Ka-HOLO Project: a protocol for a randomized controlled trial of a native cultural dance program for cardiovascular disease prevention in Native Hawaiians.

BACKGROUND: As a major risk factor for cardiovascular and cerebrovascular disease (CVD), hypertension affects 33% of U.S. adults. Relative to other US races and ethnicities, Native Hawaiians have a high prevalence of hypertension and are 3 to 4 times more likely to have CVD. Effective, culturally-relevant interventions are needed to address CVD risk in this population. Investigators of the Ka-HOLO Project developed a study design to test the efficacy of an intervention that uses hula, a traditional Hawaiian dance, to increase physical activity and reduce CVD risk. METHODS: A 2-arm randomized controlled trial with a wait-list control design will be implemented to test a 6-month intervention based on hula to manage blood pressure and reduce CVD risk in 250 adult Native Hawaiians with diagnosed hypertension. Half of the sample will be randomized to each arm, stratified across multiple study sites. Primary outcomes are reduction in systolic blood pressure and improvement in CVD risk as measured by the Framingham Risk Score. Other psychosocial and sociocultural measures will be included to determine mediators of intervention effects on primary outcomes. Assessments will be conducted at baseline, 3 months, and 6 months for all participants, and at 12 months for intervention participants only. DISCUSSION: This trial will elucidate the efficacy of a novel hypertension management program designed to reduce CVD risk in an indigenous population by using a cultural dance form as its physical activity component. The results of this culturally-based intervention will have implications for other indigenous populations globally and will offer a sustainable, culturally-relevant means of addressing CVD disparities. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02620709 , registration date November 23, 2015.

The effects of perceived racism on psychological distress mediated by venting and disengagement coping in Native Hawaiians.

BACKGROUND: Studies have linked perceived racism to psychological distress via certain coping strategies in several different racial and ethnic groups, but few of these studies included indigenous populations. Elucidating modifiable factors for intervention to reduce the adverse effects of racism on psychological well-being is another avenue to addressing health inequities. METHODS: We examined the potential mediating effects of 14 distinct coping strategies on the relationship between perceived racism and psychological distress in a community-based sample of 145 Native Hawaiians using structural equation modeling. RESULTS: Perceived racism had a significant indirect effect on psychological distress, mediated through venting and behavioral disengagement coping strategies, with control for age, gender, educational level, and marital status. DISCUSSION: The findings suggest that certain coping strategies may exacerbate the deleterious effects of racism on a person's psychological well-being. CONCLUSION: Our study adds Native Hawaiians to the list of U.S. racial and ethnic minorities whose psychological well-being is adversely affected by racism.

How is the effect of adolescent e-cigarette use on smoking onset mediated: A longitudinal analysis.

E-cigarette use by adolescents has been related to onset of cigarette smoking but there is little knowledge about the process(es) through which this occurs. Accordingly, we tested the role of cognitive and social factors for mediating the relation between e-cigarette use and smoking onset. A school-based survey was conducted with a baseline sample of 2,338 students in Hawaii (9th and 10th graders, mean age 14.7 years) who were surveyed in 2013 (Time 1, T1) and followed up 1 year later (Time 2, T2). We assessed e-cigarette use, cigarette smoking, demographic covariates, and 4 hypothesized mediators: smoking-related expectancies, prototypes, and peer affiliations as well as marijuana use. The primary structural modeling analysis, based on initial never-smokers, used an autoregressive model (entering T2 mediator values adjusted for T1 values) to test for mediational pathways in the relation between e-cigarette use at T1 and cigarette smoking status at T2. Results showed that e-cigarette use was related to all of the mediators. Tests of indirect effects indicated that changes in expectancies, affiliations, and marijuana use were significant pathways in the relation between e-cigarette use and smoking onset. A direct effect from e-cigarette use to smoking onset was nonsignificant. Findings were replicated across autoregressive and prospective models. We conclude that the relation between adolescent e-cigarette use and smoking onset is in part attributable to cognitive and social processes that follow from e-cigarette use. Further research is needed to understand the relative role of nicotine and psychosocial factors in smoking onset. (PsycINFO Database Record

E-cigarette use and willingness to smoke: a sample of adolescent non-smokers.

OBJECTIVE: There is little evidence on the consequences of using electronic cigarettes (e-cigarette) in adolescence. With a multiethnic sample of non-smokers, we assessed the relation between e-cigarette use and social-cognitive factors that predict smoking of combustible cigarettes. METHODS: School-based cross-sectional survey of 2309 high school students (mean age 14.7 years). Participants reported on e-cigarette use and cigarette use; on smoking-related cognitions (smoking expectancies, prototypes of smokers) and peer smoker affiliations; and on willingness to smoke cigarettes. Regression analyses conducted for non-cigarette smokers tested the association between e-cigarette use and willingness to smoke cigarettes, controlling for demographics, parenting, academic and social competence, and personality variables. Structural equation modelling (SEM) analysis tested whether the relation between e-cigarette use and willingness to smoke was mediated through any of the three smoking-related variables. RESULTS: Non-smokers who had used e-cigarettes (18% of the total sample) showed more willingness to smoke cigarettes compared with those who had never used any tobacco product; the adjusted OR was 2.35 (95% CI 1.73 to 3.19). SEM showed that the relation between e-cigarette use and willingness to smoke was partly mediated through more positive expectancies about smoking, but there was also a direct path from e-cigarette use to willingness. CONCLUSIONS: Among adolescent non-smokers, e-cigarette use is associated with willingness to smoke, a predictor of future cigarette smoking. The results suggest that use of e-cigarettes by adolescents is not without attitudinal risk for cigarette smoking. These findings have implications for formulation of policy about access to e-cigarettes by adolescents.

Quantifying alcohol consumption: Self-report, transdermal assessment, and prediction of dependence symptoms.

Research on alcohol use depends heavily on the validity of self-reported drinking. The present paper presents data from 647 days of self-monitoring with a transdermal alcohol sensor by 60 young adults. We utilized a biochemical measure, transdermal alcohol assessment with the WrisTAS, to examine the convergent validity of three approaches to collecting daily self-report drinking data: experience sampling, daily morning reports of the previous night, and 1-week timeline follow-back (TLFB) assessments. We tested associations between three pharmacokinetic indices (peak concentration, area under the curve (AUC), and time to reach peak concentration) derived from the transdermal alcohol signal and within- and between- person variation in alcohol dependence symptoms. The WrisTAS data corroborated 85.74% of self-reported drinking days based on the experience sampling data. The TLFB assessment and combined experience sampling and morning reports agreed on 87.27% of drinking days. Drinks per drinking day did not vary as a function of wearing or not wearing the sensor; this indicates that participants provided consistent reports of their drinking regardless of biochemical verification. In respect to self-reported alcohol dependence symptoms, the AUC of the WrisTAS alcohol signal was associated with dependence symptoms at both the within- and between- person level. Furthermore, alcohol dependence symptoms at baseline predicted drinking episodes characterized in biochemical data by both higher peak alcohol concentration and faster time to reach peak concentration. The results support the validity of self-report alcohol data, provide empirical data useful for optimal design of daily process sampling, and provide an initial demonstration of the use of transdermal alcohol assessment to characterize drinking dynamics associated with risk for alcohol dependence.

A Study of Motives for Tobacco and Alcohol Use Among High School Students in Hungary.

Motives may be an important influence for substance use among youth. The goal of this research was to study the relation of social, self-enhancement, boredom relief and affect regulation motives to smoking and drinking in a sample of Eastern European high school students and to examine variation in the effects of these motives by gender. Our sample involved 500 students (ages 14-20 years) from three high schools in a large city in Hungary. Multiple logistic regression analyses examined the relation between motives and substance user status. Social motives were significantly related to both smoking and drinking (except for boys' smoking). Affect regulation motives were a significant predictor of smoking; in addition, boredom relief was a significant motive for smoking among boys. Mother's educational level was inversely related to youth substance use, whereas father's education was positively related to alcohol use among girls. School-based prevention programs should include cognitive education and social skills training to counter perceived benefits of substance use. Further research is needed to clarify the relation of alcohol use to parental education.

Effects of perceived racial discrimination on health status and health behavior: a differential mediation hypothesis.

OBJECTIVE: Prospective data tested a "differential mediation" hypothesis: The relations (found in previous research) between perceived racial discrimination and physical health status versus health-impairing behavior (problematic substance use) are mediated by two different types of affective reactions, internalizing and externalizing. METHOD: The sample included 680 African American women from the Family and Community Health Study (M age = 37 years at Time 1; 45 years at Time 4). Four waves of data were analyzed. Perceived discrimination was assessed, along with anxiety and depression (internalizing) and hostility/anger (externalizing) as mediators, and physical health status and problematic substance use (drinking) as outcomes. RESULTS: Structural equation modeling indicated that discrimination predicted increases in both externalizing and internalizing reactions. These affective responses, in turn, predicted subsequent problematic substance use and physical health status, respectively, also controlling for earlier reports. In each case, the indirect effects from discrimination through the affective mediator to the specific health outcome were significant and consistent with the differential mediation hypothesis. CONCLUSIONS: Perceived racial discrimination is associated with increases in internalizing and externalizing reactions among Black women, but these reactions are related to different health outcomes. Changes in internalizing are associated with self-reported changes in physical health status, whereas changes in externalizing are associated with changes in substance use problems. Discussion focuses on the processes whereby discrimination affects health behavior and physical health status.

Ethnic pride and self-control related to protective and risk factors: test of the theoretical model for the strong African American families program.

OBJECTIVE: To test a theoretical model of how ethnic pride and self-control are related to risk and protective factors. DESIGN: A community sample of 670 African American youth (mean age = 11.2 years) were interviewed in households. MAIN OUTCOME MEASURES: Measures of cigarette smoking, alcohol use, and sexual behavior (lifetime to past month). RESULTS: Structural modeling analyses indicated parenting was related to self-control and self-esteem, and racial socialization was related to ethnic pride. Self-control and self-esteem variables were related to levels of deviance-prone attitudes and to perceptions of engagers in, or abstainers from, substance use and sexual behavior. The proximal factors (behavioral willingness, resistance efficacy, and peer behavior) had substantial relations to the criterion variables. Participant gender and parental education also had several paths in the model. Results were generally similar for the 2 outcome behaviors. CONCLUSIONS: In this population, self-esteem and self-control are related to parenting approaches and have pathways to attitudes and social perceptions that are significant factors for predisposing to, or protecting against, early involvement in substance use and sexual behavior.