Abstract PR012: Social and Structural Influences of Preventive Cancer Screenings for Native Hawaiian and Pacific Islander Adults in Hawaiʻi
Authors: Willingham Mark L. , Cassel Kevin , Zhang Wei , Diaz Tressa P. , Sy Angela , Pagano Ian , Ta'afaki Munirih R. , Mummert Angelina G. 
Published: September 2024

Abstract
Background: Native Hawaiians and Pacific Islanders (NHPI) are hindered by sociocultural, geographic, and environmental factors that contribute to cancer health disparities, often masked by aggregated data with Asian Americans. An average of 7,393 Hawai‘i residents are diagnosed with invasive cancer yearly, and rates are disproportionate ethnically; . Native Hawaiians and Micronesians suffer higher mortality rates for breast cancer (24.9 and 21.6 per 100,000) than White women (17.0). This study aims to investigate social drivers of health behaviors among NHPI in Hawaiʻi by examining social factors that influence cancer screenings through mixed methods. Methods: This mixed methods study is a follow-up to a cross-sectional survey administered in 2018 to 3 Pacific Islander ethnic subgroups: Native Hawaiians, Chuukese, and Marshallese in Hawaiʻi using Respondent Driven Sampling within public housing (N=1,010 NHPI). Disparate cancer screening practices were uncovered within these groups when compared to Hawaiʻi state data. Logistic regression was used to analyze predictors of colon, breast, and cervical cancer screenings. The Gelberg Behavioral Model for Vulnerable Populations and socio-ecological model served as the theoretical models. To triangulate the findings, 16 semi-structured interviews with adults living within the communities first surveyed were conducted in 2023 to uncover any additional drivers of health behaviors that the regression missed. Results: Quantitative findings include cultural/linguistic misunderstandings between NHPI and healthcare providers. Participants who indicated difficulty understanding a provider’s instructions because of language were 51% less likely to be screened for cervical cancer (p = .04). Individuals who hold neutral acculturation to both their ethnic and American culture are less likely to be screened for cancer. Those whose responses fell in a neutral category were 40% less likely than those with a high ethnic identity to have had a colon cancer screening (p = .02). Qualitative findings demonstrate differing views among Pacific Islander groups including competition for resources between groups within public housing. All of the interviewees highlight the role of God and faith in decision making. Informational exchanges take place mainly within the family and cohabitants. From triangulating the findings, there is a lack of strong social ties/networks that could facilitate health-based resources and knowledge. Families are not discussing self-care or family histories of disease, which are instrumental in the early detection of cancers and missed within the regression. Conclusion: This study provides insight into the social drivers of cancer screenings for NHPI communities in Hawaiʻi. Novel insights for the fields of medical sociology and public health are highlighted by influential social processes to NHPI cancer screening behaviors. Recommendations include further research and programs that focus on and foster social dynamics of these communities in relation to cancer screenings.
Citation Format: Mark L. Willingham Jr., Kevin Cassel, Wei Zhang, Tressa P. Diaz, Angela Sy, Ian Pagano, Munirih R. Ta'afaki, Angelina G. Mummert. Social and Structural Influences of Preventive Cancer Screenings for Native Hawaiian and Pacific Islander Adults in Hawaiʻi [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr PR012.