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PubMed1995

A longitudinal study of estrogen and calcium supplement use among Japanese women living in Hawaii.

BACKGROUND: Estrogen and calcium supplements represent accepted treatments for the prevention of osteoporosis in the United States. The effectiveness of these treatments, however, will depend upon the extent that they are utilized, which may vary over time. METHODS: We report a longitudinal study of estrogen and calcium use among a cohort of Japanese-American women living in Hawaii. Their mean age at the baseline examination in 1981 was 63.9 (age range 45 to 81). Between 1981 and 1992 the same women were repeatedly surveyed regarding their estrogen and calcium supplement use. RESULTS: During the decade of follow-up the prevalence of estrogen use doubled, with 25 to 30% of the women reporting estrogen use in the later years. The prevalence of calcium supplement use (500 mg/day or more) quadrupled over the same interval, with 20% of the women reporting calcium supplement use in the later years. The increases in estrogen and calcium supplement use derived from complex patterns of use. For estrogen, less than half of the users in 1981 were still using 5 years later; the number of women stopping estrogen, however, were more than replaced by new estrogen users. For calcium supplements, fewer than half of the women initiating use continued for as long as 5 years. Women beginning estrogen were younger, had more often used estrogen in the past, had a lower body mass index, had dietary calcium intakes of 400 mg/day or greater, and were more likely to have regularly used alcohol. Women initiating calcium supplements exhibited several of the same characteristics as women initiating estrogen use (younger age, past estrogen use, and regular alcohol use). CONCLUSIONS: The changes in use over the past decade may reduce the risk of osteoporotic fractures among our cohort. Benefits from the changes, however, could be limited by the inconsistent use by many of the cohort women. Also of concern are the weak associations observed between estrogen and calcium supplement use and bone mass measurements, which are strong indicators of fracture risk. It appears that treatment in our cohort has failed to reach many of the women with the greatest fracture risks.

Age Factors↗

PubMed2001

Impact of skin cancer prevention on outdoor aquatics staff: the Pool Cool program in Hawaii and Massachusetts.

BACKGROUND: Aquatic staff, including lifeguards, are exposed to intense sunlight for many hours each day and are likely to be at a relatively high risk for developing skin cancer. However, no interventions have been specifically directed to staff at outdoor swimming pool sites. METHODS: We conducted a randomized controlled trial among aquatic staff at 28 outdoor pool sites in Hawaii and Massachusetts. Intervention pools received sun protection education and control pools received education on child injury prevention. Staff in both arms received orientation sessions and led instruction during swim lessons. Analysis of covariance was used to compare and test for changes in outcome variables (sun protection habits and sunburning rates of aquatic staff) and pool protection policies. Surveys were completed at the beginning and end of the summer. RESULTS: Surveys were completed by 220 aquatics staff at baseline; 194 surveys were completed at posttest. Compared with staff at control pools, sun protection policies (P < 0.04) and sunburning rates (P < 0.05) improved at sun protection pools from baseline to posttest. However, the difference in the mean score of all sun protection habits between the two study groups was nonsignificant. CONCLUSION: The Pool Cool sun protection intervention had significant effects on lifeguards' sunburn rates and pool sun safety policies but did not improve reported sun protection behaviors. More intensive strategies may be needed to influence aquatics workers who have already begun to adopt skin cancer prevention practices.

Adult↗

PubMed1986

Studies of nutrients and their relationship to cancer in the multiethnic population of Hawaii.

Because of the many ethnic cultures in Hawaii, there is great dietary variation in the population, even within individual ethnic groups. Epidemiologic studies in this setting are providing useful information on the role of macro- and micronutrients in the risk for certain cancers. The results of several recent and ongoing case-control studies are described, especially with regard to the influence of dietary fat, vitamin A, and vitamin C. The degree of consistency of the findings with other reports in the literature is discussed.

Breast Neoplasms↗

PubMed1996

Lead exposure in Laysan albatross adults and chicks in Hawaii: prevalence, risk factors, and biochemical effects.

Prevalence of lead exposure and elevated tissue lead was determined in Laysan albatross (Diomedea immutabilis) in Hawaii. The relationship between lead exposure and proximity to buildings, between elevated blood lead and droopwing status, and elevated liver lead and presence of lead-containing paint chips in the proventriculus in albatross chicks was also examined. Finally, the effects of lead on the enzyme delta-aminolevulinic acid dehydratase (ALAD) was determined. There was a significant association between lead exposure or elevated tissue lead and proximity to buildings in albatross chicks and presence of lead paint chips in the proventriculus and elevated liver lead in carcasses. Although there was a significant association between elevated blood lead and droopwing chicks, there were notable exceptions. Prevalence of elevated tissue lead in albatross chicks was highest on Sand Island Midway and much less so on Kauai and virtually nonexistent in other areas. Prevalence of lead exposure decreased as numbers of buildings to which chicks were exposed on a given island decreased. Laysan albatross adults had minimal to no lead exposure. There was a significant negative correlation between blood lead concentration and ALAD activity in chicks. Based on ALAD activity, 0.03-0.05 microg/ml was the no effect range for blood lead in albatross chicks.

Aging↗

PubMed1993

Frequency of glucose-6-phosphate dehydrogenase (G6PD) mutations in Chinese, Filipinos, and Laotians from Hawaii.

In a Hawaii Hereditary Anemia Screening Project, 4,984 participants were tested for glucose-6-phosphate dehydrogenase (G6PD) deficiency by a filter paper blood spot fluorescence test. Abnormal samples and suspected heterozygotes were checked by quantitative G6PD assay (normal 4.5 to 14 units/g Hb). G6PD was deficient (< 1.5 units/g Hb) in 188 of 2,155 males; 7 other males had low activity (1.5 to 2.8 units/g Hb). The gene frequency, estimated from males after excluding referred and related cases, was 0.037 for Chinese, 0.134 for Filipinos, and 0.203 for Laotians. Among 2,829 females tested, family data showed 111 females were obliged to be at least heterozygous, regardless of G6PD activity, and 43 others had low G6PD activity. Most heterozygotes probably remained undetected by G6PD screening. In 28 females, activity was under 10%; in another 9 females, activity was < 1.5 units/g Hb. Since only 25 homozygotes would be predicted, this apparent excess of females with deficient activity could be due to unequal X-inactivation in some heterozygotes. DNA analysis by polymerase chain reaction amplification and special analytic procedures revealed 10 different missense mutations in 75 males. The nucleotide 835 A-->T and 1360 C-->T transitions were first detected in this Hawaiian Project; we found that the nucleotide 1360 mutation was the most common cause of G6PD deficiency in Filipinos. This is the first report of G6PD screening and analysis of molecular G6PD mutations in Filipino and Laotian populations.

Adult↗

PubMed1994

The peak bone mass of Hawaiian, Filipino, Japanese, and white women living in Hawaii.

Our study compares the bone mass of Hawaiian, Filipino, Japanese, and white women living in Oahu, Hawaii. Eligible women ranged in age from 25 to 34; all had bone mass measurements at the spine, calcaneus, and proximal and distal radius. Their average bone mineral density (BMD) remained stable with age at all four bone sites, indicating that the age range 25-34 may represent the peak bone mass. Bone mass varied, however, between ethnicities; differences in BMD up to 11% were observed. The Hawaiian women had the greatest BMD, and whites had the second greatest BMD at the spine and calcaneus. The Japanese most frequently had the lowest BMD. Differences in body size partly explained the differences; most ethnic differences were reduced or eliminated after adjusting for height and weight. At the spine, the ethnic differences for BMD were also apparent with BMC and with vertebral area. Hawaiian and white women had greater values than Japanese or Filipino women. Differences at the proximal radius resembled the spine, except that whites had the widest proximal widths. The results were more complex for the distal radius. At the distal radius whites had the lowest BMD of the four ethic groups. The difference between whites and Hawaiians derived from the greater bone mineral content (BMC) of the Hawaiian women. By contrast, the difference between whites and the Japanese and Filipinos derived from the wider distal widths of the white women. Compared with the Japanese and Filipino women, the white women appeared to disperse their BMC at the distal radius across a wider bone width.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1993

The case for restructuring health care in the United States: the Hawaii paradigm.

Health care in the United States is plagued by many problems. This includes excessive specialization with too few generalists, burdensome bureaucratic federal rules and regulations, and outlandish malpractice awards--all contributing to costs of care that exceeds all other nations. Cost has erroneously been identified as the cause of the problem rather than being one of many results of a failing system. Rather than repetitive unsuccessful efforts to tinker with cost as the cause, it makes far more sense to design and build a better structure of health care including expanding the existing biomedical model into a broader biomedical-psychosocial model. Hawaii, with virtually 100% of its population insured, is closer to this model than most states. It also manages to be ranked the healthiest state with one of the lowest health care costs in the nation.

Cost Control↗

PubMedDate not supplied

Effects of pentachlorophenol and other chemical preservatives on the health of wood-treating workers in Hawaii.

The morbidity and mortality of workers occupationally exposed to wood treating chemicals used in Hawaii for the years 1960 to 1981 were evaluated. The specific chemical exposures investigated were CCA (chromated copper-arsenate), TBTO (tributyl tin oxide) and PCP (pentachlorophenol). Results of detailed medical histories, laboratory and physiological tests, and physical examinations of 88 wood treaters were compared with those of 58 matched controls. The occupationally exposed cases had a significantly higher mean level of urinary PCP as compared to the controls (mean of 174 ppb vs. 35 ppb, micrograms/kg). There were no significant differences between the groups for the other urinary pesticide residues. The medical histories and physical examinations revealed no significant variations between the wood treaters and the comparison group. Review of all organ systems and laboratory data showed no clinically significant differences between exposed and nonexposed cohorts, although elevated hepatic enzymes in both groups merit further study. The results indicated no adverse health effects or increased incidence of mortality resulting from exposure to wood preservative chemicals in wood treaters who had worked in the industry for 0.33 to 26.3 years with a median of 6.5 years. Only 6 deaths were reported, 5 of cardiovascular disease, one of cause undetermined and none of cancer. Total number of deaths were less than the 8 anticipated for this age group.

Animals↗

PubMed1980

Reported lactose tolerance of members of various racial/ethnic groups in Hawaii and Asia.

Subjects from various racial/ethnic groups in Hawaii and homeland Chinese, Japanese, and Koreans reported on their milk drinking in childhood and adulthood, as well as on whether or not milk drinking produced symptoms of intolerance. Intolerance was comparatively infrequent in all groups, although significant differences existed between groups in the frequency with which they manifested symptoms and in discomfort scores. Differences between Hawaiian subjects of Asian ancestry and homeland Asians in the frequency of reported symptoms, in mean discomfort scores, and in amount of milk needed to produce symptoms, as well as the high proportion of symptomatology among Hapa-Haoles (persons of Caucasian and Oriental ancestry) and other data reported herein, are not supportive of the usual genetic explanation of lactose tolerance and are supportive of the belief that dietary practice influences tolerance.

Adult↗

PubMedDate not supplied

Maternal diabetes and congenital malformations among live births in Hawaii.

The frequency of congenital malformations in 187,266 live births in Hawaii from 1956 through 1966, was found to be significantly higher among offspring diabetic mothers (0.0175) than in offspring of non-diabetic mothers (0.0086) or mothers with no complications of pregnancy (0.0074). However, the frequency of malformations in offspring of diabetic mothers was not significantly higher than in offspring of mothers with heart conditions of hypertension.

Adult↗

PubMed2004

Relations between land use and organochlorine pesticides, PCBs, and semi-volatile organic compounds in streambed sediment and fish on the island of Oahu, Hawaii.

Bed-sediment and/or fish samples were collected from 27 sites around the island of Oahu (representing urban, agricultural, mixed, and forested land use) to determine the occurrence and distribution of hydrophobic organic compounds including organochlorine pesticides, polychlorinated biphenyls (PCBs), and semi-volatile organic compounds (SVOCs). Of the 28 organochlorine compounds analyzed in the fish, 14 were detected during this study. Nineteen of the 31 organochlorine compounds and 40 of the 65 SVOCs were detected in the sediment. Urban sites had the highest number of detections and tended to have the highest concentrations of pesticides. Chlordane compounds were the most frequently detected constituents at urban sites, followed by dieldrin, polycyclic aromatic hydrocarbons (PAHs), and DDT compounds. PAHs were the most frequently detected constituents in watersheds with mixed (urban and agricultural) land use. The only pesticides detected at agricultural sites were DDT and its degradation products, DDD and DDE. No pesticides or PCBs were detected at the forested sites, but a few ubiquitous SVOCs were found in sediments at some forested sites. In general, concentrations of the most frequently detected pesticides were higher in fish than in sediment. Following a trend that has been observed elsewhere in the nation, concentrations of most organochlorine pesticides and PCBs are decreasing in Hawaii.

Agriculture↗

PubMed2006

Effectiveness of a coral-derived surfacing material for reducing sediment production on unpaved roads, Schoffield barracks, Oahu, Hawaii.

This study evaluated the effectiveness of two application rates of a coral-derived surfacing material for both traffic and nontraffic road conditions using simulated rainfall (110-120 mm h(-1) for 30-90 min) on 0.75-m (wide) x 5.0-m (long) plots of similar slope (roughly 0.1 m m(-1)). The coral is a locally available material that has been applied to unpaved roads surfaces on Schoffield Barracks, Oahu, Hawaii (USA), where this experiment was conducted. The simulations show that compared with a bare control plot, the coral-based surface application rates of 80 and 160 kg m(-2) (equivalent to only 10- and 20-mm thicknesses) reduced road sediment production by 75% and 95%, respectively, for nontraffic conditions. However, after two passes of the research vehicle during wet conditions, sediment production rates for the two coral treatments were not significantly different from those on the bare road plots. The overall effectiveness of the coral-derived surfacing material is unsatisfactory, primarily because the on-road surface thickness associated with the application rates tested was too small. These rates were selected to bracket those applied to training roads in the study area. Furthermore, the composition of the coral-based material does not facilitate the development of a sealed, erosion-resistant surface. When applied at the low rates tested, the coral material breaks down under normal traffic conditions, thereby losing its ability to counter shearing forces exerted by overland flow on long hillslopes where erosion measures are most needed. These simulations, combined with observations on roads in the study area, indicate that this material is not an appropriate road surfacing material for the site-at least for the low application rates examined. These results are preliminary; extended testing of higher applications rates at the hillslope scale under natural climate and traffic conditions is needed to better judge the effectiveness of this material over time.

Analysis of Variance↗

PubMed1982

Glucose intolerance and nine-year mortality in Japanese men in Hawaii.

The relationship between glucose intolerance and nine-year mortality was examined in a cohort of approximately 8,000 men of Japanese ancestry living in Hawaii who were 45 to 68 years of age at baseline examination. Age-adjusted mortality for death from all causes, cardiovascular disease, coronary heart disease and causes other than cardiovascular disease and cancer were significantly higher in men with glucose intolerance, defined by either medication for diabetes or 1-hour post-load serum glucose levels above the 90th percentile cut-point (225 mg/dl) at baseline examination, than in normoglycemic men. Although many cardiovascular risk factors were found to be associated with glucose intolerance, both post-load serum glucose level and medication for diabetes remained significant as risk factors for overall, cardiovascular and coronary death in multivariate logistic analysis in which confounding effects of age, blood pressure, serum cholesterol, body mass index and other important risk factors were taken into account.

Age Factors↗

PubMed1987

Postmortem findings in sudden and non-sudden deaths among Japanese-American men in Hawaii.

Analyses were made of the cause of death and major pathologic findings among 1,085 autopsied Japanese-American men in Hawaii to determine the differences between the 167 men who experienced sudden death within 24 hours of being well and the 918 men with non-sudden death. Sudden deaths were further divided into three subgroups according to the interval from the onset of symptoms to death: (less than one hour; one to six hours; more than six hours). Nearly 90 percent of sudden deaths and 25 percent of non-sudden deaths were attributed to cardiovascular disease. The proportion of deaths due to coronary heart disease was highest in sudden deaths less than one hour (72 percent) and lowest in sudden deaths more than six hours (49 percent), whereas the proportion of stroke deaths was highest in sudden deaths more than six hours (37 percent) and lowest in sudden deaths less than one hour (9 percent). The prevalence of myocardial infarction and the grade of coronary atherosclerosis were also significantly greater for sudden deaths (especially sudden deaths less than one hour) than for non-sudden deaths.

Aged↗

PubMed1983

The impact of elevated blood pressure upon 10-year mortality among Japanese men in Hawaii: the Honolulu Heart Program.

The impact of blood pressure upon total and cause-specific mortality during 10 years of follow-up was studied for 7610 Japanese men in Hawaii, aged 45-68 at baseline examination. The age adjusted rate of total mortality for men with definite hypertension (WHO criteria) was twice that for normotensive men. The relative risk of mortality was five for all cardiovascular diseases (CVD), four for coronary heart disease (CHD), and six for stroke. Men with borderline hypertension also had significantly high mortality rates intermediate between the definite hypertensives and the normotensives. Both systolic blood pressure (SBP) and diastolic blood pressure (DBP) were the most important independent predictors of total, CVD, CHD and stroke mortality in multivariate analysis, taking account of 11 other known risk factors. However, SBP was more strongly related to total, CVD and CHD mortality than was DBP, whereas the reverse was true for stroke mortality. There was no significant association of either SBP or DBP with cancer and other non-cardiovascular mortality in multivariate analysis. Men who were receiving antihypertensive medication at baseline examination had a higher mortality from CVD, CHD and stroke as compared to untreated men in every category of blood pressure status. This apparently paradoxical finding probably reflects more advanced status of hypertension existing before treatment rather than adverse effects of drugs per se; however, this latter possibility cannot be dismissed.

Aged↗

PubMed1983

Campylobacter jejuni enteritis in Honolulu, Hawaii.

The incidence of Campylobacter jejuni in patients with acute diarrhoea was studied in Honolulu, Hawaii. C. jejuni was recovered from 8.7% of diarrhoeal stools, compared to isolation rates of 4.2% for Salmonella and 3.8% for Shigella. C. jejuni occurred mainly in the summer and autumn, and in all age and racial groups. There was a significantly higher incidence of abdominal pain, fever history, bloody stools and faecal leucocytes in patients with Campylobacter enteritis.

Acute Disease↗

PubMed1996

Aplysiatoxin and debromoaplysiatoxin as the causative agents of a red alga Gracilaria coronopifolia poisoning in Hawaii.

The causative toxins of a red alga Gracilaria coronopifolia poisonings in Hawaii, which broke out in succession in September of 1994, were studied. Two major toxins were isolated from both extracts of the two original algal samples which caused separate poisonings. By spectroscopic method, these toxins were shown to be completely identical with aplysiatoxin and debromoaplysiatoxin which have previously been obtained from the sea hare and also from blue green algae. The human symptoms and the amount of these toxins in the original algal samples indicate that aplysiatoxin and debromoaplysiatoxin were the causative agents of the human poisoning incidents. This is the first reported case of the implication of aplysiatoxin and debromoaplysiatoxin in food poisoning. The existence of these toxins in the residue of algae washed in saline was confirmed by HPLC analysis. Furthermore, we observed blue-green algal parasitism on the surface of the toxic G. coronopifolia. Therefore, epiphytic organisms such as blue-green algae might be the true origin of the toxins in G. coronopifolia.

Carcinogens↗

PubMed1994

The high prevalence of diabetes mellitus and hyperinsulinemia among the Japanese-Americans living in Hawaii and Los Angeles.

A comparative epidemiologic investigations was conducted among Japanese immigrants and their offspring living in Hawaii and the Los Angeles area, and among Japanese living in Hiroshima. All subjects received an oral glucose tolerance test and the diagnosis of diabetes was made on the basis of WHO criteria. In the subjects aged 40 years or older, the age, sex, and obesity-specific prevalence of diabetes was 2-3 times higher among Japanese living in America than those in Hiroshima. The fasting and post-glucose load serum immunoreactive insulin concentrations were higher in the Japanese-Americans compared to the Hiroshima inhabitants with the same degree of obesity and glucose tolerance. We suggest that a westernized lifestyle induces peripheral insulin resistance and promotes the development of diabetes among Japanese.

Adult↗