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How multiagency partnerships can successfully address large-scale pollution problems: a Hawaii case study.

Oceanic circulation patterns deposit significant amounts of marine pollution, including derelict fishing gear from North Pacific Ocean fisheries, in the Hawaiian Archipelago [Mar. Pollut. Bull. 42(12) (2001) 1301]. Management responsibility for these islands and their associated natural resources is shared by several government authorities. Non-governmental organizations (NGOs) and private industry also have interests in the archipelago. Since the marine debris problem in this region is too large for any single agency to manage, a multiagency marine debris working group (group) was established in 1998 to improve marine debris mitigation in Hawaii. To date, 16 federal, state, and local agencies, working with industry and NGOs, have removed 195 tons of derelict fishing gear from the Northwestern Hawaiian Islands. This review details the evolution of the partnership, notes its challenges and rewards, and advocates its continued use as an effective resource management tool.

Conservation of Natural Resources↗

Well-done red meat, metabolic phenotypes and colorectal cancer in Hawaii.

Heterocyclic amines (HAAs) and polycyclic hydrocarbons are suspected colorectal cancer (CRC) carcinogens that are found in well-done meat. They require metabolic activation by phase I enzymes, such as the smoking-inducible CYP1A isoenzymes. N-acetyltransferase 2 (NAT2) also play a role in the further activation of HAAs. We conducted a population-based case-control study in Hawaii to test the associations of preference for well-done red meat and HAA intake with colon and rectal cancers, as well as the modifying effects of NAT2 and CYP1A2. We interviewed 727 Japanese, Caucasian or Native Hawaiian cases and 727 controls matched on sex, age, and ethnicity. HAA intake was estimated based on consumption of meat and fish for each of several cooking methods and doneness levels. A subgroup of 349 cases and 467 controls was phenotyped for CYP1A2 by a caffeine test. We found that preference for well-done red meat was associated with a 8.8-fold increased risk of CRC (95% CI: 1.7-44.9) among ever-smokers with the NAT2 and CYP1A2 rapid phenotypes, compared to ever-smokers with low NAT2 and CYP1A2 activities and who preferred their red meat rare or medium. A dose-dependent association was also found between the HAA intake estimates and male rectal cancer, with a two- to three-fold increase in risk from the low (T(1)) to high (T(3)) tertile of intake for each HAA. This association was strongest for MeIQx. HAA intake was not associated with male colon cancer or colon or rectal cancer in women. These data provide support to the hypothesis that exposure to pyrolysis products through consumption of well-done meat increases the risk of CRC, particularly in individuals who smoke and are genetically susceptible (as determined by a rapid phenotype for both NAT2 and CYP1A2). An attempt to examine the risk associated with specific HAAs suggested that the main HAAs increase risk of rectal cancer in men and that they do not appreciably affect risk of rectal cancer in women or of colon cancer in either sex.

Adolescent↗

Nonmelanoma skin cancer in Japanese residents of Kauai, Hawaii.

A prospective 3-year survey of nonmelanoma skin cancer in Japanese-American residents of the Hawaiian island of Kauai was conducted beginning in January 1983. The crude rate for basal cell and squamous cell carcinoma was 123/100,000, 88 times higher than the corresponding figure from Japan. This discrepancy may be attributed to an increase in ultraviolet exposure due to lifestyle and latitude, but arsenic exposure may also have played a role. Nonmelanoma skin cancer in Japanese in Hawaii appears to be a significant problem that has not been appreciated because these malignancies are not reportable to tumor registries.

Aged↗

Bowen's disease (squamous cell carcinoma in situ) in Kauai, Hawaii. A population-based incidence report.

BACKGROUND: The incidence of Bowen's disease (squamous cell carcinoma in situ) is rarely investigated. OBJECTIVE: Our purpose was to report the incidence of Bowen's disease in a defined Caucasian population in Kauai, Hawaii. METHODS: We conducted a prospective 5-year population study. RESULTS: We found 71 Caucasian residents, 44 men and 27 women, who had an initial episode of Bowen's disease during the 5-year period. The average annual incidence rate per 100,000 Caucasian residents of Kauai, standardized to the 1980 U.S. Caucasian population, was 174 for men and 115 for women, with a combined rate of 142. The incidence increased in older age groups. The mean age of the patients was 65.2 years. The most common anatomic site was the extremities. Subsequent Bowen's disease occurred in eight patients (11.3%). Recurrence after treatment developed in only one patient (1.4%). Twenty-six patients (36.6%) had concurrent skin cancers, either basal cell carcinoma or squamous cell carcinoma, or both. There was no increased incidence of internal malignancy. CONCLUSION: The incidence of Bowen's disease is high in Caucasian residents of Kauai and is 10 times higher than that reported from a northern Midwestern community. Kauai's intense ambient UV light and greater opportunity for year-round outdoor activities likely contributes to this higher rate.

Adult↗

Skin cancer prevention for children, parents, and caregivers: a field test of Hawaii's SunSmart program.

BACKGROUND: Children are at particular risk for sun exposure, a major cause of skin cancer. Parents and caregivers can help protect children by educating them about practicing safe sun habits, serving as role models, and providing supportive environments. OBJECTIVE: We evaluated SunSmart, a cancer prevention program for 6- to 8-year-old children, their parents, and outdoor recreation staff. METHODS: The intervention included staff training, on-site activities for children, interactive take-home booklets, behavior-monitoring scoreboards, incentives, providing sunscreen, and encouraging sun safe environments and policies. The program was evaluated by baseline and follow-up surveys of parents and recreation staff, monitoring forms, and on-site observations. RESULTS: There were positive changes in all major outcomes, including knowledge; sun protection habits of parents, children, and staff; readiness to change; sun protection policies; and sun protection norms. The changes ranged from improvements of 3% to more than 20%, and several changes were statistically significant. CONCLUSION: The results demonstrated the feasibility and short-term impact of Hawaii's SunSmart program and suggested areas for refinement and expansion.

Caregivers↗

Dysbaric cerebral air embolism in Hawaii.

Cerebral air embolism is a major cause of death and disability among sport scuba divers. To better define the epidemiologic and clinical manifestations of this infrequently encountered disorder, the records of all recompression treatments in Hawaii from 1976 through 1979 were reviewed. Forty-two cases of dysbaric air embolism (DAE) were identified on the basis of clinical criteria, accounting for 18% of the patients undergoing recompression treatment for diving-related disorders during this four-year period. In 22 patients (52%), DAE was part of a dysbarism syndrome that involved one or more forms of decompression sickness and/or in which DAE could not be differentiated from neurologic decompression sickness. The presenting signs and symptoms varied, with asymmetric multiplegia being the most common finding. Two patients died, giving a case fatality rate of 5% for those who survived until reaching the recompression chamber. Overall, 78% of the cases manifested either complete (61%) or substantial (17%) recovery with recompression and adjunctive medical measures. Traditional concepts of dysbaric cerebral air embolism are not adequate to explain the spectrum of clinical manifestations encountered in this condition.

Adolescent↗

Alcohol, tobacco, and other drug use among Asian American and Pacific Islander Adolescents in California and Hawaii.

As an aggregate group, the lowest rates of alcohol, tobacco, and other drug (ATOD) use are often reported for Asian Americans/Pacific Islanders (AAPIs), compared to other groups. However, the low rates are often based upon samples with small representations of AAPIs, or represented by only one or two AAPI groups. Consequently, reliable data on the rates of ATOD use among specific AAPI subgroups are severely lacking. Using data from school surveys collected from 9th grade students in California and 10th grade students in Hawaii, we compared the ATOD rates of Whites, Chinese, Filipino, Japanese, and Pacific Islander/Native Hawaiian adolescents. We found considerable variation in ATOD rates among subgroups of AAPIs, variation that was consistent across surveys. Chinese reported the lowest ATOD rates; Whites, Pacific Islanders, and Native Hawaiians reported among the highest. We found similar variation in need for alcohol and other drug treatment for these groups. Implications of these findings and recommendations for future research are discussed.

Acculturation↗

Symphalangism in Hawaii: a study of three distinct ethnic pedigrees.

Symphalangism was introduced into Hawaii by a Cherokee Indian in the late 1800s. The resultant pedigree, along with two other racially distinct pedigrees, confirms that the condition is an autosomal dominant genetic trait. Associated conditions include carpal and tarsal coalitions, cervical fusions, brachydactylism, symphalangism of the toes, and hearing loss. Surgical intervention in the hands is seldom, if ever, indicated but correction of the associated hearing loss is rewarding.

Adolescent↗

Preparation of high-titred antisera for sigma virus strains from Hawaii and France and their use in neutralization tests in vitro and in vivo.

Antisera were prepared in rabbits against two strains of sigma virus, from France and Hawaii respectively, using purified virus from cell cultures. All antisera had the same titre by immunofluorescence, 1/400 or 1/800, whether tested against the homologous or the heterologous virus. An antiserum prepared with the French strain neutralized the Hawaiian virus at a dilution of 1/800 both in vitro and in vivo. The Hawaiian virus was not neutralized to a significant extent by reference mouse ascitic fluids for 26 different vertebrate rhabdoviruses.

Aedes↗

Influences of ethnicity, treatment, and comorbidity on breast cancer survival in Hawaii.

The purpose of this study was to examine factors contributing to the ethnic discrepancies in breast cancer survival described previously. Through the use of the Hawaii Tumor Registry and insurance claims data, 1,052 breast cancer patients' survival times were examined in relation to demographics, disease characteristics, comorbidity, and treatment patterns as compared to national guidelines for breast cancer treatment. In stepwise and hierarchical Cox regression models, TNM stage was the strongest predictor of survival and explained all of the ethnic survival differences. In addition, comorbidity and treatment patterns were significant in predicting survival. In this population of health plan members, ethnic differences in survival were not a result of differential treatment, but due to variations in early detection. These results support the hypothesis that pre-existing conditions and treatment patterns are related to breast cancer survival even after controlling for stage at diagnosis indicating the usefulness of insurance claims data in this research field.

Adult↗

Ethnicity and conditional breast cancer survival in Hawaii.

The conditional survival experience of 4502 female breast cancer cases diagnosed in Hawaii between 1960 and 1983 was studied. The calculation of conditional survival is based on patients who have already survived for a specified time period. Cox proportional hazards models were used to examine the effect of ethnicity, stage at diagnosis, and menopausal, marital, and socioeconomic statuses on conditional survival prognosis. Native Hawaiian and Filipino women showed a significantly higher risk of dying from breast cancer than any other ethnic group, followed by Chinese and Caucasian women, while Japanese women had the lowest risk. The ethnic pattern of breast cancer survival changed and ethnic survival differences decreased from 17 to 4% as time progressed. Conditional survival varied greatly with stage at first diagnosis. For localized, regional, and distant disease, the conditional survival rate increased from 92, 71, and 24% after diagnosis to 95, 85, and 65% 5 years after diagnosis, respectively, indicating that stage at diagnosis becomes less important in determining survival as time progresses. Being married and of a high socioeconomic status increased survival probability. These results suggest that considering time effect, the conditional survival rate is an informative tool to assess clinical outcome of breast cancer among ethnic groups over a long follow-up period.

Breast Neoplasms↗

A prospective study of colon and rectal cancer among Hawaii Japanese men.

The goals of this study were to assess the association of diet, alcohol, smoking, and other life-style factors with the risk of colon and rectal cancer and to examine the differences in the risk factors associated with each cancer site. Information on diet, alcohol, smoking, and other life-style factors was obtained from 7945 Japanese-American men who were living in Hawaii and examined from 1965 through 1968. After 174,514 person-years of observation, 330 incident cases of colon cancer and 123 incident cases of rectal cancer were diagnosed by histology. The risk of both colon and rectal cancer increased with age, alcohol intake, and pack-years of cigarette smoking. For colon cancer, there was also a direct association with body mass index and heart rate, while an inverse association was observed with serum cholesterol, intake of monounsaturated fatty acid, and percentage of calories from fat. For rectal cancer, the risk decreased with an increase in the intake of carbohydrates as percentage of calories. These findings suggest that some of the risk factors for colon cancer are different from those for rectal cancer.

Age Distribution↗

Food security stakeholders in Hawaii: perceptions of food security monitoring.

OBJECTIVE: The purpose of this study was to document Hawai'i's food security stakeholders' perceptions of (1) definitions of food insecurity and hunger, (2) what should be measured, (3) how stakeholders interpret the Core Food Security Module (CFSM) and Face Valid Food Security Measure (FVFSM), and (4) the value of specific items in the CFSM. DESIGN: Perceptions were gathered through focus groups and interviews. SUBJECTS: The 43 stakeholders included 19 WIC nutritionists, 10 food pantry providers, 4 Hawaii foodbank board members, 4 social workers, 3 legislators, and 3 homeless food providers. ANALYSIS PERFORMED: Transcripts were analyzed using constant comparative analysis of each question asked, comparisons between groups, and comparisons with the research literature. RESULTS: Stakeholders desired more detailed information than the CFSM currently yields and also a simple tool to measure the entire range of food insecurity that could be used to "help the needy." Participants favored the FVFSM over the CFSM because "it is more accurate as far as seeing the picture properly." IMPLICATIONS: A "Simple Food Security Monitoring Tool," which is based on the FVFSM, was created as an alternative tool for local food security monitoring.

Adult↗

Socioeconomic status does not moderate the familiality of cognitive abilities in the Hawaii family study of cognition.

Data from 949 families of Caucasian and 400 families of Japanese ancestry who took part in the Hawaii Family Study of Cognition were used to ascertain the associations of parental cognitive ability, parental education and paternal occupation with offspring cognitive ability. In particular, analyses were focused on testing the possible moderating effects of parental socioeconomic status on the familial transmission of cognitive abilities. Parental cognitive ability was substantially associated and parental education and paternal occupation only trivially associated with offspring performance. In contrast to the findings of Turkheimer et al. (2003), there was no evidence in these data that familiality for cognitive abilities was lower in the lower as opposed to upper levels of socioeconomic status. These results were consistent across measures, ethnicity and sex of offspring.

Cognition↗

A case-control study of mammographic densities in Hawaii.

Epidemiologic evidence suggests that mammographic densities are markers of breast cancer risk. This project investigated the relation between breast cancer and densities in women of Chinese, Japanese, Filipino, Native Hawaiian, and Caucasian ancestry. Mammograms from breast cancer cases and from healthy controls were compared using a computer-assisted method of mammographic density assessment. From 1991 to 1997, 935 cases of breast cancer were diagnosed at Kaiser Permanente in Hawaii; for 647 (69%) subjects, a control woman matched by ethnicity, year of mammogram, and age was identified. Conditional multiple logistic regression was applied to estimate the relative risk of developing breast cancer. Breast cancer risk was associated with percent densities and with the size of the dense areas. Women in the category with the most densities experienced a twofold risk of developing breast cancer as compared to women with the least densities. Adjustment for risk factors reduced the strength of the association. Odds ratios were of similar magnitude in Asian women as in Caucasian/Native Hawaiian women, but they were not statistically significant. The results of this study indicate that the associations of breast cancer risk with the magnitude of the dense areas and with the percent densities are of similar strength in women of different ethnicities although density levels vary by ethnicity.

Adult↗

Serum vitamin D metabolite levels and the subsequent development of prostate cancer (Hawaii, United States)

OBJECTIVES: Because several serum studies of vitamin D metabolites have produced equivocal results on their relation to prostate cancer risk, the purpose of this study is to evaluate this association further. METHODS: A nested case-control study in a cohort of 3,737 Japanese-American men examined from 1967 to 1970 was conducted in Hawaii (United States). At the time of examination, a single blood specimen was obtained, and the serum was frozen. After a surveillance period of over 23 years, 136 tissue-confirmed incident cases of prostate cancer were identified. Their stored sera and those of 136 matched controls were measured for the following: 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D, calcium, phosphorus, and parathyroid hormone. RESULTS: There were no notable differences between cases and controls in their median serum levels of the five laboratory measurements. Odds ratios (OR) for prostate cancer, based on the quartiles of serum levels in controls, were also determined. The ORs for the highest quartiles relative to the lowest were 0.8 (95 percent confidence interval [CI] = 0.4-1.8) for 25-hydroxyvitamin D and 1.0 (CI = 0.5-2.1) for 1,25-dihydroxyvitamin D. CONCLUSION: It is possible that the lack of sufficient numbers of study subjects with low vitamin D levels affected the results. Nonetheless, the findings suggest that there is a lack of a strong association between vitamin D and prostate cancer.

Age Distribution↗

A case-control study of diet and colorectal cancer in a multiethnic population in Hawaii (United States): lipids and foods of animal origin.

Temporal trend and migrant studies have indicated that the etiology of colorectal cancer is predominantly environmental and, hence, modifiable. Animal fat intake has been frequently, but inconsistently, associated with the risk of this disease. We conducted a population-based case-control study in Hawaii (United States) among ethnic groups at different risks of the disease to evaluate the role of dietary lipids and foods of animal origin on the risk of colorectal cancer. We interviewed 698 male and 494 female Japanese, Caucasian (White), Filipino, Hawaiian, and Chinese patients diagnosed during 1987-91 with pathologically confirmed adenocarcinoma of the colon or rectum, and 1,192 population controls matched to cases on age, gender and ethnicity. Odds ratios (OR), adjusted for caloric intake and other dietary and non-dietary risk factors, were estimated using conditional logistic regression. Intakes of total fat, saturated fat (S) and polyunsaturated fat (P) were not related to the risk of colorectal cancer. However, an inverse association was found for the P/S ratio, with ORs of 0.6 in both genders (95 percent confidence interval [CI] = 0.4-1.0 for males; CI = 0.3-0.9 for females) for the highest compared with the lowest quartile (P < 0.05 for trend). Intakes of red meat and processed meat were associated with the risk of cancer in the right colon and rectum, respectively, in men only. Fat-trimmed red meat and fish intakes were not related to risk. Chicken eaten without skin was associated inversely with risk in both genders. The strongest association was found for eggs, with an OR of 2.7 (CI = 1.7-4.0) and 2.3 (CI = 1.4-3.7) for the highest compared with the lowest quartile of intake in men and women, respectively (P < 0.001 for trend). This association was dose-dependent, not explained by known confounders or other dietary variables, and was very consistent between genders, among ethnic groups, and across all segments of the large bowel. These data suggest that the ratio of polyunsaturated to saturated fat may be a better indicator of colorectal cancer risk than the absolute amount of specific fats in the diet. They also suggest that eggs and, possibly, untrimmed red meat and processed meat increase, and chicken eaten without skin decreases, colorectal cancer risk.

Adenocarcinoma↗