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Concept: Pacific Islander American


Malignant mesothelioma is a neoplasm associated with occupational and environmental inhalation exposure to asbestos* fibers and other elongate mineral particles (EMPs) (1-3). Patients have a median survival of approximately 1 year from the time of diagnosis (1). The latency period from first causative exposure to malignant mesothelioma development typically ranges from 20 to 40 years but can be as long as 71 years (2,3). Hazardous occupational exposures to asbestos fibers and other EMPs have occurred in a variety of industrial operations, including mining and milling, manufacturing, shipbuilding and repair, and construction (3). Current exposures to commercial asbestos in the United States occur predominantly during maintenance operations and remediation of older buildings containing asbestos (3,4). To update information on malignant mesothelioma mortality (5), CDC analyzed annual multiple cause-of-death records(†) for 1999-2015, the most recent years for which complete data are available. During 1999-2015, a total of 45,221 deaths with malignant mesothelioma mentioned on the death certificate as the underlying or contributing cause of death were reported in the United States, increasing from 2,479 deaths in 1999 to 2,597 in 2015 (in the same time period the age-adjusted death rates(§) decreased from 13.96 per million in 1999 to 10.93 in 2015). Malignant mesothelioma deaths increased for persons aged ≥85 years, both sexes, persons of white, black, and Asian or Pacific Islander race, and all ethnic groups. Despite regulatory actions and the decline in use of asbestos the annual number of malignant mesothelioma deaths remains substantial. The continuing occurrence of malignant mesothelioma deaths underscores the need for maintaining measures to prevent exposure to asbestos fibers and other causative EMPs and for ongoing surveillance to monitor temporal trends.

Concepts: Cancer, Death, Demography, United States, Race, Mesothelioma, Asbestos, Pacific Islander American


This study examined the state of obesity, diabetes, and associated health disparities among understudied multiracial, Native Hawaiian and Other Pacific Islander (NHOPI), and American Indian and Alaskan Native (AIAN) adults.

Concepts: Hawaii, United States, White American, Pacific Ocean, Native Americans in the United States, Hispanic and Latino Americans, Native Hawaiians, Pacific Islander American


National estimates of U.S. Native Hawaiian and other Pacific Islander (NHPI), American Indian/Alaskan Native (AIAN), and multiracial adolescent substance use and suicidality are scarce because of their small population sizes. The aim was to estimate the national prevalence of, and disparities in, substance use and suicidality among these understudied adolescents.

Concepts: Hawaii, United States, White American, Pacific Ocean, Native Americans in the United States, Hispanic and Latino Americans, Native Hawaiians, Pacific Islander American


Targeting Native Hawaiian and other Pacific Islander (NHOPI) children based on their physical activity (PA) stages of change (SOC) may improve intervention effectiveness. No known SOC surveillance system exists for NHOPI jurisdictions. The purpose was to determine the PA SOC prevalence over 5 years in children living in Hawai'i. Self-reported PA SOC from 5 cohorts (3-6 grade students) in Hawai'i were compared between cohorts and sex. The combined PA SOC distribution (n = 1726, 50.7% female) was: Precontemplation, 7.5%; Contemplation, 7.6%; Preparation, 9.9%; Action, 33.4%; Maintenance, 41.5%. There were no significant difference between cohorts 1 and 2 (n = 258), χ(2) (16) = 21.75, p = 0.15; 2 and 3 (n = 129), χ(2) (16) = 17.51, p = 0.35; 3 and 4 (n = 171), χ(2) (16) = 17.28, p = 0.77; 4 and 5 (n = 129), χ(2) (16) = 17.51, p = 0.35; and for all cohorts between males and females (p > 0.05). Most participants were in Action and Maintenance. Prevention efforts should emphasize maintaining PA levels. Extending PA behavior surveillance systems to include intention in NHOPI jurisdictions is warranted.

Concepts: Hawaii, Male, Female, United States, Sex, Pacific Ocean, Native Hawaiians, Pacific Islander American


Asian American/Pacific Islanders (AAPIs) are the fastest-growing racial group in the United States. Despite a higher socioeconomic status, AAPI women experience higher rates of maternal morbidity and mortality.

Concepts: United States, Race, Ethnic group, White American, Hispanic and Latino Americans, Asian American, Mexican American, Pacific Islander American


The Diabetes Prevention Program (DPP), an evidenced-based lifestyle intervention for type 2 diabetes (T2D), has been translated for use with ethnic minority communities throughout the United States that are disproportionately at-risk for T2D. The present paper sought to critically review ethnic translation studies of the DPP with respect to translation methods utilized, the success of these methods, and alternative or supplemental methodologies for future translation efforts. Manuscripts reviewed were found by searching PubMed and PsycINFO, using the terms: “diabetes prevention program” AND [“translation” or “ethnic”]. Of 89 papers found, only 6 described ethnic translations of the DPP in the United States, and were included in this review. Translations of the DPP to African American, Hispanic/Latino, Native Hawaiian and Other Pacific Islander, Arab American, and American Indian and Native Alaskan communities were identified and reviewed. The most common translation strategies included group-based delivery and use of bilingual study personnel. Generally, these factors appeared to increase acceptability of the intervention within the ethnic communities reviewed, and should be considered in future efforts to implement and translate the DPP to ethnic communities in the United States.

Concepts: Hawaii, United States, White American, Native Americans in the United States, Hispanic and Latino Americans, Mexican American, Translation, Pacific Islander American


The percentage of out-of-hospital births increased from 1.26% of U.S. births in 2011 to 1.36% in 2012, continuing an increase that began in 2004. In 2012, out-of-hospital births comprised 2.05% of births to non-Hispanic white women, 0.49% to non-Hispanic black women, 0.46% to Hispanic women, 0.81% to American Indian women, and 0.54% to Asian or Pacific Islander women. In 2012, out-of-hospital births comprised 3%-6% of births in Alaska, Idaho, Montana, Oregon, Pennsylvania, and Washington, and between 2% and 3% of births in Delaware, Indiana, Utah, Vermont, and Wisconsin. Rhode Island (0.33%), Mississippi (0.38%), and Alabama (0.39%) had the lowest percentages of out-of-hospital births. In 2012, the risk profile of out-of-hospital births was lower than for hospital births, with fewer births to teen mothers, and fewer preterm, low birthweight, and multiple births. In 1900, almost all U.S. births occurred outside a hospital; however the proportion of out-of-hospital births fell to 44% by 1940 and to 1% by 1969, where it remained through the 1980s (1-3). Although out-of-hospital births are still rare in the United States, they have been increasing recently (4). If this increase continues, it has the potential to affect patterns of facility usage, clinician training, and resource allocation, as well as health care costs (5-8). This report updates previous analyses (2,9) to examine recent trends and characteristics of out-of-hospital births, including home and birthing center births, in the United States from 1990-2012, and compares selected characteristics with hospital births.

Concepts: United States, U.S. state, Race, White American, Native Americans in the United States, Hispanic and Latino Americans, Mexican American, Pacific Islander American


As HIV incidence rises globally, Asian and Pacific Islander communities are increasingly affected. While often overlooked, Asian and Pacific Islander American women have shown the greatest percentage increase in HIV diagnosis rates. The development of a multilevel and multistrategy approach to HIV/AIDS education, prevention, and treatment among Asian and Pacific Islander females requires health care providers to identify personal and cultural barriers to prevention and treatment and implement culturally sensitive and specific measures. The purpose of this article is to illuminate barriers to HIV-related prevention, treatment, and care among Asian and Pacific Islander American females and provide practical application-based suggestions for providers, which may enhance Asian and Pacific Islander female inclusion in comprehensive HIV prevention.

Concepts: Health care, Female, United States, Culture, New Zealand, White American, Woman, Pacific Islander American


Breastfeeding is nurturing, cost-effective, and beneficial for the health of mother and child. Babies receiving formula are sick more often and are at higher risk for childhood obesity, diabetes, asthma, and other conditions compared with breastfed children. National and international organizations recommend exclusive breastfeeding for 6 months. Exclusive breastfeeding in Asian and Native Hawaiian or Other Pacific Islander (NHOPI) subgroups is not well characterized. Data from the 2004-2008 Hawaii Pregnancy Risk Assessment Monitoring System, a population-based surveillance system on maternal behaviors and experiences before, during, and after pregnancy, were analyzed for 8,508 mothers with a recent live birth. We examined exclusive breastfeeding status for at least 8 weeks. We calculated prevalence risk ratios across maternal race groups accounting for maternal and socio-demographic characteristics. The overall estimate of exclusive breastfeeding for at least 8 weeks was 36.3 %. After adjusting for maternal age, pre-pregnancy weight, cesarean delivery, return to work/school, and self-reported postpartum depressive symptoms, the racial differences in prevalence ratios for exclusive breastfeeding for each ethnic group compared to Whites were: Samoan (aPR = 0.54; 95 % CI 0.43-0.69), Filipino (aPR = 0.58; 95 % CI 0.53-0.63), Japanese (aPR = 0.58; 95 % CI 0.52-0.65), Chinese (aPR = 0.64; 95 % CI 0.58-0.70), Native Hawaiian (aPR = 0.67; 95 % CI 0.61-0.72), Korean (aPR = 0.72; 95 % CI 0.64-0.82), and Black (aPR = 0.79; 95 % CI 0.65-0.96) compared to white mothers. Providers and community groups should be aware that just over one-third of mothers breastfeed exclusively at least 8 weeks with lower rates among Asian, NHOPI, and Black mothers. Culturally appropriate efforts to promote exclusive breastfeeding are recommended particularly among Asian subgroups that have high breastfeeding initiation rates that do not translate into high exclusivity rates.

Concepts: Hawaii, Childbirth, Infant, United States, Breastfeeding, Race, Ethnic group, Pacific Islander American


Lack of annual population estimates for disaggregated Native Hawaiian and Other Pacific Islander (NHOPI) populations limits the ability to examine cancer incidence rates and trends to understand the cancer burdens among NHOPIs.

Concepts: Hawaii, United States, Native Americans in the United States, Native Hawaiians, Island, Polynesians, Pacific Islander, Pacific Islander American