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Diabetes and Hypertension in Marshallese Adults: Results from Faith-Based Health Screenings

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Journal of Racial and Ethnic Health Disparities Aims and scope Submit manuscript

Abstract

Background

The Pacific Islander population in the USA is growing rapidly. However, research on Pacific Islanders in the USA is limited, or sometimes misleading due to aggregation with Asian Americans. This project seeks to add to the dearth of health literature by conducting a health assessment of Marshallese in northwest Arkansas.

Methods

Using a community-based participatory research approach, nine health screening events were conducted at local Marshallese churches. Participants completed the Behavioral Risk Factors Surveillance Survey core questionnaire and diabetes module if applicable. Biometric data, including Hemoglobin A1c, blood pressure, and body mass index, were gathered by an interprofessional team.

Results

Four hundred one participants completed health screenings. High proportions of diabetes, obesity, and hypertension were found. A high percentage of participants were uninsured, and multiple barriers to health care were found within the sample.

Discussion

This project represents one of the first broad health assessments of Pacific Islanders in the USA. Proportions of diabetes, hypertension, obesity, and uninsured found in the sample are much higher than national proportions.

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References

  1. Hixson L, Hepler B, Kim M. The native Hawaiian and other Pacific islander population 2010. Washington, DC: United States Census Bureau; 2012.

    Google Scholar 

  2. Central Intelligence Agency. World Factbook: United States. 2014. https://www.cia.gov/library/publications/resources/the-world-factbook/geos/us.html. Accessed 26 March 2015.

  3. 108th United States Congress. Compact of Free Association Amendments Act of 2003. http://www.gpo.gov/fdsys/pkg/PLAW-108publ188/html/PLAW-108publ188.htm. Accessed 25 May 2014.

  4. McElfish P. Interview with Carmen Chong-gum. Springdale, AR: Arkansas Marshallese Consulate; 2013.

    Google Scholar 

  5. Springdale Public School District. Springdale school lunch program data. Springdale, AR: Springdale Publich School District; 2014.

    Google Scholar 

  6. Arkansas Department of Health. Healthy people 2010 health status report. Little Rock, AR: Arkansas Department of Health, Office of Minority Health & Health Disparities; 2010.

    Google Scholar 

  7. United States Census Bureau. The American community—Pacific islanders: 2004. Washington, DC: United States Census Bureau; 2007.

    Google Scholar 

  8. Working Group of the Applied Research Center, National Council of Asian Pacific Americans. Best practices: researching Asian Americans, native Hawaiians and Pacific islanders. New York, NY: Applied Research Center; National Council of Asian Pacific Americans; 2013.

    Google Scholar 

  9. Ro M, Yee A. Out of the shadows: Asian Americans, native Hawaiians, and Pacific islanders. Am J Public Health. 2010;100(5):776–8.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Roehr B. Asians and Pacific islanders in US need greater prominence in research. BMJ. 2010;340.

  11. Srinivasan S, Guillermo T. Toward improved health: disaggregating Asian American and native Hawaiian Pacific islander data. Am J Public Health. 2000;90(11):1731–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Park C, Bruan K, Horiuchi B, Tottori C, Onaka A. Longevity disparities in multiethnic Hawai’i: an analysis of 2000 life tables. Public Health Rep. 2009;124(4):579–84.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Hong B, Bayat N. National Asian American and Pacific Islander cardiovascular health action plan: Eliminating racial and ethnic disparities in cardiovascular health: Improving the cardiovascular health of Asian American and Pacific Islander populations in the United States. San Francisco, CA: Asian Pacific Islander American Health Forum; 1999.

  14. Yamada S, Dodd A, Soe T, Chen T, Bauman K. Diabetes mellitus prevalence in out-patient Marshallese adults on Ebeye Island, Republic of the Marshall Islands. Hawaii Med J. 2004;63(2):45–51.

    PubMed  Google Scholar 

  15. Minegishi M, Fujimori K, Nakajima N, et al. Diabetes mellitus and obesity among participants receiving screening for cancer in the Republic of the Marshall Islands. J Int Health. 2007;22(3):133–41.

    Google Scholar 

  16. International Diabetes Federation. IDF Diabetes Atlas. 5th ed. Brussels, Belguim: International Diabetes Federation; 2011. http://www.idf.org/diabetesatlas. Accessed 11 April 2013.

  17. LeDoux C. Challenges Encountered Reaching the Marshallese in Arkansas. Arkansas Assessment Initiative; 2009.

  18. Reddy R, Shehata C, Smith G, Maskarinec G. Characteristics of Marshallese with type 2 diabetes on Oahu: a pilot study to implement a community-based diabetic health improvement project. Californian J Health Promot. 2005;3(4):36–47.

    PubMed Central  Google Scholar 

  19. Tan C, Haumea S, Juarez D, Grimm C. A descriptive study of Marshallese and Chuukese patients with diabetes in Hawai‘i. Hawaii J Med Public Health. 2014;73(6):168–71.

    PubMed  PubMed Central  Google Scholar 

  20. Hallgren E, McElfish P, Rubon-Chutaro J. Barriers and opportunities: a community-based participatory research study of health beliefs related to diabetes in a US Marshallese community. Diabetes Educ. 2015;41(1):86–94.

    Article  PubMed  Google Scholar 

  21. McElfish P, Hallgren E, Yamada S. Effect of US health policies on health care access for Marshallese migrants. Am J Public Health. 2015;105(4):637–43.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Donoho G, McElfish P, Avants R, Hallgren E. A novel recruiting and surveying method: participatory research during a Pacific islander community's traditional cultural event. Gateways. 2015;8(1):150–9.

    Article  Google Scholar 

  23. McElfish P, Kohler P, Smith C, et al. Community-driven research agenda to reduce health disparities. Clin Transl Sci. 2015;8(6):690–5.

    Article  PubMed  PubMed Central  Google Scholar 

  24. McElfish P, Bridges M, Hudson J, et al. Family model of diabetes education with a Pacific islander community. Diabetes Educ. 2015;41(6):706–15.

    Article  PubMed  PubMed Central  Google Scholar 

  25. McElfish P, Hallgren E, Henry L, Ritok M, Rubon-Chutaro J, Kohler P. Health beliefs of Marshallese regarding type 2 diabetes. Am J Health Behav. 2016;40(1):248–57.

    Article  PubMed  PubMed Central  Google Scholar 

  26. McElfish P, Moore R, Woodring D, et al. Social ecology and diabetes self-management among Pacific islanders in Arkansas. J Fam Med Dis Prevent. 2016;2(1):026.

    Google Scholar 

  27. McElfish PA, Goulden PA, Bursac Z, et al. Engagement practices that join scientific methods with community wisdom: designing a patient-centered, randomized control trial with a Pacific Islander community. Nurs Inq. 2016.

  28. McElfish P, Purvis R, Maskarinec G, et al. Interpretive policy analysis: Marshallese COFA migrants and the affordable care act. Int J Equity in Health. 2016;15(1):91.

    Article  Google Scholar 

  29. Cardenas VM, Orloff MS, Kaminaga J, et al. Tuberculosis and leprosy infections in the Marshallese population of Arkansas, USA. Lepr Rev. 2016;87(1):109–12.

    PubMed  Google Scholar 

  30. Scott A, Shreve M, Ayers B, McElfish PA. Breast-feeding perceptions, beliefs and experiences of Marshallese migrants: an exploratory study. Public Health Nutr. 2016:1–10.

  31. McElfish P, Post J, Rowland B. A social ecological and community-engaged perspective for addressing health disparities among Marshallese in Arkansas. Int J Nurs Clin Pract. 2016;3:1–6.

    Article  Google Scholar 

  32. Barker H. Bravo for the Marshallese: regaining control in a post-nuclear, post-colonial world. Belmont, CA: Cengage Learning; 2012.

    Google Scholar 

  33. Cooke S. In mortal hands: a cautionary history of the nuclear age. New York, NY: Bloomsbury USA; 2010.

    Google Scholar 

  34. Martin EJ, Rowland RH. Castle series, 1954. Washington, DC: Defense Nuclear Agency; 1982.

    Google Scholar 

  35. Adams W, Heotis P, Scott W. Medical status of Marshallese accidentally exposed to 1954 bravo fallout radiation: January 1985 through December 1987. Upton, NY: Brookhaven National Laboratory; 1989.

    Google Scholar 

  36. Cohn SH, Rinehart RW, Gong JK, et al. Nature and extent of internal radioactive contamination of human beings, plants, and animals exposed to fallout. Bethesda, MD and San Francisco, CA: Naval Medical Research Institute and Naval Radiological Defense Laboratory; 1955.

    Google Scholar 

  37. Sondhaus CA, Bond VP. Physical factors and dosimetry in the Marshall Island radiation exposures. San Francisco, CA: Naval Radiological Defense Laboratory; 1955.

    Google Scholar 

  38. Cronkite E, Bond V, Browning L, et al. Study of response of human beings accidentally exposed to significant fallout radiation. Bethesda, MD and San Francisco, CA: Naval Medical Research Institute and U.S. Naval Radiological Defense Laboratory; 1954.

    Google Scholar 

  39. Cronkite EP, Bond VP, Conard RA, et al. Response of human beings accidentally exposed to significant fall-out radiation. J Am Med Assoc. 1955;159(5):430–4.

    Article  CAS  PubMed  Google Scholar 

  40. Conrad R. Fallout: the experiences of a medical team in the care of a Marshallese population accidentally exposed to fallout radiation. Brookhaven National Laboratory: Upton, NY; 1992.

    Book  Google Scholar 

  41. Yamada S, Akiyama M. "For the good of mankind": the legacy of nuclear testing in Micronesia. Soc Med. 2014;8(2):83–92.

    Google Scholar 

  42. Evans-Campbell T. Historical trauma in American Indian/native Alaska communities: a multilevel framework for exploring impacts on individuals, families, and communities. J Interpers Violence. 2008;23(3):316–38.

    Article  PubMed  Google Scholar 

  43. Minkler M. Ethical challenges for the “outside” researcher in community-based participatory research. Health Educ Behav. 2004;31(6):684–97.

    Article  PubMed  Google Scholar 

  44. Wallerstein N. Power between evaluator and community: research relationships within New Mexico’s healthier communities. Soc Sci Med. 1999;49:39–53.

    Article  CAS  PubMed  Google Scholar 

  45. Sotero M. A conceptual model of historical trauma: implications for public health practice and research. J Health Disparities Res Pract. 2006;1(1):93–108.

    Google Scholar 

  46. Shek D, Yamada S. Health care for Micronesians and constitutional rights. Hawaii Med J. 2011;70(11 Suppl 2):4–8.

    PubMed  PubMed Central  Google Scholar 

  47. Jimeno R. A profile of the Marshallese community in Arkansas, volume 3. Little Rock, AR and Fayetteville, AR: Winthrop Rockefeller Foundation, University of Arkansas; 2013.

    Google Scholar 

  48. Kellams L. Marshallese families and the affordable care act. Springdale, AR: Arkansas Advocates for Chidren & Families; 2013.

    Google Scholar 

  49. National Immigration Law Center. Immigrants and the affordable care act (ACA). Los Angeles, CA: National Immigration Law Center; 2014.

    Google Scholar 

  50. Ishida D, Toomata-Mayer T, Braginsky N. Beliefs and attitudes of Samoan women toward early detection of breast cancer and mammography utilization. Cancer. 2001;91(Suppl 1):262–6.

    Article  CAS  PubMed  Google Scholar 

  51. Mishra S, Aoelua P, Hubbell F. Knowledge of and attitudes about cancer among American Samoans. Cancer Detect Prev. 2000;24(2):186–95.

    CAS  PubMed  Google Scholar 

  52. McElfish P, Bing W, Ayers B, et al. Partnering with Marshallese faith-based organizations to screen for hypertension and diabetes. Manuscr Under Rev. 2016.

  53. Garrow JS, Webster J. Quetelet's index (W/H2) as a measure of fatness. Int J Obes. 1985;9(2):147–53.

    CAS  PubMed  Google Scholar 

  54. Centers for Disease Control and Prevention. Behavioral risk factor surveillance system (BRFSS). Atlanta, GA: Centers for Disease Control and Prevention; 2015.

    Google Scholar 

  55. American Diabetes Association. Standards of medical care in Diabetes−2015. Alexandria, VA: American Diabetes Association; 2015.

    Google Scholar 

  56. American Heart Association. Understanding and managing high blood pressure. Dallas, TX: American Heart Association; 2014.

    Google Scholar 

  57. Centers for Disease Control and Prevention. Healthy Weight: About Adult BMI. 2015. https://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/.

  58. Department of Health and Human Services, Health Resources and Services Administration. Diabetes HbA1c {poor control}. Washington, DC: US Department of Health and Human Services; 2012.

    Google Scholar 

  59. American Diabetes Association. Statistics About Diabetes: Overall Numbers, Diabetes and Prediabetes. 2015. http://www.diabetes.org/diabetes-basics/statistics/. Accessed 10 May 2016.

  60. Nwankwo T, Yoon SS, Burt V, Gu Q. Hypertension among adults in the United States: National Health and nutrition examination survey, 2011-2012. NCHS Data Brief. 2013;133:1–8.

    Google Scholar 

  61. Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and adult obesity in the United States, 2011-2012. JAMA. 2014;311(8):806–14.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  62. Mayo Clinic. Diabetes: complications. 2014. http://www.mayoclinic.org/diseases-conditions/diabetes/basics/complications/con-20033091. Accessed 2 June 2016.

  63. Mayo Clinic. High blood pressure (hypertension): complications. 2016. http://www.mayoclinic.org/diseases-conditions/high-blood-pressure/basics/complications/con-20019580. Accessed 2 June 2016.

  64. Smith J, Medalia C. Health insurance coverage in the United States: 2014. Washington, DC: United States Census Bureau; 2015.

    Google Scholar 

  65. Yancey A, Ortega A, Kumanyika S. Effective recruitment and retention of minority research participants. Annu Rev Public Health. 2006;27:1–28.

    Article  PubMed  Google Scholar 

  66. UyBico S, Pavel S, Gross C. Recruiting vulnerable populations into research: a systematic review of recruitment interventions. J Gen Intern Med. 2007;22(6):852–63.

    Article  PubMed  PubMed Central  Google Scholar 

  67. Panapasa SV, McNally JW, Heeringa SG, Williams DR. Impacts of long-term obesity on the health status of Samoan and Tongan men in the United States: results from the Pacific islander health study. Ethn Dis. 2015;25(3):279–86.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

This research is made possible because of our CBPR partnership with the Marshallese Consulate General in Springdale, Arkansas, Marshallese faith-based leaders, the Arkansas Coalition of Marshallese, and the Gaps in Services to Marshallese Task Force. We also acknowledge the work of Eleanor Hughes and Leslie Hitt who organized interprofessional faculty and students to make the project possible.

The CBPR partnership support is provided by the University of Arkansas for Medical Sciences Translational Research Institute grant UL1TR000039, which is funded through the National Institutes of Health National Center for Research Resources and National Center for Advancing Translational Sciences. The content of this paper is solely the responsibility of the authors and does not necessarily represent the official views of the funders.

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Authors and Affiliations

  1. Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 1125 North College Avenue, Fayetteville, AR, 72703, USA

    Pearl Anna McElfish, Brett Rowland, Christopher R. Long & Williamina Ioanna Bing

  2. College of Pharmacy, University of Arkansas for Medical Sciences Northwest, 1125 North College Avenue, Fayetteville, AR, 72703, USA

    Jonell Hudson, Michelle Piel & T. Scott Warmack

  3. College of Nursing, University of Arkansas for Medical Sciences Northwest, 1125 North College Avenue, Fayetteville, AR, 72703, USA

    Bill Buron

  4. Department of Family Medicine, University of Arkansas for Medical Sciences Northwest, 1125 North College Avenue, Fayetteville, AR, 72703, USA

    Sheldon Riklon

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  1. Pearl Anna McElfish
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  2. Brett Rowland
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Corresponding author

Correspondence to Pearl Anna McElfish.

Ethics declarations

The authors declare that they have no conflicts of interest. All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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McElfish, P.A., Rowland, B., Long, C.R. et al. Diabetes and Hypertension in Marshallese Adults: Results from Faith-Based Health Screenings. J. Racial and Ethnic Health Disparities 4, 1042–1050 (2017). https://doi.org/10.1007/s40615-016-0308-y

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