O le tagata ma lona aiga, o le tagata ma lona fa'asinomaga (Every person belongs to a family and every family belongs to a person): Development of a parenting framework for adolescent mental wellbeing in American Samoa.

American Samoan adolescents experience a high prevalence of mental health problems, including depression, anxiety, substance use, and suicidal thoughts and behaviors. To complement existing health system efforts, family-based interventions may be a feasible, cost-effective, and relevant opportunity to promote mental health. This community-partnered, qualitative study aimed to: (1) identify potential family-related psychosocial protective factors for adolescent mental health and (2) develop a framework for a parenting program to promote adolescent mental health in American Samoa. Applying the fa'afaletui framework developed for research in Samoan communities, which emphasizes the importance of weaving a range of community member perspectives to reach consensus, semi-structured in-depth interviews with adult key informants (n=28) were conducted between October 2020 and February 2021. Results were validated through five focus groups with Samoan adolescents (n=35) between May and June 2022. Adult participants were sampled for diversity in profession, age, gender, education, and region of residence; adolescent participants were sampled for diversity in gender. Participants were recruited using personal networks and snowball sampling; adolescent participants also responded to Facebook advertising. The semi-structured interviews focused on broad topics including common mental health problems, contributors to mental illness, and potential interventions, among others. Transcripts were coded in duplicate and analyzed using deductive thematic analysis. Themes were collaboratively mapped onto an adapted fonofale model, an existing framework for Pacific Island health research. Six themes described key practices: (1) provide emotional safety and security; (2) provide physical safety and security; (3) encourage sense of self; (4) strengthen intergenerational communication skills; (5) prioritize quality time; and (6) cultivate healthy coping strategies. Participants also expressed the importance of a supportive environment grounded in culture, family and community, and caregiver mental health. These results provide an initial step to identify family-focused factors that promote adolescent mental health in American Samoa and categorize them into a framework to inform intervention development. Drawing on a collaborative and community-partnered process, these findings provide the first evidence-based framework to develop a parenting program to promote adolescent mental wellbeing and resilience in Samoan communities.

'Tausi Feagaiga: A Project to Train Caregivers and Empower the American Samoan Community.

The 'Tausi Feagaiga (Covenant Keeper) project was a partnership to support the traditional values of tausi matua (caring for one's elders). The partners included a non-governmental organization (Pacific Youth and Community Development), a faith-based organization (Roman Catholic Diocese of Samoa-Pago Pago), and an institute of higher education (University of Hawai'i John A. Burns School of Medicine). The project was created to address the lack of community-based health care such as home health or hospice, and families needing to work outside the home. A culturally based caregiving curriculum was developed to educate caregivers and improve their knowledge and skills. Using a train-the-trainer model, 125 caregivers were trained in family caregiving from 2016-2020. Training was conducted through an intensive workshop followed by practicum at Hope House, the Catholic Diocese home for the aged. Participants who expressed a willingness and competency were mentored to be trainers to continue the 'Tausi Feagaiga project. The mean self-rated confidence in caregiving improved significantly from 3.17 ± 1.02 (mean SD) pre workshop to 3.53 ± 0.71 post workshop (P = .001). Competence in geriatric syndromes was improved from 18.04 ± 4.27 to 21.31 ± 4.30 after attending the workshop (P < .001) and the feedback was extremely positive. Technical assistance was provided to obtain funding through American Samoa Medicaid State Agency to improve the existing infrastructure of Hope House, obtain much needed supplies, and increase ability to hire the participants. 'Tausi Feagaiga positively impacted the lives of the residents of Hope House, the course participants, the elders in the community, and those who care for them.

Accelerometer-Based Estimates of Physical Activity and Sedentary Time Among Samoan Adults.

BACKGROUND: The prevalence of obesity-related cardiometabolic disease in Samoa is among the highest globally. While physical activity is a modifiable risk factor for obesity-related disease, little is known about physical activity levels among adult Samoans. Using wrist-worn accelerometer-based devices, this study aimed to characterize physical activity among Samoan adults. METHODS: Samoan adults (n = 385; 55% female, mean [SD] age 52 [10] y) wore Actigraph GT3X+ devices for 7 to 10 days. General linear models were used to examine mean daily minutes of sedentary time, light physical activity, and moderate to vigorous physical activity by various participant characteristics. RESULTS: Time spent in moderate to vigorous physical activity did not differ statistically between men (88 [5] min; 95% confidence interval [CI], 80-97) and women (78 [4] min; 95% CI, 70-86; P = .08). Women, however, spent more time than men in light physical activity: 380 (7) minutes (95% CI, 367-393) versus 344 (7) minutes (95% CI, 329-358; P < .001). While there were no differences in physical activity by census region, education, or occupation among women, men in urban areas spent significantly less time in moderate to vigorous physical activity than those in peri-urban and rural areas (P = .015). Women with class II/III obesity spent more time in sedentary activities than those with healthy weight or overweight/class I obesity (P = .048). CONCLUSIONS: This study characterizes physical activity among Samoan adults and highlights variation by sex, urbanicity, and weight status. In providing initial device-measured estimates of physical activity in Samoa, this analysis establishes a baseline from which the success of future attempts to intervene on physical activity may be assessed.

Associations of childhood BMI traits with blood pressure and glycated haemoglobin in 6-9-year-old Samoan children.

INTRODUCTION: Prevalence and risk factors for elevated glycated haemoglobin (HbA1c) and blood pressure (BP) are poorly understood among Pacific children. We examined associations of HbA1c and BP in 6-9 year-olds with body mass index (BMI) at ages 2, 5, and BMI velocity between 2-9 years in Samoa. METHODS: HbA1c (capillary blood) and BP were measured in n = 410 Samoan children who were part of an ongoing cohort study. Multilevel models predicted BMI trajectory characteristics. Generalized linear regressions assessed associations of childhood characteristics and BMI trajectories with HbA1c and BP treated as both continuous and categorical outcomes. Primary caregiver-reported childhood characteristics were used as covariates. RESULTS: Overall, 12.90% (n = 53) of children had high HbA1c (≥5.7%) and 33.17% (n = 136) had elevated BP. BMI at 5-years and BMI velocity were positively associated with high HbA1c prevalence in males. A 1 kg/m2 per year higher velocity was associated with a 1.71 (95% CI: 1.07, 2.75) times higher prevalence of high HbA1c. In females, higher BMI at 5-years and greater BMI velocity were associated with higher BP at 6-9 years (95% CI: 1.12, 1.40, and 1.42, 2.74, respectively). CONCLUSION: Monitoring childhood BMI trajectories may inform cardiometabolic disease screening and prevention efforts in this at-risk population.

Type 2 Diabetes Prevalence, Control and Management within Fiji, Kiribati, Samoa, the Solomon Islands, Tonga, and Vanuatu: A Scoping Review with a Systematic Approach.

BACKGROUND: Type 2 diabetes (T2D) causes significant morbidity and is disproportionately prevalent in Pacific Island Countries (PICs). The socio-political demographics of PICs are rapidly changing, and health services must adapt to match the needs of their population. OBJECTIVES: The objective of this study was to review the literature published within the last 15 years relating to T2D prevalence, control, and management, with a specific focus on targetable areas for future funding and research projects. METHODS: This review was conducted using the PRISMA guidelines. Inclusion criteria were: discussion on T2D in the six PICs. Results were limited to those published between 1st January, 2006, and 27th July, 2023. RESULTS: A total of 6,640 publications were retrieved, and 110 met the inclusion criteria. Nineteen additional studies were identified through hand-searching. T2D prevalence differed between countries but was predicted to increase in the coming decades, with projections of up to 31.2% by 2030 in Tonga. Factors associated with T2D varied between countries, including Indian-Fijian ethnicity in Fiji and tuberculosis in Kiribati. Control was generally poor, with high rates of undiagnosed diabetes and microvascular complications. Epidemiological data was limited in some cases, as was information describing the structure and function of diabetes services. CONCLUSION: The prevalence, control, and management of T2D varied between Fiji, Kiribati, Samoa, the Solomon Islands, Tonga, and Vanuatu. Significant gaps remain in the data describing these domains; however, there are clearly targetable areas for future research and diabetes management programs.

"There are still broken or fragmented systems": Qualitative assessment of needs to strengthen adolescent mental health services in American Samoa.

Mental health challenges appear common among adolescents in American Samoa. There is a community-identified need to better understand the health burden and identify opportunities to strengthen the mental health system to better meet adolescent mental health needs. The goal of this qualitative study was to gather community stakeholders' perceptions of common mental health problems among adolescents in American Samoa, identify existing services for adolescent mental health, and highlight strength-based opportunities to enhance care. Using the Fa'afaletui research framework, semi-structured in-depth interviews (n = 28) were conducted between October 2020 and February 2021 using Zoom. Key informants were adults living in American Samoa, sampled for diversity in profession, age, gender, education, and region of residence. Transcripts were coded in duplicate and analysed using deductive thematic analysis. Participants reported that suicide, depression, anxiety, and post-traumatic stress disorder are the conditions of highest burden. Participants identified an impressive amount of infrastructure and community mobilization, but also limitations in these services in addressing adolescents' health needs. Four themes arose related to the need to: (1) strengthen existing infrastructure; (2) reduce barriers to treatment access; (3) improve sustainability; and (4) encourage collaboration among leaders. Policymakers should prioritize the allocation of resources to strengthen infrastructure, public education, and stakeholder collaboration to improve adolescent mental health in American Samoa.

Violence in childhood and community contexts: a multi-level model of factors associated with women's intimate partner violence experience in Samoa.

Background: Intimate partner violence (IPV) affects approximately 26% of women worldwide and is driven by a complex interplay of factors across individual, relationship/household, community and societal levels. Individual and relationship/household factors are well studied however little empirical evidence exists on factors at the community level that drive IPV which are needed to inform prevention interventions. Methods: We conducted a cross-sectional, multi-level analysis of factors associated with women's IPV experience in Samoa using the 2019-20 Demographic and Health Multiple Indicator Cluster Survey. We used hierarchical multivariable logistic regression to assess individual, relationship/household and community level effects on women's risk of physical, sexual and/or emotional IPV. Findings: The past year prevalence of physical, sexual and/or emotional IPV among women in Samoa was 31.4%. At the individual and relationship/household level, women's employment, witnessing IPV between parents, experiencing physical abuse from a parent, and partner's alcohol use and controlling behaviours were associated with higher risk of IPV. At the community level, higher levels of women with higher education and involved in household decision-making, and higher levels of men in employment were protective against IPV. Interpretation: A complex interplay of factors across individual, relationship/household and community levels are associated with women's experience of IPV in Samoa. Experiences of IPV are embedded within a broader context of violence against children and harmful alcohol use. Community contexts, including women's empowerment and men's employment, are also associated with women's IPV experience in Samoa. These findings not only demonstrate that public health issues such as IPV, violence against children and harmful alcohol use should be addressed together as part of multi-pronged approaches, but they point towards the importance of community-level analyses for designing and delivering community-based interventions. Greater knowledge of community dynamics will enable community-based interventions to create environments at the community level that support meaningful and sustainable change towards IPV prevention. Funding: Funding for this study was provided by UKRI (ref. MR/S033629/1).

Oto'otoga o le Sue'suega: E tusa ma le 26 % o tamaitai ua aafia I saua'ga i faigapa'aga i le lalolagi atoa e afua mai i ni mafua'aga mai le tagata lava ia, fai'a ma le aiga o loo nofotane ai, faapea lona tulaga I lona i lona nuu po o le sio'siomaga o nofo ai. O faigapaa'ga taitoatasi ma le siosiomaga I aiga taitasi o nonofo ai sa mafuli I ai lenei sue'suega, ae e faa'leai ni mafuaaga o sau'aga i nuu e manaomia e fuafua ai ni tali o lenei faa'fitauli tu'ga. Auala na Faa'ogaina I le Suesuega: Sa faa'ogaina ni i'uga o mafuaaga o Sau'aga o Faigapaaga mai le Nofoaga filiafila e le suesuega a le Soifua Maloloina na aa'fia ai tamaitai Samoa mai le tausaga 2019-20. Sa faaogaina le metotia ua taua faaperetania (Hierarchical Multivariable Logistic Regression) e suesueina ai tama'itai taitasi ua aa'fia ma latou fai'a ma aiga o latou paaga, o le aa'fiaga o nuu ma nofoaga i nei ituaiga sau'aga. Tau'nuuga o le Suesuega: E tusa ma le 31.4% o tamaitai Samoa na aa'fia i sauaga faa'faigapaaga e aafia ai le tino, feusuaiga, mafaufau ma lagona. O le va o le tamaitai ma le aiga o lana paaga I le itu I le tamaoaiga, lona tulaga I galuega ua molimauina ai sau'aga I le va o matua o le tamaitai ma matua foi o lana pa'aga. O upu faa'luma'luma a matua, o le taumafa ava malosi ma le pule'pule tutu o matua I fanau o tulaga ia ua avea ma faapogai o sau'aga I le va o tamaitai ma latou paa'ga. I totonu o nuu ma alalafaga e maualuga le numera o tamaitai aoaoina lelei o oloo auai I le faiga o faaiuga faapea foi ta'malii faigaluega lelei latou te puipui'a tama'itai mai sauaga ma latou paa'ga. Au'iliiliga o le Sue'su'ega: E lavelave ma faigata ona manino mai mafua'ga e aa'fia ai tamaitai i sauaga fai'faapaaga ona o le mafua'aga e mai lava i a te ia ma lona va ma lona aiga o loo nofotane ai, o matua aemaise foi le nuu. O aa'fiaga o nei sa'uaga ua aafia ai le fanau ona o le inu ava malosi le tau'pulea. O le siitia o tulaga o le aoaoina ma le tamaoaiga o tina ma le lelei o galuega a alii i nuu ma a'lala'faga, ua maitauina ua avea ma mafuaa'ga o nei sau'aga i Samoa. O tau'nuuga o lenei suesuega, ua faa'ilo ai i le vaega o le Soifua Maloloina Lautele o Sau'aga o fanau ma le inu ava malosi le tau pule'a e ta'tau ona faavae ai ni fofo o lenei faafitauli o Sau'aga o faa'faigapaaga e taulamua ai nuu ma alalafaga. O le ao'ga o le malamalama lelei I faavae o nuu ma alalafaga, o se atamai sili lelei ona lelei e faataatiatia ai alafua e gafataulimaina e nuu taitasi ina ia faa'foia ai Sau'aga I Fai'gapaaga mo se nofo lelei o aiga taitasi. Faatupeina o lenei Su'esu'ega: O lenei Suesuega na faa'tupeina e le faa'lapotopotoga ale UKRI (ref. MR/S033629/1). Disclaimer: This translation in Samoan was submitted by the authors and we reproduce it as supplied. It has not been peer reviewed. Our editorial processes have only been applied to the original abstract in English, which should serve as reference for this manuscript.

Incidence and Causes of Cellulitis Among Patients at Tupua Tamasese Meaole Hospital in Upolu, Samoa in 2019.

OBJECTIVE: To study the incidence and causes of cellulitis in patients who visited the only tertiary hospital in Samoa, i.e., Tupua Tamasese Meaole (TTM) Hospital, in 2019. METHOD: Of the total of 14,198 patients who presented to TTM Hospital in 2019, a chart review of all 258 patients who presented with cellulitis was conducted. All charts with the final primary admitting diagnosis of cellulitis were extracted. No exclusion criteria were employed, and raw data were analyzed manually. RESULTS: Of the 14,198 patients who sought care at TTM Hospital in 2019, 258 patients received care for cellulitis. This represents an incidence rate of 1.8%. Most patients were male (62.4%). Those in the age group of 41 to 80 years old accounted for 79.5% of the total. The leg (94.6%) was the major site of infection. Of those who had blood cultures drawn, 76.4% had negative results. Of the 56 patients with positive microbial growth, Staphylococcus and Streptococcus species accounted for a combined total of 71.4% of the cases. The mainstay of antibiotic treatment was flucloxacillin alone or in conjunction with other antibiotics (92.2%). Of the many comorbidities affecting patients, diabetes (44.2%) was the most prevalent. Hospital admission, ranging from three to 10 days was needed in 63.5% of patients. CONCLUSION: The incidence rate of cellulitis at TTM in 2019 was 1.8%, which was marginally higher than noted in other parts of the world. Male patients and people over the age of 40 years are affected the most. The leg is affected the most mainly by Staphylococcus and Streptococcus species. Flucloxacillin is the main antibiotic used to treat cellulitis at the TTM Hospital. From the data analyses, it is inferred that a large proportion of patients who presented had moderate to severe cellulitis.

Culturally Competent Interventions for Child Sexual Abuse: A Scoping Review of the Literature and the Implications for American Samoa.

Significant stigma regarding child sexual abuse exists in American Samoa. Although cultural interventions may help prevent child sexual abuse, very little is known about such interventions. Therefore, through a scoping review process, this study aimed to gain a broad understanding of past and current culturally tailored interventions to prevent child sexual abuse. Because no studies examine interventions to prevent child sexual abuse in American Samoa specifically, the reviewed literature investigates interventions in different cultures. The literature search initially identified 180 relevant articles. After applying inclusion and exclusion criteria, nine studies met the eligibility criteria for review. Extracted data from these articles included the country or population, sample, study methods, children's age, intervention type, and details about the intervention. Results suggest that culturally tailored interventions for preventing child sexual abuse exist in various countries and cultural contexts. Results highlight that child sexual abuse prevention interventions are effective if translated into the native language. Findings from this study highlight the importance of using a culturally tailored approach to addressing child sexual abuse and can help guide the development of new interventions. Although more research on the prevention of child sexual abuse in American Samoa is needed, the results of this study might inform the development of culturally tailored interventions for the region.

Assessing Knowledge on Gestational Diabetes Mellitus and Child Health.

Gestational diabetes mellitus (GDM) is a diagnosis of glucose intolerance during pregnancy. The risk of type II diabetes mellitus (T2DM) and obesity for the child and mother increases when GDM develops. Preventing the development of GDM could help lower the prevalence of obesity and type II diabetes mellitus morbidity rates in children of affected mothers. The purpose of the study was to identify the awareness level of females ages 12 and 51 years, on the long-term risk of obesity and T2DM on their children in Australia and Samoa. This is a quantitative study involving 202 females, from across Australia and Samoa, between April 2021 and November 2021, comparing the level of knowledge between a developing and developed country. In Australia and Samoa, 15% (n=16) and 34% (n=33) of females respectively, were aware of the long-term complications of GDM on their children. These findings indicate that there is inadequate knowledge regarding the long-term consequences associated with GDM on both the risk for T2DM in women and the risk for long-term complications for their children. The greatest source of information in both countries was obtained from physicians or midwives, 52% (n=105). This supports the need for increased education on GDM, through social media, the internet, and community health professionals. By increasing awareness of GDM and implementing preventive strategies, it may be possible to reduce the prevalence of obesity and T2DM in Australia and Samoa.

Influencing Factors to mHealth Uptake With Indigenous Populations: Qualitative Systematic Review.

BACKGROUND: The advancements and abundance of mobile phones and portable health devices have created an opportunity to use mobile health (mHealth) for population health systems. There is increasing evidence for the feasibility and acceptance of mHealth with Indigenous populations. Providing a synthesis of qualitative findings of mHealth with Indigenous populations will gain insights into the strengths and challenges to mHealth use in Indigenous populations. OBJECTIVE: This review aimed to identify and synthesize qualitative data pertaining to the experiences and perceptions of mHealth from the perspectives of end users (patients and service providers) living in the colonial settler democracies of Canada, Australia, New Zealand, the United States, the Pacific Islands, and the Sápmi region of northern Europe. METHODS: In May 2021, systematic searches of peer-reviewed, scientific papers were conducted across the 5 databases of PubMed, CINAHL, Embase, PsycINFO, and Web of Science. Qualitative or mixed method studies were included where a mHealth intervention was the primary focus for responding to health challenges with Indigenous populations. Two authors independently screened papers for eligibility and assessed the risk of bias using a modified version of the Critical Appraisal Skills Programme. A meta-aggregative approach was used to analyze the findings of included studies. RESULTS: Seventeen papers met the eligibility criteria, 8 studies with patients, 7 studies with service providers, and 2 studies that included both patients and service providers. Studies were conducted in Australia (n=10), Canada (n=2), New Zealand (n=2), Papua New Guinea (n=1), the United States (n=1), and Samoa (n=1). Our interpretation of these qualitative findings shows commonalities between Indigenous patients' and service providers' perceptions of mHealth. We summarize our findings in six themes: (1) mHealth literacy, (2) mHealth as a facilitator for connection and support, (3) mHealth content needed to be culturally relevant, (4) mHealth security and confidentiality, (5) mHealth supporting rather than replacing service providers, and (6) workplace and organizational capacity. CONCLUSIONS: This research suggests that mHealth can meet the needs of both patients and service providers when the mHealth intervention is culturally relevant, accounts for digital and health literacy, incorporates interactive components, is supported by workplaces, fits into health provider workflows, and meets security and confidentiality standards. Future mHealth research with Indigenous populations should partner with key representatives (eg, patients, service providers, and executive leaders) in the mHealth design appropriate to the purpose, people, setting, and delivery.

Prevalence of malnutrition among Samoan children aged 5 to 11 years in 2019-2020.

BACKGROUND: Globally, rapid economic development, urbanisation, and nutrition transitions have led to rising levels of malnutrition in all forms. AIM: The study objective was to document the prevalence of overweight/obesity, underweight, stunting, and anaemia among Samoan children in 2019-2020. SUBJECTS AND METHODS: Children from the Ola Tuputupua'e "Growing Up" in Samoa study at ages 5-11 years with complete physical assessments were included. Overweight/obesity, underweight, and stunting were classified using World Health Organisation Z-scores for body mass index-for-age (BMIZ> +1), weight-for-age (WAZ< -2SD), and height-for-age (HAZ< -2SD), respectively. Anaemia was defined as haemoglobin concentration <11.5 g/dL. Prevalence was compared by child age, sex, and census region of residence (representing urbanicity and exposure to nutrition transition) using Wilcoxon two-sample, Chi-square, or Fisher's exact tests. RESULTS: The prevalence of overweight/obesity, underweight, stunting, and anaemia was 36.2%, 0.5%, 1.6%, and 31.6%, respectively. Overweight/obesity in children was positively associated with age and highly prevalent in periurban and urban regions. While children living in the rural region with the lowest exposure to nutrition transition had the highest prevalence of mild-to-moderate stunting, anaemia prevalence was lower compared to those in the urban region. No sex differences in malnutrition were observed. CONCLUSION: Moderate-to-high levels of overweight/obesity and anaemia call for comprehensive intervention strategies.

Love Shouldn't Hurt - E le Saua le Alofa: Co-designing a theory of change for preventing violence against women in Samoa.

Despite the widespread adoption of Theories of Change (ToC) for programme evaluation, the process of collaboratively developing these theories is rarely outlined or critical analysed, limiting broader methodological discussions on co-production. We developed a ToC as part of E le Saua le Alofa ('Love Shouldn't Hurt') - a participatory peer-research study to prevent violence against women (VAW) in Samoa. The ToC was developed in four phases: (1) semi-structured interviews with village representatives (n = 20); (2) peer-led semi-structured interviews with community members (n = 60), (3) community conversations with 10 villages (n = 217) to discuss causal mechanisms for preventing VAW, and (4) finalising the ToC pathways. Several challenges were identified, including conflicting understandings of VAW as a problem; the linearity of the ToC framework in contrast to intersecting realities of people's lived experiences; the importance of emotional engagements, and theory development as a contradictory and incomplete process. The process also raised opportunities including a deeper exploration of local meaning-making, iterative engagement with local mechanisms of violence prevention, and clear evidence of ownership by communities in developing a uniquely Samoan intervention to prevent VAW. This study highlights a clear need for ToCs to be complemented by indigenous frameworks and methodologies in post-colonial settings such as Samoa.

Pollution and Health Risk Assessments of Potentially Toxic Elements in the Fine-Grained Particles (10−63 µm and <10 µm) in Road Dust from Apia City, Samoa

Fine road dust is a major source of potentially toxic elements (PTEs) pollution in urban environments, which adversely affects the atmospheric environment and public health. Two different sizes (10−63 and <10 µm) were separated from road dust collected from Apia City, Samoa, and 10 PTEs were analyzed using inductively coupled plasma mass spectrometry (ICP-MS). Fine road dust (<10 µm) had 1.2−2.3 times higher levels of copper (Cu), zinc (Zn), arsenic (As), cadmium (Cd), antimony (Sb), lead (Pb), and mercury (Hg) than 10−63 µm particles. The enrichment factor (EF) value of Sb was the highest among PTEs, and reflected significant contamination. Cu, Zn, and Pb in road dust were also present at moderate to significant levels. Chromium (Cr), cobalt (Co), and nickel (Ni) in road dust were mainly of natural origins, while Cu, Zn, Sb, and Pb were due to traffic activity. The levels of PTEs in road dust in Samoa are lower than in highly urbanized cities, and the exposure of residents in Samoa to PTEs in road dust does not pose a noncarcinogenic health risk. Further studies of the effects of PTEs contamination in road dust on the atmosphere and living organisms are needed.

Spatially Explicit Environmental Factors Associated with Lymphatic Filariasis Infection in American Samoa.

Under the Global Program to Eliminate Lymphatic Filariasis (LF) American Samoa conducted seven rounds of mass drug administration (MDA) between 2000 and 2006. Subsequently, the territory passed the WHO recommended school-based transmission assessment survey (TAS) in 2011/2012 (TAS-1) and 2015 (TAS-2) but failed in 2016, when both TAS-3 and a community survey found LF antigen prevalence above what it had been in previous surveys. This study aimed to identify potential environmental drivers of LF to refine future surveillance efforts to detect re-emergence and recurrence. Data on five LF infection markers: antigen, Wb123, Bm14 and Bm33 antibodies and microfilaraemia, were obtained from a population-wide serosurvey conducted in American Samoa in 2016. Spatially explicit data on environmental factors were derived from freely available sources. Separate multivariable Poisson regression models were developed for each infection marker to assess and quantify the associations between LF infection markers and environmental variables. Rangeland, tree cover and urban cover were consistently associated with a higher seroprevalence of LF-infection markers, but to varying magnitudes between landcover classes. High slope gradient, population density and crop cover had a negative association with the seroprevalence of LF infection markers. No association between rainfall and LF infection markers was detected, potentially due to the limited variation in rainfall across the island. This study demonstrated that seroprevalence of LF infection markers were more consistently associated with topographical environmental variables, such as gradient of the slope, rather than climatic variables, such as rainfall. These results provide the initial groundwork to support the detection of areas where LF transmission is more likely to occur, and inform LF elimination efforts through better understanding of the environmental drivers.

Persistence of Rare Salmonella Typhi Genotypes Susceptible to First-Line Antibiotics in the Remote Islands of Samoa.

For decades, the remote island nation of Samoa (population ~200,000) has faced endemic typhoid fever despite improvements in water quality, sanitation, and economic development. We recently described the epidemiology of typhoid fever in Samoa from 2008 to 2019 by person, place, and time; however, the local Salmonella enterica serovar Typhi (S. Typhi) population structure, evolutionary origins, and genomic features remained unknown. Herein, we report whole genome sequence analyses of 306 S. Typhi isolates from Samoa collected between 1983 and 2020. Phylogenetics revealed a dominant population of rare genotypes 3.5.4 and 3.5.3, together comprising 292/306 (95.4%) of Samoan versus 2/4934 (0.04%) global S. Typhi isolates. Three distinct 3.5.4 genomic sublineages were identified, and their defining polymorphisms were determined. These dominant Samoan genotypes, which likely emerged in the 1970s, share ancestry with other 3.5 clade isolates from South America, Southeast Asia, and Oceania. Additionally, a 106-kb pHCM2 phenotypically cryptic plasmid, detected in a 1992 Samoan S. Typhi isolate, was identified in 106/306 (34.6%) of Samoan isolates; this is more than double the observed proportion of pHCM2-containing isolates in the global collection. In stark contrast with global S. Typhi trends, resistance-conferring polymorphisms were detected in only 15/306 (4.9%) of Samoan S. Typhi, indicating overwhelming susceptibility to antibiotics that are no longer effective in most of South and Southeast Asia. This country-level genomic framework can help local health authorities in their ongoing typhoid surveillance and control efforts, as well as fill a critical knowledge gap in S. Typhi genomic data from Oceania. IMPORTANCE In this study, we used whole genome sequencing and comparative genomics analyses to characterize the population structure, evolutionary origins, and genomic features of S. Typhi associated with decades of endemic typhoid fever in Samoa. Our analyses of Samoan isolates from 1983 to 2020 identified a rare S. Typhi population in Samoa that likely emerged around the early 1970s and evolved into sublineages that are presently dominant. The dominance of these endemic genotypes in Samoa is not readily explained by genomic content or widespread acquisition of antimicrobial resistance. These data establish the necessary framework for future genomic surveillance of S. Typhi in Samoa for public health benefit.

Community Perspectives on Contraception in the Context of Zika Virus in American Samoa and the Commonwealth of the Northern Mariana Islands.

The prevention of unintended pregnancy was identified as a primary prevention strategy to reduce Zika-related adverse birth outcomes during the 2016-2017 Zika virus outbreak. The Centers for Disease Control and Prevention in partnership with local health agencies conducted formative research to guide the development of culturally appropriate messages and materials to increase awareness of the prevention of unintended pregnancy as a strategy to decrease Zika-related adverse outcomes in American Samoa and the Commonwealth of the Northern Mariana Islands (CNMI). Nine focus groups (N=71) were conducted with women and men aged 18-44 years living in American Samoa and CNMI. Semi-structured interview guides were used to explore participants' knowledge and perceptions of Zika, family planning, and contraception; barriers and facilitators to access contraception and use; and information sources and contraception decision-making. Trained staff from local organizations co-moderated each focus group. Thematic analysis was conducted with NVivo 10. Participants had mixed knowledge about Zika virus and its relation to pregnancy and birth defects. Women and men had varied knowledge of the full range of contraceptive methods available in their jurisdiction and identified barriers to contraceptive access. Social factors including stigma, gender roles, and religion often deterred participants from accessing contraceptive services. Participants highlighted the need for culturally appropriate and clear messaging about contraceptive methods. Results demonstrate the feasibility of conducting formative research as an effective strategy for understanding community perspectives on unintended pregnancy prevention in the context of the Zika virus outbreak to develop health communication materials.

A screening-level human health risk assessment for microplastics and organic contaminants in near-shore marine environments in American Samoa.

Solid waste disposal is a growing concern among Pacific Island nations. With severe limitations in land area, in combination with the lack of reuse or recycling options, many near-shore marine ecosystems across Oceania are highly impacted by locally derived marine debris, including plastics, microplastics and associated chemical contaminants. In order to catalyze improved solid waste management and plastic use policies, the potential ecological and public health risks must be clearly identified and communicated. Using an ecological risk assessment framework, potential risks to marine ecosystems and human health are explored by quantifying microplastics and organic contaminants in 4 study sites located in Tutuila, American Samoa. Results of sampled near-shore marine waters, marine sediments and molluscs indicate that microplastics are unevenly distributed in the marine environment, with the highest concentrations detected in marine molluscs (e.g. average of 15 and 17 particles per organism, the majority of which were microfibers identified as polyethylene terephthalate). These invertebrates also have the highest environmental concentrations of organic contaminants, including phthalates, pesticides and PCBs. However, based on estimated rates of invertebrate consumption, the risk of adverse impacts to human health are likely to be low. Regardless, future studies are recommended to better understand the environmental partitioning of microplastics in dynamic near-shore marine environments, as well as the specific pathways and consequences of the physical and chemical impacts of microplastics on marine species populations and overall marine ecosystem health.

Gestational Diabetes Mellitus Prevalence, Screening, and Treatment Practices in American Samoa, 2016.

Gestational diabetes mellitus (GDM) is a serious pregnancy complication and understudied public health issue in American Samoa. The goals of this study were to (1) estimate the prevalence of GDM in American Samoa, (2) evaluate current screening practices for GDM, and (3) evaluate obtainment of GDM treatments in 2016. This cross-sectional study used 3 data sources: electronic health records, a labor and delivery logbook, and the American Samoa Department of Health (ASDOH) Maternal and Children's Health (MCH) Postpartum database. Out of 995 women with a singleton birth in American Samoa during the study period, 60.1% (n=598) completed a glucose tolerance test for GDM. Of these women, 41.8% (n=250) completed the testing within the recommended 24-28 weeks gestation timeframe. The estimated prevalence of GDM was 14.0% (95% confidence interval: 11.2-16.8) but has many limitations due to missing data. There were 4 treatments analyzed: nutrition counseling, insulin, metformin, and diabetes counseling. Of all women diagnosed with GDM (n=84), 76% were prescribed any of the 4 treatments. However, only 52% of those women obtained the treatment prescribed. Access to testing and treatment needs to be expanded to provide adequate prenatal care to women in American Samoa.

Modelling lymphatic filariasis elimination in American Samoa: GEOFIL predicts need for new targets and six rounds of mass drug administration.

BACKGROUND: As part of the global effort to eliminate the debilitating mosquito-borne disease lymphatic filariasis (LF), seven rounds of two-drug (diethylcarbamazine and albendazole) mass drug administration (MDA) were conducted in American Samoa over 2000-2006. However subsequent surveys demonstrated ongoing transmission prompting further rounds of three-drug (diethylcarbamazine, albendazole, and ivermectin) MDA starting in 2018. METHODS: We extend GEOFIL, a spatially-explicit agent-based model of LF transmission to predict the probability and timing of the local elimination or resurgence of LF for different MDA scenarios starting in 2018: two-drug vs. three-drug MDA, two to seven annual rounds, and population coverage rates of 55-75%. We developed an interactive visualisation comparing the effect of MDA strategies on different outcomes. RESULTS: At least six annual rounds of three-drug MDA treating 75% of the population were required to achieve LF elimination in American Samoa by 2035 in > 50% of simulations. In scenarios where MDA did not achieve elimination, prevalence doubled approximately every three years, even if MDA reduced antigen prevalence to <1% (the target recommended by the World Health Organisation). Prevalence in six- and seven-year-old children was approximately one quarter of the prevalence in the general population. CONCLUSION: The three rounds of three-drug MDA conducted in 2018, 2019, and 2021 may have come close to WHO targets but are unlikely to interrupt LF transmission in American Samoa without further interventions. The recommended post-MDA surveillance strategy of testing primarily six and seven-year-old children will delay detection of resurgence compared to population representative surveys. The recommended elimination targets (reducing antigen prevalence below 0.5%, 1%, or 2%) may not be sufficient to interrupt transmission in countries with LF epidemiology like American Samoa. Alternative surveillance strategies and interventions designed to identify and eliminate spatially localized residual transmission may need to be considered. Interactive visualisations may assist decision-makers to choose locally appropriate strategies.