Neighborhood-Level Stressors and Individual-Level Cardiovascular Disease Risk in Native Hawaiians: a Cross-Sectional Study.

Introduction: Native Hawaiian people have higher rates of illness and death related to cardiovascular disease (CVD) than non-Hispanic White people. Research in other populations has shown that individual-level CVD risk factors (ie, high-fat diet, physical inactivity, obesity, and tobacco use) are associated with neighborhood characteristics (ie, social cohesion, walkability, availability of healthy food, and safety). This association has yet to be examined among Native Hawaiians. Methods: We conducted a cross-sectional survey of community-dwelling Native Hawaiian people in 2020. Three multiple regression models and 1 logistic regression model were assessed. Each model included individual-level CVD risk factors, age, sex, education, income, and neighborhood characteristics. Results: The regression models for body mass index (BMI) and physical activity showed significant results. The BMI model (R2 = 0.22, F = 4.81, P < .001) demonstrated that age, sex, education level, physical activity, and percentage of fat in the diet were significantly related to BMI. The availability of healthy foods had a significant, independent relationship with BMI (standardized ß = -1.47, SE = 0.53, P = .01). The physical activity model (R2 = 0.21, F = 4.46, P < .001) demonstrated that age, sex, education, and BMI were significantly related to physical activity. None of the neighborhood characteristics had significant, independent relationships to physical activity. Conclusions: We found that neighborhood-level factors improved the model's ability to explain variance in BMI. Efforts to decrease BMI would benefit from improving the availability of healthy foods in neighborhoods, a finding supported by research in other populations.

Case report from the field: integrating Hawaiian and Western healing arts in Papakolea.

Papakolea, the only Native Hawaiian (NH) homestead community located in urban Honolulu, has one of the highest proportions of NHs living in a single geographic area. Despite prior attempts dating back to the 1920s to improve the health of the community, many health disparities remain within the Papakolea community. This is the story of how the Papakolea community decided to confront the health of its community by integrating Hawaiian and Western healing arts. The purpose of this "Case Report from the Field" is to share the journey the Papakolea community started back in 1992 to build capacity within their own community by forming its first 501c3 community based non-profit organization entitled Kula no na Po'e Hawai'i (referred to as Kula). Through Kula, a unique traditional healing training program was started called Na Lomilomi O Papakolea (NLOP). NLOP became the first self-sustaining health program for training lomilomi practitioners (traditional NH therapeutic massage) in the Papakolea community. This case report describes how lomilomi practitioners and medical practitioners began sharing their skills and expertise to heal their clients and in the process began to heal the community itself. The purpose of this paper is to describe their journey with the intent of sharing how one dedicated group of people has been successful in healing their community and is now on the road to better health and sustained well being by working together.

Partnerships to address obesity disparities in Hawai'i: the PILI 'Ohana Project.

Community-based participatory research (CBPR) is an approach to scientific research that is gaining broader application to address persistent problems in health care disparities and other hypothesis-driven research. However, information on how to form CBPR community-academic partnerships and how to best involve community partners in scientific research is not well-defined. The purpose of this paper is to share the experience of the Partnership for Improving Lifestyle Interventions (PILl) 'Ohana Project in forming a co-equal CBPR community-academic partnership that involved 5 different community partners in a scientific research study to address obesity disparities in Native Hawaiians and other Pacific Peoples (i.e., Samoans, Chuukese, and Filipinos). Specifically, the paper discusses (1) the formation of our community-academic partnership including identification of the research topic; (2) the development of the CBPR infrastructure to foster a sustainable co-equal research environment; and (3) the collaboration in designing a community-based and community-led intervention. The paper concludes with a brief summary of the authors' thoughts about CBPR partnerships from both the academic and community perspectives.