Acculturation and Cancer Risk Behaviors among Pacific Islanders in Hawaii

To communicate research to the public, the National Cancer Institute developed the Health Information National Trends Survey (HINTS). However, as with most national health surveillance, including the Behavioral Risk Factor Surveillance System, HINTS data are not sufficient to address unique demographic subpopulations such as US Pacific Islanders (PIs). National sampling methods do not adequately reach participants from small, medically underserved populations.

This study aims to document the cancer-relevant knowledge, attitudes, behaviors, and information-seeking practices of PIs in Hawaii (HI).

We conducted a cross-sectional survey during 2017-2018 of Native Hawaiians, Chuukese, and Marshallese in HI using Respondent Driven Sampling (RDS) to recruit these geographically diffuse groups. The modified HINTS survey included questions about cancer knowledge, attitudes and behaviors, health communications, and cultural practices.

A total of 515 Native Hawaiians, 305 Chuukese, and 180 Marshallese completed the survey. Differences were found across a variety of cancer-related attitudes, knowledge, and behaviors. These groups also differed regarding acculturation, health locus of control, and trust in medical professionals. Native Hawaiians were significantly more acculturated (P=.0001) than Chuukese or Marshallese and more likely to smoke cigarettes (P=.0001). Among participants aged >50 years, we found no significant differences across ethnic groups (P=.30) for those completing a colon cancer screening (37%). However, only 27% were referred to screening by a physician.

Cancer prevention programs are greatly needed for PIs in HI. This study provides knowledge concerning the efficiency of RDS to recruit participants, and the role of culture in communications influencing cancer risk behaviors, which may be generalizable to migrant PIs in the United States.