'Imi Ho'ola: Creating Pathways to Success for Indigenous Students in Medicine at the University of Hawai'i John A. Burns School of Medicine.

'Imi Ho'ola is a program for those seeking to heal. Since 1973, 'Imi Ho'ola has provided educational opportunities to students from underrepresented populations in medicine and has demonstrated its success as a pathway for Native Hawaiians and other Pacific Islanders into the University of Hawai'i John A. Burns School of Medicine (JABSOM). The program's student-centered, individualized, and team-based approach offers participants the opportunity to develop effective learning and study skills while solidifying students' foundation in the basic sciences and humanities. 'Imi Ho'ola is an educational model that has had a longstanding impact on the diversity within JABSOM and has contributed to the success of indigenous students in medicine.

Depression and Help-Seeking Among Native Hawaiian Women.

The purpose of this mixed-methods study was to gain insight about Native Hawaiian (NH) women's experiences with, and viewpoints of, depression and help-seeking behaviors (N = 30: 10 from the university and 20 from the community). More women reported depression in the interviews than through their Center for Epidemiologic Studies Depression Scale (CES-D) responses. Quantitative data revealed 57% of the women had ever received mental health help (80% of university vs. 45% of community sample). There was a range of satisfaction reported for various types of mental health care, with satisfaction being the highest for spiritual/religious advisor/folk healer. During the interviews, one woman reported that she is currently receiving professional care and five women are seeking help from their family/social network. Future research should explore reasons for the differences in the quantitative and qualitative findings regarding depression and associated help-seeking as well as in the satisfaction levels by type of help-seeking.

Folk and biological perceptions of dementia among Asian ethnic minorities in Hawaii.

OBJECTIVE: To study if Asian ethnic groups in Hawaii today maintain folk-based beliefs about dementia, have inadequate biomedical understanding of dementia, and differ among each other regarding perceptions of dementia. DESIGN: The study adapts and expands a 2004 survey of ethnic groups on perceptions of Alzheimer disease demonstrating that ethnic minority groups hold more folk perceptions and less biomedical perceptions of dementia than Caucasians. This study surveys particular ethnic minority family members of elders admitted to four long-term care and inpatient facilities in Hawaii. Seventy-one family members completed surveys, including 23 Chinese, 18 Filipino, and 30 Japanese participants. Elders may or may not have had the diagnosis of dementia, though an estimated half of elders in all four facilities already held the diagnosis of dementia. RESULTS: Findings indicated that Japanese and Chinese respondents in this study held perceptions about dementia that were more consistent with current biomedical understanding compared with their Filipino counterparts (mean differences/percent correct for Japanese: 57%, Chinese: 56% versus Filipino: 38%; F = 6.39, df = 2,55, p = 0.003). Filipino respondents were less likely than Japanese and Chinese respondents to report that persons with dementia can develop physical and mental problems-97% of Japanese participants and 82% of Chinese participants responded correctly compared with 63% of Filipino participants (Fisher's Exact test p = 0.009). With regard to folk beliefs about dementia, variation occurred with no consistent trend among the groups. CONCLUSION: Low levels of biomedical understanding of dementia were reflected by all three subgroups of Asians living in Hawaii with less prominence of folk beliefs compared with prior studies of ethnic minority perceptions. Education did not predict variability in dementia perceptions among the groups. Lower levels of acculturation, suggested by primary home language other than English, may correlate with a perception of dementia that is less consistent with current biomedical understanding of dementia. Persisting folk beliefs about dementia and the evident lack of biomedical understanding, particularly the belief that dementia is a normal part of aging, emphasizes the need for more culturally tailored strategies in patient education about dementia and the importance of early intervention.

The integral role of food in Native Hawaiian migrants' perceptions of health and well-being.

PURPOSE: Obesity is prevalent among Native Hawaiians, but the relationship between food and perceptions of health and well-being is not well understood. The purpose was to explore the role of food in Native Hawaiians' perceptions of health and well-being. DESIGN: A qualitative descriptive design was used. Twenty-seven Native Hawaiian participants in Las Vegas took part in semistructured interviews. RESULTS: Participants expressed that food can be dangerous to health. However, eating Hawaiian food seems to relieve homesickness, and they occasionally indulge in binge overeating. CONCLUSIONS: Hawaiian food plays an important role in participants' health and well-being. Participants' concurrent attraction to Hawaiian-style food and desire to avoid unhealthy food create a challenging struggle. IMPLICATIONS: To support cultural connectedness, Native Hawaiians can be encouraged to expend consumed calories in physical activity as their ancestors did. Discussing nutrition from a family framework might be helpful to Native Hawaiians.

Nutrient intake from multivitamin/mineral supplements is similar among users from five ethnic groups: the Multiethnic Cohort Study.

A multivitamin/mineral supplement is the most widely used type of dietary supplement among American adults. Therefore, accurate assessment of intake from this supplement is crucial when studying diet and chronic diseases. From 1999 to 2001, the Multiethnic Cohort Study collected detailed information on multivitamin/mineral use among five ethnic groups: African Americans, Native Hawaiians, Japanese Americans, Latinos, and whites. Daily nutrient intakes from multivitamin/minerals were calculated using the nutrient composition specified on the product label. For reported supplements with insufficient detail to match to a specific product, default nutrient profiles were assigned. Multivitamin/mineral use was reported by 50% of the participants (38% for Native Hawaiians to 57% for whites). Default profiles were assigned for 38% of users. The median daily nutrient intakes from multivitamin/minerals among users (n=75,865) were well above the Recommended Daily Allowance or Adequate Intake for vitamins A, B-6, B-12, and E, thiamin, riboflavin, niacin, pantothenic acid, folate, and zinc. Although nutrient intakes from multivitamin/minerals varied widely among individuals, there was no substantial difference in the median intake across ethnic groups. To accurately estimate nutrient intakes from multivitamin/minerals, detailed information on the product consumed should be collected. When detailed information is not available, the same default nutrient profiles can be used when estimating intakes for these five ethnic groups.

Self identity through Ho'oponopono as adjunctive therapy for hypertension management.

OBJECTIVE: Self Identity through Ho'oponopono is a step-by-step problem-solving approach to identify and relieve stress. The objective of this study was to determine if Self Identity through Ho'oponopono along with standard medical therapy might better control hypertension than standard therapy alone. DESIGN, SETTING, PARTICIPANTS: Twenty-three Asian, Hawaiian, and other Pacific Islanders from a local community in Hawaii participated in a longitudinal design comparing pre- and post-intervention measures of blood pressure. INTERVENTION: Participants attended a half-day class on Self Identity through Ho'oponopono to learn ways to create balance and correct stress through an understanding of their own self identity. Participants learned processes to care for themselves through repentance, forgiveness, and transmutation and how to apply the processes in their daily lives. MAIN OUTCOME MEASURES: Repeated blood pressure measurements were compared before and after the intervention using generalized estimating equations; two spirituality questionnaires were administered before and after the intervention and analyzed with paired RESULTS: Systolic blood pressure decreased after the intervention, averaging 11.86 mm Hg below pre-intervention levels. Diastolic blood pressure decreased by 5.44 mm Hg. Spirituality scores significantly increased after the intervention. CONCLUSIONS: Self Identity through Ho'oponopono was associated with a statistically and clinically significant reduction in mean blood pressure. Spirituality scores increased after the intervention. We conclude that Self Identity through Ho'oponopono may be an effective adjunctive therapy for hypertension. Further research is needed to validate these preliminary findings.

Genetic and functional analysis of CHEK2 (CHK2) variants in multiethnic cohorts.

The CHEK2-1100delC mutation is recurrent in the population and is a moderate risk factor for breast cancer. To identify additional CHEK2 mutations potentially contributing to breast cancer susceptibility, we sequenced 248 cases with early-onset disease; functionally characterized new variants and conducted a population-based case-control analysis to evaluate their contribution to breast cancer risk. We identified 1 additional null mutation and 5 missense variants in the germline of cancer patients. In vitro, the CHEK2-H143Y variant resulted in gross protein destabilization, while others had variable suppression of in vitro kinase activity using BRCA1 as a substrate. The germline CHEK2-1100delC mutation was present among 8/1,646 (0.5%) sporadic, 2/400 (0.5%) early-onset and 3/302 (1%) familial breast cancer cases, but undetectable amongst 2,105 multiethnic controls, including 633 from the US. CHEK2-positive breast cancer families also carried a deleterious BRCA1 mutation. 1100delC appears to be the only recurrent CHEK2 mutation associated with a potentially significant contribution to breast cancer risk in the general population. Another recurrent mutation with attenuated in vitro function, CHEK2-P85L, is not associated with increased breast cancer susceptibility, but exhibits a striking difference in frequency across populations with different ancestral histories. These observations illustrate the importance of genotyping ethnically diverse groups when assessing the impact of low-penetrance susceptibility alleles on population risk. Our findings highlight the notion that clinical testing for rare missense mutations within CHEK2 may have limited value in predicting breast cancer risk, but that testing for the 1100delC variant may be valuable in phenotypically- and geographically-selected populations.

Prostate cancer incidence and intake of fruits, vegetables and related micronutrients: the multiethnic cohort study* (United States).

OBJECTIVE: To describe the relationship between the intake of fruits, vegetables, and related vitamins and antioxidants, and the risk of prostate cancer in male participants in a large multiethnic cohort study. METHODS: Food and nutrient intakes in 1993-1996 were calculated from a detailed food frequency questionnaire (FFQ) designed to account for the food and nutrient intake of the ethnic groups represented in the study (82,486 African-American, Japanese-American, Native-Hawaiian, Latino and White males included here). Follow-up for incident cancers utilized local SEER registries. Vital status was ascertained using state death files. Data on PSA utilization from a later questionnaire was also examined. RESULTS: A total of 3,922 incident cancer cases were ascertained during follow-up. Modestly increased risks of prostate cancer were observed in relation to higher intakes of several food items including light green lettuce and dark leafy green vegetables. Notably, no significant protective associations of any foods were seen, including tomato intake; and intakes of two complex foods containing tomato sauce (pizza and Spanish rice) were associated with modest increases in risk. PSA test use was significantly and positively related to intake of some of these same items, implying a degree of disease detection-bias. Analysis of non-localized and high grade disease (1,345 cases) showed no significant protective associations with overall fruits and vegetables intake, related micronutrients, or with intake of selected complex food items. CONCLUSIONS: We found no statistically significant evidence of a protective effect against prostate cancer of higher levels of intake of any of these foods, associated micronutrients or supplements. A possible explanation for the positive associations with risk of several of the foods normally considered to be healthy is detection bias, since "healthy" dietary intake was related to greater use of the PSA test.

Improving the experience of hospitalization for Hawaiian children on the mainland through cultural sensitivity to Hawaiian ways of healing.

The experience of hospitalization for Hawaiian children on the mainland might be improved through the understanding and development of cultural sensitivity to Hawaiian ways of healing. This article contains a selected review of the literature on meeting the cultural health care needs of Hawaiian children and their families, a discussion of some of the challenges of caring for Hawaiian children in Utah, and suggestions for practice that may improve the experience of hospitalization for Hawaiian children in general.

Calcium intake of Asian and Caucasian adolescents in Hawaii.

The purpose of this study was to assess calcium intake of Asian and Caucasian adolescents in Hawaii, food and beverage sources of calcium, and key factors influencing calcium intake. Data were gathered in a cross-sectional survey of 51 adolescents and included two 24-hour recalls per person. Mean calcium intakes were below the U.S. Dietary Reference Intake's Adequate Intake level for calcium; still, they were higher than nationally reported calcium intakes of this age group. Although ethnic differences in dietary calcium intake were not seen between the Asian and Caucasian/Other group, the sample size may not be large enough to demonstrate a difference. Asians in Hawaii consumed more calcium than in previous studies. Caucasian/Other group consumed more non-fat milk than the Asian adolescent group. The Caucasian/Other group and the higher socio-economic group consumed more calcium from dietary supplements than Asians and the lower-socioeconomic group. A higher calcium intake was found on the weekday in comparison with the weekend (Sunday), which was largely due to calcium intake from school meals.