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The scientific basis of Hawaii's public health rabies prevention program is discussed, as is a proposed minor modification offered to assist Hawaii residents who use guide dogs and who want to travel out of state. Hawaii's current quarantine program has successfully prevented the introduction of the disease. Alternative programs involve risks that are not easily evaluated.
The mental health system for the State of Hawaii includes 8 Community Mental Health Centers (CMHC), each a State-funded mental health clinic serving a special geographic area on Oahu, and the Hawaii State Hospital (HSH), operated by the Mental Health Division (MHD), State Department of Health (DOH). Hawaii is one of the states that allocates more funds into community-based services than it does to the hospital. Approximately 64% of the service budget is spent for outpatient services and 36% for the HSH.
Malaysia and Hawaii have several advantages for epidemiologic and laboratory studies on nasopharyngeal carcinoma. Both have multiethnic populations with different incidence rates of nasopharyngeal carcinoma and different life-styles. Malaysia has large populations of Chinese, Malaya, and Indians, and the number of cases of nasopharyngeal carcinoma at any one time is comparatively large. Incidence rates for 1968--72, age-standardized to the World population, for Guangdong hua (Cantonese Chinese) in Malaysia were 24.3/100,000 for males and 12.0/100,000 for females. In Hawaii, the ratio was 12.9/100,000 for males and 6.7/100,000 for females. The small number of cases in Hawaii would require that research in that State be conducted in collaboration with research elsewhere with larger case numbers.
To better understand the increased morbidity and mortality of asthma in Hawaii, a profile was established from questionnaires completed by 76 asthmatics in a residential area and by 204 asthmatics attending emergency rooms. The general profile differed from profiles on other islands and mainland USA in that allergens were more important and exercise less. Variations occurred in the profile in association with ethnicity, time in Hawaii, and prescribing habits. The Chinese did not recognize infection as a trigger; the Filipinos had little familial asthma, less pollen sensitivity, and used few steroids; and the Japanese were sensitive to Kona weather but not to pollen. The newcomers (military) who were sensitive to pollen and less to emotion and exercise, rated their attacks more severe and used more nebulizers and steroids. Certain other relationships emerged such as house dust as a trigger and the increased use of steroids. Asthmatics of two civilian ERs used fewer nebulizers and steroids. In conclusion, Hawaii's increased morbidity and mortality of asthma should be examined further in terms of ethnicity, infection, house dust, and prescribing habits.
Hawaii has been dubbed a leader in health care. In August 1994, Hawaii began a five-year demonstration project with federal backing--QUEST. The trial managed-care project was designed to provide quality care to public clients in a cost-effective manner. This study surveyed doctors in Hawaii to assess QUEST at the six-month mark. The survey showed that QUEST's early performance is short of meeting its goals. Further evaluation and accounting will be needed to determine if QUEST can represent the future of managed care.
This study examines the association between maternal sociodemographic characteristics and the receipt of different levels of prenatal care use (no care, inadequate, intermediate, adequate) in order to determine different patterns in the relationships between maternal characteristics and these distinct categories of prenatal care use. Using the 1979-1992 Hawaii live birth vital record file, single live births to Hawaii resident mothers of white, Hawaiian/part-Hawaiian, Filipino, or Japanese ethnicity, who did not indicate on the birth certificate that either parent was active duty military, were selected. Over one quarter of this study population did not initiate prenatal care in the first trimester. Given the high level of insurance coverage found in Hawaii, this finding is disconcerting, particularly in relation to the U.S. Year 2000 Objective of 90% initiation in the first trimester. Overall, the factors that predicted receipt of any prenatal care predicted more adequate use of prenatal care as well. Noteworthy exceptions were maternal age and ethnicity. Identifying these exceptions is important for the development of a more detailed understanding of risk factors related to use of prenatal care to better target program responses aimed at improving prenatal care use. In addition, these data suggest that removing financial barriers to access to care does not guarantee universal use of disease prevention and health promotion services.
Basal cell cancers are the most common of all cancers. They rarely metastasize and very rarely kill. Melanomas, however, do kill! An estimated 20 people in Hawaii will die this year from malignant melanoma. Early diagnosis and treatment can save much morbidity--surgery, scars and other defects--and can save lives. This manuscript reviews melanoma data from several agencies in Hawaii and from the experience of the author's private practice. In his private practice, he has seen the incidence of melanomas jump from an average of one a year in 1970 to 1975 to 7.4 each year between 1986 and 1990. While basal cell cancers and melanomas occur more in Caucasians, they are seen in all races. Everyone can get skin cancer and melanoma. Physicians must teach their patients to Practice Safe Sun--Hawaii.
This ecological study investigated the association between mammography utilization and breast cancer incidence in Hawaii with the hypothesis that geographic areas with high mammography use have higher breast cancer incidence than geographic areas with low mammography use. Insurance claims for mammograms received during 1992 and 1993 were combined with breast cancer incidence data from the Hawaii Tumor Registry and data from the 1990 Census ZIP File. The claims data were obtained from four private and three public health plans and covered approximately 85% of women 40 years of age and older. Age-specific breast cancer incidence rates for the 79 ZIP code areas were regressed on mammography rates and selected aggregate demographic variables using multiple linear regression. An estimated 42% of women 40 years of age and older had received at least 1 mammogram during 1992 and 1993, with the highest rate (45%) in women ages 50-64 years old. Overall, 23% of the variation in age-specific breast cancer incidence could be predicted by mammography utilization, 23% by increasing age, and 4% by higher education. The relationship between mammography use and breast cancer incidence was strongest for women 50-64 years old and for localized disease. The magnitude of the association between breast cancer incidence and mammography utilization was comparable to the increase in breast cancer rates observed in Hawaii during the mid-1980s, supporting the hypothesis that the sharp increase in breast cancer incidence was attributable to screening and early detection. However, the long-term 1% increase in breast cancer incidence requires alternate explanations.
Subclass-specific antibody responses to the Norwalk virus capsid protein in adults challenged with Norwalk, Snow Mountain, or Hawaii virus were evaluated by solid-phase enzyme immunoassay using recombinant Norwalk virus capsid antigen (rNV). Fourfold or greater serum immunoglobulin G (IgG) antibody responses to rNV were detected in 15 of 20 volunteers challenged with Norwalk virus, and serum IgA and IgM antibody responses to rNV were seen in almost all subjects who had rNV IgG responses. Serum rNV IgG antibody responses also were detected in 6 of 15 volunteers challenged with Snow Mountain virus and 2 of 12 volunteers challenged with the Hawaii virus. However, the magnitude of antibody response and the geometric mean postchallenge rNV IgG antibody titers were lower in subjects challenged with Snow Mountain or Hawaii virus, and serum IgA and IgM responses generally did not occur.
PURPOSE. The present investigation tested the linear hypothesis of generational assimilation/acculturation among second (Nisei), third (Sansei) and fourth (Yonsei) generations of Japanese­Americans in Hawaii. METHODOLOGY. Investigators assessed ethnic identity using the Ethnic Identity Questionnaire (EIQ), a widely studied instrument especially designed for use with Japanese ancestral populations. PRINCIPAL FINDINGS. Results indicated that when holding gender constant, fourth-generation (Yonsei) Japanese­Americans residing in Hawaii evidenced no differences from third-generation (Sansei) Japanese­Americans in the extent of their ethnic identity with traditional Japanese culture as measured by the Ethnic Identity Questionnaire (EIQ). This finding can be contrasted to previous results comparing first (Issei), second (Nisei), and third (Sansei) generations of Japanese-Americans in which the different generations demonstrated a linear progression toward reduced identification with Japanese culture. When gender by generation relationships were analyzed using a two (male versus female) by three (Nisei, Sansei, Yonsei) cell analysis of variance, gender­generation inter-relationships were found, suggesting ethnic identity is complexly determined by gender variables. CONCLUSIONS. Ethnic identity appears to be a function of local, national, and even international factors. Simple linear assimilation hypotheses do not capture the complexity of the ethnic identification process. This is the first evidence of an attenuation in the progressive reduction of ethnic identification with Japanese culture among Japanese-Americans living in Hawaii across the generations. Efforts must be made to study acculturation within specific behavioral domains and contexts, and to control for generation, age and historical variables. RELEVANCE TO ASIAN-AMERICAN/PACIFIC ISLANDER POPULATIONS. This article adds to our understanding of assimilation/acculturation processes among Japanese­Americans and raises questions about this process for other recent Asian immigrant groups. KEY WORDS. Ethnic Identity, Japanese-Amercans, Acculturation, Assimilation.
The UH-CRC is an NIH minority funded infrastructure program at the University of Hawaii in partnership with Hawaii Pacific Health, now in its ninth year. The main purpose of the UH-CRC is to foster clinical research at UH in order to improve the health of the citizens of Hawaii, particularly those who suffer disproportionately from disorders affecting these communities. This status report documents the continued success and progress of the Center Manuscripts published or in press have increased from an average of 43 in years 1-3 to 54 in years 4-6 to 84 for years 7-9. Actual dollars received per year ranged from 1-7 million dollars the first 6 years, but reached 8-22 million dollars the last three years. This status report also documents the mandate for this clinical research infrastructure program to compete successfully for mainstream funding status by 2010.
From October 1969 to January 31, 1973, an island-wide small mammal survey was conducted by the Hawaii State Department of Health in Hilo, Hawaii. A total of 2,982 rodents and mongooses from East and West Hawaii were cage-trapped and were examined by serological and cultural methods for evidence of leptospirosis. Of the 2,957 animals tested, 899 (30.4%) were culturally or serologically positive and 2058 (69.6%) were negative for evidence of leptospiral infection. Three leptospiral serotypes were isolated (L. icterohaemorrhagiae, L. ballum, and L. sejroe). The incidence among animal species was compared with earlier studies on this island.
The present study addressed whether diabetes mellitus was a strong risk factor for cardiovascular disease (CVD) death. Between 1976 and 1984, 927 (404 men) Japanese-Americans in Hawaii aged 40-79 years participated at baseline examination including a 75 g oral glucose tolerance test. Diabetes was defined as fasting serum glucose >or=140 mg/dl, 2 h postload glucose >or=180 mg/dl, or the use of drugs for diabetes. Causes of death were classified by ICD-9 codes on the reports from the Hawaii State Public Health Bureau. Until 1994, 178 individuals suffered death; 81 were attributed to CVD and 43 to coronary heart disease (CHD). The age-adjusted and coronary risk factors-adjusted relative risks for CHD and CVD mortality were significant for diabetes both in men and women. The impact of diabetes on CHD mortality was greater for women. However, no gender difference in the contribution of diabetes to fatal CVD was observed. Serum fasting glucose levels tended to be associated with CHD death and were associated with CVD death in diabetic subjects. In conclusion, diabetes is a strong independent risk factor for CVD mortality in Japanese-American men and women. Hyperglycemia is associated with CVD mortality in diabetic subjects.
Autochthonous dengue infections were last reported in Hawaii in 1944. In September 2001, the Hawaii Department of Health was notified of an unusual febrile illness in a resident with no travel history; dengue fever was confirmed. During the investigation, 1,644 persons with locally acquired denguelike illness were evaluated, and 122 (7%) laboratory-positive dengue infections were identified; dengue virus serotype 1 was isolated from 15 patients. No cases of dengue hemorrhagic fever or shock syndrome were reported. In 3 instances autochthonous infections were linked to a person who reported denguelike illness after travel to French Polynesia. Phylogenetic analyses showed the Hawaiian isolates were closely associated with contemporaneous isolates from Tahiti. Aedes albopictus was present in all communities surveyed on Oahu, Maui, Molokai, and Kauai; no Ae. aegypti were found. This outbreak underscores the importance of maintaining surveillance and control of potential disease vectors even in the absence of an imminent disease threat.
The author describes results of a continuing study of skin sensitivity to histoplasmin among United States Navy recruits from Alaska, Hawaii, the Philippine Islands and Puerto Rico. For comparison, material is also included for several groups of recruits from different states of mainland United States.The evidence is interpreted as indicating that the frequent large reactions in Puerto Rican and Filipino recruits represent specific infection with Histoplasma, whereas the small reactions in recruits from Hawaii and the Philippines represent cross-reactions due to sensitization with a presently unknown agent or agents.
BACKGROUND: A high prevalence rate of obsessive-compulsive disorder (OCD) among Hawaiian adolescents, particularly Native Hawaiians, has been reported. Because Native Hawaiian and other Polynesian youth are at an increased risk for rheumatic fever, caused by an autoimmune response to group A beta-hemolytic streptococci, we hypothesized that the genetic and environmental risk factors for streptococcal infections and their autoimmune sequelae potentially may be associated with the presence of OCD and may partially explain this high OCD prevalence. OBJECTIVE: To describe, among the adolescents in Hawaii diagnosed as having OCD through a previous study, OCD prevalence by ethnicity, household crowding and other measures of socioeconomic status, various measures of physical health and health-seeking behavior, and comorbid psychopathologic features. DESIGN: Six hundred nineteen adolescents from 5 high schools in the state of Hawaii were interviewed from April 15, 1993, to May 7, 1996. Interview instruments included the Diagnostic Interview Schedule for Children and other measurements of psychopathology. Obsessive-compulsive disorder diagnoses, based on current and past 6-month symptoms elicited via structured interview of the adolescents, were reported. RESULTS: Relative to other ethnicities, Native Hawaiians had a 2-fold higher risk (odds ratio = 2.03) for OCD. Degree of Polynesian ancestry correlated positively with OCD prevalence. Obsessive-compulsive disorder prevalence also correlated positively with crowding in the household; measures of physical illness; and measures of depression, anxiety, aggression, and illicit substance use. CONCLUSIONS: The characteristics of OCD in this sample suggest the need to consider the possibility of a streptococcal origin and the need for further studies to clarify the genetic and environmental risk factors for OCD in Hawaiian and other Polynesian youth.
The authors compared the risk of dying from site-specific cancer within five years after diagnosis for Hawaii residents diagnosed in 1960-1964, 1965-1969, and 1970-1974. Twelve cancer sites were analyzed with adjustments for age at diagnosis and ethnicity by a multivariate method. Four of these sites were adjusted for sex as well. The adjusted relative risk for site-specific cancer death was significantly greater than 1.0 (P less than 0.05) when patients diagnosed in 1960-1969 were compared with those diagnosed in 1970-1974 for the following sites: stomach, rectum (males), lung, prostate, leukemia, and lymphoma. The adjusted relative risk was greater than 1.0, but not significantly greater, for the remaining cancer sites: colon, rectum (females), liver, pancreas, breast, corpus uteri, and ovary. These results indicate that, for several cancer sites, the risk of cancer death has significantly declined in Hawaii during 1960-1974. However, specific reasons for this improvement in cancer prognosis were not determinable from the available data.
In 1979, a pilot survey defined respiratory status and unmet health care needs of retired and former male asbestos workers in Hawaii. Of 1,401 identified subjects, 741 were contacted and 411 were interviewed. Forty-five subjects were between 39 and 54 years of age; 208, between 55 and 64; and 158, age 65 or more. They represented the main ethnic groups--Caucasian, Chinese, Filipino, Hawaiian and part-Hawaiian, and Japanese--on Oahu. Most subjects had had significant exposure to asbestos in a shipyard, and 83% were current nonsmokers (160 had never smoked, and 111 were ex-smokers for ten years or more). Taking age and ethnicity into account, our group had more chronic respiratory and gastrointestinal problems than the comparable male population of Oahu in 1979, but fewer such problems than active shipyard workers elsewhere. These problems related primarily to current smoking status and secondarily to the length of asbestos exposure. Health care was available, but former workers used it less than retirees, despite having more symptoms. Very few abnormalities were reported by the subjects on their chest X-rays, pulmonary function tests, and sputum cytology performed elsewhere. These findings are compared to those of other shipyards, and support the hypothesis that the biological effects of asbestos exposure are generally mild in Hawaii.