Progress 10/01/16 to 09/30/17

Outputs
Target Audience:During this time period, alternative Native Hawaiian family recruitment strategies were examined, and broader community organizations sought to explore recruitment and dissemination sites.The possibility of Hawaiian family recruitment were discussed with Office of Hawaiian Affairs staff, Papa O Lokahi, and Hawaiian Homelands explored. When funds for interviews and recruitment are available, recruitment strategies will be tested. Changes/Problems:Native Hawaiian 2-3 Generation Family Participation andrecruitment is an ongoing problem. It was difficult hold family sessions for 2-3 generations in this expensive state. Some families' members worked two jobs and didn't have a common time that overlapped for intensive face to face family interview sessions. Variations of face to face plus video conferencing must be tested with cell phone picture documentation of food consumption with recipe must be tested and validated.2017 research indicated that several photo documentation of food types and consumption may lead to effective and efficient data collection ion busy families. After new recruitment and data collection strategies have been finalized, the IRB application will be submitted. Grant funding must be secured to support a Native Hawaiian graduate student help conduct these more effective family sessions. The recruitment and resulting interview protocol is dependent upon Native Hawaiian family's ability and willingness to participate in this study. What opportunities for training and professional development has the project provided?The PI attended several nutrition workshops 12th International Academy on Nutrition and Aging and health beliefs and lifestyle presentations at the International Geriatrics and Gerontology meeting. Attendance at this meeting served to enhance the PIs knowledge regarding health beliefs and lifestyle/nutrition measurement strategies and techniques with older participants. Another type of session that the PI found useful were the sessions that accessed family research projects, and family interventions. How have the results been disseminated to communities of interest?While seeking and expanding community collaborators (Papa O Lokahi-Native Hawaiian Health organization, school garden networks, Hawaiian Homelands, and Office of Hawaiian Affairs), we discussed some preliminary challenges in recruiting Native Hawaiian Families, and conducting 2-3 generational family studies. What do you plan to do during the next reporting period to accomplish the goals?Secure funding to conduct further pilots to test possible Native Hawaiian family recruitment strategies; revision and modification of protocols to collect health beliefs and lifestyles; explore possible nutrition data collection using cell phone technology and social media dissemination of outcomes to overcome time barriers of Native Hawaiian 2-3 generation participants.

Impacts
What was accomplished under these goals? Project Goal: Health and Wellness in Asian and Pacific Islander Families and Communities: To enhance the collaborative and land grant integration of research/instruction/extension framework and improve, opportunities for future project collaborations to improve health and wellness of Asian and Pacific Islander Families and Communities. Objective 1: To review, document and collaborate across university and community resources in Health and Wellness: a. Identify and establish key collaborations with university and community individuals/organizations Additional collaborators were sought to expand Native Hawaiian family recruitment, community participatory suggestions,and dissemination of health beliefs and nutrition lifestyle outcomes data b. Identify and seek community participatory funding opportunities Alternate funding sources have been sought to expand piloting of recruitment strategies and health beliefs/health lifestyle instruments Objective 2: Improve the integration of the land grant mission throughout FCS research, instruction and extension and produce a greater number of integrated, collaborative and multidisciplinary Health and Wellness projects: a. Increase Faculty/Student/Community Instruction-course based and service-learning opportunities, internship, and extracurricular events and long term engagements There was exploration of possible future faculty and Native Hawaiian graduate student collaborations. Planning for a special journal issue entitled "Culturally Responsive Prevention Research for Native Hawaiians and Other Pacific Islanders". The special issue proposal was accepted and over the next year will solicit, review and write articles for this special issue. Lessons learned regarding NHOPI community participatory research issues, health beliefs and lifestyle practices will be incorporated into articles in this special issue. b Increase Research and evaluation components in Extension projects Planned after research and data collection portion of the project completed c. Increase the translation of science based health and wellness research findings for Pacific Islander families and communities into extension programming locally and nationally Planned after research and data collection portion of the project completed Pilot Project Goals: Intergenerational Transmission of Health Beliefs and Lifestyle Practices among Native Hawaiian and Pacific Islander Families The following pilot project will develop and pilot research tools, and examine the most effective recruitment strategies for Pacific Islander families, adapt existing and proposed more culturally responsive health and wellness methodology, survey, questionnaire and assessment tools for Pacific Islander families. Objective 1: Develop and test research protocol questionnaire and survey, with methods to examine Health Beliefs and Lifestyle Practices for Two or Three generations of female and male related adults: GrandFathers, Fathers, GrandSons, Grandmothers, Mothers and GrandDaughters a. Modify, adapt and test health and wellness instruments for young adults, middle age and elderly family members.--The instruments will be modified after the Native Hawaiian recruitment strategy is selected. With the high costs of living, it is difficult to have a 2 hour live session with 2-3 generations in the same session. Possible recruitment and family sessions may be combinations of live and phone conference calls. b. Modify, adapt, and test health and wellness instruments for gender validity-Completed, but age and generational issues regarding recruitment, health beliefs and lifestyle measurements must be further explored Objective 2: Test the efficacy of several recruitment and sampling strategies for two or three generational family research participation through a variety of Pacific Islander family recruitment methods-See Objective 1a Objective 3: Development of an efficient food/meal sampling from two-three generation families (which meals or days/1 day versus week type of food/recipe sample collection strategy -Exploration of the validity and testing of food sampling was examined but actual efficient and effective food sampling possibilities to be tested.

Publications

Progress 10/01/15 to 09/30/16

Outputs
Target Audience: Nothing Reported Changes/Problems:During this time period, the PI experienced a major flood in the PI's building. This flood required evacuation of the entire building and packing of all PI materials with ongoing mold mitigation occurring almost a year later. Right after the Native Hawaiian student graduated, the PI's hard drive crashed, with data, software, and analysis secured,but some unrecovered. Previous data entry and further qualitative data analyses were lost. Previous work with the data was reconstructed, some recovered, data files, organized but was delayed for submission of new IRB to cover new data collection strategy and human subject protection. The two major changes that are required are: 1. Shift in face to face data collection strategy (2-4 hour session with all generations in the family together) to online and cell phone data collection for majors parts of the collection, with new IRB to be submitted prior to continuance of data collection; 2. Securing funding to continue and improve participant recruitment and data collection strategies for studying health beliefs and lifestyle behaviors among multiple generations in Native Hawaiian Families. What opportunities for training and professional development has the project provided?The PI attended a Qualitative Workshop to learn about the: 1. Various types of collection and solicitation of qualitative data (interview formats, types of qualitative questions to solicit idea responses, qualitative research methods and resulting data analysis, benefits of using qualitative responses to inform quantitative responses); 2. Data coding of qualitative data; 3. Analysis strategies of qualitative data; 4. Reporting of qualitative data; and 5. Reporting and publication of qualitative data with quantitative data. How have the results been disseminated to communities of interest? Nothing Reported What do you plan to do during the next reporting period to accomplish the goals?During this past year, there were issues that created delays and IRB revision requirements. Additional funding must be secured to collect data with new online and cell phone data collection strategies. New IRB submission must outline how participant privacy will be secured with online and cell phone data collection methods. The research literacy about human subjects protections are new and will be evaluatedfor use in a new IRB. The literature below will be reviewed regarding best strategy to protect human subjects via online and cell phone data collection strategies: Pisani, A. R., Wyman, P. A., Mohr, D. C., Perrino, T., Gallo, C., Villamar, J., ... & Brown, C. H. (2016). Human subjects protection and technology in prevention science: selected opportunities and challenges.Prevention Science, 1-14. Tung, I. L. Y., Machalek, D. A., & Garland, S. M. (2016). Attitudes, Knowledge and Factors Associated with Human Papillomavirus (HPV) Vaccine Uptake in Adolescent Girls and Young Women in Victoria, Australia.PLoS ONE,11(8), e0161846. http://doi.org/10.1371/journal.pone.0161846 Fenner, Y., Garland, S. M., Moore, E. E., Jayasinghe, Y., Fletcher, A., Tabrizi, S. N., ... Wark, J. D. (2012). Web-Based Recruiting for Health Research Using a Social Networking Site: An Exploratory Study.Journal of Medical Internet Research,14(1), e20. http://doi.org/10.2196/jmir.1978 Topolovec-Vranic, J., & Natarajan, K. (2016). The Use of Social Media in Recruitment for Medical Research Studies: A Scoping Review.Journal of Medical Internet Research,18(11), e286. http://doi.org/10.2196/jmir.5698 Close, S., Smaldone, A., Fennoy, I., Reame, N., & Grey, M. (2013). Using Information Technology and Social Networking for Recruitment of Research Participants: Experience From an Exploratory Study of Pediatric Klinefelter Syndrome.Journal of Medical Internet Research,15(3), e48. http://doi.org/10.2196/jmir.2286 Hendricks, S., Düking, P., & Mellalieu, S. D. (2016). Twitter Strategies for Web-Based Surveying: Descriptive Analysis From the International Concussion Study.JMIR Research Protocols,5(3), e179. http://doi.org/10.2196/resprot.4542 Lee, J. L., DeCamp, M., Dredze, M., Chisolm, M. S., & Berger, Z. D. (2014). What Are Health-Related Users Tweeting? A Qualitative Content Analysis of Health-Related Users and Their Messages on Twitter.Journal of Medical Internet Research,16(10), e237. http://doi.org/10.2196/jmir.3765

Impacts
What was accomplished under these goals? The PI was in the process of learning several qualitative software analysis programs with the qualitative data professional skills. Some of that data was lost during a hard drive crash and catastrophic building incident that flooded 3 floors of the PIs offices. Data collection stopped when the MS nutrition student graduated early. Previous and numerous family recruitment strategies needed major revisions since there were ongoing and numerous participant recruitment barriers in getting three generations together for a 2-4 hour data collection session. Alternative strategies for data collection such as computer online (e.g., Survey Money or SPSS mechanisms and cell phone data collection for sections of the protocol researched, established and approved in new IRB request. Creation of new data collection strategies and new participant protections of privacy, a new IRB application needed to be submitted. The previously approved IRB was not renewed since the recruitment strategy and data collection methodology was radically different.

Publications

Progress 10/01/14 to 09/30/15

Outputs
Target Audience:Outreach, project recruitment and nutrition education efforts were made at 6 Makahiki ceremonies and community events (Native Hawaiian celebration and thanks to Lono for providing food and productivity of the land, ocean, etc.). Other outreach events included attending locations where potential Native Hawaiian and Pacific Islander families would gather such as churches, Pacific Peace forum, Hui Lanakila Canoe Club day, Hula Halau events, etc. Recruitment of 2-3 generation families has been an ongoing challenge and made more complex due to competing responsibilities of the PI, such as department program review and sabbaticallast year. Only3twogeneration families, plus several individuals were recruited for total ofnine respondents. A project announcement requesting interest by 2-3 generation Hawaiian and Pacific Islander families was put into the Office of Hawaiian Affairs ad section. A regular section of this newspaper was announcements of Hawaiian family gatherings; however, we were not allowed to put this announcement in that section. Another announcement of this project was highlighted in the regular nutrition column Star-Advertiser. These recruitment strategies were not effective in the context of the time commitment. Ongoing nutrition and school garden outreach continued with the Hawaii School Garden Network over the year to increase collaboration and communication of opportunities regarding nutrition, food, and families. This project and staff served as resources for this network. In 2012 survey, the Hawaii School Garden Networkincluded 60+ schools across Hawaii and involves over 21,577+ students with 830 teachers. In 2015, The Hawaii School Garden Network secured funding for farm-to-school coordinator to assist with this effort. Changes/Problems:A major and ongoing challenge is recruitment of 2-3 generation Native Hawaiian and Pacific Islander families in this context of extremely highcost of living in Hawaii. Many peoplehave 1-2 jobs to make ends meet for basic necessities such as rent, foodor clothing fortheir families.The process ofhaving a family discussion with 2-3 generations in the same room for a 2-4 hour family discussion session is extremely problematicif they need to take time away from work. This may translate into shorter work hours and pay for this person. The financial incentives need to be sufficiently high to offset not working during these hours. This is a significant financial barrier for 2-3 generation family participation, and especially for those with low incomes or those challenged with two minimum wage jobs per generation. Alternate 2-3 generation Native Hawaiian and Pacific Islander family data collection and recruitment strategies will be explored in the next period. What opportunities for training and professional development has the project provided?A Native Hawaiian MS graduate student has been supported from the Human Nutrition and Animal Sciences Program in the college. He participated in all aspects of the family project from literature review on Native Hawaiian and Pacific Islander health and examination of health disparities for minority populations, to recruitment, community nutrition talks, and nutritional assessment strategies to family discussion sessions. He also participated in the all phases of the data collection, database creation to preliminary analyses of pilot data. He has graduated with his MS degree. How have the results been disseminated to communities of interest?The results of this project have not yet been disseminated, but general health and nutrition presentations have been made to over 10community organizations. What do you plan to do during the next reporting period to accomplish the goals?The next year will be spent developing new recruitment strategies and explore other multimedia and more time efficient strategies for nutrition data collection.

Impacts
What was accomplished under these goals? Objective 1: To review, document and collaborate across university and community resources in Health and Wellness: a. Identify and establish key collaborations with university and community individuals/organizations As part of the effort to identify key traditional and non-traditional organizations within the university and community, churches, Native Hawaiian, and college partners were identified. Objective 2: Improve the integration of the land grant mission throughout FCS research, instruction and extension and produce a greater number of integrated, collaborative and multidisciplinary Health and Wellness projects: a. Increase Faculty/Student/Community Instruction-course based and service-learning opportunities, internship, and extracurricular events and long term engagements Linkages and resources exchanges were made between community organizations such as the School Garden Network, faculty members at UHM such as the Master Gardener program and faculty members working on Family Education, agricultural stem and farming for families' projects. The impact was stronger ties with school garden network, CTAHR Master Gardener and CTAHR faculty members in STEM and food sustainability efforts with youth. b.Increase Research and evaluation components in Extension projects Facilitation of school garden and development of Jr. Master Gardener and collaboration with Texas Grow Eat Go and other programs c. Increase the translation of science based health and wellness research findings for Pacific Islander families and communities into extension programming locally and nationally During the nutritional analysis of favorite family recipes, simple recipe modifications strategies can be shared with the larger Native Hawaiian and Pacific Islander community and general public through newspaper nutrition columns, health newsletters, etc. Pilot Project Goals: Intergenerational Transmission of Health Beliefs and Lifestyle Practices among Native Hawaiian and Pacific Islander Families The following pilot project will develop and pilot research tools, and examine the most effective recruitment strategies for Pacific Islander families, adapt existing and proposed more culturally responsive health and wellness methodology, survey, questionnaire and assessment tools for Pacific Islander families. Objective 1: Develop and test research protocol questionnaire and survey, with methods to examine Health Beliefs and Lifestyle Practices for Two or Three generations of female and male related adults: GrandFathers, Fathers, GrandSons, Grandmothers, Mothers and GrandDaughters a. Modify, adapt and test health and wellness instruments for young adults, middle age and elderly family members b. Modify, adapt, and test health and wellness instruments for gender validity Health and wellness instruments and tools appear to work well across males and females. However nutrition tools may need to be modified for people in their 80s and those with low literacy. The length of time spent on these nutrition assessment sections of the research protocol were lengthy and added significant time during the family session. Modifications to the protocol in securing nutrition information from elders or low literate people should be modified. Objective 2: Test the efficacy of several recruitment and sampling strategies for two or three generational family research participation through a variety of Pacific Islander family recruitment methods The recruitment strategies of contact with churches or at public events such as Makahikiwere not effective, and recruitment staff needed to be on staff. The limited budget of this project did not allow for hiring of these recruitment staff personnel. Objective 3: Development of an efficient food/meal sampling from two-three generation families (which meals or days/1 day versus week type of food/recipe sample collection strategy The food and meal sampling nutrition assessment was complex for most respondents. It required nutrition staff guided demonstrations (food sample and sizes/volume) to solicit reliable nutrition information from therespondents. This taskwas most difficult for elderly respondents. The complexity ofnutrition assessments added significant time to thefamily sessions (2-4 hours). This extensive time for the 2-3 generation family session proved to be a significant barrier during the family recruitment phase of the project.

Publications

Progress 10/01/13 to 09/30/14

Outputs
Target Audience: A wide variety of individuals, programs, organizations, and agencies were identified and contacted for development of family recruitment strategies during this project. In order to identify two to three generation Native Hawaiian and Pacific Islander families, culture and social clubs or specialized organizations and agencies, such as student campus or senior citizen clubs were identified and contact information collected. Relevant contacts and discussions were made with department, college, State and national organizations who either conducted nutrition research or nutrition extension activities, and other non-nutrition community partners such as 4-H youth faculty and 4-H, FCE, and FCLE organizations to collaborate on this and future research and extension projects. Other organizations such as Office of Hawaiian Affairs, Hawaiian Homestead community groups, low income housing complexes, communities, and homeless agencies were contacted about the study. Presentations were made by the PI and research assistants to educate communities about the study and disseminate information about its goals. Research Team members included a small number of research assistants' original student team members graduated or left Hawaii for employment abroad: 1 MS nutrition graduate Native Hawaiian student, and two undergraduate research assistants (1 Native Hawaiian nutrition BS student and Hawaiian language and pre-med major). Past team members in this research and extension project were: PI, 2 Co-PIs Extension faculty in nutrition and 4-H youth development, 1 Hawaiian-Samoan-Filipino undergraduate RA, 1 Hawaiian graduate student in nutrition. 1 Sociology RA and Post-Doctoral Malaysian South Indian Research Associate. During the recruitment presentations, health, nutrition and wellness community and campus collaborators have been identified. The composition of the research team changed about every two years since the majority of team members were students and had educational and extension components, in addition to the research mission, training for subject protection and interview and recruitment training conducted over the entire project. As a result of changes in the conduct of human subjects and IRB policies in research staff training at the University of Hawaii at Manoa, the research staff underwent and passed newly required Human Subjects courses or refresher courses. The research team was composed of nutrition and Pacific Islander research assistants, research associates, graduate students, and research collaborators. There were gaps in the training and development of recruitment and research tools since Pacific Islander undergraduate research assistants were in or out of school or transferred to another university due to personal reasons. MS research assistant and two undergraduates (nutrition and pre-med) helped to disseminate information about the study and assist with the family interviews. Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided? The opportunities for training and professional development have been numerous. For instance, a Native Hawaiian nutrition MS graduate student was hired as research assistant to this project. He will use a portion of the data collected for his MS thesis. He has received research training (e.g., health status, nutrition and wellness indicators for Pacific Islander populations, opportunity to use portion of this data for completion of this MS degree, and received ongoing research mentoring about nutrition among Pacific Islander populations, sampling, subject recruitment for hard to reach community Native Hawaiian and Pacific Islander participants). During the last period, two undergraduate students (one in nutrition and the other as pre-medicine and ethnic studies majors) were hired to provide community health education, assist project in dissemination of study announcements, and with the family session. How have the results been disseminated to communities of interest? The study has not yet completed the data collection phase and the results will be disseminated upon completion and analysis. Participants and families have expressed interest in learning the outcomes of the study and learn strategies for improvement of their own nutrition and health for improvement of family wellness. After completion of the study and analysis of results, the Native Hawaiian nutrition graduate student has committed to conducting some community nutrition education courses. Analysis of the nutrition activities developed by youth will be examined to further MyPlate nutrition education tools and exercises for a variety of audiences and communities. Examination of alternate versions of MyPlate activities will be systematically reviewed, such as use of cell phone photos of meals, before and after eating to determine food groups and portion consumed with development of technology to provide accurate estimations of food consumption. The empirical literature will be searched for validated techniques to secure reliable assessment of MyPlate food groups. What do you plan to do during the next reporting period to accomplish the goals? Enhancements of community partnerships have occurred over the last year through the school garden projects with 4-H, Master Gardeners and Jr. Master Gardeners planning, discussions, and partnership development, and the PI has begun discussions with the Hawaii School Garden Network collaborations. In 2012, the Hawaii Farm to School and School Garden Hui conducted a Department of Education survey in Hawaii schools. In 2013, there were 168 school gardens, with 21,577 students and 830 teachers gardening on 30 acres of land. This large nutrition, school garden, and wellness network can be accessed for data collection and nutrition dissemination. The long term goal would be to provide instructional, research, and extension-outreach opportunities to enhance the health and wellness of underserved and Native Hawaiian or Pacific Islander families across Hawaii.

Impacts
What was accomplished under these goals? Ongoing literature searches were conducted for possible health beliefs and lifestyle nutrition tools for cultural appropriateness, wide age ranges, and variability of health literacy by generations (i.e., young, middle aged, elderly) of Native Hawaiian and other Pacific Islander families was conducted. The research team created versions of a MyPlate nutrition tool for health literacy among Pacific Island families. An approved IRB (CHS#19327, 2010-2013) with three approved modifications included males, and expanded family composition to 2 or 3 generations (approved March, 2013). The IRB renewal (CHS# 19327, June 2013-2014) approved a protocol modification to address pilot participant difficulty with the nutrition homework (i.e., food and diet recall and recipe portion and volume measurement) and individual interview protocol, and length of session. As a result of a pilot with a three generation family, the research team streamlined and simplified protocols, shifted self-administered sections as homework and moved more difficult tasks for face to face time with research team members. The resulting protocol streamlined formatting in chart format, accommodated wide literacy levels in the family, and addressed fatigue levels of the oldest family members (June 2013-2014). Prior to the Talk Story Day, after agreeing to participate, a Homework Packet was provided and included: sample consent form; HealthStyle questionnaire (1981, PHS, US DHHS) in six lifestyle domains (i.e., 2 smoking, 3 alcohol and drugs, 1 medication safety, 4 nutrition/ food, 1 weight, 3 exercise, 1 job, 2 stress items, 2 social network, 5 safety items); Nutrition Belief Survey, the family selects Favorite Family recipe, but individual members document how they prepared this family favorite recipe. The Ohana (Family) Health Talk Story Wellness Day included: 1) review and signing of participant consent; 2) individual interviews (i.e., demographic information, fat scale measurement; collection of Homework; 1 typical day food choices and estimation of food portion/volume; review of Nutrition Beliefs Survey and Family Recipe Homework; MyPlate estimation of portion sizes by food groups in Ideal Healthy MyPlate and Actual MyPlate of their Main Meal; and discussed the individual's Top Three Lifestyle Practices (food and nutrition, physical activities and fitness; coping with stress, mind and brain health, and family and friendship practices); and 3) During the Ohana Talk Story Session, the family members gathered together to discuss and come to family consensus regarding: 1) top Family Health and Wellness Strategies and top three unhealthy lifestyle habits to avoid; 2) Family decision on the top family lifestyle practices to promote good nutrition, physical fitness, effectively dealing with stress, to maintain mine/brain health, and maintain positive family and friendships. A participant debrief was held regarding their research experiences, the family was thanked for their participation, and provided gift cards for their assistance with this project. The latest IRB approval simply indicated an ongoing data collection with the previously approved sampling, recruitment, and protocol modification (CHS# 19327, June 2014-2015) that was responsive to numerous piloting of participant recruitment strategies, family sampling and design, and protocol modifications. As a result of changes in the family recruitment and sampling frame, and changes in the format of data collection by simplification of original measures/instruments, all protocols and modifications in the research protocol were approved by the subject protection process and regulations under IRBs at the University of Hawaii at Mano?. The research team changed from the previous year since the post-doc found a job in Malaysia, and undergraduate team members left. Two new undergraduate students (1 MS undergraduate in nutrition and 1 undergraudate pre-med and Hawaiian ethnic studies student were hired, successfully passed IRB training, and assisted with community recruitment efforts. The protocol was piloted and significantly revised the nutrition, family health and wellness assessment activities and tools, expanded our family recruitment to include males and females who are part of a two or three generational Native Hawaiian or Pacific Islander family. During this last year, the final nutrition and health beliefs protocol was used in data collection. Recruitment contacts were made with senior citizen centers, Native Hawaiian/Pacific Islander organizations, low income housing, and community health centers on Oahu, and student organizations were found as potential sources of recruitment for multiple generation family participants. Data collection on multiple generation families started in the Spring 2014 after the PI recruited other nutrition team member since a previous undergraduate and Post-Doc team members left Honolulu. The fixed age ranges were considered too restrictive, excluded too many families, and may have hindered participant recruitment because families varied widely in actual spacing between generations in Pacific Islander families (e.g., young 18-34 years of age, middle 35-54, and elderly 55+). Generational age ranges of participants could vary by + or - 5 years to reflect generational spaces within Native Hawaiian and Pacific Islander families. Other important changes were made to the survey protocol and instruments to accommodate the health literacy, education, and age constraints regarding difficulty of tasks as homework or self-administered versus face to face with interviewers assistance for completion of nutrition assessment tasks. In the last year, 11 families were recruited and interviewed, for a total of 23 participants. The mean age of the current sample was 41 years of age, with an age range of 15 to 81 years of age. There were 8 males and 15 females participants in the sample. Current family types recruited by generation and gender compositions were: 1 three generational family of Grandfather, Mother, and Daughter; 4 Mother-Daughter; 3 Mother-Son; 2 Father-Daughter; and 1 Father-Son family. Recruitment outreach efforts have taken place at Hawaiian Homeland communities, church groups, social media and college campus flyer recruitment efforts, community health centers, community centers, recreation canoe club, cultural festival, senior citizen center meetings, and community events targeted to Pacific Islanders. Recruitment of 3 generation families have proved difficult with the conflicting schedule required for the joint family discussion session and poor recruitment yields at each recruitment site or effort. There have been 1-2 families recruited for each recruitment efforts. Future Pacific Islander families recruitment efforts will expand the scope of possible participant recruitment to test more effective strategies, especially for 3 generation families. Part of this recruitment difficulty is that neither the PI and research assistant has long term relationships with the Pacific Islander communities in Honolulu, an ongoing concern for any human research project with underserved or hard to reach minority populations. Preliminary data entry protocol has been drafted. The PI is currently learning 3 qualitative software programs to analyze text of the open ended responses for trends and patterns. The Native Hawaiian research assistant will be using the data for this project as part of his Master's thesis.

Publications