Biomarkers of tobacco smoke exposure in racial/ethnic groups at high risk for lung cancer

OBJECTIVES

We examined biomarkers of tobacco smoke exposure among Native Hawaiians, Filipinos, and Whites, groups that have different lung cancer risk.

METHODS

We collected survey data and height, weight, saliva, and carbon monoxide (CO) levels from a sample of daily smokers aged 18-35 (n = 179). Mean measures of nicotine, cotinine, cotinine/cigarettes per day ratio, trans 3' hydroxycotinine, the nicotine metabolite ratio (NMR), and expired CO were compared among racial/ethnic groups.

RESULTS

The geometric means for cotinine, the cotinine/cigarettes per day ratio, and CO did not significantly differ among racial/ethnic groups in the adjusted models. After adjusting for gender, body mass index, menthol smoking, Hispanic ethnicity, and number of cigarettes smoked per day, the NMR was significantly higher among Whites than among Native Hawaiians and Filipinos (NMR = 0.33, 0.20, 0.19, P ≤ .001). The NMR increased with increasing White parental ancestry. The NMR was not significantly correlated with social-environmental stressors.

CONCLUSIONS

Racial/ethnic groups with higher rates of lung cancer had slower nicotine metabolism than Whites. The complex relationship between lung cancer risk and nicotine metabolism among racial/ethnic groups needs further clarification.

Kumu hula perspectives on health

To prepare for research studies that would evaluate the impact of hula as part of a clinical intervention, including cardiovascular disease (CVD) prevention and management programs, kumu hula defined as "culturally recognized hula educators and experts," were interviewed. Investigators sought to elicit their views regarding hula's traditional and contemporary connections to health and well-being, assess the cultural appropriateness of such projects, and suggest ways to maintain hula's cultural integrity throughout clinical intervention programs. Six prominent kumu hula from five different Hawaiian Islands participated in semi-structured key informant interviews lasting between 60 and 90 minutes. Each was asked open-ended questions regarding their attitudes, beliefs, and experiences regarding the connections of hula to health as well as their recommendations on maintaining the integrity of the dance's cultural traditions when developing and implementing a hula-based CVD program. All kumu hula endorsed the use of hula in a CVD intervention program and articulated the strong, significant, and enduring connections of hula to health and well-being. Each kumu hula also recognized that health is the full integration of physical, mental, emotional, and spiritual well-being. When care is taken to preserve its cultural integrity, hula may be an effective integrated modality for interventions designed to improve health and wellness.

The PILI 'Ohana Project: a community-academic partnership to achieve metabolic health equity in Hawai'i

Native Hawaiians and Pacific Islanders (NHPI) have higher rates of excess body weight and related medical disorders, such as diabetes and cardiovascular disease, compared to other ethnic groups in Hawai'i. To address this metabolic health inequity, the Partnership for Improving Lifestyle Intervention (PILI) 'Ohana Project, a community-academic partnership, was formed over eight years ago and developed two community-placed health promotion programs: the PILI Lifestyle Program (PLP) to address overweight/obesity and the Partners in Care (PIC) to address diabetes self-care. This article describes and reviews the innovations, scientific discoveries, and community capacity built over the last eight years by the PILI 'Ohana Project's (POP) partnership in working toward metabolic health equity. It also briefly describes the plans to disseminate and implement the PLP and PIC in other NHPI communities. Highlighted in this article is how scientific discoveries can have a real-world impact on health disparate populations by integrating community wisdom and academic expertise to achieve social and health equity through research.

Ethnic and gender differences in ideal body size and related attitudes among Asians, Native Hawaiians, and Whites

Often overlooked explanations for the varied obesity rates across ethno-cultural groups include differences in attitudes toward excess weight, with certain populations assumed to have larger ideal body sizes (IBS). Past studies found ethnic and gender difference in IBS across and within different groups. This study examined the effects of ethnicity and gender, and their interaction, in accounting for differences in IBS and attitudes toward those ideals. Multiple regression analyses were used to better understand the effects of ethnicity and gender in accounting for differences in perceived IBS according to ethnic-specific and Western ideals and attitudes in 1,124 people of Native Hawaiian, Filipino, Japanese, and White ancestry. The analyses controlled for socio-demographics, body mass index, health-related behaviors, and psychosocial variables. The results indicated that Native Hawaiians selected larger ethnic IBS, Filipinos selected smaller ethnic IBS, and Native Hawaiians selected slightly smaller Western IBS than other ethnic groups. Overall, males selected larger IBS compared to females. Interaction analyses indicated that the relationship between ethnic IBS and attitude toward that IBS varied as a function of ethnicity, such that Native Hawaiians who selected a larger ethnic IBS held less favorable attitudes toward that IBS. The discrepancy between Native Hawaiians' selection of larger ethnic IBS as ideal and their less positive attitude toward that selection warrants more investigation. However, it does suggest that Native Hawaiians, on a personal level, do not prefer larger body sizes, which contradicts their perceptions of social norms. These findings have important implications for obesity interventions among Native Hawaiians.

Translating the Diabetes Prevention Program in Native Hawaiian and Pacific Islander communities: the PILI 'Ohana Project

Native Hawaiians/Pacific Islanders experience a high prevalence of overweight/obesity. The Diabetes Prevention Program Lifestyle Intervention (DPP-LI) was translated into a 3-month community-based intervention to benefit these populations. The weight loss and other clinical and behavioral outcomes of the translated DPP-LI and the socio-demographic, behavioral, and biological factors associated with the weight loss were examined. A total of 239 Native Hawaiian/Pacific Islander adults completed the translated DPP-LI through four community-based organizations (CBOs). Changes from pre- to post-intervention assessments in weight, blood pressure, physical functioning, exercise frequency, and fat in diet were measured. Significant improvements on all variables were found, with differences observed across the four CBOs. CBOs with predominately Native Hawaiian and ethnically homogenous intervention groups had greater weight loss. General linear modeling indicated that larger baseline weight and CBO predicted weight loss. The translated DPP-LI can be effective for Native Hawaiians/Pacific Islanders, especially when socio-cultural, socio-economic, and CBO-related contextual factors are taken into account.

Patient perspectives on the Hula Empowering Lifestyle Adaptation Study: benefits of dancing hula for cardiac rehabilitation

BACKGROUND

The Hula Empowering Lifestyle Adaption Study, funded by the National Institute on Minority Health and Health Disparities, was a 5-year research trial evaluating the impact of the traditional Native Hawaiian dance form, hula, as an exercise modality for cardiac rehabilitation, compared with usual care, on individuals recently hospitalized for a cardiac event or who had recently undergone coronary artery bypass surgery.

METHOD AND RESULTS

Seeking to learn what physical, mental, spiritual, and social effects the intervention may have had for participants, we interviewed 20 of a total of 35 patients who were enrolled in the dance arm of the study. Classical thematic triangulation analysis was used. Participants recognized that hula's coordination of body, mind, and spirit as a group activity deepened their appreciation of and connections to Hawaiian culture. This was true for those who were Native Hawaiian, connecting to their own cultural heritage, as well as for non-Native Hawaiians, who found that it improved their appreciation of the surrounding cultural traditions of the host culture where they now live.

CONCLUSIONS

Not only was hula a safe activity that improved functional capacity, participants also regarded its significant sociocultural aspects-even for participants who are not Native Hawaiian -as enhancing its value and meaningfulness. Learning the words of well-known Hawaiian songs provided additional long-term cues that encouraged "ownership" of the therapy and acted as practical reminders of the importance of exercise and lifestyle moderation while also offering new spiritual connections to the surrounding social environment.

Metabolic equivalent determination in the cultural dance of hula

Ethnic minorities share an unequal burden of cardiometabolic syndrome. Physical activity (PA) has been shown to be an important factor for improving the outcomes of these diseases. While metabolic equivalents (METs) have been calculated for diverse activities, most cultural activities have not been evaluated. Hula, the traditional dance of Native Hawaiians, is practiced by men and women of all ages but its MET value is unknown. To our knowledge, this is the first scientific evaluation of energy expenditure of hula. 19 competitive hula dancers performed 2 dance sets of low- and high-intensity hula. METs were measured with a portable indirect calorimetry device. Mean and standard deviations were calculated for all the variables. A 2-way ANOVA was conducted to identify differences for gender and intensity. The mean MET were 5.7 (range 3.17-9.77) and 7.55 (range 4.43-12.0) for low-intensity and high-intensity, respectively. There was a significant difference between intensities and no significant difference between genders. This study demonstrates that the energy expenditure of both low- and high-intensity hula met the recommended guidelines for moderate and vigorous intensity exercise, respectively, and that hula can be utilized as a prescribed PA.

Sociodemographic, behavioral, and biological variables related to weight loss in native Hawaiians and other Pacific Islanders

OBJECTIVE

Native Hawaiians and other Pacific Islanders (NHs/PIs) have a high obesity prevalence compared to other ethnic groups. We examined socio-demographic, behavioral, and biological factors related to ≥3% weight loss in 100 overweight/obese NHs/PIs who completed a lifestyle intervention.

DESIGN AND METHODS

Data were from 56 Native Hawaiians, 22 Chuukese, and 22 Other Pacific Islanders who participated in a randomized controlled trial of the Partnership for Improving Lifestyle Intervention (PILI) 'Ohana Project. All completed a 3-month weight loss program (WLP) to initiate weight loss and were then randomized into either a 6-month family/community focused WLP called the PILI Lifestyle Program (PLP; n = 49) or a standard behavior WLP (SBP; n = 51). We collected baseline, 3- and 9-month follow-up data on socio-demographics, weight (kg), a 6-min. walk test, dietary fat, exercise frequency, and blood pressure.

RESULTS AND CONCLUSION

Based on ANCOVA or logistic fit, ethnicity, sex, initial weight loss, fat in diet at baseline, change in systolic blood pressure, and intervention type were significantly associated (P ≤ .05) with ≥3% weight loss at 9-month follow-up. A logistic regression model indicated that Chuukese (OR = 6.04; CI = 1.14-32.17) and participants who had more weight loss in the first 3-months (OR = 1.47; CI = 1.22-1.86) and who were in the PLP (OR = 4.50; CI = 1.50-15.14) were more likely to achieve ≥3% weight loss [model; χ(2) (7, N = 100) = 45.50, P < .0001]. The same lifestyle intervention does not benefit all NHs/PIs equally, possibly due to differences in acculturation status and social support. The findings also point to the importance of initial weight loss to sustain motivation toward long-term weight loss maintenance.

A family and community focused lifestyle program prevents weight regain in Pacific Islanders: a pilot randomized controlled trial

Preventing weight regain after the loss of excess weight is challenging for people, especially for ethnic minorities in the United States. A 6-month weight loss maintenance intervention designed for Pacific Islanders, called the PILI Lifestyle Program (PLP), was compared with a 6-month standard behavioral weight loss maintenance program (SBP) in a pilot randomized controlled trial using a community-based participatory research approach. Adult Pacific Islanders (N = 144) were randomly assigned to either PLP (n = 72) or SBP (n = 72) after completing a 3-month weight loss program. Successful weight maintenance was defined as participants' postintervention weight change remaining ≤ 3% of their preintervention mean weight. Both PLP and SBP participants achieved significant weight loss maintenance (p ≤ .05). Among participants who completed at least half of the prescribed sessions, PLP participants were 5.1-fold (95% confidence interval = 1.06, 24; p = .02) more likely to have maintained their initial weight loss than SBP participants. The pilot PLP shows promise as a lifestyle intervention to address the obesity disparities of Pacific Islanders and thus warrants further investigation.

Translating diabetes prevention into native Hawaiian and Pacific Islander communities: the PILI 'Ohana Pilot project

BACKGROUND

Native Hawaiians (NH) and Other Pacific Islanders (OPI) bear an excess burden of diabetes health disparities. Translation of empirically tested interventions such as the Diabetes Prevention Program Lifestyle Intervention (DPP-LI) offers the potential for reversing these trends. Yet, little is known about how best to translate efficacious interventions into public health practice, particularly among racial/ethnic minority populations. Community-based participatory research (CBPR) is an approach that engages the community in the research process and has recently been proposed as a means to improve the translation of research into community practice.

OBJECTIVES

To address diabetes health disparities in NHOPIs, CBPR approaches were used to: (1) culturally adapt the DPP-LI for NHOPI communities; and (2) implement and examine the effectiveness of the culturally-adapted program to promote weight loss in 5 NHOPI communities.

METHODS

Informant interviews (n=15) and focus groups (n=15, with 112 NHOPI participants) were completed to inform the cultural adaptation of the DPP-LI program. A team of 5 community investigators and 1 academic research team collaboratively developed and implemented the 12-week pilot study to assess the effectiveness of the culturally adapted program.

RESULTS

A total of 127 NHOPIs participated in focus groups and informant interviews that resulted in the creation of a significantly modified version of the DPP-LI, entitled the PILI 'Ohana Lifestyle Intervention (POLI). In the pilot study, 239 NHOPIs were enrolled and after 12 weeks (post-program), mean weight loss was -1.5 kg (95%CI -2.0, -1.0) with 26% of participants losing > or = 3% of their baseline weight. Mean weight loss among participants who completed all 8 lessons at 12 weeks was significantly higher (-1.8 kg, 95%CI -2.3, -1.3) than participants who completed less than 8 lessons (-0.70 kg, 95%CI -1.1, -0.29).

CONCLUSION

A fully engaged CBPR approach was successful in translating an evidence based diabetes prevention program into a culturally relevant intervention for NHOPI communities. This pilot study demonstrates that weight loss in high risk minority populations can be achieved over a short period of time using CBPR approaches.

Effects of perceived racism and acculturation on hypertension in Native Hawaiians

OBJECTIVE

To examine the effects of perceived racism and acculturation on the hypertension status of Native Hawaiians.

DESIGN

Cross-sectional data from 94 Native Hawaiian adults were obtained which included the following: 1) socio-demographic variables and self-reported hypertension status; 2) a 5-item Hawaiian cultural identity subscale (HCSS) and a 5-item American cultural identity subscale (ACSS); and 3) perceived racism based on a 6-item modified version of the 32-item Oppression Questionnaire (OQ).

RESULTS

Based on logistic regression analysis, the ACSS scores and OQ scores had significant (p<.05) and independent effects on hypertension status, after considering the effects of age, sex, and education level, and HCSS scores. Of the variables examined, OQ scores had the greatest magnitude of effect on hypertension status.

CONCLUSION

More perceived racism and a greater identification with the American mainstream culture were both, independently, related to self-reported hypertension in Native Hawaiians. These findings have important clinical and public health implications.

Cardiometabolic health disparities in native Hawaiians and other Pacific Islanders

Elimination of health disparities in the United States is a national health priority. Cardiovascular disease, diabetes, and obesity are key features of what is now referred to as the "cardiometabolic syndrome," which disproportionately affects racial/ethnic minority populations, including Native Hawaiians and other Pacific Islanders (NHOPI). Few studies have adequately characterized the cardiometabolic syndrome in high-risk populations such as NHOPI. The authors systematically assessed the existing literature on cardiometabolic disorders among NHOPI to understand the best approaches to eliminating cardiometabolic health disparities in this population. Articles were identified from database searches performed in PubMed and MEDLINE from January 1998 to December 2008; 43 studies were included in the review. There is growing confirmatory evidence that NHOPI are one of the highest-risk populations for cardiometabolic diseases in the United States. Most studies found increased prevalences of diabetes, obesity, and cardiovascular risk factors among NHOPI. The few experimental intervention studies found positive results. Methodological issues included small sample sizes, sample bias, inappropriate racial/ethnic aggregation of NHOPI with Asians, and a limited number of intervention studies. Significant gaps remain in the understanding of cardiometabolic health disparities among NHOPI in the United States. More experimental intervention studies are needed to examine promising approaches to reversing the rising tide of cardiometabolic health disparities in NHOPI.

Cardiometabolic health disparities in native Hawaiians and other Pacific Islanders

Elimination of health disparities in the United States is a national health priority. Cardiovascular disease, diabetes, and obesity are key features of what is now referred to as the "cardiometabolic syndrome," which disproportionately affects racial/ethnic minority populations, including Native Hawaiians and other Pacific Islanders (NHOPI). Few studies have adequately characterized the cardiometabolic syndrome in high-risk populations such as NHOPI. The authors systematically assessed the existing literature on cardiometabolic disorders among NHOPI to understand the best approaches to eliminating cardiometabolic health disparities in this population. Articles were identified from database searches performed in PubMed and MEDLINE from January 1998 to December 2008; 43 studies were included in the review. There is growing confirmatory evidence that NHOPI are one of the highest-risk populations for cardiometabolic diseases in the United States. Most studies found increased prevalences of diabetes, obesity, and cardiovascular risk factors among NHOPI. The few experimental intervention studies found positive results. Methodological issues included small sample sizes, sample bias, inappropriate racial/ethnic aggregation of NHOPI with Asians, and a limited number of intervention studies. Significant gaps remain in the understanding of cardiometabolic health disparities among NHOPI in the United States. More experimental intervention studies are needed to examine promising approaches to reversing the rising tide of cardiometabolic health disparities in NHOPI.

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.

Association between acculturation modes and type 2 diabetes among Native Hawaiians

OBJECTIVE

To examine the association between acculturation modes (integrated, assimilated, traditional, and marginalized) and type 2 diabetes prevalence in Native Hawaiians.

RESEARCH DESIGN AND METHODS

Cross-sectional data were analyzed from 495 Native Hawaiians, including acculturation modes, diabetes status, triglycerides, fasting insulin, BMI, age, and education level. Acculturation modes were assessed using an eight-item cultural affiliation questionnaire.

RESULTS

Native Hawaiians in a traditional mode of acculturation were more likely to have type 2 diabetes (27.9%) than those in integrated (15.4%), assimilated (12.5%), or marginalized (10.5%) modes.

CONCLUSIONS

The higher prevalence of type 2 diabetes among Native Hawaiians in a traditional mode of acculturation could not be attributed to any of the sociodemographic or biological factors included in this study. We discuss the role of psychosocial factors as possible mediators in the relationship between acculturation modes and type 2 diabetes.

Pacific Islanders' perspectives on heart failure management

OBJECTIVE

To identify the health beliefs, attitudes, practices, and social and family relations important in heart failure treatment among Pacific Islanders.

METHODS

Four focus groups were convened with 36 Native Hawaiians and Samoans with heart failure and their family caregivers. Thematic data analysis was used to categorize data into four domains: health beliefs and attitudes, preferred health practices, social support systems, and barriers to heart failure care.

RESULTS

Common coping styles and emotional experiences of heart failure in this population included avoidance or denial of illness, hopelessness and despair, and reliance on spiritual/religious beliefs as a means of support. Among study participants, more Samoans preferred to be treated by physicians whereas more Native Hawaiians preferred traditional Hawaiian methods of healing. Two types of social support (informational and tangible-instrumental) were identified as important in heart failure care. Barriers to heart failure care included poor knowledge of heart failure, lack of trust in physicians' care, poor physician-patient relations, finances, dietary changes, and competing demands on time.

CONCLUSION

The recruitment, retention, and adherence of Pacific Islanders to heart failure interventions is affected by an array of psychosocial and socio-cultural factors.

PRACTICE IMPLICATIONS

Interventions might be improved by offering participants accurate and detailed information about heart failure and its treatment, engaging the extended family in providing necessary supports, and providing tools to facilitate physician-patient relationships, among others, within the context of a larger socio-cultural system.

Discussion of Crabbe: Restoring Balance to Hawaii: “Kūpa'a i Ke Kāhua o Hawai'i”

Dr Crabbe presents a broad overview of the sociohistory of Hawaii following western contact and its colonisation by the United States (US). He describes the constant political, societal, and psychological struggles of Kānaka Maoli (native Hawaiians) against the never-ending tides of foreign influences to the shores of Hawaii. Within his sociohistorical overview, three significant issues for Kānaka Maoli are emphasised. One issue is that of ' Āina land. (The word ' Āina is capitalised throughout because, in the Native Hawaiian worldview, ' Āina is a living entity who gives and sustains life; it is an ancestor of the Hawaiian people, and it is important to the existence of Kānaka Maoli.) The second issue has to do with Kānaka Maoli is identity, which has been impacted by various foreign contacts and US colonisation that has negatively impacted traditional Hawaiian practices, customs, beliefs, language, and society. The constant struggle of Kānaka Maoli in regaining sovereignty, or self-determination, is a third issue of significance in Dr Crabbe's article. This article will briefly discuss the interplay among, and significance of, these three issues: ' Āina, Kānaka Maoli, and sovereignty, focusing on the importance and relevance of the first for the second and third.

Prevalence of diabetes and glucose intolerance in an ethnically diverse rural community of Hawaii

BACKGROUND

We report the prevalence of diabetes in a rural, multiethnic community in Hawaii, of predominantly Asian and Native Hawaiian ancestry, by using 1997 World Health Organization diagnostic criteria applied to a two-hour oral glucose tolerance test.

METHODS

This cross-sectional survey included 1452 men and nonpregnant women who were >18 years of age. Blood was drawn in the fasting and postchallenge states. Individuals under pharmacologic treatment for diabetes were excluded. Information obtained included demographics, medical history, dietary intake, physical activity, and anthropometric measurements.

RESULTS

Prevalence of diabetes was approximately three-fold higher among Asian and Native Hawaiian ancestry groups than among Caucasians, even after adjusting for other risk factors. Furthermore, diabetes prevalence was similar among all non-Caucasian ethnic groups despite significant differences in body mass indices.

CONCLUSIONS

These findings indicate that earlier reports of high prevalence of diagnosed diabetes among Asians and Hawaiian ethnic groups were not due to detection bias, since our study revealed similar prevalence of previously unrecognized diabetes. Furthermore, similar prevalence among these groups was observed despite significant differences in body mass indices, diet, and physical activity. This apparent paradox may reflect limitations in the measurement of these risk factors; differences in the impact of these risk factors on diabetes risk in different ethnic groups; or ethnic differences in lifestyle, biochemical, or genetic factors that were not examined in this study.

Ethnic-by-gender differences in cigarette smoking among Asian and Pacific Islanders

We examined the interaction between ethnicity and gender in predicting the likelihood of having ever smoked (vs. having never smoked) and being a current smoker (vs. being a former smoker) and in predicting years spent as a regular smoker. These relationships were examined while controlling for the possible confounding effects of sociodemographics, psychosocial factors, and chronic medical conditions. The analysis examined cross-sectional data from 1,158 people of Native Hawaiian, Filipino, Japanese, and White ethnic ancestry, finding large ethnic and gender-ethnic differences in the prevalence of former and current smoking. Multiple regression analyses showed significant gender x ethnicity interactions in predicting the likelihood of having ever smoked but not in the likelihood of being a current smoker (vs. having quit) or in the duration of years spent smoking. The results of the present study have important implications for smoking prevention programs among men and women in three distinct Asian and Pacific Islander ethnic groups.

Ethnic differences in perinatal outcome of gestational diabetes mellitus

OBJECTIVE

Despite the high rates of gestational diabetes mellitus (GDM) among certain Pacific Islander and Asian ethnic groups in the U.S., little is known about the risk for adverse perinatal outcomes in these populations. We sought to examine ethnic differences in perinatal outcome among Asian and Pacific-Islander women with GDM.

RESEARCH DESIGN AND METHODS

A retrospective review of all women referred to the largest outpatient GDM program in the state of Hawai'i from 1995 to 2005 was conducted. Patients of Native-Hawaiian/Pacific-Islander, Japanese, Chinese, Filipino, and Caucasian ethnicity were included (n = 2,155). Treatment of all patients consisted of an outpatient education class, dietary management, self-monitoring of blood glucose, and insulin instruction (if indicated). Demographics, maternal and neonatal characteristics, and delivery information were evaluated.

RESULTS

Neonates born to Native-Hawaiian/Pacific-Islander mothers and Filipino mothers had 4 and 2 times the prevalence of macrosomia, respectively, compared with neonates born to Japanese, Chinese, and Caucasian mothers. These differences persisted after adjustment for other statistically significant maternal and fetal characteristics. Ethnic differences were not observed for other neonatal or maternal complications associated with GDM, with the exception of neonatal hypoglycemia and hyperbilirubinemia.

CONCLUSIONS

Significant ethnic differences in perinatal outcomes exist across Asian and Pacific-Islander women with GDM. This finding emphasizes the need to better understand ethnic-specific factors in GDM management and the importance of developing ethnic-tailored GDM interventions to address these disparities.

Ethnic differences in the relationship between depressive symptoms and health-related quality of life in people with type 2 diabetes

OBJECTIVE

To examine ethnic differences in the relationship between depressive symptoms and specific aspects of heath-related quality of life in people with type 2 diabetes.

DESIGN

Cross-sectional data from 190 people with type 2 diabetes of Native Hawaiian (50%), Filipino (16%), Japanese (18%), and mixed-ethnic (16%) ancestries from the rural community of North Kōhala, Hawai'i were examined in this study. Depressive symptoms were measured with the Center for Epidemiological Studies-Depression (CES-D) scale. Health-related quality of life was measured with the Short Form-36 Health Survey (SF-36). Eight health-related quality of life constructs were examined: Physical Functioning, Role-Physical Functioning, Role-Emotional Functioning, Social Functioning, Bodily Pain, Vitality, General Health, and Health Transition.

RESULTS

Hierarchical regression analyses of the interaction between ethnicity and the SF-36 subscales of Physical Functioning, Role-Emotional Functioning, Bodily Pain, Vitality, and General Health indicated statistically significant associations with CES-D scores after controlling for sociodemographic factors, glycemic status, and social support.

CONCLUSION

Ethnicity moderated the relationship between depressive symptoms and the health-related quality of life aspects of physical and role-emotional functioning, bodily pain, vitality, and general health perception in people with type 2 diabetes. This relationship was strongest for Filipinos followed by Native Hawaiians and people of mixed-ethnic ancestries.