Most Native Hawaiians, Pacific Islanders Missed Aid

Though Native Hawaiians and Pacific Islanders (NHPI) experienced negative mental health and economic impacts during the pandemic, for a range of reasons, available assistance programs and resources were underutilized, according to a new report spotlighting how COVID-19 affected NHPIs in California.

The report, which was based on a survey of more than 900 Native Hawaiians and Pacific Islander adults in California between January 2024 and May 2024, found that about 1 in 3 NHPI adults (33.9%) reported needing mental health care in the prior year for help with stress, depression or emotions. And 17% of NHPIs reported avoiding or delaying needed mental health care in the previous 12 months.

The most commonly cited reasons for delaying or not receiving care included cost/money/not having insurance, not knowing how to find a mental health provider, not wanting friends or family to find out, being unable to take time off from work and mental health care not being covered by their insurance plan. Only 26.8% of NHPI adults said they had at any point in their lives sought mental health care.

"Our report helps address a data gap that Native Hawaiian and Pacific Islander community leaders have expressed," said Brittany Morey, the report's lead author and associate professor of health, society and behavior at the Joe C. Wen School of Population & Public Health at UC Irvine. "We knew from stories that NHPI communities were deeply impacted, and continue to be impacted, by the pandemic. But now we have the data to show the extent of the impact and provide some insight into what we can do about it."

In the past, NHPIs have been erroneously lumped into the Asian American category (because no NHPI category was provided) in population survey data, Morey said, which has presented an inaccurate picture of their lives. For example, NHPI Californians have a significantly lower average per capita income ($31,721) compared to Asians in the state ($48,970).

Among the report's key mental health findings:

• 5% of NHPI adults reported moderate distress and 9.2% reported high levels of distress during the pandemic.
• The major sources of stress for NHPIs during the pandemic included health-related concerns (43.9%), financial concerns (38.8%), and the pandemic's impact on family members (37.6%), their work (32.4%) and their elders (31.1%).
• The most common coping strategies that NHPI adults used to manage stress included: communicating with friends and family (53.2%); meditation, mindfulness or prayer (43.5%); engaging in more family activities (34.8%); watching television or engaging in other screen activities (27.6%); or eating/snacking more often (23.2%).

The report, which was produced by researchers from the UCLA Center for Health Policy Research's Native Hawaiian and Pacific Islander Data Policy Lab, UC Irvine and UC Riverside, originated from concerns about COVID-19's effect on NHPI communities. NHPIs had higher COVID case and death rates than other racial and ethnic groups in 13 of the 19 states that reported this data.

Responding to this devastating impact, researchers and community members worked together to create the California Pacific Islander Well-being and COVID-19 Economic Survey (CAPIWAVES). In the report, which is based on CAPIWAVES data, participants were categorized into one of seven NHPI groups: CHamoru, Fijian, Marshallese, Native Hawaiian, Sāmoan, Tongan and other Pacific Islander (including, not otherwise specified).

Benefits of community-engaged research

The researchers said working with members of the different NHPI communities throughout the entire process was essential.

"CAPIWAVES would not have been possible without them," the researchers wrote. "We are truly grateful for the tireless efforts and guidance that community members have provided toward this survey."

The CAPIWAVES report is among the first population surveys of its size in California to shed light on the experiences of specific groups within the NHPI community. This breakdown allowed researchers to see how often members of different NHPI groups have ever sought mental health care. The data showed that 26.8% of NHPIs overall sought mental health care at some time in their lives. In a further breakdown, the report revealed that 40.7% of Native Hawaiians sought care, 37.2% of CHamorus, 20.5% of Sāmoans and 19.7% of Tongans.

"This report illustrates the powerful insights we gain from data disaggregation," said Ninez Ponce, director of the UCLA CHPR and principal investigator of the NHPI Data Policy Lab. "Without knowing how different populations are affected by social conditions and how much they use available resources, it's impossible to develop effective policies and programs."

The report also compiled a wide range of economic data on how the pandemic affected NHPI communities in California:

• More than 1 in 3 NHPI adults reported a decrease in household income since the COVID-19 pandemic, and broken down by smaller groups it was Fijian (46.3%), Marshallese (42.9%), Tongan (41.4%) and Native Hawaiian (35.6%) respondents.
• Nearly 1 in 7 (13.8%) NHPI respondents lost their regular jobs during the pandemic.
• More than 25% of NHPI adults had difficulty meeting basic financial needs during the COVID-19 pandemic, including paying bills, paying tuition, affording groceries, or paying their rent or mortgage.

Although NHPI adults in California experienced severe economic impacts due to the pandemic, fewer than expected NHPI adults were able to access financial assistance, even when they were eligible. The report showed that:

• 1 in 5 NHPI adults received government health benefits, including Medi-Cal (California's Medicaid program) or Medicare. Of those who were eligible based on reported household income, less than one-third (31.2%) received government health benefits.
• Among only those who were determined to be eligible based on reported household income, less than one-third (31.5%) received CalFresh (the federally funded Supplemental Nutrition Assistance Program).

"Throughout my life, I've seen how our NHPI communities are rarely considered when public health resources are allocated," said Calvin Chang, director of the NHPI Data Policy Lab. "This data helps our communities pursue our fair share of resources by giving weight to our stories and lived experiences."

Audrey Kawaiopua Alo, of the Southern California Pacific Islander Community Response Team, who collaborated with the researchers to encourage participation in the study, said the report will help planning going forward.

"The importance of CAPIWAVES is that the data was gathered from community, by community, for community. It brings to light where our struggles and challenges are and where we can put our efforts for policy and initiatives gleaned from our own data," she said.