Physical Activity Among Native Hawaiians and Pacific Islanders: A Systematic Review and Meta-Analysis

Racial Misclassification, Discrimination, Consciousness, and Self-Rated Health Among Native Hawaiian and Pacific Islander Adults in the USA

BACKGROUND

Medical researchers have historically utilized the variable of race uncritically, rarely defining race, rarely acknowledging it as a social construct, and often omitting information about how it was measured. In this study, we use the following definition of race: "a system of structuring opportunity and assigning value based on the social interpretation of how one looks." We examine the influence of racial misclassification, racial discrimination, and racial consciousness on the self-rated health of Native Hawaiian and Pacific Islanders (NHPI) living in the United States of America (USA).

METHODS

Our analysis used online survey data from a subgroup of NHPI adults living in the USA (n = 252) who were oversampled as part of a larger study of US adults (N = 2022). Respondents were recruited between September 7, 2021 and October 3, 2021, from an online opt-in panel of individuals across the USA. Statistical analyses include weighted and unweighted descriptive statistics for the sample, as well as a weighted logistic regression for poor/fair self-rated health.

RESULTS

Odds of poor/fair self-rated health were greater for women (OR = 2.72; 95% CI [1.19, 6.21]) and those who experienced racial misclassification (OR = 2.90; 95% CI [1.20, 7.05]). No other sociodemographic, healthcare, or race-related variables were significantly associated with self-rated health in the fully adjusted results.

CONCLUSIONS

Findings suggest that racial misclassification may be an important correlate of self-rated health among NHPI adults in the US context.

Physical Inactivity Prevalence in the Islamic World: An Updated Analysis of 47 Countries

BACKGROUND

Physical inactivity prevalence estimates for youth and adults have been published on a global scale and for various geographical and geopolitical permutations. Only one such study has presented estimates for adults in Muslim countries, and it is nearly 10 years old. I conducted an update of this study by incorporating newer data, refining methods, and including youth estimates.

METHODS

I identified 47 Muslim countries with physical inactivity data for youth, adults, or both. Data were extracted by country primarily from global estimates reported by Guthold et al in 2018 and 2020 and from World Health Organization surveillance data repositories. Weighted prevalence calculations for total prevalence and by sex, ethnicity (Arab vs non-Arab), and country income group accounted for country population, study sample size, and a country's proportion of Muslims. Z tests and chi-square tests, and follow-up odds ratios and percentage deviations, respectively, were used to determine differences by sex, ethnicity, and country income group.

RESULTS

Overall physical inactivity prevalence was 84.2% (youth) and 29.6% (adults). Gaps favoring males over females were observed for youth (5.6% lower prevalence) and adults (9.6% lower prevalence). Gaps favoring non-Arabs over Arabs were observed for youth (3.9% lower) and adults (3.8% lower). No pattern emerged for country income group for youth; however, prevalence for adults trended upward across income groups from low (22.7%) to high (62.0%).

CONCLUSIONS

Gaps by sex and ethnicity have narrowed since the original report and prevalence values are somewhat higher than current global estimates.

Prevalence and socio-demographic distributions of meeting RMI Guidelines for Healthy Living among elementary school children in Majuro, Republic of Marshall Islands: a cross-sectional population-based survey

Background

Childhood obesity is high in Republic of Marshall Islands (RMI). We report the prevalence and socio-demographic distribution of selected obesity-related risk factors among children in Majuro, RMI.

Methods

Sixteen elementary schools were approached and students and parents in Grades 1, 3, and 5 invited to participate in this cross-sectional population-based survey. Accelerometry and a questionnaire were used to collect data on children's physical activity (PA), sleep, screen time and dietary behaviours. Descriptive statistics and mixed-effects logistic regression were used to examine differences in the proportions of children meeting selected RMI Healthy Living Guidelines by sex, school grade and school sector.

Findings

Thirteen schools and 958 children were recruited, of which 892 (52.2% girls; mean age 9.3 ± 1.8 years) provided useable data. Around 90% met the PA, 29% screen time, 13% sleep, 69% sugar-sweetened beverage and 56% highly processed food guidelines. The proportion meeting individual guidelines was higher among children in Grade 1 compared with Grade 5. Being a girl (0.27; 95% CI 0.16, 0.46) was associated with lower odds of meeting the PA recommendation. Compared with children from Grade 1, those in Grade 5 had lower odds of meeting the PA (0.28; 95% CI 0.15, 0.55), screen time (0.60; 95% CI 0.40, 0.89), sleep duration (0.33; 95% CI 0.18, 0.59), sugar-sweetened beverage (0.35; 95% CI 0.23, 0.53), and consumption of highly processed foods recommendations (0.49; 95% CI 0.33, 0.72).

Interpretation

While most children in RMI are adequately active, resources are needed to promote healthier levels of screen time, sleep, sugar-sweetened beverage and highly processed food consumption, especially among older children.

Funding

This study was funded by World Diabetes Foundation; Canvasback Missions, RMI; NHMRC Australia (APP1176858); Pacific Community.

College student aerobic and muscle-strengthening activity: the intersection of gender and race/ethnicity among United States students

Objective: To adopt an intersectional approach to examine differences in aerobic and muscle-strengthening participation based on the intersection of gender and race/ethnicity among college students. Methods: Data from the American College Health Association (ACHA) National College Health Assessment collected between 2015 and 2018 were analyzed. Differences in the prevalence of meeting activity recommendations based on the intersection of gender and race/ethnicity were computed and displayed graphically. Odds of meeting activity recommendations were determined by calculating odds ratios controlling for age, year of enrollment, sexual orientation, and health status. Results: Aerobic and muscle-strengthening activity differed significantly between races within genders, and between genders within races. With minor exceptions, men were more likely to meet aerobic and muscle-strengthening activity recommendations than women of the same race/ethnicity. Disparities based on race varied considerably between genders. Conclusions: The intersection of gender and race/ethnicity should be considered when examining and addressing physical activity disparities.

Associations between physical activity and functional limitations in Native Hawaiian and Pacific Islander middle-aged and older adults in the United States

OBJECTIVES

Physical activity (PA) can help individuals maintain physical function and independence. The association between PA and functional limitations (FL) has not been explored in the Native Hawaiian and Pacific Islander (NHPI) population. The purpose of this study was to examine relationships between PA and FL among NHPI adults (age ≥ 45 years) living in the United States.

DESIGN

Cross-sectional data from the 2014 NHPI-National Health Interview Survey (N = 628) was used to create three constructs of FL based on responses from the Functioning and Disability Survey Module: needing equipment/assistance, having difficulty walking, and having difficulty with performing self-care and other fine motor activities. We used 2-stage least squares regression to examine the relationship between PA and FL of NHPI adults while accounting for the potential endogeneity of PA to FL.

RESULTS

Compared to NHPI adults who met the guideline for recommended levels of aerobic and strengthening PA, those who met only the strengthening guideline experienced less difficulty in two FL constructs (use of medical equipment/assistance and difficulty walking). Those who met the aerobic guideline reported even less difficulties in all three FL constructs. NHPI adults who met both the aerobic and strengthening guidelines experienced the least difficulties in all three FL constructs compared to those who met neither PA guidelines.

CONCLUSIONS

PA is associated with function in this adult NHPI population. Aerobic guidelines alone may be more beneficial than meeting the strengthening guideline alone; however, meeting both the aerobic and strengthening guidelines is most protective against FL.

The Barriers to and Facilitators of Physical Activity and Sport for Oceania with Non-European, Non-Asian (ONENA) Ancestry Children and Adolescents: A Mixed Studies Systematic Review

BACKGROUND

Participation in sport and physical activity (PA) leads to better overall health, increased life expectancy, and decreased mortality rates across the lifespan; however, there may be a range of individual, family, and community factors that influence PA participation among ONENA children and adolescents residing in the 22 Pacific Island Countries and Territories (PICT) and Australia. This review aimed to synthesise existing quantitative and qualitative literature regarding barriers to and facilitators of PA and sport among ONENA youth.

METHODS

The literature was systematically searched to include studies reporting barriers to and facilitators of PA and sports participation among ONENA children and adolescents aged 0-18 years residing in the 22 PICT and Australia. Using a pre-established taxonomy based on the social-ecological model, a deductive analysis was performed. Quality appraisal was performed using the mixed methods appraisal tool.

RESULTS

Of 1388 articles, 14 studies were included, with 128 ONENA children and adolescent participants across the four qualitative studies; 156,581 ONENA children and adolescents across the seven quantitative studies; 801 parents, children, and adolescents in one quantitative study; and 642 parents in two quantitative studies. Of the 14 included studies, none were based in Australia and only 10 of the 22 PICT were reported as the participants' residence: Palau, New Zealand, Tonga, Cook Islands, Kiribati, Samoa, Solomon Islands, Tuvalu, Vanuatu, and Fiji. Four studies reported barriers, and another four studies reported facilitators of PA and sport, with the remaining studies reporting both barriers and facilitators. Overall, there were more barriers reported (30 in total) than facilitators (27 in total).

CONCLUSIONS

Research in this area is lacking, with ONENA youth living in Australia and 12 PICT not represented. Overall, there were a larger number of facilitators experienced at individual and interpersonal levels, while barriers were highest at the community level, with the policy level having facilitators and barriers equally represented. Programs that offer PA and sport participation options with embedded SDT-informed strategies for all family members; that are accessible through existing transport and related social, cultural, and physical infrastructure; and that are committed to communities through formal co-design partnerships are needed, to enhance the PA and sport participation of ONENA youth residing in PICT.

Freshman physical activity constraints are related to the current health behaviors and outcomes of college upperclassmen

ObjectiveExamine differences in physical activity (PA) constraints experienced as freshmen among college upperclassmen based on sex, race/ethnicity, adiposity, and fitness. Participants and methods: Upperclassmen (n = 524) from self-reported demographics, PA, subjective changes in PA, and freshman PA constraints via an online survey, and had adiposity and predicted aerobic fitness objectively assessed. Results: Self-reported reductions in PA since high school and freshmen year were associated with a lack of motivation as a freshman, lower current PA levels, and poorer aerobic fitness compared to those who maintained or increased PA. Women were less active than men and reported greater constraints, while non-Hispanic white students had greater vigorous PA than minority students. Multiple regression analyses revealed that motivation constraints predicted PA regardless of sex and race/ethnicity. Conclusions: Findings highlight the importance of college administrators and health promoters alleviating freshman PA constraints, particularly among women, to promote the adoption of an active lifestyle.

Examining the Relationship Between Physical Activity and Self-Efficacy for Exercise Among Overweight and Obese Marshallese Adults

This study examined associations between physical activity frequency and self-efficacy for exercise (SEE) among Marshallese adults in the United States. Data were collected from overweight and obese Marshallese participants (N = 378) enrolled in a Diabetes Prevention Program trial. Logistic and ordinal logistic regressions were employed to examine associations between physical activity and SEE, adjusting for covariates. SEE was significantly associated with engaging in sufficient total physical activity [odds ratio (OR) = 1.70], moderate physical activity (OR = 2.23), and vigorous physical activity (OR = 2.13). Unemployment was associated with less frequent moderate physical activity (OR = 0.59). Younger age (OR = 0.98), being male (OR = 2.67), and reporting excellent health (OR = 3.14) or good health (OR = 2.06) were associated with more frequent vigorous physical activity. Physical activity is a modifiable lifestyle behavior associated with many chronic disease disparities faced by the Marshallese community, and the study results will be useful for practitioners and researchers working to address these disparities.

Neighborhood social cohesion and physical activity and obesity outcomes among Native Hawaiian and Pacific Islander individuals

OBJECTIVE

Native Hawaiian and Pacific Islander (NHPI) individuals report high obesity rates and low physical activity (PA) levels. This study examined associations between neighborhood social cohesion, obesity, and PA among NHPI adults.

METHODS

Cross-sectional data from the 2014 NHPI National Health Interview Survey were analyzed. Social cohesion was assessed using a summative scale and categorized as low, medium, and high. PA was measured via self-report and categorized as insufficiently active (0-149 min/wk) or sufficiently active (150+ min/wk). Obesity status was based on self-reported height and weight measures converted into standard BMI categories. Multivariable logistic regression models estimated odds of obesity and sufficient PA associated with social cohesion level.

RESULTS

The study sample included n = 2,590 NHPI adults. Compared with those in low social cohesion neighborhoods, participants in high social cohesion neighborhoods had increased sufficient PA odds (odds ratio [OR] = 1.59, 95% CI: 1.19-2.12; p = 0.003) and decreased obesity odds (OR = 0.57, 95% CI: 0.40-0.83; p = 0.005). No associations were observed between social cohesion and obesity and PA outcomes comparing individuals in medium versus low social cohesion neighborhoods.

CONCLUSIONS

High social cohesion was associated with reduced obesity odds and increased sufficient PA odds. Findings highlight the importance of enhancing social connectivity as a potential strategy to promote PA and healthy weight among NHPI individuals.