The Potential of "Watchful" Care: Preventing Suicide with Aloha in Hawaii.

As a therapeutic practice of care, "watchfulness" (Garcia 2010) implies a vigilant responsibility and constant mindfulness of others; in Hawaii, this is captured in the concept of aloha. This article explains how watchful care with aloha is discussed and mobilized in community suicide prevention in Hawaii. Rates of suicidality and suicide attempts in the state are high, among young people in particular. My ethnographic research follows a network of workers and volunteers as they incorporate local understandings of aloha into suicide prevention outreach. Following a history of aloha's meanings and (mis)uses in and beyond Hawaii, I draw on ethnographic examples to reveal how care with aloha prioritizes personal connection and individuality, rather than being rhetorically detached or "anonymous" (Stevenson 2014). But as my central vignettes reveal, there are difficulties in the implementation of this kind of watchful care, which ultimately question its utility in suicide prevention.

Propensity for Intra-abdominal and Hepatic Adiposity Varies Among Ethnic Groups.

BACKGROUND & AIMS: We compared fat storage in the abdominal region among individuals from 5 different ethnic-racial groups to determine whether fat storage is associated with disparities observed in metabolic syndrome and other obesity-associated diseases. METHODS: We collected data from 1794 participants in the Multiethnic Cohort Study (60-77 years old; of African, European [white], Japanese, Latino, or Native Hawaiian ancestry) with body mass index values of 17.1-46.2 kg/m2. From May 2013 through April 2016, participants visited the study clinic to undergo body measurements, an interview, and a blood collection. Participants were evaluated by dual-energy x-ray absorptiometry and abdominal magnetic resonance imaging. Among ethnic groups, we compared adiposity of the trunk, intra-abdominal visceral cavity, and liver, adjusting for total fat mass; we evaluated the association of adult weight change with abdominal adiposity; and we examined the prevalence of metabolic syndrome mediated by abdominal adiposity. RESULTS: Relative amounts of trunk, visceral, and liver fat varied significantly with ethnicity-they were highest in Japanese Americans, lowest in African Americans, and intermediate in the other groups. Compared with African Americans, the mean visceral fat area was 45% and 73% greater in Japanese American men and women, respectively, and the mean measurements of liver fat were 61% and 122% greater in Japanese American men and women. The visceral and hepatic adiposity associated with weight gain since participants were 21 years old varied in a similar pattern among ethnic-racial groups. In the mediation analysis, visceral and liver fat jointly accounted for a statistically significant fraction of the difference in metabolic syndrome prevalence, compared with white persons, for African Americans, Japanese Americans, and Native Hawaiian women, independently of total fat mass. CONCLUSIONS: In an analysis of data from the participants in the Multiethnic Cohort Study, we found extensive differences among ethnic-racial groups in the propensity to store fat intra-abdominally. This observation should be considered by clinicians in the prevention and early detection of metabolic disorders.

Electronic cigarette use and psychological distress in the Native Hawaiian and Pacific Islander adults compared with other racial/ethnic groups: Data from the National Health Interview Survey, 2014.

Document the prevalence of electronic cigarette (E-cigarette) use among the native Hawaiian and other Pacific Islander (NHPI) adults compared with other racial/ethnic groups, and examine associations between psychological distress and E-cigarette use. 2014 National Health Interview Survey (NHIS) and 2014 NHPI-NHIS were combined for comparisons. Data were analyzed using descriptive statistics, Rao-Scott χ2 test, and multivariable logistic regression. E-cigarette use among NHPI (5.6%) was significantly higher than among Blacks (2.1%), Hispanics (2.2%), and Asians (1.7%; p < .001). NHPI with Kessler 6 (K6) score of 11-24 had greater odds of using E-cigarettes (odds ratio [OR]: 3.90; 95% confidence intervals [CI]: 1.81-8.42) as compared to those with a K6 score of 0. Associations between having a K6 score of 11-24 and using E-cigarettes were also found for Whites (OR: 3.49; CI: 2.44-4.99), Asians (OR: 5.29; CI: 1.29-21.70), and Hispanics (OR: 6.14; CI: 2.72-13.83). E-cigarette use was higher among NHPI relative to other racial/ethnic groups. NHPI with K6 score of 11-24 had greater odds of using E-cigarettes as compared to those with a K6 score of 0. Policies and strategies to reduce E-cigarette use among NHPI should give careful consideration to the associations between E-cigarette use and psychological distress in the NHPI population.

Disparities in Diabetes Prevalence Among Native Hawaiians/Other Pacific Islanders and Asians in Hawai'i.

INTRODUCTION: The prevalence of diabetes varies widely among racial/ethnic groups in Hawai'i. How prevalence varies by age for Asian subgroups and Native Hawaiian/Other Pacific Islanders (NHOPIs) is understudied. We examined diabetes prevalence by age and race/ethnicity and assessed how socioeconomic status and lifestyle behaviors affected prevalence among Japanese, Filipino, Chinese, NHOPI, and white populations in Hawai'i. METHODS: We studied 18,200 subjects aged 18 or older from the Hawai'i Behavioral Risk Factor Surveillance System. We performed Poisson regression analyses to examine the prevalence of diabetes by race/ethnicity, age, sex, marital status, education, income, health care coverage, obesity, smoking and drinking status, physical activity, and fruit and vegetable consumption and examined the interactions of these factors with age and race/ethnicity. RESULTS: We found disparities in diabetes prevalence among respondents aged 35 to 44 and among Asians and NHOPIs, and disparities increased with age. NHOPIs and Filipinos had the highest prevalence of diabetes after controlling for other demographic factors and lifestyle variables. Japanese adults were less likely than NHOPIs and Filipinos to have diabetes; however, whites had the lowest prevalence. Income, physical activity, and obesity were the strongest predictors of diabetes. CONCLUSION: NHOPIs and Filipinos have higher rates of diabetes compared with other races/ethnicities in Hawai'i. More research is needed to reduce diabetes disparities among NHOPI and Filipino populations in Hawai'i. This study also shows the importance of conducting age-specific analyses of racial/ethnic-subgroups for health disparities.

Type 2 diabetes and colorectal cancer survival: The multiethnic cohort.

This analysis examined type 2 diabetes (T2D) as a predictor of colorectal cancer (CRC) survival within the Multiethnic Cohort Study. Registry linkages in Hawaii and California identified 5,284 incident CRC cases. After exclusion of cases with pre-existing cancer diagnosis within 1 year and systemic disease, the analytic dataset had 3,913 cases with 1,800 all-cause and 678 CRC-specific deaths after a mean follow-up of 9.3 ± 5.2 years. Among CRC cases, 707 were diagnosed with T2D 8.9 ± 5.3 years before CRC. Cox regression with age as time metric was applied to estimate hazard ratios (HR) and 95% confidence intervals (CI) for T2D status as predictor of CRC-specific and all-cause survival while adjusting for known confounders. Overall, CRC-specific survival was not associated with pre-existing T2D (HR = 0.84; 95% CI = 0.67-1.07). However, a significant interaction was seen for comorbidity (pinteraction  = 0.03) with better survival among those without pre-existing conditions (HR = 0.49; 95% CI = 0.25-0.96) while no association was seen in patients with comorbid conditions. All-cause mortality was also not related to pre-existing T2D (HR = 1.11; 95% CI = 0.98-1.27), but significantly elevated for individuals with T2D reporting comorbid conditions (HR = 1.36; 95% CI = 1.19-1.56). Stratification by T2D duration suggested higher CRC-specific and all-cause mortality among participants with a T2D history of ≥10 than <10 years. The findings were consistent across sex and ethnic subgroups. In contrast to previous reports, pre-existing T2D had no influence on disease-specific and all-cause survival among CRC patients. Only participants with additional comorbidity and possibly those with long T2D duration experienced higher mortality related to T2D.

Frequency and predictors of health services use by Native Hawaiians and Pacific Islanders: evidence from the U.S. National Health Interview Survey.

BACKGROUND: Native Hawaiians and Pacific Islanders (NHPIs) are one of the fasting growing racial groups in the United States (US). NHPIs have a significantly higher disease burden than the US population as a whole, yet they remain underrepresented in research. The purpose of this study is to examine factors associated with health care utilization among NHPIs. METHODS: Drawing from the 2014 NHPI-National Health Interview Survey, we used stereotype logistic regressions to examine utilization of emergency department (ED) and outpatient services among 2172 individuals aged 18 and older. RESULTS: NHPIs with chronic diseases were twice as likely to be multiple ED users and nearly four times as likely to be frequent-users of outpatient services. Social support played a protective role in preventing multiple use of ED. Having a usual source of care made it more than eight times as likely to be a frequent-user of outpatient services. Use of eHealth information increased the odds of using ED and outpatient services. Ability to afford health care increased the odds of using outpatient services. There was no association between health insurance coverage and use of ED and outpatient services among NHPIs. CONCLUSIONS: This research provides the first available national estimates of health services use by NHPIs. Efforts to improve appropriate use of health services should consider leveraging the protective factors of social support to reduce the odds of frequent ED use, and having a usual source of care to increase use of outpatient services.

Ethnic Comparison of Clinical Characteristics and Ischemic Stroke Subtypes Among Young Adult Patients With Stroke in Hawaii.

BACKGROUND AND PURPOSE: Native Hawaiians and other Pacific Islanders (NHOPI) with ischemic stroke have younger age of stroke onset compared with whites. However, ethnic differences in stroke subtypes in this population have been inadequately studied. METHODS: Consecutive young adult patients (aged ≤55 years) who were hospitalized for ischemic stroke between 2006 and 2012 at a tertiary center in Honolulu were studied. Clinical characteristics and stroke subtypes based on pathophysiological TOAST classification (Trial of Org 10172) of NHOPI and Asians were compared with whites. RESULTS: A total of 427 consecutive young adult (mean age, 46.7±7.8 years) patients (NHOPI 45%, Asians 38%, and whites 17%) were studied. NHOPI had a higher prevalence of hypertension, diabetes mellitus, prosthetic valve, higher body mass index, hemoglobin A1c, and lower high-density lipoprotein than whites (all P<0.05). Stroke subtype distribution was not different between the ethnic groups. Specifically, the prevalence of small-vessel disease was similar between NHOPI (26.6%), whites (28.4%), and Asians (24.8%). In the univariate analyses, the use of intravenous tissue-type plasminogen activator was lower among NHOPI (4.7%; P=0.01) and Asians (3.1%; P=0.002) than among whites (12.5%). In the multivariable model, NHOPI (odds ratio, 0.35; 95% confidence interval, 0.12-0.98) and Asians (odds ratio, 0.23; 95% confidence interval, 0.07-0.74) were less likely to be treated with intravenous tissue-type plasminogen activator than whites. CONCLUSIONS: NHOPI have greater cardiovascular risk factors than whites, but there were no differences in stroke subtypes between the ethnic groups. Furthermore, NHOPI and Asians may be less likely to be treated with intravenous tissue-type plasminogen activator than whites.

Pathways to potentially preventable hospitalizations for diabetes and heart failure: a qualitative analysis of patient perspectives.

BACKGROUND: Potentially preventable hospitalizations (PPH) for heart failure (HF) and diabetes mellitus (DM) cost the United States over $14 billion annually. Studies about PPH typically lack patient perspectives, especially across diverse racial/ethnic groups with known PPH health disparities. METHODS: English-speaking individuals with a HF or DM-related PPH (n = 90) at the largest hospital in Hawai'i completed an in-person interview, including open-ended questions on precipitating factors to their PPH. Using the framework approach, two independent coders identified patient-reported factors and pathways to their PPH. RESULTS: Seventy-two percent of respondents were under 65 years, 30 % were female, 90 % had health insurance, and 66 % had previously been hospitalized for the same problem. Patients' stories identified immediate, precipitating, and underlying reasons for the admission. Underlying background factors were critical to understanding why patients had the acute problems necessitating their hospitalizations. Six, non-exclusive, underlying factors included: extreme social vulnerability (e.g., homeless, poverty, no social support, reported by 54 % of respondents); health system interaction issues (e.g., poor communication with providers, 44 %); limited health-related knowledge (42 %); behavioral health issues (e.g., substance abuse, mental illness, 36 %); denial of illness (27 %); and practical problems (e.g., too busy, 6 %). From these findings, we developed a model to understand an individual's pathways to a PPH through immediate, precipitating, and underlying factors, which could help identify potential intervention foci. We demonstrate the model's utility using five examples. CONCLUSIONS: In a young, predominately insured population, factors well outside the traditional purview of the hospital, or even clinical medicine, critically influenced many PPH. Patient perspectives were vital to understanding this issue. Innovative partnerships and policies should address these issues, including linkages to social services and behavioral health.

Alcohol and substance use prevention programs for youth in Hawaii and Pacific Islands: A literature review.

This article provides a literature review of recent programs to prevent alcohol and substance use in Hawaii and Pacific Islander youths. Five programs for alcohol and substance use prevention among Hawaii and Pacific Islander youths were found in peer-reviewed literature. Of these, two focused on Native Hawaiians and/or other Pacific Islanders and three focused on overall youths in Hawaii. The main themes of these programs were increasing cultural pride, character development through personal efficacy and integrity, connecting youth to family and community, and being school- or community-centered. Two studies showed a decrease in substance use, one showed a change in knowledge, and two did not published outcomes. This review highlights a lack of evidence-based culturally appropriate options for preventing substance use by Native Hawaiian and Pacific Islander youth. Dialogue about best practices is needed and should be supported through publication of program evaluations.

Assessment of HBV preventive services in a medically underserved Asian and Pacific Islander population using provider and patient data.

BACKGROUND: Hepatitis B (HBV) represents a significant health disparity among medically underserved Asian and Hawaiian/Pacific Islander (API) populations. Studies evaluating adherence to HBV screening and vaccination guidelines in this population are limited. OBJECTIVE: The purpose of this study was to evaluate HBV screening and vaccination practices using both provider self-report and patient records. DESIGN: Medical records for 20,574 API adults were reviewed retrospectively and primary care providers were surveyed to evaluate rates and adherence to HBV screening and vaccination guidelines. PARTICIPANTS: The study included primary care providers and their adult API patients in the San Francisco safety-net healthcare system. MAIN MEASURES: Patient, practice, and provider factors, as well as HBV screening and vaccination practices, were assessed using provider survey constructs and patient laboratory and clinical data. Generalized linear mixed models and multivariate logistic regression analyses were used to identify factors associated with recommended HBV screening and vaccination. KEY RESULTS: The mean age of patients was 52 years, and 63.4 % of patients were female. Only 61.5 % underwent HBV testing, and 47.4 % of HBV-susceptible patients were vaccinated. Of 148 (44.8 %) responding providers, most were knowledgeable and had a favorable attitude towards screening, but 43.2 % were unfamiliar with HBV guidelines. HBV screening was positively associated with favorable provider attitude score (OR per unit 1.80, 95 % CI 1.18-2.74) and negatively associated with female patient sex (OR 0.82, 95 % CI 0.73-0.92), a higher number of clinic patients per week (OR per 20 patients 0.46, 95 % CI 0.28-0.76), and provider barrier score (OR per unit 0.45, 95 % CI 0.24-0.87). HBV vaccination was negatively associated with provider barrier score (OR per unit 0.48, 95 % CI 0.25-0.91). CONCLUSIONS: Rates of HBV screening and vaccination of API patients in this safety-net system are suboptimal, and provider factors play a significant role. Efforts to cultivate positive attitudes among providers and expand healthcare system resources to reduce provider barriers to HBV care are warranted.

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.

Stroke Disparities: Disaggregating Native Hawaiians from other Pacific Islanders.

OBJECTIVES: To compare the clinical characteristics of Native Hawaiians (NH) and other Pacific Islanders (PI) who are hospitalized with ischemic stroke. DESIGN: Retrospective, cross-sectional analysis of medical records. SETTING: Tertiary, Primary Stroke Center in Honolulu, Hawaii. PATIENTS: Consecutive patients with race/ethnicity identified as NH or PI who were hospitalized for ischemic stroke between January 2006 and December 2012. OUTCOME MEASURES: Age, sex, cardiovascular risk factors, intravenous tissue plasminogen activator (IV-tPA) utilization rate and hospital length of stay. RESULTS: A total of 561 patients (57% NH and 43% PI) were studied. PI were younger (59 ± 13 years vs 62 ± 14 years, P = .002), had higher prevalence of diabetes mellitus (58% vs 41%, P < .0001) and prosthetic valve (6% vs 2%, P = .007), lower prevalence of smoking (14% vs 21%, P = .03), lower HDL cholesterol (38 ± 11 mg/dL vs 41 ± 13 mg/dL, P = .004), and higher discharge diastolic blood pressure (79 ± 15 vs 76 mm Hg ± 14 mm Hg, P = .04) compared to NH. No difference was seen in other cardiovascular risk factors. The IV-tPA utilization rate (5% vs 6%, P = .48) and the hospital length of stay (10 ± 17 days vs 10 ± 49 days, P = .86) were not different between the two groups. CONCLUSION: Native Hawaiians and other Pacific Islanders with ischemic stroke have modestly different age of stroke presentation and burden of risk factors compared to each other. Disaggregating these two racial groups may be important to unmask any potential clinical differences in future studies.

Ethnic differences in serum adipokine and C-reactive protein levels: the multiethnic cohort.

BACKGROUND: Ethnic disparities in metabolic disease risk may be the result of differences in circulating adipokines and inflammatory markers related to ethnic variations in obesity and body fat distribution. SUBJECTS/METHODS: In a cross-sectional design, we compared serum levels of leptin, adiponectin, C-reactive protein (CRP), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) in control subjects (321 men and 930 women) from two nested case-control studies conducted within the Multiethnic Cohort Study consisting of whites, Japanese Americans (JA), Latinos, African Americans (AA) and Native Hawaiians (NH). General linear models were applied to evaluate ethnic differences in log-transformed serum biomarker levels before and after adjusting for body mass index (BMI) at cohort entry. RESULTS: In comparison to whites, significant ethnic differences were observed for all biomarkers except TNF-α. JA men and women had significantly lower leptin and CRP levels than whites, and JA women also had lower adiponectin levels. Leptin was significantly higher in AA women (P < 0.01), adiponectin was significantly lower in AA men and women (P = 0.02 and P < 0.001), and CRP and IL-6 were significantly higher in AA men and women. Lower adiponectin (P < 0.0001) and CRP (P = 0.03) levels were the only biomarkers in NH women that differed from whites; no statistically significant differences were seen for NH men and for Latino men and women. When adjusted for BMI at cohort entry, the differences between the lowest and the highest values across ethnic groups decreased for all biomarkers except adiponectin in men indicating that ethnic differences were partially due to weight status. CONCLUSIONS: These findings demonstrate the ethnic variations in circulating adipokine and CRP levels before and after adjustment for BMI. Given the limitation of BMI as a general measure of obesity, further investigation with visceral and subcutaneous adiposity measures are warranted to elucidate ethnicity-related differences in adiposity in relation to disparities in obesity-related disease risk.

The influence of community and individual health literacy on self-reported health status.

BACKGROUND: Individual health literacy is an established predictor of individual health outcomes. Community-level health literacy may also impact individual health, yet limited research has simultaneously considered the influence of individual and community health literacy on individual health. OBJECTIVE: The study goal was to determine if community health literacy had an independent relationship with individual self-reported health beyond individual health literacy. DESIGN: We used data from the 2008 and 2010 Hawai'i Health Survey, a representative statewide telephone survey. Multilevel models predicted individual self-reported health by both individual and community health literacy, controlling for relevant individual-level (education, race/ethnicity, gender, poverty, insurance status, age, and marital status) and community-level variables (community poverty and community education). PARTICIPANTS: The sample included 11,779 individuals within 37 communities. MAIN MEASURES: Individual health literacy was defined by validated self-reported measurement. Communities were defined by zip code combinations. Community health literacy was defined as the percentage of individuals within a community reporting low health literacy. Census data by ZIP Code Tabulation Areas provided community-level variables. KEY RESULTS: In descriptive results, 18.2 % self-reported low health literacy, and 14.7 % reported self-reported poor health. Community-level low health literacy ranged from 5.37 % to 35.99 %. In final, multilevel models, both individual (OR: 2.00; 95 % CI: 1.63-2.44) and community low health literacy (OR: 1.02; 95 % CI: 1.00-1.03) were significantly positively associated with self-reported poor health status. Each percentage increase of average low health literacy within a community was associated with an approximately 2 % increase in poor self-reported health for individuals in that community. Also associated with poorer health were lower educational attainment, older age, poverty, and non-White race. CONCLUSIONS: Both individual and community health literacy are significant, distinct correlates of individual general health status. Primary care providers and facilities should consider and address health literacy at both community and individual levels.

Survival Difference of Colorectal Adenocarcinoma Among Racial and Ethnic Minority Groups: A SEER Database Study.

Despite advances in diagnosis and treatment, racial disparities continue to exist in colorectal cancer (CRC) survival. This study aims to characterize the CRC survival differences among racial and ethnic minority groups. The Surveillance, Epidemiology, and End Results (SEER) database was used to identify adults diagnosed with CRC from 2015 to 2019. Demographics, disease characteristics, surgical treatment, stages, and survival data for individuals who are Hispanic, Black, Southeast Asian, Chinese, American Indian and Alaskan Native (AIAN), Asian Indian and Pakistani (AIP), and Native Hawaiian and Other Pacific Islanders (NHOPI) were extracted. Survival analysis was done using the Kaplan-Meier survival curve. Multivariate analysis was done with the Cox proportional hazard model. There were 40 091 individuals with CRC. NHOPI had the youngest median age of 59 years, while Chinese individuals had the oldest median age of 65 years. From the total sample of their respective subgroups, 43.8% of Black patients and 36.7% of AIAN patients had a median household income of <$60 000, while 55.3% of Southeast Asian patients, 59.7% of Chinese patients, 55.8% of AIP patients, and 65.6% of NHOPI patient had a median household income >$70 000. The 1-year survival rate was lower for patients who were Hispanic (62.0%), Black (60.9%), and AIAN (63.1%). Even after multivariate analysis, Black patients had a significant hazard ratio (HR) of 1.21 (95% confidence interval [95% CI]: 1.05-1.38), while AIP had a HR of 0.68 (95% CI 0.55-0.84), compared to AIAN. Other significant variables that were linked with survival included older age, advanced stage of CRC, a median household income <$60 000, male sex, no surgery, subtotal colectomy/hemicolectomy, and total colectomy. Further studies are needed to elucidate the specific causes of these differences and create appropriate strategies to reduce this survival disparity.

The Prevalence of Hospitalized Parkinson's Disease Patients in All Case Hospitalization among Different Race/Ethnic Subgroups in Hawaii.

Background: Little is known about the epidemiology of Parkinson's disease (PD) patients in Native Hawaiian Or Other Pacific Islander (NHPI) and Asian American (AA) subgroups. Objective: To determine if the prevalence of hospitalized PD patients is different across age groups and racial/ethnic subgroups in Hawaii. Methods: We conducted a retrospective analysis of Hawaii statewide registry (2016-2020) hospitalization data for patients who were 50 years or older. PD patients were identified using an ICD 10 code: Parkinson's Disease (G20) as their primary/secondary hospitalization discharge diagnosis code. Demographic and clinical characteristics among racial/ethnic subgroups (White, Japanese, Filipino, Chinese, NHPI, or Other) were compared. Results: Of 146,844 total hospitalized patients (n = 429,879 records), 1.6% (n = 2,401) had a PD diagnosis. The prevalence of hospitalized PD patients was 2.3% among Japanese and Chinese, followed by 1.7% for Whites, 1.2% for Filipinos and was lowest for NHPI with 0.9% (p < 0.001). As patient's age increased, the prevalence of hospitalized PD patients increased, with 80-84 years old for the highest age range (3.4%). The prevalence of hospitalized PD patients at 80-84 years old varied across the race/ethnic subgroups (Chinese 4.3%, Japanese 4.0%, Whites 3.7%, Filipinos 2.5%, NHPI 2.3%). Conclusions: The prevalence of hospitalized PD patients among all case hospitalizations were lower for NHPI and Filipino compared to that of Japanese, Chinese, and Whites. As patients' age increased, the prevalence of hospitalized patients with PD increased, but less so in NHPI and Filipino groups. Further research is warranted to understand the reason for these observed differences among racial/ethnic subgroups.

The Association of Alcohol Outlet Density With Alcohol Intake: The Multiethnic Cohort.

OBJECTIVE: Neighborhood characteristics have been shown to influence lifestyle behaviors. Here we characterized alcohol outlet density in Los Angeles County, CA, and Hawaii and assessed the association of alcohol outlet density with self-reported alcohol intake in the Multiethnic Cohort. METHOD: Participants (n = 178,977) had their addresses geocoded at cohort entry (1993-1996) and appended to block group-level alcohol outlet densities (on- and off-premises). Multinomial logistic regression was performed to assess the association between self-reported alcohol intake and on- and off-premise alcohol outlet densities by each state. Stratified analysis was conducted by sex, race, and ethnicity. RESULTS: Overall, we did not find associations between alcohol outlet density and self-reported alcohol intake in Los Angeles County, but we found that on-premise alcohol outlets were associated with 59% (odds ratio [OR] = 1.59, 95% CI [1.29, 1.96]) increased odds of consuming more than two drinks per day in Hawaii. Women living in neighborhoods with a high density of on-premise alcohol outlets (Los Angeles County: OR = 1.15, 95% CI [0.95, 1.40]; Hawaii: OR = 2.07, 95% CI [1.43, 3.01]) had an increased odds of more than two drinks per day. CONCLUSIONS: This study suggests that neighborhood factors are associated with individual-level behaviors and that multilevel interventions may be needed.

Eliminating tobacco disparities among native Hawaiian Pacific Islanders through policy change: the role of community-based organizations.

Although cigarette smoking in the general U.S. population has decreased considerably over the past several decades, prevalence rates among Native Hawaiian Pacific Islanders (NHPI) have remained elevated by comparison with other groups. The aggregation of NHPI smoking data with that of Asians has drawn attention away from the serious smoking problems that NHPIs experience, thus, limiting funding, programs, and policies to reduce tobacco-related health disparities in their communities. In California, community-based organizations (CBOs) have played a major role in supporting the state's comprehensive tobacco control program, which is arguably one of the most successful in the nation. In this commentary, we describe the tobacco control activities of five NHPI-serving CBOs in Southern California and how they have provided anti-tobacco education for thousands of Native Hawaiians, Chamorros, Marshallese, Samoans, Tongans, and other Pacific Islander subgroups, and used advocacy and coalition building to promote smoke-free environment policies in their communities. The concerted efforts of the CBOs and their community members have made vital contributions to the reduction of tobacco-related disparities for NHPI populations in California.