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It is well appreciated that the social determinants of health are intimately related with health outcomes. However, there is a paucity of literature that explores these themes comprehensively for the indigenous people within Micronesia. Certain Micronesia-specific factors, such as transitions from traditional diets, the consumption of betel nut, and exposure to radiation from the nuclear bomb testing in the Marshall Islands, have predisposed certain Micronesian populations to an increased risk of developing a variety of malignancies. Furthermore, severe weather events and rising sea levels attributed to climate change threaten to compromise cancer care resources and displace entire Micronesian populations. The consequences of these risks are expected to increase the strain on the already challenged, disjointed, and burdened healthcare infrastructure in Micronesia, likely leading to more expenses in off-island referrals. A general shortage of Pacific Islander physicians within the workforce reduces the number of patients that can be seen, as well as the quality of culturally competent care that is delivered. In this narrative review, we comprehensively underscore the health disparities and cancer inequities faced by the underserved communities within Micronesia.

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@#Objective: The Commonwealth of the Northern Mariana Islands (CNMI) is a remote Pacific island territory with a population of 47 329 that successfully prevented the significant introduction of coronavirus disease (COVID-19) until late 2021. This study documents how the response to the introduction of COVID-19 in CNMI in 2021 was conducted with limited resources without overwhelming local clinical capacity or compromising health service delivery for the population. Methods: Data from COVID-19 case investigations, contact tracing, the Commonwealth’s immunization registry and whole genome sequencing were collated and analysed as part of this study. Results: Between 26 March 2020 and 31 December 2021, 3281 cases and 14 deaths due to COVID-19 were reported in CNMI (case fatality rate, 0.4%). While notification rates were highest among younger age groups, hospitalization and mortality rates were disproportionately greater among those aged >50 years and among the unvaccinated. The first widespread community transmission in CNMI was detected in October 2021, with genomic epidemiology and contact tracing data indicating a single introduction event involving the AY.25 lineage and subsequent rapid community spread. Vaccination coverage was high before widespread transmission occurred in October 2021 and increased further over the study period. Discussion: Robust preparedness and strong leadership generated resilience within the public health sector such that COVID-19 did not overwhelm CNMI’s health system as it did in other jurisdictions and countries around the world. At no point was hospital capacity exceeded, and all patients received adequate care without the need for health-care rationing.

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The brown treesnake (BTS) (Boiga irregularis) invasion on Guåhan (in English, Guam) led to the extirpation of nearly all native forest birds. In recent years, methods have been developed to reduce BTS abundance on a landscape scale. To help assess the prospects for the successful reintroduction of native birds to Guåhan following BTS suppression, we modeled bird population persistence based on their life history characteristics and relative sensitivity to BTS predation. We constructed individual-based models and simulated BTS predation in hypothetical founding populations for each of seven candidate bird species. We represented BTS predation risk in two steps: risk of being encountered and risk of mortality if encountered. We link encounter risk from the bird's perspective to snake contact rates at camera traps with live animal lures, the most direct practical means of estimating BTS predation risk. Our simulations support the well-documented fact that Guåhan's birds cannot persist with an uncontrolled population of BTS but do indicate that bird persistence in Guåhan's forests is possible with suppression short of total eradication. We estimate threshold BTS contact rates would need to be below 0.0002-0.0006 snake contacts per bird per night for these birds to persist on the landscape, which translates to an annual encounter probability of 0.07-0.20. We simulated the effects of snake-proof nest boxes for Sihek (Todiramphus cinnamominus) and Såli (Aplonis opaca), but the benefits were small relative to the overall variation in contact rate thresholds among species. This variation among focal bird species in sustainable predation levels can be used to prioritize species for reintroduction in a BTS-suppressed landscape, but variation among these species is narrow relative to the required reduction from current BTS levels, which may be four orders of magnitude higher (>0.18). Our modeling indicates that the required predation thresholds may need to be lower than have yet been demonstrated with current BTS management. Our predation threshold metric provides an important management tool to help estimate target BTS suppression levels that can be used to determine when bird reintroduction campaigns might begin and serves as a model for other systems to match predator control with reintroduction efforts.

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The prevention of unintended pregnancy was identified as a primary prevention strategy to reduce Zika-related adverse birth outcomes during the 2016-2017 Zika virus outbreak. The Centers for Disease Control and Prevention in partnership with local health agencies conducted formative research to guide the development of culturally appropriate messages and materials to increase awareness of the prevention of unintended pregnancy as a strategy to decrease Zika-related adverse outcomes in American Samoa and the Commonwealth of the Northern Mariana Islands (CNMI). Nine focus groups (N=71) were conducted with women and men aged 18-44 years living in American Samoa and CNMI. Semi-structured interview guides were used to explore participants' knowledge and perceptions of Zika, family planning, and contraception; barriers and facilitators to access contraception and use; and information sources and contraception decision-making. Trained staff from local organizations co-moderated each focus group. Thematic analysis was conducted with NVivo 10. Participants had mixed knowledge about Zika virus and its relation to pregnancy and birth defects. Women and men had varied knowledge of the full range of contraceptive methods available in their jurisdiction and identified barriers to contraceptive access. Social factors including stigma, gender roles, and religion often deterred participants from accessing contraceptive services. Participants highlighted the need for culturally appropriate and clear messaging about contraceptive methods. Results demonstrate the feasibility of conducting formative research as an effective strategy for understanding community perspectives on unintended pregnancy prevention in the context of the Zika virus outbreak to develop health communication materials.

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Conservation benefits from incorporating genomics to explore the impacts of population declines, inbreeding, loss of genetic variation and hybridization. Here we use the near-extinct Mariana Islands reedwarbler radiation to showcase how ancient DNA approaches can allow insights into the population dynamics of extinct species and threatened populations for which historical museum specimens or material with low DNA yield (e.g., scats, feathers) are the only sources for DNA. Despite their having paraphyletic mitochondrial DNA (mtDNA), nuclear single nucleotide polymorphisms (SNPs) support the distinctiveness of critically endangered Acrocephalus hiwae and the other three species in the radiation that went extinct between the 1960s and 1990s. Two extinct species, A. yamashinae and A. luscinius, were deeply divergent from each other and from a third less differentiated lineage containing A. hiwae and extinct A. nijoi. Both mtDNA and SNPs suggest that the two isolated populations of A. hiwae from Saipan and Alamagan Islands are sufficiently distinct to warrant subspecies recognition and separate conservation management. We detected no significant differences in genetic diversity or inbreeding between Saipan and Alamagan, nor strong signatures of geographical structuring within either island. However, the implications of possible signatures of inbreeding in both Saipan and Alamagan, and long-term population declines in A. hiwae that pre-date modern anthropogenic threats require further study with denser population sampling. Our study highlights the value that conservation genomics studies of island radiations have as windows onto the possible future for the world's biota as climate change and habitat destruction increasingly fragment their ranges and contribute to rapid declines in population abundances.

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The study expounds upon the psychological concept of 'ambiguous loss,' proposed by Pauline Boss. The article attempts to broaden the concept's individualistic focus by offering a more ethnographically nuanced and socioculturally contextualized application of the concept. It examines how Okinawan WWII survivors, who repatriated from the Northern Mariana Islands after the war, relied on their belief system to make sense of 'abnormal' deaths during war, and the lack of proper mortuary rituals usually conducted for 'normal' deaths. The article argues that religio-spiritual rituals during their pilgrimages to the Marianas were the means with which those struggling with ambiguous loss attempt to deal with their psychological trauma and spiritual pain. It is also argued, however, that the uncollected bodies/bones continue to haunt the bereaved families, so their struggle with the loss cannot come to a complete 'closure,' resulting in their repeated visits to the sites of their loved ones' violent deaths.

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This paper analyses documents on health and disease among Chamorro people during and after 333 years (1565-1898) of the Spanish claim to and occupation of Guam. Here, a complex neurodegenerative disease-known locally as lytico-bodig and medically as amyotrophic lateral sclerosis and Parkinsonism-dementia complex (ALS/PDC)-reached hyperendemic proportions in the mid-twentieth century but then declined and is now disappearing. A tau-dominated polyproteinopathy, clinical phenotypes included amyotrophic lateral sclerosis (ALS or lytico), atypical parkinsonism with dementia (P-D or bodig), and dementia alone. A plausible etiology for lytico-bodig is consumption of flour derived from the incompletely detoxified seed of Cycas micronesica (fadang in Chamorro; Federico in Spanish), a poisonous gymnosperm that survives climatic extremes that can affect the island. Traditional methods for safe consumption appear to have been lost over the course of time since governors Francisco de Villalobos (1796-1862) and Felipe de la Corte (1855-1866) proposed banning consumption in view of its acute toxic effects. A death certificate issued in 1823 might suggest ALS/PDC in people dying with disability or impedidos, and premature aging and a short life was linked to food use of fadang in the mid-1850s (Guam Vital Statistics Report, 1823). During the Japanese occupation of Guam (1941-1944), Chamorro people took refuge in the jungle for months, where they relied on insufficiently processed fadang as a staple food. After World War II, traditional foods and medicines were subsequently replaced as islanders rapidly acculturated to North American life.

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Tree snails in the family Partulidae are widespread across the tropical Pacific, with endemic species occurring on most high islands. Partulid species have faced catastrophic range reductions and extinctions due primarily to introduced predators. Consequently, most extant species are threatened with imminent extinction. The U.S. administered Mariana Islands, consisting of Guam in the South and the Commonwealth of the Northern Mariana Islands (CNMI) in the north, historically harbored six endemic partulid species, half of which are thought to be extinct. While conducting a phylogenetic assessment of Partula gibba, an extant tree-snail with a range spanning at least seven islands within the archipelago, it was discovered that what has been identified as P. gibba on the island of Rota is a misidentified cryptic species. Here we use molecular phylogenetics, shell morphometrics and reproductive anatomy to describe it as a new species, Partula lutaensis sp. nov.. Because the new species has suffered population declines and has a restricted range, consisting solely of the small island of Rota, we highlight the urgent need for conservation measures.

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While undertaking a botanical survey of the Andersen Air Force Base on Guam (Mariana Islands) in 1994, botanists from the National Tropical Botanical Garden collected an unusual suffrutescent, non-aromatic member of the Lamiaceae family growing on limestone cliffs in the northeastern part of the island. Based on morphology and molecular data (trnLF, matK), it was determined to belong to the genus Pogostemon Desf., a genus previously unknown from the Micronesian, Melanesian, and Polynesian region. Moreover, the analysis also showed that it was not conspecific with P. cablin (patchouli), and of the species available to include in the phylogenetic analyses it is sister to P. hirsutus¸ a species from India and Sri Lanka. Differing from its congeners by its large, loose inflorescence 2.5-5 cm wide and up to 7 cm wide in fruit, it is here illustrated and described as a new species, Pogostemon guamensis Lorence & W.L. Wagner and its habitat and conservation status are discussed.

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In the light of recent phylogenetic studies, we re-assess the taxonomy and biogeography of the Varanus populations distributed in the Micronesian islands of Palau, the Western Carolines and the Marianas. Whether these populations are of natural origin or human introductions has long been contentious, but no study has fully resolved that question. Here, we present molecular and morphological evidence that monitor lizards of the Varanus indicus Group reached both Palau and the Mariana Islands sometime in the late Pleistocene and subsequently differentiated into two separate species endemic to each geographical region. One species is confined to the Mariana Islands, and for these populations, we revalidate the name V. tsukamotoi Kishida, 1929. The other species has a disjunct distribution in Palau, the Western Carolines and Sarigan Island in the Northern Marianas and is herein described as V. bennetti sp. nov. Both species are most closely allied to each other, V. lirungensis and V. rainerguentheri, suggesting that colonization of Micronesia took place from the Moluccas. We discuss the biogeographic distributions of both species in the light of the likely colonization mechanism and previous arguments for human introduction, and we argue that bounties for Palauan populations are ill-advised and plans for eradication of some other populations must first demonstrate that they are, in fact, introduced and not native.

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RATIONALE & OBJECTIVE: Native Hawaiians and Pacific Islanders (NHPI) have been reported to have the highest rates of incident end-stage kidney disease (ESKD) compared with other races in the United States. However, these estimates were likely biased upward due to the exclusion of nearly half the NHPI population that reports multiple races in the US Census. We sought to estimate the incidence rate of ESKD, including individuals reporting multiple races, and describe the clinical characteristics of incident cases by race and location. STUDY DESIGN: Health care database study. SETTING & PARTICIPANTS: US residents of the 50 states and 3 Pacific Island territories of the United States whose ESKD was recorded in the US Renal Data System (USRDS) between 2007 and 2016, as well as US residents recorded in the 2010 Census. PREDICTORS: Age, sex, race, body mass index, primary cause of ESKD, comorbid conditions, estimated glomerular filtration rate, pre-ESKD nephrology care, and hemoglobin A1c level among ESKD cases. OUTCOME: Initiation of maintenance dialysis or transplantation for kidney failure. ANALYTICAL APPROACH: Crude ESKD incidence rates (cases/person-years) were estimated using both single- and multiple-race reporting. RESULTS: Even after inclusion of multirace reporting, NHPI had the highest ESKD incidence rate among all races in the 50 states (921 [95% CI, 904-938] per million population per year)-2.7 times greater than whites and 1.2 times greater than blacks. Also using multirace reporting, the NHPI ESKD incident rate in the US territories was 941 (95% CI, 895-987) per million population per year. Diabetes was listed as the primary cause of ESKD most frequently for NHPI and American Indians/Alaska Natives. Sensitivity analysis adjusting for age and sex demonstrated greater differences in rates between NHPI and other races. Diabetes was the primary cause of ESKD in 60% of incident NHPI cases. Patients with ESKD living in the territories had received less pre-ESKD nephrology care than had patients living in the 50 states. LIMITATIONS: Different methods of race classification in the USRDS versus the US Census. CONCLUSIONS: NHPI living in the 50 US states and Pacific territories had the highest rates of ESKD incidence compared with other races. Further research and efforts are required to understand the reasons for and define how best to address this racial disparity.

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This study reports the level of care dogs received from their caretakers and the attitudes of caretakers and non-caretakers toward dogs on the islands of Guam and Saipan. Surveys were collected from residents of Guam and Saipan (274 and 275, respectively) and analyzed using chi-squared tests. Dogs were the most popular companion animal (Guam 66.4%; Saipan 72% ownership) with a strong preference toward pedigree, male puppies (Guam 45.4%; Saipan 62.4%). The more preferred dogs were housed inside and fed dog food, while the less preferred local mixed-breed dogs were free-roaming and fed table scraps. Fifty-nine per cent of caretakers in Saipan and 22.8% of caretakers in Guam had never provided veterinary care to their dog. Generally, caretakers on both islands did not sterilize their dogs, which may result in the potential for unplanned litters and a growth in the dog population. Residents of both islands reported witnessing abusive acts toward dogs, despite dogs being reported as having an important role on the island. This paper aims to identify challenges in dog welfare and management options for the stray population.

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Ninety-six juvenile specimens (37-54 mm standard length; LS ) of the rarely collected Upward-Mouth Spikefish Atrophacanthus japonicus (Triacanthodidae) were obtained from the stomachs of three Yellowfin Tuna Thunnus albacares collected off Guam in the Mariana Islands in the central Pacific Ocean. These specimens extend the range of A. japonicus eastward into Oceania. We review the systematic characters of the monotypic genus Atrophacanthus and present colour photographs of freshly collected specimens. The diet of the juvenile specimens of A. japonicus consisted of thecosome pteropods and foraminiferans. We present a range map of A. japonicus based on all known specimens and show that specimen size is related to whether specimens were collected in the pelagic zone or on the bottom. Our results support that, compared to all other Triacanthodidae, A. japonicus has an unusually extended pelagic larval and juvenile period, up to 54 mm LS , before settling to the bottom as adults. Lastly, we provide a multilocus phylogeny addressing the phylogenetic placement of Atrophacanthus based on eight of 11 triacanthodid genera and six genetic markers. Our results reveal that Atrophacanthus is the sister group of Macrorhamphosodes and they provide new insights about the evolutionary history of the family.

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Conservation has long focused on preserving or restoring pristine ecosystems. However, understanding and managing novel ecosystems has grown in importance as they outnumber pristine ecosystems worldwide. While non-native species may be neutral or detrimental in pristine ecosystems, it is possible that even notorious invaders could play beneficial or mixed roles in novel ecosystems. We examined the effects of two long-established non-native species-Philippine deer (Rusa marianna) and feral pigs (Sus scrofa)-in Guam, Micronesia, where native vertebrate frugivores are functionally absent leaving forests devoid of seed dispersers. We compared the roles of deer and pigs on seedling survival, seed dispersal and plant community structure in limestone karst forests. Deer, even at low abundances, had pronounced negative impacts on forest communities by decreasing seedling and vine abundance. By contrast, pigs showed no such relationship. Also, many viable seeds were found in pig scats, whereas few were found in deer scats, suggesting that pigs, but not deer, provide an ecosystem function-seed dispersal-that has been lost from Guam. Our study presents a discrepancy between the roles of two non-native species that are traditionally managed as a single entity, suggesting that ecological function, rather than identity as a non-native, may be more important to consider in managing novel systems.

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Species interactions, both mutualistic and antagonistic, are widely recognized as providing important ecosystem services. Fruit-eating animals influence plant recruitment by increasing germination during gut passage and moving seeds away from conspecifics. However, relative to studies focused on the importance of frugivores for plant population maintenance, few studies target frugivores as ecosystem service providers, and frugivores are underappreciated as ecosystem service providers relative to other mutualists such as pollinators. Here, we use an accidental experiment to elucidate the role of seed dispersal by frugivores for maintaining a culturally and economically important plant, the donne' sali chili (Capsicum frutescens) in the Mariana Islands. One of the islands (Guam) has lost nearly all of its native forest birds due to an invasive snake (Boiga irregularis), whereas nearby islands have relatively intact bird populations. We hypothesized that frugivore loss would influence chili recruitment and abundance, which could have economic and cultural impacts. By using video cameras, we confirmed that birds were the primary seed dispersers. We used captive bird feeding trials to obtain gut-passed seeds to use in a seedling emergence experiment. The experiment showed that gut-passed seeds emerged sooner and at a higher proportion than seeds from whole fruits. Consistent with our findings that birds benefit chilies, we observed lower chili abundance on Guam than on islands with birds. In a survey questionnaire of island residents, the majority of residents reported an association between the wild chili and local cultural values and traditions. In addition, we identified a thriving market for chili products, suggesting benefits of wild chilies to people in the Marianas both as consumers and producers. Our study therefore documents seed dispersal as both a cultural and a supporting ecosystem service. We provide a comprehensive case study on how seed-dispersed plants decline in the absence of their disperser, and how to apply mixed-methods in ecosystem service assessments. Furthermore, we suggest that scientists and resource managers may utilize fruit-frugivore mutualisms concerning socially valuable plants to gather support for frugivore and forest conservation efforts.

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This paper discusses and illustrates the 23 primnoid species collected by the R/V Okeanos Explorer in the US marine protected areas in the central and western Pacific, ranging from the Musician Seamounts in the north to American Samoa to the south, and the northern Mariana Islands to the west (CAPSTONE expeditions, 2015-2017). In situ photographs are provided for most species. Thirteen of the 23 species are described as new, as well as two new genera. One new genus, Macroprimnoa, possesses some of the largest polyps in the family. A dichotomous key is provided to facilitate comparisons among the 27 species of Calyptrophora. An update of the abyssal octocorallian species occurring deeper than 3000 m is provided, increasing that number from 39 to 49 species. The character of the articulating ridge, found on the distal edge of the basal body wall scales, is re-evaluated, resulting in four genera having this character state, and requiring the description of the new genus Pseudonarella.

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BACKGROUND: Areca (betel) nut is considered a Group 1 human carcinogen shown to be associated with other chronic diseases in addition to cancer. This paper describes the areca (betel) nut chewing trend in Guam, and health behaviors of chewers in Guam and Saipan. METHODS: The areca (betel) nut module in the Guam Behavioral Risk Factor Surveillance Survey was used to calculate the 5-year (2011-2015) chewing trend. To assess the association between areca (betel) nut chewing and health risks in the Mariana Islands, a cross-section of 300 chewers, ≥18years old, were recruited from households in Guam and Saipan. Self-reported socio-demographics, oral health behaviors, chronic disease status, diet, and physical activity were collected. Anthropometry was measured. Only areca (betel) nut-specific and demographic information were collected from youth chewers in the household. RESULTS: The 5-year areca (betel) nut chewing prevalence in Guam was 11% and increased among Non-Chamorros, primarily other Micronesians, from 2011 (7%) to 2015 (13%). In the household survey, most adult chewers (46%) preferred areca nut with betel leaf, slaked lime, and tobacco. Most youth chewers (48%) preferred areca nut only. Common adult chronic conditions included diabetes (14%), hypertension (26%), and obesity (58%). CONCLUSION: The 5-year areca (betel) nut chewing prevalence in Guam is comparable to the world estimate (10-20%), though rising among Non-Chamorros. Adult and youth chewers may be at an increased risk for oral cancer. Adult chewers have an increased risk of other chronic health conditions. Cancer prevention and intervention strategies should incorporate all aspects of health.

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Harryplax severus, a new genus and species of coral rubble-dwelling pseudozioid crab is described from the island of Guam in the western Pacific Ocean. The unusual morphological features of its carapace, thoracic sternum, eyes, antennules, pereopods and gonopods place it in the family Christmaplacidae Naruse & Ng, 2014. A suite of characters on the cephalothorax, pleon and appendages distinguishes Harryplax severusgen. & sp. n. from the previously sole representative of the family, Christmaplax mirabilis Naruse & Ng, 2014, described from Christmas Island in the eastern Indian Ocean. This represents the first record of Christmaplacidae in the Pacific Ocean. With the discovery of a second genus, a revised diagnosis for Christmaplacidae is provided.

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A number of dumpsites occur on the island of Saipan and in the surrounding coastal waters. Many of these sites date back to the immediate post WWII clean-up period and contain a variety of wartime wastes. Metallic debris is generally the most visible waste material and commonly includes bomb fragments, artillery shells, bullets, and other military hardware. In this investigation, we examined the heavy metal status of soils from around several of these dumpsites and in any obvious drainage pathways leading from them to the coast. Sediments were also taken for analysis from a number of coastal discharge points and three submerged sites. Metal enrichment was evident for one or more elements in deposits from two of the three submerged sites and 24 of the 32 land-based sites visited. Copper, Pb, and Zn were the most commonly encountered contaminant metals with levels well in excess of 1000 µg/g(-1) in several instances. Elevated Hg and Cd concentrations were also relatively widespread throughout the study area although levels of each element seldom exceeded 1.0 and 10.0 µg/g(-1), respectively. Silver, another element of toxicological concern, was only occasionally detected despite registering a high of 42 µg/g(-1) at one particular site. The metal data were weighed against established benchmarks formulated for the protection of human and ecological health. Implications of the findings and issues of primary concern are briefly addressed.

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