Angela Sy | University of Hawaii at Manoa (original) (raw)

Papers by Angela Sy

Annals of global health, Dec 31, 2022

Health Promotion Practice, Mar 31, 2023

American Samoa and the Federated States of Micronesia (FSM) are two small Pacific Island nations ... more American Samoa and the Federated States of Micronesia (FSM) are two small Pacific Island nations that have some of the highest noncommunicable disease (NCD) mortality rates in the world. Supported by church leaders to address obesity as an NCD risk factor, American Samoa, and Chuuk and Kosrae States of FSM selected the implementation of healthy beverages as a nutrition intervention through a water- and coconut water-only pledge in church events. The consumption of water and coconut water was tracked. Across 105 church events in the three jurisdictions, the count of water bottles before and after events decreased from 142.8 to 22.3, the number of coconuts before and after events decreased from 19.6 to 1.2, and cups of water before and after events decreased from 52.9 to 7.6. The promotion of healthy beverages in church settings holds promise in the Pacific as a feasible, accessible, and culturally responsive nutrition approach, given limited access to other nutritional alternatives, e.g., fresh fruits and vegetables. Supplemental health promotion messaging to maintain knowledge and attitudes about healthy is recommended for future scaling up.

NIMHD/NIH-T37MD008636-08 (sponsor

Journal of health disparities research and practice, 2018

Purpose/Background: The United Nation outlines a blueprint for addressing social determinants of ... more Purpose/Background: The United Nation outlines a blueprint for addressing social determinants of health (SDOH), reconciling disparities between and within countries. Indigenous people living in Small Island Developing States like the U.S. territories experience health disparities. In American Samoa (AS), SDOH involving political, social, and data limitations provide challenges to in-country research and health services delivery capacity including cancer prevention and treatment. For example, in AS less than 7% of age-eligible adults participated in colorectal cancer (CRC) screening, while the Healthy People 2020 target is 70% screened. In 2004 a cancer awareness and service needs assessment in AS funded by the National Cancer Institute reporting descriptive qualitative results was published. Cancer specific resources, as a SDOH, was found to be lacking in AS. As a response to building cancer resources , the American Samoa Community Cancer Coalition (ASCCC), a community-based organization in AS, partnered with academic researchers in Hawaii and California. In 2015 the INdigenous Samoan Partnership to Initiate Research Excellence (INSPIRE) conducted by the ASCCC was funded through the National Institute of Minority Health Disparities to improve research capacity addressing colorectal cancer disparities. Objective: To obtain an updated cancer resources assessment, a similar qualitative methodology was conducted in 2015-2016. This abstract reports on the methods and results of an updated cancer resources qualitative assessment assessing cancer resources in AS and SDOH to compare progress and priorities in cancer prevention and treatment since the 2004 assessment. Discussion/Conclusion: This qualitative assessment demonstrates some improvements on cancer prevention, treatment, resources, and SDOH, but barriers still remain since the 2004 needs assessment. Further development and planning are needed to problem solve, including identifying effective strategies, to increase cancer awareness and prevention.

Home Health Care Management & Practice, Oct 8, 2018

By 2050, the number of U.S. citizens 65 years or older is projected to more than double from 40.2... more By 2050, the number of U.S. citizens 65 years or older is projected to more than double from 40.2 million in 2010 to 88.5 million. 1 Between 2013 and 2030, the white (non-Hispanic [NH]) population 65 years and older is projected to increase by 50% compared with 123% for older racial and ethnic populations, Hispanics (153%), black (NH) (99%), Asians (NH) (121%). 2 More than likely, these older adults will need assistance with activities of daily living (ADLs) and personal and health care from both family and formal caregivers in the form of home-based assistance or institutional assistance. 3 The objective of this article is to compare sociodemographic characteristics and various care preferences of informal (family) and formal (paid, home health, nursing home/assisted living, other nonfamily) caregiver help with ADLs.

Cancer, Mar 26, 2018

BACKGROUND: Asian American (AA) ethnic subgroups are diverse in socioeconomic status, years in th... more BACKGROUND: Asian American (AA) ethnic subgroups are diverse in socioeconomic status, years in the United States, English proficiency, and cultures with different health seeking behaviors and health care access. Fifty-two percent of AAs age 50 years had colorectal cancer screening (CRCS) in 2013, compared with 61% of non-Hispanic whites. We hypothesized that CRCS prevalence among AA ethnicities is heterogeneous and that the reasons related to CRCS among AA subgroups are associated with demographic characteristics, acculturation, health care access, and health attitudes. METHODS: Medical Expenditure Panel Survey data for 2009-2014 compared CRCS status among whites (n 5 28,834), Asian Indians (n 5 466), Chinese (n 5 652), and Filipinos (n 5 788). Multivariate logistic regression examined ethnic differences and correlates of CRCS accounting for complex sampling design. RESULTS: Whites had the highest prevalence of screening (62.3%), followed by Filipinos (55.0%), Chinese (50.9%), and Asian Indians (48.6%). Older age, having health insurance, and having a usual care provider predicted CRCS across all ethnicities. Different demographic, health care access, and health attitude predictors within each ethnic group were related to CRCS. CONCLUSION: This study contributes to the literature on influences of differential CRCS prevalence among AA subgroups. CRCS promotion should be tailored according to attitudes and structural barriers affecting screening behavior of specific ethnic subgroups to truly serve the health needs of the diverse AA population.

Journal of School Health, May 1, 2008

BACKGROUND-The effectiveness of school-based tobacco use prevention programs depends on proper im... more BACKGROUND-The effectiveness of school-based tobacco use prevention programs depends on proper implementation. This study examined factors associated with teachers' implementation of a smoking prevention curriculum in a cluster randomized trial called Project SPLASH (Smoking Prevention Launch Among Students in Hawaii). METHODS-A process evaluation was conducted and a cross-condition comparison used to examine whether teacher characteristics, teacher training, external facilitators and barriers, teacher attitudes, and curriculum attributes were associated with the dose of teacher implementation in the intervention and control arms of the study. Data were collected from a total of 62 middle school teachers in 20 public schools in Hawaii, during the 2000-2001 and 2001-2002 school years. Sources included teacher questionnaires and interviews. Chi-square test and t test revealed that implementation dose was related to teachers' disciplinary backgrounds and skills and student enjoyment of the curriculum. RESULTS-Content analysis, within case, and cross-case analyses of qualitative data revealed that implementing the curriculum in a yearlong class schedule and high teacher self-efficacy supported implementation, while high perceived curriculum complexity was associated with less complete implementation. CONCLUSIONS-The results have implications for research, school health promotion practice, and the implementation of evidence-based youth tobacco use prevention curricula. Keywords smoking and tobacco; school health instruction; teaching techniques Tobacco use prevention education beginning in middle school or earlier is critical for delaying the onset and decreasing the incidence of youth smoking, and for preventing smoking into adulthood. 1,2 Studying factors related to the implementation of school health programs, including smoking prevention, are important because difficulties in the

JCO global oncology, May 1, 2022

Carolina Digital Repository (University of North Carolina at Chapel Hill), 2015

Background Breast and cervical cancers have emerged as major global health challenges and disprop... more Background Breast and cervical cancers have emerged as major global health challenges and disproportionately lead to excess morbidity and mortality in low-and middle-income countries (LMICs) when compared to high-income countries. The objective of this paper was to highlight key findings, recommendations, and gaps in research and practice identified through a scoping study of recent reviews in breast and cervical cancer in LMICs. Methods We conducted a scoping study based on the six-stage framework of Arskey and O'Malley. We searched PubMed, Cochrane Reviews, and CINAHL with the following inclusion criteria: 1) published between 2005-February 2015, 2) focused on breast or cervical cancer 3) focused on LMIC, 4) review article, and 5) published in English. Results Through our systematic search, 63 out of the 94 identified cervical cancer reviews met our selection criteria and 36 of the 54 in breast cancer. Cervical cancer reviews were more likely PLOS ONE |

Ethnicity & Disease, Feb 21, 2019

Services (DHHS) action plan to reduce racial and ethnic health disparities emphasizes the importa... more Services (DHHS) action plan to reduce racial and ethnic health disparities emphasizes the importance of a diverse workforce. 1 A growing field of investigation has unveiled the

In response to the National Institutes of Health (NIH) All of Us Medicine Research Initiative, th... more In response to the National Institutes of Health (NIH) All of Us Medicine Research Initiative, the Precision Medicine Research (PreMeR) Diversity Consortium was formed by four institutions from the Research Centers in Minority Institutions (RCMI) Translational Research Network (RTRN). This synergistic approach proposed evidence-based, best practices used by experienced researchers to engage, recruit and retain diverse populations in the All of Us initiative. Conceptualization of the proposed approach was aided by social influence theories to better understand how people's beliefs and opinions should be modified to affect change leading to action [1]. The Social-Ecological Model (SEM), for Health Promotion [2], from Stokols [1] and Community-Based Participatory (CBPR) Models[3],[4] guided proposed engagement, recruitment, and retention strategies contextualized with the individual, interpersonal, organizational, community, and policy spheres of influence. The PreMeR produced a partnership to evaluate and improve the effectiveness of current engagement, recruitment, and retention strategies for minority participation in scientific studies. This approach illustrates the need to incorporate multiple methods of engagement to reach a diverse audience to participate in scientific research. Engagement, recruitment, and retention strategies in community and biomedical research must be viewed as community engaged public health interventions, utilizing the same theoretical principles and approaches.

Cancer, Mar 26, 2018

Background-Non-adherence to colorectal cancer (CRC) screening among Asian Americans is high but n... more Background-Non-adherence to colorectal cancer (CRC) screening among Asian Americans is high but not well understood. This study examined correlates of screening intention among Filipino, Hmong and Korean Americans who were non-adherent to CRC screening. Methods-Using cross-sectional, pre-intervention survey data from 504 Asian Americans (115 Filipinos, 185 Hmong, and 204 Koreans) aged 50 to 75 who were enrolled in a multi-site cluster randomized controlled trial of lay health educator intervention, we analyzed correlates of selfreported CRC screening non-adherence, defined as not being up-to-date for fecal occult blood test, sigmoidoscopy, or colonoscopy. Results-Only 26.8% indicated intention to obtain screening within 6 months (Hmong: 12.4%; Korean: 30.8%; and Filipino: 42.6%; p<0.001). One third ever had prior screening, and a majority did not know screening is a CRC prevention method (61.3%) or any CRC screening guidelines (53.4%). Multivariable analyses showed that patient-provider ethnicity concordance, provider's recommendation of screening, participants' prior CRC screening, perceived severity and susceptibility of CRC, and guideline knowledge were positively associated with screening intention. Specifically, knowing one or more screening guidelines doubled the odds of screening intention (AOR = 2.38; 95% CI: 1.32-4.28). Hmong were less likely to have screening intention

Cancer Research, Dec 1, 2022

Cancer Research, Jun 15, 2022

Since 2003, the University of Hawai‘i Cancer Center (UHCC) and the University of Guam (UoG) have ... more Since 2003, the University of Hawai‘i Cancer Center (UHCC) and the University of Guam (UoG) have worked in partnership to explore health disparities/inequalities for different Pacific Island Populations (PIP). Investigators explore health behaviors and sources of health disparities and equity among Micronesian and Filipino community members in Hawai‘i, Guam, and the neighboring U.S. Associated Pacific Islands (USAPI) through the Pacific Island Partnership for Cancer Health Equity (PIPCHE). The Community Outreach Core of the partnership works towards objectives that include assisting and promoting PIPCHE research, ensuring inclusion PIP and Filipino community perspectives in research, and building healthcare providers’ competencies. This work aims to directly address the disproportionately high rates of cancer incidence and mortality found amongst these groups in Hawai‘i and Guam. Currently, few cancer control initiatives are designed to specifically address Micronesians and Filipinos, which comprise 40% of Hawai‘i’s population and 70% of Guam’s population. Colorectal cancer is the second leading cause of death for men and the third leading cause of death for Filipinos in Hawai‘i. Also, Micronesians and Filipinos are highly underrepresented among cancer researchers and cancer health care professionals; culturally-grounded approaches to achieve parity in cancer control are sorely needed which remains a focus of the COC. To address the needs of the Filipino community in Hawai‘i, we conducted five semi-structured interviews with Filipino community members to facilitate community engagement, build relationships, and direct future areas for cancer control. Another goal was to establish a relationship-building process to recruit members for the COC Outreach Advisory Council to guide future community efforts. Participants ranged in age; however, all five identified as female were born in various parts of the Philippines, and migrated to Hawai'i at different ages. Some findings from the interviews included the need for culturally tailored and translated cancer materials and resources, a charge to focus on colorectal and breast cancer initiatives, and provide translated health communications utilizing local radio and faith-based organizations. These members were then asked to serve on our Outreach Advisory Council for a period of 5 years to help shape the COC’s efforts towards community engagement with the Filipino community. These planned community-focused efforts should be modeled to ensure shared community-based decision-making for this minority population. Citation Format: Mark Lee Willingham, Kevin Cassel, Angela Sy, Munirih R. Ta'afaki, Reyna Bodnar, Lilnabeth P. Somera, Tressa P. Diaz, Angelina G. Mummert, Harmony C. Palaganas. Using key informants to guide community outreach for cancer topics and areas of focus for Filipino communities [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3684.

Californian journal of health promotion, May 1, 2013

Smoking prevalence for Asian-Americans (AA) is low compared to non-AAs; however in Hawai`, the pr... more Smoking prevalence for Asian-Americans (AA) is low compared to non-AAs; however in Hawai`, the prevalence of smoking among Filipina high school girls is more than double that of Japanese high school girls. This study explored socio-cultural factors facilitating or serving as barriers against tobacco use among Filipina girls. Representatives from four community organizations, recognized for their work with Filipinos, were engaged throughout the research to facilitate the project and to ensure cultural relevance. Eleven focus groups (n=88), led by peer facilitators, discussed smoking. Twelve cultural key informants interpreted results presented from the transcripts. Results: Self-reported reasons why Filipina girls may smoke included the need to cope and to fit in. School and family responsibilities were commonly stated as barriers to smoking among Filipina girls. Nonetheless, many girls said they were given cigarettes from family members who smoked. Cultural key informants recommended conducting research on a larger sample of Filipina girls and offering family and school-based tobacco prevention programs. Conclusion: Collaboration with a variety of community partners helped provide rich qualitative data and findings regarding socio-cultural factors associated with smoking and recommendations to prevent smoking among Filipina girls. The role of family in preventing and promoting tobacco use needs further exploration. Family appears to be a promising area to explore future interventions to prevent smoking among Filipina girls.

Cancer Causes & Control, Mar 17, 2020

Purpose Cervical cancer disproportionately burdens low-resource populations where access to quali... more Purpose Cervical cancer disproportionately burdens low-resource populations where access to quality screening services is limited. A greater understanding of sustainable approaches to implement cervical cancer screening services is needed. Methods We conducted a systematized literature review of evaluations from cervical cancer screening programs implemented in resource-limited settings globally that included a formal evaluation and intention of program sustainment over time. We categorized the included studies using the continuum of implementation research framework which categorizes studies progressively from "implementation light" to more implementation intensive. Results Fifty-one of 13,330 initially identified papers were reviewed with most study sites in low-resource settings of middle-income countries (94.1%) ,while 9.8% were in low-income countries. Across all studies, visual inspection of the cervix with acetic acid (58.8%) was the most prevalent screening method followed by cytology testing (39.2%). Demandside (client and community) considerations were reported in 86.3% of the articles, while 68.6% focused scientific inquiry on the supply side (health service). Eighteen articles (35.3%) were categorized as "Informing Scale-up" along the continuum of implementation research. Conclusions The number of cervical cancer screening implementation reports is limited globally, especially in low-income countries. The 18 papers we classified as Informing Scale-up provide critical insights for developing programs relevant to implementation outcomes. We recommend that program managers report lessons learnt to build collective implementation knowledge for cervical cancer screening services, globally.

Journal of community engagement and scholarship, 2021

In 2017, the National Institutes of Health (NIH) All of Us Research Program announced a funding o... more In 2017, the National Institutes of Health (NIH) All of Us Research Program announced a funding opportunity for community partners to "educate, motivate, and facilitate enrollment" of volunteers. In response to this opportunity, four institutions from the Research Centers in Minority Institutions (RCMI) Translational Research Network (RTRN) formed the Precision Medicine Research (PreMeR) Diversity Consortium. This multi-institutional collaboration proposed to employ evidence-based best practices to engage, recruit, and retain diverse populations in the All of Us program. The PreMeR approach was premised on the notion that engagement, recruitment, and retention strategies in community and biomedical research must be viewed as community-engaged public health interventions and utilize the same theoretical principles and approaches. To that end, social influence theories were key in conceptualizing approaches to engaging diverse populations in research, as they helped PreMeR members better understand how people's beliefs and opinions could be modified to effect change and lead to action (Stokols, 1996). PreMeR adopted the social-ecological model (SEM) for health promotion (Dahlberg & Krug, 2006) from Stokols (1996) and community-based participatory research (CBPR) models (Israel et al., 1998, 2005; Wallerstein & Duran, 2010) to guide proposed engagement, recruitment, and retention strategies. The processes of contextualizing engagement strategies across the individual, interpersonal, organizational, community, and policy spheres of influence necessitated the incorporation of multiple methods to reach diverse audiences. This article provides a model for applying a theory-driven approach to research engagement, recruitment, and retention.

Annals of global health, Dec 31, 2022

Health Promotion Practice, Mar 31, 2023

American Samoa and the Federated States of Micronesia (FSM) are two small Pacific Island nations ... more American Samoa and the Federated States of Micronesia (FSM) are two small Pacific Island nations that have some of the highest noncommunicable disease (NCD) mortality rates in the world. Supported by church leaders to address obesity as an NCD risk factor, American Samoa, and Chuuk and Kosrae States of FSM selected the implementation of healthy beverages as a nutrition intervention through a water- and coconut water-only pledge in church events. The consumption of water and coconut water was tracked. Across 105 church events in the three jurisdictions, the count of water bottles before and after events decreased from 142.8 to 22.3, the number of coconuts before and after events decreased from 19.6 to 1.2, and cups of water before and after events decreased from 52.9 to 7.6. The promotion of healthy beverages in church settings holds promise in the Pacific as a feasible, accessible, and culturally responsive nutrition approach, given limited access to other nutritional alternatives, e.g., fresh fruits and vegetables. Supplemental health promotion messaging to maintain knowledge and attitudes about healthy is recommended for future scaling up.

NIMHD/NIH-T37MD008636-08 (sponsor

Journal of health disparities research and practice, 2018

Purpose/Background: The United Nation outlines a blueprint for addressing social determinants of ... more Purpose/Background: The United Nation outlines a blueprint for addressing social determinants of health (SDOH), reconciling disparities between and within countries. Indigenous people living in Small Island Developing States like the U.S. territories experience health disparities. In American Samoa (AS), SDOH involving political, social, and data limitations provide challenges to in-country research and health services delivery capacity including cancer prevention and treatment. For example, in AS less than 7% of age-eligible adults participated in colorectal cancer (CRC) screening, while the Healthy People 2020 target is 70% screened. In 2004 a cancer awareness and service needs assessment in AS funded by the National Cancer Institute reporting descriptive qualitative results was published. Cancer specific resources, as a SDOH, was found to be lacking in AS. As a response to building cancer resources , the American Samoa Community Cancer Coalition (ASCCC), a community-based organization in AS, partnered with academic researchers in Hawaii and California. In 2015 the INdigenous Samoan Partnership to Initiate Research Excellence (INSPIRE) conducted by the ASCCC was funded through the National Institute of Minority Health Disparities to improve research capacity addressing colorectal cancer disparities. Objective: To obtain an updated cancer resources assessment, a similar qualitative methodology was conducted in 2015-2016. This abstract reports on the methods and results of an updated cancer resources qualitative assessment assessing cancer resources in AS and SDOH to compare progress and priorities in cancer prevention and treatment since the 2004 assessment. Discussion/Conclusion: This qualitative assessment demonstrates some improvements on cancer prevention, treatment, resources, and SDOH, but barriers still remain since the 2004 needs assessment. Further development and planning are needed to problem solve, including identifying effective strategies, to increase cancer awareness and prevention.

Home Health Care Management & Practice, Oct 8, 2018

By 2050, the number of U.S. citizens 65 years or older is projected to more than double from 40.2... more By 2050, the number of U.S. citizens 65 years or older is projected to more than double from 40.2 million in 2010 to 88.5 million. 1 Between 2013 and 2030, the white (non-Hispanic [NH]) population 65 years and older is projected to increase by 50% compared with 123% for older racial and ethnic populations, Hispanics (153%), black (NH) (99%), Asians (NH) (121%). 2 More than likely, these older adults will need assistance with activities of daily living (ADLs) and personal and health care from both family and formal caregivers in the form of home-based assistance or institutional assistance. 3 The objective of this article is to compare sociodemographic characteristics and various care preferences of informal (family) and formal (paid, home health, nursing home/assisted living, other nonfamily) caregiver help with ADLs.

Cancer, Mar 26, 2018

BACKGROUND: Asian American (AA) ethnic subgroups are diverse in socioeconomic status, years in th... more BACKGROUND: Asian American (AA) ethnic subgroups are diverse in socioeconomic status, years in the United States, English proficiency, and cultures with different health seeking behaviors and health care access. Fifty-two percent of AAs age 50 years had colorectal cancer screening (CRCS) in 2013, compared with 61% of non-Hispanic whites. We hypothesized that CRCS prevalence among AA ethnicities is heterogeneous and that the reasons related to CRCS among AA subgroups are associated with demographic characteristics, acculturation, health care access, and health attitudes. METHODS: Medical Expenditure Panel Survey data for 2009-2014 compared CRCS status among whites (n 5 28,834), Asian Indians (n 5 466), Chinese (n 5 652), and Filipinos (n 5 788). Multivariate logistic regression examined ethnic differences and correlates of CRCS accounting for complex sampling design. RESULTS: Whites had the highest prevalence of screening (62.3%), followed by Filipinos (55.0%), Chinese (50.9%), and Asian Indians (48.6%). Older age, having health insurance, and having a usual care provider predicted CRCS across all ethnicities. Different demographic, health care access, and health attitude predictors within each ethnic group were related to CRCS. CONCLUSION: This study contributes to the literature on influences of differential CRCS prevalence among AA subgroups. CRCS promotion should be tailored according to attitudes and structural barriers affecting screening behavior of specific ethnic subgroups to truly serve the health needs of the diverse AA population.

Journal of School Health, May 1, 2008

BACKGROUND-The effectiveness of school-based tobacco use prevention programs depends on proper im... more BACKGROUND-The effectiveness of school-based tobacco use prevention programs depends on proper implementation. This study examined factors associated with teachers' implementation of a smoking prevention curriculum in a cluster randomized trial called Project SPLASH (Smoking Prevention Launch Among Students in Hawaii). METHODS-A process evaluation was conducted and a cross-condition comparison used to examine whether teacher characteristics, teacher training, external facilitators and barriers, teacher attitudes, and curriculum attributes were associated with the dose of teacher implementation in the intervention and control arms of the study. Data were collected from a total of 62 middle school teachers in 20 public schools in Hawaii, during the 2000-2001 and 2001-2002 school years. Sources included teacher questionnaires and interviews. Chi-square test and t test revealed that implementation dose was related to teachers' disciplinary backgrounds and skills and student enjoyment of the curriculum. RESULTS-Content analysis, within case, and cross-case analyses of qualitative data revealed that implementing the curriculum in a yearlong class schedule and high teacher self-efficacy supported implementation, while high perceived curriculum complexity was associated with less complete implementation. CONCLUSIONS-The results have implications for research, school health promotion practice, and the implementation of evidence-based youth tobacco use prevention curricula. Keywords smoking and tobacco; school health instruction; teaching techniques Tobacco use prevention education beginning in middle school or earlier is critical for delaying the onset and decreasing the incidence of youth smoking, and for preventing smoking into adulthood. 1,2 Studying factors related to the implementation of school health programs, including smoking prevention, are important because difficulties in the

JCO global oncology, May 1, 2022

Carolina Digital Repository (University of North Carolina at Chapel Hill), 2015

Background Breast and cervical cancers have emerged as major global health challenges and disprop... more Background Breast and cervical cancers have emerged as major global health challenges and disproportionately lead to excess morbidity and mortality in low-and middle-income countries (LMICs) when compared to high-income countries. The objective of this paper was to highlight key findings, recommendations, and gaps in research and practice identified through a scoping study of recent reviews in breast and cervical cancer in LMICs. Methods We conducted a scoping study based on the six-stage framework of Arskey and O'Malley. We searched PubMed, Cochrane Reviews, and CINAHL with the following inclusion criteria: 1) published between 2005-February 2015, 2) focused on breast or cervical cancer 3) focused on LMIC, 4) review article, and 5) published in English. Results Through our systematic search, 63 out of the 94 identified cervical cancer reviews met our selection criteria and 36 of the 54 in breast cancer. Cervical cancer reviews were more likely PLOS ONE |

Ethnicity & Disease, Feb 21, 2019

Services (DHHS) action plan to reduce racial and ethnic health disparities emphasizes the importa... more Services (DHHS) action plan to reduce racial and ethnic health disparities emphasizes the importance of a diverse workforce. 1 A growing field of investigation has unveiled the

In response to the National Institutes of Health (NIH) All of Us Medicine Research Initiative, th... more In response to the National Institutes of Health (NIH) All of Us Medicine Research Initiative, the Precision Medicine Research (PreMeR) Diversity Consortium was formed by four institutions from the Research Centers in Minority Institutions (RCMI) Translational Research Network (RTRN). This synergistic approach proposed evidence-based, best practices used by experienced researchers to engage, recruit and retain diverse populations in the All of Us initiative. Conceptualization of the proposed approach was aided by social influence theories to better understand how people's beliefs and opinions should be modified to affect change leading to action [1]. The Social-Ecological Model (SEM), for Health Promotion [2], from Stokols [1] and Community-Based Participatory (CBPR) Models[3],[4] guided proposed engagement, recruitment, and retention strategies contextualized with the individual, interpersonal, organizational, community, and policy spheres of influence. The PreMeR produced a partnership to evaluate and improve the effectiveness of current engagement, recruitment, and retention strategies for minority participation in scientific studies. This approach illustrates the need to incorporate multiple methods of engagement to reach a diverse audience to participate in scientific research. Engagement, recruitment, and retention strategies in community and biomedical research must be viewed as community engaged public health interventions, utilizing the same theoretical principles and approaches.

Cancer, Mar 26, 2018

Background-Non-adherence to colorectal cancer (CRC) screening among Asian Americans is high but n... more Background-Non-adherence to colorectal cancer (CRC) screening among Asian Americans is high but not well understood. This study examined correlates of screening intention among Filipino, Hmong and Korean Americans who were non-adherent to CRC screening. Methods-Using cross-sectional, pre-intervention survey data from 504 Asian Americans (115 Filipinos, 185 Hmong, and 204 Koreans) aged 50 to 75 who were enrolled in a multi-site cluster randomized controlled trial of lay health educator intervention, we analyzed correlates of selfreported CRC screening non-adherence, defined as not being up-to-date for fecal occult blood test, sigmoidoscopy, or colonoscopy. Results-Only 26.8% indicated intention to obtain screening within 6 months (Hmong: 12.4%; Korean: 30.8%; and Filipino: 42.6%; p<0.001). One third ever had prior screening, and a majority did not know screening is a CRC prevention method (61.3%) or any CRC screening guidelines (53.4%). Multivariable analyses showed that patient-provider ethnicity concordance, provider's recommendation of screening, participants' prior CRC screening, perceived severity and susceptibility of CRC, and guideline knowledge were positively associated with screening intention. Specifically, knowing one or more screening guidelines doubled the odds of screening intention (AOR = 2.38; 95% CI: 1.32-4.28). Hmong were less likely to have screening intention

Cancer Research, Dec 1, 2022

Cancer Research, Jun 15, 2022

Since 2003, the University of Hawai‘i Cancer Center (UHCC) and the University of Guam (UoG) have ... more Since 2003, the University of Hawai‘i Cancer Center (UHCC) and the University of Guam (UoG) have worked in partnership to explore health disparities/inequalities for different Pacific Island Populations (PIP). Investigators explore health behaviors and sources of health disparities and equity among Micronesian and Filipino community members in Hawai‘i, Guam, and the neighboring U.S. Associated Pacific Islands (USAPI) through the Pacific Island Partnership for Cancer Health Equity (PIPCHE). The Community Outreach Core of the partnership works towards objectives that include assisting and promoting PIPCHE research, ensuring inclusion PIP and Filipino community perspectives in research, and building healthcare providers’ competencies. This work aims to directly address the disproportionately high rates of cancer incidence and mortality found amongst these groups in Hawai‘i and Guam. Currently, few cancer control initiatives are designed to specifically address Micronesians and Filipinos, which comprise 40% of Hawai‘i’s population and 70% of Guam’s population. Colorectal cancer is the second leading cause of death for men and the third leading cause of death for Filipinos in Hawai‘i. Also, Micronesians and Filipinos are highly underrepresented among cancer researchers and cancer health care professionals; culturally-grounded approaches to achieve parity in cancer control are sorely needed which remains a focus of the COC. To address the needs of the Filipino community in Hawai‘i, we conducted five semi-structured interviews with Filipino community members to facilitate community engagement, build relationships, and direct future areas for cancer control. Another goal was to establish a relationship-building process to recruit members for the COC Outreach Advisory Council to guide future community efforts. Participants ranged in age; however, all five identified as female were born in various parts of the Philippines, and migrated to Hawai'i at different ages. Some findings from the interviews included the need for culturally tailored and translated cancer materials and resources, a charge to focus on colorectal and breast cancer initiatives, and provide translated health communications utilizing local radio and faith-based organizations. These members were then asked to serve on our Outreach Advisory Council for a period of 5 years to help shape the COC’s efforts towards community engagement with the Filipino community. These planned community-focused efforts should be modeled to ensure shared community-based decision-making for this minority population. Citation Format: Mark Lee Willingham, Kevin Cassel, Angela Sy, Munirih R. Ta'afaki, Reyna Bodnar, Lilnabeth P. Somera, Tressa P. Diaz, Angelina G. Mummert, Harmony C. Palaganas. Using key informants to guide community outreach for cancer topics and areas of focus for Filipino communities [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3684.

Californian journal of health promotion, May 1, 2013

Smoking prevalence for Asian-Americans (AA) is low compared to non-AAs; however in Hawai`, the pr... more Smoking prevalence for Asian-Americans (AA) is low compared to non-AAs; however in Hawai`, the prevalence of smoking among Filipina high school girls is more than double that of Japanese high school girls. This study explored socio-cultural factors facilitating or serving as barriers against tobacco use among Filipina girls. Representatives from four community organizations, recognized for their work with Filipinos, were engaged throughout the research to facilitate the project and to ensure cultural relevance. Eleven focus groups (n=88), led by peer facilitators, discussed smoking. Twelve cultural key informants interpreted results presented from the transcripts. Results: Self-reported reasons why Filipina girls may smoke included the need to cope and to fit in. School and family responsibilities were commonly stated as barriers to smoking among Filipina girls. Nonetheless, many girls said they were given cigarettes from family members who smoked. Cultural key informants recommended conducting research on a larger sample of Filipina girls and offering family and school-based tobacco prevention programs. Conclusion: Collaboration with a variety of community partners helped provide rich qualitative data and findings regarding socio-cultural factors associated with smoking and recommendations to prevent smoking among Filipina girls. The role of family in preventing and promoting tobacco use needs further exploration. Family appears to be a promising area to explore future interventions to prevent smoking among Filipina girls.

Cancer Causes & Control, Mar 17, 2020

Purpose Cervical cancer disproportionately burdens low-resource populations where access to quali... more Purpose Cervical cancer disproportionately burdens low-resource populations where access to quality screening services is limited. A greater understanding of sustainable approaches to implement cervical cancer screening services is needed. Methods We conducted a systematized literature review of evaluations from cervical cancer screening programs implemented in resource-limited settings globally that included a formal evaluation and intention of program sustainment over time. We categorized the included studies using the continuum of implementation research framework which categorizes studies progressively from "implementation light" to more implementation intensive. Results Fifty-one of 13,330 initially identified papers were reviewed with most study sites in low-resource settings of middle-income countries (94.1%) ,while 9.8% were in low-income countries. Across all studies, visual inspection of the cervix with acetic acid (58.8%) was the most prevalent screening method followed by cytology testing (39.2%). Demandside (client and community) considerations were reported in 86.3% of the articles, while 68.6% focused scientific inquiry on the supply side (health service). Eighteen articles (35.3%) were categorized as "Informing Scale-up" along the continuum of implementation research. Conclusions The number of cervical cancer screening implementation reports is limited globally, especially in low-income countries. The 18 papers we classified as Informing Scale-up provide critical insights for developing programs relevant to implementation outcomes. We recommend that program managers report lessons learnt to build collective implementation knowledge for cervical cancer screening services, globally.

Journal of community engagement and scholarship, 2021

In 2017, the National Institutes of Health (NIH) All of Us Research Program announced a funding o... more In 2017, the National Institutes of Health (NIH) All of Us Research Program announced a funding opportunity for community partners to "educate, motivate, and facilitate enrollment" of volunteers. In response to this opportunity, four institutions from the Research Centers in Minority Institutions (RCMI) Translational Research Network (RTRN) formed the Precision Medicine Research (PreMeR) Diversity Consortium. This multi-institutional collaboration proposed to employ evidence-based best practices to engage, recruit, and retain diverse populations in the All of Us program. The PreMeR approach was premised on the notion that engagement, recruitment, and retention strategies in community and biomedical research must be viewed as community-engaged public health interventions and utilize the same theoretical principles and approaches. To that end, social influence theories were key in conceptualizing approaches to engaging diverse populations in research, as they helped PreMeR members better understand how people's beliefs and opinions could be modified to effect change and lead to action (Stokols, 1996). PreMeR adopted the social-ecological model (SEM) for health promotion (Dahlberg & Krug, 2006) from Stokols (1996) and community-based participatory research (CBPR) models (Israel et al., 1998, 2005; Wallerstein & Duran, 2010) to guide proposed engagement, recruitment, and retention strategies. The processes of contextualizing engagement strategies across the individual, interpersonal, organizational, community, and policy spheres of influence necessitated the incorporation of multiple methods to reach diverse audiences. This article provides a model for applying a theory-driven approach to research engagement, recruitment, and retention.