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  • Why Community-Based Participatory Research Projects in Hawai`i Are Successful

    Posted Apr 1, 2019 at 9:12am

    When researchers work together with community members to conduct studies to address health disparities, both groups reap the benefits, says a new paper from University of Hawaiʻi at Mānoa researchers.

    The study was published in the March issue of the Hawaiʻi Journal of Medicine & Public Health.

    Katherine Yang, a recent master’s graduate from the UH Office of Public Health Studies and a current PhD student in epidemiology, and her colleagues conducted detailed interviews with 12 leading local experts. The goal is to learn about their experiences in using a community-based participatory research (CBPR) approach to improve health outcomes and promote health equity.

    “In CBPR, researchers take the time to get to know their communities by being present and listening to their concerns and priorities,” Yang said. “Our analysis showed that CBPR can serve as a bridge between academic researchers and the communities that they study.”

    CBPR projects involve community members not as research “subjects,” but as active participants and co-leaders in all research phases. Community members work closely with researchers to conduct the study from beginning to end.

    Research that uses a CBPR approach starts with an issue that is important to the community, values reciprocal learning and benefits and promotes social action. 

    For example, in one project, researchers who were developing a substance abuse prevention program worked with ōpio (teenagers) in a rural Hawaiian community. The teens took pictures of things that represented Native Hawaiian values to them, and then worked with the researchers to use the photos in designing a public health intervention to prevent substance use.

    In another example, UH researchers worked with Waimānalo families to construct sustainable aquaponics systems, which the families then used to enhance their access to fresh vegetables, fruit and fish. They also learned how to prepare healthy meals.

    “Community members feel engaged when they know their voices matter and that research is relevant to their experiences, concerns and priorities,” said Jane J. Chung-Do, an associate professor with UH public health and co-author of the paper. “We wanted to better understand what makes these projects successful and what we can work on to advance CBPR in Hawai‘i.”

    Analysis of the interviews revealed that a key component for CBPR projects is for researchers to build and sustain relationships and trust within the community. Other important findings were the development of a sense of ownership that community members felt about the project, and the strength-based approach of CBPR that values knowledge and the unique experiences of each community.

    However, there are challenges in promoting CBPR. For example, it is difficult to secure funding for this type of research, which can take longer than conventional research approaches to studying community health. Research grants are often time-limited, and funding agencies typically do not allow for the time needed to build relationships and trust between university researchers and the community. 

    Since the authors noted that their study was small, the next steps would be to expand the study to include perspectives of community partners who have been involved in CBPR and to investigate other factors that might promote CBPR success and, subsequently, improve health.

    “Hawai‘i’s close-knit communities make it an ideal place to conduct CBPR projects,” Yang said. “CBPR projects are growing in Hawaiʻi, and we believe that meaningful community participation in research has the potential to promote health equity.”

    In addition to Yang and Chung-Do, co-authors include Kathryn L. Braun, director of UH public health, and current and former public health students including Loren Fujitani, Alyssa Foster, Shannon Mark, Yuito Okada, Zeyana Saad-Jube and Fadi Youkhana.

    Other co-authors are Kevin Cassel, UH Cancer Center; Scott K. Okamoto, UH Cancer Center and Hawaiʻi Pacific University; Susana Helm and Claire Townsend Ing, both at the John A. Burns School of Medicine; Christy Nishita and Lana Sue Ka‘opua, Myron B. Thompson School of Social Work; Kristine Qureshi, School of Nursing and Dental Hygiene; Peter J. Mataira, Hawai‘i Pacific University; and Karen Umemoto, University of California at Los Angeles.

  • Public Health Journalism Fellowship 2019-20: A collaboration with Public Health, Communication, and Journalism

    Posted Mar 22, 2019 at 10:43am

    UHM Office of Public Health Studies and the School of Communications announce the Public Health Journalism Student Fellowship Program, a competitive program by application for current undergraduate and graduate students from any major at UH Mānoa

  • Tuberculosis Could Be Eradicated in 26 Years, Public Health Report Says

    Posted Mar 20, 2019 at 5:19pm

    The entire world could be free of tuberculosis (TB) by 2045, if world leaders decided today to invest a cumulative amount of at least $2 billion in a year in research and development, leading to effective treatment and prevention of the disease.
    That is the premise of a report in the Lancet Global Health journal written by leading global TB experts and researchers including Victoria Fan, an assistant professor of public health in the Myron B. Thompson School of Social Work at the University of Hawaiʻi at Mānoa.

  • UH Public Health Research Reveals That Parenting May Be Hard on the Heart

    Posted Mar 20, 2019 at 4:42pm

    Parents who have five or more children may face a higher risk of heart disease than those who have only one or two keiki, according to new findings from public health researchers at the University of Hawaiʻi at Mānoa.

     Researchers led by Sara Hipp, a recent graduate of the Master of Public Health (MPH) program, looked at data from nearly 25,000 participants ages 50 and older who took part in a national health survey.

     "Many studies have linked women's reproductive characteristics, such as their age at their first childbirth, with their risk of heart disease later in life," Hipp said. "But there wasn't much known about the association between family size and heart disease, and very few studies have looked at how fatherhood may relate to men's risk of heart disease."

  • UH Mānoa Public Health Program Earns Spot on National Rankings

    Posted Mar 18, 2019 at 4:40pm

    The graduate program in Public Health at the University of Hawaiʻi at Mānoa has earned a spot for the first time in the annual rankings published by U.S. News and World Report. 

    The ranking includes not only public health schools but also public health programs, which are smaller than schools. Among accredited programs, the UHM graduate program is ranked No. 36 out of 65.

    There are 35 schools and programs in the U.S. that are designated by the U.S. Department of Education as providing service to Asian Americans, Native Americans, Pacific Islanders, Alaska Natives,or Native Hawaiians, and of these, the UHM program is ranked No. 5. 

    "We are happy to see our program listed in this ranking," said Kathryn Braun, DrPH, who is the director of the Office of Public Health Studies and is also the chair of the PhD in Public Health graduate program. "This confirms for us that our students are receiving a solid education in public health and that our program is recognized by national leaders in public health education."

    In previous years, the U.S. News and World Report rankings included only schools, meaning that all public health programs that are housed within larger schools or departments at their universities were not included. The UHM public health program is housed within the Myron B. Thompson School of Social Work.

    Among all ranked public health schools and programs in the U.S., the UHM program is No. 89 among 177. 

    Not all public health programs in the U.S. are listed in the rankings. To be ranked, schools and programs needed to be accredited by the Council on Education for Public Health (CEPH). In addition, rankings are only published for schools and programs that earn a score of at least 2.0 out of 5 on average in a nationwide survey of school administrators. The UHM program is the only public health program in Hawaiʻi that was ranked. 

    Graduate students in public health at UHM have many options. They can earn a Master of Public Health (MPH) degree, a Master of Science (MS) in Public Health, or a PhD in either epidemiology or public health. In addition, the program also offers an undergraduate (BA) degree in public health. 

    Graduates of the program have gone on to work in research,medicine, education, and public policy. They may work at the Hawaiʻi State Department of Health or at the national level. 

    "We look forward to continuing to serve the communities of Hawaiʻi by educating the future public health leaders in our state," Braun said.

  • Training college students in Brazil how to improve their country's public health

    Posted Mar 1, 2019 at 6:18am

    The rocky and semi-arid terrain of northeastern Brazil, dotted with small cities and rural communities, represents a formidable barrier not only to travel, but to conducting quality health research. Now, Office of Public Health Studies researchers at the University of Hawaiʻi at Mānoa are partnering with Brazilian epidemiologists to reach out to college students in Brazil seeking to improve health programs in this hard-to-reach and economically disadvantaged region.

    The students are being taught to administer health surveys, interview study participants, collect epidemiological data in the field and write research articles for publication in peer-reviewed journals, according to a published paper in the Journal of Global Health.

    “These students want to learn how to conduct epidemiological research so that they can improve the health programs of their community and we want to support them in doing this,” said Catherine Pirkle, UH Mānoa assistant professor.

    In one project, training modules conveyed how to properly collect data on body measurements and take samples for laboratory analyses in pregnant women. In another, students were taught how to recruit pregnant women for a study and provided tips on how to conduct systematic interviews to address women’s health and factors that might contribute to the high rate of teen pregnancy in the region.

    “We chose to focus on adolescent pregnancy because doing research on this topic requires a solid understanding of the social, economic and psychological motivations of community members—and all of these ideas are at the core of what we do as public health researchers,” said Pirkle.

    Associate Professor Tetine Sentell added that exposing the students to international training was an important objective. Four students from northeastern Brazil visited UH Mānoa to learn how to draft scientific manuscripts for submission to public health journals. So far, three have been published.

    “These students are interested in graduate school and academic careers, so we wanted to support their academic development,” said Sentell. “We’re hoping to help them build a thriving research community and to provide new opportunities to support health in this region.”

  • Faculty helps build China's first global health curriculum

    Posted Feb 5, 2019 at 2:30pm

    China is facing an increasing demand for health professionals with a background in global health issues, and University of Hawaiʻi at Mānoa Professor Yuanan Lu is working to help Chinese universities meet this demand for a highly-trained public health workforce.

    Recently Lu, of the Office of Public Health Studies at the Myron B. Thompson School of Social Work, collaborated with global healthexperts on a project to create the first global health bachelor curriculum in China. The new program at Wuhan University can be used as a guide for other institutions that want to develop similar programs.

    “We wanted to create a curriculum that will provide students with a strong background in understanding and addressing global health issues, such as food security and maternal-child health,” Lu said. “We wanted the students of this program to graduate and be prepared to become health professionals with international and intercultural competencies.” Lu and his colleagues published a paper outlining the new curriculum in BMJ Open.

    Expanding collaborative efforts in China

    In a separate project, Lu worked with collaborators at Fudan University to test drinking water in the city of Shaoxing for chemicals called nitrosamines, which are linked with cancer and stillbirths. Shaoxing is a developing, middle-sized city located in the Yangtze River Delta.

    Researchers found that the levels of some nitrosamines exceeded the levels allowed in U.S. drinking water by the Environmental Protection Agency. The findings show that there is an urgent need to improve nitrosamine regulations in China, the researchers wrote in their study, published in December in Environmental Science and Pollution Research.

    Building a thriving public health exchange program with China

    Both projects stemmed from a thriving international exchange program between UH Mānoa’s Office of Public Health Studies and several schools of public health and traditional Chinese medicine in China. Lu is the chair of the program.

    As China’s economy continues to grow, health issues and health inequality have quickly become challenges for the country, Lu says. Since the exchange program began in 2007, 22 faculty members and 39 students from UH Mānoa’s Public Health have gone to China, and more than 200 faculty members and students have come to UH Mānoa from Wuhan University, Nanchang University and Fudan University.

    The program has resulted in more than 100 published research papers over 12 years.

    “Global health education programs are common in universities in many highly-developed countries today, and now China is working to establish a better health care education system,” Lu said. “This system will help the country to address health issues and conduct research to provide evidence for policy-making decisions.”

  • Chuukese People in Hawai‘i Commonly Experience Racial Discrimination, UH Public Health Research Finds

    Posted Jan 10, 2019 at 7:05am

    Chuukese people face many barriers to accessing medical care in Hawaiʻi, and now a new study shows that many Chuukese may experience racial discrimination, leading to poor access to appropriate healthcare.

    The study also found that Chuukese people face other barriers including miscommunication with providers. They endure insensitive remarks when trying to access services, and face great difficulties navigating the healthcare system due to the differences between the US and Chuukese systems.

    "This study highlights the importance of addressing racial discrimination, cultural beliefs, and community assets when working towards health and healthcare equity for the Chuukese," said Megan Kiyomi Inada, DrPH, the lead researcher on the study. Dr. Inada, formerly with UH Public Health, now works at Kokua Kalihi Valley Comprehensive Family Services, a federally-qualified health center in Kalihi.

    For the study, Dr. Inada interviewed nine Chuukese community members in Hawaiʻi and eight healthcare providers, including physicians, interpreters, and community health workers who provide health services to Chuukese people. The researchers then analyzed transcripts of the interviews.

    Results showed that almost all of the Chuukese community members in the study said that they or someone they know had received poor care or heard rude remarks from providers. Several providers in the study reported that they had witnessed colleagues discriminating against Chuukese patients.

    The participants also reported that aside from racial discrimination, other barriers that prevent Chuukese people from getting the health care they need include a lack of appropriate healthcare coverage, financial resources, health literacy, and access to food and transportation.

    In Chuuk, patients do not need to make appointments, nor do they need to pay to see providers. When they come to Hawai‘i, inadequate insurance coverage becomes a barrier.  Many migrants who come to the US from Micronesia are not able to fully participate in government programs such as Medicaid.

    For those with limited English, this is compounded by communication barriers. Although some providers have interpreters available, Chuukese culture includes a general reluctance to discuss health problems with a person who is not a family member. Also, the prospect of seeing several physicians at different locations can quickly become overwhelming.

    Still, the researchers reported that the study participants identified several solutions. Building trust with Chuukese community and educating patients on navigating the healthcare system, as well as educating providers about the Chuukese history and culture could help to reduce the barriers, they said.

    “Mistaken assumptions and harmful stereotypes could be overcome by working to build stronger patient-provider relationships, mutual understanding, and respect,” notes Dr. Inada.

    The study will be published in the January 2019 issue of the journal Social Medicine. Inada's co-authors included Kathryn L. Braun, DrPH, the director of UH Public Health, and Tetine Sentell, PhD, an associate professor with UH Public Health. Co-authors also included Parkey Mwarike, of the College of Micronesia in the Federated States of Micronesia, Kevin Cassel, DrPH, of the University of Hawai‘i Cancer Center, Randy Compton, JD, of the  William S. Richardson School of Law, and Seiji Yamada, MD, MPH, of the John A. Burns School of Medicine.

  • To prevent chronic disease in Hawai‘i, researchers look to Albania

    Posted Jan 9, 2019 at 6:15am

    In Albanian, “Si je?” means “How are you?” Public health researchers at the University of Hawaiʻi at Mānoa asked exactly that question of an innovative new health program in Albania. Their analysis shows how one country is making progress toward a goal of preventing chronic diseases like diabetes and heart disease on a national level. Their findings hold lessons for other locations, including Hawaiʻi.

    A global effort is underway to prevent chronic diseases, rather than focus on treating people once they become ill. Toward this goal, the small European country of Albania launched an innovative health program in 2015, called “Si je?” which encourages middle-age adults to go to their local community health center every year for a free check-up. The program is aimed at shifting healthcare resources toward disease prevention through personal contact with primary healthcare providers.

    “Right now, there is a growing understanding worldwide that in order for a nation to be healthy, it has to have a health system that aims to prevent chronic diseases, not just treat patients once they are sick,” said Tetine Sentell, lead author of the study and an associate professor with UH Mānoa Office of Public Health Studies in the Myron B. Thompson School of Social Work. “Our new study shows that the Si Je? program is working—it is building a culture of prevention and health in Albania.”

    Study results and challenges

    Researchers analyzed the screening database created from this program and conducted interviews with 15 health center directors. Results showed that about 270,000 people got a checkup during the program’s first year, which is more than a quarter of the number of people who were eligible. The program also successfully strengthened links between communities and health centers and had higher-than-expected participation rates in rural communities. As in Hawaiʻi, family members were important motivators to getting check-ups and screening.

    But challenges remain. The researchers noted a need for greater participation among some groups. For example, men had lower participation than women.

    Building a culture of prevention

    The study found that Albania, like Hawaiʻi, seeks to build a culture of prevention that will reduce health inequities by increasing patient-centered relationships with clinicians and the healthcare system and by diversifying the primary healthcare workforce to meet community needs.

    “Lessons can be learned by studying country-wide transformative programs such as Si Je? that extend far beyond Albania,” said Catherine M. Pirkle, assistant professor of public health and a co-author of the study.

    “For example, the activities to reinforce community-clinical linkages resemble similar efforts in Hawaiʻi, which may help us here as we seek to strengthen the relationships and bridges between our primary care centers with the communities they serve,” Pirkle said.

    The study was published online November 30 in Prevention Science and is a collaborative outcome from Sentell’s Fulbright Specialist program stay in Tirana, Albania in January 2017.

  • Public Health Undergrads' Hard Work Pays Off with Successful Undergrad Summit

    Posted Dec 6, 2018 at 11:18am

    After months of data collection, analysis, and thinking critically about public health issues, more than 50 undergraduate public health students put their hard work on display on Thursday in the Public Health Undergraduate Summit.

    The bi-annual event drew students and faculty members from all over the UH campus, as well as alumni and public health community members, who came to see the students' posters exhibited at the Biomed building.

    "This semester's summit was a huge success," said Denise Nelson-Hurwitz, assistant professor and chair of the public health undergraduate program. "These projects from our undergraduate students make a valuable contribution to the public health community and to research being conducted here in Hawaiʻi."

    The students' projects spanned all aspects of public health, and many projects focused on the health of Native Hawaiians or other Indigenous peoples. Leila Chang's project explored the relationships between globalization and changes in the diet of Samoans, and Cherry Yamane's project looked at ways to reduce health disparities in Indigenous populations using interventions that are based on culture.

    In one project, which dealt directly with health at UH Mānoa, Pua Yang conducted an assessment of mosquito breeding sites on campus. Mosquito larvae were found most often in littered coffee cups, which accumulate standing water. So, something as simple as reducing litter could prevent the spread of mosquito-born infections on campus.

    Prevention was a popular theme with other students as well, with a project on preventing cardiovascular disease from Kelly Knowles, a project on preventing breast cancer by Nathalie Lozano, and one on preventing diabetes by Haleigh Romero.

    Some students presented their literature reviews, an early step of completing a project, and are slated to present their completed projects at the next Public Health Undergraduate Summit in May 2019. Julia Andaya presented her literature review on promoting oral health education in kids, and Charlene Mikee Nguyen presented her early findings on promoting breastfeeding for expectant women.  

    "Student capstone projects make a difference in the way we understand the public health issues facing our communities," Nelson-Hurwitz said. These capstone projects are completed over three semesters of coursework, where students first familiarize themselves with a public health topic, then work to address it under the mentorship of a community-based or research faculty advisor, then finally link their field experiences and academic learning into a final paper and poster presentation.  

    “The projects show that our students are truly well-prepared to enter the public health workforce in Hawaiʻi or go on to graduate school,” Nelson-Hurwitz said. "It is always exciting to see where our students go next with their work."

    The Bachelor of Arts in Public Health at the University of Hawaiʻi at Mānoa is a new and exciting undergraduate degree program, preparing students for careers in multiple professional pathways in public health. High school students applying to the University of Hawai‘i at Mānoa may declare Public Health as their major upon entry. For further information about the program, contact the Undergraduate Advisor at phadvise@hawaii.edu.

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