Describing the Medical Needs of Hawai'i's Houseless Population During COVID at Free Student Run Outpatient Clinics (Hawai'i HOME Project).

Hawai'i experiences some of the highest rates of houselessness per capita in the country. COVID-19 has exacerbated these disparities and made it difficult for these individuals to seek medical care. Hawai'i's Houseless Outreach in Medical Education (HOME) clinic is the largest student run free clinic in the state, which provides medical services to this patient population. This article reports the demographics, medical needs, and services provided to patients of Hawai'i's HOME clinic during the era of COVID-19. From September 2020 to 2021, the HOME clinic saw 1198 unique visits with 526 distinct patients. The most common chief complaints included wound care (42.4%), pain (26.9%), and skin complaints (15.7%). A large portion of the population suffered from comorbidities including elevated blood pressure (66%), a formal reported history of hypertension (30.6%), diabetes (11.6%), and psychiatric concerns including schizophrenia (5.2%) and generalized anxiety (5.1%). Additionally, a large portion of patients (57.2%) were substance users including 17.8% of patients endorsing use of alcohol, 48.5% tobacco and 12.5% marijuana. The most common services provided were dispensation of medication (58.7%), wound cleaning/dressing changes (30.7%), and alcohol or other drug cessation counseling (25.2%). This study emphasizes that the houseless are a diverse population with complex, evolving medical needs and a high prevalence of chronic diseases and comorbidities.

E-cigarette Use Related to Demographic Factors in Hawai'i.

E-cigarette use is rapidly expanding in the United States and is projected to be a $3 billion industry by the end of this year. E-cigarette use in Hawai'i is significantly higher than national averages. The goal of this study was to examine the relationship in Hawai'i between demographic characteristics and several aspects of e-cigarette use including percentage of residents trying e-cigarettes, reasons for use, and perceived effects on health. Survey data were collected from a random sample of Hawai'i residents via the telephone in the summer of 2015, using methodology similar to that of the Hawai'i Health Survey. Chi-squared tests found e-cigarette use to be significantly associated with age (P =.001), gender (P =.03), ethnicity (P <.001), and education (P <.001). Among e-cigarette users, 12% said they started smoking regular cigarettes after starting e-cigarettes, 21% said their use of regular cigarettes did not change, 6% said they reduced use of regular cigarettes, and 20% said they completely stopped smoking regular cigarettes. Multivariable logistic regression results suggest Native Hawaiians (OR=29.1, P =.01) and Filipinos (OR=24.3, P =.01) were significantly more likely to report perceived improved health due to e-cigarette use compared to Caucasians. Given existing health disparities for Native Hawaiians and Filipinos, the fact that these groups are significantly more likely than other ethnic/racial groups to report that e-cigarettes improved their health bears notice and highlights the need for additional research in this area.