For many Native Hawaiians and other Pacific Islanders with chronic health conditions, health interventions should include their family members or close friends, according to University of Hawaiʻi at Mānoa public health research. The paper is published in Chronic Illness.

Researchers led by Tetine Sentell, director of the Office of Public Health Studies in the Thompson School of Social Work & Public Health, interviewed 22 adult patients who were hospitalized at The Queen’s Medical Center. The researchers asked the patients about the people in their lives who they turned to when they needed help with their health. Most patients were of Native Hawaiian or other Pacific Islander heritage.

“The patients in our study generally preferred to have family members or close friends involved in their care, to improve their health and reduce expensive hospitalizations,” said co-author Joy Agner, who worked on this study as a UH Mānoa graduate student. “We concluded that it is important to develop appropriate interventions that include the people who are important to patients, rather than expecting patients to go it alone.”

For the study, Sentell and her co-authors assessed each patient’s health literacy, which is their ability to understand and use healthcare information to make health decisions. Then, the patients answered questions about the people who helped them with their health, by doing things such as reminding them to take medications or assisting them in making health decisions. The researchers looked at the age, sex, education level and health knowledge of the people who helped the patients.

All of the patients in the study were hospitalized for conditions such as uncontrolled diabetes or heart disease—conditions that don’t usually require hospitalization if the patient receives high-quality, culturally-relevant primary care.

Results showed that most patients had at least one person who helped them manage their chronic health condition. Many saw the people who helped them with their health frequently, and usually saw them in person. Maintaining these relationships is an important consideration in the time of COVID-19.

“People’s social connections play a critical role in the management of their health,” Sentell said. “For Native Hawaiians and other Pacific Islanders, tapping into the power of these important connections can help to fight health disparities and build a strength-based approach.”

Not all patients wanted family or friends in their care. Future research should examine these patients’ preferences for their care and look for ways to improve their health.

Sentell and Agner’s co-authors include Deborah Taira, James Davis, Santhosh Mannem, Todd B. Seto, May Vawer and Thomas W. Valente.

Story originally posted at UH News

The COVID-19 pandemic has worsened many of the problems faced by Native Hawaiian communities, but in a new paper, public health researchers detail the numerous efforts of Native Hawaiian-led groups that show these communities’ strength and resilience.

Since the start of the pandemic, Native Hawaiians and other Pacific Islanders have faced a higher risk of contracting COVID-19 than other groups in Hawaiʻi. They also endured high levels of unemployment and economic insecurity.

“This paper highlights the power of Native Hawaiian communities during these trying times,” said Jane Chung-Do, senior author and associate professor with University of Hawaiʻi at Mānoa’s Office of Public Health Studies within the Thompson School of Social Work & Public Health. The paper is published in the Journal of Indigenous Social Development.

Nonprofit efforts

The nonprofit group Ke Kula Nui O Waimānalo (KKNOW), whose aim is to promote health and support the self-sustainability of the Waimānalo community, has partnered with other nonprofits, businesses and governmental agencies to provide food for Waimānalo families. Since mid-March, the group has distributed 24,000 prepared meals and 3,550 boxes of fresh produce. KKNOW also delivered seeds and seedlings of traditional Hawaiian crops such as kalo (taro) and ʻuala (sweet potato) to families and community members who are vulnerable to food insecurity, economic instability and other social challenges.

“The goal of KKNOW is to build community resilience by helping fellow Native Hawaiians grow their own food before further disruptions strike,” said Kirk Dietschman, president of Ke Kula Nui O Waimānalo and a co-author of the paper.

Other nonprofits have also pitched in. The meals were prepared by chefs and students in a culinary training program, coordinated by the nonprofit KUPU Hawaiʻi. Meal delivery was led by Aloha Harvest, and the Department of Hawaiian Home Lands and the Waimānalo Market Co-Op, which provided the sites for the daily food distribution.

“These efforts succeeded because these Native Hawaiian-led groups anticipated the needs of the community and leveraged existing resources and relationships to meet those needs,” said Ilima Ho-Lastimosa, the lead author of the paper and a community coordinator at the Waimānalo Learning Center of the UH Mānoa College of Tropical Agriculture and Human Resources (CTAHR). “It is key that these organizations all have history with the community and have earned the trust of the members.”

Producing long-lasting results

Historically, efforts to address health disparities have used western-centric methods and have often failed to produce long-lasting results among Indigenous peoples, the researchers wrote in their paper. They concluded that place-based, culturally-grounded interventions show promising results with Indigenous peoples and will be needed to restore the health of Native Hawaiians.

The co-authors on the paper also include LeShay Keliʻiholokai, Kaua Kassebeer, Hae Kassebeer, Joseph Awa Kamai, Ikaika Rogerson, Kenneth Ho Jr., Manahā Ho, Kamalei Ho, and Denise Kaʻaʻa, of Ke Kula Nui O Waimānalo; Alexxus Ho, of the HawaiʻiPacific University College of Health and Society, and Theodore Radovich of CTAHR.

This research is an example of UH Mānoa’s goal of Excellence in Research: Advancing the Research and Creative Work Enterprise (PDF), one of four goals identified in the 2015–25 Strategic Plan (PDF), updated in December 2020.

Story originally posted at UH News

Amalie ʻAlohilani Monlux described her experience to earn her PhD at the University of Hawaiʻi at Mānoa as a “steep and slow ascent to the top of a mountain” that almost made her turn back several times during her arduous five-year journey. However, her tenacity, a supportive network and a fateful phone call from a concerned program chair, encouraged the mother of four to achieve her goal. Next week, she will celebrate with nearly 2,000 fellow graduates when she earns her PhDin public health. 

Monlux was selected as the UH Mānoa fall 2020 commencement speaker, and is the first PhD candidate to be chosen for that role.

Born and raised on Oʻahu, Monlux is a Kamehameha Schools graduate and previously earned her master’s in public health from UH Mānoa and a bachelor’s in exercise science from Brigham Young University in Provo, Utah. 

Growing up as a Native Hawaiian and mindful of health disparities the community faces with chronic issues at a younger age and at a higher rate than other racial groups, Monlux had a passion for health and wellness and pursued her PhD in public health to “become part of the solution.” She said, “Because I’m a mom, I’m especially invested in the health of Native Hawaiian children.”

Overwhelming obstacles

Monlux began her PhD studies in fall 2015, but after successfully completing three semesters, she felt too overwhelmed to continue and took a leave of absence in the spring 2017 semester. “The feeling of disappointment was heavy. I really thought I could do it, but that day I gave up,” she said.

Monlux described the next few months as blissful, not having to worry about papers, tuition or deadlines. When the fall 2017 semester approached, she felt recharged to continue her studies. She completed the semester but felt overwhelmed again when spring 2018 rolled around. 

“I decided to quietly disappear by not enrolling for any classes, which would cause me to get dropped from the program,” she said. “I was more than embarrassed that after using a leave of absence I still couldn’t handle the pressure.” 

It was the last day to enroll in classes when Monlux received a call from Office of Public Health Studies Graduate Chair and Professor Kathryn Braun. Braun was concerned that she had not registered at all. Monlux explained her situation, and Braun suggested enrolling in a one-credit course to keep her good standing in the program.

“This was my saving grace. I saw that even minimal forward progress was progress,” Monlux said.

“I gave myself a pep talk and made the commitment to see it through. I had to do some major soul searching and really questioned why I was pursuing my PhD. My passion in Native Hawaiian health and wellness was what fueled me throughout, to one day being able to make a positive impact in my community.” 

A grateful graduate

Monlux stressed the importance of support, asking for help, and giving thanks to those who helped her and expected nothing in return. She said her PhD journey would not be possible if not for her supportive network of professors and her family. She credits her professors, like Braun, for “caring about my education and goals, and at times holding my hand so I could persevere.” Her husband, siblings and parents also played a big role to provide care for her children so she could focus on her studies.

“I auditioned to become a student speaker because it has been a labor of love by so many people for me to earn my degree, and I wanted to acknowledge them for believing in me and cheering me on during these last five years,” she said. “It’s so important, especially for a college student, and especially for a mom, to have a support system.”

Monlux said she celebrates with her fellow graduates who have overcome their own obstacles, especially in a year where they faced a “tumultuous election and a global pandemic,” to make that climb to the top of the mountain.

UH Mānoa will post recorded speeches from Monlux and PBS Hawaiʻi CEO and President Leslie Wilcox, Mahalo Messages from graduates, and a PDF of the commencement program on Monday, December 21. Visit the UH Mānoa commencement website for more information.

—By Arlene Abiang

Restrictions on flavored tobacco products are a great way to promote public health, and these restrictions work best if public health experts form partnerships with tobacco retailers, run intensive media campaigns and advocate for comprehensive bans on the products. That’s according to a study published in Tobacco Control from the University of Hawaiʻi at Mānoa Office of Public Health Studies researchers.

For the study, UH researchers interviewed experts from across the U.S. and Canada who had firsthand experience in passing, implementing or evaluating bans on flavored tobacco products. The researchers then analyzed the interviews for common themes.

“We wanted to identify the best ways to implement flavored tobacco policies,” said lead author Katey Peck, who was a UH Mānoa public health graduate student at the time of the study. Peck and her co-authors asked experts about the economic impacts, lessons learned and unforeseen consequences of implementing restrictions.

Study findings

One key finding was that comprehensive bans on the products were more effective and easier to enforce than partial bans. Partial bans might allow sales of menthol flavored products to continue or sales to proceed at retailers located within a certain distance from schools.

“The experts agreed that comprehensive bans are better because the rules are simpler. The sale of flavored tobacco products is not allowed, period,” Peck said. “With comprehensive bans, tobacco retailers don’t wind up in situations where they are trying to answer questions from customers.”

Another important finding was that media campaigns that raise awareness of the health impacts of flavored tobacco products and educate the public on the details of any new policy proposals were essential to successfully implementing new policies.

“Flavored tobacco products are risky, and the experts we talked to emphasized the importance of providing accurate, factual information to the public about the known risks of these products,” Peck said.

The experts also said public health advocates should treat tobacco retailers as partners in establishing new policies, rather than as businesses that need to be regulated. Moreover, tapping the knowledge held by retailers, who encounter the tobacco-buying public every day, can help public health advocates to create appropriate educational materials for their local populations.

“The regulation of flavored tobacco products is a new and growing area of public health,” Peck added. “Our study showed that gathering information from experts and asking them to identify and share their ideas about best practices has potential to improve the implementation and efficacy of flavored tobacco policies.”

Peck’s co-authors on the study included Rebekah Rodericks, Tetine Sentell and Catherine Pirkle, of UH Mānoa’s Office of Public Health Studies; and Lola Irvin, Lila Johnson, Jill Tamashiro and Lance Ching, of the Hawaiʻi State Department of Health.