1
|
Quint J, Matagi C, Kaholokula JK. The Hawai'i NHPI Data Disaggregation Imperative: Preventing Data Genocide Through Statewide Race and Ethnicity Standards. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2023; 82:67-72. [PMID: 37901675 PMCID: PMC10612414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
Federal race and ethnicity data standards are commonly applied within the state of Hawai'i. When a multiracial category is used, Native Hawaiians are disproportionately affected since they are more likely than any other group to identify with an additional race or ethnicity group. These data conventions contribute to a phenomenon known as data genocide - the systematic erasure of Indigenous and marginalized peoples from population data. While data aggregation may be unintentional or due to real or perceived barriers, the obstacles to disaggregating data must be overcome to advance health equity. In this call for greater attention to relevant social determinants of health through disaggregation of race and ethnicity data, the history of data standards is reviewed, the implications of aggregation are discussed, and recommended disaggregation strategies are provided.
Collapse
Affiliation(s)
| | - Chantelle Matagi
- Center for Pacific Island Studies, University of Hawai‘i at Mānoa, Honolulu, HI (CM)
| | - Joseph Keawe‘aimoku Kaholokula
- Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai‘i at Mānoa, Honolulu, HI (JKK)
| |
Collapse
|
2
|
Delafield R, Kwon H, Mar A, Hermosura AH, De Sousa EBC, Levinson J, Pauker K. Examining Implicit Racial Attitudes among College Students in Hawai'i, a Project of the Hawai'i Implicit Bias Initiative. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2023; 82:29-35. [PMID: 37901673 PMCID: PMC10612416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
For the past 2 decades, investigations into implicit racial bias have increased, building evidence on the impact of bias on health and health care for many minority communities in the US. However, few studies examine the presence and impacts of implicit bias in Hawai'i, a context distinct in its history, racial/ethnic diversity, and contemporary inequities. The absence of measures for major racialized groups, such as Native Hawaiians, Pacific Islanders, and Filipinos, impedes researchers' ability to understand the contribution of implicit bias to the health and social disparities observed in Hawai'i. The purpose of this study was to measure bias toward these underrepresented groups to gain a preliminary understanding of the implicit racial bias within the distinctive context of this minority-majority state. This study measured implicit racial bias among college students in Hawai'i using 3 implicit association tests (IATs): (1) Native Hawaiian compared to White (N = 258), (2) Micronesian comparedto White (N =257), and (3) Filipino compared to Japanese (N = 236). Themean IAT D scores showed implicit biases that favored Native Hawaiiansover Whites, Whites over Micronesians, and Japanese over Filipinos. Multipleregression was conducted for each test with the mean IAT D score as theoutcome variable. The analysis revealed that race was a predictor in the vastmajority of tests. In-group preferences were also observed. This investigationadvances the understanding of racial/ethnic implicit biases in the uniquelydiverse state of Hawai'i and suggests that established social heirarchies mayinfluence implicit racial bias.
Collapse
Affiliation(s)
- Rebecca Delafield
- Dept. Of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai‘i at Mānoa, Honolulu, HI (RD, AM, AHH)
| | - Heewon Kwon
- Dept. Of Psychology, College of Social Sciences, University of Hawai‘i at Mānoa, Honolulu, HI (HK, KP)
| | - Amy Mar
- Dept. Of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai‘i at Mānoa, Honolulu, HI (RD, AM, AHH)
| | - Andrea H. Hermosura
- Dept. Of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai‘i at Mānoa, Honolulu, HI (RD, AM, AHH)
| | - Elizabeth B. Chapman De Sousa
- Institute for Teacher Education – Elementary Education and Multilingual Learning Program, College of Education, University of Hawai‘i at Mānoa, Honolulu, HI (CD)
| | - Justin Levinson
- William S. Richardson School of Law, University of Hawai‘i at Mānoa, Honolulu, HI (JL)
| | - Kristin Pauker
- Dept. Of Psychology, College of Social Sciences, University of Hawai‘i at Mānoa, Honolulu, HI (HK, KP)
| |
Collapse
|
3
|
Delafield R, Hermosura A, Ahn HJ, Kaholokula JK. Implicit Racial Attitudes and Associations Among Obstetricians in Hawai'i: a Pilot Study. J Racial Ethn Health Disparities 2022; 9:2395-2403. [PMID: 34973153 PMCID: PMC9633441 DOI: 10.1007/s40615-021-01176-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 10/15/2021] [Accepted: 10/21/2021] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Pacific Islanders living in Hawai'i with ancestral ties to islands in the western Pacific region of Micronesia are common targets of uninhibited forms of prejudice in multiple sectors, including healthcare. Whether the explicit societal-level attitudes toward this group are reflected in implicit attitudes among healthcare providers is unknown; therefore, we designed a pilot study to investigate this question. Our study measures implicit racial bias toward Pacific Islanders from Micronesia among Obstetrician-Gynecologists (OB-GYNs) in Hawai'i. METHODS We developed 4 new implicit association tests (IATs) to measure implicit attitudes and associations (i.e., stereotypes) toward Pacific Islanders from Micronesia in 2 conditions: (1) Micronesians vs. Whites and (2) Micronesians vs. Japanese Americans. Participants were practicing OB-GYNs in Hawai'i. The study was conducted online and included survey questions on demographic and physician practice characteristics in addition to IATs. The primary outcome was the mean IAT D score. Associations between IAT D scores and demographic and practice characteristics were also analyzed. RESULTS Of the 49 OB-GYNs, 38 (77.6%) were female, mean age was 40 years, 29.5% were Japanese, 22.7% were White, and none were from a Micronesian ethnic group. The mean IAT D score in the Micronesian vs. White condition (N = 29) was 0.181, (SD: 0.465, p < 0.05) for the Attitude IAT and 0.197 (SD: 0.427; p < 0.05) for the Stereotype IAT. CONCLUSION The findings from this pilot suggest a slight degree of implicit bias favoring Whites over Micronesians within this sample of OB-GYNs and warrant a larger investigation into implicit biases toward this unique and understudied Pacific Islander population.
Collapse
Affiliation(s)
- Rebecca Delafield
- Department of Native Hawaiian Health, University of Hawai'i, John A. Burns School of Medicine, 677 Ala Moana Blvd., Ste. 1016B, Honolulu, HI, 96813, USA.
| | - Andrea Hermosura
- Department of Native Hawaiian Health, University of Hawai'i, John A. Burns School of Medicine, 677 Ala Moana Blvd., Ste. 1016B, Honolulu, HI, 96813, USA
| | - Hyeong Jun Ahn
- Department of Quantitative Health Sciences, University of Hawai'i, John A. Burns School of Medicine, 651 Ilalo St. Medical Education Bldg., Ste 411, Honolulu, HI, 96813, USA
| | - Joseph Keaweʻaimoku Kaholokula
- Department of Native Hawaiian Health, University of Hawai'i, John A. Burns School of Medicine, 677 Ala Moana Blvd., Ste. 1016B, Honolulu, HI, 96813, USA
| |
Collapse
|
4
|
Ayers BL, Purvis RS, Bogulski CA, Reece S, CarlLee S, Kim Yeary KH, McElfish PA. "It's Okay With Our Culture but We're in a Different Place and We Have to Show Respect": Marshallese Migrants and Exclusive Breastfeeding Initiation. J Hum Lact 2022; 38:732-739. [PMID: 35337206 PMCID: PMC11247540 DOI: 10.1177/08903344221077133] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Pacific Islanders in the United States have lower initiation rates and shorter duration of exclusive breastfeeding compared to other racial/ethnic groups. RESEARCH AIM To describe infant feeding beliefs and experiences of Marshallese living in the United States. METHODS We used a prospective and cross-sectional exploratory, descriptive qualitative design with Marshallese participants (N = 36) residing in the United States between July 2019 and July 2020. Data were collected at 6-8 weeks postpartum. Our qualitative analytic approach integrated inductive and deductive techniques. RESULTS Participants' mean age was 27.1 years (SD = 6.1), and 88.9% (n = 32) were born in the Marshall Islands. A majority of participants were single, widowed, or in an unmarried partnership (n = 28, 77.8%). Most participants had a high school education or lower (n = 30, 83.3%). Mean household size was 7.2 (SD = 2.8). Fewer than half of participants had no health insurance (n = 14, 38.9%), and almost all participants (91.7%) did not work at the time of data collection. Two themes emerged: 1) infant feeding initiation and practices; and 2) concerns over breastfeeding in public. The majority of participants' infants received both human milk and formula. Participants described beliefs that breastfeeding in public was against American customs, which influenced their decision about breastfeeding in public. CONCLUSIONS Our study was the first to document infant feeding beliefs and experiences of Marshallese living in the United States at 6-8 weeks postpartum. Findings will inform future health education programs.
Collapse
Affiliation(s)
- Britni L Ayers
- University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Rachel S Purvis
- University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Cari A Bogulski
- University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Sharon Reece
- University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Sheena CarlLee
- University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | | | - Pearl A McElfish
- University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| |
Collapse
|
5
|
Ng Kamstra JS, Molina T, Halliday T. Compact for care: how the Affordable Care Act marketplaces fell short for a vulnerable population in Hawaii. BMJ Glob Health 2021; 6:bmjgh-2021-007701. [PMID: 34845000 PMCID: PMC8634008 DOI: 10.1136/bmjgh-2021-007701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 11/08/2021] [Indexed: 11/12/2022] Open
Abstract
The Patient Protection and Affordable Care Act (ACA) was passed in 2010 to expand access to health insurance in the USA and promote innovation in health care delivery. While the law significantly reduced the proportion of uninsured, the market-based protection it provides for poor and vulnerable US residents is an imperfect substitute for government programs such as Medicaid. In 2015, residents of Hawaii from three Compact of Free Association nations (the Federated States of Micronesia, Palau and Marshall Islands) lost their eligibility for the state’s Medicaid program and were instructed to enrol in coverage via the ACA marketplace. This transition resulted in worsened access to health care and ultimately increased mortality in this group. We explain these changes via four mechanisms: difficulty communicating the policy change to affected individuals, administrative barriers to coverage under the ACA, increased out of pocket health care costs and short enrolment windows. To achieve universal health coverage in the USA, these challenges must be addressed by policy-makers.
Collapse
Affiliation(s)
- Joshua S Ng Kamstra
- The Queen's Health Systems, Honolulu, Hawaii, USA .,Department of Surgery, University of Hawai'i at Manoa John A Burns School of Medicine, Honolulu, Hawaii, USA
| | - Teresa Molina
- Department of Economics, University of Hawai'i at Manoa, Honolulu, Hawaii, USA.,IZA Institute of Labor Economics, Bonn, Nordrhein-Westfalen, Germany
| | - Timothy Halliday
- Department of Economics, University of Hawai'i at Manoa, Honolulu, Hawaii, USA.,IZA Institute of Labor Economics, Bonn, Nordrhein-Westfalen, Germany
| |
Collapse
|
6
|
Shek DM, Delafield R, Viernes JP, Pangelinan J, Sound-Kikku I, Paul J, Day TT, Asher SS. Micronesians Building Healthier Communities During the COVID-19 Pandemic. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2021; 80:30-35. [PMID: 34704066 PMCID: PMC8538110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Micronesian communities in Hawai'i have a long history of mobilizing to address challenges they encounter as the most recent and fastest growing Pacific Islander immigrant population in the state. In particular, community leaders navigate a slew of obstacles specific to systemic racism and health care access. These hurdles have become exacerbated by the COVID-19 pandemic, prompting a range of Micronesian-led responses to the health crisis including strategic adaptations to existing networks and roles to address essential public health functions. These community responses have filled many critical gaps left by the state's delayed response to addressing the disparate impact of COVID-19 on Micronesian communities. This article highlights and encourages engagement with diverse models of collaboration and elevation of Micronesian leadership that has resulted in more productive cooperation with government leaders, agencies, and policymakers. This work offers insight into pathways forward toward healthier Micronesian families and communities.
Collapse
Affiliation(s)
- Dina M. Shek
- William S. Richardson School of Law, University of Hawai‘i at Mānoa, Honolulu, HI
| | - Rebecca Delafield
- Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai‘i at Mānoa, Honolulu, HI
| | - James Perez Viernes
- Center for Pacific Islands Studies, University of Hawai‘i at Mānoa, Honolulu, HI
| | - Joseph Pangelinan
- John T. Milliken Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO
| | | | | | | | | |
Collapse
|
7
|
Quint JJ, Van Dyke ME, Maeda H, Worthington JK, Dela Cruz MR, Kaholokula JK, Matagi CE, Pirkle CM, Roberson EK, Sentell T, Watkins-Victorino L, Andrews CA, Center KE, Calanan RM, Clarke KE, Satter DE, Penman-Aguilar A, Parker EM, Kemble S. Disaggregating Data to Measure Racial Disparities in COVID-19 Outcomes and Guide Community Response - Hawaii, March 1, 2020-February 28, 2021. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2021; 70:1267-1273. [PMID: 34529634 PMCID: PMC8445382 DOI: 10.15585/mmwr.mm7037a1] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Native Hawaiian and Pacific Islander populations have been disproportionately affected by COVID-19 (1-3). Native Hawaiian, Pacific Islander, and Asian populations vary in language; cultural practices; and social, economic, and environmental experiences,† which can affect health outcomes (4).§ However, data from these populations are often aggregated in analyses. Although data aggregation is often used as an approach to increase sample size and statistical power when analyzing data from smaller population groups, it can limit the understanding of disparities among diverse Native Hawaiian, Pacific Islander, and Asian subpopulations¶ (4-7). To assess disparities in COVID-19 outcomes among Native Hawaiian, Pacific Islander, and Asian populations, a disaggregated, descriptive analysis, informed by recommendations from these communities,** was performed using race data from 21,005 COVID-19 cases and 449 COVID-19-associated deaths reported to the Hawaii State Department of Health (HDOH) during March 1, 2020-February 28, 2021.†† In Hawaii, COVID-19 incidence and mortality rates per 100,000 population were 1,477 and 32, respectively during this period. In analyses with race categories that were not mutually exclusive, including persons of one race alone or in combination with one or more races, Pacific Islander persons, who account for 5% of Hawaii's population, represented 22% of COVID-19 cases and deaths (COVID-19 incidence of 7,070 and mortality rate of 150). Native Hawaiian persons experienced an incidence of 1,181 and a mortality rate of 15. Among subcategories of Asian populations, the highest incidences were experienced by Filipino persons (1,247) and Vietnamese persons (1,200). Disaggregating Native Hawaiian, Pacific Islander, and Asian race data can aid in identifying racial disparities among specific subpopulations and highlights the importance of partnering with communities to develop culturally responsive outreach teams§§ and tailored public health interventions and vaccination campaigns to more effectively address health disparities.
Collapse
|
8
|
Delafield R, Elia J, Chang A, Kaneshiro B, Sentell T, Pirkle CM. A Cross-Sectional Study Examining Differences in Indication for Cesarean Delivery by Race/Ethnicity. Healthcare (Basel) 2021; 9:159. [PMID: 33546153 PMCID: PMC7913232 DOI: 10.3390/healthcare9020159] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 01/19/2021] [Accepted: 01/25/2021] [Indexed: 11/21/2022] Open
Abstract
(1) Background: There are persistent racial/ethnic disparities in cesarean delivery in the United States (U.S.), yet the causes remain unknown. One factor could be provider bias. We examined medical indications for cesarean delivery that involve a greater degree of physician discretion (more subjective) versus medical indications that involve less physician discretion (more objective) to better understand factors contributing to the higher rate among Micronesian, one of the most recent migrant groups in the state, compared to White women in Hawai'i. (2) Methods: A retrospective chart review was conducted to collect data on 620 cesarean deliveries (N = 296 White and N = 324 Micronesian) at the state's largest maternity hospital. Multivariate regression models were used to examine associations between maternal and obstetric characteristics and (1) subjective indication defined as non-reassuring fetal heart tracing (NRFHT) and arrest of labor disorders, and (2) objective indication defined as all other indications (e.g., malpresentation). (3) Results: We found that Micronesian women had significantly higher odds of cesarean delivery due to a subjective indication compared to White women (aOR: 4.17; CI: 2.52-6.88; P < 0.001; N = 619) after adjusting for multiple covariates. (4) Conclusion: These findings suggest unmeasured factors, possibly provider bias, may influence cesarean delivery recommendations for Micronesian women in Hawai'i.
Collapse
Affiliation(s)
- Rebecca Delafield
- Thompson School of Social Work & Public Health, Office of Public Health Studies, University of Hawai‘i at Mānoa, Honolulu, HI 96822, USA; (T.S.); (C.M.P.)
| | - Jennifer Elia
- John A. Burns School of Medicine, Department of Obstetrics, Gynecology and Women’s Health, University of Hawai‘i, Honolulu, HI 96826, USA; (J.E.); (A.C.); (B.K.)
| | - Ann Chang
- John A. Burns School of Medicine, Department of Obstetrics, Gynecology and Women’s Health, University of Hawai‘i, Honolulu, HI 96826, USA; (J.E.); (A.C.); (B.K.)
| | - Bliss Kaneshiro
- John A. Burns School of Medicine, Department of Obstetrics, Gynecology and Women’s Health, University of Hawai‘i, Honolulu, HI 96826, USA; (J.E.); (A.C.); (B.K.)
| | - Tetine Sentell
- Thompson School of Social Work & Public Health, Office of Public Health Studies, University of Hawai‘i at Mānoa, Honolulu, HI 96822, USA; (T.S.); (C.M.P.)
| | - Catherine M. Pirkle
- Thompson School of Social Work & Public Health, Office of Public Health Studies, University of Hawai‘i at Mānoa, Honolulu, HI 96822, USA; (T.S.); (C.M.P.)
| |
Collapse
|
9
|
McElfish PA, Purvis R, Willis DE, Riklon S. COVID-19 Disparities Among Marshallese Pacific Islanders. Prev Chronic Dis 2021; 18:E02. [PMID: 33411668 PMCID: PMC7845552 DOI: 10.5888/pcd18.200407] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR 72703.
| | - Rachel Purvis
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas
| | - Don E Willis
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas
| | - Sheldon Riklon
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas
| |
Collapse
|