Waimanalo Pono Research Hui: A Community-Academic Partnership to Promote Native Hawaiian Wellness through Culturally Grounded and Community-Driven Research and Programming.

Although Hawai'i is often portrayed as an idyllic paradise and is recognized as one of the healthiest States in the United States, pervasive health disparities exist among Native Hawaiians. Similar to other indigenous populations across the globe, these disparities are linked to unjust social and economic policies rooted in colonization and historical trauma. Western-centric efforts to address these disparities have yielded limited results. Consequently, indigenous frameworks to decolonize western-centric research processes have emerged. The Waimanalo Pono Research Hui is an example of a community-academic partnership that uses indigenous methodologies and principles of community-based participatory research as the foundation to engage Native Hawaiian community members in research. Monthly gatherings are held where community members and academic researchers share a meal and discuss community priorities with the goal of shaping research and programming that are rooted in Native Hawaiian values. A mission for the group has been created as well as protocols for community engagement to ensure all projects that work with the Waimanalo Pono Research Hui are ethically sound and grounded in the community's preferences, cultural knowledge, and lived experiences. Our community members continually report that the Waimanalo Pono Research Hui has positively transformed their perception of and willingness to engage in research. Similarly, university students and academic researchers express how much their knowledge about working with communities has grown and inspired them. Creating spaces for communities and researchers to build authentic relationships and engage in ongoing conversations can promote culturally grounded and community-driven research and programming.

Anti-Diabetic Potential of Noni: The Yin and the Yang.

Escalating trends of chronic diseases such as type-2 diabetes (T2D) have sparked a renewed interest in complementary and alternative medicine, including herbal products. Morinda citrifolia (noni) has been used for centuries by Pacific Islanders to treat various ailments. Commercial noni fruit juice has been marketed as a dietary supplement since 1996. In 2003, the European Commission approved Tahitian noni juice as a novel food by the Health and Consumer Protection Directorate General. Among noni's several health benefits, others and we have demonstrated the anti-diabetic effects of fermented noni fruit juice in animal models. Unfortunately, noni's exciting journey from Polynesian medicine to the research bench does not reach its final destination of successful clinical outcomes when translated into commercial products. Noni products are perceived to be safe due to their "natural" origin. However, inadequate evidence regarding bioactive compounds, molecular targets, mechanism of action, pharmacokinetics, long-term safety, effective dosages, and/or unanticipated side effects are major roadblocks to successful translation "from bench side to bedside". In this review we summarize the anti-diabetic potential of noni, differences between traditional and modern use of noni, along with beneficial clinical studies of noni products and challenges in clinical translation of noni's health benefits.

MALAMA: Cultivating Food Sovereignty through Backyard Aquaponics with Native Hawaiian Families.

Native Hawaiians were a healthy and robust population who developed a sophisticated food system that was dismantled by colonization. Currently, Native Hawaiians face pervasive health disparities due to the limited access to healthy foods and lifestyles. This study pilot tested a family-based community-driven intervention called MALAMA, which teaches families to build and use a backyard aquaponics system to grow their own food. A total of 21 participants from 10 families completed a three-month curriculum that included a series of hands-on workshops. Participant attendance was recorded and participants completed a behavioral health questionnaire as well as provided clinical indicators at three time points. They also attended a focus group at the end of the curriculum. There was a high level of engagement and no participant attrition. Fruit consumption among all participants significantly increased and there were favorable trends in blood pressure and fish and vegetable consumption. No significant differences were found in the other clinical indicators. Participants found MALAMA to be highly culturally acceptable and identified multiple benefits. Community-driven solutions, such as MALAMA, may be a promising approach to addressing pervasive health disparities and promoting health equity in minority and Indigenous communities.

Pili Pono Practice: A Qualitative Study on Reimagining Native Hawaiian Food Sovereignty through MALAMA Backyard Aquaponics.

Living in one of the most remote island chains in the world, Native Hawaiians developed sophisticated food cultivation systems that sustained a thriving and robust population for centuries. These systems were disrupted by colonization, which has contributed to the health disparities that Native Hawaiians face today. MALAMA, a culturally grounded backyard aquaponics program, was developed to promote food sovereignty among Native Hawaiians. This study utilized participant interview and focus group data to identify how participating in the MALAMA program impacts the wellbeing. The findings demonstrate that MALAMA enhanced the participants' pilina (relationship, connection) to traditional foods, land, cultural identity, family, and community, which contributed to the quick adoption of the program into Native Hawaiian communities. To address food insecurity, it is imperative to seek Indigenous-developed, community-based, and culturally grounded programs and solutions like the MALAMA program.

Psychometric Evidence of the Attitudes Toward Food Scale for Native Hawaiians.

Many efforts are being made to promote healthy eating habits and nutrition among Native Hawaiian communities by cultivating positive attitudes toward healthy foods. However, there are limited quantitative scales that have been psychometrically validated with Native Hawaiian communities. This paper examines evidence on the reliability and validity of the Attitudes Toward Food (ATF) scale used with 68 Native Hawaiian adults from Waimanalo who are participating in a backyard aquaponics intervention called Mini Ahupua'a for Lifestyle and Mea'ai through Aquaponics (MALAMA). Exploratory factor analysis (EFA) and internal consistency reliability analysis were conducted to examine the underlying constructs of the ATF scale. Cognitive interviews with 3 MALAMA participants were also conducted to analyze how participants understood, processed, and responded to the scale. Findings from the cognitive interviews provided response-process evidence of validity and acceptability. Findings from the EFA revealed 2 factors. Factor 1 contained items that discussed confidence in preparing and using healthy foods. Factor 2 contained items that involved the consumption of healthy foods. The reliability analysis suggested that the 2 factors of the ATF scale are internally consistent (Cronbach's alpha = 0.79 and 0.71, respectively). Taken together, the evidence provides provisional support for the validity and reliability of the instrument for measuring attitudes among Native Hawaiians from Waimanalo. The ATF scale may be useful for similar health and nutritional programs for Native Hawaiians in Hawai'i. Future studies with larger samples and diverse sources of validity evidence may provide additional support of the scale's validity.

Economic Adversity Transitions From Childhood to Older Adulthood Are Differentially Associated With Later-Life Physical Performance Measures in Men and Women in Middle and High-Income Sites.

Objective: This study examines the relationship between economic adversity transitions from childhood to older adulthood and older adulthood physical performance among 1,998 community-dwelling older adults from five demographically diverse sites from middle and high-income countries. Method: The principal exposure variable was economic adversity transition. No adversity encompassed not experiencing poverty in both childhood and older adulthood, improved described having only experienced poverty in childhood, worsened captured having experienced poverty in older adulthood, and severe is having experienced poverty in both childhood and older adulthood. The short physical performance battery (SPPB) was used for outcome measures. Analyses of the continuous SPPB score used linear regression, while analysis of a binary outcome (SPPB < 8 vs. ≥8) used Poisson regression models with robust error variance, both adjusting for sex, education, and site location. Result: In sex-stratified models, the SPPB < 8 prevalence rate ratio (PRR) was higher for the severe (PRR: 2.80, 95% confidence interval [CI] = [1.70, 4.61]), worsened (PRR: 2.40, 95% CI = [1.41, 4.09]), and improved (PRR: 1.82, 95% CI = [1.11, 3.01]) groups, compared with those with no adversity in childhood or as adults, but only for females. Discussion: Findings from this study indicate that persistent economic adversity has a negative effect on older adult physical performance, especially among women.

Integrating Native Hawaiian tradition with the modern technology of aquaponics.

Prior to western arrival in 1778, Native Hawaiians possessed a sophisticated culture and resource management system conducive to an island ecosystem. However, disenfranchisement from ancestral lands and traditional food sources as a result of colonization led to Native Hawaiians being forced to abandon many of their traditional practices. Today, many Native Hawaiians experience food insecurity, placing them at further risk for obesity and other nutrition-related chronic diseases. Consequently, there is a growing need for place-based and culturally relevant strategies rooted in Hawaiian epistemology to address these issues. This paper describes the history and development of one such intervention - the MALAMA study - in the community of Waimanalo that innovatively merges the modern technology of aquaponics with traditional Native Hawaiian practices and values.

Insights in public health: Community strengthening through canoe culture: Ho'omana'o Mau as method and metaphor.

Historical trauma occurs across generations and is evidenced by indigenous disparities. Efforts made to address this issue commonly utilize European ethnocentric methods. Rather, a community-based approach should be used to empower indigenous communities. God's Country Waimanalo (GCW) is a grassroots organization developed by Native Hawaiians for Native Hawaiians. Its wa'a (canoe) project, Ho'omana'o Mau (everlasting memories; abbreviated Ho'o) is meant to perpetuate pre-colonial Hawaiian practices by educating Native Hawaiian communities and its partners through hands on experience. Since 2012, GCW has opened its wa'a curricula to educators, counselors, and students from the University of Hawai'i at Manoa, Queen Lili'uokalani Children's Center, Alu Like, Hina Mauka, and the Youth Correctional Facility and contributed to Waimanalo based events such as funeral ash scattering and the papio fishing tournament. As metaphor, Ho'o is viewed as the catalyst to engage the next generation of Hawaiians to remember where they descend from, the lineage of chiefs and royalty, while establishing a solid foundation of independence and enhancing their ability to become self-sustaining. As a method, Ho'o is viewed as a classroom, a hands-on learning environment, and an ocean vessel, assembled according to traditional Hawaiian knowledge. Through this knowledge and practice, both indigenous and non-indigenous communities can work together in empowering Native Hawaiians to overcome historical trauma and reduce health disparities.