For 20 years, faculty and students at the University of Hawaiʻi (UH) at Mānoa’s Office of Public Health Studies have served as external evaluators for the Healthy Hawaiʻi Initiative (HHI), a statewide effort to encourage healthy lifestyles and promote supportive environments, policies, and system changes. The role of the HHI Evaluation Team (HHIET) has evolved over time in response to the changing public health landscape, including broadening its scope to support the entire Chronic Disease and Prevention Health Promotion Division at the Hawaiʻi Department of Health.

HHI was created by the Hawaiʻi Department of Health (DOH) in 2000 with tobacco settlement funds, guided by a common vision to make “the healthy choice the easiest choice.” The Initiative also emphasized accessibility to public health data, published research, and evaluation reports, meant to advance its goals and bolster inter-sector partnerships. It thus required an evaluation team to support its goals. 

To meet this need for research and evaluation, HHIET built an evaluation portfolio focused on reducing tobacco use, addressing physical inactivity, and improving nutrition. In recent years, led by co-PIs Drs. Sentell & Pirkle, HHIET has expanded their evaluation work to include chronic disease management programs and health systems’ strengthening to reflect evolving DOH priorities. They additionally provide support through technical assistance, capacity building, and research surveys. 

The UH Evaluation Team’s diverse array of projects continues to document the impacts of HHI and foster collaboration between the university and DOH. A recent evaluation of Choose Healthy Now, a HHI point-of-decision prompt campaign in two major convenience store chains, found that the program had been successfully implemented due to the role of mutually beneficial partnerships, leadership buy-in, adaptability to retailer need, and statewide campaign reach. An article detailing the evaluation results, co-authored by DOH and HHIET staff, was published in the Journal of Nutrition Education and Behavior.

Another recent project sought to evaluate implementation of flavored tobacco legislation in other jurisdictions to support planning for a potential statewide ban in Hawai‘i. Interviewing a range of tobacco policy experts across the United States and Canada, the team identified supportive elements spanning four key areas: program planning and legislative preparations; education and community outreach, implementation and enforcement, and determining policy impact. An article co-authored by DOH and HHIET staff was recently published in Tobacco Control

In response to the emergent COVID-19 pandemic, HHIET maintains its close relationship with DOH and continues its focus on addressing chronic conditions that elevate risk of severe illness, especially for marginalized populations. On the research front, the HHIET is leading a special issue in the Hawaiʻi Journal of Health and Social Welfare that seeks to examine root causes and solutions at the intersections of chronic disease and COVID-19. These efforts coincide with several ongoing evaluations that examine the impacts of COVID-19 on the local food environment and access to healthy and affordable foods.

For more information, please visit the HHIET website


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.

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

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