Coral reefs in transition: Temporal photoquadrat analyses and validation of underwater hyperspectral imaging for resource-efficient monitoring in Guam.

The island of Guam in the west Pacific has seen a significant decrease in coral cover since 2013. Lafac Bay, a marine protected area in northeast Guam, served as a reference site for benthic communities typical of forereefs on the windward side of the island. The staghorn coral Acropora abrotanoides is a dominant and characteristic ecosystem engineer of forereef communities on exposed shorelines. Photoquadrat surveys were conducted in 2015, 2017, and 2019, and a diver-operated hyperspectral imager (i.e., DiveRay) was used to survey the same transects in 2019. Machine learning algorithms were used to develop an automated pipeline to assess the benthic cover of 10 biotic and abiotic categories in 2019 based on hyperspectral imagery. The cover of scleractinian corals did not differ between 2015 and 2017 despite being subjected to a series of environmental disturbances in these years. Surveys in 2019 documented the almost complete decline of the habitat-defining staghorn coral Acropora abrotanoides (a practically complete disappearance from about 10% cover), a significant decrease (~75%) in the cover of other scleractinian corals, and a significant increase (~55%) in the combined cover of bare substrate, turf algae, and cyanobacteria. The drastic change in community composition suggests that the reef at Lafac Bay is transitioning to a turf algae-dominated community. However, the capacity of this reef to recover from previous disturbances suggests that this transition could be reversed, making Lafac Bay an excellent candidate for long-term monitoring. Community analyses showed no significant difference between automatically classified benthic cover estimates derived from the hyperspectral scans in 2019 and those derived from photoquadrats. These findings suggest that underwater hyperspectral imagers can be efficient and effective tools for fast, frequent, and accurate monitoring of dynamic reef communities.

Knowledge, Attitudes, Beliefs, Practices Regarding Human Papillomavirus (HPV), and Barriers to Vaccination Against HPV Infection: A Cross-Sectional Survey of Guam Residents.

Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States and is linked to several cancers. In Guam, the HPV vaccination rate falls short of the National Healthy People 2030 goal. Only half of eligible Guam teens have received the HPV vaccination series. Additionally, research on Guam HPV vaccination is limited. A cross-sectional survey was conducted, and a representative sample of Guam residents (n=775) was surveyed to examine their knowledge, attitudes, beliefs, practices regarding HPV, and barriers to HPV vaccination. Aggregated scores were calculated for these scale items: attitude, knowledge, subjective norms, and perceived behavioral control regarding HPV. One-way Analysis of Variance (ANOVA) was used to compare the means of the scores and check for significant differences. Binary logistic regression helped to identify significant predictors of HPV vaccination among respondents with children. Significant differences were found for sex, education, income, and ethnicity. Women and those with higher education and income demonstrated higher positive attitudes and knowledge about HPV vaccination. Also, those with health insurance and those who were advised by their physician were more likely to get their children vaccinated. These results will guide the implementation of effective strategies for developing targeted behavioral and other appropriate interventions to increase HPV vaccination in Guam.

What Motivates Betel Quid Chewers to Quit? An Analysis of Several Cessation-Relevant Variables.

Introduction: Betel quid (BQ) is globally the fourth most consumed psychoactive substance. It is consumed by an estimated 600 million people worldwide, accounting for nearly 8% of the world's population. There have been very few studies assessing chewers' motivation to quit. Objectives: In the current study, we sought to understand the relationship between several cessation-relevant variables and chewers' motivation to quit. Hypotheses: Based on analogous research on cigarette smoking, we hypothesized that the following cessation-relevant variables would be associated with motivation to quit: health risk perceptions, number of chews per day, cost, degree of BQ dependence, withdrawal symptoms, number of quit attempts, reasons for use, personal health improvement, and type of BQ chewed. Methods: A total of 351 adult BQ chewers from Guam participated in the survey and served as the sample for the analyses. Results: Majority of chewers want to quit and intend to quit. Chewers relatively high in motivation to quit evinced greater health risk perceptions of BQ chewing, greater perceived health benefits to quitting, and a greater number of past quit attempts, compared to those relatively low in motivation to quit. Conclusions: Understanding which factors are associated with chewers' motivation to quit can be helpful for designing BQ cessation programs. The results suggest that BQ cessation programs could be improved by an increased emphasis on information about the negative health effects of BQ chewing and relapse-prevention.

Disparities in Colorectal Cancer Incidence among Asian and Pacific Islander Populations in Guam, Hawai'i, and the United States.

Colorectal cancer (CRC) ranks among the three most common cancers in Guam (GU), Hawai'i (HI), and the mainland United States (US). CRC prevalence in these areas is high among Filipinos, and indigenous CHamorus and Native Hawaiians; however, data on these populations are frequently aggregated in epidemiological studies, which can mask true CRC disparities. We examined CRC cumulative incidence rates (CIRs) among CHamorus in GU, Filipinos in GU, HI, and the US, and Native Hawaiians in HI and the US. CRC CIRs were calculated for two age groups (20-49 years; early onset, and 50-79 years; senior) and four time periods (2000-2004, 2005-2009, 2010-2014, and 2015-2019), stratified by ethnicity, sex, and location. Data analyzed included all invasive CRC cases reported to the Surveillance, Epidemiology, and End Results 9-Registry (n = 166,666), the Hawai'i Tumor Registry (n = 10,760), and the Guam Cancer Registry (n = 698) between 2000 and 2019. Senior CIRs were highest in HI and lowest in GU throughout all time periods, with a downward trend observed for senior CIRs in the US and HI, but not GU. This downward trend held true for all ethnic groups, except for CHamorus in GU, females in GU, and females of CHamoru ethnicity in GU. In contrast, early onset CIRs increased across all locations, sexes, and ethnic groups, except for Filipinos in HI and males of Filipino ethnicity in HI. Our findings provide crucial insights for future research and policy development aimed at reducing the burden of CRC among indigenous populations.

Taxonomic profiling of Nasutitermes takasagoensis microbiota to investigate the role of termites as vectors of bacteria linked to ironwood tree decline in Guam.

The ironwood tree (Casuarina equisetifolia, family Casuarinaceae), an indigenous agroforestry species in Guam, has been threatened by ironwood tree decline (IWTD) since 2002. Formation of bacterial ooze by the wilt pathogen from the Ralstonia solanacearum species complex and wetwood bacteria (primarily Klebsiella species) has been linked to IWTD. In addition, termite infestation of trees was statistically associated with IWTD. Termites are known carriers of a diverse microbiome. Therefore, we hypothesized that termites could be vectors of bacteria linked to IWTD. To investigate the potential role of termites as pathogen vectors, we employed next-generation 16S rRNA gene sequencing to describe the bacteria diversity of Nasutitermes takasagoensis (Family Termitidae) workers collected from 42 ironwood trees of different disease stages in Guam in association with tree-, plot-, and location-related factors. Nasutitermes takasagoensis workers account for the majority of termite infestations of ironwood trees. The bacterial phyla composition of N. takasagoensis workers was typical for wood-feeding higher termites consisting mainly of Spirochaetes and Fibrobacteres. However, Ralstonia species were not detected and Klebsiella species were rare even in termites collected from trees infected with Ralstonia and wetwood bacteria. Feeding experiments suggested that termites prefer to consume wood with low pathogen content over wood with high pathogen load. Termites were able to ingest Ralstonia but Ralstonia could not establish itself in healthy termite bodies. We concluded that N. takasagoensis workers are not vectors for Ralstonia spp. or the bacterial endophytes associated with wetwood (Klebsiella, Pantoea, Enterobacter, Citrobacter, and Erwinia) that were previously observed in IWTD-infested trees. The bacterial diversity in termite samples was significantly influenced by various factors, including Tree Health, Site Management, Plot Average Decline Severity, Proportion of Dead Trees in the Plot, Proportion of Trees with Termite Damage in the Plot, Presence of Ralstonia, and Altitude.

Spatial extent of dysbiosis in the branching coral Pocillopora damicornis during an acute disease outbreak.

Globally, coral reefs face increasing disease prevalence and large-scale outbreak events. These outbreaks offer insights into microbial and functional patterns of coral disease, including early indicators of disease that may be present in visually-healthy tissues. Outbreak events also allow investigation of how reef-building corals, typically colonial organisms, respond to disease. We studied Pocillopora damicornis during an acute tissue loss disease outbreak on Guam to determine whether dysbiosis was present in visually-healthy tissues ahead of advancing disease lesions. These data reveal that coral fragments with visual evidence of disease are expectedly dysbiotic with high microbial and metabolomic variability. However, visually-healthy tissues from the same colonies lacked dysbiosis, suggesting disease containment near the affected area. These results challenge the idea of using broad dysbiosis as a pre-visual disease indicator and prompt reevaluation of disease assessment in colonial organisms such as reef-building corals.

Types of Offers of Combustible Cigarettes, E-Cigarettes, and Betel Nut Experienced by Guam Youths.

The present study examined types of scenarios in which Guam youths are offered tobacco-namely, combustible cigarettes and e-cigarettes-and betel (areca) nut. We conducted 10 focus groups with public middle school students (n = 34) from Guam. Results suggested that the types of offer scenarios of combustible cigarettes, e-cigarettes, and betel nut referenced by the students fall into two categories-direct-relational offers and indirect-contextual offers. The results also suggested that both categories of offer scenarios were more likely to occur in school rather than in other locations such as the home. Family members were more likely to make offers than other types of people. Indirect-contextual offers were more easily avoidable depending on the substance offered, the location where the offer took place, and the person making the offer. Based on the findings, we provide brief suggestions on developing a school-based prevention curriculum focused on training young adolescents from Guam on ways to resist offers of cigarettes, e-cigarettes, and betel nut.

[Parkinson-dementia and amyotrophic lateral sclerosis association (complex of Guam). Diagnostic challenge, Mexican patient]. / Asociación Parkinson-demencia y esclerosis lateral amiotrófica (complejo Guam). Reto diagnóstico, paciente mexicano.

Background: The Amyotrophic Lateral Sclerosis-Parkinsonism-Dementia Complex (ALS-PDC) was first described in the islands of Guam. This pathology presented its peak incidence in the 1950s. Due to the rarity of the association, we report a clinical case with this complex. The objective was to describe the nosological and pathogenic implications of these neurodegenerative disorder, since they are not frequent to find in our population. Clinical case: We present a case of Latinoamerican origin who initially manifested systemic symptoms of more than 6 years of evolution, with subsequent cognitive alterations. Later, patient began with gait disturbances and motor symptoms suggestive of parkinsonism with atypical data and data of motor neurone disease (MND). More studies were carried out and confirmed findings compatible with upper and lower motor neuron involvement. A mutation in the POLG gene was observed, related to mitochondrial depletion syndrome. Conclusion: Despite the knowledge of this association, it is an entity whose clinical diagnosis could be very difficult to achieve. In addition, molecular mechanisms have not been fully identified, the most common genes related to Parkinsonism and ALS have been excluded, and even attempts to locate the locus were made, without achieving accurate results. Unfortunately, being a neurodegenerative disease, the prognosis is fatal, with no disease-modifying treatment.

Introducción: el complejo parkinsonismo-demencia-esclerosis lateral amiotrófica fue descrito por primera vez en las islas de Guam. Esta patología presentó su pico de incidencia en los años 50. Debido a la rareza de la asociación, informamos sobre un caso clínico que la presenta. El objetivo fue describir las implicaciones nosológicas y patogénicas de este trastorno neurodegenerativo, ya que no es frecuente encontrar esta asociación en nuestra población. Caso clínico: presentamos un caso de origen latinoamericano que inicialmente se manifestó con síntomas sistémicos de más de 6 años de evolución, con posteriores alteraciones cognitivas. Después presentó alteraciones de la marcha y síntomas motores sugestivos de parkinsonismo con datos atípicos y datos de enfermedad de motoneurona. Se hicieron estudios de extensión que confirmaron hallazgos compatibles con afectación en motoneurona superior e inferior. Observamos mutación en gen POLG, relacionada con síndrome de depleción mitocondrial. Conclusión: a pesar del conocimiento de esta asociación, es una entidad cuyo diagnóstico clínico puede ser muy difícil de obtener. Además, no se han identificado del todo los mecanismos moleculares, se han excluido los genes más comunes relacionados con parkinsonismos y esclerosis lateral amiotrófica e incluso se intentó localizar el locus, sin lograr resultados certeros. Desafortunadamente al ser una enfermedad neurodegenerativa el pronóstico es fatal, sin que haya tratamiento modificador de la enfermedad.

Perceived Barriers and Benefits of COVID-19 Testing among Pacific Islanders on Guam.

Pacific Islanders residing in the U.S. Affiliated Pacific Islands have had among the highest COVID-19-associated morbidity and mortality rates in the U.S. To reduce this disparity, we conducted a study to increase the reach and uptake of COVID-19 testing in Guam. Participants, who completed a pre-survey on demographics, health status, history of COVID-19 testing and vaccination, access to COVID-19 testing, sources of COVID-19 information, and knowledge and attitudes towards COVID-19 test results and transmission, were invited to attend an online educational session about COVID-19 testing and transmission and to complete a post-survey. There were significant positive changes between pre- and post-survey in knowledge and perceptions about COVID-19 testing and transmission, but changes were not necessarily due to exposure to the educational session. Compared to CHamoru participants (n = 380), Other Micronesians (n = 90) were significantly less knowledgeable about COVID-19 transmission and testing, were significantly more likely to not want to know if they had COVID-19, were more likely to believe if they did have COVID-19 there was not much that could be done for them, and that they would have difficulty in getting the needed healthcare. This study is another example of disparities in health knowledge and perceptions of certain Pacific Islander groups.

Prediction of habitat complexity using a trait-based approach on coral reefs in Guam.

Scleractinian corals are primary contributors to the structural complexity of coral reef ecosystems. The structure derived from their carbonate skeletons underpins the biodiversity and myriad of ecosystem services provided by coral reefs. This study used a trait-based approach to provide new insights into the relationships between habitat complexity and coral morphology. Three-Dimensional (3D) photogrammetry techniques were used to survey 208 study plots on the island of Guam, from which structural complexity metrics were derived and physical traits of corals were quantified. Three traits at the individual colony level (e.g., morphology, size, and genera) and two site-level environmental characteristics (e.g., wave exposure and substratum-habitat type) were examined. Standard taxonomy-based metrics were also included at the reef-plot level (e.g., coral abundance, richness, and diversity). Different traits disproportionately contributed to 3D metrics of habitat complexity. Larger colonies with a columnar morphology have the highest contribution to surface complexity, slope, and vector ruggedness measure, whereas branching and encrusting columnar colonies have the highest contribution to planform and profile curvature. These results highlight the importance of considering colony morphology and size in addition to conventional taxonomic metrics for the understanding and monitoring reef structural complexity. The approach presented here provides a framework for studies in other locations to predict the trajectory of reefs under changing environmental conditions.

Guam Adolescents' Use of Strategies to Resist Cigarette, e-Cigarette, and Betel Nut Offers: Findings from a Focus Group Study.

Background: This study examined resistance strategies used by predominantly Pacific Islander young adolescents in response to offers of tobacco, e-cigarettes, and betel [areca] nuts. This study was intended to inform the development of a prevention curriculum focused on training young adolescents from the U.S.-Affiliated Pacific Islands (USAPI) on culturally appropriate strategies to resist substance use offers. Currently, very little is understood in terms of how Pacific Islander youths deal with tobacco and other substance use offers, although the use of tobacco products among Pacific Islander youths is high. Specifically, given the collectivist sociocultural orientation of the Pacific Islander communities, it is unclear whether the direct (overt) confrontational style of resistance is a viable mode of resistance for youths to practice when faced with a substance use offer. Methods: We conducted 10 focus groups with public middle school students (N = 34) from Guam, which is part of the USAPI. Results: Results suggested that, as with other communities in the U.S., the resistance strategies fall into two categories-overt/confrontational and non-confrontational resistance strategies. Overt/confrontational strategies included (a) saying "no" and (b) verbally confronting the offeror. Non-confrontational strategies included (a) avoiding or leaving the situation and (b) telling an adult. Conclusions: Our findings have implications for the development of culturally grounded interventions aimed at preventing youth tobacco and other substance use in Guam, the USAPI, and the Pacific region.

A mathematical model of invasion and control of coconut rhinoceros beetle Oryctes rhinoceros (L.) in Guam.

The coconut rhinoceros beetle (CRB), is one of the most damaging pests to coconut palms causing severe economic harm. Its expansion from Asia to the Pacific in the early 20th century has been stopped by virus control. However, a new haplotype CRB-Guam has recently escaped this control and invaded Guam, other Pacific islands, and has even established itself in the Western Hemisphere. In this paper, we present a compartmental ODE model of CRB population and control. We carefully consider CRB life stages and its interplay with coconut palms as well as "the green waste", the organic matters used by CRB for breeding sites. We calibrate and validate the model based on data count of CRBs trapped in Guam between 2008 and 2014. We derive the basic reproduction number determining the CRB population growth without any control measures. We also identify control levels required to eliminate CRBs. We show that, in the absence of viable virus control, the sanitation, i.e., the removal of the green waste is the most efficient way to control the population. Our model predicts that the sanitation efforts need to roughly double from the current levels to eliminate CRB from Guam. Furthermore, we demonstrate that a rare event like Typhoon Dolphin that hit Guam in 2015 can lead to a quick rise of the CRB population.

Breast, cervical, and colorectal cancer screening test use in the US territories of Guam, Puerto Rico, and the US Virgin Islands.

BACKGROUND: The United States Preventive Services Task Force (USPSTF) recommends breast, cervical, and colorectal cancer screening among eligible adults, but information on screening use in the US territories is limited. METHODS: To estimate the proportion of adults up-to-date with breast, cervical, and colorectal cancer screening based on USPSTF recommendations, we analyzed Behavioral Risk Factor Surveillance System data from 2016, 2018, and 2020 for the 50 US states and DC (US) and US territories of Guam and Puerto Rico and from 2016 for the US Virgin Islands. Age-standardized weighted proportions for up-to-date cancer screening were examined overall and by select characteristics for each jurisdiction. RESULTS: Overall, 67.2% (95% CI: 60.6-73.3) of women aged 50-74 years in the US Virgin Islands, 74.8% (70.9-78.3) in Guam, 83.4% (81.7-84.9) in Puerto Rico, and 78.3% (77.9-78.6) in the US were up-to-date with breast cancer screening. For cervical cancer screening, 71.1% (67.6-74.3) of women aged 21-65 years in Guam, 81.3% (74.6-86.5) in the US Virgin Islands, 83.0% (81.7-84.3) in Puerto Rico, and 84.5% (84.3-84.8) in the US were up-to-date. For colorectal cancer screening, 45.2% (40.0-50.5) of adults aged 50-75 years in the US Virgin Islands, 47.3% (43.6-51.0) in Guam, 61.2% (59.5-62.8) in Puerto Rico, and 69.0% (68.7-69.3) in the US were up-to-date. Adults without health care coverage reported low test use for all three cancers in all jurisdictions. In most jurisdictions, test use was lower among adults with less than a high school degree and an annual household income of < $25,000. CONCLUSION: Cancer screening test use varied between the US territories, highlighting the importance of understanding and addressing territory-specific barriers. Test use was lower among groups without health care coverage and with lower income and education levels, suggesting the need for targeted evidence-based interventions.

Traditional and new lifestyle interventions to prevent breast cancer recurrence (TANICA): a qualitative study.

PURPOSE: Breast cancer is the second cause of death from cancer in Guam and Hawai'i and disproportionately impacts Native Hawaiian, CHamoru, and Filipino women. Although a few culturally informed interventions addressing breast cancer survivorship exist, none have been developed or tested for Native Hawaiian, CHamoru, and Filipino women. To address this, the TANICA study began with key informant interviews in 2021. METHODS: Purposive sampling and grounded theory approaches were used to conduct semi-structured interviews with individuals experienced in providing healthcare or implementing community programs and/or research with ethnic groups of interest in Guam and Hawai'i. A literature review and expert consultation identified intervention components, engagement strategies, and settings. Interview questions aimed to understand the relevance of evidence-based interventions and explored socio-cultural factors. Participants completed demographics and cultural affiliation surveys. Interviews were independently analyzed by trained researchers. Themes were mutually agreed upon by reviewers and key themes were identified based on frequencies. RESULTS: Nineteen interviews were conducted in Hawai'i (n=9) and Guam (n=10). Interviews confirmed the relevance of most of the previously identified evidence-based intervention components for Native Hawaiian, CHamoru, and Filipino breast cancer survivors. Ideas around culturally responsive intervention components and strategies emerged that were shared across and unique to each ethnic group and site. CONCLUSION: Evidence-based intervention components appear relevant, yet cultural and place-based strategies are needed for Native Hawaiian, CHamoru, and Filipino women in Guam and Hawai'i. Future research should triangulate these findings with the lived experiences of Native Hawaiian, CHamoru, and Filipino breast cancer survivors to develop culturally informed interventions.

Suicide risk and prevention in Guam: Clinical and research considerations and a call to action.

The suicide rate in Guam, a United States (U.S.) territory, is markedly higher than the suicide rate within the U.S. There are also important differences in who is most at risk for suicide in Guam, relative to within the general U.S. Understanding these distinctions is important for implementing effective suicide prevention initiatives in this region. In the current article, we discuss considerations for preventing suicide in Guam, including distinctions in suicide risk, relative to within the general U.S. For example, suicide rates in Guam are highest for those who are Pacific Islander, young, or male. Further, suicide in Guam more commonly involves hanging and less commonly involves firearms, a pattern that differs from suicide methods used within the general U.S. Additional considerations include the large military and Veteran population in Guam, as well as cultural and religious beliefs regarding suicide. Finally, given the geographic isolation of Guam, access to healthcare is likely an important facet of suicide risk. Considering these characteristics, it is imperative to develop and implement culturally-sensitive suicide prevention interventions for individuals residing in this region. We conclude by discussing future research avenues to address critical knowledge gaps to prevent suicide in Guam.

Cervical Cancer and HPV Knowledge and Awareness: An Educational Intervention among College Students in Guam.

BACKGROUND: Compared to the U.S. population, cervical cancer (CC) incidence is significantly higher among the CHamoru, Micronesian, and Caucasian populations in Guam. From 2008-2012, CC was the fifth most common cancer diagnosed on the island. Despite the prevalence of CC and low HPV vaccine uptake, there is a concerning lack of awareness and preventative behavior among young adults.  This study was aimed at influencing college students' knowledge and awareness of CC, CC screening, HPV, and the HPV vaccination. METHODS: We delivered a 30-minute educational intervention to a sample of 108 university students in a classroom setting. The effect of the educational intervention was measured through a pre-and post-test on CC and HPV health behaviors, knowledge, and awareness. Results were analyzed using SPSS and an exact McNemar's test was used to examine the difference in the proportion of correct answers to the tests. Two-way mixed ANOVA was used to examine between (gender, ethnicity, and class level) and within subjects (pre-and post-test) program effects. RESULTS: Of the 108 participants, only 39 (36.1%) reported being vaccinated for HPV, 23 (21.3%) had not been vaccinated, and 46 (42.6%) did not know if they had been vaccinated for HPV.  Only forty-one (60.3%) female participants had had a Pap smear. When comparing the pre-to-posttest responses, most questions had an increase in correct responses. Time also influenced CCA and HPV knowledge and awareness scores as there was a significant increase in scores from the pre- to post-test. CONCLUSION: The educational intervention was an effective tool for increasing knowledge and awareness of CC, HPV, and HPV vaccination among college students. While study results demonstrate the educational intervention's success as a baseline measure of knowledge, the inclusion of behavioral outcome measures, such as intent to get vaccinated or screened, could result in more robust future studies.

Locating Culturally Safe Care in Narratives of Historical Trauma and Health in Guam: A Third-Space Model of CHamoru Health.

We sought to understand contemporary health beliefs and practices of the CHamorus of Guam in the context of their perceptions of historical trauma. Narrative analysis of 20 story-eliciting interviews with 10 CHamoru adults identified stories of health and illness and living in-betweenness, wherein participants described navigation between health practices of Traditional and Western cultures in the centuries-long involvement with the colonizing culture. Those connections pointed to a conceptual third-space, informed by Homi Bhabha, in which historical trauma and the in-betweenness of Traditional and Western health open new possibilities of what culturally safe health care might look like for CHamorus.

Knowledge and Attitudes of Guam Residents towards Cancer Clinical Trial Participation.

(1) Background: Currently there are no cancer clinical trials in Guam, where CHamoru people suffer the highest rates of cancer mortality, and interest to do so is growing. This study investigated the knowledge and attitudes of Guam residents towards cancer clinical trial participation prior to implementation. (2) Methods: A telephone survey was developed, tested, and conducted among Guam resident adults, 18 years of age and older. Survey questions were summarized by descriptive statistics. Logistic regression models were used to investigate the associations between Guam residents' demographics and their clinical trial knowledge and attitudes. Adjusted odds ratios (aOR) and associated 95% confidence intervals (CI) were calculated. (3) Results: One hundred fifty-two people participated in the survey, most of whom were CHamoru (47.0%). Fifty-three percent had heard the term 'clinical trial'; 73.7% would take part in a trial if they had cancer; and 59.9% believed they would receive good quality treatment from a trial offered in Guam. CHamoru were more likely than Whites to associate out-of-pocket expenses with clinical trial participation (aOR = 5.34, 95% CI = 1.68-17.00). Physician ethnicity was important to 30% of non-Whites and significantly associated with those who spoke a language other than English (aOR = 3.40, 95% CI = 1.29-8.95). Most people (65.0%) did not believe clinical trials participants were 'guinea pigs'. (4) Conclusion: Though knowledge about cancer clinical trials is limited, attitudes were primarily positive towards participating in cancer clinical trials offered in Guam. Future delivery of cancer clinical trials will benefit from identifying potential barriers to recruitment and adopting an approach suited to Guam's population.