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Little is known about the impacts of living in diaspora from the Hawaiian Islands on Native Hawaiian health. To address this, the authors conducted an exploratory analysis using cross-sectional data from the 2021 Native American COVID-19 Alliance Needs Assessment. A total of 1418 participants identified as Native Hawaiian (alone or in any combination), of which 1222 reported residency in the continental US and 196 in Hawai'i. Residency status in the continental US vs Hawai'i was evaluated as a predictor of survey outcomes using likelihood ratio tests on linear and logistic regression models for linear and binary outcomes, respectively. Results showed that NH residency in the continental US was significantly associated with increased odds of reporting fair or poor self-rated health; increased odds for screening positive for anxiety, depression, and suicidality; and increased odds of health insurance loss ( P 's < .05). Residency in the continent was also associated with lower odds of reporting a diagnosed chronic health condition ( P < .05). Residency in the continental US had no observed effect on the odds that participants engaged cultural activities or cultural coping strategies. These results support the role of place of residency as an important Native Hawaiian health predictor during and beyond the COVID-19 pandemic., Competing Interests: This article was prepared, in part, while Dr. Walters was employed at the University of Washington, Indigenous Wellness Research Institute. The present study was internally funded by the Ola Pasifika Lab. The authors claim no conflict of interest. The authors extend our gratitude to the participants, funders, and partners of NACA. Mahalo no ka hui pū ‘ana., (©Copyright 2024 by University Health Partners of Hawai‘i (UHP Hawai‘i).)