Native Hawaiians who have higher levels of resilience may also have better health, according to new public health research from the University of Hawaiʻi at Mānoa.

Researchers led by Mapuana C.K. Antonio, an assistant professor in Native Hawaiian and indigenous health at the Office of Public Health Studies in the Myron B. Thompson School of Social Work, developed a new scale to measure resilience in Native Hawaiians. The scale was included in a survey of 124 Native Hawaiian adults living on Hawaiian Homestead Lands. The researchers compared the participants’ resilience scores with their self-reported health.

The findings are published online in the journal Behavioral Medicine.

“Resilience is complicated to measure,” Antonio said. For the new study, she and her co-authors incorporated scales that expanded on traditional measures of resilience, which look at a person’s ability to overcome adversity and persevere in times of difficulty. Traditional measures have generally looked only at internal traits, such self-reliance.

The researchers developed a new measure that takes into account the indigenous perspective of resilience, which places high value on relationships. “It is important to consider that for Native Hawaiians, health and resilience involves cultural identity and a sense of lōkahi, or harmony between the physical, spiritual, social and emotional self, and extends to include the outside world or environment,” said Antonio.

The researchers tested out their new scale and found it had good validity. They also found that the participants in their survey who scored higher on the resilience scale also reported higher levels of general health, mental health and physical functioning.

Native Hawaiians face much adversity that stems from colonization and historical trauma, including discrimination, health disparities and lower socioeconomic status compared with other racial and ethnic groups. “Our findings suggest that resilience may slightly mediate the effect that adversity has on health,” Antonio said.

The new scales can be used in future research on Native Hawaiian health that uses a strength-based approach, meaning research that focuses on the positive aspects of the community, rather than targeting deficits.

“A multi-faceted measure of resilience is needed to promote better health outcomes for Native Hawaiians,” added Antonio.

Antonio’s co-authors on the study included Earl S. Hishinuma, Claire Townsend Ing, Fumiaki Hamagami and Joseph Keaweʻaimoku Kaholokula of the John A. Burns School of Medicine; Adrienne Dillard, B. Puni Kekauoha and Cappy Solatorio of Kula no na Poʻe Hawaiʻi; Kevin Cassel of the University of HawaiʻiCancer Center; and Kathryn L. Braun, also of the Office of Public Health Studies.

When Hawaiʻi’s government officials and policy makers want to know what lies ahead in the COVID-19pandemic, they look to University of Hawaiʻi at Mānoa’s Thomas Lee, an assistant professor of epidemiology in the Office of Public Health Studies in the Myron B. Thompson School of Social Work, to provide some answers. In his role as the forecaster and modeler for Hawaiʻi’s response effort, Lee analyzes reams of data and gives state policy makers a picture of what the coming months may hold.

Lee creates epidemiological models of Hawaiʻi’s current COVID-19 infection rate and test results. As part the Hawaiʻi Emergency Management Agency (HI-EMA) COVID-19 Emergency Response Team, Lee synthesizes these models with the latest science on coronavirus transmission rates, population risk factors and the effects of physical distancing to create forecasts of the pandemic’s possible impacts on the state.

“The goal of my work is to provide decision makers in Hawaiʻi with the best available information on the possible future spread and impacts of COVID-19,” Lee said. When he began this work in early April, the urgent focus was to predict infections for the coming days and weeks. Now, as the state looks ahead to opening up, his tasks have shifted to figuring out the outcomes of different scenarios.

Lee is currently figuring out how Hawaiʻi’s case count may change if the state decides to screen all travelers, rather than not screen them. He is working on predicting how many COVID-19 patients may require long-term hospitalization, and at what point it makes sense for the state to create a dedicated skilled nursing facility to care for them. His scenarios on future cases inform HI-EMA’s calculations on how much personal protective equipment Hawaiʻi will need for the second wave of infections.

Lee’s background

Born and raised in Hawaiʻi, Lee is an alumnus of the public health program for which he now teaches.

“The UH Mānoa public health program does a great job in training epidemiologists to be multidisciplinary,” Lee said. Prior to the pandemic, most of his research focused on modeling rates of chronic conditions, such as Alzheimer disease and risk factors for depression.

As a U.S. Army reservist placed on active duty, Lee relies on his military training to understand the logistics and planning aspects of the state’s larger pandemic response effort. His role as HI-EMA‘s forecaster requires not only data analysis skills, but also the ability to engage in communications, education, coordination and planning.

“In the military and public health, I’ve learned to look at problems holistically, and that perspective has certainly been needed in this response effort,” he said.

As part of his work at UH Mānoa, Lee participates with other faculty members in the Hawaiʻi Pandemic Applied Modeling (HiPAM) workgroup. This group includes epidemiologists, data scientists and health care workers, and helps the state in adapting models and other tools for Hawaiʻi’s unique context.

“Thomas has a rare combination of strong scientific and technical expertise in epidemiology, as well as humility and excellent powers of listening and reflection that are the basis of his excellent communication skills,” said Victoria Fan, chair of the HiPAM workgroup and an associate professor at UH Mānoa. “I believe Thomas is instrumental for the Office of Public Health Studies in bridging the gap between the academic and the real world.”

Hawaiʻi moving forward

Lee said that an important part of his work is communicating to policy makers the limitations of the data. “I don’t have a crystal ball,” he said. “My job is to communicate the forecasts along with the assumptions and caveats that we used to develop the forecasts.” Any possible scenario could lead to a range of outcomes, and Lee feels a massive responsibility to explain to policy makers that his models are meant to provide likely outcomes, not definitive answers.

Ultimately, Hawaiʻi’s ability to move forward will depend on each person’s efforts to adhere to the best public health practices, such as maintaining physical distancing and staying informed.

“We all have an impact on how we continue to open up, and how healthy we are as a state,” Lee said. “Everyone has a responsibility to do their best.”

The Public Health Undergraduate Summit, a much-anticipated biannual event that highlights student projects, went virtual in April at the University of Hawaiʻi at Mānoa. From living rooms across the islands, students, faculty members, alumni and public health community members joined via Zoom to watch students explain their completed, or proposed, projects.

This spring semester, 37 students presented posters of their literature reviews (an early step of the capstone project), and nine others shared research findings or policy analyses based on completed service-learning experiences.

The capstone projects are completed over three semesters, where students familiarize themselves with a public health topic and apply it, either in a community or research setting while working with a community mentor or faculty advisor. Then students spend a semester linking the academic preparation to their field experiences and presenting their work.

“We’re so proud of these students,” said Vanessa Buchthal, an assistant professor with the Office of Public Health Studies, who helped coordinate the summit. “We moved to online education while the students were in the middle of working on their projects, and they’ve come through.”

Many students focused their projects on public health issues facing Hawaiʻi. Yongqi Ou investigated ways to prevent opioid misuse in Hawaiʻi, Taryn Furman studied access to water sports for children with disabilities and Kaitlin Tilitile researched how to increase suicide prevention awareness among teachers in Hawaiʻi. Samantha Harper looked at policies to increase access to after school programs for youth in Hawaiʻi and Christine Quiaoit examined ways to prevent falls in older adults.

“We’ve received some wonderful feedback from alumni and community members who were excited to participate via Zoom this year,” said Denise Nelson-Hurwitz, the undergraduate chair for public health.

“The students have done a lovely job, and we’re excited to see some of them graduate and join the community of public health workers in Hawaiʻi,” Buchthal said. “A strong public health workforce is needed now more than ever.”

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