NIMHD’s Conversations with Principal Investigators at Research Centers in Minority Institutions

As we celebrate Asian American and Pacific Islander (AAPI) Heritage Month this year, we are recognizing community-engaged researchers at institutions that are historically committed to training populations underrepresented in science.

The Research Centers in Minority Institutions (RCMI) program promotes minority health and health disparities research while increasing diversity among scientists and supporting diversity in clinical studies. Its three-tiered research structure offers opportunities for basic, clinical, and/or behavioral research to generate discoveries in minority health and health disparities.

Meet Noreen Mokuau, DSW, multiple principal investigator (along with Dr. Jerris Hedges, dean and professor of the John A. Burns School of Medicine) for the RCMI U54 Center at the University of Hawaiʻi at Mānoa. The Center holds a Hawaiian name, Ola HAWAII, with “ola” meaning “health” and “to heal” in the Hawaiian language, and “HAWAII”, in this case an acronym standing for “Health And Wellness Achieved by Impacting Inequalities.” Prior to this, she served as multiple principal investigator (MPI) for the RCMI U54 Center (2014-2019) titled RMATRIX, the RCMI Multidisciplinary And Translational Research Infrastructure eXpansion. She is a newly retired dean and professor emerita of the Thompson School of Social Work & Public Health at the University of Hawaiʻi at Mānoa.

As a prominent researcher in the field of social work and noted as the first Native Hawaiian woman with a doctorate in social work from the University of Hawaiʻi at Mānoa, she is committed to education and research founded in the unique attributes of Hawaii and the Pacific-Asia region. Like many other Native Hawaiians, Dr. Mokuau is of multiracial background with genealogy traced to Native Hawaiian, Japanese, Chinese, and German lineage. She believes that she has an inherited responsibility to improve the circumstances of Native Hawaiians and all people of Hawaii through higher education and health disparities research. Native Hawaiians’ experience of disproportionate social and health disparities in their own island homeland is slowly being offset by changes reflecting population resiliency. Health disparities research that lead to health promotion and intervention are integral to these changes.

The substance of her work emphasizes social justice, health equity, and cultural competence, with special attention to Native Hawaiians, the indigenous people of Hawaii, Pacific Islanders, and Asian populations. She has edited books on Asians and Pacific Islanders, authored numerous articles, presented extensively at international, national and regional conferences, and served on national leadership committees on minority affairs in preeminent social work organizations. As the inaugural co-chair of the Barbara Cox Anthony Endowment in Aging and co-principal investigator of Hā Kūpuna – National Resource Center for Native Hawaiian Elders, much of her research has emphasized Native Hawaiian elders. A current book project uses storytelling as a qualitative method with Native Hawaiian elders to identify ancestral practices for health and social justice.

Her commitment to social change is shared and demonstrated in Ola HAWAII’s use of community-based participatory research (CBPR), which is grounded in indigenous research. With its emphasis on relational epistemology, indigenous research captures the cultural values of the community. For Native Hawaiian communities, the relational aspect is reflected in the intricate linkages of people, the environment and spirituality. They take seriously the charge to engage in research that benefits underrepresented and disenfranchised populations, and to do so, they recognize the urgency of the Ola HAWAII team to work together. They are a diverse team committed to a common purpose. The Hawaiian word kākou means “we” and is intended to reflect the synergistic relationship of people working toward a common cause.

Q&A with Dr. Noreen Mokuau

What is the center’s research goal, purpose and aim?

While Hawaii enjoys the status of being one of the “healthiest states” in the nation, there are many who struggle disproportionately from negative genetic, environmental, and social-behavioral determinants of health. The goal of Ola HAWAII is to grow and support health disparities investigators and collaborators to harness the power of diverse thought to determine the causes and interventions for health disparities in Hawaii and the Pacific.

With its piko (center) based at the John A. Burns School of Medicine, the breadth of research encompasses the College of Health Sciences and Social Welfare, which includes the Thompson School of Social Work & Public Health, the Center on Aging, and the School of Nursing and Dental Hygiene. Other partners include the University of Hawaii (UH) Cancer Center, the UH Hilo College of Pharmacy, and the Pacific Biosciences Research Center. These professional units have strong records of commitment to educating and serving underrepresented populations with health disparities, including Native Hawaiians, Filipinos, and other Pacific Islanders.

The Center goal is achieved through three strategic aims, to:

1. Foster and facilitate the conduct of high impact team-science research addressing health disparities.
2. Strengthen and diversify the basic, biomedical, clinical, and behavioral research focusing on health disparities.
3. Enhance, consolidate, and sustain core facilities and resources for health disparities research.

How is the center advancing the science and populations experiencing health disparities? Are you seeing specific changes in particular communities or groups?

Through this U54 RCMI award from the NIMHD, Ola HAWAII advances health disparity research through the careful stewardship and leveraging of resources that facilitate the transdisciplinary engagement of university investigators and community partners. The leveraging of resources is based on inter-institutional, university-wide, and community-based partnerships. To achieve this, a dedicated and expert team of Ola HAWAII leaders work collaboratively in four infrastructure cores: Administrative, Research, Investigator Development, and Community Engagement.

The focus is on priority populations with significant health disparities such as Native Hawaiians, Filipinos, and other Pacific Islanders. All cores, but in particular, the Community Engagement Core (CEC) emphasize the university-community exchange that nurtures trust-based collaboration in which the community fully participates. These community-based efforts build research capacity and generate benefit from resource sharing and are informed through research dissemination. CEC leadership and the nine-member advisory board have lifelong commitments to our underserved communities, evidenced in a strong network of active partnerships with community nonprofits, government agencies, hospitals, community-based health centers, and statewide associations.

This foundation has led to gratifying success with the number and quality of proposals and funded projects. Funded projects address the complex health problems experienced by these priority populations and include testing tenofovir disoproxil fumarate for prevention of HIV infection in Native Hawaiians and other Pacific Islanders (basic research), using epigenomic information in predicting clinically diagnosed diabetes mellitus in Native Hawaiians and Pacific Islanders (basic/clinical research), evaluating the effect of interpregnancy interval length on perinatal health outcomes in Native Hawaiian and Filipino populations (clinical research), and developing a resiliency instrument through land connectedness among Native Hawaiians (behavioral research).

In addition, we note a continued and expanding interest of locally developed talent, particularly new and early stage investigators from several underrepresented groups including those of Native Hawaiian and Filipino descent.

In the research you are doing, what has surprised you about the discoveries from your center and its impact? Please provide a couple of examples.

Our campus holds a strong record of research commitment to minority communities with over 35 years of NIH funding support for RCMI capacity building programs such as the G12 RCMI Bridges, P20 RCMI Clinical Research Infrastructure Initiative, and U54 RCMI Infrastructure for Clinical and Translational Research. As a Native Hawaiian social worker committed to CBPR, it has been rewarding to be involved with an increasing investment in CBPR with special attention to social and behavioral determinants of health. This investment is reflected in the surprising ease of transition to team science in which basic, clinical, and behavioral researchers from multiple disciplines work together with an appreciation of CBPR and a clear and intended focus on priority communities.

Team science has created opportunities for research which examines the building and testing of community-based interventions for health. One Ola HAWAII example focused on the testing of a culturally tailored aquaponics intervention to promote healthy eating among Native Hawaiian families. Led by public health and social work investigators with deep ties to the community, the pilot project emphasizes families creating their own backyard aquaponics system to grow healthy food options. Post pilot funding from the Robert Wood Johnson Foundation is helping expand the work.

A second Ola HAWAII example pertains to the recent funding of a Rapid Acceleration of Diagnostics Underserved Populations (RADx-UP) project on community-driven research to mitigate COVID-19 among Hawaii’s more vulnerable populations. The project increases testing access and will create novel messaging and education for priority populations. Led by an interdisciplinary team from medicine, economics, and education, this project is culturally tailored and fully integrated into the community.

What inspired you to become a researcher in minority health and health disparities?

My inspiration to conduct research in minority health and health disparities is anchored in my family history, cultural lineage and commitment to the broader community. My family history shows high risk and disproportionate burden from certain health problems. In particular, while undergoing a BReast CAncer gene (BRCA) assessment, I discovered that over 15 family members had breast or ovarian cancer. My mother survived breast cancer but died from ovarian cancer, and I am a breast cancer survivor. As needed, my family learned to live beyond the diagnosis, summon actions of compassionate caregiving, and grieve when we could do no more. In building family capacity to deal with cancer, we relied on the mixture of Hawaiian and Christian spirituality, coordinated family caregiving, and access to quality health care.

The circumstances in my family are similar to other Native Hawaiian families. Specifically, Native Hawaiians have consistently had the highest incidence and mortality rates for breast cancer in Hawaii. My family’s health influenced my professional commitment to minority health, and in particular, the health of Native Hawaiians. My family experiences became the starting point for a research project on a culturally tailored intervention to build family capacity for Native Hawaiian women with breast cancer. Feasibility testing of the intervention showed that building family capacity in the context of cultural values and practices strengthened relationships with the health care system, enhanced family support, and reinforced women’s efforts to stay healthy.

How do we encourage the next generation of scientists?

We encourage and prepare the next generation of scientists with exemplary education. Such education provides cutting edge knowledge, skill-based learning, opportunities and resources for application. In Ola HAWAII we believe that a key tenet in encouraging the next generation of scientists, particularly minority investigators, is to demonstrate an inclusiveness for diverse ways of knowing, including indigenous knowledge.

There is a Native Hawaiian proverb that captures this perspective: `A`ohe pau ka `ike i ka hālau ho`okāki (“One can learn from many sources.”) In modeling this tenet, we strive to honor the integration of Western science with indigenous and other cultural ways of knowing. One of the best ways to ensure culturally inclusive learning is through university-community partnerships. With these partnerships, minority investigators will see that their research may have meaningful impact for their families and communities of origin.

Building the next generation of scientists requires career development activities and strong mentorship by experienced and dedicated mentors. At Ola HAWAII we have worked with affiliates including the RCMI Coordinating Center, the National Research Mentoring Network, and the Mountain West Clinical Translational Research Infrastructure Network to strengthen and diversify the pool of emerging scientists.

A signature event for Ola HAWAII is a university-wide team science mentoring bootcamp taught by senior investigators with active research funding using a problem-based approach over twelve sessions. Topics include grant applications, publications, ethical issues in biomedical research, human subjects, data acquisition, community engagement, and cultural approaches to intervention research.

What do you envision as the future of minority health and health disparities research?

In an increasingly culturally diverse world and nation, the responsible imperative is to advance minority health and health disparities research. In the past year, the COVID pandemic has had a devastating impact on all families and communities, but it has punctuated the burden of inequities experienced by minority communities in terms of infection and death rates. Problems are further layered by political, economic, and social inequities. As a nation, advancing human rights and promoting social justice and health equity are central to a future agenda on minority health and health disparities research.

The NIMHD holds a central role and considerable responsibility in the vision of “an America in which all populations will have an equal opportunity to live long, healthy, and productive lives.” In line with that responsibility, the NIMHD is essential to the NIH UNITE Initiative which bolsters efforts “for diversity within the scientific workforce and racial equity on the NIH campus and within the extramural community.”

At Ola HAWAII, our efforts to improve the health of our priority populations and other disenfranchised groups encompass basic, clinical and behavioral research, with focused attention on university-community collaborations that elevate research meaningful to minority communities. In complex and numerous ways, this research contributes to policies and practices which affirm a vision of equal opportunity for all people and advances a health care system that provides access, affordability, and acceptable care. We believe that when we engage in research that helps to improve the health of minority populations, we contribute to the transformation and uplifting of our island homeland and the entire nation.

Page updated Jan. 12, 2024