The Critical Role Hawai'i's Community Health Workers Are Playing in COVID-19 Response Efforts.

Community health workers play an instrumental role in the health care system and are critical partners in pandemic response. In Hawai'i, community health workers are working to reduce the burden of chronic disease among Pacific Islander, Filipino, and Native Hawaiian populations in partnership with government agencies and health care organizations. This commentary reviews the role community health workers in Hawai'i are playing in assisting with the COVID-19 response. Utilizing their skills and the community's trust, they are optimally positioned to reach marginalized and vulnerable populations hit hardest by COVID-19; community health workers educate, screen, and provide social service referrals to community members.

Sugar-Sweetened Beverage Fee: A Model to Address Health Disparities in Hawai'i.

Sugar-sweetened beverage (SSB) consumption is associated with increased risk of obesity, diabetes, and other chronic diseases. SSB consumption is also a health equity issue, as rates of consumption and related chronic diseases vary by race, ethnicity, and income in Hawai'i. The COVID-19 pandemic has highlighted the need for greater investment in public health and the well-being of communities experiencing health disparities because individuals with chronic diseases are more likely to develop complications from the virus. It has also created economic hardships for the people of Hawai'i, especially the state's most vulnerable populations. Amid this health and economic crisis, an opportunity exists to implement an SSB fee in Hawai'i. An SSB fee would impose a fee on SSB distributors that would be passed on to consumers in the form of price increases that influence purchasing behavior. Jurisdictions with SSB taxes or fees have seen reductions in SSB purchases and consumption and have generated millions of dollars in revenues to support health initiatives and reduce socioeconomic disparities. Models predict that a $0.02 SSB fee in Hawai'i could generate $60.5 million and significantly reduce healthcare costs and chronic diseases. This commentary will present an SSB fee policy as a viable model for Hawai'i to reduce SSB consumption, lower chronic disease risks, and generate needed revenues to support health, reduce inequities, and rebuild the state's economy.

The Healthy Hawai'i Initiative: insights from two decades of building a culture of health in a multicultural state.

BACKGROUND: The Healthy Hawai'i Initiative was created in 2000 with tobacco settlement funds as a theory-based statewide effort to promote health-supporting environments through systems and policy change. Still active today, it is imbedded explicitly in a multi-sectoral, social ecological approach, effectively striving to build a culture of health before this was the name for such an ambitious effort. METHODS: From interviews with key informants, we analyze two decades of the Healthy Hawai'i Initiative (HHI) in the context of the Robert Wood Johnson Foundation (RWJF) Culture of Health Action Framework (CHAF). We list HHI accomplishments and examine how the Initiative achieved notable policy and environmental changes supportive of population health. RESULTS: The Healthy Hawai'i Initiative started with an elaborate concept-mapping process that resulted in a common vision about making "the healthy choice the easiest choice." Early on, the Initiative recognized that making health a shared value beyond the initial stakeholders required coalition and capacity building across a broad range of governmental and nonprofit actors. HHI coalitions were designed to promote grassroots mobilization and to link community leaders across sectors, and at their height, included over 500 members across all main islands of the state. Coalitions were particularly important for mobilizing rural communities. Additionally, the Initiative emphasized accessibility to public health data, published research, and evaluation reports, which strengthened the engagement to meet the shared vision and goals between diverse sector partners and HHI. Over the past two decades, HHI has capitalized on relationship building, data sharing, and storytelling to encourage a shared value of health among lawmakers, efforts which are believed to have led to the development of health policy champions. All of these factors combined, which centered on developing health as a shared value, have been fundamental to the success of the other three action areas of the CHAF over time. CONCLUSIONS: This evidence can provide critical insights for other communities at earlier stages of implementing broad, diverse, multifaceted system change and fills a key evidence gap around building a culture of health from a mature program in a notably multicultural state.

Community Health Worker (CHW) Movement in Hawai'i: Moving Towards a CHW Association.

This editorial presents the perspectives of allies - a group of governmental, university and public health organizations that support the creation of a professional association for CHWs in Hawai'i. We support the efforts of CHWs as they organize and move towards establishing a professional association. Hawai'i CHWs have held monthly meetings starting in 2017 to discuss variety of issues around their work and share information and experiences. A group of CHWs and allies developed a strategic plan in 2018 in preparation to establish a professional association. They shared the results with colleagues from across the state. One desirable outcome for many was a professional CHW association. Such an association could be a forum of shared learning, information sharing, networking, and advocating for workforce and professional development issues, such as training, reimbursement for services, credentials, and certifications. Furthermore, allies support CHW-led efforts to develop an association, for instance, by securing diversified funding sources for CHW trainings, networking, and planning activities. Allies also help by informing supervisors, employers, and policymakers about the importance of trainings and other workforce and professional development for CHWs. A professional association for CHWs in Hawai'i could be useful to many. This editorial provides more insights into this topic.

Insights in Public Health: Formative Factors for a Statewide Tobacco Control Advocacy Infrastructure: Insights from Hawai'i.

Hawai'i has comprehensive statewide tobacco control policies and was the first US state to raise the minimum age of sale, purchase, and possession of tobacco products to age 21 ("Tobacco 21") in a policy including not just cigarettes, but also electronic smoking devices and other tobacco products. This insights article provides strategic thinking about tobacco control advocacy planning. Specifically, we identify formative factors critical to building and sustaining our cross-sector, statewide advocacy infrastructure that has been able to address many ongoing challenges of tobacco-use prevention and control over time. This can provide new insights for other large-scale tobacco-control advocacy efforts.

Activating multi-ethnic youth for smoking prevention: design, baseline findings, and implementation of project SPLASH.

BACKGROUND: Achieving significant reductions in tobacco use by youth is an important challenge. There is a pressing need to develop and evaluate innovative strategies that stimulate youth involvement and are effective in multi-ethnic populations. This article describes an innovative tobacco prevention trial, and reports baseline characteristics of participants and findings about implementation of the curriculum. METHODS: The aim of Project SPLASH is to evaluate the impact of a school-based smoking prevention intervention that emphasizes active involvement of middle school students, on rates of smoking initiation and regular smoking in a multi-ethnic cohort of youth in Hawaii. Project SPLASH is a group randomized trial that compares a 2-year innovative intervention with a social influence prevention program, in 20 public schools in Hawaii. The main outcome is mean 30-day smoking prevalence rates. RESULTS: The response rate was 78.4%. Approximately 1 in 4 students had tried smoking and 30-day smoking prevalence at baseline was 8%. Intervention and control groups were comparable in terms of tobacco use, gender, ethnicity, behavioral, environmental, and psychosocial characteristics. Differences in ethnic identification, socio-economic status, acculturation, and involvement in prevention activities may be due to chance. The intervention was well implemented by teachers across both the intervention and control school classes. CONCLUSION: For this study, 20 schools in Hawaii with close to 4000 participating students were recruited. Student smoking behavior and curriculum implementation were comparable by group status. The intervention study has the potential to elucidate how youth respond to an intervention with student involvement that incorporates cognitive and social action components.

The healthy Hawaii initiative: A social ecological approach promoting healthy communities.

PURPOSE: The tobacco settlement has provided the opportunity for the state of Hawaii to implement the Healthy Hawaii Initiative (HHI), targeting smoking, poor nutrition and physical inactivity. The purpose of this paper is to describe and document preliminary findings. METHODS: The social ecological model is translated into practice through school and community grants to create systems, environmental and policy changes, teacher training on health and physical education standards, continuing education for the medical community in behavioral health, and a public education campaign. A comprehensive evaluation provides ongoingfeedback for program improvement and progress on the effects of psychosocial mediators, behaviors, and long-term chronic diseases. RESULTS AND DISCUSSION: Preliminary process results presented here are promising. The components are thought to interact synergistically to bring about behavior changes statewide. The HHI is one example of how to implement a multilevel initiative to target the three major behavioral determinants of chronic disease (tobacco use, physical inactivity, and poor nutrition) and build healthier communities.