News (all)

  • Hawai‘i youth have high rates of chronic disease

    Posted Jul 29, 2020 at 6:37am

    Chronic diseases typically associated with middle age and older adulthood are common in young people needing hospital care in Hawaiʻi, according to public health researchers from the University of Hawaiʻi at Mānoa. More than a quarter of hospitalized youth and 12 percent of youth who visited an emergency department had at least one chronic condition such as diabetes, chronic kidney disease or high blood pressure. The study was published in Preventing Chronic Disease, which is sponsored by the Centers for Disease Control and Prevention.

    “It’s likely that our results reveal only the tip of the iceberg, because chronic conditions are often underdiagnosed in young people,” said Tetine Sentell, lead author on the study and director of the Office of Public Health Studies (OPHS) in the Myron B. Thompson School of Social Work. “Importantly, we found that the rates of chronic conditions start to increase at age 9, which means we have to start early with our prevention efforts. Chronic disease management programs should be designed with the needs of children, teens and young adults in mind.”

    “Health care providers need to be aware that chronic disease is common among youth needing hospitalization and should work closely with them and their families to effectively manage these conditions,” said Catherine Pirkle, an associate professor in OPHS and co-author of the study. “Efforts are needed building from community strengths, knowledge and relationships across the lifespan, starting as early as pregnancy and throughout childhood, to prevent chronic disease.”

    At-risk groups

    Young Native Hawaiians appear at particular risk in youth and early adulthood. Of all hospitalized children or young adult patients, 25 percent were Native Hawaiian. However, among the hospitalized patients who had asthma, 38 percent were Native Hawaiian, and among those with diabetes, 31 percent were Native Hawaiian. Higher rates of chronic conditions were also seen in other Pacific Islanders and Filipinos. Of all hospitalized patients, 13 percent were other Pacific Islander, and 15 percent were Filipino. But among the hospitalized patients with hypertension, 21 percent were other Pacific Islander and 18 percent were Filipino. Of the hospitalized patients with diabetes, 19 percent were other Pacific Islander and 16 percent were Filipino. These are higher than population averages for these groups.

    Previous research has shown that Native Hawaiians, Filipinos and other Pacific Islanders were at risk for chronic disease at earlier ages in adulthood than other racial/ethnic groups. This new study quantifies how this trend is reaching into youth.

    “This information will help us take next steps to addressing chronic disease earlier in life,” said May Okihiro, a pediatrician at the Waiʻanae Coast Comprehensive Health Center and assistant professor in pediatrics at UH Mānoa’s John A. Burns School of Medicine (JABSOM). “Culturally grounded interventions, such as those that include community and family and connect people with the land or ocean may be relevant for reducing chronic disease rates in Native Hawaiian, other Pacific Islander and Filipino populations.”

    For the study, Sentell and her co-authors pulled data on all inpatient and emergency department visits statewide for children and young adults ages 5 to 29 during 2015 and 2016. After excluding visits related to pregnancy, they analyzed data from 13,514 inpatient stays and 228,548 emergency department visits over the two-year period. The authors were also able to estimate the costs associated with these hospitalizations and the proportion paid by Medicaid.

    Sentell and Pirkle’s co-authors on the study included Michelle Quensell, L. Brooke Keliikoa and Émilie Corriveau, all of OPHS; So Yung Choi, JABSOM; and Lance Ching, Hawaiʻi State Department of Health.

  • New 'one health' course connects animal, human, environment interactions

    Posted Jul 22, 2020 at 6:24am

    Although much remains unknown about the origin of the COVID-19 pandemic, it likely involved the spillover of a coronavirus from a bat or another species to humans. Diseases such as COVID-19exemplify how human health and animal health are often linked.

    A new University of Hawaiʻi at Mānoa undergraduate public health course, called “Introduction to One Health,” aims to teach students about the myriad animal-human-environment interactions occurring globally as well as in Hawaiʻi, that could adversely affect the health of humans and the planet now and into the future.

    “In the future, global citizens will need to understand the connections between animal health, human health and climate change,” said Catherine Pirkle, an associate professor with the Office of Public Health Studies (OPHS), who teaches the course. “This course aims to give students the knowledge they will need to help address the complex challenges facing our world.”

    Critical connections

    Ministries of health and numerous public health organizations, including the World Health Organization and the Centers for Disease Control and Prevention, recognize the importance of the one health concept. Typically, one health courses integrate lessons from veterinary medicine, public health, health policy, biology, ecology, climatology and sociology.

    UH students enrolled in the course will complete broadly themed modules. In a module on water sources and contamination, students learn how lead in drinking water in Flint, Mich., has impacted children’s health, and how Hawaiian monk seals develop infections from contaminated wastewater entering the Pacific. In a module on fossil fuels, class activities cover the impacts of global warming and rising seas on coastal indigenous people, as well as coral bleaching events.

    “The goal is for students to learn to see the connections between all of these disparate impacts, and also learn about the critical policy decisions behind the events that are changing our environment,” Pirkle said. The course is taught asynchronously, meaning that students can work at their own pace to complete the assignments by the deadlines but still engage in group discussions via the course’s forum.

    Regional relevancy

    The topics covered are particularly relevant to Hawaiʻi and the Pacific region. This course is an integral part of an interdisciplinary, inter-departmental collaboration to support undergraduate engagement in one health concepts in research and training funded by a recent competition. This project brings together strengths from the OPHS, John A. Burns School of Medicine (JABSOM), College of Tropical Agriculture and Human Resources and the School of Ocean and Earth Science and Technology.

    “The vast majority of emerging infectious diseases are zoonotic, meaning they start with the transmission of a microbe from animals to humans,” said Richard Yanagihara, a professor of pediatrics at JABSOM and the lead of the inter-departmental collaboration.

    “Human encroachment on animal habitats and human consumption of wild animals contribute to the emergence of infectious diseases,” Yanagihara said. “It is imperative to better understand the connectivity between humans, animals and the environment to develop more effective solutions to mitigate and prevent infectious diseases with epidemic potential.”

    “These issues, and our collaborations, are becoming ever more urgent in the time of COVID-19,” said Tetine Sentell, the chair and director of OPHS. “We are excited about this course and to continue to work together to grow collaborative research and teaching in one health across the strengths of UH.”

    The inaugural one health course is open to undergraduate and graduate students of any major, and the next course will be offered in 2021. Interested students may contact Pirkle at cmpirkle@hawaii.edu for more information.

  • Hawai‘i blood pressure monitoring programs a success

    Posted Jul 22, 2020 at 6:16am

    Remote healthcare is increasingly critical in the time of COVID-19. Five health clinics in Hawaiʻi recently launched programs to help patients monitor their blood pressure at home, and these programs were successful in addressing patients’ health and psychosocial needs, according to public health researchers at the University of Hawaiʻi at Mānoa.

    The clinics were all federally qualified health centers (FQHCs), which serve many patients below the federal poverty level. The researchers worked in a collaborative partnership to study the programs to find out what barriers the programs faced, and what factors contributed to the programs’ success in enrolling patients. The paper is published in Preventing Chronic Disease.

    “We know that these programs can help people to substantially decrease their blood pressure, but there is no clear protocol for starting programs like these,” said David Stupplebeen, who led the study and recently completed his doctoral degree with the UH Mānoa Office of Public Health Studies.

    “These programs could provide a great tool for providers to monitor their patients’ health at a distance during the COVID-19 pandemic,” Stupplebeen said.

    For the study, the researchers interviewed nine healthcare providers who worked in the blood pressure monitoring programs. They asked how the providers went about identifying and enrolling program participants, and how the patients were monitored.

    “Our analysis showed the FQHCs were not just instrumental in supporting these programs, but creative in how they leveraged their existing programs, like exercise or other lifestyle-change programs,” Stupplebeen said. “Their team-based care model allowed for multiple staff touchpoints in order to work toward meeting patients’ needs.”

    Clinical changes

    Moreover, these programs successfully integrated clinical changes through patients monitoring their blood pressure with important lifestyle education on diet, including menu planning, food preparation demonstrations and nutritionist referrals.

    The researchers found that the programs’ main goals were to confirm a hypertension diagnosis and to help patients achieve control over their blood pressure, meaning bring their blood pressure back down into a healthier range. Federal data from health centers show that only about two-thirds (64 percent) of patients at Hawaiʻi FQHCs with high blood pressure had achieved blood pressure control in 2017.

    The barriers the programs faced included limited ability to reach patients who were homeless or had mental illness, and the lack of a standardized, pre-written curriculum for such programs. The program staff had built the programs by combining materials from a variety of sources.

    “Our study highlights the innovation of FQHCs and their capacity to make the most of limited resources to support the health and well-being of our communities,” said L. Brooke Keliʻikoa, an assistant specialist with the UH Mānoa Office of Public Health Studies who also worked on the study.

    This project is part of the Healthy Hawaiʻi Initiative partnership.

    Stupplebeen and Keliʻikoa’s co-authors on the paper included Tetine L. Sentell, and Catherine Pirkle, also of the UH Mānoa Office of Public Health Studies; Blythe M. I. Nett and Lindsey S. K. Ilagan, of the Chronic Disease Prevention and Health Promotion Division of the Hawaiʻi State Department of Health; Bryan Juan, of the Hawaiʻi Primary Care Association; and Jared Medeiros, of the Lānaʻi Community Health Center.

  • #PowerOfPublicHealth808 encourages Hawai‘i community to wear masks

    Posted Jul 15, 2020 at 11:46am

    To help demonstrate the power of public health in Hawaiʻi, two University of Hawaiʻi at Mānoa Office of Public Health Studies faculty launched a social media campaign #PowerOfPublicHealth808 to promote wearing face masks to help slow the spread of COVID-19.

    Denise Nelson-Hurwitz, an assistant professor at the Office of Public Health Studies in the Myron B. Thompson School of Social Work, and Lisa Kehl practicum coordinator at the Office of Public Health Studies, designed the social media campaign #PowerOfPublicHealth808 to empower Hawaiʻi’s community to do their part to help keep people safe by wearing a mask during the COVID-19 pandemic.

    “We wanted the campaign, and hashtag, to be empowering, and relevant to our local community,” said Kehl. “We feel the aloha spirit practiced throughout Hawaiʻi, and our strong sense of community encourages us to protect our neighbors, families and ourselves from COVID-19 by practicing physical distancing and wearing masks.”

    To participate, post a photo of you, your family or organization, wearing face masks and add the caption “I/we wear a mask to protect…” on Facebook, Instagram or Twitter, using the hashtag #PowerOfPublicHealth808.

    “We’ve seen growing participation on Facebook and Twitter from many age groups,” said Nelson-Hurwitz. “I’ve especially loved seeing our students and graduates living out their public health training and posting their masked selfies.”

    Among those showing support for the social media campaign are Gov. David Ige and First Lady Dawn Amano-Ige, who posted a photo wearing their masks on Facebook and Instagram.

    “Wearing a mask has been effective in limiting the transmission of respiratory diseases for over a century. It is more effective at protecting others, but it is still effective at reducing the risk of getting sick yourself,” said Nelson-Hurwitz. “We in Hawaiʻi can do this for our kupuna and our keiki, for our high-risk populations, including Native Hawaiians and other Pacific Islanders, and we can again demonstrate to the world why we’re lucky to live in Hawaiʻi.“

  • Tough Decisions Needs Better Data and Inclusive Voices

    Posted Jun 29, 2020 at 1:30pm

    Writer Laurie Garrett once wrote, “Public health is a negative. When it is at its best, nothing happens: There are no epidemics.”

    Public health advocates have long been faced with a communication challenge – how can we communicate the seriousness of acting when “nothing happens”?

    COVID-19 was temporarily subdued by the decisive action of Gov. David Ige to shut down the state and restrict inbound travelers with a 14-day quarantine. After three months, Hawaii briefly returned to this stage of “nothing happening” with only a handful of cases each day.

    That is, of course, before the most recent spike. Something appears to be happening.

    Meanwhile, our tourist-dependent economy has been devastated, our state is in dire financial straits. The lines for unemployment services, food, health insurance, mental health services, and all kinds of assistance stretch on. People are suffering.

    Let’s be clear. This state had no other choice but to go with the mass shutdown and quarantine measures because cases were skyrocketing back in March. At a wildfire spread, our hospitals could have been overwhelmed with cases. Fortunately, we live in an island state where shutdown lends to a natural extinguishing of the virus.

    Now, we again face a critical juncture. What should the state do in light of the recent spikes of double-digit cases? How quickly should the state lift the shutdown measures? Are we adequately reinforcing our most important tool in our Epidemic Prevention Toolkit: Testing-Contact Tracing-Quarantine strategy?

    This latter strategy is what Taiwan has called its “precision” epidemic prevention tool – as opposed to a medieval “mass shutdown” tool, effective but painfully costly to our state. Will our state avoid another shutdown? What are the trade offs between COVID-19 care and other health care, between human lives and economic recovery?

    These kinds of questions prompted us to form the Hawaii Pandemic Applied Modeling (HiPAM) Work Group. We are a group of applied epidemiologists, data scientists, and health professionals who want to help the state tackle these tough questions – which have only bad or worse outcomes, no good ones.

    We face a new virus and our understanding of its biological features is constantly changing. No one expert or authority can presume to have complete expertise. We must draw on a broad base of thoughts and ideas but also thoughtfully use “data” and “evidence” in the face of many known unknowns and unknown unknowns.

    As a community, we know better than others who we are and what we do. While we seek support from outside the state, only we can make the best decisions for ourselves. To do that, we need to come together in an inclusive and unified way – bringing everyone to the table and channeling our collective knowledge and mana‘o. Such an approach creates transparency and accountability, one that can be strengthened with mutual gratitude, respect, and trust.

    We cannot dismiss others’ knowledge. We must welcome and include other voices to the table in order to be more effective.

    About the Authors

    Victoria Fan, ScD is faculty at the University of Hawaii Manoa and a member of the Hawaii Pandemic Applied Modeling Work Group, a voluntary brain trust to help confront the challenges of COVID-19 via the use of data and models.

    Nick Redding Ph.D. is executive director of the Hawaii Data Collaborative. He is a member of the Hawaii Pandemic Applied Modeling Work Group, a voluntary brain trust to help confront the challenges of COVID-19 via the use of data and models.

  • Lessons from Another Pandemic

    Posted Jun 24, 2020 at 7:24am

    This week, the Legislature is convening to make critical spending decisions for the future of our state. Most of these decisions will dictate how we address our local COVID-19 outbreak.

    I offer here the perspective of someone who has worked for over 15 years in some of the most severely resource-constrained settings in the world. They’re based on my professional experiences working on another global pandemic — HIV/AIDS.

    I began my career at a unique historical moment in which global funds to address HIV/AIDS went from almost non-existent to spectacularly abundant. This happened in 2003 and coincided with President Bush’s State of the Union speech in which he simultaneously announced intentions to go to war with Iraq and a $15-billion-dollar relief package to address HIV/AIDS.

    The decade to follow was a remarkable time for research and action, as well as for critical reflection about our responses.

    I present three considerations from my work on HIV/AIDS that may provide lessons for moving forward with our responses to COVID-19.

    The first consideration is “Know your epidemic, know your response.”

    This slogan was led by UNAIDS, the United Nations agency responsible for strategic direction in the global response against HIV/AIDS. The slogan recognized that there is no single HIV epidemic, but instead many diverse ones that reflect the unique social, demographic, economic, and health system characteristics of the places where they occur.

    As such, no singular prevention or treatment solution exists. This lesson equally applies to our current COVID-19 outbreak.

    “Know your epidemic, know your response” is a reminder that successfully combatting a disease requires nuanced insights into the people infected and affected, including broader community expectations around behavior. Most human health conditions, including those caused by infectious organisms, are rooted in people’s behaviors. People’s behaviors are constrained by social structures.

    Social structures broadly describe how we organize our society and the institutions that govern our actions. Our economic and political systems are examples.

    Public policies also reflect these, including how we fund health services, who has access to those services, and which services we deem most important. Social structures also manifest in how we define groups — race, sex, occupation — and how we treat those groups, including the options that are available to them to protect their health. Not everyone is treated equally, nor have the same options available to them.

    Waiting For A Vaccine

    This brings me to the second consideration, biomedicalization.

    At varying moments over the past four decades of addressing the HIV pandemic, there were intense debates about who should be “at the table” to address the problem. At times, the epidemic was viewed as “a medical problem best addressed by purely technical, biomedical solutions whose management should be left to biomedical professionals and scientists.” This is biomedicalization. Such a response searches for singular solutions — such as a wonder drug or vaccine — to solve a complex problem that cannot be parsed out from the complicated ways people behave and interact, and the inequalities between people.

    This is no different from now. All of us, including myself, are hoping for a silver bullet solution like a vaccine. There are no guarantees one will be developed. In the meantime, we must address the ongoing pandemic. Diagnostic tests and case-tracing are critical tools to effectively address outbreaks across the globe, but they are insufficient. A purely biomedical response to the disease will fail, because it doesn’t consider the people and communities in which disease transmission happens. It ignores the behaviors, and social structures, that facilitate or prevent viral transmission.

    This brings me to my final consideration — vertical approaches.

    When we biomedicalize a response to a given health condition, like COVID-19, our actions and funding tend to concentrate exclusively on that condition and a set of limited technical solutions to resolve it. This is a vertical approach. While vertical approaches make sense, especially when resources are scarce, they often do not work as intended.

    The problem is that most deadly diseases, including COVID-19, are efficient at reaching the vulnerable members in our society. The much higher rates of infection, hospitalization, and death among underserved and marginalized racial/ethnic minorities in the US exemplifies this point. Vertical approaches are incapable of addressing the complex factors that place certain groups at higher risk than others.

    The other issue with vertical approaches is the challenge associated with implementing them within health systems and public health networks. Neither function well vertically. When we throw all our money and effort into addressing a singular disease, we risk creating duplicate systems that compete with each other.

    After President Bush’s State of the Union speech in 2003, large sums of money went to vertical, heavily biomedical approaches. In general, this new windfall could not be used to build capacity within already fragile health systems.

    The result was a fracturing of the existing health system. For example, staff who once treated critical medical issues like malaria or worked in delivery care took better paying jobs working on HIV/AIDS.

    Bolster Resources

    Governmental agencies limped along with sparse budgets, while newly created HIV/AIDS units flourished. But, these new units could not be sustained without external infusions of money. Because of this, they often lacked independence to make decisions pertinent to their communities and funds frequently flowed in inexplicable ways driven by external donors unfamiliar with the local context. In other words, “Know your epidemic, know your response” was ignored.

    We can learn from the considerations above. For example, to properly know our epidemic, we need to identify and target the unique social vulnerabilities that place certain groups in our state — for example Filipinos and Pacific Islanders — at higher risk than others. To do so means avoiding an exclusively biomedical response, part of which requires a diversity of perspectives, including from social scientists and community leaders, to guide the response.

    Finally, there are risks to vertical approaches that seek to bolster resources for a singular health condition while failing to support the broader system in which these approaches are implemented. To successfully combat this disease, we should limit our dependence on unsustainable external funds that create siloed, vertical programs, with a limited number of technical fixes, rather than reinforce the whole system.

  • UH helps shelter homeless, provide services during COVID-19

    Posted Jun 23, 2020 at 12:45pm

    Public, private and non-profit organizations and agencies formed the Behavioral Health and Homelessness Statewide Unified Response Group (BHHSURG) with the support of the University of Hawaiʻi at Mānoa, to break down silos and to ensure the community’s most vulnerable receive the care they need, especially during the COVID-19 pandemic.

    The Hawaiʻi Department of Health has operated the TQIC with a number of community partners, including the Institute for Human Services; the Hawaiʻi Homeless Healthcare Hui; Local 5, the union that represents hospitality, healthcare and food service workers; and others. Collectively, the groups provided the necessary human resources support, including healthcare professionals, case managers and round-the-clock security for the center to open its doors in late March.

    As a result, the center has been able to free up hospital space to improve care capacity, save on medical costs, and keep the community protected from potentially infected individuals.

    According to a recent report prepared by the Department of Health and the UH Mānoa Office of Public Health Studies, data collected from clients at the center has also proven that such a facility has been effective in tackling a deeper, more pervasive challenge: the need for a behavioral health crisis stabilization center to take care of the health and social needs of homeless individuals, including those with substance use disorder.

    “The population we serve is often marginalized but the services we provide are vitally important to the overall health and wellbeing of our entire community, and is a necessary component to safely reopening our state,” said Edward Mersereau, the Department of Health’s deputy director of behavioral health.

    Mersereau said unsheltered individuals generally have other chronic, pre-existing health conditions such as undiagnosed or unmanaged diabetes and heart disease and have a disproportionately high rate of behavioral health conditions, including substance use disorders. This makes their care more complex, requiring an interdisciplinary approach.

    “Through our work at UH on analytics, evaluation and the CARES Line, we are grateful for the opportunity for UH to partner with DOH on this proof of concept of a behavioral health crisis stabilization center which has the potential to save the state the large medical and economic costs of behavioral health crises,” said Victoria Fan, a UH Mānoa associate professor in the Myron B. Thompson School of Social Work.

    For more see the Hawaiʻi Department of Health website.

  • First national Medicare counseling certification

    Posted Jun 15, 2020 at 6:24pm

    The first course training students to earn a national Medicare counseling certification began this past spring at the University of Hawaiʻi at Mānoa. The inaugural cohort of the Introduction to Medicare started with 11 students from the Office of Public Health Studies and the Myron B. Thompson School of Social Work.

    This new course was the first partnership between the Executive Office on Aging (EOA), Hawaiʻi State Health Insurance Assistance Program (State Health Insurance Assistance Program) and UH Mānoa’s Office of Public Health Studies and School of Social Work.

    “This was the first joint course between Public Health and Social Work, the first course sponsored by the DOH Executive Office of Aging, and the first course using a national Medicare curriculum,” said Victoria Fan, UH Mānoa associate professor of health policy.

    The innovative curriculum used a variety of modalities to familiarize students with Medicare. Training included online learning modules from the national SHIP network, guest speakers from EOA and case study reviews with Hawaiʻi SHIP staff and volunteers.

    “It was rewarding to learn alongside both the students and teaching team throughout this innovative course offering, which pairs extensive Medicare knowledge with tangible real world application,” said Whitney Kim, a MSW student and Pacific Health Analytics Collaborative graduate assistant.

    Service learning projects

    Students were split into four groups to develop service learning projects. Two groups explored health insurance options for the Marshallese community and veterans and their spouses. Another group focused on dual-eligible populations that qualify for Medicare and Medicaid. The last group translated basic Medicare information into Korean and Tagalog for people with limited English.

    “From day one we had an amazing teaching team and the Hawaiʻi Executive Office on Aging that were welcoming and helpful,” said Justin Mortensen, an undergraduate public health student. “They made learning a complicated insurance system easy to learn in small parts through activities and modules. It was a great experience being able to build relationships with community partners and work with my group to create a product that could benefit Medicare beneficiaries.”

    Collectively, the students research produced powerpoint presentations, brochures and infographics that will help their focus communities and Hawaiʻi SHIP. The COVID-19 stay-at-home order prompted the teaching team to restructure the course for the remainder of the semester. Classes and meetings took place virtually, allowing the teaching team to provide extra support to the students.

    “As co-instructor, it was extremely rewarding to see how much students have gained knowledge of Medicare and actualized their service-learning projects with community partners, which would not have been possible without support from Hawaiʻi SHIP partners Lani, Wanda, and Candace, and mentorships from SHIP volunteers,” said Seunghye Hong, UH Mānoa associate professor of social work. 

    “Even if insurance has never been an interest to you, I recommend taking this course, as the knowledge and skills you will walk away with can be applicable personally and professionally,” said Mortensen.

    Story originally posted at UH News

  • Healthy Hawai‘i Initiative Celebrates 20 years of lifting communities

    Posted Jun 10, 2020 at 1:20pm

    Preventing and managing chronic conditions such as diabetes and heart disease remain especially critical during the COVID-19 pandemic. For 20 years, the Healthy Hawaiʻi Initiative has been working to build healthier, more equitable communities and helping to reduce health disparities related to chronic diseases. Deaths due to heart disease decreased by 34 percent, stroke by 44 percent, and lung cancer by 10 percent during this time. Smoking prevalence among public high school students dropped by 72 percent over two decades, from 29.2 percent to 8.1 percent.

    Now, as diabetes, heart disease and other conditions are associated with increased risk for COVID-19, it is important to maintain these gains.

    In a paper published in BMC Public Health, researchers from the University of Hawaiʻi at Mānoa Office of Public Health Studies report how the Healthy Hawaiʻi Initiative was created in 2000 with tobacco settlement funds as a statewide effort to promote health-supporting environments through systems and policy change.

    The Healthy Hawaiʻi Initiative started with a vision to make “the healthy choice the easiest choice,” for all Hawaiʻi residents, the researchers wrote. The initiative built relationships between community members, lawmakers and stakeholders across the islands and had many notable policy and project successes, including Complete Streets policies, the Choose Healthy Now ad campaign, and the Hawaiʻi Health Data Warehouse.

    “Making health a shared value requires a cultural shift, and we believe the Healthy Hawaiʻi Initiative has contributed a new understanding that can be useful to long-term public health initiatives,” said Catherine Pirkle, one of the authors of the report and an associate professor with the UH Mānoa Office of Public Health Studies.

    Long-term vision

    For the new paper, Pirkle and her co-authors interviewed 10 public health leaders and community members who have worked on the initiative. The goal was to better understand the history, achievements and challenges of the Healthy Hawaiʻi Initiative.

    The interviews revealed that a clear, long-term vision of health in the state was essential to the Healthy Hawaiʻi Initiative’s successes. Moreover, by developing long-term relationships with lawmakers, building strong, publically-available data surveillance tools and telling compelling stories, the initiative garnered support for health promotion programs.

    “The success of the Healthy Hawaiʻi Initiative over the course of 20 years can be seen through the change and growth of the program since its creation and vision,” said Tetine Sentell, director of the UH Office of Public Health Studies and senior author of the paper.

    Today, the Healthy Hawaiʻi Initiative continues to support the prevention and management of chronic disease, including supporting culturally-tailored programs relevant to Hawaiʻi’s diversity and encouraging communities to take care of their chronic disease even in the stress and confusion of COVID-19.

    “Addressing health and prevention focusing on our communities will continue to be the Healthy Hawaiʻi Initiative’s focus,” Sentell said. “We want to turn theoretical ideas into health practices and promote and sustain long-term change throughout the islands.”

    Pirkle and Sentell’s co-authors on the paper include Opal Vanessa Buchthal, assistant professor of the UH Mānoa Office of Public Health Studies; Joy Agner, of the UH Mānoa Department of Community and Cultural Psychology; Lola Irvin, of the Hawaiʻi State Department of Health; Jay E. Maddock, of Texas A&M University; Jessica Yamauchi, of the Hawaiʻi Public Health Institute; and Ranjani Starr, of the Hawaiʻi State Department of Health and Human Services.

    Learn more about the Healthy Hawaiʻi Initiative.

    Story originally posted at UH News

  • Physical Activity to benefit people with genetic risk of obesity

    Posted Jun 10, 2020 at 1:12pm

    Certain genes influence people’s risk of obesity, but many aspects of their lives interact with those genes, and these interactions over a lifetime can drive people’s body mass index (BMI) further up or down. That’s according to a new study published in the International Journal of Obesity by public health researchers at the University of Hawaiʻi at Mānoa Office of Public Health Studies in the Myron. B. Thompson School of Social Work.

    For the study, researchers led by Mika Thompson, a UH Mānoa public health graduate research assistant, used data from about 6,700 participants in the ongoing Health and Retirement Study, which includes samples of black and white men and women in the U.S. who are older than age 50.

    Thompson and his co-authors looked at certain factors of people’s lives that they can control, such as alcohol use, smoking and physical activity, and factors that they could not control, such as the income level of their family during their childhood. In addition, saliva samples were collected from participants to test their DNA.

    “Our findings reinforce the importance of physical activity among people with an elevated genetic risk for obesity,” Thompson said.

    Among white women who had the highest genetic risk for obesity, the BMI of those who engaged in vigorous physical activity was 1.66 points (about 10 pounds) lower, on average, compared with those who did not engage in physical activity. The effect was less pronounced among white women with lower genetic risk.

    “The association found in this study by Thompson further supports the statement that your zip code is a greater predictor of your health outcome than your genetic code,” said Lola Irvin, administrator of the Chronic Disease Prevention and Health Promotion Division in the Hawaiʻi State Department of Health, who was not involved in conducting the study. “The opportunities and choices in one’s community for physical activity, such as sidewalks, bike lanes and recreational facilities, are not determined by individual choice, but by policies and systems decisions.”

    Genetic risk score

    Researchers have identified thousands of genetic variations that have been linked to BMI, however, these individual variations explain only a small amount of people’s obesity risk. In the new study, the researchers took a different approach and used a calculation to create a genetic risk score based on many genetic variations that increase or decrease a person’s obesity risk. They broke down their results by race, sex and age.

    Factors such as diet and exercise influence obesity risk. Moreover, research shows that these genes interact with factors in a person’s environment.

    “The association between people’s genetic risk for obesity and their BMI became weaker as people aged,” said Catherine Pirkle, an associate professor with the Office of Public Health Studies and a co-author on the paper. “This suggests genetic risk for obesity becomes less influential in older adulthood.”

    Other findings suggest links between BMI and alcohol consumption, and BMI and childhood socioeconomic status. The researchers will further investigate these results in future research.

    Most research to date on the genes linked to obesity have come from studies of people in Europe. More research is needed to better measure genetic risk in diverse samples from the U.S. and other world regions.

    “The new findings may help to improve approaches to helping people to lower their BMI during their older adulthood years,” Pirkle said.

    Thompson and Pirkle’s co-authors on the paper include Office of Public Health Studies Fadi Youkhana, a graduate assistant, and Yan Yan Wu, an associate professor.

    Story originally posted at UH News

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