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PubMed2001

Immune status of free-ranging green turtles with fibropapillomatosis from Hawaii.

Cell-mediated and humoral immune status of free-ranging green turtles (Chelonia mydas) in Hawaii (USA) with and without fibropapillornatosis (FP) were assessed. Tumored and non-tumored turtles from Kaneohe Bay (KB) on the island of Oahu and from FP-free areas on the west (Kona/Kohala) coast of the island of Hawaii were sampled from April 1998 through February 1999. Turtles on Oahu were grouped (0-3) for severity of tumors with 0 for absence of tumors, 1 for light, 2 for moderate, and 3 for most severe. Turtles were weighed, straight carapace length measured and the regression slope of weight to straight carapace length compared between groups (KB0, KB1, KB2, KB3, Kona). Blood was assayed for differential white blood cell count, hematocrit, in vitro peripheral blood mononuclear cell (PBMC) proliferation in the presence of concanavalin A (ConA) and phytohaemagglutinin (PHA), and protein electrophoresis. On Oahu, heterophil/lymphocyte ratio increased while eosinophil/monocyte ratio decreased with increasing tumors score. Peripheral blood mononuclear cell proliferation indices for ConA and PHA were significantly lower for turtles with tumor scores 2 and 3. Tumor score 3 turtles (KB3) had significantly lower hematocrit, total protein, alpha 1, alpha 2, and gamma globulins than the other four groups. No significant differences in immune status were seen between non-tumored (or KB1) turtles from Oahu and Hawaii. There was no significant difference between groups in regression slopes of body condition to carapace length. We conclude that turtles with severe FP are imunosuppressed. Furthermore, the lack of significant difference in immune status between non-tumored (and KB1) turtles from Oahu and Kona/Kohala indicates that immunosuppression may not be a prerequisite for development of FP.

Animals↗
PubMed1994

Hawaii's health care system: imparting ideas for reform.

The state of Hawaii has implemented a health care system that offers high-quality, cost-effective care to all of its citizens. This article provides an analysis of each of the six basic principles of the Clinton Administration's proposals and how these principles are used in Hawaii's health care system. A key question posed by the authors is whether, and to what extent, Hawaii's success with its health care delivery model can be packaged and applied to other parts of the nation.

Community Participation↗
PubMed1999

Local and gay: addressing the health needs of Asian and Pacific Islander American (A/PIA) lesbians and gay men in Hawaii.

Asian and Pacific Islander American lesbians and gay men, who are "local" born and raised in Hawaii face conflicting personal and social expectations due to factors including prejudicial attitudes about homosexuality, A/PIA racial/ethnic traditions, and the unique cultural milieu of Hawaii. Based on anecdotal and research reports of this Hawaii population, health and social needs are discussed with implications for professional health practice.

Asian↗
PubMed2000

Health education needs in Hawaii: social work, dental hygiene and nursing.

In this article, the need for selected health education programs in Hawaii will be discussed. Changes in the health care system, population and provider population impacting supply are identified. Health trends in Hawaii are highlighted and strategies needed to assure that Hawaii's demand for health professionals in social work, dental hygiene and nursing are suggested.

Education, Nursing↗
PubMed1975

Dietary patterns among men of Japanese ancestry in Hawaii.

The dietary patters of 6663 men of Japanese ancestry, living in Hawaii and participating in the Honolulu Heart and Japan-Hawaii Cancer Studies, were analyzed according to country of birth and boyhood education. Approximately 80% of the men were born and educated in Hawaii (Nisei); the others were either born in Japan (Issei) or traveled to Japan for 5 or more years of boyhood education (Kibei). Twenty-four-hr diet recalls, obtained at the first cycle of examinations (1965 to 1968), revealed that the Nisei consumed significantly greater intakes of total and animal protein, total and saturated fat, and cholesterol than the Issei and Kibei. Values for weight, height, skinfold thickness, and serum cholesterol were in the same direction, and the differences were statistically significant. Food frequency questionnaires at the 1st and 3rd examinations covered a 6-year interval. At both time periods, the Issei and Kibei ate Japanese foods more frequently and in greater quantities than the Nisei. In general, the Nisei consumed more Western foods. Both food frequency questionnaires included 6 identical items; coffee, milk, green tea, rice, tofu (soybean curd), and tsukudani (preserved seaweed paste). The frequent and infrequent consumers were similarly characterized over the 6-year period. The findings suggest that the country of birth and education has lasting effects on adult eating patterns. The observed heterogeneity for specific food items and nutrients between the Nisei and Issei-Kibei men augers well for attempts to relate such items to chronic diseases such as cancer.

Body Height↗
PubMed1976

A comparative pathology study of myocardial lesions and atherosclerosis in Japanese men living in Hiroshima, Japan and Honolulu, Hawaii.

Autopsies were conducted on Japanese men from 45 to 71 years of age in Hiroshima, Japan (191 patients) and in Honolulu, Hawaii (298 patients). They were performed according to a common protocol. In both locations the patients studied were representative of decedents from population-based cohorts with respect to age and cause of death. The degree of atherosclerosis in the coronary arteries and aorta, assessed according to the panel method, was found to be substantially more severe in men in Hawaii than in those in Japan. Areas of recent myocardial necrosis were 3.5 times more frequent in men in Honolulu than in those in Hiroshima. Large myocardial scars were 1.5 times more frequent in the men in Honolulu. It was characteristic of men in Honolulu that severe atherosclerosis and myocardial lesions appeared at younger ages than in those in Hiroshima. These data demonstrate that there is an increase in the frequency and severity of ischemic lesion in the myocardium of Japanese who have migrated to Hawaii and that this increase is the result of atherosclerosis of the extramural segments of the coronary arteries.

Aged↗
PubMed1992

Studies of cardiovascular disease and cause-specific mortality trends in Japanese-American men living in Hawaii and risk factor comparisons with other Japanese populations in the Pacific region: a review.

The Honolulu Heart Program (HHP) is a long-term prospective epidemiologic study of cardiovascular disease (CVD) in male descendants of Japanese migrants to Hawaii. The article is a review of data from recent and past HHP studies relevant to the Seventeenth Pacific Science Congress symposium "Changes in Disease Patterns in the Western Pacific and Southeast Asia." The Ni-Hon-San Study, which compared CVD rates and risk factors in Japanese men living in Japan, Hawaii (HHP), and California, showed that coronary heart disease (CHD) and stroke mortality rates in Hawaii were intermediate between rates in Japan and California. Gradients in CVD risk factors were similar to the gradients in disease rates. From 1966 to 1984 trends in incidence rates for CHD, stroke, and cause-specific mortality were compared for the 8006 participants and 3130 non-participants in the HHP. CHD and stroke rates declined by about 40% for the total HHP cohort. There was a larger decline for CHD mortality (over 60%) in the nonparticipants. There was also a much greater decline in total mortality and cancer mortality rates in the nonparticipants. The results of the reviewed studies show that the subjects, although sharing a common ethnic background, experience different rates of disease when living in diverse geographic and cultural locales. This finding supports evidence that environmental and behavioral factors influence chronic disease rates and provides a basis for intervention and prevention. The finding that nonparticipants in epidemiologic studies can show different incidence trends suggests that caution should be used in interpreting trends limited only to participants.

Aged↗
PubMed2003

Murine typhus--Hawaii, 2002.

Murine typhus, a zoonotic disease caused by Rickettsia typhi, is uncommon in the United States. Hawaii typically reports five or six cases annually; however, 47 cases were reported in 2002. This report summarizes clinical data for three of these cases and describes murine typhus activity in Hawaii during 2002 and control efforts of the Hawaii Department of Health (HDH). The high number of reported cases in 2002 underscores the need for community education to prevent murine typhus and an assessment of environmental factors that might contribute to local disease transmission.

Adolescent↗
PubMed2004

Community-associated methicillin-resistant Staphylococcus aureus infections in Pacific Islanders--Hawaii, 2001-2003.

Methicillin-resistant Staphylococcus aureus (MRSA) is emerging as a cause of skin and soft-tissue infections in persons who have little or no contact with health-care settings. The majority of these infections are mild, involving skin and soft tissue; however, certain cases can progress to invasive tissue infections, bacteremia, and death. Transmission of MRSA has been reported most frequently in certain populations (e.g., children, sports participants, or jail inmates). Persons in the American Indian or Alaska Native population in the United States and aboriginals and Pacific Islanders (PIs) in Australia have high rates of MRSA colonization and infection. In 2003, clinicians reported an increased number of skin abscesses caused by MRSA among patients examined in ambulatory care settings. This report summarizes the findings of a retrospective study of community-associated MRSA (CA-MRSA) infections in Hawaii that identified a higher proportion of cases among PIs than were identified among Asians, compared with their respective proportions in the Hawaii population. Efforts to prevent CA-MRSA in Hawaii should focus on identifying factors causing the disproportionate number of infections among PIs.

Adolescent↗
PubMedDate not supplied

Perinatal substance use among high risk women in Hawaii: patterns and impact on pregnancy outcomes.

PURPOSE: This study examines the relationship between perinatal substance use and adverse pregnancy outcomes among a select group of high risk women residing in the state of Hawaii. METHODS: Participants were the 2,750 women who had live births during 1994 and 1995 and were enrolled in Hawaii's Perinatal Support Services (PSS) program. Demographic and behavioral risk factors associated with selection for participation in the PSS program were examined along with patterns of substance use and adverse perinatal outcomes. PRINCIPAL FINDINGS: After adjustment for demographic factors, Hawaiian/part Hawaiian women compared to non-Hawaiian women were 1.5 times as likely to drink alcohol (p<0.01) and 1.8 times as likely to smoke (p<0.001). Among these women, the relative risk (RR) for preterm delivery was significantly higher for those who used alcohol (RR=1.7, p=0.027), tobacco (RR=1.6, p=0.027), or illicit drugs (RR=1.8, 0.029). Among the same women, the relative risk for low birth weight was significantly higher for those who smoked (RR=1.6, p=0.010) or used illicit drugs (RR=1.7, p=0.046). CONCLUSION: Hawaiian/part Hawaiian PSS women had a higher prevalence of substance use than non-Hawaiian PSS women, even after adjusting for age, education, and marital status. RELEVANCE TO ASIAN AMERICAN AND PACIFIC ISLANDER POPULATIONS: Special attention must be paid to the reasons why Hawaiian/part Hawaiian pregnant women use tobacco and alcohol at higher rates than women of other ethnic groups enrolled in Hawaii's PSS Program. Furthermore, services to assist pregnant women refraining from using illicit drugs should be supported.

Adult↗
PubMed2004

Sun protection policy in elementary schools in Hawaii.

INTRODUCTION: Childhood sun exposure is a major risk factor for skin cancer, the most common form of cancer in the United States. Schools in locations that receive high amounts of ultraviolet radiation have been identified as important sites for reducing excessive sun exposure. METHODS: The objective of this study was to determine the prevalence of sun protection policies, environmental features, and attitudes in public elementary schools in Hawaii. Surveys were sent to all (n = 177) public elementary school principals in Hawaii. Non-respondents were called three weeks after the initial mailing. The survey asked about sun protection policies, environmental features, and attitudes toward sun protection. The survey was designed to measure all seven components of Guidelines for School Programs to Prevent Skin Cancer, issued by the Centers for Disease Control and Prevention. RESULTS: Seventy-eight percent of schools responded to the survey. Only one school had a written school policy. Almost all schools (99.3%) scheduled outdoor activities during peak sun hours. School uniforms rarely included long pants (6.5%), long-sleeved shirts (5.1%), or hats (1.5%). Current policies did not support or restrict sun protection habits. Almost one third of those surveyed were in favor of a statewide policy (28.1%), and most believed excessive sun exposure was an important childhood risk (78.9%), even among non-white students (74.5%). CONCLUSION: Results of this study suggest the following: 1) school personnel in Hawaii are concerned about childhood sun exposure; 2) current school policies fail to address the issue; 3) most schools are receptive to developing sun protection policies and programs; and 4) students appear to be at high risk for sun exposure during school hours.

Child↗
PubMed2005

Hawaii's public mental health system.

The following article addresses the nature of and problems with the public mental health system in Hawaii. It includes a brief history of Hawaii's public mental health system, a description and analysis of this system, economic factors affecting mental health, as well as a needs assessment of the elderly, individuals with severe mental illness, children and adolescents, and ethnically diverse individuals. In addition to having the potential to increase suicide rates and unnecessarily prolong personal suffering, problems in the public mental health system such as inadequate services contribute to an increase in social problems including, but not limited to, an increase in crime rates (e.g., domestic violence, child abuse), divorce rates, school failure, and behavioral problems in children. The population in need of mental health services in Hawaii is under served, with this inadequacy of services due to economic limitations and a variety of other factors.

Adolescent↗
PubMed1992

Providing health care to Hawaii's elderly.

Hawaii's rapidly aging population is a challenge for Hawaii's health care providers. What with the high cost of care, limited health care resources, and a rapidly increasing population of frail elderly patients living in the community, will our medical practices be able to adapt to the care of patients who require more time and who will have not only multiple medical illnesses but complicated psychosocial conditions as well? Will our health care facilities be prepared for the typically longer stay and more expensive older patient? Will the cost of care in Hawaii keep on rising? Who will pay? Will this challenge turn into a crisis?

Aged↗
PubMed2005

Ethnicity and breast cancer in Hawaii: increased survival but continued disparity.

OBJECTIVES: To examine ethnic variation in survival among 7722 women diagnosed with invasive breast cancer in Hawaii between 1990 and 2002 and to extend previous multivariate analyses by adding a new prognostic variable: estrogen receptor/progesterone receptor (ER/PR) status. DESIGN: Cox regression analysis of retrospective data. SETTING: Population-based data from the Hawaii Tumor Registry, which is part of the National Cancer Institute's Surveillance, Epidemiology, and End Results Program. PARTICIPANTS: 7722 women in 5 ethnic groups--Caucasian, Chinese, Japanese, Filipino, and Native Hawaiian--diagnosed with invasive breast cancer between 1990 and 2002. MAIN OUTCOME MEASURE: Survival, examining death from breast cancer and death from a cause other than breast cancer. RESULTS: Compared to Caucasians, significantly smaller proportions of Japanese and Chinese women and larger proportions of Native Hawaiian and Filipino women were diagnosed in later stages of disease and at earlier ages. The four minority ethnic groups had higher rates of ER+PR+ tumors than Caucasians. For both causes of death, ethnic disparities in survival were reduced, but still existed, after controlling for age, stage, and ER/PR status. Japanese had the highest rates of survival for either cause of death. Native Hawaiians and Filipinos had the lowest rates of survival for breast cancer, and Native Hawaiians and Caucasians had the lowest rates of survival for other causes of death. CONCLUSIONS: Future studies should examine other reasons for continued ethnic differences in breast cancer survival in Hawaii, including socioeconomic status, access to insurance, adequacy of recommended screening frequency, comorbid conditions, treatment appropriateness and compliance, and genetic markers of tumor aggressiveness.

Adult↗
PubMed2005

Prevalence of physical activity levels by ethnicity among adults in Hawaii, BRFSS 2001.

BACKGROUND: Few studies have examined the differences in physical activity levels between subgroups of Asian or Pacific Islanders living in the United States. This study compared levels of physical activity for three subgroups of Asian or Pacific Islanders residing in Hawaii. METHODS: Data on Native Hawaiian/Part Native Hawaiian (N=585), Filipino (N=548), Japanese (N=871), and White (N=1728) adults were obtained from the Hawaii 2001 Behavioral Risk Factor Surveillance System (BRFSS), which contained more detailed questions on ethnicity than are collected by most states. Six physical activity categories were compared: inactive, insufficient (some activity but less than recommended activity), moderate activity (> or = 30 minutes of moderate activity > or = 5 days a week), vigorous activity (> or = 20 minutes of vigorous activity > or = 3 days a week), recommended activity (meeting either moderate or vigorous activity requirements), and a recently suggested target of > or = 60 minutes of moderate activity 7 days a week or > or = 20 minutes of vigorous activity > or = 4 days a week. RESULTS: Among Asians or Pacific Islanders, Native Hawaiians/Part Native Hawaiians were most active (38.9% moderate and 23.9% vigorous), followed by Japanese (32.1%, 20.4%) and Filipinos (31.8%, 18.6%). Whites were more active than any of these three subgroups (47.2%, 35.4%). CONCLUSIONS: Differences in physical activity levels between subgroups of Asians or Pacific Islanders in Hawaii suggests that aggregated data for all subgroups obscures important information about disparities in activity levels. State efforts to reduce disparities in activity levels should take into account differences between Asian or Pacific Islander subgroups.

Adolescent↗
PubMed2006

Ethnic differences for developing rheumatic fever in a low-income group living in Hawaii.

UNLABELLED: The risk factors responsible for acute rheumatic fever (ARF) are complex, in part, because group A streptococcus (GAS) infection is a prerequisite for this disease. We attempted to differentiate socioeconomic from genetic risk factors by studying subjects in a Hawaii pediatric cardiology clinic who qualified for Medicaid. This ethnically diverse group was unique because they maintained a low socioeconomic but generally healthy lifestyle with more limited risks than those living in extremely impoverished conditions. METHODS: Questionnaires were administered to consenting subjects in the clinic, who were divided into those diagnosed with ARF (n = 26) and those with other (primarily congenital) heart diseases (n = 41). RESULTS: The socioeconomic status of the ARF and non-ARF groups was lower than that of the Hawaii population in general, and little differences were noted between the groups. The ARF group, however, had slightly larger household sizes and more children than the non-ARF group. The greatest difference was in ethnicity. By the Fisher exact test, the number of Polynesians belonging to the ARF group was significantly greater than all other ethnicities (P = .005). Polynesians had an odds ratio > 4.80 of developing ARF, which increased to 6.33 when number of children per household was considered. CONCLUSION: The potential contribution of genetic predisposing factors for developing ARF was analyzed in subjects living in a homogeneously low socioeconomic level relative to the general Hawaii population. Polynesians were at highest risk when compared to other ethnicities living in similar socioeconomic conditions.

Acute Disease↗
PubMed1991

Sarcoidosis: a Hawaii rarity.

Sarcoidosis is so rarely seen in residents of Hawaii that it may not be considered as a diagnostic possibility. The differential diagnosis is more complex in Hawaii due to the presence of granulomatous diseases such as tuberculosis and leprosy. We present the first known case of sarcoidosis in a Hawaii resident together with an overview of the disorder.

Adult↗
PubMedDate not supplied

Intra-ethnic and inter-ethnic marriage and divorce in Hawaii.

A comparison of intra- and inter-ethnic divorce rates in Hawaii showed that inter-ethnic marriages resulted in a higher proportion of divorces than did intra-ethnic marriages when the marriage data used had to do with all marriages occurring in Hawaii. However, a sizeable portion of marriages in Hawaii are of nonresidents who, if they divorce, probably divorce elsewhere. Nonresident marriages are chiefly intra-ethnic marriages of Caucasians. When examining the proportions of divorces to resident marriages, within-group marriages are more at risk than inter-ethnic marriages. As in prior research, persons who marry members of other racial/ethnic groups tend to marry persons from groups with income levels similar to their own. As in previous reports, some cross-ethnic combinations appeared more at risk for divorce than did others. Group income appeared to be a predictor of risk. When considering only resident marriages as related to divorces, those marriages in which the bride was from a higher income group than the groom were at a significantly greater risk for divorce than marriage in which the bride came from an income group lower than that of the groom.

Divorce↗