International Journal of Environmental Research and Public Health

Research

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

Viewed by 752

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 - 06 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

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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 - 01 Feb 2024

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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

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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 4 | Viewed by 1422

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 - 07 Jun 2023

Viewed by 1621

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 1187

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)

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