I 
111TH CONGRESS 
1ST SESSION H. R. 4024 
To amend the Native Hawaiian Health Care Improvement Act to revise 
and extend that Act. 
IN THE HOUSE OF REPRESENTATIVES 
NOVEMBER 4, 2009 
Ms. HIRONO (for herself and Mr. ABERCROMBIE) introduced the following bill; 
which was referred to the Committee on Energy and Commerce 
A BILL 
To amend the Native Hawaiian Health Care Improvement 
Act to revise and extend that Act. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Native Hawaiian 
Health Care Improvement Reauthorization Act of 2009’’. 
SEC. 2. AMENDMENT TO THE NATIVE HAWAIIAN HEALTH 
CARE IMPROVEMENT ACT. 
The Native Hawaiian Health Care Improvement Act 
(42 U.S.C. 11701 et seq.) is amended to read as follows: 
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‘‘SEC. 1. SHORT TITLE; TABLE OF CONTENTS. 
‘‘(a) SHORT TITLE.—This Act may be cited as the 
‘Native Hawaiian Health Care Improvement Act’. 
‘‘(b) TABLE OF CONTENTS.—The table of contents 
of this Act is as follows: 
‘‘Sec. 1. Short title; table of contents. 
‘‘Sec. 2. Findings. 
‘‘Sec. 3. Definitions. 
‘‘Sec. 4. Declaration of national Native Hawaiian health policy. 
‘‘Sec. 5. Comprehensive health care master plan for Native Hawaiians. 
‘‘Sec. 6. Functions of Papa Ola Lokahi. 
‘‘Sec. 7. Native Hawaiian health care. 
‘‘Sec. 8. Administrative grant for Papa Ola Lokahi. 
‘‘Sec. 9. Administration of grants and contracts. 
‘‘Sec. 10. Assignment of personnel. 
‘‘Sec. 11. Native Hawaiian health scholarships and fellowships. 
‘‘Sec. 12. Report. 
‘‘Sec. 13. Use of Federal Government facilities and sources of supply. 
‘‘Sec. 14. Demonstration projects of national significance. 
‘‘Sec. 15. Rule of construction. 
‘‘Sec. 16. Compliance with Budget Act. 
‘‘Sec. 17. Severability. 
‘‘SEC. 2. FINDINGS. 
‘‘(a) IN GENERAL.—Congress finds that— 
‘‘(1) Native Hawaiians begin their story with 
the Kumulipo, which details the creation and inter-
relationship of all things, including the evolvement of 
Native Hawaiians as healthy and well people; 
‘‘(2) Native Hawaiians— 
‘‘(A) are a distinct and unique indigenous 
people with a historical continuity to the origi-
nal inhabitants of the Hawaiian archipelago 
within Ke Moananui, the Pacific Ocean; and 
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‘‘(B) have a distinct society that was first 
organized almost 2,000 years ago; 
‘‘(3) the health and well-being of Native Hawai-
ians are intrinsically tied to the deep feelings and at-
tachment of Native Hawaiians to their lands and 
seas; 
‘‘(4) the long-range economic and social 
changes in Hawai’i over the 19th and early 20th 
centuries have been devastating to the health and 
well-being of Native Hawaiians; 
‘‘(5) Native Hawaiians have never directly relin-
quished to the United States their claims to their in-
herent sovereignty as a people or over their national 
territory, either through their monarchy or through 
a plebiscite or referendum; 
‘‘(6) the Native Hawaiian people are deter-
mined to preserve, develop, and transmit to future 
generations, in accordance with their own spiritual 
and traditional beliefs, their customs, practices, lan-
guage, social institutions, ancestral territory, and 
cultural identity; 
‘‘(7) in referring to themselves, Native Hawai-
ians use the term ‘Kanaka Maoli’, a term frequently 
used in the 19th century to describe the native peo-
ple of Hawai’i; 
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‘‘(8) the constitution and statutes of the State 
of Hawai’i— 
‘‘(A) acknowledge the distinct land rights 
of Native Hawaiian people as beneficiaries of 
the public lands trust; and 
‘‘(B) reaffirm and protect the unique right 
of the Native Hawaiian people to practice and 
perpetuate their cultural and religious customs, 
beliefs, practices, and language; 
‘‘(9) at the time of the arrival of the first non-
indigenous people in Hawai’i in 1778, the Native 
Hawaiian people lived in a highly organized, self-suf-
ficient, subsistence social system based on communal 
land tenure with a sophisticated language, culture, 
and religion; 
‘‘(10) a unified monarchical government of the 
Hawaiian Islands was established in 1810 under Ka-
mehameha I, the first King of Hawai’i; 
‘‘(11) throughout the 19th century until 1893, 
the United States— 
‘‘(A) recognized the independence of the 
Hawaiian Nation; 
‘‘(B) extended full and complete diplomatic 
recognition to the Hawaiian Government; and 
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‘‘(C) entered into treaties and conventions 
with the Hawaiian monarchs to govern com-
merce and navigation in 1826, 1842, 1849, 
1875, and 1887; 
‘‘(12) in 1893, John L. Stevens, the United 
States Minister assigned to the sovereign and inde-
pendent Kingdom of Hawai’i, conspired with a small 
group of non-Hawaiian residents of the Kingdom, 
including citizens of the United States, to overthrow 
the indigenous and lawful Government of Hawai’i; 
‘‘(13) in pursuance of that conspiracy— 
‘‘(A) the United States Minister and the 
naval representative of the United States 
caused Armed Forces of the United States 
Navy to invade the sovereign Hawaiian Nation 
in support of the overthrow of the indigenous 
and lawful Government of Hawai’i; and 
‘‘(B) after that overthrow, the United 
States Minister extended diplomatic recognition 
of a provisional government formed by the con-
spirators without the consent of the native peo-
ple of Hawai’i or the lawful Government of Ha-
wai’i, in violation of— 
‘‘(i) treaties between the Government 
of Hawai’i and the United States; and 
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‘‘(ii) international law; 
‘‘(14) in a message to Congress on December 
18, 1893, President Grover Cleveland— 
‘‘(A) reported fully and accurately on those 
illegal actions; 
‘‘(B) acknowledged that by those acts, de-
scribed by the President as acts of war, the 
government of a peaceful and friendly people 
was overthrown; and 
‘‘(C) concluded that a ‘substantial wrong 
has thus been done which a due regard for our 
national character as well as the rights of the 
injured people required that we should endeavor 
to repair’; 
‘‘(15) Queen Lili‘uokalani, the lawful monarch 
of Hawai’i, and the Hawaiian Patriotic League, rep-
resenting the aboriginal citizens of Hawai’i, prompt-
ly petitioned the United States for redress of those 
wrongs and restoration of the indigenous govern-
ment of the Hawaiian Nation, but no action was 
taken on that petition; 
‘‘(16) in 1993, Congress enacted Public Law 
103–150 (107 Stat. 1510), in which Congress— 
‘‘(A) acknowledged the significance of 
those events; and 
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‘‘(B) apologized to Native Hawaiians on 
behalf of the people of the United States for the 
overthrow of the Kingdom of Hawai’i with the 
participation of agents and citizens of the 
United States, and the resulting deprivation of 
the rights of Native Hawaiians to self-deter-
mination; 
‘‘(17) between 1897 and 1898, when the total 
Native Hawaiian population in Hawai’i was less 
than 40,000, more than 38,000 Native Hawaiians 
signed petitions (commonly known as ‘Ku’e Peti-
tions’) protesting annexation by the United States 
and requesting restoration of the monarchy; 
‘‘(18) despite Native Hawaiian protests, in 
1898, the United States— 
‘‘(A) annexed Hawai’i through Resolution 
No. 55 (commonly known as the ‘Newlands 
Resolution’) (30 Stat. 750), without the consent 
of, or compensation to, the indigenous people of 
Hawai’i or the sovereign government of those 
people; and 
‘‘(B) denied those people the mechanism 
for expression of their inherent sovereignty 
through self-government and self-determination 
of their lands and ocean resources; 
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‘‘(19) through the Newlands Resolution and the 
Act of April 30, 1900 (commonly known as the 
‘1900 Organic Act’) (31 Stat. 141, chapter 339), the 
United States— 
‘‘(A) received 1,750,000 acres of land for-
merly owned by the Crown and Government of 
the Hawaiian Kingdom; and 
‘‘(B) exempted the land from then-existing 
public land laws of the United States by man-
dating that the revenue and proceeds from that 
land be ‘used solely for the benefit of the inhab-
itants of the Hawaiian Islands for education 
and other public purposes’, thereby establishing 
a special trust relationship between the United 
States and the inhabitants of Hawai’i; 
‘‘(20) in 1921, Congress enacted the Hawaiian 
Homes Commission Act, 1920 (42 Stat. 108, chap-
ter 42), which— 
‘‘(A) designated 200,000 acres of the 
ceded public land for exclusive homesteading by 
Native Hawaiians; and 
‘‘(B) affirmed the trust relationship be-
tween the United States and Native Hawaiians, 
as expressed by Secretary of the Interior 
Franklin K. Lane, who was cited in the Com-
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mittee Report of the Committee on Territories 
of the House of Representatives as stating, 
‘One thing that impressed me . . . was the fact 
that the natives of the islands . . . for whom in 
a sense we are trustees, are falling off rapidly 
in numbers and many of them are in poverty.’; 
‘‘(21) in 1938, Congress again acknowledged 
the unique status of the Native Hawaiian people by 
including in the Act of June 20, 1938 (52 Stat. 
781), a provision— 
‘‘(A) to lease land within the extension to 
Native Hawaiians; and 
‘‘(B) to permit fishing in the area ‘only by 
Native Hawaiian residents of said area or of 
adjacent villages and by visitors under their 
guidance’; 
‘‘(22) under the Act of March 18, 1959 (48 
U.S.C. prec. 491 note; 73 Stat. 4), the United 
States— 
‘‘(A) transferred responsibility for the ad-
ministration of the Hawaiian home lands to the 
State; but 
‘‘(B) reaffirmed the trust relationship that 
existed between the United States and the Na-
tive Hawaiian people by retaining the exclusive 
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power to enforce the trust, including the power 
to approve land exchanges and legislative 
amendments affecting the rights of beneficiaries 
under that Act; 
‘‘(23) under the Act referred to in paragraph 
(22), the United States— 
‘‘(A) transferred responsibility for adminis-
tration over portions of the ceded public lands 
trust not retained by the United States to the 
State; but 
‘‘(B) reaffirmed the trust relationship that 
existed between the United States and the Na-
tive Hawaiian people by retaining the legal re-
sponsibility of the State for the betterment of 
the conditions of Native Hawaiians under sec-
tion 5(f) of that Act (73 Stat. 6); 
‘‘(24) in 1978, the people of Hawai’i— 
‘‘(A) amended the constitution of Hawai’i 
to establish the Office of Hawaiian Affairs; and 
‘‘(B) assigned to that Office the author-
ity— 
‘‘(i) to accept and hold in trust for the 
Native Hawaiian people real and personal 
property transferred from any source; 
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‘‘(ii) to receive payments from the 
State owed to the Native Hawaiian people 
in satisfaction of the pro rata share of the 
proceeds of the public land trust estab-
lished by section 5(f) of the Act of March 
18, 1959 (48 U.S.C. prec. 491 note; 73 
Stat. 6); 
‘‘(iii) to act as the lead State agency 
for matters affecting the Native Hawaiian 
people; and 
‘‘(iv) to formulate policy on affairs re-
lating to the Native Hawaiian people; 
‘‘(25) the authority of Congress under the Con-
stitution to legislate in matters affecting the aborigi-
nal or indigenous people of the United States in-
cludes the authority to legislate in matters affecting 
the native people of Alaska and Hawai’i; 
‘‘(26) the United States has recognized the au-
thority of the Native Hawaiian people to continue to 
work toward an appropriate form of sovereignty, as 
defined by the Native Hawaiian people in provisions 
set forth in legislation returning the Hawaiian Is-
land of Kaho‘olawe to custodial management by the 
State in 1994; 
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‘‘(27) in furtherance of the trust responsibility 
for the betterment of the conditions of Native Ha-
waiians, the United States has established a pro-
gram for the provision of comprehensive health pro-
motion and disease prevention services to maintain 
and improve the health status of the Hawaiian peo-
ple; 
‘‘(28) that program is conducted by the Native 
Hawaiian Health Care Systems and Papa Ola 
Lokahi; 
‘‘(29) health initiatives implemented by those 
and other health institutions and agencies using 
Federal assistance have been responsible for reduc-
ing the century-old morbidity and mortality rates of 
Native Hawaiian people by— 
‘‘(A) providing comprehensive disease pre-
vention; 
‘‘(B) providing health promotion activities; 
and 
‘‘(C) increasing the number of Native Ha-
waiians in the health and allied health profes-
sions; 
‘‘(30) 
those 
accomplishments 
have 
been 
achieved through implementation of— 
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‘‘(A) the Native Hawaiian Health Care Act 
of 1988 (Public Law 100–579); and 
‘‘(B) the reauthorization of that Act under 
section 9168 of the Department of Defense Ap-
propriations Act, 1993 (Public Law 102–396; 
106 Stat. 1948); 
‘‘(31) the historical and unique legal relation-
ship between the United States and Native Hawai-
ians has been consistently recognized and affirmed 
by Congress through the enactment of more than 
160 Federal laws that extend to the Native Hawai-
ian people the same rights and privileges accorded to 
American Indian, Alaska Native, Eskimo, and Aleut 
communities, including— 
‘‘(A) the Native American Programs Act of 
1974 (42 U.S.C. 2991 et seq.); 
‘‘(B) the American Indian Religious Free-
dom Act (42 U.S.C. 1996); 
‘‘(C) the National Museum of the Amer-
ican Indian Act (20 U.S.C. 80q et seq.); and 
‘‘(D) the Native American Graves Protec-
tion and Repatriation Act (25 U.S.C. 3001 et 
seq.); 
‘‘(32) the United States has recognized and re-
affirmed the trust relationship to the Native Hawai-
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ian people through legislation that authorizes the 
provision of services to Native Hawaiians, specifi-
cally— 
‘‘(A) the Older Americans Act of 1965 (42 
U.S.C. 3001 et seq.); 
‘‘(B) the Developmental Disabilities Assist-
ance and Bill of Rights Act Amendments of 
1987 (42 U.S.C. 6000 et seq.); 
‘‘(C) the Veterans’ Benefits and Services 
Act of 1988 (Public Law 100–322); 
‘‘(D) the Rehabilitation Act of 1973 (29 
U.S.C. 701 et seq.); 
‘‘(E) the Native Hawaiian Health Care Act 
of 1988 (42 U.S.C. 11701 et seq.); 
‘‘(F) the Health Professions Reauthoriza-
tion Act of 1988 (Public Law 100–607; 102 
Stat. 3122); 
‘‘(G) the Nursing Shortage Reduction and 
Education Extension Act of 1988 (Public Law 
100–607; 102 Stat. 3153); 
‘‘(H) the Handicapped Programs Technical 
Amendments Act of 1988 (Public Law 100– 
630); 
‘‘(I) the Indian Health Care Amendments 
of 1988 (Public Law 100–713); and 
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‘‘(J) the Disadvantaged Minority Health 
Improvement Act of 1990 (Public Law 101– 
527); 
‘‘(33) the United States has affirmed that his-
torical and unique legal relationship to the Hawaiian 
people by authorizing the provision of services to 
Native Hawaiians to address problems of alcohol 
and drug abuse under the Anti-Drug Abuse Act of 
1986 (21 U.S.C. 801 note; Public Law 99–570); 
‘‘(34) in addition, the United States— 
‘‘(A) has recognized that Native Hawai-
ians, as aboriginal, indigenous, native people of 
Hawai’i, are a unique population group in Ha-
wai’i and in the continental United States; and 
‘‘(B) has so declared in— 
‘‘(i) the documents of the Office of 
Management and Budget entitled— 
‘‘(I) ‘Standards for Maintaining, 
Collecting, and Presenting Federal 
Data on Race and Ethnicity’ and 
dated October 30, 1997; and 
‘‘(II) ‘Provisional Guidance on 
the Implementation of the 1997 
Standards for Federal Data on Race 
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and Ethnicity’ and dated December 
15, 2000; 
‘‘(ii) the document entitled ‘Guidance 
on Aggregation and Allocation of Data on 
Race for Use in Civil Rights Monitoring 
and Enforcement’ (Bulletin 00–02 to the 
Heads of Executive Departments and Es-
tablishments) and dated March 9, 2000; 
‘‘(iii) the document entitled ‘Questions 
and Answers when Designing Surveys for 
Information Collections’ (Memorandum for 
the President’s Management Council) and 
dated January 20, 2006; 
‘‘(iv) Executive Order Number 13125 
(64 Fed. Reg. 31105; relating to increas-
ing participation of Asian-Americans and 
Pacific Islanders in Federal programs) 
(June 7, 1999); 
‘‘(v) the document entitled ‘HHS 
Tribal Consultation Policy’ and dated Jan-
uary 2005; and 
‘‘(vi) the Department of Health and 
Human Services Intradepartment Council 
on Native American Affairs, Revised Char-
ter, dated March 7, 2005; and 
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‘‘(35) despite the United States having ex-
pressed in Public Law 103–150 (107 Stat. 1510) its 
commitment to a policy of reconciliation with the 
Native Hawaiian people for past grievances— 
‘‘(A) the unmet health needs of the Native 
Hawaiian people remain severe; and 
‘‘(B) the health status of the Native Ha-
waiian people continues to be far below that of 
the general population of the United States. 
‘‘(b) FINDING OF UNMET NEEDS AND HEALTH DIS-
PARITIES.—Congress finds that the unmet needs and seri-
ous health disparities that adversely affect the Native Ha-
waiian people include the following: 
‘‘(1) CHRONIC DISEASE AND ILLNESS.— 
‘‘(A) CANCER.— 
‘‘(i) IN GENERAL.—With respect to all 
cancer— 
‘‘(I) as an underlying cause of 
death in the State, the cancer mor-
tality rate of Native Hawaiians of 
218.3 per 100,000 residents is 50 per-
cent higher than the rate for the total 
population of the State of 145.4 per 
100,000 residents; 
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‘‘(II) Native Hawaiian males 
have the highest cancer mortality 
rates in the State for cancers of the 
lung, colon, and rectum, and for all 
cancers combined; 
‘‘(III) Native Hawaiian females 
have the highest cancer mortality 
rates in the State for cancers of the 
lung, breast, colon, rectum, pancreas, 
stomach, ovary, liver, cervix, kidney, 
and uterus, and for all cancers com-
bined; and 
‘‘(IV) for the period of 1995 
through 2000— 
‘‘(aa) the cancer mortality 
rate for all cancers for Native 
Hawaiian males of 217 per 
100,000 residents was 22 percent 
higher than the rate for all males 
in the State of 179 per 100,000 
residents; and 
‘‘(bb) the cancer mortality 
rate for all cancers for Native 
Hawaiian females of 192 per 
100,000 residents was 64 percent 
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higher than the rate for all fe-
males in the State of 117 per 
100,000 residents. 
‘‘(ii) BREAST CANCER.—With respect 
to breast cancer— 
‘‘(I) Native Hawaiians have the 
highest mortality rate in the State 
from 
breast 
cancer 
(30.79 
per 
100,000 residents), which is 33 per-
cent higher than the rate for Cauca-
sian-Americans (23.07 per 100,000 
residents) and 106 percent higher 
than the rate for Chinese-Americans 
(14.96 per 100,000 residents); and 
‘‘(II) nationally, Native Hawai-
ians have the third-highest mortality 
rate as a result of breast cancer (25.0 
per 100,000 residents), behind Afri-
can-Americans (31.4 per 100,000 
residents) and Caucasian-Americans 
(27.0 per 100,000 residents). 
‘‘(iii) CANCER OF THE CERVIX.—Na-
tive Hawaiians have the highest mortality 
rate as a result of cancer of the cervix in 
the State (3.65 per 100,000 residents), fol-
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lowed by Filipino-Americans (2.69 per 
100,000 residents) and Caucasian-Ameri-
cans (2.61 per 100,000 residents). 
‘‘(iv) LUNG CANCER.—Native Hawai-
ian males and females have the highest 
mortality rates as a result of lung cancer 
in the State, at 74.79 per 100,000 for 
males and 47.84 per 100,000 females, 
which are higher than the rates for the 
total population of the State by 48 percent 
for males and 93 percent for females. 
‘‘(v) PROSTATE CANCER.—Native Ha-
waiian males have the third-highest mor-
tality rate as a result of prostate cancer in 
the State (21.48 per 100,000 residents), 
with Caucasian-Americans having the high-
est mortality rate as a result of prostate 
cancer (23.96 per 100,000 residents). 
‘‘(B) DIABETES.—With respect to diabe-
tes, in 2004— 
‘‘(i) Native Hawaiians had the highest 
mortality rate as a result of diabetes 
mellitis (28.9 per 100,000 residents) in the 
State, which is 119 percent higher than 
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the rate for all racial groups in the State 
(13.2 per 100,000 residents); 
‘‘(ii) the prevalence of diabetes for 
Native Hawaiians was 12.7 percent, which 
is 87 percent higher than the total preva-
lence for all residents of the State of 6.8 
percent; and 
‘‘(iii) a higher percentage of Native 
Hawaiians with diabetes experienced dia-
betic retinopathy, as compared to other 
population groups in the State. 
‘‘(C) ASTHMA.—With respect to asthma 
and lower respiratory disease— 
‘‘(i) in 2004, mortality rates for Na-
tive Hawaiians (31.6 per 100,000 resi-
dents) from chronic lower respiratory dis-
ease were 52 percent higher than rates for 
the total population of the State (20.8 per 
100,000 residents); and 
‘‘(ii) in 2005, the prevalence of cur-
rent asthma in Native Hawaiian adults 
was 12.8 percent, which is 71 percent 
higher than the prevalence of the total 
population of the State of 7.5 percent. 
‘‘(D) CIRCULATORY DISEASES.— 
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‘‘(i) HEART
DISEASE.—With respect 
to heart disease— 
‘‘(I) in 2004, the mortality rate 
for Native Hawaiians as a result of 
heart disease (305.5 per 100,000 resi-
dents) was 86 percent higher than the 
rate for the total population of the 
State (164.3 per 100,000 residents); 
and 
‘‘(II) in 2005, the prevalence for 
heart attack was 4.4 percent for Na-
tive Hawaiians, which is 22 percent 
higher than the prevalence for the 
total population of 3.6 percent. 
‘‘(ii) CEREBROVASCULAR DISEASES.— 
With respect to cerebrovascular diseases— 
‘‘(I) the mortality rate from cere-
brovascular diseases for Native Ha-
waiians (75.6 percent) was 64 percent 
higher than the rate for the total pop-
ulation of the State (46 percent); and 
‘‘(II) in 2005, the prevalence for 
stroke was 4.9 percent for Native Ha-
waiians, which is 69 percent higher 
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than the prevalence for the total pop-
ulation of the State (2.9 percent). 
‘‘(iii) 
OTHER
CIRCULATORY
DIS-
EASES.—With respect to other circulatory 
diseases (including high blood pressure and 
atherosclerosis)— 
‘‘(I) in 2004, the mortality rate 
for Native Hawaiians of 20.6 per 
100,000 residents was 46 percent 
higher than the rate for the total pop-
ulation of the State of 14.1 per 
100,000 residents; and 
‘‘(II) in 2005, the prevalence of 
high blood pressure for Native Hawai-
ians was 26.7 percent, which is 10 
percent higher than the prevalence for 
the total population of the State of 
24.2 percent. 
‘‘(2) INFECTIOUS
DISEASE
AND
ILLNESS.— 
With respect to infectious disease and illness— 
‘‘(A) in 1998, Native Hawaiians comprised 
20 percent of all deaths resulting from infec-
tious diseases in the State for all ages; and 
‘‘(B) the incidence of acquired immune de-
ficiency syndrome for Native Hawaiians is at 
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ranged from 5 to 10 years less than that of the 
overall State population average; 
‘‘(C) the most recent tables for 1990 show 
Native Hawaiian life expectancy at birth (74.27 
years) to be approximately 5 years less than 
that of the total State population (78.85 years); 
and 
‘‘(D) except as provided in the life expect-
ancy calculation for 1920, Native Hawaiians 
have had the shortest life expectancy of all 
major ethnic groups in the United States since 
1910. 
‘‘(6) MATERNAL AND CHILD HEALTH.— 
‘‘(A) IN GENERAL.—With respect to ma-
ternal and child health, in 2000— 
‘‘(i) 39 percent of all deaths of chil-
dren under the age of 18 years in the 
State were Native Hawaiian; 
‘‘(ii) perinatal conditions accounted 
for 38 percent of all Native Hawaiian 
deaths in that age group; 
‘‘(iii) Native Hawaiian infant mor-
tality rates (9.8 per 1,000 live births) 
are— 
‘‘(I) the highest in the State; and 
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‘‘(II) 151 percent higher than the 
rate for Caucasian infants (3.9 per 
1,000 live births); and 
‘‘(iv) Native Hawaiians have 1 of the 
highest infant mortality rates in the 
United States, second only to the rate for 
African-Americans of 13.6 per 1,000 live 
births. 
‘‘(B) PRENATAL
CARE.—With respect to 
prenatal care— 
‘‘(i) as of 2005, Native Hawaiian 
women have the highest prevalence (20.9 
percent) of having had no prenatal care 
during the first trimester of pregnancy, as 
compared to the 5 largest ethnic groups in 
the State; 
‘‘(ii) of the mothers in the State who 
received no prenatal care in the first tri-
mester, 33 percent were Native Hawaiian; 
‘‘(iii) in 2005, 41 percent of mothers 
with live births who had not completed 
high school were Native Hawaiian; and 
‘‘(iv) in every region of the State, 
many Native Hawaiian newborns begin life 
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in a potentially hazardous circumstance, 
far higher than any other racial group. 
‘‘(C) BIRTHS.—With respect to births, in 
2005— 
‘‘(i) 45.2 percent of live births to Na-
tive Hawaiian mothers were nonmarital, 
putting the affected infants at higher risk 
of low birth weight and infant mortality; 
‘‘(ii) of the 2,934 live births to Native 
Hawaiian single mothers, 9 percent were 
low birth weight (defined as a weight of 
less than 2,500 grams); and 
‘‘(iii) 43.7 percent of all low birth- 
weight infants born to single mothers in 
the State were Native Hawaiian. 
‘‘(D) TEEN PREGNANCIES.—With respect 
to births, in 2005— 
‘‘(i) Native Hawaiians had the highest 
rate of births to mothers under the age of 
18 years (5.8 percent), as compared to the 
rate of 2.7 percent for the total population 
of the State; and 
‘‘(ii) nearly 62 percent of all mothers 
in the State under the age of 19 years 
were Native Hawaiian. 
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‘‘(E) FETAL MORTALITY.—With respect to 
fetal mortality, in 2005— 
‘‘(i) Native Hawaiians had the highest 
number of fetal deaths in the State, as 
compared to Caucasian, Japanese, and Fil-
ipino residents; and 
‘‘(ii)(I) 17.2 percent of all fetal deaths 
in the State were associated with expectant 
Native Hawaiian mothers; and 
‘‘(II) 43.5 percent of those Native 
Hawaiian mothers were under the age of 
25 years. 
‘‘(7) BEHAVIORAL HEALTH.— 
‘‘(A) ALCOHOL AND DRUG ABUSE.—With 
respect to alcohol and drug abuse— 
‘‘(i)(I) in 2005, Native Hawaiians had 
the highest prevalence of smoking of 27.9 
percent, which is 64 percent higher than 
the rate for the total population of the 
State (17 percent); and 
‘‘(II) 53 percent of Native Hawaiians 
reported having smoked at least 100 ciga-
rettes in their lifetime, as compared to 
43.3 percent for the total population of the 
State; 
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‘‘(ii) 33 percent of Native Hawaiians 
in grade 8 have smoked cigarettes at least 
once in their lifetime, as compared to— 
‘‘(I) 22.5 percent for all youth in 
the State; and 
‘‘(II) 28.4 percent of residents of 
the United States in grade 8; 
‘‘(iii) Native Hawaiians have the high-
est prevalence of binge drinking of 19.9 
percent, which is 21 percent higher than 
the prevalence for the total population of 
the State (16.5 percent); 
‘‘(iv) the prevalence of heavy drinking 
among Native Hawaiians (10.1 percent) is 
36 percent higher than the prevalence for 
the total population of the State (7.4 per-
cent); 
‘‘(v)(I) in 2003, 17.2 percent of Na-
tive Hawaiians in grade 6, 45.1 percent of 
Naive Hawaiians in grade 8, 68.9 percent 
of Native Hawaiians in grade 10, and 78.1 
percent of Native Hawaiians in grade 12 
reported using alcohol at least once in 
their lifetime, as compared to 13.2, 36.8, 
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59.1, and 72.5 percent, respectively, of all 
adolescents in the State; and 
‘‘(II) 62.1 percent Native Hawaiians 
in grade 12 reported being drunk at least 
once, which is 20 percent higher than the 
percentage for all adolescents in the State 
(51.6 percent); 
‘‘(vi) on entering grade 12, 60 percent 
of Native Hawaiian adolescents reported 
having 
used 
illicit 
drugs, 
including 
inhalants, at least once in their lifetime, as 
compared to— 
‘‘(I) 46.9 percent of all adoles-
cents in the State; and 
‘‘(II) 52.8 of adolescents in the 
United States; 
‘‘(vii) on entering grade 12, 58.2 per-
cent of Native Hawaiian adolescents re-
ported having used marijuana at least 
once, which is 31 percent higher than the 
rate of other adolescents in the State (44.4 
percent); 
‘‘(viii) in 2006, Native Hawaiians rep-
resented 40 percent of the total admissions 
to substance abuse treatment programs 
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funded by the State Department of Health; 
and 
‘‘(ix) in 2003, Native Hawaiian ado-
lescents reported the highest prevalence for 
methamphetamine use in the State, fol-
lowed by Caucasian and Filipino adoles-
cents. 
‘‘(B) CRIME.—With respect to crime— 
‘‘(i) during the period of 1992 to 
2002, Native Hawaiian arrests for violent 
crimes decreased, but the rate of arrest re-
mained 38.3 percent higher than the rate 
of the total population of the State; 
‘‘(ii) the robbery arrest rate in 2002 
among Native Hawaiian juveniles and 
adults was 59 percent higher (6.2 arrests 
per 100,000 residents) than the rate for 
the total population of the State (3.9 ar-
rests per 100,000 residents); 
‘‘(iii) in 2002— 
‘‘(I) Native Hawaiian men com-
prised between 35 percent and 43 per-
cent of each security class in the State 
prison system; 
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