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BACKGROUND: The Healthy Hawaii Initiative, funded through the Hawaii tobacco settlement, allocates funds from the Hawaii Department of Health to the Hawaii Department of Education for school programs that promote health and reduce the burden of chronic disease. This article outlines progress, challenges, and insights from the first 3 years of the Hawaii Partnership for Standards-based School Health Education (the Partnership). CONTEXT: The Hawaii Department of Education added health education as a content area to the Hawaii Content and Performance Standards in 1999. The American Cancer Society, Hawaii Pacific, Inc., convened a Comprehensive School Health Education Committee that initiated a school health professional development program for teachers. During the 2000-2001 academic year, new Healthy Hawaii Initiative funding began for school health programs. METHODS: Healthy Hawaii Initiative (HHI) funding has been used to provide new state and district resource teacher positions, professional development workshops for educators, tuition waivers and materials for graduate-level summer institutes for educators, annual statewide school health conferences, and pilot school implementation of coordinated school health programs. CONSEQUENCES: Schools across Hawaii demonstrate clear progress in implementing standards-based school health education and coordinated school health programs. The funding has led to increased support from other sources to build school health programs. INTERPRETATION: The ultimate beneficiaries of school health programs are the children and families of Hawaii. This health and education partnership continues to work toward improved health outcomes for young people as the future leaders and citizens of Hawaii.
The Hawaii agent is a Norwalk-like virus of acute gastroenteritis in humans which is antigenically distinct from the prototype Norwalk agent. We established a solid phase sandwich type microtiter enzyme immunoassay (EIA) for Hawaii antigen employing sera and stools from experimentally challenged volunteers as reagents. This assay detected the Hawaii agent in stools from 3 of 8 volunteers who were ill after oral challenge with the Hawaii agent, including one specimen which was positive to a dilution of 1/320. Virus shedding occurred on days 3 to 7 after challenge. The Hawaii-positive stools did not react in the EIAs for Norwalk and Snow Mountain agent (SMA), nor did Norwalk or SMA-positive stools react in the Hawaii EIA. Human rotavirus, enteric adenovirus, feline calicivirus, and several enteroviruses also did not react in the Hawaii EIA. A blocking EIA to detect serum antibody to the Hawaii agent was also developed employing a diarrheal stool containing Hawaii as a source of antigen. Serum antibody rises were detected in 15 of 16 individuals with experimentally induced illness after challenge and in 3 of 5 individuals who remained well after challenge. The EIA for the Hawaii agent should permit epidemiologic studies of the Hawaii agent to be carried out as well as allow further characterization of the Hawaii virion.
Despite increase in serum total cholesterol, high smoking rate, and frequency of adverse blood pressure levels in Japan, coronary heart disease (CHD) incidence and mortality apparently remain substantially lower at all ages in Japan than in the US and other Western societies. To better understand these differences, we compared CHD biomedical risk factors and dietary variables in Japanese living in Japan and 3rd and 4th generation Japanese emigrants living a primarily Western lifestyle in Hawaii, in an ancillary study of the INTERMAP. Men and women aged 40-59 years were examined by common standardized methods-four samples in Japan (574 men, 571 women) and a Japanese-American sample in Hawaii (136 men, 131 women). Average systolic (SBP) and diastolic (DBP) blood pressures were significantly higher in men in Japan than in Hawaii; there were no significant differences in women. The treatment rate of hypertension was much lower in Japan than Hawaii. Smoking prevalence was higher, markedly so for men, in Japan than Hawaii. Body mass index, serum total and low-density lipoprotein cholesterol, HbA1c, and fibrinogen were significantly lower in Japan than in Hawaii; high-density lipoprotein cholesterol was higher in Japan. Total fat, saturated fatty acid intake, and Keys dietary lipid score were lower in Japan than in Hawaii. Polyunsaturated/saturated fatty acid ratio and omega-3 fatty acid intake were higher in Japan than in Hawaii. In conclusion, levels of several, especially lipid, CHD risk factors were generally lower in Japanese in Japan than in Japanese in Hawaii. These differences were smaller for women than men between Japan and Hawaii. They may partly explain lower CHD incidence and mortality in Japan than Western industrialized countries.
The American Cancer Society (ACS), Hawaii Pacific, Inc., initiated the Hawaii Partnership for Standards-Based School Health Education in July 1999. The goal of the partnership is to implement standards-based school health education to promote child and adolescent health in Hawaii. The partnership includes representatives from the Hawaii Department of Education, the Hawaii Board of Education, the Hawaii Department of Health, the University of Hawaii College of Education, Meadow Gold Dairies, the Hawaiian Electric Companies, the Hawaii Medical Services Association, and local divisions of the American Cancer Society. During its first year, the partnership collaborated to sponsor 15 teacher workshops on the new Hawaii Health Content Standards. In addition, Meadow Gold Dairies initiated a Got Health? milk carton side-panel promotional campaign to publicize the standards. This article describes development of the Hawaii Health Content Standards, history of the partnership, activities to date, concurrent supporting efforts, future plans, and lessons learned during the first year.
Cancer incidence rates were compared for Filipinos in Hawaii (1978-81) and Manila (1977). Data for Hawaii were from the statewide Hawaii Tumor Registry; those for Manila were from the Central Tumor Registry of the Philippines. In addition, time trends (4-yr intervals) for cancer among Filipinos in Hawaii were examined for the period 1962-81 and compared with corresponding patterns among Caucasians. For most cancer sites, the rates among Filipinos in Hawaii showed expected increases or decreases from the Manila rates. Notable findings included a dramatic increase in thyroid cancer rates among Filipino women in Hawaii (highest of all ethnic groups), a surprising lack of increase in female breast cancer rates in Hawaii, and a lower than expected increase in colon cancer rates in Hawaii. The time trend analyses showed remarkably similar patterns in Filipinos and Caucasians in Hawaii and no suggestion that differences between the 2 populations are decreasing over time. These observations indicate that useful clues to cancer etiology can be found by further study of the Filipino experience in Hawaii.
BACKGROUND: To the authors' knowledge, human papillomavirus (HPV)-associated carcinomas in Hawaii have not been studied in detail. METHODS: Surveillance, Epidemiology, and End Results data (from 1973-1996) were used to study rate of incidence patterns of squamous cell carcinomas (SCCs) of the uterine cervix, vulva/vagina, anus, penis, and palatine tonsils among Asian/Pacific Islanders and whites in Hawaii and among whites in the U.S. in general. RESULTS: With the exception of invasive cervical SCC, male and female Asian/Pacific Islanders in Hawaii had considerably lower incidence rates of HPV-associated SCCs than Hawaii whites and U.S. whites. Among women, Hawaii whites and U.S. whites had rather similar rates of invasive anogenital and tonsillar SCCs, but in situ SCC of the cervix or vulva/vagina was diagnosed less often among Asian/Pacific Islanders and whites in Hawaii than among whites in the general U.S. Among men, Hawaii whites had higher rates than U.S. whites of both anal and tonsillar, but not penile, SCCs. Among Hawaiian men with anal carcinoma, 43% (15 of 35) had remained unmarried versus 3% (2 of 65) of Hawaiian women with anal carcinoma. CONCLUSIONS: Asian/Pacific Islanders in Hawaii generally have lower incidence rates of HPV-associated SCCs than whites. However, low ratios of in situ to invasive cervical SCCs suggest that many Hawaii women, notably Asian/Pacific Islanders, are not diagnosed and treated for cervical neoplasias at a preinvasive stage. The high rate of incidence of anal SCC in male Hawaiian whites and the high proportions of unmarried men among patients with this disease suggest the transmission of HPV through homosexual contact. These men may be targeted in future screening programs for anal carcinoma.
A retrospective morphologic survey (1973-1983) of 146 cases of malignant lymphoma among the Hawaii-Japanese (migrant Japanese and their offspring) was conducted to determine whether differences in the incidence and cytologic types of malignant lymphoma exist when compared to those of native Japanese (lifetime residents of Japan). The age-adjusted incidence rates for malignant lymphoma among the Hawaii-Japanese were similar to rates for U.S. whites. However, higher rates for follicular centre cell (FCC) lymphoma with a follicular pattern were observed in the Hawaii-Japanese population when compared with rates for native Japanese. On the basis of the cytologic types of the Lukes-Collins classification, non-Hodgkin's lymphomas among the Hawaii-Japanese resembled those of Western countries, rather than those of Japan. B-cell lymphomas predominated (72 per cent), while T-cell types comprised 23 per cent of cases. Follicular centre cell types were encountered most often (59 per cent), and the small cleaved FCC subtype was the most common (30 per cent). The high degree of follicularity (29 per cent) was at variance with the consistently low rates reported in Japan. This may be explained, in part, by higher rates of nodal lymphomas among the Hawaii-Japanese. Of the T-cell lymphomas, diffuse large cell types (T-cell immunoblastic sarcoma, T-IBS), often with cytologic pleomorphism, were relatively frequently encountered (16 per cent), and comprised 15 per cent of non-Hodgkin's lymphomas; this observation necessitates special clinical and epidemiologic consideration in view of the large Japanese migration to Hawaii from HTLV-I endemic regions of southern Japan. No registered cases of non-Hodgkin's lymphoma or of Hodgkin's disease were documented in Hawaii-Japanese subjects under the age of 15 years. The age-adjusted incidence rates for Hodgkin's disease among the Hawaii-Japanese were similar with those of native Japanese. Nodular sclerosis was the most frequent histologic subtype. The difficulty in distinguishing between Hodgkin's disease and non-Hodgkin's lymphoma, particularly when immunologic cell surface markers are not available, is addressed. Low rates for chronic lymphocytic leukemia among the Hawaii-Japanese were confirmed. Not one well-documented case was identified in the 11-year period surveyed.
Stomach cancer incidence rates were compared among four groups: Japanese in Japan, Japanese in Hawaii, Caucasians in Hawaii, and all American whites. The highest rates at all ages occurred in the Japan Japanese, followed next by the Hawaii Japanese. Hawaii Caucasians tended to have similar age-specific rates to American whites in general. When the Japanese and Caucasians in Hawaii were divided by place of birth, the Japanese migrants to Hawaii had higher age-adjusted incidence rates than the Japanese born in Hawaii, while the Caucasian migrants to Hawaii (chiefly from the United States mainland) had lower rates than the Caucasians born in Hawaii. Examination of dietary data in relation to the place-of-birth-specific incidence rates showed positive association of stomach cancer with consumption of rice, pickled vegetables, and dried/salted fish, and a negative association with vitamin C intake. The results are consistent with the particular hypothesis that stomach cancer is caused by endogenous nitrosamine formation from dietary precursors, and that vitamin C may protect against the disease.
Carrying out a somatotype comparison of both, by using data of anthropometry of Hawaii-born Japanese Children (Hawaii-Children) and Amami-born Japanese Children (Amami-Children) that were carried out in 1977-78 a study with regard to the determination of obesity was carried out. The result that compared a somatotype was as follows. 1. The height of hawaii-Children was almost higher than that of Amami-Children. 2. A body weight was almost the same. 3. Trunk length of Amami-Children was longer than that of Hawaii-Children. 4. Lower limb length of Hawaii-Children was bigger than that of Amami-Children a little. 5. The letio of Rohrer index of Amami-Children was greater than that of Hawaii-Children. Therefore, it is determined that Amami-Children were obesity even from Hawaii-Children. when obesity index is judged from the ratio of the height to body weight. As for skin-fold thicknesses (amount of subcutaneous fat), Hawaii-Children is showing a high value more always than Amami-Children and Hawaii-Children is obesity obviously. Although the measurement result of Rohrer index and skin-fold thicknesses are contradicting this cause is because it differs with both trunk length and Lower limb length. Considering those result, it became obvious that a obesity index calculated from the height and body weight does not show fat volume inside a body precisely. The measurement of amount of subcutaneous fat needs to be carried out to check real obesity. Also, it is important to carry out the measurement of trunk length and Lower limb length in addition to the height and a body weight at least, to know a obesity.
Moyamoya disease (MMD) is a rare entity in the US with a few retrospective series and sporadic cases reported in the US and North America. Although it is known that MMD exists in all races, there is a predilection for people of Asian origin. Because of the relatively high percentage of Asians living in Hawaii, it was hypothesized that the estimated prevalence of MMD would be higher in Hawaii than the remaining US. All practicing neurologists, neurosurgeons, neuroradiologists and major hospitals in Hawaii were surveyed for MMD patients treated during the past 10 years. Medical records and angiograms (when available) were reviewed and the diagnostic guidelines for MMD from the Ministry of Health and Welfare of Japan applied. There were 53 records reviewed in 42 patients; 21 fulfilled the criteria for definite Moyamoya disease which were the focus of this study. In Hawaii, the prevalence of MMD was higher in patients of Japanese descent compared to Caucasians (P = 0.012) and higher than in the remaining US (P < 0.001). Non-Japanese Asians and Pacific Islanders had a higher incidence of MMD than Caucasians that was not statistically significant. There was no difference in MMD among Japanese living in Hawaii or Japan. Males had an equal percentage of hemorrhage and infarcts; females tended to have a higher incidence of ischemic events rather than hemorrhage. Age and sex distribution of our series were similar to larger reported MMD studies. Our results suggest that: (1) Moyamoya disease in Hawaii has a higher incidence and prevalence than the rest of the US, largely due to the larger percentage of Asians, particularly Japanese, living in Hawaii; and (2) genetic rather than environmental factors may explain the increased MMD in Hawaii.
BACKGROUND AND PURPOSE: This report examines the hypothesis that the higher risk of stroke among Japanese men in Japan compared with those in Hawaii is related to pathology in small intracerebral arteries by comparing the prevalence of such lesions in autopsied participants from two cohorts of Japanese men in Japan and Hawaii. METHODS: Existing histological sections from the left basal ganglia from 232 men from Japan and 175 men of Japanese ancestry in Hawaii were examined for selected abnormalities in arteries between 100 and 300 microns in diameter by three pathologists. The presence of lacunar infarcts was also noted, and information about cerebral infarcts, cerebral hemorrhages, and atherosclerosis in the circle of Willis was available for the Hawaii group. RESULTS: Lacunar infarcts and all small intracerebral artery lesions except medial fibrosis were more common at every age in Japan than in Hawaii. By cause of death, all lesions were three or more times more prevalent among men who died of stroke than of noncardiovascular causes in both areas. In the Hawaii group, the small intracerebral artery lesions were significantly associated with autopsy evidence of cerebral and lacunar infarcts, and with atherosclerosis in the large arteries of the circle of Willis. Among a large number of risk factors measured at the baseline examination in Hawaii, only high blood pressure and reported usual Asian diet were significantly associated with one or more measures of small intracerebral artery lesions. CONCLUSIONS: An overview of the accumulated data indicated that small intracerebral artery pathology plays an important role in the high risk of stroke in Japanese men in Japan compared with those in Hawaii. These studies support the idea that hypertension is a necessary factor in the causal pathway, but also indicate that some other factors are involved. Some aspect of an Asian diet continues to be of importance for future research.