Abstract
Experiences of racism and discrimination are stressors that adversely affect the well-being of marginalized populations, including Native Hawaiians and Pacific Islanders (NHPI). However, commonly used data aggregation methods obscure information on NHPI communities and their lived experiences. The aim of our study is to understand the types and frequency of discrimination experienced by NHPI adults in the USA. The study utilized online survey data collected from 252 NHPI adults living in the USA between September and October 2021. Younger NHPI adults, those who report constantly thinking about their race/ethnicity, and those who are socially assigned a race/ethnicity that does not match their own report experiencing more types of discrimination. NHPI who constantly think about their race/ethnicity and those who are socially assigned a race/ethnicity that does not match their own report a greater frequency of discrimination. Findings indicate the need to understand the experiences of discrimination in this population.
Keywords: Native Hawaiians and Pacific Islanders, Socially assigned race/ethnicity, Self-identified race/ethnicity, Racial discrimination, Racial and ethnic minorities
Introduction
Experiences of racism and discrimination are stressors that adversely affect the health and well-being of marginalized populations [1–3]. Prior studies have documented racism and discrimination as social determinants of health and have outlined how experiences of racism negatively affect both the physical and mental health of marginalized communities [4–8]. These negative health effects are perpetuated by systemic/structural racism (e.g., residential segregation) and manifested by differential access to services and resources (e.g., employment, housing, education), health-harming exposure/experiences (e.g., violence), and biological (e.g., epigenetic effects) and psychological mechanisms [9, 10]. Moreover, racism on an interpersonal level takes on both subtle (e.g., microaggressions) and blatant forms (e.g., unfair hiring practices) that are equally detrimental to a person’s health, especially from marginalized groups [2, 11, 12]. Therefore, documenting the experiences of racial discrimination among marginalized populations is a critical first step towards understanding the deleterious effects discrimination may be having on the health of marginalized populations.
In addition to self-reported experiences of racism and discrimination, socially assigned race may enhance our understanding of individual experiences of discrimination and racism. Socially assigned race is the perception of an individual’s race by others and includes multiple dimensions of race—the social construction of race, physical appearance, societal interactions, institutional dynamics, stereotypes, and social norms [13]. Given that racism affects health as “a system of structuring opportunity and assigning value based on the social interpretation of how one looks” [14], socially assigned race may be an important construct for assessing the “ad hoc racial classification upon which racism operates” [15]. Moreover, self-identified race serves as a poor proxy for racial appearance among many groups [16], which can vary by social context. Racial misclassification by observers (i.e., incongruence between socially assigned race and self-identified race) has been found to be highest among indigenous populations such as American Indians [17]. Racial misclassification has also been found to be associated with negative health outcomes, with some scholars noting that this may be a proxy for status loss related to certain types of misclassification [18].
Among the racial and ethnic groups who have been marginalized in the USA are Native Hawaiians and Pacific Islanders (NHPI) who make up 0.4% of the US population. Because of the relatively small population size, data related to NHPI are often aggregated with other racial and ethnic groups, such as Asian populations, in health-related research, which is one reason there is a lack of data on the lived experiences of NHPI living in the USA. These arbitrary data aggregation methods obscure NHPI health information and perpetuate a lack of understanding regarding how NHPI communities may be affected by any number of health issues [19]. Although data aggregation as an approach is a way to increase sample size and statistical power when analyzing data from smaller population groups, it does not provide analytical power for population-specific assessment of NHPI [20] and can limit the understanding of disparities among NHPI.
Disaggregated data is critical to addressing racial disparities, including experiences of racism and discrimination and health-related disparities, among the NHPI population in the USA [21]. To mitigate structural racism among the NHPI population, Morey et al. pressed for researchers to provide disaggregated health and demographic data [22]. NHPI leadership and researchers have echoed the need to shift to disaggregated data to provide a transparent appraisal of NHPI health and social issues [23]. In addition to the need for disaggregated data, anti-racist praxis in public health has called for a more within-group analysis of minoritized populations, as it is critical to revealing the diversity of perceptions and experiences rather than reproducing stereotypes of groups as homogenous or singular [24].
Racism and discrimination are major public health issues affecting NHPI [6, 25]. Although the connection between discrimination/racism and health has been documented in the literature, experiences of discrimination and racism remain understudied in the NHPI population. Within this limited body of research, scientists have found that perceived racism is associated with depression and psychological distress [7], hypertension status [6], and physiological dysregulation among Native Hawaiians [25, 26]. Rumination about race and racism-related vigilance has been linked to poor mental and physical health outcomes in other minoritized populations (e.g., African Americans), including an increase in depressive symptoms, accelerated aging, and premature stress-related illness [27–29]. However, research on experiences of racism and discrimination among NHPI has primarily been limited to Native Hawaiians living in Hawai ‘i [5–8], and these studies among Native Hawaiians did not examine the types of discrimination experienced. Given that the experience and nature of racism can vary by social context, it is important to examine the effects of racism among NHPI more broadly.
To examine the experience of racism among NHPI individuals from across the USA, the aim of our study was to better understand the types and frequency of discrimination experienced by NHPI adults in the USA. This understudied health determinant warrants further scrutiny to understand the racialized lived experiences and racial health inequities among NHPI [13]. Understanding experiences of racial discrimination among NHPI adults is an essential element in addressing health disparities in this population.
Methods
Procedures
Respondents were recruited between September 7, 2021 and October 3, 2021, from an online opt-in panel of individuals across the USA and US territories, housed and managed by Atomik Research. The survey was available to respondents in English and Spanish. Inclusion criteria included being age 18 or older and living in the USA. Respondents indicated consent by agreeing to participate in the survey. An institutional review board for the protection of human subjects at the University of Arkansas for Medical Sciences (IRB #263020) approved the study procedures.
We oversampled Asian American, Black/African American, Hispanic/Latino, American Indian or Alaska Native, and NHPI individuals. This oversampling was done to avoid aggregation of racial and ethnic groups, which often obscures diverse groups, experiences, and attitudes, and to allow for large enough sample sizes to analyze within-group differences [30, 31].
Analytic Sample
The analytic sample was limited to respondents who self-identified as NHPI, including those who identified as Pacific Islander, Native Hawaiian, Guamanian or Chamorro, Samoan, or Marshallese. Due to the small number of responses in some of the categories, responses were aggregated into the NHPI category as defined by the US Census (people having origins in any of the original peoples of Hawai ‘i, Guam, Samoa, or other Pacific Islands) [32]. Of the 2022 adult respondents, 252 (12.5%) respondents self-identified as NHPI and are included in the analytic sample. There were no missing responses on variables of interest among NHPI respondents.
Measures
Racial Discrimination
Racial discrimination was measured using Krieger’s validated 9-item measure [33], which assesses whether someone has ever experienced racial discrimination across nine different situations: at school, getting hired or getting a job, at work, getting housing, getting medical care, getting service in a store or restaurant, getting credit/bank loans/a mortgage, on the street or in a public setting, and from the police or in the courts. We calculated racial discrimination in two ways: a count of the situations where discrimination was experienced and the frequency of discrimination experienced. To determine the count of the situations where discrimination was experienced, each of the nine items was dichotomized (1 = experienced), and the nine items were summed to form a count of experiences (possible range = 0–9). To calculate the frequency of discrimination experienced, respondents indicated whether they had experienced discrimination because of their race, ethnicity, or color in each of the situations in the measure, with response options of “never (= 0),” “once (= 1),” “two or three times (= 2.5),” or “four or more times (= 5).” The nine items were summed to create a scale (possible range = 0–45; α = 0.94).
Thinking About Race/Ethnicity
Respondents were asked how often they thought about their race, with categorical responses of “once a year or less,” “once a month,” “once a week,” “once a day,” and “constantly.”
Socially Assigned Race/Ethnicity
The socially assigned race/ethnicity variable was based on the question, How do other people usually classify you in this country? Would you say White, Black or African American, Hispanic or Latino, Asian, Native Hawaiian or Other Pacific Islander, American Indian or Alaska Native, or Some Other Group? [15]. As ten or fewer respondents reported being socially assigned to several racial/ethnic categories (White, Black/African American, American Indian/Alaska Native, or Asian), responses were dichotomized, with response categories of socially assigned as NHPI (= 1) or socially assigned as another race/ethnicity (= 0).
Sociodemographic Characteristics
Sociodemographic information was collected and included age, gender, and education. Age (18–34, 35–44, and 45 +) and gender (man, woman, non-binary, or self-described) were categorical variables; however, none of the NHPI respondents selected a non-binary gender or self-described. Therefore, the analytic sample included only self-identified men and women. Education was measured by asking respondents their highest degree or level of school completed; respondents with less than high school and only some high school were combined with high school graduates, as were those with a bachelor’s degree or higher, due to the low frequency of responses for some education levels. Employment status was dichotomized to those working for wages (currently employed and self-employed) and those who were not (unemployed, homemakers, retirees, students, and those unable to work), due to the low frequency of responses for some employment categories.
Analysis
The random iterative method [34] was used to weigh the data to be representative of the US population across key demographic variables including gender (man, woman, non-binary), race/ethnicity, and age (18–24, 25–34, 35–44, 45–54, 55–64, 65 +). After six iterations, the weighted data converged. The efficiency score was acceptable at 74%.
Using the appropriate survey weights, descriptive statistics were used to characterize the sample, with means and standard deviations for continuous variables and frequency and percentages for categorical variables. Multivariate linear regression was used to determine the coefficients for the variables of interest. Analysis was completed using STATA 17.0, and a p value of 0.05 or less was considered statistically significant.
Results
Table 1 reports the descriptive statistics for the sample. The majority (64%) of the respondents were between the ages of 18 and 34, 17% were between the ages of 35 and 44, and 20% were over the age of 45. Fifty-five percent of the sample identified as men, and 44% reported having a high school education or less. Just over half (53%) reported not being employed for wages at the time of the survey. Just over a third of respondents (34%) reported thinking about their race/ethnicity constantly, 31% reported thinking about their race/ethnicity once a year or less, and 18% reported thinking of their race once a week. Seventy-seven percent of respondents reported their socially assigned race/ethnicity as NHPI—congruent with their self-identified race/ethnicity—and 23% reported their socially assigned race/ethnicity as something other than NHPI. Although not included in the table due to the small sample size, respondents were located in 37 US states, the District of Columbia, Guam, and the US Virgin Islands.
Table 1.
Weighted demographic characteristics of NHPI participants
| Mean (SD) or proportion (SE) | 95% CI | |
|---|---|---|
| Count of types of discrimination experienced | 3.4 ± 5.3 | (2.9, 3.9) |
| Frequency of discrimination experienced | 9.2 ± 19.0 | (7.5, 10.9) |
| Age | ||
| 18–34 | .64(.03) | (.57, .70) |
| 35–44 | .17(.02) | (.13, .21) |
| 45 + | .20(.03) | (.15, .26) |
| Gender | ||
| Men | .55(.04) | (.48, .52) |
| Women | .45(.04) | (.38, .52) |
| Education | ||
| HS or less | .44(.04) | (.37, .51) |
| Some college | .25(.03) | (.19, .32) |
| Associate degree | .08(.02) | (.05, .11) |
| Bachelor’s or graduate degree | .24(.03) | (.18, .30) |
| Employment status | ||
| Not employed for wages | .53(.04) | (.46, .60) |
| Employed for wages | .47(.04) | (.40, .54) |
| How often do you think about your race? | ||
| Once a year or less | .31(.03) | (.24, .38) |
| Once a month | .11(.02) | (.07, .16) |
| Once a week | .18(.03) | (.13, .24) |
| Once a day | .07(.02) | (.05, .11) |
| Constantly | .34(.03) | (.28, .49) |
| Socially assigned race/ethnicity | ||
| Anything other than Native Hawaiian or Pacific Islander | .23(.03) | (.17, .30) |
| Native Hawaiian or Pacific Islander | .77(.03) | (.70, .83) |
Table 2 describes the percentages of NHPI reporting each of the nine types of discrimination in the measure. For any given type of discrimination, one-third to one-half of respondents reported experiencing that type of discrimination during their lifetime. When focusing on those who did not experience specific types of discrimination, less than half of respondents (47.6%) reported never encountering discrimination on the street or in a public setting. A significant percentage of respondents reported never experiencing discrimination at school (53.0%), at work (56.1%), or when getting service in a store or restaurant (55.7%). Around two-thirds of respondents reported not experiencing discrimination when getting hired or getting a job (62.7%), from the police or in the courts (66.9%), when getting housing (72.0%) or medical care (72.3%), and when getting credit/bank loans/a mortgage (75.0%).
Table 2.
Percentage of NHPI reporting discrimination by situation
| At school | Getting hired or getting a job | At work | Getting housing | Getting medical care | Getting service in a store or restaurant | Getting credit/bank loans/a mortgage | On the street or in a public setting | From the police or in the courts | |
|---|---|---|---|---|---|---|---|---|---|
| Never | 53.0 | 62.7 | 56.1 | 72.0 | 72.3 | 55.7 | 75.0 | 47.6 | 66.9 |
| Once | 8.1 | 14.2 | 18.1 | 9.9 | 13.0 | 14.5 | 8.3 | 20.0 | 12.7 |
| 2 or 3 times | 24.0 | 12.4 | 13.9 | 8.7 | 7.3 | 16.4 | 8.6 | 17.0 | 10.0 |
| 4 + times | 14.9 | 10.6 | 12.0 | 9.4 | 7.4 | 13.4 | 8.0 | 15.4 | 10.4 |
Table 3 reports the results of the multivariate linear regression model of the count of discrimination experiences for NHPI. NHPI who are over age 45 report fewer situations where they have experienced discrimination (β = − 1.19, p = 0.020) compared to their younger peers. Furthermore, NHPI who report being socially assigned as NHPI report fewer situations where they have experienced discrimination (β = − 1.15, p = 0.048) compared to their peers who are socially assigned a race/ethnicity other than NHPI. NHPI who report thinking about their race constantly report more situations where they have experienced discrimination (β = 1.40, p = 0.016) compared to NHPI who never think about their race. There were no statistically significant differences by gender, education, or employment.
Table 3.
Association between self-reported count of types of racial discrimination experienced and sociodemographic characteristics, thoughts about race/ethnicity, and socially identified race
| Coefficient | SE | p value | 95% CI | |
|---|---|---|---|---|
| Age | ||||
| 35–44 | .53 | .54 | .320 | (− .52, 1.59) |
| 45 + | − 1.19 | .51 | .020 | (− 2.19, − .18) |
| Women | − .65 | .51 | .203 | (− 1.65, .35) |
| Education | ||||
| Some college | − .22 | .57 | .699 | (− 1.34, .90) |
| Associate degree | − .08 | .73 | .913 | (− 1.50, 1.35) |
| Bachelor’s or graduate degree | 1.08 | .60 | .073 | (− .10, 2.27) |
| Employed for wages | − .63 | .49 | .202 | (− 1.60, .34) |
| How often do you think about your race? | ||||
| Once a month | .67 | .70 | .340 | (− .71, 2.06) |
| Once a week | .68 | .72 | .351 | (− .74, 2.10) |
| Once a day | .94 | .72 | .188 | (− .46, 2.34) |
| Constantly | 1.40 | .58 | .016 | (.26, 2.54) |
| Socially assigned NHPI | − 1.15 | .58 | .048 | (− 2.29, − .01) |
| Constant | 4.08 | .80 | < .001 | (2.50, 5.65) |
Similar results are found regarding the frequency of discrimination (Table 4). Individuals who are socially assigned as NHPI report a lower frequency of discrimination (β = − 4.61, p = 0.047) compared to those who are socially assigned a race/ethnicity other than NHPI. Respondents who think about their race constantly report a higher frequency of discrimination (β = 5.32, p = 0.009) compared to NHPI respondents who never think about their race. There were no statistically significant differences by age, gender, education, or employment.
Table 4.
Association between self-reported frequency of racial discrimination and sociodemographic characteristics, thoughts about race/ethnicity, and socially identified race
| Coefficient | SE | p value | 95% CI | |
|---|---|---|---|---|
| Age | ||||
| 35–44 | .83 | 1.77 | .639 | (− 2.64, 4.30) |
| 45 + | − 2.99 | 1.82 | .101 | (− 6.56, .58) |
| Women | − 3.05 | 1.79 | .089 | (− 6.57, .46) |
| Education | ||||
| Some college | .63 | 2.17 | .770 | (− 3.62, 4.89) |
| Associate degree | .69 | 2.28 | .761 | (− 3.77, 5.15) |
| Bachelor’s or graduate degree | 2.33 | 2.03 | .252 | (− 1.65, 6.31) |
| Employed for wages | − 1.55 | 1.87 | .408 | (− 5.21, 2.12) |
| How often do you think about your race? | ||||
| Once a month | − .46 | 2.28 | .841 | (− 4.94, 4.02) |
| Once a week | 2.15 | 2.77 | .437 | (− 3.28, 7.59) |
| Once a day | 2.88 | 2.53 | .256 | (− 2.09, 7.85) |
| Constantly | 5.32 | 2.04 | .009 | (1.31, 9.34) |
| Socially assigned NHPI | − 4.61 | 2.32 | .047 | (− 9.15, − .06) |
| Constant | 12.22 | 2.89 | < .001 | (6.54, 17.89) |
Discussion
Racism and discrimination are major public health issues affecting NHPI [6–8]. The aim of our study was to understand the types and frequency of discrimination experienced by NHPI adults in the USA. Regarding the types of discrimination experienced, we found the majority of NHPI respondents report having experienced discrimination on the street or in a public setting, at school, or at work. Younger NHPI adults, those who report constantly thinking about their race, and those who are socially assigned a race/ethnicity that does not match their own reported experiencing more types of discrimination. Regarding the frequency of discrimination, we found those who report constantly thinking about their race and those who are socially assigned a race/ethnicity that does not match their own report a greater frequency of discrimination. These results indicate that the experience of racism for NHPI in the USA is pervasive and in need of being addressed.
Braveman and Parker offer an outline of the sequential steps of ways that experiences of racism act as deleterious health effects: systemic/structural racism, differential access to resources, health-harming exposure/experiences, and biological mechanisms [9]. Our results indicate at least a subset of NHPI adults experience systemic/structural racism and barriers to accessing needed services and resources. Further work is needed to understand how these experiences lead to both health-harming exposure/experiences and how these experiences “get under the skin” through biological pathways, such as increases in allostatic load [28]. Among Native Hawaiians, the frequency or intensity of perceived racism has been found to be associated with depressive symptoms [35], cortisol dysregulation [25], higher systolic blood pressure, an exaggerated cardiovascular response, and incomplete cardiovascular recovery [26]. Our findings here warrant similar investigations to ones completed on Native Hawaiians living in Hawai ‘i among other Pacific Islander subpopulations. Understanding these factors is key to understanding how experiences of discrimination and racism lead to poor health outcomes.
We find that older NHPI respondents reported fewer situations in which they experienced discrimination. Aside from the possibility that older NHPI operate in fewer settings or social contexts, this finding raises questions about the length of time people have lived in the USA. It may be that younger individuals are more aware of discrimination due to a greater familiarity with discriminatory practices within the USA, and therefore, older and younger NHPI read situations differently. Another possible explanation may be that many older Pacific Islanders are migrants from US-affiliated Pacific Islands who often rely on their children or younger adults in the household to interact on their behalf with healthcare, social, and other services due to their limited English proficiency. Thus, younger NHPI have more interaction with other people outside their racial/ethnic communities and are exposed to more situations in which discrimination can occur. Future research should explore these questions further and investigate the role of timing in the life course as well as time spent within the USA. Qualitative research may be particularly helpful in understanding any age grading in the understanding of social interactions as discriminatory or not.
Self-identified race/ethnicity is the most common measure used to understand the effects of identifying as belonging to a racial or ethnic group. However, socially assigned race—the perception of an individual’s race by others—may be another avenue for understanding the experience of racism [13]. In our analysis, being socially assigned as NHPI decreased the count and frequency of discrimination experienced by NHPI adults. Congruence between socially assigned and self-identified race appears to be protective for NHPI. This finding is similar to studies which found mismatches between socially assigned and self-identified racial or ethnic classifications were associated with increased experiences of discrimination among Latinx individuals [36]. Aside from the frustration caused when a person’s racial/ethnic identity is in question, this finding highlights the importance of ensuring services provided to the NHPI population are culturally informed by including NHPI stakeholders, as well as additional training and awareness of bias towards racial and ethnic minorities by people working within these systems. Given their authoritative roles and ability to connect people with resources, healthcare professionals and other service providers should closely familiarize themselves with the communities they serve and avoid assuming racial identities, which risks misidentifying individuals.
NHPI adults who report thinking constantly about their race reported a higher count of discrimination experiences and a greater frequency of these experiences. Ruminations about race and racism-related vigilance have been linked to poor mental and physical health outcomes in other minoritized populations (e.g., African Americans), including an increase in depressive symptoms, accelerated aging, and premature stress-related illness [27–29]. It is likely that the frequency of racist interactions leads many people to be hyper-vigilant about their racial or ethnic identity and how they may be treated because of that identity. Further work is needed to understand the relationship between rumination, racism-related vigilance, and health in the NHPI population to effectively address existing health disparities.
The study is not without limitations. The study used cross-sectional data, and therefore, we are unable to establish causal relationships. Despite their many advantages, online surveys often suffer from low participation among minoritized racial and ethnic groups. We anticipated this limitation and addressed it by oversampling NHPI adults to ensure their representation in the study. We rely on self-report for the measure of lifetime experiences of discrimination, which does leave open the potential for bias; however, we attempted to mitigate bias by using validated measures. Also, our measure of experiences of discrimination, despite being widely used, did not include some everyday experiences of discrimination that are often more prevalent among NHPI (e.g., discrimination related to language and/or accent) [37]. The small sample size did not allow us to disaggregate several variables including socially-defined race, education, and employment, which may obscure a difference in experiences of discrimination. For employment specifically, we were unable to definitively define the influence of the pandemic on those who reported not working for wages.
Finally, the NHPI rubric is made up of very diverse Pacific Islander subgroups who originate from different regions of the Pacific. Although the NHPI are categorized as a single racial/ethnic group by the US government and in this study, they do represent very diverse cultural and linguistic groups with different acculturation statuses and nationalities (e.g., COFA migrants versus US-born). Thus, the experience of racism in the USA could differ substantially by Pacific Islander subgroups.
Conclusion
The findings of this study are an important part of understanding the experiences of discrimination and racism among NHPI adults and are essential to addressing disparities in this population. This study is one of very few to look at lifetime discrimination in an NHPI sample. The results indicate the need for more research to understand the experiences of discrimination in this population and how discrimination and racism lead to health-harming exposure/experiences and “get under the skin” through biological pathways, which may lead to an increase in allostatic load or otherwise negatively affect NHPI health [6, 25, 28, 38, 39]. This finding highlights the importance of ensuring services provided to the NHPI population are culturally informed by including NHPI stakeholders, as well as additional training and awareness of bias towards racial and ethnic minorities by people working within these systems. Our findings also demonstrate a greater number of experiences of racial discrimination among those who are socially assigned a racial identity incongruent with their self-identified race. In combination with the body of research which demonstrates such incongruence is associated with worse health outcomes, future studies should explore how such divergences may influence NHPI health through the mechanisms of racial discrimination. Finally, there is a need for additional research to understand the relationship between rumination, racism-related vigilance, and health in the NHPI population to address existing health disparities.
Author Contribution
Jennifer A. Andersen: substantial contributions to the conception or design of the work, analysis, interpretation of data, drafting the work, and critically revising it for important intellectual content.
Don E. Willis: substantial contributions to the conception or design of the work, acquisition of and interpretation of data, and revising it critically for important intellectual content.
Joseph Keawe ‘aimoku Kaholokula: interpretation of data, drafting the work, and revising it critically for important intellectual content.
Brett Rowland: drafting the work and revising it critically for important intellectual content.
Sarah Council: drafting the work and revising it critically for important intellectual content.
Sheldon Riklon: revising the work critically for important intellectual content.
Pearl A. McElfish: substantial contributions to the conception or design of the work, acquisition of data, and revising it critically for important intellectual content.
Funding
The community engagement related to this research is supported by the University of Arkansas for Medical Sciences Translational Research Institute funding awarded through the National Center for Research Resources and National Center for Advancing Translational Sciences of the National Institutes of Health (NIH) (UL1 TR003107); Rapid Acceleration of Diagnostics (RADx) (NIH 3 R01MD013852-03S2); and the Community Engagement Alliance (CEAL) Against COVID-19 Disparities (NIH 10T2HL156812-01). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
Data Availability
The deidentified data underlying the results presented in this study may be made available upon reasonable request from the corresponding author, Dr. Pearl A. McElfish, at pamcelfish@uams.edu.
Declarations
Ethics Approval
An institutional review board for the protection of human subjects at the University of Arkansas for Medical Sciences (IRB #263020) approved the study procedures.
Consent to Participate
Respondents indicated consent by agreeing to participate in the survey.
Consent for Publication
Not applicable.
Competing Interests
The authors declare no competing interests.
Footnotes
The original version of this article was revised: In two places in this article as originally published (abstract and Discussion), it was erroneously stated that older NHPI experience more types of discrimination.
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Change history
3/6/2023
A Correction to this paper has been published: 10.1007/s40615-023-01547-z
Contributor Information
Jennifer A. Andersen, Email: jaandersen@uams.edu
Don E. Willis, Email: dewillis@uams.edu
Joseph Keawe‘aimoku Kaholokula, Email: kaholoku@hawaii.edu.
Brett Rowland, Email: mbrowland@uams.edu.
Sarah Council, Email: skcouncil@uams.edu.
Sheldon Riklon, Email: sriklon@uams.edu.
Pearl A. McElfish, Email: pamcelfish@uams.edu
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The deidentified data underlying the results presented in this study may be made available upon reasonable request from the corresponding author, Dr. Pearl A. McElfish, at pamcelfish@uams.edu.