American Samoa, 610 from Hawaii, and 615 from Los Angeles). The majority of residents had some positive attitudes about cancer prevention and treatment but often also had misconceptions about risk factors for cancer. Logistic regression analysis revealed that site of residence was an important predictor of attitudes. For example, being residents of American Samoa or Hawaii predicted that the respondents would rather not know that they had cancer (odds ratio [OR], 1.5, 2.1, respectively); that cancer can be caused by aitu, or spirits (OR, 1.9, 2.1, respectively); that cancer is a punishment from God (OR, 2.0, 2.2, respectively); and that cancer can be cured by fofo, or traditional Samoan healers (OR, 2.0, 3. 1, respectively). This study documented cancer-related knowledge and attitudes among American Samoans and set the stage for culturally sensitive interventions aimed at improving cancer control in this population. It also identified many issues that should be addressed in such interventions.

Migration and acculturation among Samoans: some sources of stress and support.

Daily excretion of the stress hormone, epinephrine, has been employed to study potential stressors associated with acculturation and migration. Young men and women from Samoan communities in Hawaii (HI), American Samoa (AS) and Western Samoa (WS) which differ in exposure to American culture were included. Psychosocial factors associated with elevations in hormone excretion were assumed to be stressors, while associations with reduced excretions were assumed to be supportive or buffers. Hormone excretion levels were similar in all locations, but there were different associations which could be attributed to migration and acculturation. Among all migrants (HI) ethnic networks were apparent stressors, while a high degree of community involvement was stressful for migrant women. In sites of culture contact (HI, AS) certain adult members of the extended family were supportive, as was a superior knowledge of Samoan cultural concepts. For women in Samoa (WS, AS) community involvement was supportive. In contrast for men in WS and AS, but not in HI, being of mixed ancestry or having close family of mixed ancestry was stressful. It is concluded that hormone analysis can provide meaningful clues concerning social stressors in acculturating or migrant communities. Also that migration or acculturation do not necessarily result in increased levels of stress.

Overview of the Native American Cancer Conference III. Risk factors, outreach and intervention strategies.

BACKGROUND: Based on the lack of published information regarding Native Americans and cancer and the success of previous meetings, the Network for Cancer Control Research among American Indian and Alaska Native Populations (NCCR-AIANP) and the Native Hawaiian and American Samoan Cancer Research Network determined there was sufficient need to have annual national Native American cancer conferences. METHODS: The NCCR-AIANP, the Native Hawaiian and American Samoan Cancer Research Network, and the AMC Native American Cancer Research Program collaborated to organize the third national Native American cancer conference, "Native American Cancer Conference III: Risk Factors, Outreach and Intervention Strategies." RESULTS: The conference was held in Seattle, Washington, June 16-19, 1995. It provided a forum for scientific discussion and dissemination of information related to cancer prevention and control. CONCLUSIONS: Conference participants benefited from the topics presented and the diversity of the audience members. There continues to be a need to share what is happening in cancer research with this unique population and to address new issues of concern. A cancer conference seems to be a useful mechanism to provide such an opportunity.

Native American Cancer Conference III. Cognitive correlates and impressions of attendees.

BACKGROUND: The results of preconference and postconference surveys, as well as conference evaluation forms, distributed to attendees at the "Native American Cancer Conference III: Risk Factors, Outreach and Intervention Strategies," Seattle, Washington, June 16-19, 1995, are presented. METHODS: Conference attendees were requested to complete a multi-item survey designed to assess knowledge and perceptions relating to cancer among native peoples at the beginning and end of the conference. The evaluation instrument solicited qualitative impressions of the conference. RESULTS: Survey respondents were predominantly female (70%), and approximately half were native persons representing 48 different American Indian and Alaska Native communities. Knowledge levels were generally high at baseline for most items relating to cancer, with evidence of significant improvement for several items on the postconference survey. The majority of respondents believed that cancer was of equal importance compared with other health problems and that cancer services for American Indians and Alaska Natives are generally less extensive compared with the majority population; there was no evidence of opinion change noted in the postconference survey. Results from the qualitative evaluation expressed the unique and affirmative experiences among participants in terms of the social, cultural, and informational sharing that occurred. CONCLUSIONS: It is hoped that the positive experiences of conference attendees will serve to stimulate the organization of similar programs and the design of research projects that both assess and expand cancer control services among Native peoples.

Native Americans' cancer rates in comparison with other peoples of color.

BACKGROUND: The National Cancer Institute developed population-specific programs to better understand cancer as it occurs within underserved populations such as American Indians, Alaska Natives, Native Hawaiians, and American Samoans. METHODS: The data for American Samoans are derived from regional studies and from data collected from the Hawaii Surveillance, Epidemiology, and End Results (SEER) Registry. Native Hawaiian data are from the Hawaii SEER program and are limited to Native Hawaiians who live in that state. Alaska Native data are from the Lanier and Knutson 15-year summary of Alaska Native cancer data. American Indian data are from the New Mexico SEER program, which is generalizable to natives living in Arizona and New Mexico only and is relatively free of racial misclassification errors. RESULTS: An overview of age-adjusted cancer incidence and mortality rates among American Indians, Alaska Natives, Native Hawaiians, African Americans, and whites for 1977-1983 is provided. Five-year relative survival rates from cancer are from 1975-1984. Relative survival rates are provided for American Indians, Native Hawaiians, African Americans, and whites. CONCLUSIONS: Based on the limited data available, divergent cancer patterns appear to be present in these Native American populations. Alaska Natives and Native Hawaiians consistently display elevated rates that are frequently camouflaged when data are collapsed into "other" racial categories.

Overview of National Cancer Institute networks for cancer control research in Native American populations.

BACKGROUND: The National Cancer Institute established two Native American cancer control research networks. These networks were created to develop and promote a cadre of cancer prevention and control scientists to conduct culturally sensitive research among Native American populations (i.e., American Indian, Alaska Native, Native Hawaiian, and American Samoan). The primary objective of these research efforts is to reduce morbidity and mortality from cancer. Toward reaching this objective, the networks have (1) conducted research, (2) affiliated with or stimulated other groups to conduct research, or (3) facilitated research by encouraging the training of new researchers of Native American origin to promote prevention and early detection as well as state-of-the-art treatment among their people. METHODS: The networks are organized and financially supported by the NCI. Members of the network have established working committees that follow up on tasks identified during the meetings. RESULTS: Accomplishments of these networks have been recorded between 1990 and 1996. Two strategic plans for cancer control research among American Indians and Alaska Natives have been drafted and disseminated. One of the plans was designed for federal agencies and the other for state health departments. The networks have conducted three national surveys regarding native peoples' access to cancer prevention and control services and conducted two national Native American cancer conferences. The Native Hawaiian/American Samoan Task Force was established in 1992 due to the high incidence and mortality statistics for cancer in these populations. CONCLUSIONS: Through support mechanisms such as those implemented by the NCI, independent networks can be created to advocate actively for cancer prevention and control efforts within Native American communities, among nonnatives, and within professional organizations and governmental agencies.

Cancer among indigenous populations. The experience of American Samoans.

BACKGROUND: Little is known about the cancer control needs of American Samoans. This report provides some of the first data on cancer incidence among American Samoans in Hawaii. METHODS: The Hawaii Tumor Registry, a Surveillance, Epidemiology, and End Results population-based, active cancer surveillance program, provided archival data on American Samoans residing in Hawaii and on those referred to Hawaii for diagnosis and treatment from the U.S. Territory of American Samoa. RESULTS: In American Samoan males, the more commonly encountered cancers included cancer of the lung, prostate, stomach and liver, and leukemia. In American Samoans females, breast carcinoma was most frequent, followed by cancer of the corpus uteri, cervix uteri and thyroid, and leukemia. Females were more likely than males to receive a diagnosis of cancer at an early age: 34.5% of females and 19.9% of males with cancer were diagnosed when they were between the ages of 0 and 44 years. Males were more likely than females to be diagnosed with cancer after metastasis had occurred (45% vs. 33.9%). Compared with other Polynesians (i.e., Western Samoans and Hawaiians), American Samoan males have a relatively higher frequency of lung, prostate, thyroid, and liver cancers and a lower frequency of colon and rectum cancers. American Samoan females, compared with other Polynesians, have a higher frequency of leukemia and corpus uteri, thyroid, and pancreatic cancers and a lower frequency of colon and rectum cancers. CONCLUSIONS: The data provide baseline information that has important public health and research implications for cancer control programs for this population.

Cancer among American-Samoans: site-specific incidence in California and Hawaii.

BACKGROUND: There is a paucity of data about cancer among American-Samoans, the largest Pacific Islander group after Hawaiians. This study provides the first data on the incidence and relative risk for all cancers among American-Samoans on the US mainland and in Hawaii. METHODS: The University of Southern California Cancer Surveillance Program and the Hawaii Tumor Registry, two population-based cancer surveillance programmes, provided archival data on American-Samoans residing in Los Angeles Country. California and in Hawaii, respectively. RESULTS: There were significant differences in the incidence and age-adjusted site-specific relative risk of cancers between American-Samoans, Hawaiians, and Anglos (non-Hispanic whites). In Hawaii, American-Samoans diagnosed with cancer compared with Hawaiians had a higher age-adjusted site-specific relative risk for cancers of the nasopharynx (especially males), liver, prostate, thyroid, and blood (especially females) and a lower relative risk for cancers of the colon, rectum (especially males), lung (especially females) and breast. Furthermore, compared with Anglos diagnosed with cancer in Hawaii, American-Samoans had a higher relative risk for cancers of the nasopharynx (especially males), stomach, liver, lung (especially males), corpus uteri, thyroid and blood, and a lower relative risk for cancers of the colon, skin, breast, testes, cervix uteri, bladder (especially males), and lymph nodes. A relatively similar profile of cancer distribution and relative risk was observed among American-Samoans and Anglos diagnosed with cancer in California. CONCLUSIONS: The data provide baseline information which has important implications for future cancer control research and prevention in this population.