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Non-communicable diseases (NCD) have been identified as a health emergency in the US-affiliated Pacific Islands (USAPI).1 This assessment, funded by the National Institutes of Health, was conducted in the US Territory of Guam and describes the burdens due to NCD, with an emphasis on diabetes; and assesses the system of service capacity and current activities for service delivery, data collection, and reporting as well as identifying the issues that need to be addressed. There has been an increase of 2.6% in the total population between 2000 and 2010. Findings reveal that the risk factors of poor diet, lack of physical activity, and lifestyle behaviors are associated with overweight and obesity. The leading causes of death include heart disease, cancer, and cerebrovascular accidents. Population surveys show that 9.1% of the adult population in 2009 reported being diagnosed with diabetes. Other data reports show that of the adults, 35.4% were overweight and 25.9% were obese; and among youth, 30% were overweight or obese. Other findings show significant gaps in the system of administrative, clinical, data, and support services to address NCDs and diabetes. There is no Territory-wide health plan to address the prevention and control of NCDs including diabetes. There are no common standards of care or policy and procedures that are used by all the various medical and health care providers. Based on these findings, priority issues and needs were identified for the administrative and clinical systems.

Non-communicable diseases (NCD) have been identified as a health emergency in the US-affiliated Pacific Islands (USAPI).1 This assessment, funded by the National Institutes of Health, was conducted in American Samoa and describes the burden of selected NCDs (ie, diabetes, heart disease, hypertension, stroke, and chronic kidney disease); and assesses the system of service capacity and activities regarding service delivery, data collection and reporting as well as identifies the issues needing to be addressed. Findings reveal that nutrient-poor diet, lack of physical activity, and other lifestyle behaviors are associated with overweight and obesity and subsequent NCDs that impact the morbidity and mortality of the population. The leading causes of death include heart disease, diabetes, cancer and stroke. Population surveys show that 93% of the adults are overweight or obese and 47% have diabetes. Among public school children, 44.6% are overweight or obese. Other data show that between 2006 and 2010, there was a 33% increase in the number of patients receiving hemodialysis. Other findings show significant gaps in the system of administrative, clinical, data, and support services to address these NCDs. There is a paucity of health plans, policy and procedure manuals, coordination among providers, and lack of common standards of care. The combined administrative and clinical system of service needs were identified and prioritized. They include the need for a Territory-wide health strategy and plan, need for standards of care, and a need for collaborative team approach for the treatment and management of patients with diabetes and other chronic diseases.

Background: In 2005, approximately 26% of Micronesian women aged 40 or older in Hawai'i used mammography for breast cancer screening. We describe an 18-month project to increase screening participation in this population by tailoring educational materials and using a lay educator approach., Community Context: New immigrants to Hawai'i are Marshallese from the Republic of the Marshall Islands and Chuukese, Pohnpeians, and Kosraeans from the Federated States of Micronesia. In Hawai'i, these 4 groups refer to themselves collectively as Micronesians, although each group has its own distinct culture and language., Methods: From 2006 through 2007, we applied principles of community-based participatory research--trust building, joint assessment, cultural tailoring of materials, and skills transfer--to develop and track the reach of Micronesian women lay educators in implementing a cancer awareness program among Micronesian women living in Hawai'i., Outcome: Using our tailored in-language materials, 11 lay educators (5 Chuukese, 3 Marshallese, 2 Pohnpeians, and 1 Kosraean) provided one-on-one and small group in-language cancer information sessions to 567 Micronesian women (aged 18-75 years). Among the 202 women aged 40 or older eligible for mammography screening, 166 (82%) had never had a mammogram and were assisted to screening appointments. After 6 months, 146 (88%) of the 166 had received a mammogram, increasing compliance from 18% to 90%. Lay educators reported increases in their skills and their self-esteem and want to extend their skills to other health issues, including diabetes management and immunization., Interpretation: Tailoring materials and using the lay educator model successfully increased participation in breast cancer screening. This model may work in other communities that aim to reduce disparities in access to cancer screening.

Objectives: We examined receptivity to developing church-based cancer programs with Samoans. Cancer is a leading cause of death for Samoans, and investigators who have found spiritually linked beliefs about health and illness in this population have suggested the Samoan church as a good venue for health-related interventions., Design: We interviewed 12 pastors and their wives, held focus groups with 66 Samoan church members, and engaged a panel of pastors to interpret data. All data collection was conducted in culturally appropriate ways. For example, interviews and meetings started and ended with prayer, recitation of ancestry, and an apology for using words usually not spoken in group setting (such as words for body parts), and focus groups were scheduled to last five hours, conferring value to the topic and allowing time to ensure that cancer concepts were understood (increasing the validity of the data collected)., Results: We found unfamiliarity with the benefits of timely cancer screening, but an eagerness to learn more. Church-based programs were welcome, if they incorporated fa'aSamoa (the Samoan way of life) -- including a strong belief in the spiritual, a hierarchical group orientation, the importance of relationships and obligations, and traditional Samoan lifestyle. This included training pastors to present cancer as a palagi (White man) illness versus a Samoan (spiritual) illness, about which nothing can be done, supporting respected laity to serve as role models for screening and witnesses to cancer survivorship, incorporating health messages into sermons, and sponsoring group education and screening events., Conclusion: Our findings inform programming, and our consumer-oriented process serves as a model for others working with minority churches to reduce cancer health disparities.

In 2000, cancer health indicators for Native Hawaiians were worse than those of other ethnic groups in Hawai'i, and Native Hawaiians were under-represented in research endeavors. To build capacity to reduce cancer health disparities, 'Imi Hale applied principles of community-based participatory research (CBPR) and empowerment theory. Strategies included: 1) engaging Native Hawaiians in defining cancer priorities; 2) developing culturally appropriate processes and products; 3) supplementing primary and secondary cancer prevention activities; 4) offering skills training and technical assistance; and 5) providing an infrastructure to support culturally appropriate research. Between 2000 and 2005, 'Imi Hale involved more than 8000 Native Hawaiians in education, training, and primary and secondary prevention activities; developed 24 culturally tailored educational products (brochures, curricula, and self-help kits); secured $1.1 million in additional program and research funds; trained 98 indigenous researchers, 79 of whom worked on research projects; and engaged more than 3000 other Native Hawaiians as research participants and advisors. Evidence of empowerment was seen in increased individual competence, enhanced community capacity and participation, reduced barriers, and improved supports to address cancer in Hawaiian communities. Operationalizing CBPR and empowerment requires a commitment to involving as many people as possible, addressing community priorities, following cultural protocol, developing and transferring skills, and supporting an infrastructure to reduce barriers and build supports to sustain change. This approach is time consuming, but necessary for building competence and capacity, especially in indigenous and minority communities. Cancer 2006. (c) 2006 American Cancer Society.