Racial Discrimination, Health, and Healthcare in Hawaii's Chuukese Community

Abstract

Purpose: The purpose of this dissertation was to assess the relationship between racial discrimination and health in Hawai‘i’s Chuukese community. Increased experiences with racial discrimination has been found to negatively affect health in other communities. Experts in this field have highlight the importance of tailoring you tool you specific study population. Anecdotal evidence of racial discrimination towards Chuukese has been documented, however no formal research has been published. This dissertation looks to fill that gap. Methods: Based off of findings from a review of the peer-reviewed literature (study 1) and interviews with community members (study 2) a culturally appropriate measurement tool was created. Using this tool face-to-face interviews with Chuukese community members were conducted (study 3). Bivariate relationships between racial discrimination and health were explored. Multivariate logistic regression was conducted to test if these relationships were still significant after controlling for demographic characteristics, access to appropriate healthcare, and tobacco use. Results: Major findings from study 1 include: 1) the majority of studies done with other indigenous and Asian Pacific Islander groups only measured individual rather than collective racial discrimination; and 2) tools created specifically for these study populations included unique examples of racial discrimination for their particular group. In study 2 examples of racial discrimination experienced by the Chuukese community were identified, along with methods and words to help facilitate Chuukese individuals disclosing experiences with racial discrimination in future quantitative research. Lastly in study 3, 72 face-to-face interviews were conducted with Chuukese community members. Analysis revealed that: 1) Chuukese in Hawai‘i experienced high levels of both collective and individual racial discrimination; 2) Increased experiences with any type of racial discrimination was significantly associated with bad self-report health outcomes, often times even after controlling for our other variables; and 3) for the Chuukese community collective experiences with racial discrimination may have a stronger impact on their health outcomes compared to individual experiences. Conclusion: When addressing health inequities in Hawai‘i’s Chuukese community it is important to consider their experiences with racial discrimination. In particular collective racial discrimination may be particularly important when considering health inequities of this group.