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Retrovirus-associated adult T-cell leukemia-lymphoma: an epidemiologic study of five cases among Hawaii-born offspring of migrant Japanese.

Adult T-cell leukemia-lymphoma (ATLL) is a distinct clinicopathologic entity etiologically linked to HTLV-I infection. We have identified five cases of retrovirus-associated ATLL among Hawaii-born first generation offspring (nisei) of migrant Japanese. Four patients were offspring of migrant Japanese (issei) who emigrated to Hawaii from Okinawa, an HTLV-I endemic area. The fifth patient was born of parents who emigrated to Hawaii from Fukushima and Miyagi prefectures, HTLV-I nonendemic areas. Epidemiologic implications and family studies with regard to HTLV-I antibody testing of the index cases are discussed. The high rate of HTLV-I antibody seropositivity among family members and relatives indicates that the risk of acquiring HTLV-I infection and of developing ATLL persists long after migration. Documentation of ATLL among offspring of Japanese immigrants to Hawaii is an important observation because it confirms the potential for long latency between putative exposure to virus and the development of overt disease. Changing marriage patterns among the Hawaii-Japanese may weaken the risk of vertical virus transmission to the descendents of migrants from southern Japan, while increasing the risk to children born of mixed marriages. In addition, blood products derived from high-risk donors will constitute a continuing hazard if they are not subject to screening.

Adolescent↗
PubMed1994

Health of infant is the main reason for breast-feeding in a WIC population in Hawaii.

OBJECTIVE: To determine factors influencing infant feeding method choices among women who received services from the Special Supplemental Food Program for Women, Infants, and Children (WIC) during pregnancy in Hawaii. DESIGN: A retrospective survey mailed to all resident mothers who had live births in Hawaii between January 1, 1989, and March 31, 1989, and who received WIC services during pregnancy. SETTING: The state of Hawaii. SUBJECTS: The subjects were 322 mothers who received WIC services during pregnancy for whom data were complete, taken from a sample of 2,013 women who had live births in the state of Hawaii (51% response rate) between January 1, 1989, and March 31, 1989, of whom 324 participated in WIC during pregnancy. MAIN OUTCOME MEASURES: Infant feeding method (exclusive breast, exclusive formula or mixed) at hospital discharge. STATISTICAL ANALYSES PERFORMED: The chi 2 analysis for differences among feeding method groups and multiple logistic regression to calculate odds ratios for independent effects of maternal characteristics and other influences on feeding method choice. RESULTS: Reasons for infant feeding choice, timing of the choice, maternal age, parity, and place of residence were the main factor influencing infant method choice. Health of the infant was the primary reason for choice of feeding method and was the strongest determinant of exclusive breast-feeding (odds ratio = 23.99; confidence interval = 9.75-59.02; P < .0001) and was negatively related to the choice to formula-feed (odds ratio = 0.03; confidence interval = 0.01-0.08; P < .0001). APPLICATIONS: Relationship between WIC and hospital lactation consultants could enhance follow up in the hospital and after returning home with WIC mothers who prenatally state an intention to breast-feed. Convenience and bonding are aspects of breast-feeding enjoyed by WIC mothers in Hawaii that could be used in breast-feeding promotion efforts.

Adult↗
PubMed2003

Residence, delivery and referral patterns of infants and fetuses with birth defects delivered in Hawaii, 1986-1999.

Information on residence, delivery and referral patterns is useful to a birth defects program for allocation of resources, predicting where deliveries may have occurred, and estimating the impact of altering geographic inclusion criteria. The purpose of this study was to describe the residence, delivery and referral patterns for infants and fetuses with birth defects delivered in Hawaii. Data were obtained from the Hawaii Birth Defects Program and included birth defects cases delivered between 1986 and 1999 with known delivery residence and place of delivery. Of 12,873 total cases, 171 (1%) were delivered to out-of-state residents. Of the remaining 12,702 cases delivered to residents in the four Counties of Hawaii, 9905 (78%) were to City and County of Honolulu residents and 2797 (22%) were to residents of Hawaii, Kauai and Maui Counties. Of the cases delivered to City and County of Honolulu residents, 9903 were delivered in that County. Of the cases delivered to residents of the other three Counties, 591 (21%) were referred to the City and County of Honolulu for delivery, and 1602 (57%) were referred to the City and County of Honolulu for any reason. Honolulu delivery referral rates and total referral rates for cases delivered to Hawaii, Kauai and Maui County residents were higher with prenatal diagnosis of a birth defect (59 and 87%, respectively) and elective termination (70 and 85%, respectively), and varied among 53 different types of birth defect (0-83% and 23-100%, respectively).

Congenital Abnormalities↗
PubMed1998

Ethnic-specific predictors of prenatal care utilisation in Hawaii.

The state of Hawaii has had near-universal health insurance coverage for the last 20 years. Its highly diverse population offers the opportunity for a unique, natural experiment in the United States on the examination of social differences in health care utilisation when financial barriers are removed. Therefore, the objective of this study is to examine predictors of prenatal care utilisation patterns in the four major ethnic groups in Hawaii. The data used in this study are the 1979-92 Hawaii livebirth vital record files. A total of 165,301 singleton livebirths to Hawaii-resident mothers of Caucasian, native Hawaiian, Japanese or Filipino ancestry were selected. Despite near-universal health care coverage in Hawaii, a surprising number of women did not adequately utilise prenatal care, with large differences between groups. Multivariate analyses indicated that similar maternal socio-demographic factors were associated with prenatal care use in each ethnic group. Social variation continues to exist among all ethnic groups even in the presence of universal access to care. These data emphasise the need to address the distinct cultural needs of populations for providing health services, and further challenge the assumption that removal of financial barriers will ensure a high level of prenatal care use.

Adolescent↗
PubMed2005

Host population persistence in the face of introduced vector-borne diseases: Hawaii amakihi and avian malaria.

The past quarter century has seen an unprecedented increase in the number of new and emerging infectious diseases throughout the world, with serious implications for human and wildlife populations. We examined host persistence in the face of introduced vector-borne diseases in Hawaii, where introduced avian malaria and introduced vectors have had a negative impact on most populations of Hawaiian forest birds for nearly a century. We studied birds, parasites, and vectors in nine study areas from 0 to 1,800 m on Mauna Loa Volcano, Hawaii from January to October, 2002. Contrary to predictions of prior work, we found that Hawaii amakihi (Hemignathus virens), a native species susceptible to malaria, comprised from 24.5% to 51.9% of the avian community at three low-elevation forests (55-270 m). Amakihi were more abundant at low elevations than at disease-free high elevations, and were resident and breeding there. Infection rates were 24-40% by microscopy and 55-83% by serology, with most infected individuals experiencing low-intensity, chronic infections. Mosquito trapping and diagnostics provided strong evidence for year-round local transmission. Moreover, we present evidence that Hawaii amakihi have increased in low elevation habitats on southeastern Hawaii Island over the past decade. The recent emergent phenomenon of recovering amakihi populations at low elevations, despite extremely high prevalence of avian malaria, suggests that ecological or evolutionary processes acting on hosts or parasites have allowed this species to recolonize low-elevation habitats. A better understanding of the mechanisms allowing coexistence of hosts and parasites may ultimately lead to tools for mitigating disease impacts on wildlife and human populations.

Animals↗
PubMed1996

Cancer among American-Samoans: site-specific incidence in California and Hawaii.

BACKGROUND: There is a paucity of data about cancer among American-Samoans, the largest Pacific Islander group after Hawaiians. This study provides the first data on the incidence and relative risk for all cancers among American-Samoans on the US mainland and in Hawaii. METHODS: The University of Southern California Cancer Surveillance Program and the Hawaii Tumor Registry, two population-based cancer surveillance programmes, provided archival data on American-Samoans residing in Los Angeles Country. California and in Hawaii, respectively. RESULTS: There were significant differences in the incidence and age-adjusted site-specific relative risk of cancers between American-Samoans, Hawaiians, and Anglos (non-Hispanic whites). In Hawaii, American-Samoans diagnosed with cancer compared with Hawaiians had a higher age-adjusted site-specific relative risk for cancers of the nasopharynx (especially males), liver, prostate, thyroid, and blood (especially females) and a lower relative risk for cancers of the colon, rectum (especially males), lung (especially females) and breast. Furthermore, compared with Anglos diagnosed with cancer in Hawaii, American-Samoans had a higher relative risk for cancers of the nasopharynx (especially males), stomach, liver, lung (especially males), corpus uteri, thyroid and blood, and a lower relative risk for cancers of the colon, skin, breast, testes, cervix uteri, bladder (especially males), and lymph nodes. A relatively similar profile of cancer distribution and relative risk was observed among American-Samoans and Anglos diagnosed with cancer in California. CONCLUSIONS: The data provide baseline information which has important implications for future cancer control research and prevention in this population.

Adolescent↗
PubMed1988

A comparison of the 12-year mortality and predictive factors of coronary heart disease among Japanese men in Japan and Hawaii.

The mortality and predictive factors of coronary heart disease among men of Japanese ancestry in Japan and Hawaii were compared on the basis of 12 years follow-up data using comparable methods of case ascertainment and risk factor measurements. Among 1,687 men (Japan) and 7,536 men (Hawaii) who were free of coronary heart disease and aged 45-69 at baseline examination in 1965-1968, 20 (Japan) and 123 (Hawaii) cases of fatal coronary heart disease were identified. The age-adjusted mortality rate was 40% higher in Hawaii than in Japan. The difference was not statistically significant, but consistent with earlier studies. More than half of this difference in mortality rate was attributed to different levels of known risk factors in the two cohorts. In multivariate analysis using the combined population, age, blood pressure, serum cholesterol, serum glucose, cigarette smoking, and alcohol intake (inversely) remained as significant predictors of coronary heart disease mortality. Although the associations of risk factors with coronary heart disease tended to be stronger in Hawaii than in Japan, there was no statistically significant difference in regression coefficient for any of the risk factors studied. These findings cannot be claimed to be definitive because of the small number of cases, especially in Japan.

Actuarial Analysis↗
PubMed2006

Dietary factors related to higher plasma fibrinogen levels of Japanese-americans in hawaii compared with Japanese in Japan.

OBJECTIVE: We investigated whether dietary factors explain higher plasma fibrinogen levels in Japanese emigrants living a Western lifestyle in Hawaii compared with Japanese in Japan. METHODS AND RESULTS: Plasma fibrinogen and nutrient intakes were examined by standardized methods in men and women 40 to 59 years of age from a Japanese-American sample in Hawaii (100 men and 106 women) and 4 population samples in Japan (569 men and 567 women). Multiple linear regression models were used to examine the relationship between dietary factors and the plasma fibrinogen difference between Hawaii and Japan. Average plasma fibrinogen was significantly higher in Hawaii compared with Japan (P<0.001 in both genders). In multiple linear regression analyses with each dietary variable considered separately, body mass index reduced the plasma fibrinogen difference between Hawaii and Japan by 20.4%; iron intake (mg/1000 kcal) and estimated total sugar intake (%kcal) reduced this difference by 30.0% and 14.4%, respectively. In a model that included body mass index, iron, estimated total sugars, and caffeine (also age and gender), this difference was reduced by 61.3% (from 42.2 to 16.3 mg/dL). CONCLUSIONS: Higher intake of iron, sugar, and caffeine, in addition to obesity, account largely for higher fibrinogen levels with Westernized lifestyle.

Adult↗
PubMed1997

IDDM incidence in a multiracial population. The Hawaii IDDM Registry, 1980-1990.

OBJECTIVE: The Hawaii IDDM Registry was created to determine the incidence rate of IDDM among children aged < 15 years of Oahu between 1980 and 1990. Because of the multiracial population living in Hawaii, it is an ideal state in which to study the effect of migration on IDDM incidence. RESEARCH DESIGN AND METHODS: Data were collected by a retrospective hospital chart review and physician survey. Registry criteria included 0-14 years of age at IDDM diagnosis and primary residence on Oahu. Children who were military dependents were excluded. Denominator data were compared from two sources. RESULTS: A total of 113 new-onset IDDM cases were identified. Case ascertainment was 97%. The unadjusted annual incidence rate was 7.04-7.61 per 100,000 (95% CI 5.83-9.19), depending on which denominator source was used. Race- and ethnicity-specific rates varied greatly (all rates per 100,000): part Hawaiian, 15.34-16.58; Caucasian, 6.21-6.71; Filipino, 3.66-3.96; and Japanese, 2.85-3.08. Temporally, the incidence fluctuated between a low of 2.96 per 100,000 in 1981 to highs of 11.11 and 11.85 per 100,000 in 1985 and 1989, respectively. Ascertainment-corrected rates for these years (3.70, 11.76, and 13.48 per 100,000, respectively) show that the fourfold incidence increase between 1980 and 1989 was not due to ascertainment differences. CONCLUSIONS: IDDM incidence among children < 15 years of age in Hawaii was the lowest documented in the U.S. The incidence among part-Hawaiian children was 2.5 times greater than that of Caucasian children in Hawaii. IDDM incidence rates among Japanese children in Hawaii were comparable with rates in Japan. The temporal variation in IDDM incidence corresponded with a mid-1980s pandemic of IDDM documented elsewhere.

Adolescent↗
PubMed2004

Genotype and phylogenetic characterization of hepatitis B virus among multi-ethnic cohort in Hawaii.

AIM: Hepatitis B virus (HBV) genomes in carriers from Hawaii have not been evaluated previously. The aim of the present study was to evaluate the distribution of HBV genotypes and their clinical relevance in Hawaii. METHODS: Genotyping of HBV among 61 multi-ethnic carriers in Hawaii was performed by genetic methods. Three complete genomes and 61 core promoter/precore regions of HBV were sequenced directly. RESULTS: HBV genotype distribution among the 61 carriers was 23.0% for genotype A, 14.7% for genotype B and 62.3% for genotype C. Genotypes A, B and C were obtained from the carriers whose ethnicities were Filipino and Caucasian, Southeast Asian, and various Asian and Micronesian, respectively. All cases of genotype B were composed of recombinant strains with genotype C in the precore plus core region named genotype Ba. HBeAg was detected more frequently in genotype C than in genotype B (68.4% vs 33.3%, P<0.05) and basal core promoter (BCP) mutation (T1762/A1764) was more frequently found in genotype C than in genotype B. Twelve of the 38 genotype C strains possessed C at nucleotide (nt) position 1858 (C-1858). However there was no significant difference in clinical characteristics between C-1858 and T-1858 variants. Based on complete genome sequences, phylogenetic analysis revealed one patient of Micronesian ethnicity as having C-1858 clustered with two isolates from Polynesia with T-1858. In addition, two strains from Asian ethnicities were clustered with known isolates in carriers from Southeast Asia. CONCLUSION: Genotypes A, B and C are predominant types among multi-ethnic HBV carriers in Hawaii, and distribution of HBV genotypes is dependent on the ethnic background of the carriers in Hawaii.

Adult↗
PubMed2000

Diarrhea-associated hospitalizations among children in Hawaii.

OBJECTIVE: To estimate the burden of diarrhea-associated hospitalizations among children in Hawaii. DESIGN: Retrospective analysis of hospital discharge records. PATIENTS: Children from 1 month through 4 years of age with a diarrhea-associated diagnosis listed on the hospital discharge record in Hawaii. SETTING: Acute care hospitals in the state of Hawaii, 1994 through 1997. RESULTS: During 1994-1997, 2288 children (11.3% of all hospitalizations for children < 5 years of age) had a diarrhea-associated diagnosis listed at hospital discharge. The average annual incidence (per 10,000 children) of diarrhea-associated hospitalizations was 62.3; the incidence was higher for children < 1 year (101.6) than for those 1 through 4 years of age (52.7). Rates for Hawaii were lower than national rates during 1993 through 1995 (US annual rate of 89 per 10,000 children). The median length of hospital stay was 2 days for diarrhea-associated hospitalizations, and 3 days for hospitalizations specifically associated with rotavirus-related diarrhea. Diarrhea-associated hospitalizations were highest during the period December through June. CONCLUSIONS: Diarrhea is an important cause of hospitalization among children in Hawaii, where approximately 1 in 32 children may be hospitalized by 5 years of age. The age-specific and temporal trends reported here are consistent with those previously described for rotavirus-associated hospitalizations, suggesting that this pathogen is a major contributor to the overall morbidity from diarrhea.

Child, Preschool↗
PubMed2002

Report of the first annual Hawaii Asthma Research Consortium.

The first Hawaii Asthma Research Consortium was held on 7 May 2001 at Tripler Army Medical Center. Researchers investigating asthma-related problems and program directors of asthma projects were solicited statewide to present their projects. Ten lecturers focused on research and asthma projects in Hawaii in 20-minute presentations. An informal ten-minute discussion followed each presentation to encourage audience questions about the project and to discuss possible collaboration efforts between institutions. The institutions that were represented include: American Lung Association-Hawaii, Kaiser Permanente Center for Health Research Hawaii, Kapiolani Medical Center, Tripler Army Medical Center, University of Hawaii at Manoa, and Waianae Coast Comprehensive Health Center.

Asthma↗
PubMed2003

Epidemiology of early hearing loss detection in Hawaii.

OBJECTIVE: Universal Newborn Hearing Screening began in 2 Honolulu hospitals in 1992, and by 1999, all 14 civilian birthing facilities in Hawaii were providing screening. Examination of 1998 Hawaii data indicated that approximately 13% of infants who did not pass initial hearing screening in the hospital did not return for the indicated follow-up. The purpose of this study was to determine the epidemiologic profile of infants who were born in 1999 and did not return for follow-up. METHODS: A population-based, cohort study of the hearing screening completion rates among the 13 civilian birthing facilities in Hawaii that provided data to the Department of Health was conducted. Analysis included a bivariate analysis of the demographic characteristics of infants who completed the screening/follow-up process compared with those who did not and logistic regression modeling to ascertain the demographic profile of infants at high risk for being lost to follow-up. RESULTS: Of 12 456 infants, hearing screening data could be linked to the birth certificate file, and a final disposition regarding completion of the screening/follow-up process was determined for 10 328 (83%). Less than 2% (n = 176) of the linked infants failed to complete the screening/follow-up procedures. Low birth weight and white infants and infants born to women who had not completed high school were approximately twice as likely not to complete the screening as were their normal birth weight or nonwhite counterparts. CONCLUSIONS: Failure to complete the hearing screening follow-up may be related to cultural differences that have been previously reported in other maternal and child health studies of the diverse populations in Hawaii. The results of this study will allow the Hawaii Newborn Hearing Screening Program to target its efforts and limited resources toward infants who are at higher risk of not completing the screening and who may need special attention to encourage their mothers to complete the screening process, and to move quickly with rescreening infants whose initial tests are positive so that infants are not lost to follow-up.

Audiometry, Evoked Response↗
PubMed2006

Hawaii's "7 by 7" for school health education: a PowerPoint presentation on integrating the national health education standards with priority content areas for today's school health education in grades kindergarten through 12.

School-based health education can help young people develop the knowledge, skills, motivation, and support they need to choose health-enhancing behaviors and resist engaging in behaviors that put them at risk for health and social problems and school failure. The health of school-age youth is significantly associated with their school achievement. However, in the midst of today's increased emphasis on school accountability in the areas of reading, writing, and mathematics, subject areas such as health education tend to receive less prominence in the school curriculum. Recalling their own lackluster school experiences related to health topics, decision makers may not realize that today's skills-based school health curriculum involves a highly interactive and engaging approach to promoting good health and preventing the most serious health problems among youth. Health education is one important component of a coordinated school health program that includes health education, physical education, school health services, nutrition services, school counseling and psychological services, a healthy school environment, school promotion for faculty and staff, and involvement of family and community members. The purpose of this PowerPoint presentation--Healthy Keiki, Healthy Hawaii: Hawaii's "7 by 7" for School Health Education--is to educate health and education decision makers, teachers, parents, and community members on how Hawaii has integrated seven health education standards with seven priority health content areas to create an effective approach to school health education in grades kindergarten through 12. The goal of Hawaii's "7 by 7" curriculum focus is to ensure that all of Hawaii's keiki (children) have well-planned opportunities at school to become fit, healthy, and ready to learn.

Adolescent↗
PubMed1991

The Hawaii Medical Fellowship Mission to China.

The Hawaii Medical Fellowship Foundation is a non-profit Hawaii corporation to provide and exchange medical fellowship, knowledge, care, cooperation and service, and to support other humanitarian causes here in Hawaii and abroad. The Foundation plans a mission to China in October 1991. Hawaii physicians, at their own expense and time, will be spending a week in Shantou, China, providing medical service to and sharing techniques with their Chinese counterparts. The Foundation also plans to establish scholarships for students in Hawaii who wish to pursue health careers and to establish clinic/health fairs for the immigrants. It is willing to entertain ideas and suggestions for additional projects.

China↗
PubMed1989

Pneumococcal bacteremia in Hawaii: initial findings of a pneumococcal disease prevention project.

The Hawaii Department of Health (DOH) recently established a pneumococcal disease initiative to determine the scope of serious pneumococcal disease in residents of Hawaii and to investigate methods of increasing vaccine utilization in the State. The initial phase of the project involved a review of pneumococcal bacteremia at all 38 microbiology laboratories in Hawaii during 1986 and 1987. Two hundred twenty-two residents with bacteremia were identified. Eighty-six percent of adults had pneumonia as the primary source of bacteremia. In children greater than 5 years old, pneumonia was present in 24%, otitis media in 35%, and meningitis in 11%. Bacteremia with no apparent focus of infection was found in 30% of children. The overall annual incidence of pneumococcal bacteremia was 9/10(5) population. Rates were highest in children greater than 2 years old (103/10(5] and persons greater than or equal to 65 years old (22/10(5]. These are similar to rates reported from other populations in the United States during the 1970s and early 1980s, but are less than those detected in 2 more recent population-based studies. The overall case-fatality rate in our study was relatively low (16%); however, 35% of persons greater than or equal to 65 years old died. A record of previous pneumococcal vaccination was found in the medical records of only 2 (1%) patients. Our study confirms that pneumococcal bacteremia causes significant morbidity and mortality among elderly residents of Hawaii and suggests that vaccine coverage is very low among this high-risk population. Phase 2 of the initiative included surveys of Hawaii physicians and the public to ascertain attitudes toward pneumococcal immunization.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1977

Gastrointestinal carcinoma in the Japanese of Hawaii: a status report.

The primary aim of the Japan--Hawaii Cancer Study was to identify factors that could explain the changes in cancer risk experienced by Japanese who migrated to Hawaii. Many investigations were conducted in this long-term prospective study since its inception in 1971. Among the findings that relate to gastrointestinal carcinoma were the following: 1) Bowel transit time does not appear to be related to the occurrence of large bowel cancer or to any of the benign conditions with which it is associated; 2) adenomatous and hyperplastic polyps, as well as diverticula, are much more prevalent among autopsy specimens from Japanese who had lived in Hawaii than of those in Japan; 3) adenomatous polyps and diverticula are positively associated with atherosclerosis in the necropsy population in Hawaii; 4) although the incidence of the diffuse histopathologic type of gastric cancer does not differ appreciably among the Japanese in Hawaii and Japan, the migrants have a significantly lower incidence of the intestinal type of stomach cancer; and 5) case-control studies indicated that the two conditions frequently associated with gastric carcinoma, i.e., gastric ulcer and intestinal metaplasia of the stomach, are associated with high salt intakes and adherence to the traditional Japanese diet.

Aged↗
PubMed1982

Immigration and leprosy in Hawaii, 1960-1981.

The 140-year-old epidemic of leprosy among the people of Hawaii reached its peak at about the beginning of this century and has been subsiding ever since. A preliminary review of new cases in Hawaii in the past 15 years showed 49 among those born in Hawaii, plus 360 new immigrant cases (largely from the Philippines and Samoa), 130 of whom were of the borderline lepromatous or lepromatous (BL/L) form. Since 1970 all new cases have been treated as ambulatory patients in their home communities. A detailed review of all 95 new Hawaii-born cases in the past 21 years showed a continuing rapid decline in incidence among ethnic Hawaiian people, with a fall in the proportion of BL/L cases from its former plateau around 40% to only 20% in the last seven years. The new immigrant BL/L cases have apparently not caused a significant secondary outbreak among the Hawaiians but have caused a modest increase among groups. Among these recent non-Hawaiian secondary cases, the proportion of BL/L cases has also recently dropped so sharply that the risk of significant tertiary spread is minor. The possible role of improved nutrition in Hawaii as an influence on these recent leprosy patterns is suggested.

Adult↗