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PubMed1996

Determinants of vertebral fracture prevalence among native Japanese women and women of Japanese descent living in Hawaii.

Age-adjusted prevalence of vertebral fracture has been reported to be higher among native Japanese women than among women of Japanese descent living in Hawaii. In this cross-sectional population-based study, we examined a variety of potential risk factors for associations with prevalent vertebral fractures and investigated whether these factors could explain the difference in vertebral fracture prevalence between native Japanese and Japanese-American women. Spine radiographs and data on spine bone mineral density (BMD) and other potential risk factors were collected among 802 Japanese women aged 50-88 years living in Hiroshima and 840 Japanese-American women aged 52-88 years living in Hawaii. In logistic regression analysis, BMD was a major predictor of prevalent vertebral fracture. In linear regression models, weight, age, and menstrual history (age at menopause or years between menarche and menopause) were significantly associated with BMD and thus might contribute to fracture risk indirectly through their effects on BMD. However, age and menstrual history provided additional and complementary information about fracture prevalence after adjusting for BMD. These variables together explained much of the difference in vertebral fracture prevalence between the two study populations. We conclude that the observed difference in age-adjusted prevalence of spine fracture between native Japanese and Japanese-American women was accounted for primarily by the differences in BMD, duration of estrogen exposure, and/or duration of estrogen deficiency. Thus, current BMD is a major but not the sole risk factor for vertebral fractures. Age-related and menopause-related mechanisms may also play an important role in spine fracture independent of BMD.

Absorptiometry, Photon↗
PubMed2004

A comparison between Japanese-Americans living in Hawaii and Los Angeles and native Japanese: the impact of lifestyle westernization on diabetes mellitus.

We have been conducting the Hawaii-Los Angeles-Hiroshima Study since 1970, mainly to determine the effects of environmental changes on various diseases by comparing Japanese-Americans with native Japanese subjects. Japanese-Americans living in Hawaii and Los Angeles are originated mainly from Hiroshima, Japan and are genetically identical with native Japanese. Through this study, we made several clear observations about Japanese-Americans. First, Japanese-Americans were highly exposed to a westernized lifestyle ; in other words, a relatively high fat and simple carbohydrate diet with low physical activity as compared to native Japanese. Second, the prevalence of type 2 diabetes among Japanese-Americans and death from ischemic heart disease among Japanese-American diabetic patients were higher. Third, the serum fasting insulin level as well as the insulin level after a glucose load, was higher among Japanese-Americans, even when the serum glucose levels were not statistically different as compared to native Japanese. Accordingly, Japanese-Americans were thought to have a high insulin resistance status. However, the initial insulin response after a glucose load was low, which was more similar to Japanese people than to Caucasians. Fourth, the total cholesterol and triglyceride levels were higher among Japanese-Americans. These results are supposed to be derived from the insulin resistant status by the westernization of lifestyle, as well as from the weakness of pancreatic beta cell function that is supposed to be genetically regulated among Japanese. In conclusion, it appears that for genetically Japanese people, environmental factors are important for the development of metabolic diseases such as diabetes mellitus and cardiovascular disease.

Adult↗
PubMed2005

Emergence of Salmonella serotype Enteritidis phage type 4 in Hawaii traced to locally-produced eggs.

OBJECTIVES: In August 1998, the Hawaii Department of Health observed a nine-fold increase in human Salmonella Enteritidis (SE) infections. Isolates were phage type 4 (PT4). An investigation was initiated to determine the source of the outbreak. METHODS: A matched case-control study enrolled 38 cases. Cases were Hawaii residents with diarrhea and a stool culture yielding SE. RESULTS: Eating eggs was associated with SE illness; 28 cases (74%) ate eggs in the three days before illness compared to 34 (45%) of 76 controls (MOR=3.0, 95% CI=1.4-7.4). Eighteen (47%) of 38 case patients ate eggs from Farm A compared to 11 (14%) of 76 controls (MOR=12.0, 95% CI=3.1-78.0); the eggs were not properly handled or refrigerated. Cultures from Farm A yielded SE. Human illness subsided following selective flock depopulation. CONCLUSIONS: This outbreak highlights the importance of proper handling and refrigeration of eggs. The egg industry must implement quality assurance programs to prevent the spread of SE PT4 and human SE illness.

Animal Husbandry↗
PubMed2004

Ethnic differences in the prevalence of overweight among young children in Hawaii.

OBJECTIVES: To compare the prevalence of overweight among young children of different ethnic backgrounds and describe the age pattern of overweight in early childhood. METHODS: Cross-sectional study of 21,911 children, 12 to 59 months old, participating in the Hawaii Special Supplemental Nutrition Program for Women, Infants, and Children in 1997-1998. They were grouped in eight ethnic categories. For 1-year-olds we defined overweight as weight-for-age at the 95th percentile or more and underweight as weight-for-age at less than the 10th percentile. For 2- to 4-year-olds overweight was defined as body mass index (BMI) at the 95th percentile or more, underweight as BMI less than 10th percentile, tall stature as height-for-age at the 95th percentile or more, and short stature as height-for-age at less than the 10th percentile. The National Center for Health Statistics 2000 growth charts were the reference values. The analysis included bivariate and multivariate methods. RESULTS: Large differences were found among ethnic groups. Among 1-year-olds, Samoans were the heaviest (17.5% overweight) and Filipinos the lightest (30.2% underweight). Among 2- to 4-year-olds, Samoans were the heaviest (27.0% overweight) and the tallest (16.9% tall), whereas Asians were the lightest (12.2% underweight), and Filipinos the shortest (19.0% short). Hawaiians and Asians also had a high percentage of short children (13.6% and 12.2%, respectively). Prevalence of overweight in all 2- to 4-year-olds was more than the expected 5%, especially for Samoans, Filipinos, Hawaiians, and Asians. At age 2 to 4 years, overweight was almost twice as prevalent as at age 1. Multivariate analysis showed that ethnicity (Samoan) had the strongest independent association with weight-for-age percentile, BMI, and overweight in the two age groups, followed by birth weight. CONCLUSIONS: This is the first study of overweight among children of Asian and Pacific Island backgrounds in Hawaii. It identified important characteristics of growth and will be helpful in the design of appropriate activities to prevent overweight.

Acculturation↗
PubMed2004

Population-based study of small intestinal atresia and stenosis, Hawaii, 1986-2000.

Atresia and stenosis are some of the most common birth defects affecting the small intestine. Few population-based studies have examined the epidemiology of small intestinal atresia/stenosis. Eighty-two cases of small intestinal atresia/stenosis were identified through a population-based birth defects registry in Hawaii during 1986-2000. The relationships of various clinical and demographic factors with small intestinal atresia/stenosis and duodenal atresia/stenosis were examined. The small intestinal atresia/stenosis and duodenal atresia/stenosis rates were 2.9 per 10,000 live births [95% confidence interval (CI) 2.3-3.6] and 1.3 per 10,000 live births (95% CI 1.0-1.9), respectively. No secular trend was observed (P = 0.067 and 0.090, respectively). Maternal age risk for small intestinal atresia/stenosis was U-shaped, while duodenal atresia/stenosis rates were highest with maternal age of 35 years or more. Small intestinal atresia/stenosis was substantially more common among Far East Asians than Caucasians [rate ratio (RR) 1.96, 95% CI 1.24-2.94]. Duodenal atresia/stenosis risk was higher in Hawaii County than in Honolulu County (RR 2.55, 95% CI 1.10-5.02). Small intestinal atresia/stenosis was also associated with low birth weight (RR 11.50, 95% CI 8.05-15.92), low gestational age (RR 8.60, 95% CI 6.34-11.41) and multiple births (RR 3.79, 95% CI 1.39-8.24). In conclusion, this study found associations between small intestinal atresia/stenosis and maternal age, maternal race/ethnicity, county of residence, birth weight, gestational age and plurality, but not delivery period. Many of the associations between small intestinal atresia/stenosis and other factors noted in this investigation were similar to those reported by other studies.

Adolescent↗
PubMed2001

Breast-feeding practices among WIC participants in Hawaii.

OBJECTIVE: To describe breast-feeding practices and identify correlates of breast-feeding among participants in the Hawaii Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program. DESIGN: A cross-sectional survey. SUBJECTS/SETTING: We conducted structured, in-person interviews with 535 women at WIC clinics throughout Hawaii (95% response rate). The interview collected information on maternal characteristics and infant-feeding practices. STATISTICAL ANALYSES: Breast-feeding prevalence was examined by infant age and predictors of infant-feeding method were examined via bivariate tests and multivariable logistic regression analysis. Reported breast-feeding promotion efforts in health care settings outside of WIC were also examined. RESULTS: Most women (82%) attempted to breast-feed, albeit for short durations for many women; of the women who breast-fed in combination with formula feeding, 46% introduced formula within the first week after delivery. Significant predictors of breast-feeding initiation included previous breast-feeding experience, having a close relative or friend who breast-fed, multiparity, Asian/Pacific Island ethnicity (other than Filipino), and being foreign-born. Significant predictors of mixed feeding (vs exclusive breast-feeding) included working or attending school, age less than 20 years, Hawaiian/part Hawaiian or Filipino ethnicity, being Hawaiian-born, and residing in Oahu county. CONCLUSIONS: Although most women in this population initiated breast-feeding, formula was usually introduced at an early age. This study identified several factors associated with breast-feeding initiation and exclusive breast-feeding, factors that may prove useful for the development of appropriate interventions to promote these behaviors.

Adult↗
PubMed1990

Urothelial cancer in white and Japanese patients in Hawaii: pathology.

The sites, growth patterns, histological grades and degrees of invasion of urothelial tumors were assessed among white and Japanese patients in Hawaii. Tissues were available from 225 white and 164 Japanese patients, representing virtually all of the urothelial tumors from these races entered into the Hawaii Tumor Registry for Oahu island between 1977 and 1986. No statistically significant interracial differences emerged from the analysis. Grade 1 papillary tumors were the most numerous types encountered, consisting of 43% of the urothelial tumors in men of both races, and 37.5% in white and 31% in Japanese women. Recently, observed increasing incidence trends of urothelial tumors among white men in the United States are associated with a synchronous decrease in mortality trends. Our analysis indicates that these diverging trends cannot be accounted for by increased numbers of noninvasive papillary tumors.

Adenocarcinoma↗
PubMed2003

Malignant melanoma in non-Caucasians: experience from Hawaii.

Data from the Hawaii Tumor Registry suggest that the incidence of melanoma in the non-Caucasian population of Hawaii is not substantially different from that of the remainder of the United States. Our experience indicates that melanoma in this population, although unusual, is not rare. Although lesions on the palms and soles are more common. as are subungal melanomas, primary tumors on other skin sites account for the majority of patients with cutaneous melanoma in the non-Caucasian population. The substantial difference in primary tumor thickness suggests the reported poorer outcomes for non-Caucasian patients with cutaneous melanoma may be explained, at least in part, by a delay in diagnosis. Given the evidence that preventive measures and educational efforts have dramatically impacted the diagnosis and outcome of melanoma patients, it is critical to recognize that similar efforts should be directed at the non-Caucasian population.

Black or African American↗
PubMed1999

Plasma fibrinogen and its correlates in elderly Japanese men living in Japan and Hawaii.

Plasma fibrinogen levels were determined using comparable methods for 329 Japanese men in Hiroshima Japan, and 3571 Japanese-American men in Honolulu Hawaii, aged 71-93 years. The age-adjusted mean fibrinogen level in Japanese-American men (307 mg/dl) was significantly higher (p<0.0001) than in native Japanese men (270 mg/dl). In multiple linear regression models, the fibrinogen level was associated significantly and positively with white blood cell count (WBC) and total cholesterol, and inversely with HDL cholesterol and hematocrit in both study samples. The strongest association with fibrinogen was shown for WBC, and this association was not mediated through cigarette smoking. The observed difference in fibrinogen levels could not be fully explained by WBC, total and HDL cholesterol, triglyceride, hematocrit, body mass index, and diabetes. Some unmeasured environmental or lifestyle variables such as diet and physical activity may be partly responsible for the observed difference in fibrinogen levels between native Japanese men and Japanese-American men in Hawaii.

Aged↗
PubMed1999

Isoflavone levels in soy foods consumed by multiethnic populations in Singapore and Hawaii.

Concentrations and glucosidic conjugation patterns of isoflavones were determined in soy foods consumed by multiethnic populations in Singapore and Hawaii. Six raw and 11 cooked food groups traditionally consumed in Singapore and 8 food groups consumed in Hawaii were analyzed by reversed-phase high-pressure liquid chromatography with diode array detection. Mean total isoflavone levels varied between 35 and 7500 ppm, with the lowest values found in soy milk and burgers and the highest levels observed in soybean and its seeds and in supplements. Total isoflavone levels and conjugation patterns varied as a function of soybean variety, storage conditions, and food processing. A large contribution to the differences in total isoflavone content between food groups was due to the water content in foods and to leaching of polar analytes into the water phase during boiling. Soy protein drinks and traditional soy foods were found to possess very similar isoflavone amounts considering usual serving sizes.

Beverages↗
PubMed1998

Anthropometric predictors of breast cancer incidence and survival in a multi-ethnic cohort of female residents of Hawaii, United States.

OBJECTIVES: The purpose of the study was to describe the associations between height and body mass index (BMI) (wt/ht2) and breast cancer incidence and survival among female residents of Hawaii. METHODS: The study sample is a randomly-selected, multi-ethnic cohort of 17,628 women. A total of 378 incident breast cancer cases were identified via linkage to the Hawaii Tumor Registry over an average follow-up period of 14.9 years. Using age 50 as a cut-point, 86 were considered premenopausal cases, and 292 were postmenopausal. Proportional hazards analysis was used to describe the risks associated with height and BMI, after adjustment for age, education, race/ethnicity, and drinking status. For mortality analyses, there were 34 breast cancer deaths among the 365 breast cancer cases for which staging information was available. RESULTS: The risk of postmenopausal breast cancer was found to increase progressively across approximate tertiles of the distribution of height (P = 0.02 for trend test), with a significantly excess risk among women in the tallest tertile (risk ratio [RR] = 1.5, 95 percent confidence interval [CI] = 1.1-2.1). Baseline levels of BMI were related positively to breast cancer incidence among postmenopausal women, after control for the above covariates (P = 0.01 for trend test). Among postmenopausal women in the highest quintile of the BMI distribution, the RR was 1.5 (CI = 1.0-2.3, P = 0.04). Further analyses indicated the association between BMI and postmenopausal breast cancer incidence was strongest among women aged 65 years and older. After statistical control for the above covariates and stage of disease, pre-morbid levels of BMI were significantly predictive of death from breast cancer, with an approximate nine percent increase in risk per unit increase in BMI (P = 0.01). Compared with women in the lowest two quartiles, the RR among the heaviest women was 2.2 (CI = 0.9-5.4,P = 0.08). Height was not associated with risk of breast cancer mortality. CONCLUSIONS: Relative weight may be an important modifiable risk factor for both breast cancer incidence and prognosis. The association between height and breast cancer incidence is more difficult to interpret, but may underscore the importance of early life exposures in the development of breast cancer.

Adult↗
PubMed1989

Incidence trends and ethnic patterns for childhood leukaemia in Hawaii: 1960-1984.

We analysed data obtained from the Hawaii Tumor Registry, a population-based participant in the Surveillance, Epidemiology, and End Results (SEER) programme that monitors cancer incidence and mortality for the entire state. A total of 138 males and 116 females, under the age of 15, were diagnosed with leukaemia between 1960 and 1984, with average annual age-adjusted incidence rates of 49.6 and 44.8 per million, respectively. Time trend analysis by 5-year calendar periods revealed an increasing rate for leukaemia among females only, whereas other populations have shown a positive trend in both sexes. The incidence rates for all ethnic groups combined were similar to those for US whites. Japanese and Chinese males had a slightly higher rate for leukaemia than US whites, while Filipinos, Hawaiians and whites in Hawaii had relatively lower rates. Among females, incidence was higher among whites, Filipinos, Hawaiians and Chinese than among US whites, and lower among Japanese. Thus, there were notable sex differences in the ethnic distribution of this disease.

Adolescent↗
PubMed2001

Advance directive completion rates and end-of-life preferences in Hawaii.

To estimate rates of advance directive completion, preference for in-home death and hospice services at life's end, and support for physician assistance in dying, questions were added to two statewide, random-sample telephone surveys-the 1998 Behavioral Risk Factor Surveillance System (N=2,153) and the 1999 OmniTrak health survey (N=700). Data were compared across age, ethnic, and gender groups. Overall, 29% of Hawaii residents had a living will, 22% had a healthcare power of attorney, 65% said they would prefer a home death, 60% would want hospice services, 64% believed a person had a moral right to end his or her life when faced with an incurable illness, and 63% felt doctors should be allowed by law to end a patient's life if the patient and his or her family requested it. Advance directive completion rates increased with age, desire for an in-home death varied by gender and ethnicity, and support of assisted-death options varied by ethnicity. Despite a large minority population, end-of-life preferences among the general population in Hawaii are similar to those of U.S. mainlanders. However, age, gender, and ethnic differences exist. Clinicians are encouraged to ask patients directly about their preferences as a first step toward improving end-of-life care.

Adolescent↗
PubMed1999

Acanthocephalus bufonis (Acanthocephala) from Bufo marinus (Bufonidae: Amphibia) in Hawaii.

During a survey of the helminth parasites of the introduced toad, Bufo marinus, on O'ahu, Hawaii, an acanthocephalan corresponding to Acanthocephalus bufonis (Shipley, 1903) was found in the intestinal tract. This is a new host and locality record for A. bufonis which has only previously been recorded from amphibians in the Orient. Possible mechanisms for the introduction of A. bufonis to Hawaii, and its transmission to the toad, are discussed. Almost 98% of toads were infected with a mean intensity of 28.6 acanthocephalans per infected toad. There was a significant negative correlation between host length and intensity of infection with subadult toads having significantly higher infection levels than adult male and female toads. Trunk length of both male and female acanthocephalans was significantly related to host length.

Acanthocephala↗
PubMed1986

Modes of transmission and evidence for viral latency from studies of human T-cell lymphotrophic virus type I in Japanese migrant populations in Hawaii.

Human T-cell lymphotrophic virus type I (HTLV-I) seroprevalence was 20% among Hawaiian Japanese migrants (issei) and their offspring (nisei) from Okinawa compared to 35% in similarly aged men who were lifetime residents of Okinawa. A control group of migrants from a nonendemic area of Japan, Niigata, had low rates of HTLV-I antibodies, suggesting that Hawaii per se is not an endemic area for HTLV-I. Factors that were significantly associated with seropositivity in the Okinawa migrant groups were years of residence in Japan before migration (issei) and age for offspring of Okinawa migrants (nisei). Antibody titer was highest in Okinawa lifetime residents, intermediate in migrants (issei), and significantly lower in offspring of Okinawa migrants (nisei), with increasing titer observed with advancing age in the offspring of the migrant group. Based on these data, infection within the household occurring early in life appears to be a major route of HTLV-I transmission and may help to explain the curious geographic clustering of this virus in certain locales. As yet to be defined cofactors, including sexual transmission and/or environmental exposures (e.g., particularly before age 20), also may contribute to HTLV-I seropositivity. The pattern of rising seroprevalence and titer with age in the offspring of migrants who resided all of their lives in Hawaii raises the possibility that HTLV-I infection acquired early in life may become dormant and reexpressed with reactivation of latently infected T cells. The importance of this model in the process of viral leukemogenesis is supported by recent reports of adult T-cell leukemia in offspring (nisei) of Okinawa migrants.

Age Factors↗
PubMed1994

Hawaii's healthcare system is a disaster--no matter what you have heard.

Hawaii enacted many of the administration's healthcare proposals almost 20 years ago, and President and Mrs Clinton apparently like the system. However, in this commentary, the author, a physician who lives in Hawaii, describes the day-to-day reality of an obviously very flawed plan.

Hawaii↗
PubMed1990

Reproducibility of a diet history in older men in Hawaii.

A diet history method was tested for reproducibility among 106 older men from the five major ethnic groups (Japanese, Caucasian, Hawaiian, Filipino, and Chinese) of Hawaii. The questionnaire, administered by trained interviewers, was designed to estimate the dietary intakes of total and saturated fat, cholesterol, vitamin A, beta-carotene, vitamin C, and zinc. Subjects were asked to recall their usual frequencies and amounts of consumption during a usual month of more than 100 food items, along with the intake of seasonal foods with a high vitamin A content. A second interview was conducted 1-14 months later to obtain a diet history covering the same time period as the first interview. The same questionnaire was utilized in both interviews. The effects of ethnicity, age, and recall interval (period between the diet reference date and initial interview) on the reproducibility of nutrient intakes were examined. The intraclass correlation coefficient (rI) and the weighted kappa statistic (Kw) were used to assess agreement. The overall levels of reproducibility were relatively good. Neither ethnicity, age, nor length of recall period had a major effect on reproducibility. The data suggested that this diet history method is an appropriate instrument for estimating the usual dietary intakes of a healthy heterogeneous group of older men in Hawaii.

Age Factors↗
PubMedDate not supplied

Asian and Pacific Islander mortality differences in Hawaii.

In the United States, national health status data pertaining to Asian and Pacific Islander (API) Americans are rarely disaggregated. By aggregating API data, however, the poor health status of some API groups is often masked by the favorable health status of others. The purpose of this paper is two-fold: (1) to compare mortality rates of the five major ethnic groups in Hawaii (Caucasians, Chinese, Filipinos, Japanese, and Hawaiians) and (2) to explore methodological issues related to comparative studies of API health indicators. Standardized and age-specific mortality rates and 95 per cent confidence intervals for major causes of death were estimated for 1990 based on Hawaii vital records and population data. In general, death rates were highest for Hawaiians and lowest for Japanese and Chinese, illustrating the importance of API data disaggregation and suggesting that special attention be paid to improving the health of Hawaiians. Methodologically, the study demonstrated that, while some compromises in analysis are required, legitimate comparisons across API groups can be made if data sets are available.

Adolescent↗