International Journal of Environmental Research and Public Health

Research

17 pages, 886 KiB

Open AccessArticle

Exploring Cultural and Age-Specific Preferences to Develop a Community-Based Colorectal Cancer Screening Intervention for CHamorus and Filipinos in Guam—Findings from a Qualitative Study

by Tressa P. Diaz, Santino G. Camacho, Elizabeth J. Elmore, Corinth T. Aguon and Angela Sy

Int. J. Environ. Res. Public Health 2025, 22(5), 746; https://doi.org/10.3390/ijerph22050746 - 9 May 2025

Abstract

The decline in colorectal cancer (CRC) due to screening success in the U.S. is inconsistent across populations and age groups. CHamorus (Chamorros) and Filipinos constitute minorities in the U.S. but comprise over 70% of the population in Guam where steep increases in CRC [...] Read more.

The decline in colorectal cancer (CRC) due to screening success in the U.S. is inconsistent across populations and age groups. CHamorus (Chamorros) and Filipinos constitute minorities in the U.S. but comprise over 70% of the population in Guam where steep increases in CRC incidence occur before the age of 50, and only 53.9% of persons have met national screening standards. This preliminary study explored knowledge, cultural beliefs, and age-specific recommendations associated with CRC and screening. Five focus groups segregated by age and gender were conducted with persons aged 40 and above. Data were collected on knowledge, attitudes, beliefs, and screening education recommendations. Focus group participants (n = 25) were predominantly CHamoru (60%), Filipino (32%), and female (56%). The mean age was 55. Participants preferred interventions that integrated storytelling from CRC survivors with emphasis on family education rather than limiting to screening-age adults. Multicoders performed an iterative collaborative analysis for the main themes: knowledge of CRC/screening primarily derives from family experiences; increased outreach is needed for men; use of personal narratives; and screening is motivated by family values and intergenerational consciousness. Findings can inform future studies on age- and culturally-tailored early detection strategies to improve CRC screening participation in Pacific populations. Full article

(This article belongs to the Special Issue Disparity of Non-Communicable Diseases Among Pacific Islanders)

13 pages, 1098 KiB

Open AccessArticle

Native Hawaiian and Pacific Islanders’ Identity and Housing Status: The Impact on Historical Trauma and Perceived Stress

by Tessa Palafu, Danielle L. Carreira Ching, Veronica M. Acosta, Scott K. Okamoto and Kelsie H. Okamura

Int. J. Environ. Res. Public Health 2024, 21(9), 1249; https://doi.org/10.3390/ijerph21091249 - 21 Sep 2024

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Abstract

Native Hawaiian and Pacific Islanders (NHPIs) are overrepresented in Hawai‘i’s houseless population. Indigenous populations, such as NHPIs, may encounter experiences of historical trauma that impact their well-being. This original research project examines how NHPI identity and houselessness compound to affect the perceived stress [...] Read more.

Native Hawaiian and Pacific Islanders (NHPIs) are overrepresented in Hawai‘i’s houseless population. Indigenous populations, such as NHPIs, may encounter experiences of historical trauma that impact their well-being. This original research project examines how NHPI identity and houselessness compound to affect the perceived stress and historical trauma of transition-aged youth. Fifty-one participants aged 18 to 24 (M = 21.37, SD = 1.93) completed a survey that included the historical traumatic events scale, historical loss scale, perceived stress scale, and a demographic questionnaire. Over half (n = 26, 51.0%) of the participants identified as NHPI. A two-way ANOVA indicated a non-significant effect of NHPI identity and housing status on perceived stress. However, housed participants scored significantly higher than participants experiencing houselessness on the historical traumatic events scale (p = 0.006). Our findings elucidate the role of knowledge in the experience of historical trauma. Further results, limitations, and future directions are offered. Full article

(This article belongs to the Special Issue Disparity of Non-Communicable Diseases Among Pacific Islanders)

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17 pages, 1787 KiB

Open AccessArticle

Validating Constructs of the Depression, Anxiety, and Stress Scale-21 and Exploring Health Indicators to Predict the Psychological Outcomes of Students Enrolled in the Pacific Islands Cohort of College Students

by Rebecca H. Kim, Yvette C. Paulino and Yoshito Kawabata

Int. J. Environ. Res. Public Health 2024, 21(4), 509; https://doi.org/10.3390/ijerph21040509 - 19 Apr 2024

Cited by 2 | Viewed by 2793

Abstract

The Depression, Anxiety, and Stress Scale-21 (DASS-21) has been used in various countries to assess the mental states of individuals. The objectives of this study were to validate the DASS-21 for use in Guam, an island that endures a high burden of mental [...] Read more.

The Depression, Anxiety, and Stress Scale-21 (DASS-21) has been used in various countries to assess the mental states of individuals. The objectives of this study were to validate the DASS-21 for use in Guam, an island that endures a high burden of mental health challenges, such as suicide, and examine the predictive impact of selected health indicators on DASS-21 variables. Three years of data (2017–2019) were pooled from the Pacific Islands Cohort of College Students (PICCS) study conducted annually at the University of Guam. In total, 726 students were included in the secondary data analysis. MPlus statistical software was used to perform a confirmatory factor analysis (CFA) for the validation and structural equation modeling (SEM) for the predictive modeling. The results from the CFA suggested an acceptable model fit (RMSEA: 0.073, CFI: 0.901, TLI: 0.889, RMR: 0.044), while SEM suggested that sleep quality and physical activity were significant predictors of DASS-21 variables. Therefore, the DASS-21 is a valid instrument for measuring depression, anxiety, and stress among emerging adults in Guam. Full article

(This article belongs to the Special Issue Disparity of Non-Communicable Diseases Among Pacific Islanders)

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12 pages, 545 KiB

Open AccessArticle

Acculturation and Health Status in the Children’s Healthy Living Program in the Pacific Region

by Kalanikiekie S. Sparks, Marie K. Fialkowski, Rica Dela Cruz, Andrew Grandinetti, Lynne Wilkens, Jinan C. Banna, Andrea Bersamin, Yvette Paulino, Tanisha Aflague, Patricia Coleman, Jonathan Deenik, Travis Fleming and Rachel Novotny

Int. J. Environ. Res. Public Health 2024, 21(4), 448; https://doi.org/10.3390/ijerph21040448 - 6 Apr 2024

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Abstract

Acculturation/enculturation has been found to impact childhood health and obesity status. The objective of this study is to use cross-sectional data to examine the association between proxies of adult/caregiver acculturation/enculturation and child health status (Body Mass Index [BMI], waist circumference [WC], and acanthosis [...] Read more.

Acculturation/enculturation has been found to impact childhood health and obesity status. The objective of this study is to use cross-sectional data to examine the association between proxies of adult/caregiver acculturation/enculturation and child health status (Body Mass Index [BMI], waist circumference [WC], and acanthosis nigricans [AN]) in the U.S.-Affiliated Pacific Islands (USAPI), Alaska, and Hawaiʻi. Study participants were from the Children’s Healthy Living (CHL) Program, an environmental intervention trial and obesity prevalence survey. Anthropometric data from 2–8 year olds and parent/caregiver questionnaires were used in this analysis. The results of this study (n = 4121) saw that those parents/caregivers who identified as traditional had children who were protected against overweight/obesity (OWOB) status and WC > 75th percentile (compared to the integrated culture identity) when adjusted for significant variables from the descriptive analysis. AN did not have a significant association with cultural classification. Future interventions in the USAPI, Alaska, and Hawaiʻi may want to focus efforts on parents/caregivers who associated with an integrated cultural group as an opportunity to improve health and reduce child OWOB prevalence. Full article

(This article belongs to the Special Issue Disparity of Non-Communicable Diseases Among Pacific Islanders)

10 pages, 2370 KiB

Open AccessArticle

Thyroid Cancer Survival in the Multiethnic Cohort Study

by Janine V. Abe, Song-Yi Park, Christopher A. Haiman, Iona Cheng, Loïc Le Marchand, Brenda Y. Hernandez and Lynne R. Wilkens

Int. J. Environ. Res. Public Health 2024, 21(3), 324; https://doi.org/10.3390/ijerph21030324 - 10 Mar 2024

Cited by 1 | Viewed by 2049

Abstract

Objective: The US 5-year survival rate after thyroid cancer (TC) diagnosis is over 95%. Our aim was to investigate survival differences by sex and race and ethnicity in a multiethnic US population. Design: In the Multiethnic Cohort (MEC) study, a total of 605 [...] Read more.

Objective: The US 5-year survival rate after thyroid cancer (TC) diagnosis is over 95%. Our aim was to investigate survival differences by sex and race and ethnicity in a multiethnic US population. Design: In the Multiethnic Cohort (MEC) study, a total of 605 incident TC cases were identified by linkage to HI and CA statewide cancer registries. Cox models were performed to compare the risk of all-cause mortality among TC cases by sex and race and ethnicity, with adjustment for age, first course of treatment, baseline body mass index, smoking status, alcohol intake, and neighborhood socioeconomic status. Survival among cases was also compared to matched MEC controls with no thyroid cancer. Results: After a mean follow-up of 10.1 years, 250 deaths occurred among TC cases, including 63 deaths attributed to thyroid cancer. The median survival was 14.7 years, and the 5-year age-adjusted overall survival was 84.4% for female cases and 68.7% for male cases (p < 0.0001, HR 2.28 (95% CI: 1.72, 3.01)). Age-adjusted survival was lower among African American, Native Hawaiian, and Filipino cases, compared to Japanese American cases, with Whites and Latinos being intermediate. Men and Filipinos were found to have excess mortality due to thyroid cancer compared to controls (adjusted HR 1.39, 95% CI: 1.11, 1.74; HR 1.62, 95% CI: 1.04, 2.53, respectively). Conclusions: Sex and racial and ethnic disparities in survival among TC cases were similar to those found in the general population. However, cases with TC had an excess risk of death among males and for Filipinos. Full article

(This article belongs to the Special Issue Disparity of Non-Communicable Diseases Among Pacific Islanders)

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8 pages, 948 KiB

Open AccessArticle

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

by JaeYong Choi, Grazyna Badowski, Yurii B. Shvetsov, Louis Dulana, Rodney Teria, Su Bin Jin, Cabrini Aguon, Renata Bordallo and Rachael T. Leon Guerrero

Int. J. Environ. Res. Public Health 2024, 21(2), 170; https://doi.org/10.3390/ijerph21020170 - 1 Feb 2024

Cited by 1 | Viewed by 2580

Abstract

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 [...] Read more.

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. Full article

(This article belongs to the Special Issue Disparity of Non-Communicable Diseases Among Pacific Islanders)

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12 pages, 321 KiB

Open AccessArticle

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

by Francis Dalisay, Scott K. Okamoto, Jane Teneza, Christina Dalton, Kayli Lizama, Pallav Pokhrel and Yoshito Kawabata

Int. J. Environ. Res. Public Health 2023, 20(19), 6832; https://doi.org/10.3390/ijerph20196832 - 26 Sep 2023

Viewed by 2374

Abstract

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 [...] Read more.

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. Full article

(This article belongs to the Special Issue Disparity of Non-Communicable Diseases Among Pacific Islanders)

10 pages, 683 KiB

Open AccessArticle

The Betel Nut Intervention Trial (BENIT)—A Randomized Clinical Trial for Areca Nut and Betel Quid Cessation: Primary Outcomes

by Thaddeus A. Herzog, Lynne R. Wilkens, Grazyna Badowski, Ana Joy Pacilan Mendez, Adrian A. Franke, Pallav Pokhrel, Jade S. N. Chennaux, Lynnette F. Tenorio, Patrick P. Sotto, Crissy T. Kawamoto and Yvette C. Paulino

Int. J. Environ. Res. Public Health 2023, 20(16), 6622; https://doi.org/10.3390/ijerph20166622 - 21 Aug 2023

Cited by 5 | Viewed by 2674

Abstract

Background: Areca nut and betel quid (ANBQ) chewing is a widespread carcinogenic habit. The BENIT (ClinicalTrials—NCT02942745) is the first known randomized trial designed for ANBQ chewers. Methods: We compared the intensive behavioral treatment intervention condition (IC) with the control condition (CC) in the [...] Read more.

Background: Areca nut and betel quid (ANBQ) chewing is a widespread carcinogenic habit. The BENIT (ClinicalTrials—NCT02942745) is the first known randomized trial designed for ANBQ chewers. Methods: We compared the intensive behavioral treatment intervention condition (IC) with the control condition (CC) in the BENIT and included a 5-stage early stopping rule. We report the primary analysis at stage 3. English-literate adults in Guam and Saipan who self-identified as ANBQ chewers with tobacco were enrolled between August 2016 and August 2020. IC participants (n = 88) received five in-person sessions over 22 days and a brochure containing quitting advice. CC participants (n = 88) received only the brochure. Participants were assessed at baseline and on day 22 of follow-up. Self-reported chewing status at day 22 was determined by a composite of two survey items with disparate wording and response options for cross-verification. Results: Cessation rates were 38.6% (IC) and 9.1% (CC). Proportional hazards regression revealed a p = 0.0058, which met the Stage 3 criteria for significance, and an estimated reduction in ANBQ chewing for IC compared to the CC of 71% (95% CI: 41%–88%). Conclusions: Robust self-reported intervention effects at day 22 suggest that intensive cessation programs such as BENIT should be further developed and implemented on a larger scale. Full article

(This article belongs to the Special Issue Disparity of Non-Communicable Diseases Among Pacific Islanders)

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13 pages, 495 KiB

Open AccessArticle

Barriers, Facilitators, and Strategies for Developing a Culturally Informed Lifestyle Intervention for Native Hawaiian, CHamoru, and Filipino Breast Cancer Survivors: Mixed-Methods Findings from Focus Group Participants

by Tanisha F. Aflague, Kristi Hammond, Bernice Delos Reyes, Dareon Rios, Elaine De Leon, Rachael T. Leon Guerrero and Monica K. Esquivel

Int. J. Environ. Res. Public Health 2023, 20(12), 6075; https://doi.org/10.3390/ijerph20126075 - 7 Jun 2023

Cited by 1 | Viewed by 3509

Abstract

Breast cancer disproportionately impacts Native Hawaiian, CHamoru, and Filipino women. Few culturally informed interventions addressing breast cancer survivors exist and none have been developed or tested specifically for Native Hawaiian, CHamoru, and Filipino women. This study aimed to conduct focus groups with Native [...] Read more.

Breast cancer disproportionately impacts Native Hawaiian, CHamoru, and Filipino women. Few culturally informed interventions addressing breast cancer survivors exist and none have been developed or tested specifically for Native Hawaiian, CHamoru, and Filipino women. This study aimed to conduct focus groups with Native Hawaiian, CHamoru, and Filipino women previously diagnosed with breast cancer to inform future research in Guam and Hawai’i. Convenience sampling and grounded theory approaches were used. Focus group sessions were conducted during summer 2023 and included questions to understand the barriers, motivators, and implementation recommendations for lifestyle interventions aimed at reducing the risk for breast cancer recurrence among the target population. Data saturation was reached after a total of seven focus groups (an average of four survivors/group per site) were conducted (three in Hawai’i and four in Guam), which represented 28 breast cancer survivors. Themes from the focus groups emerged around developing support systems with other survivors, providing physical activity and nutrition intervention activities and materials in multiple formats, and incorporating activities and foods that accommodate the side effects of breast cancer treatments and are culturally relevant. The average desired intervention length was eight weeks. These findings will inform the development and feasibility testing of a culturally informed lifestyle intervention for breast cancer survivors in Guam and Hawai’i. Full article

(This article belongs to the Special Issue Disparity of Non-Communicable Diseases Among Pacific Islanders)

13 pages, 624 KiB

Open AccessArticle

Knowledge and Attitudes of Guam Residents towards Cancer Clinical Trial Participation

by Munirih R. Taafaki, Amy C. Brown, Kevin D. Cassel, John J. Chen, Eunjung Lim and Yvette C. Paulino

Int. J. Environ. Res. Public Health 2022, 19(23), 15917; https://doi.org/10.3390/ijerph192315917 - 29 Nov 2022

Cited by 1 | Viewed by 1842

Abstract

(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 [...] Read more.

(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. Full article

(This article belongs to the Special Issue Disparity of Non-Communicable Diseases Among Pacific Islanders)

Review

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22 pages, 1513 KiB

Open AccessReview

Regional Variations in the Prevalence of Risk Factors and Non-Communicable Diseases in Papua New Guinea: A Scoping Review

by Bobby Porykali, Ryley Gronau, Phyllis Tran, Juliana Chen, Margaret Allman-Farinelli, Anna Rangan, Shelina Porykali, Robin Oge, Hans Nogua and Alyse Davies

Int. J. Environ. Res. Public Health 2025, 22(1), 102; https://doi.org/10.3390/ijerph22010102 - 14 Jan 2025

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Abstract

Often referred to as ‘the last unknown’, Papua New Guinea’s largely unexplored environments across its four distinct regions, the Highlands, New Guinea Islands, Momase, and Southern, exhibit remarkable diversity. Understanding this diversity is significant in contextualising the risk factors associated with developing non-communicable [...] Read more.

Often referred to as ‘the last unknown’, Papua New Guinea’s largely unexplored environments across its four distinct regions, the Highlands, New Guinea Islands, Momase, and Southern, exhibit remarkable diversity. Understanding this diversity is significant in contextualising the risk factors associated with developing non-communicable diseases. This review aims to map and summarise the literature to provide region-specific prevalence data for risk factors and non-communicable diseases. Four databases and grey literature were searched. Two reviewers completed the screening and data extraction. Twenty-one studies were included, with five reporting the data by region and the remaining reporting the data nationwide. Six studies reported on risk factors, thirteen reported on non-communicable diseases, and two reported on risk factors and non-communicable diseases. The Southern region, which includes the Capital, Port Moresby, reported the highest prevalence for most risk factors: anthropometric (overweight, obesity, and waist circumference), lifestyle (betel nut, alcohol, unhealthy diet, and stress), and biochemical (cholesterol, triglycerides, HbA1c, and metabolic syndrome). The findings of this review highlight the limited evidence base for region-specific risk factor data and the lack of objective diagnosis of non-communicable diseases. There were variations in the prevalence of specific risk factors by region; however, the Southern region stands out as requiring immediate attention for health promotion program interventions. Full article

(This article belongs to the Special Issue Disparity of Non-Communicable Diseases Among Pacific Islanders)

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7 pages, 1207 KiB

Open AccessBrief Report

Palau: Non-Communicable Disease Off-Island Treatment Referrals 2020–2022

by Quan Lac, Yujin Na, Kennedy Kainoa Tamashiro, Kelley Withy, Myra Adelbai-Fraser, Catherine Decherong and Greg Dever

Int. J. Environ. Res. Public Health 2025, 22(3), 431; https://doi.org/10.3390/ijerph22030431 - 14 Mar 2025

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Abstract

Background: The Republic of Palau is a small island nation with limited healthcare resources and a lack of onsite subspecialty medical care services such as orthopedic surgery, cardiology, and oncology. Palauans receive sub-specialty healthcare during medical missions from other countries or when they [...] Read more.

Background: The Republic of Palau is a small island nation with limited healthcare resources and a lack of onsite subspecialty medical care services such as orthopedic surgery, cardiology, and oncology. Palauans receive sub-specialty healthcare during medical missions from other countries or when they are referred off-island to surrounding countries by the Palau Medical Referral Program. The goal of this study is to identify patterns in costs, locations, and types of cases to elucidate potential areas of improvement to the Palauan healthcare system. Methods: This study utilized the 2020–2022 referral data to analyze the frequency of medical conditions that result in off-island referrals and the associated economic burden. Data is presented in a descriptive analysis. Results: We found that oncology and cardiology are the two most common types of medical conditions requiring off-island medical referrals and that Palau is spending over 2 million dollars annually for referrals on subspecialty medical care. Cardiology and oncology are the most frequent cases and have the highest costs. The results of this study provide insight into the current state of medical care in Palau. Discussion/Conclusions: There is a need for a systematic, timely, and economically feasible approach to subspecialty medical sub-care for Palau, especially cardiology and oncology, to reduce the economic burden for Palau. This approach should be linked with appropriate prevention, risk reduction, and early intervention efforts for these non-communicable diseases. Full article

(This article belongs to the Special Issue Disparity of Non-Communicable Diseases Among Pacific Islanders)

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