Publications by authors named "Kathryn L Braun"

151 Publications

Physical Activity and Health Among Native Hawaiian and other Pacific Islander Older Adults.

J Aging Health 2022 Jan 10;34(1):120-129. Epub 2021 Aug 10.

Thompson School of Social Work & Public Health, 3939University of Hawai'i at Mānoa, Honolulu, HI, USA.

Native Hawaiian and other Pacific Islander (NHPI) older adults often experience social disadvantages and poor health outcomes. Physical activity has been associated with better health in other racial groups, but limited studies have examined these associations in NHPI older adults. Using data from the 2014 Native Hawaiian and Pacific Islander National Health Interview Survey ( = 1,045), logistic regression models examined associations between physical activity and memory/psychological distress/self-rated health. Sufficient levels of physical activity were associated with lower odds of memory problems, serious psychological distress, and poor/fair self-rated health. Unfortunately, only half of the sample reported sufficient physical activity and approximately 30% reported none. Also, 78% of the sample was estimated to be overweight/obese, and 29% had diabetes. Culturally-appropriate interventions are recommended to increase physical activity in this population, which could also help reduce high rates of overweight/obesity and diabetes.
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http://dx.doi.org/10.1177/08982643211032468DOI Listing
January 2022

Community Engagement Practices at Research Centers in U.S. Minority Institutions: Priority Populations and Innovative Approaches to Advancing Health Disparities Research.

Int J Environ Res Public Health 2021 06 21;18(12). Epub 2021 Jun 21.

Department of Biology, College of Science, Engineering and Technology, Jackson State University, Jackson, MS 39217, USA.

This paper details U.S. Research Centers in Minority Institutions (RCMI) Community Engagement Cores (CECs): (1) unique and cross-cutting components, focus areas, specific aims, and target populations; and (2) approaches utilized to build or sustain trust towards community participation in research. A mixed-method data collection approach was employed for this cross-sectional study of current or previously funded RCMIs. A total of 18 of the 25 institutions spanning 13 U.S. states and territories participated. CEC specific aims were to support community engaged research (94%); to translate and disseminate research findings (88%); to develop partnerships (82%); and to build capacity around community research (71%). Four open-ended questions, qualitative analysis, and comparison of the categories led to the emergence of two supporting themes: (1) establishing trust between the community-academic collaborators and within the community and (2) building collaborative relationships. An overarching theme, building community together through trust and meaningful collaborations, emerged from the supporting themes and subthemes. The RCMI institutions and their CECs serve as models to circumvent the historical and current challenges to research in communities disproportionately affected by health disparities. Lessons learned from these cores may help other institutions who want to build community trust in and capacities for research that addresses community-related health concerns.
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http://dx.doi.org/10.3390/ijerph18126675DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8296474PMC
June 2021

Neighborhood Social Cohesion and the Health of Native Hawaiian and Other Pacific Islander Older Adults.

J Gerontol Soc Work 2021 May 11:1-21. Epub 2021 May 11.

Thompson School of Social Work & Public Health, University of Hawai'i at Mānoa, Honolulu, Hawaii, USA.

Native Hawaiian and other Pacific Islander (NHPI) older adults experience various social and health challenges. There is a growing literature linking neighborhood conditions with health, yet few have focused on NHPI older adults. This study examines associations between neighborhood social cohesion and health outcomes (i.e., self-rated health, psychological distress, and memory) in this population. Data from the 2014 Native Hawaiian and Pacific Islander National Health Interview Survey (n=1,045 with respondents aged 50+) were analyzed with logistic regression models. The level of neighborhood social cohesion was determined by responses to items on perceptions of mutual help, dependability, trust, and close relationships within the neighborhood. Higher perceived neighborhood social cohesion was associated with lower odds of having serious psychological distress or memory problems. There was no statistical association of social cohesion with self-rated health. Socially cohesive neighborhoods are important to the health of NHPI. We discuss methods to improve neighborhood social cohesion as a way to promote health equity for NHPI older adults in the United States (U.S.).
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http://dx.doi.org/10.1080/01634372.2021.1917033DOI Listing
May 2021

Developing a culturally responsive dementia storybook with Native Hawaiian youth.

Gerontol Geriatr Educ 2021 Apr 22:1-13. Epub 2021 Apr 22.

Hā Kūpuna National Resource Center for Native Hawaiian Elders, University of Hawai'i at Mānoa, Honolulu, Hawai'i, USA.

Similar to the nation's majority and racial/ethnic minority populations, Native Hawaiian families provide the bulk of care to loved ones with dementia. Limited research has focused on youth caregivers, who are largely invisible to the eldercare service system. This knowledge gap is especially critical for Native Hawaiians who place a high value on eldercare, often provided in multigenerational homes. To address this gap, we describe the process by which a university-community center developed a culturally responsive storybook on dementia targeted to Native Hawaiian youth. The development process honored community-based participatory research principles grounded in the cultural values and practices of Native Hawaiians, active collaboration of an advisory council, and face-to-face engagement with Native Hawaiian youth. Future directions are shared about culture-based programming and evaluation in dementia care that may be useful in work with other racial/ethnic youth and families.
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http://dx.doi.org/10.1080/02701960.2021.1885398DOI Listing
April 2021

Effectiveness of mHealth Interventions for Improving Contraceptive Use in Low- and Middle-Income Countries: A Systematic Review.

Glob Health Sci Pract 2020 12 23;8(4):813-826. Epub 2020 Dec 23.

Office of Public Health Studies, University of Hawai'i at Mānoa, Honolulu, HI, USA.

Background: mHealth interventions are being tested to improve contraceptive uptake in low- and middle-income countries (LMICs); however, the effectiveness of these interventions has not been systematically reviewed.

Objectives: The primary objective of this systematic review was to assess the effectiveness of mHealth interventions to improve contraceptive uptake and adherence in LMICs. A second objective was to identify mHealth features and behavior change communication components used in these mHealth interventions.

Methods: A systematic search was conducted of online databases for peer-reviewed articles that reported on intervention studies with men and women from LMICs and measured mHealth intervention impact on contraceptive uptake and/or adherence. Key search terms included "mHealth" or "mobile health," "contraception" or "family planning," and "low- and middle-income countries." PRISMA guidelines were followed for reporting review methods and findings. The Cochrane risk-of-bias 2 tool for randomized trials was used to assess the risk of bias of the included studies. The GRADE approach was used to determine the quality of evidence.

Results: Eight randomized controlled trial studies met the inclusion criteria. Four studies experienced implementation challenges (e.g., intervention components were not utilized fully by participants, intervention participants did not receive the full intervention content, contamination, low response rate, and/or missing data). Only 3 interventions were found to be effective, and these included a "push" approach, interactive communication, information tailored to participants, motivational messaging, and male partner involvement.

Conclusion: To date, the delivery of mHealth interventions for improving family planning in LMICs has met with implementation challenges that have reduced the researcher's ability to test intervention effectiveness. Although 3 of 8 studies found improved contraceptive use in the intervention group, the review cannot draw concrete conclusions on the overall effectiveness of mHealth interventions to increase contraceptive use in LMICs. Further research with robust program fidelity is recommended.
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http://dx.doi.org/10.9745/GHSP-D-20-00069DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7784076PMC
December 2020

Social Work in Action: Aloha E Dean Mokuau: Mai Ka Ho'oku'i A Ka Hālāwai. From Zenith to Horizon.

Hawaii J Health Soc Welf 2020 08;79(8):259-261

Department of Social Work, Myron B. Thompson School of Social Work, University of Hawai'i at Mānoa, Honolulu, HI and Office of Public Health Studies, Myron B. Thompson School of Social Work, University of Hawai'i at Mānoa, Honolulu, HI.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7417635PMC
August 2020

A Resilience Model of Adult Native Hawaiian Health Utilizing a Newly Multi-Dimensional Scale.

Behav Med 2020 Jul-Sep;46(3-4):258-277. Epub 2020 May 1.

Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai'i at Mānoa.

Resilience has conventionally focused on an individual's ability to overcome adversity. Recent research expands on this definition, making resilience a multi-dimensional construct. Native Hawaiians experience health disparities compared to the general population of Hawai'i. Despite the pressing need to address health disparities, minimal research examines resilience factors that serve as buffers for adverse experiences of Native Hawaiians. The purpose of this study was to estimate psychometric properties of scales that measured resilience-based factors through multiple levels using higher-order confirmatory factor analyses (CFA) and ascertain if this construct of resilience mediated or moderated adversity experienced by a sample of Native Hawaiians. Participants included 125 adults who participated in the Hawaiian Homestead Health Survey. Based on higher-order CFA, resilience comprised internal assets measured by hope, satisfaction with life, and environmental mastery, and external resources measured by social support and Native Hawaiian cultural identity. Results of the structural equation models were consistent with literature focusing on resiliency and health. Findings emphasized the importance of enhancing resilience by considering strengths and resources on the individual, interpersonal, and community levels. Findings also demonstrated the need to address adversity factors directly, with a specific need of addressing socio-economic status factors. According to structural equation models, resilience slightly mediated and moderated the effect of adversity related to socio-economic status. These findings have implications for future research exploring resilience as a mediator or moderator of adversity among Native Hawaiians and emphasize a multi-faceted construct of resilience to promote better health outcomes.
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http://dx.doi.org/10.1080/08964289.2020.1758610DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8006915PMC
October 2021

Insights in Public Health: Outpatient Care Gaps for Patients Hospitalized with Ambulatory Care Sensitive Conditions in Hawai'i: Beyond Access and Continuity of Care.

Hawaii J Health Soc Welf 2020 03;79(3):91-97

Daniel K. Inouye College of Pharmacy, University of Hawai'i at Hilo, Hilo, HI (DAT).

Ambulatory care sensitive conditions (ACSCs) are conditions that can generally be managed in community-based healthcare settings, and, if managed well, should not require hospital admission. A 5-year, mixed methods study was recently concluded that (1) documented disparities in hospitalizations for ACSCs in Hawai'i through quantitative analysis of state-wide hospital discharge data; and (2) identified contributing factors for these hospitalizations through patient interviews. This Public Health Insights article provides deeper context for, and consideration of, a striking study finding: the differences between typical measures of access to care and the quality of patient/provider interactions as reported by study participants. The themes that emerged from the patients' stories of their own potentially preventable hospital admissions shed light on the importance of being heard, trust, communication, and health knowledge in their relationships with their providers. We conclude that improving the quality of the relationship and level of engagement between the patient and community/outpatient providers may help reduce hospitalizations for ACSCs in Hawai'i and beyond. These interpersonal-level goals should be supported by systems-level efforts to improve health care delivery and address health disparities.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7061028PMC
March 2020

Correction to: Native Hawaiian Views on Biobanking.

J Cancer Educ 2020 Feb;35(1):210

University of Washington, Seattle, USA.

The original version of this article unfortunately contained a mistake. The name of "Maile Taualii" is now corrected in the author group of this article.
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http://dx.doi.org/10.1007/s13187-019-01633-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7012420PMC
February 2020

Chuukese community experiences of racial discrimination and other barriers to healthcare: Perspectives from community members and providers.

Soc Med (Soc Med Publ Group) 2019 Jan-Apr;12(1):3-13

John A. Burns School of Medicine, Department of Family Medicine and Community Health, 651 Ilalo St, Honolulu, HI 96813.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6853624PMC
November 2019

Twelve-Month Retention in and Impact of Enhance®Fitness on Older Adults in Hawai'i.

J Aging Res 2019 2;2019:9836181. Epub 2019 Sep 2.

Kaua'i Agency on Elderly Affairs, Pi'ikoi Building, 4444 Rice Street, Suite 330, Lihue, Kaua'i, HI 96766, USA.

Introduction: Enhance®Fitness is a low-cost group exercise program designed specifically for older adults (60+ years) to improve physical performance. The Hawai'i Healthy Aging Partnership, a statewide health promotion initiative, has continuously offered Enhance®Fitness to Hawai'i's multicultural population since 2007. This study examined 12-month participation in and impact of Enhance®Fitness on physical performance among older adults in Hawai'i.

Method: Linear mixed-effects models were applied to analyze the physical performance measures (chair-stands, arm curls, and the up-and-go test) collected at baseline (month 0) and at 4, 8, and 12 months. We also compared the characteristics of participants who participated in the program for 12 months with those who dropped out in order to gain insights on participant retention.

Results: Of 1,202 older adults with baseline data, 427 (35.5%) were continuously enrolled in Enhance®Fitness for 12 months and participated in follow-up data collection. On average, participants attended 63.7% of thrice-weekly classes each month. Participants' physical performance measures improved after 4 months, continued to improve until 8 months, and were maintained thereafter. Besides continuous attendance, performance-measure improvements were associated with younger age, male gender, living with others (vs. alone), and fewer chronic conditions. Compared to those who completed 12 months of the program, the 775 who left the program over the course of the year were more likely to be younger, to be Caucasian (vs. Asian or Pacific Islander), to self-report depression as a chronic condition, and to have lower levels of fitness at baseline. Common reasons for dropping out were illness, relocation, time conflicts, lost interest, and transportation issues.

Conclusions: Long-term participants in Enhance®Fitness initially improved and then maintained physical performance. Future research is needed to identify strategies to maintain enrollment of older adults in the exercise programs over time.
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http://dx.doi.org/10.1155/2019/9836181DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6745157PMC
September 2019

Estimating intervention dose of the multilevel multisite children's healthy living program intervention.

Transl Behav Med 2020 10;10(4):989-997

Colege of Tropical Agriculture and Human Resources, University of Hawaii at Manoa, Honolulu, HI, USA.

Increased community collective efficacy (CE), defined as social cohesion among neighbors and their willingness to intervene for common good, is associated with improved community health outcomes. However, processes to increase CE and estimate its dose within an intervention are not well understood. The 2 year Children's Healthy Living (CHL) intervention aimed to improve child behaviors known to affect obesity. We used data from CHL to estimate CE dose and examine its association with a successful outcome from CHL-reduction in children's recreational screen time. Monthly reports from nine intervention communities were quantified, and CE dose was calculated for each community overall, at 4 time intervals (6, 12, 18, and 24 months), and for each CE building block-social bonding, social bridging, social leveraging, empowerment, and civic engagement. CE dose at each time interval and change in screen time was correlated using Spearman's rho. Next, communities were categorized as having a high CE dose or a low CE dose, and differences between four high-dose and five low-dose communities were compared using a two-tailed t-test. The correlation between change in screen time and CE dose was significant (rs = 0.83, p = .003). Significantly more activities facilitating empowerment and civic engagement were conducted in high-dose communities, which were more likely to show improvements in screen time, than in low-dose communities. This method of estimating an intervention's CE dose and examining change over time and effect of CE and its building blocks on intervention outcomes shows promise.
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http://dx.doi.org/10.1093/tbm/ibz073DOI Listing
October 2020

Testing a Talkstory Intervention to create Supportive and Safe Violence-Free Communities for Women.

Hawaii J Med Public Health 2019 05;78(5):169-174

School of Nursing and Dental Hygiene, University of Hawai'i at Manoa, Honolulu, HI (LM, JS, Professors Emeriti).

The purpose of this paper is to report on a community-designed and led talkstory intervention to increase awareness of intimate partner violence (IPV), decrease acceptability of IPV, and increase community leadership to address IPV. In collaboration with women engaged in prior IPV outreach and education in Hawai'i, a talkstory intervention for IPV was developed, and a single-group, pre-post-test design was used to test it. The intervention included five talkstory sessions over seven months with community groups interested in violence prevention. Pre- and post-testing were conducted to determine changes in group means on three measures. Ninety-two individuals participated in the intervention, 77 (84%) of these completed the 1-month follow-up measure, and 59 (64%) of these also completed the 6-month follow-up measure. The findings included: (1) participants in the talkstory intervention groups decreased their acceptability of violence and increased their awareness, knowledge, and confidence to address IPV; (2) the community leaders in the intervention groups gained skills in facilitation; and (3) intervention groups continued to sponsor other IPV awareness-raising activities in their communities following completion of the study. Working with community leaders to design and facilitate the intervention not only provided IPV education within the context of the community, but also led to sustainable efforts to enhance the safety and wellbeing of women experiencing violence.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6495030PMC
May 2019

Examining Long-Term Service and Support Needs and Preferences of Native Hawaiian Elders: A Mixed-Method Approach.

J Aging Health 2020 Aug-Sep;32(7-8):582-590. Epub 2019 Apr 8.

University of Hawai'i at Mānoa, Honolulu, USA.

The Native Hawaiian population experiences numerous disparities in health and income. Using a mixed-method research (MMR) design, we summarize findings from three phases of an MMR approach used to uncover kūpuna (elder) long-term service and support (LTSS) needs and care preferences. Key informants in Hawaiian health were interviewed, secondary analyses of large state data sets were conducted, and kūpuna and "ohana (family) caregivers were engaged in listening sessions. Quantitative data confirmed numerous health disparities experienced by older Native Hawaiians, whereas qualitative data exposed their limited knowledge of this poor health profile and revealed their historical and contemporary experiences with discrimination in education, employment, and health care. Hawaiian culture was identified as a continued source of resilience in support of elders and family caregiving regardless of geographic setting. We suggest three practice, policy, and research directions that offer the potential to respond to and improve kūpuna health and service use.
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http://dx.doi.org/10.1177/0898264319839903DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6996835PMC
March 2021

Advancing Community-Based Participatory Research to Address Health Disparities in Hawai'i: Perspectives from Academic Researchers.

Hawaii J Med Public Health 2019 03;78(3):83-88

Office of Public Health Studies, University of Hawai'i, Honolulu, HI (KIY, JJC-D, LF, AF, SM, YO, FY).

Community-based participatory research (CBPR) continues to be recognized as an effective research approach in which academic researchers work in partnership with communities to address health disparities. Although the literature suggests benefits associated with CBPR, more needs to be done to advance CBPR to ultimately reduce health disparities. Hawai'i presents a research-rich opportunity for CBPR because of its ethnic diversity and geographic location, resulting in close-knit communities with unique experiences and concerns. This study aims to better understand the experiences of academic researchers who are conducting CBPR in Hawai'i and their perceptions of its benefits and challenges as well as recommendations to advance the field. Twelve academic researchers with Hawai'i-based CBPR experience were interviewed. Four major themes emerged from their responses: the importance of prioritizing relationship-building; reciprocal learning and other benefits of CBPR; navigating the tensions between CBPR and funding priorities; and building an academic setting that supports CBPR. Increasing awareness of CBPR and its benefits, as well as transforming the culture in all spaces where CBPR occurs may maximize its potential to ultimately promote health equity.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6401203PMC
March 2019

Aloha Undergraduates: Development and Application of Local & Indigenous Topics into an Undergraduate Public Health Curriculum.

Front Public Health 2019 12;7:16. Epub 2019 Feb 12.

Office of Public Health Studies, University of Hawai'i at Mānoa, Honolulu, HI, United States.

As public health education expands to include undergraduate students, it is important to include discussion of local public health topics and issues to provide a sense of place to the educational experience. Inclusion of Native Hawaiian and indigenous issues and perspectives is also an established priority of the University of Hawai'i system. To address both needs, a required course was created during development of a new Bachelor of Arts (BA) public health program at the University of Hawai'i at Mānoa to specifically focus on discussion of local and indigenous public health topics of interest. Public Health Issues in Hawai'i is an introductory course included early in the recommended undergraduate curriculum and emphasizes the application of public health skills and principles to local issues (e.g., state-level legislative awareness and local sustainability topics). The Public Health Issues in Hawai'i course further challenges students to recognize public health practice in their daily activities, and encourages them to become actively engaged in local community issues early in their public health educational careers. Among multiple advantages, improved awareness of local health challenges and early connections to community members and organizations have been instrumental in actively engaging local students in their education, and has also proved beneficial for students participating in required undergraduate applied learning capstone experiences and entry-level public health careers following graduation. Here we present insights into course development, articulation with broader program curricula, and successes and challenges in the past 4 years of implementation and instruction.
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http://dx.doi.org/10.3389/fpubh.2019.00016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6379341PMC
February 2019

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

Prev Chronic Dis 2019 02 21;16:E22. Epub 2019 Feb 21.

Office of Public Health Studies, University of Hawai'i, Honolulu, 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.
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http://dx.doi.org/10.5888/pcd16.180187DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6395081PMC
February 2019

Effect of the Children's Healthy Living Program on Young Child Overweight, Obesity, and Acanthosis Nigricans in the US-Affiliated Pacific Region: A Randomized Clinical Trial.

JAMA Netw Open 2018 10 5;1(6):e183896. Epub 2018 Oct 5.

Department of Human Nutrition, Food and Animal Science, College of Tropical Agriculture and Human Resources, University of Hawaii at Manoa, Honolulu.

Importance: Pacific Islanders have among the highest rates of obesity and type 2 diabetes in the world. Targeting children is critical for primary prevention.

Objectives: To prevent young child overweight and obesity and to improve health in the US-Affiliated Pacific region via the Children's Healthy Living Program.

Design, Setting, And Participants: In this multijurisdictional, multilevel, multicomponent community randomized clinical trial, where all evaluable children were analyzed according to the random assignment of their community, hierarchical difference-in-difference models accounted for the community randomization, community clustering with jurisdictions, and these models were adjusted for the age and sex distribution of the community. The setting was 27 communities in 5 jurisdictions (Alaska, American Samoa, Commonwealth of the Northern Mariana Islands, Guam, and Hawaii). Participants were 4329 children (time 1) and 4042 children (time 2) aged 2 to 8 years in 27 selected communities from October 7, 2012, to October 25, 2015. Data analysis was completed in June 2018.

Interventions: Nineteen activities addressed policy, environment, messaging, training, and 6 target behaviors (sleep time, screen time, physical activity, fruits and vegetables, water, and sugar-sweetened beverages).

Main Outcomes And Measures: Primary outcomes were body size measurements. Secondary outcomes were acanthosis nigricans, sleep quality and duration, dietary intake, physical activity, and other questionnaire reponses.

Results: The study included 27 communities and 8371 evaluable children (mean [SD] age, 5.4 [1.8] years; 50.9% male [n = 4264]). Data analysis included 952 children in the intervention group and 930 children in the control group aged 2 to 5 years at time 1; 825 children in the intervention group and 735 children in the control group aged 2 to 5 years at time 2; 565 children in the intervention group and 561 children in the control group aged 6 to 8 years at time 1; and 517 children in the intervention group and 560 children in the control group aged 6 to 8 years at time 2. The intervention communities showed significant improvement compared with control communities in overweight and obesity prevalence (effect size [d] = -3.95%; 95% CI, -7.47% to -0.43%), waist circumference (d = -0.71 cm; 95% CI, -1.37 to -0.05 cm), and acanthosis nigricans prevalence (d = -2.28%; 95% CI, -2.77% to -1.57%). Age and sex subgroup analysis revealed greater difference among the intervention communities in acanthosis nigricans prevalence in the group aged 2 to 5 years (-3.99%) vs the group aged 6 to 8 years (-3.40%), and the interaction was significant (d = 0.59%, P < .001), as well as the smaller difference in the group aged 2 to 5 years (-0.10%) vs the group aged 6 to 8 years (-1.07%) in screen time (d = -0.97 hour per day, P = .01).

Conclusions And Relevance: The intervention reduced the prevalence of young child overweight and obesity and acanthosis nigricans. Comprehensive, effective, and sustainable interventions are needed to improve child health in the US-Affiliated Pacific region.

Trial Registration: ClinicalTrials.gov Identifier: NCT01881373.
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http://dx.doi.org/10.1001/jamanetworkopen.2018.3896DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6324447PMC
October 2018

The Role of Collective Efficacy in Reducing Health Disparities: A Systematic Review.

Fam Community Health 2019 Jan/Mar;42(1):8-19

Office of Public Health Studies, University of Hawaii at Manoa, Honolulu.

Many improvements in health equity are spearheaded by community collaborations working to change policy and social norms. But how can collective efficacy (CE), defined as the willingness and ability of a group to work toward a common good, be increased? Eight articles reporting on interventions aiming to reduce health disparities by improving CE were found for this systematic literature review. All studies showed improvements in CE and most found reduction in disparities, but operationalization of CE varied. Findings support a model of how CE can address health disparities, which can guide standardization of CE interventions and measures.
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http://dx.doi.org/10.1097/FCH.0000000000000206DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7012267PMC
January 2019

Patient empowerment: A critique of individualism and systematic review of patient perspectives.

Patient Educ Couns 2018 12 1;101(12):2054-2064. Epub 2018 Aug 1.

Office of Public Health Studies at the University of Hawai'i at Mānoa, 1960 East-West Road, Honolulu, HI 96822, USA. Electronic address:

Objective: The purpose of this review is two-fold: 1) to broaden conceptualization of patient empowerment by synthesizing qualitative research on patient perspectives, and 2) to examine how researcher's method and background may have affected their framing of patient empowerment, thereby shaping the results.

Methods: A systematic search for qualitative research on patient definitions of power, powerlessness, and empowerment was completed. Articles were analyzed at three levels (theory, method, and data) as suggested by the meta-study method for qualitative synthesis.

Results: The search yielded 13 articles from 11 investigator teams across 9 countries (the United Kingdom, Norway, Australia, Taiwan, New Zealand, China, Iran, Belgium and Italy). Emergent themes from patient perspectives included control, psychological coping, legitimacy, support, knowledge, and participation.

Conclusions: Despite variation in diagnosis, age, ethnicity, income and country of origin, patients share many perspectives on empowerment. Furthermore, there are indications that interview questions may have influenced findings such that structural barriers to empowerment were not deeply explored.

Practice Implications: This review provides knowledge that can be of direct use to medical professionals who aim to increase patient empowerment (via findings on patient perspectives) and to researchers who can use the critical appraisal of past work to improve future research on this topic.
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http://dx.doi.org/10.1016/j.pec.2018.07.026DOI Listing
December 2018

A Qualitative Study Exploring Yoga in Veterans with PTSD Symptoms.

Int J Yoga Therap 2018 Nov 17;28(1):63-70. Epub 2018 Aug 17.

2. Executive Director, Warriors at Ease, Silver Spring, Md.

Quantitative studies of yoga have reported reduced posttraumatic stress disorder (PTSD) symptoms in veterans, but little is known about how and why veterans are attracted to and stick with a yoga practice. Guided by the Health Belief Model, this study examined veterans' perceptions of the benefits, barriers, and motivations to continue practicing trauma-sensitive yoga. Interviews were conducted with nine individuals, five of whom completed a 6-week trauma-sensitive yoga intervention designed for veterans and four who did not complete the intervention. Transcripts were analyzed for themes. The benefits identified by veterans were finding mental stillness, body awareness, and social connection. The barriers were perceptions that yoga is socially unacceptable, especially for men, and physically unchallenging. Understanding these benefits and barriers can help to make yoga more attractive to service members and veterans. For example, medical personnel can refer service members and veterans to yoga not only for PTSD symptoms, but also to address back pain and to reduce isolation. Access to male yoga instructors, especially those who are themselves service members or veterans, could be expanded, and classes could be integrated into physical activity routines required of active-duty personnel. Promotional materials can feature male service members and veterans with captions related to yoga as a way to increase resiliency, self-sufficiency, and physical and mental mission readiness. Findings from this study can help the Department of Defense and the Veterans Health Administration implement yoga as an adjunct or alternative treatment for veterans with PTSD symptoms.
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http://dx.doi.org/10.17761/2018-00020DOI Listing
November 2018

2017 Writing Contest Undergraduate Winner: Pathways to Preventable Hospitalizations for Filipino Patients with Diabetes and Heart Disease in Hawai'i.

Hawaii J Med Public Health 2018 07;77(7):155-160

Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (JMM).

Filipinos are one of the fastest growing Asian ethnic groups in the United States, yet little is known about how to specifically address the varying health needs of the Filipino community with diabetes and heart disease. This is a problem because rates of potentially preventable hospitalizations (PPH) are high for Filipinos with these conditions. A PPH is a hospitalization that could potentially have been avoided with better access to quality primary care. Patients over 21 years of age with heart disease or diabetes and who were hospitalized at the Queen's Medical Center with a PPH were recruited to complete a face-to-face interview eliciting the patients' perspectives on key factors leading to this hospitalization (n=102). This study focused on a subset of Filipino patients (n=21). Two independent coders reviewed interviews to identify factors leading to their PPH. A majority of the Filipino respondents identified social vulnerabilities as the most common factor that led to their hospitalization, including financial challenges, limited social support, and life instability. Many respondents also noted challenges with the healthcare system as precipitating their hospitalization, including poor communication/coordination, management plan issues, and bad experience with their healthcare providers. Cultural and language barriers were also identified by Filipino patients as challenges leading to their hospitalizations. These findings emphasize the importance of considering patients' perspectives of the barriers they face inside and outside of healthcare facilities.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6037827PMC
July 2018

Developing an Undergraduate Public Health Introductory Core Course Series.

Front Public Health 2018 28;6:155. Epub 2018 May 28.

Office of Public Health Studies, University of Hawai'i at Mānoa, Honolulu, HI, United States.

The number of undergraduate public health education programs is increasing, but few publications provide examples of introductory public health courses that provide foundational knowledge and meet 2016 Council on Education in Public Health (CEPH) accreditation standards. This article presents the development and testing of a three-course, introductory series in public health at the University of Hawai'i at Mānoa (UHM). Development was informed by best pedagogical practices in education, web review of existing programs, literature review, key informant interviews, and accreditation standards. Student mastery of required concepts, domains, and competencies is assessed through testing and class assignments. Data from course evaluations, students' exit questionnaires at graduation, and faculty feedback were used to continuously evolve and adapt the curriculum. The three-course series-including Introduction to Public Health, Public Health Issues in Hawai'i, and Introduction to Global Health-was designed to provide incoming undergraduate public health students with a foundation in local, national, and global public health concepts and domains, while improving their skills in public health communication and information literacy. Data from class assignments, examinations, and later coursework suggest students are mastering the course materials and gaining required competencies. Data from course evaluation and exit questionnaires suggest that the students appreciate the series' approach and the challenge to apply course concepts locally and globally in subsequent courses. This foundational public health series provides a model for an introductory course series that can be implemented with existing resources by most programs, meets the new CEPH requirements, is well-received by students, and prepares students well for upper-division public health courses.
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http://dx.doi.org/10.3389/fpubh.2018.00155DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5985697PMC
May 2018

Strategies to Increase Filipino American Participation in Cardiovascular Health Promotion: A Systematic Review.

Prev Chronic Dis 2018 05 17;15:E59. Epub 2018 May 17.

University of Hawai'i at Mānoa, Office of Public Health Studies, Honolulu, Hawai'i.

Introduction: Cultural tailoring of interventions can be effective in reducing health disparities by attracting underserved populations to health promotion programs and improving their outcomes. The purpose of this systematic review was to assess what is known about increasing access to and participation in cardiovascular disease (CVD) prevention and control programs among Filipino Americans.

Methods: PubMed MEDLINE, CINAHL, and Sociologic Abstracts were searched for peer-reviewed studies and dissertations conducted in the United States from 2004 through 2016.

Results: A total of 347 articles were identified through the search, and 9 articles reporting on 7 interventions focused on CVD prevention in a Filipino American sample were included. All but one intervention used evidence-based curricula, and implementation varied across sites. All but 2 interventions used word-of-mouth advertising from friends, family, and community leaders to increase participation. The Filipino cultural values of food, social relationships, and family were prevalent aspects across interventions tailored for Filipino Americans. Aspects of spirituality and the arts were integrated into only 3 studies.

Conclusion: Given the burden of CVD in Filipino American populations, tailored interventions rooted in Filipino cultural values are vital to address this known health disparity.
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http://dx.doi.org/10.5888/pcd15.170294DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5985898PMC
May 2018

HPV vaccination prevalence, parental barriers and motivators to vaccinating children in Hawai'i.

Ethn Health 2020 10 10;25(7):982-994. Epub 2018 May 10.

School of Medicine, University of Hawai'i at Manoa, Honolulu, HI, USA.

To determine the prevalence and barriers to human papillomavirus (HPV) vaccine uptake among 11-18 year olds in the Hawai'i's four major ethnic groups-Native Hawaiians, Filipinos, Japanese, and Caucasians. A telephone survey assessed parents' knowledge of HPV and the HPV vaccine, status of their child's HPV vaccine uptake, variables operationalizing the Health Belief Model, and barriers and motivators to uptake. Across the groups, 799 parents completed the survey. About 35% of daughters and 19% of sons had received all three shots. Although ethnic differences in vaccine uptake were seen in bivariate analysis (with significantly lower uptake in Filipino youth), in multivariable logistic regression analysis, only Caucasian parents were significantly less likely to start their sons on the HPV vaccine series compared with Japanese parents (reference group). Having heard about the vaccine, believing in its effectiveness, and older age of the child were also associated with vaccine uptake. Motivators for HPV vaccination were physician's recommendation and wanting to protect one's child. The primary barrier to uptake was lack of knowledge about the vaccine. Findings reinforce the fact that a physician's recommendation and receipt of information about the vaccine are strong motivators for parents to vaccinate their children, regardless of ethnicity.
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http://dx.doi.org/10.1080/13557858.2018.1473556DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6230317PMC
October 2020

Comparing Weight Loss-Maintenance Outcomes of a Worksite-Based Lifestyle Program Delivered via DVD and Face-to-Face: A Randomized Trial.

Health Educ Behav 2018 08 4;45(4):569-580. Epub 2018 Mar 4.

1 University of Hawai'i at Mānoa, Honolulu, Hawai'i, USA.

Background: Native Hawaiians and other Pacific Islanders have high rates of overweight and obesity compared with other ethnic groups in Hawai'i. Effective weight loss and weight loss-maintenance programs are needed to address obesity and obesity-related health inequities for this group.

Aims: Compare the effectiveness of a 9-month, worksite-based, weight loss-maintenance intervention delivered via DVD versus face-to-face in continued weight reduction and weight loss maintenance beyond the initial weight loss phase.

Method: We tested DVD versus face-to-face delivery of the [email protected] Program's 9-month, weight loss-maintenance phase in Native Hawaiian-serving organizations. After completing the 3-month weight loss phase, participants ( n = 217) were randomized to receive the weight loss-maintenance phase delivered via trained peer facilitators or DVDs. Participant assessments at randomization and postintervention included weight, height, blood pressure, physical functioning, exercise frequency, and fat intake.

Results: Eighty-three face-to-face participants were retained at 12 months (74.1%) compared with 73 DVD participants (69.5%). There was no significant difference between groups in weight loss or weight loss maintenance. The number of lessons attended in Phase 1 of the intervention (β = 0.358, p = .022) and baseline systolic blood pressure (β = -0.038, p = .048) predicted percent weight loss at 12 months.

Discussion And Conclusion: Weight loss maintenance was similar across groups. This suggests that low-cost delivery methods for worksite-based interventions targeting at-risk populations can help address obesity and obesity-related disparities. Additionally, attendance during the weight loss phase and lower baseline systolic blood pressure predicted greater percent weight loss during the weight loss-maintenance phase, suggesting that early engagement and initial physical functioning improve long-term weight loss outcomes.
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http://dx.doi.org/10.1177/1090198118757824DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6043366PMC
August 2018

Mentoring, Training, and Scholarly Productivity Experiences of Cancer-Related Health Disparities Research Trainees: Do Outcomes Differ for Underrepresented Scientists?

J Cancer Educ 2019 06;34(3):446-454

South Carolina Cancer Disparities Community Network, University of South Carolina, Columbia, SC, USA.

The study aims to explore variation in scholarly productivity outcomes by underrepresented status among a diverse sample of researchers in a community-engaged training program. We identified 141 trainees from a web-based survey of researchers in the National Cancer Institute-funded, Community Networks Program Centers (CNPCs) (2011-2016). We conducted a series of multiple logistic regression models to estimate the effect of National Institutes of Health (NIH)-defined underrepresented status on four, self-reported, scholarly productivity outcomes in the previous 5 years: number of publications (first-authored and total) and funded grants (NIH and any agency). Sixty-five percent (n = 92) indicated NIH underrepresented status. In final adjusted models, non-NIH underrepresented (vs. underrepresented) trainees reported an increased odds of having more than the median number of total publications (> 9) (OR = 3.14, 95% CI 1.21-8.65) and any grant funding (OR = 5.10, 95% CI 1.77-14.65). Reporting ≥ 1 mentors (vs. none) was also positively associated (p < 0.05) with these outcomes. The CNPC underrepresented trainees had similar success in first-authored publications and NIH funding as non-underrepresented trainees, but not total publications and grants. Examining trainees' mentoring experiences over time in relation to scholarly productivity outcomes is needed.
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http://dx.doi.org/10.1007/s13187-018-1322-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6087686PMC
June 2019

Military-Tailored Yoga for Veterans with Post-traumatic Stress Disorder.

Mil Med 2018 05;183(5-6):e223-e231

Office of Public Health Studies, University of Hawai'i at Manoa, 1960 East-West Road, Biomed D209, Honolulu, HI 96822.

Introduction: Among veterans of post-9/11 conflicts, estimates of post-traumatic stress disorder (PTSD) range from 9% shortly after returning from deployment to 31% a year after deployment. Clinical and pharmaceutically based treatments are underutilized. This could be due to concerns related to lost duty days, as well as PTSD patients' fears of stigma of having a mental health condition. Yoga has been shown to reduce PTSD symptoms in the civilian population, but few studies have tested the impact of yoga on veterans of post-9/11 conflicts. The purpose of this study is to test the impact of yoga on post-9/11 veterans diagnosed with PTSD.

Materials And Methods: Participants were 18 yr of age or older and veterans of post-9/11 conflicts. They had subthreshold or diagnostic-level PTSD related to their combat military service, as determined by a score of 30 or higher on the PTSD Checklist-Military version (PCL-M). Veterans participated in 60-min weekly yoga sessions for 6 wk taught by a Warriors at Ease-trained yoga instructor who is a, post-9/11 veteran. The yoga sessions incorporated Vinyasa-style yoga and a trauma-sensitive, military-culture informed approach advocated by two separate organizations: Warriors at Ease and Meghan's Foundation. Data were collected at baseline and again after 7 wk. The primary outcome was PCL-M score. Participants also completed the Patient Health Questionnaire, the Beck Anxiety Inventory, the Pittsburgh Sleep Quality Index, and the Mindful Attention Awareness Scale at both time points.

Results: Eighteen Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn veterans completed the pre- and post-intervention self-report questionnaires. Age ranged from 26 to 62 yr (median = 43 yr), length of service ranged from 2 to 34 yr (median = 18.8 yr), and 13 (72.2%) had completed college. Decreased PTSD symptomatology was demonstrated in the three-symptom clusters represented in the PCL-M (i.e., hyperarousal, re-experiencing, and avoidance). In addition, the total score on the PCL-M decreased significantly, by both statistical and clinical measures. The participants also demonstrated improved mindfulness scores and reported decreased insomnia, depression, and anxiety symptoms.

Conclusion: This study demonstrates that a trauma-sensitive yoga intervention may be effective for veterans with PTSD symptoms, whether as stand-alone or adjunctive therapy. The impressive decrease in PTSD symptomatology may be due to the tailored military-specific nature of this intervention and the fact that it was led by a veteran of post-9/11 conflicts. More research is needed with a larger sample and a more diverse veteran population.
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http://dx.doi.org/10.1093/milmed/usx071DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6086130PMC
May 2018
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