Native Hawaiians/Pacific Islanders deeply affected by the COVID-19 pandemic, studies report

Native Hawaiians/Pacific Islanders, or NH/PIs, comprising more than 20 ethnic groups hailing from Polynesia, Micronesia, and Melanesia, are understudied despite being the third fastest growing racial group in the United States. Two studies now report that NH/PIs have been deeply affected by the COVID-19 pandemic.

Andrew Subica at the University of California, Riverside, led research groups that surveyed more than 300 NH/PIs from April-November 2021 in Washington, Utah, Oregon, California, and Arkansas -; states with large NH/PI populations. Their findings are published in two journals.

Described in the first paper, published in Public Health Reports, the researchers found 30% of the NH/PI participants reported being diagnosed with COVID-19 and approximately 50% of the participants reported having a close family member with COVID-19.

Further, nearly 1 out of 5 NH/PIs reported the death of a close family member due to COVID-19 infection; the overall U.S. COVID-19 mortality rate was 1 death per 400 persons at the end of 2021.

"NH/PIs may carry the highest rates of COVID-19 infections and deaths of any U.S. racial/ethnic minority group during the pandemic," said Subica, an associate professor in the School of Medicine's Department of Social Medicine, Population, and Public Health. "For example, an earlier report found NH/PIs possessed the highest per capita death rate in 90% of states reporting NH/PI COVID-19 deaths."

According to Subica, several factors increase NH/PIs' risk for exposure to SARS-CoV-2, the virus that spreads COVID-19. These factors include employment in essential frontline positions, dwelling in dense households and neighborhoods, and traditional sociocultural practices and obligations that result in large in-person group contact.

Our findings call for greater attention and funding of NH/PI research to prevent and reduce NH/PIs' glaring health disparities associated with COVID-19. Due to their high rates of comorbidities such as obesity, cancer, heart disease, and smoking that increase their risk of severe COVID-19 outcomes, it is crucial that future studies monitor and evaluate long-term COVID-19-related health issues facing NH/PI communities."

Andrew Subica, Associate Professor, University of California, Riverside

The research paper is titled "Assessing the Health and Impact of COVID-19 on Native Hawaiians/Pacific Islanders."

Substance use patterns and treatment needs

In the second paper, published in Drug and Alcohol Review, Subica and his team share their findings after conducting a large-scale investigation of NH/PI substance use, mental health, and treatment need during COVID-19.

The research team found NH/PI communities experienced high levels of alcohol, tobacco, and other drug use, depression, anxiety, and unmet treatment need during COVID-19; 47% and 22% of NH/PI adults reported current alcohol and cigarette use, respectively, while 35% reported lifetime illicit substance use. The national smoking rate during COVID-19 is 13%.

Further, more than 1 in 4 NH/PI adults, or 27%, screened positive for alcohol use disorder, a rate that is more than 2.6 times the national alcohol use disorder rate during the pandemic.

Participants also reported heightened depression, anxiety, and psychological distress during COVID-19 with 27% of NH/PIs screening positive for major depressive disorder and 20% for generalized anxiety disorder, vastly exceeding the general population rates for these disorders.

"What our work makes clear is that we need targeted research and treatment services to mitigate COVID-19's negative behavioral health impact on NH/PI communities," Subica said.

The researchers also found that approximately 50% of non-binary NH/PIs in the sample screened positive for probable alcohol use disorder and more than 50% reported needing mental health treatment during COVID-19.

"This illuminates the need for further research exploring the behavioral health needs of these at-risk individuals," Subica said. "We need to develop and implement culturally responsive prevention, intervention, and recovery programs to reduce NH/PI substance use and mental health disparities during and after the COVID-19 pandemic."

The research paper is titled "Native Hawaiian/Pacific Islander alcohol, tobacco, and other drug use, mental health, and treatment need in the United States during COVID-19."

Subica was joined in the first study by Dr. Howard B. Moss of UCR; Nia Aitaoto of Pacific Islander Center of Primary Care Excellence; Quixi Li of Special Services for Groups; Brittany N. Morey of UCI; Li-Tzy Wu of Duke University; Derek K. Iwamoto of the University of Maryland; and Erick G. Guerrero of I-Lead Institute.

Subica, Moss, Guerrero, Aitaoto, Morey, and Wu were joined in the second study by Tammy K. K. Martin and Scott K. Okamoto of Hawaii Pacific University.

Both projects were supported by the National Institute of Drug Abuse and National Institute of Alcohol Abuse and Alcoholism of the National Institutes of Health. None of the content of this news release represents the official views of these institutes.