Physical Activity Disparities between Native Hawaiian and Pacific Islanders and Other Racial-Ethnic Groups in the United States.

This study investigates disparities in aerobic and muscle-strengthening physical activity (PA) among Native Hawaiian and Pacific Islander (NHPI) individuals in comparison to non-Hispanic White (NHW) and other racial and ethnic groups, with particular attention to multiracial identities, gender, socioeconomic status (SES), and geographic region. Using pooled data from the 2015-2019 Behavioral Risk Factor Surveillance System (BRFSS), we applied generalized structural equation modeling to elucidate underlying behavioral patterns and mechanisms. Our findings indicate that, after adjusting for SES, NHPI men exhibit a significant advantage in meeting aerobic PA guidelines relative to NHW men. Conversely, NHPI women are significantly less likely to adhere to aerobic PA recommendations, with SES mediating a substantial portion of this disparity. Regarding muscle-strengthening PA, NHPI men demonstrated significantly higher odds of meeting guidelines compared to their NHW counterparts, a disparity that became more pronounced following SES adjustment. These results suggest that the role of SES is complex and non-uniform, functioning as a mediator or suppressor that differentially influences various subgroups. Notably, no significant racial or ethnic disparities were observed among women in muscle-strengthening activities. Regional analyses further highlighted substantial variation across the Eastern United States, West Coast, Hawaii, and Guam, underscoring the importance of geographic context. Collectively, these findings underscore that PA disparities are intricately shaped by the intersectionality of racial identity, gender, SES, and geographic location. They highlight the necessity for developing targeted, culturally tailored public health interventions that address specific barriers and leverage community strengths within these diverse populations.