Pono Choices: Lessons for School Leaders From the Evaluation of a Teen Pregnancy Prevention Program.

BACKGROUND: The US Office of Adolescent Health (OAH) funded studies of teen pregnancy and sexually transmitted infection (STI) prevention programs in 2010. The results of a 5-year OAH study conducted in the state of Hawai'i with middle school youth has implications for school leaders in the selection and implementation of comprehensive sex education curricula yielding positive outcomes for youth. METHODS: A cluster randomized controlled trial was conducted across 34 middle school in the state of Hawai'i with 1783 student participants in pre-, post-, and 1-year follow-up surveys to determine effectiveness of a culturally responsive teen pregnancy prevention curriculum, called Pono Choices, specifically developed for youth in Hawai'i. RESULTS: Students receiving the Pono Choices curriculum had significantly higher rates of knowledge gains than students in control schools, although there were no statistically significant differences in initiation of sexual activity between the groups at the 1-year follow-up. Teachers implemented the curriculum at high rates of adherence to fidelity making this a model for implementation. CONCLUSIONS: Knowledge and retention of medically accurate teen pregnancy and STI prevention information can be attributed to implementation of a comprehensive program with attention to factors such as fidelity, program quality, engagement, and dosage.

Empowered diabetes management: life coaching and pharmacist counseling for employed adults with diabetes.

The Hawai'i Demonstration to Maintain Independence and Employment was a randomized controlled trial examining the effect of a participant-driven, multicomponent intervention on 190 employed adults with diabetes, 36% of whom were Asian and 35% of whom were Native Hawaiian or Pacific Islander. A no treatment concurrent control group was used, and the treatment group was provided an intervention that paired each participant with a life coach and a pharmacist counselor with whom they worked to achieve collaboratively chosen goals. Treatment fidelity data suggest that the intervention was largely implemented as planned. Life coaches and pharmacists performed key program functions with high to moderate adherence. The quality of their adherence to the intervention model ranged from basic to above basic and below basic to above basic for life coaches and pharmacists, respectively. Results of repeated-measures analysis of covariance analyses indicate that the intervention had a significant positive effect on participants' diabetes self-efficacy, quality of life, and body mass index but not on hemoglobin A1c levels. Further analyses examining just the treatment group indicate a dosage effect, with body mass index and quality of life outcomes optimized among participants who engaged in a greater number of sessions with life coaches and pharmacists. Implications of the study findings for practice are discussed.

Self-perceptions on the impact of diabetes among working adults: insights into disability prevention.

Effective diabetes self-management requires persons to be active participants in their care to prevent poor function and maintain independence and employment. Persons' perceptions and understanding of the potential impact of the disease could influence their self-management practices and success. This study explores perceptions on the impact of diabetes on future independence and employment. Findings indicate that 34% of participants believed diabetes would affect their employment, and 57% believed it would impact their independence. Logistic regression analyses showed that participants who believed that diabetes would impact employment were more likely to be younger, Native Hawaiian, and in poor physical health and to have been diagnosed with diabetes for a longer period of time. Those concerned with future independence were more likely to be younger and in poor physical and mental health. Understanding the associations between individual characteristics and perceived future abilities may enable healthcare professionals to tailor health education, promotion, and maintenance interventions to the needs of specific sub-populations of diabetics.

Perceptions of diabetes, barriers to disease management, and service needs: a focus group study of working adults with diabetes in Hawaii.

INTRODUCTION: Research about the support needs for and barriers to successful disease management of working adults with diabetes is limited. Our objective was to gain an in-depth understanding of how working adults in Hawaii perceive diabetes, barriers to disease management, and the services needed to keep people healthy and working. METHODS: From November 2008 through March 2009, we conducted focus group interviews with 74 employed adults with diabetes enrolled in the Hawaii Demonstration to Maintain Independence and Employment project. Responses to questions were analyzed within and across groups to identify recurring themes. A third layer of analysis examined themes across responses to all questions, specifically, how barriers related to identified service needs. RESULTS: Employed participants with diabetes experienced pervasive effects on their lives as a result of the disease, although they interpreted these effects positively or negatively. Barriers to disease management, such as additional health issues, social prejudice, and lack of social support, indicated a need to educate the general public about the disease. Participants identified needing social support from other people with diabetes, psychological support to address the emotional side of diabetes, and coordinated teams of specialists to address medication side effects and other health-related barriers to disease management. Many participants discussed the challenge of integrating diabetes management with work and family responsibilities and the need for monetary support. CONCLUSION: This study provides insight into how employed adults perceived their disease and what they perceived as challenges to successfully managing diabetes. The findings provide future directions for community and workplace diabetes initiatives.

Dengue fever, Hawaii, 2001-2002.

Autochthonous dengue infections were last reported in Hawaii in 1944. In September 2001, the Hawaii Department of Health was notified of an unusual febrile illness in a resident with no travel history; dengue fever was confirmed. During the investigation, 1,644 persons with locally acquired denguelike illness were evaluated, and 122 (7%) laboratory-positive dengue infections were identified; dengue virus serotype 1 was isolated from 15 patients. No cases of dengue hemorrhagic fever or shock syndrome were reported. In 3 instances autochthonous infections were linked to a person who reported denguelike illness after travel to French Polynesia. Phylogenetic analyses showed the Hawaiian isolates were closely associated with contemporaneous isolates from Tahiti. Aedes albopictus was present in all communities surveyed on Oahu, Maui, Molokai, and Kauai; no Ae. aegypti were found. This outbreak underscores the importance of maintaining surveillance and control of potential disease vectors even in the absence of an imminent disease threat.

Dengue risk among visitors to Hawaii during an outbreak.

Despite the high rates of dengue in many tropical destinations frequented by tourists, limited information is available on the risk for infection among short-term visitors. We retrospectively surveyed 4,000 persons who arrived in Hawaii during the peak of the 2001-2002 dengue outbreak and collected follow-up serologic test results for those reporting denguelike illness. Of 3,064 visitors who responded, 94 (3%) experienced a denguelike illness either during their trip or within 14 days of departure; 34 of these persons were seen by a physician, and 2 were hospitalized. Twenty-seven visitors with denguelike illness provided a serum specimen; all specimens were negative for anti-dengue immunoglobulin G antibodies. The point estimate of dengue incidence was zero infections per 358 person-days of exposure with an upper 95% confidence limit of 3.0 cases per person-year. Thus, the risk for dengue infection for visitors to Hawaii during the outbreak was low.

Enhancing public health surveillance for influenza virus by incorporating newly available rapid diagnostic tests.

Beginning with the 1999-2000 influenza season, physicians throughout Hawaii ordering a viral culture for patients with suspected influenza were also offered influenza rapid testing. We compared the number of viral respiratory cultures sent to the Hawaii Department of Health and the number of providers who participated in influenza surveillance over consecutive influenza seasons. The number of viral respiratory cultures rose from 396 to 2,169 between the 1998-1999 and 2000-2001 influenza seasons, and the number of providers submitting >1 influenza culture increased from 34 to 327, respectively. The number of influenza isolates obtained each season also increased (from 64 to 491). The available data suggest that the changes observed in Hawaii's influenza surveillance were not secondary to differences in influenza activity between seasons. This is the first evaluation of integrating influenza rapid testing into public health surveillance. Coupling rapid tests with cultures appears to be an effective means of improving influenza surveillance.