Research

Research

A mobile app aimed at lowering the HIV-transmission rate among men who have sex with men should include an HIV test location finder and should help men to track their sexual activities, new research from the University of Hawai‘i at Mānoa shows.

For the study, public health researchers conducted in-depth interviews with Spanish-speaking men who have sex with men (a group that includes men who are homosexual, bisexual, questioning their sexual identity or orientation, or heterosexual but having sexual encounters with other men). The researchers asked the men what features they look for in apps, and what aspects of an app would make them likely to use it.

"We know from previous research that there is a need to improve HIV prevention efforts for Latino men who have sex with men in the U.S., and to help these men get tested for HIV and other sexually transmitted infections," said Jason Mitchell, PhD, MPH, an assistant professor with the Office of Public Health Studies at UH. "Mobile apps are a great way to get information and resources out to people, but prior to our research, there weren't any studies that had asked these men what they wanted in an app, and what might motivate them to download an app and keep using it over time," said Mitchell, who is the lead author of the new study.

The researchers recruited men in the Miami area whose primary language was Spanish through Facebook ads and flyers. They interviewed 15 men and then analyzed the transcripts of the interviews, looking for common themes.

When asked what they looked for in apps in general, all of the men said that it was very important to them that apps keep their personal information secure and confidential. Most said they were willing to pay for apps that were useful to them. The men also said they tended to download apps that their friends had used and liked.  

As for an HIV-prevention app, almost all of the men said they would like an app to send them reminders to get tested for HIV on certain dates and show them the nearest location where they could get tested. Most of the men also said they would like the app to send them information about HIV, either through text messages or alerts, and that they would want a feature in the app that would help them keep track of how many sexual partners and encounters they had.

"These findings could help guide future efforts to develop an HIV prevention app for Spanish-speaking men who have sex with men," Mitchell said.

The study will be published in a future issue of the Journal of Medical Internet Research: Public Health & Surveillance. Mitchell's co-authors included researchers Maria Beatriz Torres of Gustavus Adolphus College in Minnesota, Lucy Asmar of the University of Miami Miller School of Medicine in Florida, and Thu Danh and Keith Horvath, both of the University of Minnesota.

HONOLULU, HI – In the US, 1 in 5 (almost 13 million) children and adolescents are overweight or obese. One of the main contributors to obesity is insufficient levels of physical activity (PA). Understanding the impacts of the environment on PA is essential to promotion of children’s health.

A recent five-year study by researchers at the University of Colorado at Denver College of Architecture and Planning, the Colorado State University Exercise Science Laboratory and the University of Hawaii’s Office of Public Health Studies investigated the effects of schoolyard renovations and a PA recess curriculum alone and in combination on children’s PA. The Intervention for Physical Activity and Youth (IPLAY) was developed in collaboration with the Denver Public School System, and transformed schoolyards into attractive, safe multi-use playgrounds tailored to the local community to increase recess PA.

“Distinctive elements of the intervention schoolyards include community gateways and gathering spaces, public art works, age appropriate play equipment, grass playing fields, colorful structured and unstructured asphalt games, custom shade structures, habitat areas and nature play,” says first author, Claudio Nigg, PhD, a professor of Social and Behavioral Health Sciences.

Twenty-four schools in inner city Denver participated; 6 schools each were assigned to control, curriculum only, schoolyard renovations only, and curriculum plus schoolyard renovations. PA outcomes were assessed pre-program, mid-program, immediate post-program, and one year post-program. Recess periods were observed and participants wore wrist-mounted accelerometers and completed surveys to report their PA.

“No meaningful intervention effects were found among the intervention groups, and this finding is consistent with results from other intervention trials,” reports Nigg. “This suggests that interventions must not only try to increase PA during already established free-time, but also provide additional PA opportunities. Recess by itself does not seem to be long enough (15-20 minutes) to produce change in children’s PA.”

Additional studies are needed to explore other potential avenues to promote PA include making recess longer, integrating recess into the school curricula, and developing recess PA curricula integrating schoolyards. 

The best ways to lower the high rate of hypertension among Hawaiʻi residents may be to promote a strong sense of community and cultivate an awareness of risk factors, treatment and control options among the friends of those suffering from high blood pressure. That is according to research by two faculty members in the Office of Public Health Studies.

Research done in Albania, a small country in eastern Europe, by Assistant Professor Catherine Pirkle, Associate Professor Tetine Sentell and colleagues was published in a recent issue of the European Journal of Public Health.

New insights about distinct risk factors for inadequate hypertension management among the elderly in Albania has relevance to Hawaiʻi, say the researchers, because they highlight the importance of community-level and interpersonal factors—such as relationships with friends—to hypertension diagnosis/awareness and control.

In particular, it was found that having more social support from friends and having a strong sense that your community was safe led to more hypertension diagnosis/awareness and control. These findings may provide novel intervention opportunities of hypertension programs.

Said Pirkle, “This is highly relevant to current work we are doing around preventing and managing chronic disease in the state as part of the Healthy Hawaiʻi Initiative, which seeks new ways to create sustainable changes in local communities, schools and workplaces that promote better health. Leveraging social and community ties is a great way to support public health.”

Added Sentell, “Like Albania, Hawaiʻi has a unique cultural and social history. In order to better understand hypertension awareness and control in the state, it is necessary to characterize broad risk factors for hypertension from the individual to community. This ecological perspective can be critical to the successful targeting and design of impactful public health programs.”

Hypertension is prevalent in Hawaiʻi

Hypertension is a major global public health problem that is estimated to affect more than one billion people. It is highly prevalent in many settings, including Hawaiʻi, where 28 percent of adults in the 1.4 million population are known to have hypertension and many more are believed undiagnosed. That correlates with Albania, where at least 36 percent of adults in its 2.8 million population on the Balkan Peninsula suffer from high blood pressure.

Both Hawaiʻi and Albania are somewhat isolated areas of land with high rates of hypertension, especially among older adults whose proportion in the population is steadily increasing in line with global demographic trends toward an aging society.

Pirkle has been working with colleagues in Tirana, Albania, since 2012. Sentell also worked in Tirana in 2017 as a Fulbright specialist. They collaborated with Albanian medical faculty Alban Ylli and Genc Burazeri at the Institute of Public Health.

You make a lot of choices that affect your health, such as how much you exercise, whether you smoke, how many servings of fruits and vegetables you eat, and how much alcohol you drink.

Now, a new study from researchers at the University of Hawai‘i at Mānoa and Tufts University in Massachusetts shows that despite all of the possible ways people could combine their choices from these various areas, in real life, people tend to make choices about their health that "cluster," or go together.

In fact, there are just four distinct groups that people tend to fall into, the researchers found. The four groups are:

  • The "healthy" group: These people eat enough fruits and vegetables every day, and they also do enough exercise, drink in moderation or not at all, and do not smoke.
  • The "physically active" group: These people don't eat enough fruits and vegetables every day, but they do enough exercise, drink in moderation or not at all, and do not smoke.
  • The "apathetic" group aka the do nothing group: These people don't eat enough fruits and vegetables every day, and they don't exercise enough, they drink in moderation or not at all, and most of them don't smoke.
  • The "binge drinking" group: These people don't eat enough fruits and vegetables every day, they don't do enough exercise, and they binge drink. Binge drinking is defined as having five or more drinks on one or more occasion in the past month.

Previous research based on data going back to 2003 had identified these groups, and now, the new study shows that the percentage of U.S. adults who fall into each group remained relatively stable through 2015.

"Young adults tend to belong to the apathetic group — they have a pretty 'meh' attitude toward their health," said Professor Claudio Nigg, PhD, a researcher in the Office of Public Health Studies at the University of Hawai‘i at Mānoa and the senior author on the study. This group is at risk for developing chronic diseases such as type 2 diabetes and heart disease, the researchers noted. About 70 to 80 percent of adults fall into the apathetic group.

About 10 percent of U.S. adults belong to the "healthy" group, Nigg said.

The new analysis also shows that the health behavior patterns of U.S. adults are not getting worse, but they are also not improving, the researchers said. The findings suggest that public health messages should focus on the big picture of people's choices, rather than a single choice, he said.

"The new findings show that our best approach is not to make an ad campaign that just tells people, 'don't drink too much,'" Nigg said. "Instead, we should give folks tips on eating well and exercising, as well as sticking to limits on alcohol."

The data that the researchers used in the study came from a telephone survey of about 400,000 U.S. adults (for each year analyzed) in all 50 states called the Behavioral Risk Factor Surveillance System, which is conducted annually by the Centers for Disease Control and Prevention (CDC).

The findings suggest that it is imperative for public health efforts to target the "apathetic" group, which is the largest group but is often overlooked, the researchers said.

"People in this group tend to not have much money, so efforts to help them be healthier have to be really practical," Nigg said.

Lower educational attainment and income, and a higher incidence of trauma in childhood due to economic and social factors, can lead to greater health risks, according to researchers in the Office of Public Health Studies at the University of Hawai‘i at Mānoa.

Co-authors Catherine Pirkle, an assistant professor of health policy, and Yan Yan Wu, an assistant professor of epidemiology, looked at health data of more than 2,000 people in Albania, Brazil, Colombia and Canada. Their findings are featured in the BMJ Open medical research journal.

Pirkle and Wu used a model to identify the joint effects of multiple risk factors for a cluster of disorders called metabolic syndrome (MetS). These factors include increased blood pressure, high blood sugar levels, excess body fat around the waist and abnormal cholesterol levels, which collectively put a person at greater risk for heart disease, diabetes and stroke. About 34 percent of the U.S. adult population suffers from MetS.

Previous studies have examined clinical or genetic risk factors for MetS, but the UH researchers’ findings show that social and behavioral risk factors may additionally make certain groups more vulnerable to MetS than others.

“In our research, metabolic syndrome was observed in 43 percent of participants,” says Pirkle. “Not surprisingly, the risk for MetS was greater in those with low educational attainment and income, and with high numbers of childhood economic and social adversities.”

The research methods may also be applied to other diseases, such as hypertension, to identify risk clusters among other vulnerable populations in modestly sized samples. “By identifying populations most at risk for a given disease, we can better direct public health interventions to serve these populations,” explained Pirkle.

Researchers from the University of Hawaiʻi Cancer Center and Office of Public Health Studies found that patients who have type 2 diabetes in addition to other chronic diseases have a lower survival rate for colorectal cancer.

A study published in the International Journal of Cancer investigated the survival rates of colorectal cancer patients with or without type 2 diabetes, and with additional diseases such as heart disease or stroke. The findings showed type 2 diabetes alone does not significantly affect survival for colorectal cancer patients. However, patients with type 2 diabetes as well as other chronic diseases had a lower survival rate.

The researchers looked at 24 years of health data of more than 215,000 adults from California and Hawaiʻi who participated in the multiethnic cohort to identify predictors of survival. Among 3,913 new cases of colorectal cancer, the 707 participants with type 2 diabetes were compared to those without type 2 diabetes.

“The multiethnic cohort is an excellent resource that allows us to study diseases in diverse ethnic groups,” said Yvette Amshoff, lead author and education coordinator at the UH Cancer Center. “Relationships between type 2 diabetes and colorectal cancer have been studied before, with most studies finding a lower chance of survival of those with both diseases. However, in our study population of Caucasian, African American, Native Hawaiian, Latino and Japanese, only Latinos with a history of type 2 diabetes had worse survival. This shows a possible disparity in healthcare that should be addressed.”

Added Andrew Grandinetti, study co-author and associate professor of epidemiology in the Office of Public Health Studies, “The findings that participants with additional diseases and possibly those with long-term type 2 diabetes experience higher mortality are significant to policymakers and health-care providers, because they encourage screening and early detection in colorectal cancer patients to help increase life spans.”

Colorectal cancer is the second leading cause of cancer death in men and third among women in Hawaiʻi. There is an average of 224 deaths from colorectal cancer each year in the state, with an average of more than 700 new cases diagnosed each year, according to the UH Cancer Center’s Hawaiʻi Tumor Registry. In the U.S., colorectal cancer is the fourth most commonly diagnosed disease. By 2040, 642 million people worldwide are predicted to have type 2 diabetes.

In addition to Amshoff and Grandinetti, research team members include Gertraud Maskarinec, a professor of epidemiology at the UH Cancer Center, and collaborators at the University of Southern California’s Keck School of Medicine and Norris Comprehensive Cancer Center.

The Hawai‘i Chapter of Delta Omega invites all interested Public Health graduate and undergraduate Students to submit an abstract for the National Delta Omega Poster Contest Display at the APHA 2018 annual meeting to be held 10-14 November, 2018, in San Diego, CA. Each chapter is able to select no more than 2 abstracts for the graduate student competition and 1 for the undergraduate competition.

Students whose work is selected for a national award will receive a $350 cash prize from the national Delta Omega Honor Society, which the OPHS will match for a total of $700. Student awards will be made during the Delta Omega Social Hour. In addition, students will have the opportunity to present their poster during the APHA scientific poster sessions. Student abstracts will also be published on the Delta Omega National Webpage.

All abstracts must be submitted via email for consideration to katz@hawaii.edu by 17:00 (5:00 pm) Friday, March 30, 2018. No late or incomplete submissions will be accepted or considered.

See the Delta Omega Student Abstract Announcement and Delta Omega Abstract Submission Guideline documents for more details

Students from our department have been national Delta Omega student poster contest award winners for 9 of the past 10 years. We look forward to your submissions.

Please contact Dr. Katz if you have any questions.

Post-9/11 military veterans who receive mind-body therapy have significant improvements in symptoms of post-traumatic stress disorder (PTSD), according to a study co-authored by Office of Public Health Studies Professor Kathryn Braun in the Journal for Alternative and Complementary Medicine.

“Our findings show that mind-body interventions are effective in reducing the severity of PTSD symptoms associated with combat,” said Braun, director and professor at the Office of Public Health Studies within the Myron B. Thompson School of Social Work. “They also can reduce depression and anxiety symptoms, and increase mindfulness and sleep quality in veterans with PTSD.”

Combat-related PTSD is a major public health challenge for the Department of Defense and Veteran Affairs. When service members return from deployment with combat-related PTSD, conventional therapies include cognitive behavioral therapy and antidepressant medications.

But complementary and alternative treatments, such as mind-body therapies including meditation and yoga, are less invasive. Thus they may be more attractive to service members and veterans.

Not only are mind-body therapies effective, but they may also be less costly than conventional treatments. For example, yoga can be taught and delivered to a dozen service members or veterans at a time.

Study author Robin Cushing is an Army physician assistant who teaches yoga in military and veteran communities. “We reviewed 15 pieces of literature on the effects of mind-body interventions for veterans with PTSD,” said Cushing. “Our findings show that, for the majority of participants, their PTSD symptoms improved.”

The worldwide spread of a serious infectious disease could result in pandemic-related deaths of 700,000 and annual economic losses of $500 billion, according to a study in the Bulletin of the World Health Organization. Victoria Fan, an assistant professor of Health Policy and Management in the Office of Public Health Studies at the Myron B. Thompson School of Social Work at the University of Hawaiʻi at Mānoa, is lead author of “Pandemic risk: how large are the expected losses,” (PDF) which applied a theoretical model to calculate the expected number of deaths and economic losses in rare pandemic scenarios.

The study was based on Fan’s work using impact and economic evaluations. The dollar figure of economic losses is much higher than those found in previous studies, which, according to the study, means “there is an unmet need for greater investment in preparedness against major epidemics and pandemics.”

The projection of total pandemic-related costs of $500 billion in U.S. dollars, or 0.6 percent of global income, falls within the Intergovernmental Panel on Climate Change’s estimates of the costs of global warming. This implies that the losses from pandemic risk would be similar in magnitude to those of climate change.

The model may also be applied to other outbreaks, such as malaria, or catastrophic events, including nuclear attack. “Policymakers may be able to estimate the economic losses that come with rare but potentially devastating events,” said Fan. “We hope this can lead to more appropriate adjustments for national policies and investments, and international collaborations on pandemic preparedness.”

Fan was a visiting assistant professor of global health at Harvard University in fall 2017. The paper’s co-authors are Lawrence Summers, a former U.S. deputy secretary of the treasury and former president of Harvard University, and Dean T. Jamison, emeritus professor of global health at the University of Washington at Seattle.

Related links:
UH researcher's study says the world isn't prepared for global flu outbreak
Researchers calculate expected number of deaths, economic losses in rare pandemic scenarios

Older adults commonly have a fear of falling, even if they have never fallen before. Studies suggest that fear of falling may capture underlying health concerns not easily measurable by clinical examination and/or lead to self-imposed physical activity restrictions contributing to health decline. This paper observes that fear of falling predicts subsequent loss of physical function in a sample of older adults from Canada, Colombia, and Brazil, even after substantial statistical adjustment of potential confounders. This research suggests that high fear of falling in older adults may have clinical relevance and be predictive of important health declines. 

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