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PubMed1977

Epidemiologic cancer research programs of the Cancer Center of Hawaii.

Ongoing epidemiologic cancer research programs are described. These programs were developed by the Epidemiology and Demography Unit, Cancer Center of Hawaii, established in July 1974. During the 15-month period prior to the Pacific Basin Conference, many epidemiologic projects were initiated. Major descriptive, epidemiologic studies were undertaken: a) cancer mortality among the Japanese in Hawaii, adjusted by prefecture-of-origin; b) time trend of mortality rates for 80 causes between 1910--70; c) evaluation of race classification in Hawaii; d) survival analysis; and e) increased lung cancer rates among Japanese migrants in relation to smoking. Major analytic, epidemiologic studies were as follows: a) an international case-control study on breast cancer in relation to diet and exogenous estrogens; b) association between height and weight and various types of cancer; c) a follow-up study of about 9,000 shipyard workers exposed to asbestos; d) an epidemiologic survey on a 2- to 3-% sample population of Hawaii; and e) a follow-up study on leprosy patients in relation to their risks for cancer.

Alcohol Drinking↗
PubMed1994

The rise of cancer among the elderly in Hawaii.

The purpose of this study was to determine if time trends in cancer incidence among the elderly in Hawaii were similar to the trends observed in the mainland United States and to determine if the trends were comparable among the various ethnic groups living in Hawaii. Average annual incidence rates per 100,000 persons, age 65 or older, were determined by sex and ethnicity for the time periods 1973 to 1977 and 1983 to 1986 through the Hawaii Tumor Registry, a population-based central cancer registry. The incidence of all cancers combined increased 27% among men and 26% among women between the 2 time periods. Similar to the rest of the United States, melanoma and cancers of the brain, lung, colon, breast and prostate have risen substantially among elderly Hawaii residents. Comparisons across ethnic groups revealed that melanoma increased mainly among Caucasians, lung cancer increased primarily among Hawaiians and Caucasians, and colon cancer increased in all ethnic groups.

Aged↗
PubMed1993

Tuberculosis in Philippine National World War II Veterans immigrating to Hawaii, 1992-1993.

The Immigration Act of 1990* allows World War II veterans who are Philippine nationals to be naturalized as U.S. citizens and to enter the United States without any medical screening or restrictions. Following the diagnosis of tuberculosis (TB) in February 1992 in a Philippine national veteran who had recently arrived in Hawaii, the Hawaii Department of Health (HDOH) initiated efforts to assist veterans who had already arrived in Hawaii to receive TB testing and appropriate treatment and monitoring. This report describes the first case of TB identified in a veteran who entered Hawaii from the Philippines under this act and summarizes efforts by HDOH to detect and treat TB among Philippine national veterans.

Emigration and Immigration↗
PubMed1993

Hawaii's employer mandate and its contribution to universal access.

Much national debate centers around national models in which an employer mandate plays an important role in providing for health care coverage for all Americans. Hawaii has had the nation's only health insurance employer mandate for almost 20 years, yet little is known nationally about the mandate itself or Hawaii's experience with it. This article describes the long-term effects of Hawaii's employer mandate on health care access and costs, and offers reflections on the potentials of national health care reform based on Hawaii's experience.

Commerce↗
PubMed1995

The epidemic that never was: yellow fever in Hawaii.

The Kingdom of Hawaii suffered a disastrous series of epidemics starting from the first contact with Captain Cook's crew and continuing to the present. Despite the huge volume of shipping to and through Hawaii, one plague failed to appear. Yellow Jack (yellow fever) engendered more fear in sailors of the 19th century than any other disease. By 1910 the details of transmission were well-known and Hawaii met all the requirements for an epidemic. On October 30, 1910, the first case of shipboard yellow fever arrived at Honolulu but quarantine averted the threat. On October 28, 1911, a Hawaiian man, employed as a quarantine guard, was reported to have yellow fever and efforts were initiated to control a possible epidemic. This was the only occurrence of yellow fever in Hawaii.

Communicable Disease Control↗
PubMed1996

Leprosy in Hawaii; the end of an epidemic.

Two different patterns of leprosy have occurred in Hawaii. First is the continuing influx of infected people among immigrants from several leprosy-endemic areas. The number of new cases among their descendents has tended to abate within one generation after arrival in Hawaii. The most recent example of this has occurred in Asians arriving since immigration laws were liberalized in 1965, followed by a rise of imported leprosy, peaking in 1970-1980, then falling. The second pattern was an explosive epidemic among native Hawaiians, rising to its peak in the 1890s, then slowly subsiding, and now approaching zero. It appears that official disease-control efforts (physical isolation and/or early multidrug treatment) cannot fully explain the ending of the epidemic in Hawaii, in spite of the continuing importation of M. leprae. It is suggested that the influence of changing socioeconomic factors (nutrition, crowding, genetics) has been of importance, particularly among the Hawaiians, who have undergone profound foreign influence (both positive and negative) during the 150-year history of this epidemic. The late Dr. Ma Haide was responsible for leprosy control in China, where leprosy is also fading away, but not simultaneously in all subpopulations. He summarized his view by saying, "Leprosy lingers longest among the poorest" (personal communication). This statement appears to hold true for Hawaii, also.

Disease Outbreaks↗
PubMed1997

Newborn hearing screening in Hawaii.

Hawaii has been a pioneer and national leader in implementing universal newborn hearing screening. In fact, Hawaii is one of only two states (Rhode Island is the other) which have a statewide newborn hearing screening program in which 95% or more of all newborns are screened. Hawaii is the best example of a truly integrated system of services to provide effective intervention for all infants and toddlers who are identified as having a hearing loss. The success of the newborn hearing screening program is measurable in two ways: 1) all available information indicates that not a single infant with hearing loss has been missed by the screening process and not a single infant has been misdiagnosed as having a hearing loss; and 2) many of the children identified with hearing loss by the newborn hearing screening program have transitioned out of the early intervention program with age-appropriate developmental and communication skills. The success of Hawaii's program is a tribute to the enthusiastic support and collaboration of legislators, pediatricians, hospital staff, and DOH personnel.

Hawaii↗
PubMed1998

Herbal medicines in Hawaii from tradition to convention.

The stories of kava and chaulmoogra demonstrate the importance of herbal products in ancient and recent Hawaiian medicine. Kava is a psychoactive beverage that has been used ceremonially for millennia throughout the Pacific. It is a nonfermented depressant that causes tranquil intoxication in which thoughts and memory remain clear. Its broad pharmacologic activity led to use in Hawaii to treat skin disorders and later in Germany to treat gonorrhea. Kava is now available outside the Pacific basin as a relaxant, emerging as a popular, albeit deritualized, natural product. In the late 19th century, the main treatment for leprosy was chaulmoogra, extracted from Hydnocarpus seeds. Chaulmoogra had been a traditional treatment for skin diseases in Ayurvedic and Chinese medicine. Chaulmoogra from Asian markets was expensive and usually adulterated so the USDA decided to plant Hydnocarpus in Hawaii. Joseph Rock, a botanist at University of Hawaii, trekked through southeast Asia collecting fresh seeds to plant on Oahu. Rock's trees provided chaulmoogra for leprosy patients on Molokai and elsewhere until it was replaced by dapsone. Chaulmoogra, once the treatment for leprosy worldwide, is now nearly forgotten; kava, once poorly known outside the Pacific, is now a widely-used alternative medicine. Hawaii will probably continue its role in the transition of plants from traditional use to conventional use.

Anti-Anxiety Agents↗
PubMed2005

Science in the public process of ecosystem management: lessons from Hawaii, Southeast Asia, Africa and the US Mainland.

Partnerships and co-operative environmental management are increasing worldwide as is the call for scientific input in the public process of ecosystem management. In Hawaii, private landowners, non-governmental organizations, and state and federal agencies have formed watershed partnerships to conserve and better manage upland forested watersheds. In this paper, findings of an international workshop convened in Hawaii to explore the strengths of approaches used to assess stakeholder values of environmental resources and foster consensus in the public process of ecosystem management are presented. Authors draw upon field experience in projects throughout Hawaii, Southeast Asia, Africa and the US mainland to derive a set of lessons learned that can be applied to Hawaiian and other watershed partnerships in an effort to promote consensus and sustainable ecosystem management. Interdisciplinary science-based models can serve as effective tools to identify areas of potential consensus in the process of ecosystem management. Effective integration of scientific input in co-operative ecosystem management depends on the role of science, the stakeholders and decision-makers involved, and the common language utilized to compare tradeoffs. Trust is essential to consensus building and the integration of scientific input must be transparent and inclusive of public feedback. Consideration of all relevant stakeholders and the actual benefits and costs of management activities to each stakeholder is essential. Perceptions and intuitive responses of people can be as influential as analytical processes in decision-making and must be addressed. Deliberative, dynamic and iterative decision-making processes all influence the level of stakeholder achievement of consensus. In Hawaii, application of lessons learned can promote more informed and democratic decision processes, quality scientific analysis that is relevant, and legitimacy and public acceptance of ecosystem management.

Africa↗
PubMed2000

Kawasaki syndrome hospitalizations among children in Hawaii and Connecticut.

OBJECTIVES: To estimate the incidence and describe recent trends of Kawasaki syndrome (KS) in 2 different areas of the United States. METHODS: Retrospective analysis of Hawaii and Connecticut State KS hospital discharge records for children younger than 5 years. RESULTS: In Hawaii, 175 KS hospitalizations for children younger than 5 years were reported during 1994 through 1997; the annual hospitalization rate per 100,000 children was 47.7. The rate for Hawaiian children younger than 1 year (83.2) was greater than that for 1- to 4-year-old children (39.0), and most hospitalizations occurred prior to age 2 years (median age, 17 months). In Connecticut, 171 KS hospitalizations for children younger than 5 years were reported during 1993 through 1996; the annual hospitalization rate per 100,000 children was 18.8, and the median age at hospitalization was 28 months. For both states, most hospitalizations were for boys. Although no clear seasonality was apparent, monthly peaks occurred in some of the years from December through March. CONCLUSIONS: Kawasaki syndrome seems to remain an endemic disease in the United States. A high KS annual hospitalization rate was seen in Hawaii, especially in children younger than 1 year, whereas in Connecticut, the KS rate was more consistent with those previously reported in the continental United States. Arch Pediatr Adolesc Med. 2000;154:804-808

Child, Preschool↗
PubMed1984

Occurrence and prevention of rheumatic fever among ethnic groups of Hawaii.

To assess the occurrence of acute rheumatic fever (RF) among the ethnic groups of Hawaii, the case records of hospitalized children with RF in Oahu were reviewed for the period from October 1976 to September 1980. One hundred four of the records met the modified Jones criteria. Incidence rates per 100,000 children were as follows: Japanese, 0; white, 9; Filipino, 9.1; Hawaiian and part-Hawaiian, 27.2; and Samoan, 96.5. Carditis was most common among Samoan children; it occurred in nine of 18 children. A streptococcal, throat culture program for children with respiratory infections was in progress in 60% of Oahu's public schools during this period of time. Children with positive cultures were excluded from school until the start of treatment. However, RF occurred with equal frequency in participating and nonparticipating schools. Rheumatic fever continues to be a substantial problem among Polynesian children in Hawaii, and it is apparent that the school-based primary prevention program used in Hawaii to control streptococcal disease has not altered the frequency of RF among them.

Adolescent↗
PubMed2000

Birth defects prevalence among infants of Persian Gulf War veterans born in Hawaii, 1989-1993.

BACKGROUND: Gulf War veterans (GWVs) have expressed concern about possible teratogenic exposures. However, epidemiologic studies on birth defects prevalence among their progeny have been limited to military hospitals, anomalies diagnosed among newborns, or self-reported data. To measure the prevalence of selected birth defects among infants of GWVs and nondeployed veterans (NDVs) in Hawaii, using birth defects surveillance records. METHODS: Personal identifiers of 684,645 GWVs and 1,587,102 NDVs and their families were matched against birth certificate records of 99,545 live births reported to the State of Hawaii Department of Health between 1989 and 1993 to identify births to military personnel. These births were matched with records from the Hawaii Birth Defects Program. RESULTS: A total of 17,182 military infants (3,717 GWV infants and 13,465 NDV infants) were identified. Of these, 367 infants (2.14/100 live births) were identified with one or more of 48 major birth defects diagnoses. The prevalence of the 48 birth defects were similar for GWV and NDV infants during the prewar and postwar periods, and among GWV infants who were conceived before and after the Gulf war. CONCLUSIONS: The results must be interpreted with caution because of the small number of affected infants in each birth defects category. This study demonstrated the feasibility of measuring birth defects prevalence among military infants through multiple data linkage. Further, it included live births to parents who had separated from the military, births in civilian hospitals, and birth defects diagnosed through the first year of life.

Adult↗
PubMed1980

Malignant melanoma of the skin in Hawaii, 1960-1977.

An analysis was made of the 333 cases of invasive malignant melanoma (MM) of the skin, which were diagnosed among residents of Hawaii from 1960-1977. Caucasians accounted for 265 (79.6%) of the cases. The age-adjusted incidence rate of MM was found to have tripled among both male and female Whites during the study period, while no increase was observed for non-Whites. Among Whites, age-adjusted incidence rates increased for all anatomic sites for both sexes, except for apparently stable rates on the lower extremities of females. Rates were higher for males on the head and neck and trunk and higher for females on the lower extremities. By 1972-77, however, rates on the lower extremities were equal for the sexes. Interestingly, age-adjusted rates for Hawaii-born Whites were found to be much lower than for Caucasian immigrants, particularly among females, where a six-fold difference was observed. Thus, the epidemiology of MM in Hawaii is largely, but not entirely, consistment with the hypothesis that solar exposure is a major risk factor for MM.

Adolescent↗
PubMed1982

Racial and socioeconomic status differences in survival of colorectal cancer patients in Hawaii.

The study reported here examines the survival experience up to 84 months of patients from the five major racial groups in Hawaii diagnosed with colorectal cancer during the years between 1960 and 1974 based on data in the Hawaii Tumor Registry. Previous research in Hawaii showed that racial differences in survival existed even after adjusting for sex, age at diagnosis, stage of the disease at diagnosis, and normal life expectancy. In this paper, socioeconomic status differences between racial groups are hypothesized as a possible explanation for these survival differences. The results show that socioeconomic status did account for some survival differences between racial groups beyond what could be explained by the other variables. After adjusting for all the covariates, the only statistically significant racial differences which remained were higher survival rates for the Japanese patients compared with the rates for the Hawaiian and Filipino patients. Socioeconomic status was not found, however, to have a statistically significant effect on survival independent of race or the other variables examined. Reasons for the modest effects of socioeconomic status in this study are discussed.

Adult↗
PubMed1989

Ethnic patterns of childhood cancer in Hawaii between 1960 and 1984.

Cases of childhood cancer (less than 15 years of age at diagnosis), diagnosed between 1960 and 1984, were obtained from the Hawaii Tumor Registry, a population-based Surveillance, Epidemiology, and End Results (SEER) participant covering the entire State of Hawaii. During the 25 years of data collection, cancer was diagnosed in 398 males and 302 females, with overall age-adjusted incidence rates of 140.5 and 112.2 per million, respectively. Leukemia was the leading cause of childhood cancer, accounting for over 1/3 of diagnoses during the study period. Standardized incidence ratios (SIR) were calculated for each ethnic-sex group separately based on US white age-specific incidence rates for 1973 to 1982 from the SEER program. Overall, incidence rates for childhood cancer in Hawaii were generally similar to those found in all SEER areas.

Adolescent↗
PubMedDate not supplied

Childhood overweight problem in a selected school district in Hawaii.

Anthropometric measurements were collected from 1,437 public school students in a selected school district in Hawaii every year from 1992 to 1996. Results showed that boys and girls of Hawaiian ancestry (HA) are generally taller in stature and somewhat heavier in weight than their non-Hawaiian counterparts (Non-HA). Also, there are no clear differences between the two groups in BMI, sums of skinfolds, waist and hip circumferences, and waist/hip circumference ratios. When compared to data from NHANES III (Centers for Disease Control and Prevention), the median statures of HA boys and girls are very close to the median statures of NHANES III, but the body weights of HA are heavier at most ages. Also, the BMI values of HA are distinctly higher and their medians are closer to the 75th percentile of NHANES III. In addition, the values of the sums of skinfolds and the waist and hip circumferences of HA are also higher at most ages than NHANES III. These multiple anthropometric indicators suggest that there might be more overweight children and adolescents of HA. When compared to the statistics in NHANES III, there are twice as many HA and Non-HA boys and girls classified as obese. Clearly, a serious childhood problem exists among the children in this selected school district in Hawaii. More research is needed in other school districts in Hawaii. Also, it is suggested in this study that using multiple anthropometric indicators, rather than a single one, may be more accurate and appropriate in determining overweight problems in a youth population.

Adolescent↗
PubMed2006

Use of prenatal diagnostic procedures in pregnancies affected with birth defects, Hawaii, 1986-2002.

BACKGROUND: Information on the utilization of prenatal ultrasound (US), amniocentesis (AC), and chorionic villus sampling (CVS) in pregnancies affected by birth defects in the United States is limited. The intent of this study was to report on the utilization of these procedures in Hawaii. METHODS: Cases were all infants and fetuses of any pregnancy outcome with birth defects, included in a Hawaii birth defects registry, and delivered during 1986-2002. The rates of prenatal US, AC/CVS, and prenatal diagnosis were calculated. RESULTS: Prenatal US was performed in 76% of the cases and AC/CVS in 14% of the cases. Prenatal diagnosis of a birth defect was made in 16% of the cases. The prenatal US, AC/CVS, and prenatal diagnosis rates in 1998-2002 were 1.5, 1.5, and 1.7 times the rates in 1986-1991, respectively. Among all birth defects, the AC/CVS rate for women aged <35 years was 7% and for women aged > or =35 years was 48%. Among chromosomal abnormalities, the AC/CVS rate for women aged <35 years was 36% and for women aged > or =35 years was 66%. CONCLUSIONS: Only a fraction of the Hawaii birth defects cases was prenatally diagnosed. The rates for prenatal US, AC/CVS, and prenatal diagnosis among pregnancies affected by birth defects were higher in 1998-2002 than in 1986-1991. AC/CVS rates were lower for maternal age <35 years.

Adult↗
PubMed2002

Breast cancer incidence and estrogen receptor alpha in normal mammary tissue--an epidemiologic study among Japanese women in Japan and Hawaii.

We have undertaken a study to examine whether the difference in breast cancer incidence between 2 populations of similar genetic background is reflected in a similar pattern of estrogen receptor alpha expression in normal mammary gland. Study participants were 92 Japanese women from Sapporo, Japan (mean age 48.2 years) and 49 Japanese women from Honolulu, Hawaii (mean age 45.4 years), who underwent biopsy indicating normal breast tissue or benign, nonproliferative breast disease in hospitals in Sapporo, Japan and Honolulu, Hawaii. The breast tissue samples were formalin-fixed and paraffin-embedded. The estrogen receptor immunohistochemistry assays were conducted using Dako kits. Japanese women in Hawaii, who have a higher incidence of breast cancer compared with Japanese women in Sapporo, also had, as predicted, higher mean percentage of estrogen receptor alpha-positive normal mammary cells (2-tailed test, p approximately 0.09). The results of our study are compatible with the hypothesis that estrogen receptor alpha expression in normal mammary tissue increases breast cancer risk and they also indicate that the expression of these receptors is dependent, at least in part, on nongenetic factors.

Adult↗