Native Hawaiians and Pacific Islanders represent the second fastest-growing minority population in the US. According to the 2010 Census, there were 1,225,195 Native Hawaiian and Pacific Islanders (NHPIs) living in the US (alone or in combination with one or more other races). This group represents about 0.4 percent of the US population. California is second only to Hawaii in the number of NHPIs, with 286,145 NHPIs living in California. The five largest NHPI populations in California are Native Hawaiian, Chamorro/Guamanian, Samoan, Tongan, and Marshallese (Table 1). Pacific Islanders (PIs) represent a wide diversity of ethnic populations, with over 19 census defined groups that each have their own culture, language, traditions, health and world perspectives, and political and migration history. Some of these PI populations have close ties to the US territories and jurisdictions in the Pacific, including American Samoa, Guam, the Federated States of Micronesia, the Republic of the Marshall Islands, and the Commonwealth Nations of the Mariana Islands. Other groups such as Tongans have migrated from their small island nations in search of higher earnings to support families back home.

Despite their cultural differences, Native Hawaiian and Pacific Islanders generally face high socioeconomic and language barriers to accessing health care. According to the data from 2010 American Community Survey, 9.1% of Native Hawaiians, 12.2% of Chamorro/Guamanian, and 14.3% of Samoan had less than a high school degree, compared with 16.1% of non-Hispanic whites. Furthermore, 10.0% of Native Hawaiians, 10.8% of Chamorro/Guamanian, 14.4% of Samoans, and 20.0% of Tongans lived below 100% Federal Poverty Level, compared with 12% of non-Hispanic whites. About 5.5% of Native Hawaiian, 7.3% of Chamorro/Guamanian, 11.7% of Samoan, and 9.0% of Tongan reported receiving public assistance, compared with 4.4% of non-Hispanic whites. Additionally, 1.8% Native Hawaiian, 5.7% Chamorro/Guamanian, 13.3% of Samoan, and 20.3% of Tongan reported having limited English proficiency compared to 13.8% of non-Hispanic Whites (Table 1).

Table 1: Characteristics of five Pacific Islander populations and non-Hispanic whites in California (US Census, 2010)

  Race alone Race/ethnicity inclusive of all other races %<HS
% Public
% Limited
English Proficient c
Native Hawaiian 21,423 74,932 9.1% 10.0% 5.5% 1.8%
24,299 44,425 12.2% 10.8% 7.3% 5.7%
Samoan 40,900 60,876 14.3% 14.4% 11.7% 13.3%
Tongan 18,329 22,893 17.8% 20.0% 9.0% 20.3%
Marshallese 1,559 1,761 n/a n/a n/a n/a
NH Whites 21,453,934 22,953,374 16.1% 12.0% 4.4% 13.8%

Data from 2010 American Community Survey 5-year selected population tables
Data from 2010 SF2 100% Decennial Census

a Percentage of families and people whose income in the past 12 months is below the poverty line
b With Food Stamp/SNAP benefits in the past 12 months
c Speak English less than "very well"
n/a = data not available

Between 1992-2002, while breast cancer incidence rates decreased or remained the same for all other racial/ethnic groups, they increased for Asian Pacific Islanders (Edwards et al., 2005). Compared to nearly all other ethnic groups, PIs suffer from higher prevalence’s of the leading health disparity indicators, including hypertension, obesity, diabetes, infant mortality, tuberculosis, hepatitis B, asthma, and cigarette smoking. While data on the cancer needs of Pacific Islanders in the US is sparse, available evidence universally point to critical needs and high barriers to care for this diverse group. Among the primary factors associated with cancer onset, several are of particular concern for Pacific Islanders (CDC, 2002). First, obesity has been implicated as a causal factor in the onset of several cancers (including breast, colon, endometrium, esophagus, and kidney cancers), and rates of obesity are high in all Pacific Islander populations. In California, data from the 2009 California Health Interview Survey (CHIS) indicate that 32% of Pacific Islanders in California were obese (with a body mass index equal to or greater than 30) and 38% were overweight (with a body mass index between 25-29.9).

Studies have also documented the high rates of tobacco use among Pacific Islanders. In a review of tobacco use behaviors among Asian Americans and Pacific Islanders (AAPIs), Lew and Tanjasiri (2003) reported that Native Hawaiians, American Samoans, Chuukese and Palauans had rates of use between 42-58% among men, and between 11-67% among women. These smoking rates (with the exception of the Palauan data, which was betel nut use) were among the highest for both genders of all AAPIs. Data from the 2009 Youth Risk Behavior Survey indicated that 16.3% of NHPIs youth were smokers. While smoking among Asian Americans tends to be a malebehavior, that is not the case for Pacific Islanders. Nearly 18.2% Hawaiian/Pacific Islander females reported current smoking (Rudatsikira, Muula, & Siziya, 2009).

Finally, little to nothing is known about the cancer survivor needs and experiences of Pacific Islanders. For instance, despite the fact that breast cancer is the most common cancer for Pacific Islander women, information on ways to ameliorate the significant mental, social and physical health impacts are nearly non-existent. In two studies of differences in breast cancer treatment modalities, AAPI women were found to be less likely to receive radiation or hormonal therapy compared to white women, and more likely to receive a mastectomy rather than breast conserving surgery (Chui & Lyerly, 2002; Prehn et al., 2002). It’s unclear to what extent this reflects Pacific Islander women’s experiences, and further research must be done into treatment and quality of life experiences with the many PI subgroups.