M.S. - Public Health

Permanent URI for this collection

https://hdl.handle.net/10125/2148

Browse

Now showing 1 - 10 of 25

The Association Between Ethnicity And Allostatic Load: Findings From The 2017-2018 National Health And Nutrition Examination Survey
(University of Hawaii at Manoa, 2021) May, Stacie Lea; Hurwitz, Eric; Public Health
AbstractBackground: The lived experience of ethnicity is a source of psychosocial stress. Objectives: Estimate the association between ethnicity and allostatic load (AL) by measuring the physiological cost of prolonged stress response, reflected in measurable cardiovascular, metabolic, and immune system acclimating changes. Methods: Adult participants were selected from the National Health and Nutrition Examination Survey (NHANES) 2017-2018 survey cycle and categorized into four ethnic groups: White, African-American (AA), Mexican-/Hispanic-American (MHA), and Asian-American (AsA). AL was calculated using 10 biomarkers representing the regulatory status of cardiovascular, metabolic, and immune systems. Poisson regression analyses produced age-education-adjusted prevalence ratios (PRs) of AL stratified by gender, and age-adjusted PRs stratified by both gender and education. Results: Adjusting for age and education, AA women had the highest PRs (1.59) in the study, and AsA men had the highest PR (1.4) among men. Stratifying by both gender and education, highlighted the heterogeneity of effect that educational attainment has on the AL of each ethnicity by gender. Conclusions: Complex relationships exist between gender, ethnicity, education, and allostatic load that underscore the extensive impact of social disparities on health and socioeconomic security, and highlight the need for disaggregation of ethnic subgroups to better understand these relationships.
A demographic profile of the Cook Islands
(University of Hawaii at Manoa, 1972) Phillips, James F.; Public Health
The Cook Islands are a fifteen island archipelago between Tonga and French Polynesia in the South Pacific. Reliable data on the Maori population of the islands have been compiled since 1917, but detailed analysis of this data has been lacking. Health and
Prevalence and Associations of Asthma and Cardiovascular Disease among Asians and Pacific Islanders in Hawai‘i: A Single-Year Cross-Sectional Study from the Cardiovascular Disease Among Asians and Pacific Islanders (CASPER) Study
(University of Hawaii at Manoa, 2021) Howick, Connor Keaumakalani; Wu, Yan Yan; Public Health
Introduction and Objective: Asthma and cardiovascular disease (CVD) are two of the most burdensome chronic diseases worldwide, yet rapidly-growing Asian and Pacific Islander (API) populations are underrepresented in current literature, including in Hawai‘i. Prior research suggests the asthma exposure may be linked with CVD outcomes, but the nature of the relationship is not yet fully understood. The aims of this study are (1) to estimate overall and race-and-age-specific prevalence proportions for lifetime asthma and CVD among Hawai‘i API, and (2) to determine if lifetime asthma prevalence is associated with CVD prevalence in those aged 45 years and older. Methods: Electronic health record (EHR) data from 2018 were collected from 128,269 Kaiser Permanente Hawai‘i (KPHI) adult members enrolled in the Cardiovascular Disease Among Asian and Pacific Islanders (CASPER) study. Descriptive statistics were used to describe characteristics of the sample, and to estimate single-year period prevalence for both asthma and CVD in 2018 (overall and age-and-race-specific prevalence). Multivariable log-link and identity-link regression models assuming a Poisson distribution calculated prevalence ratios (PR) and prevalence differences (PD) as measures of the asthma-CVD association. Results: Overall period prevalence of asthma and CVD were 11.23% and 10.66%, respectively, in the 2018 sample population. Native Hawaiians and mixed-race API appeared to have higher prevalence proportions of both diseases across the age groups, and CVD prevalence increased with age. Confounder-adjusted estimates reported a 19% increase of CVD prevalence in lifetime asthmatics compared to those with no history of asthma [PR: 1.19; 95% CI: 1.13, 1.26], but did not have a significant excess in absolute CVD diagnoses [PD: 0.0253; 95% CI: -0.0069, 0.0575]. Discussion and Conclusions: Prevalence of asthma and CVD was greatest among Native Hawaiians and mixed-race API in 2018. Asthma was found to be significantly associated with overall CVD among a sample representing API and White Hawai‘i adults aged ≥45 years by relative measures of association, but not for absolute measures; further research is needed on the asthma-CVD relationship and the role that confounding factors play. These findings suggest that asthma and CVD are connected in some manner, and addressing this relationship may be crucial to preventing or moderating future CVD events in Hawai‘i.
The Determinants and Disparities of Gout within the Multiethnic Cohort
(University of Hawaii at Manoa, 2019) Thompson, Mika Daniel; Wu, Yan Yan; Public Health
BACKGROUND: While prior studies have identified differences in gout prevalence estimates by ethnic groups, especially among Polynesian and Black populations relative to Whites, the incidence and effect of behavioral factors on risk of gout within these groups remains severely understudied. In addition, few have investigated the association between biomolecules and gout, which may serve as early risk indicators. The purpose of the following Master’s Thesis was to ascertain the incidence, the effects and clustering of behavioral risk factors, and associations between biomolecules, and incident gout within a large multiethnic populations of older adults from the Multiethnic Cohort (MEC). METHODS: Two studies were performed using secondary data from the MEC linked to Medicare claims data on gout (ICD-9: 274.9; ICD-10: M10.9) to assess incident gout cases. Study 1 assessed the incidence rates, effects of behavioral factors (alcohol use, smoking, vitamin C supplementation (VC), physical activity, and dietary quality score), and risk profiles of gout among ethnically disaggregated samples of Black (B, N = 15,660), Native Hawaiian (NH, N = 7,600), Japanese (JA, N = 32,923), Latino (L, N = 21,793), and White (W, N = 29,129) participants from the MEC utilizing ethnic-specific Cox regression modeling and conditional inference survival tree analyses. Study 2 examine the associations between serum concentrations of biomolecules (C-reactive protein [CRP], cholesterols, triglycerides, tocopherols, carotenes, adiponectin, and leptin) and incident gout using an ethnically aggregated Cox regression. All covariates in Study 1 were ascertain from self-reported responses to the MEC baseline questionnaire, while biomolecules in Study 2 were assessed through high-performance liquid chromatography and an autoanalyzer (for CRP). RESULTS: NH had the highest incidence of gout (IDR: 9.97 per 1,000 person-years), followed by B, JA, W, and L participants. Three or more alcoholic drinks per day was associated with an increased risk among all ethnic groups except Ls, with the largest effect observed among B participants (HR: 1.55, 95%CI: 1.23, 1.94). Similarly, current smoking was associated with a 28% (95%CI: 10-49%) increased risk among B, and a 17% (95%CI: 3-32%) increased risk among JA, participants. Higher DASH tertiles were associated with a decreased risk of gout among all ethnic groups, apart from L, with the largest effect observed among Ws in the highest versus lowest tertile comparison (HR1vs3: 0.70, 95%CI: 0.63, 0.78), while VC was weakly associated with a decreased risk of gout only among NH (HR: 0.85, 95%CI: 0.75, 0.98) and JA (HR: 0.91, 95%CI: 0.85, 0.98) participants. Survival tree analysis identified several risk clusters, with BMI identified as the most important factor in predicting gout risk (cut-point: 25.843, p < 0.001). The highest risk profile was identified as NHs with a BMI > 25.843 and a history of hypertension, that consumed greater than 285.526 grams of white rice per day. The highest tertile of CRP (HR1vs3: 1.84, 95%CI: 1.51, 2.25) and γ-tocopherol (HR1vs3: 1.69, 95%CI: 1.35, 2.11) were associated with an increased risk of gout compared to the lowest tertile serum concentrations. Compared to the lowest tertile, elevated concentrations of leptin (HR1vs2: 1.55, 95%CI: 1.26, 1.91; HR1vs3: 2.73, 95%CI: 2.14, 3.47) and triglycerides (HR1vs2: 1.34, 95%CI: 1.10, 1.65; HR1vs3: 1.83, 95%CI: 1.50, 2.23) were generally associated with an elevated risk of gout. Conversely, HDL-cholesterol (HR1vs3: 0.62, 95%CI: 0.51, 0.77), adiponectin (HR1vs2: 0.76, 95%CI: 0.63, 0.92; HR1vs3: 0.67, 95%CI: 0.54, 0.82), α-carotene (HR1vs2: 0.68, 95%CI: 0.55, 0.84; HR1vs3: 0.56, 95%CI: 0.44, 0.70), and β-carotene (HR1vs2: 0.62, 95%CI: 0.50, 0.76; HR1vs3: 0.52, 95%CI: 0.41, 0.66) were associated with a decreased risk of gout in an apparent ‘dose-response’ gradient. DISCUSSION: Overall, ethnic differences in both the incidence and effects of modifiable risk factors in gout were observed, with NH having the highest rates of gout and L having the lowest. Alcohol use and smoking were associated with an increased risk, while physical activity, VC, and DASH scores were associated with a decreased risk. Specific and novel dietary factors were identified through the exploratory risk profile analysis, and high-risk profiles were identified. In addition, several biomolecular associations were observed that were consistent with prior literature, possibly elucidating objectively measured early-warning indicators for gout. Limitations are discussed, including self-reporting of demographic characteristics, medical histories, and behaviors, along with disadvantages in using Medicare claims as a proxy for incident gout. Finally, future directions are recommended to address issues that fell outside of the scope of the current investigation.
The Association of Significant Depressive Symptoms on the Risk of Falls: A Prospective Cohort Study from the Health and Retirement Study.
(University of Hawaii at Manoa, 2018-05) Motchnik, Tania M.; Public Health
Falls are one of the leading causes of injury-related morbidity and mortality among the older adult population. Medical costs attributable to falls is projected to increase as the population grows over the next decades. Depression is one of the most common neurological disorders experienced among older adults. Utilizing data from the Health and Retirement Study, this study investigated the association between significant depressive symptoms (SDS) on the risk of falls among individuals aged 65 and up. After adjusting for potential confounders, individuals with SDS had a 25% increased risk for incident falls when compared to individuals without SDS (risk ratio [RR] 1.25, 95% confidence interval [CI] 1.22, 1.27). Both sex and BMI were found to be effect modifiers in the association of SDS on fall risk. This study suggests that depressive symptoms is a risk factor for falls, consistent with previous literature.
The Association of Violence on Educational Achievement within the Iraqi Population through 2003-2010.
(University of Hawaii at Manoa, 2017-08) Youkhana, Fadi A.; Public Health
This study assesses the impact of the violence in Iraq in 2003-2010 on the education of individuals aged 7-23 years. The Iraq Body Count and the 2011 Iraqi Multiple Indicator Cluster Survey were used which included 26,336 households and 83,121 persons. Governorates of high intensity of violence yielded a larger difference between expected and observed completed levels of education compared to governorates of low intensity. Participants in secondary cohort are estimated to complete 0.081 (95%CI 0.066, 0.96) levels of schooling compared to 0.78 (95%CI 0.771, 0.784) levels in primary cohort. Living in a household that is classified as “richest” via the wealth index quintile, and in a household whose head has had a secondary or post-secondary education yielded greater estimates for completing one-level of schooling than other households. The better we understand the impact of violence on education, the more equipped we are to propose, design, and execute intervention programs.
Exploring the Odds of Diabetes and Physical Activity as an Effect Modifier in the Kohala Research Project: A Multi-Ethnic Secondary Data Analysis of a Cross-Sectional Study
(University of Hawaii at Manoa, 2017-05) Guillermo, Cherie Joyce T.; Public Health
Diabetes is a chronic disease that affects people globally. With the increasing odds of diabetes and it becoming the 7th leading cause of death, it is important to see what lifestyle choices that can be modified to live a healthier life. Objective: This project looks at the odds of developing diabetes in terms of physical activity amongst the following ethnic groups in Kohala, Hawaii: Caucasian, Filipino, Hawaiian or Part Hawaiian, and Japanese. Methods: This is a secondary data analysis of a cross-sectional study from the Kohala Research Project in which data was collected between 1997-2000. Men and non-pregnant women aged 18 years or older were eligible to participate in the study where blood samples were acquired and an intensive questionnaire was given. Results: It was found that physical activity is protective for Caucasians, Filipinos, and Hawaiian/Part Hawaiians, but it had an increased odds of developing diabetes for Japanese.
Descriptive Study Of Emergency Medical Services Attended Child Abuse And Intimate Partner Violence Incidents
(University of Hawaii at Manoa, 2017-05) Garza, Codie; Public Health
Intimate partner violence and child abuse and neglect are significant public health issues that are often related. Surveillance systems that monitor these events and the health issue related to these behaviors vary. These systems include surveys, court records, and incident reports. There are pros and cons to each of these systems and given the complex nature of these incidents, a combination of systems is most effective. This study examined a new system to identify intimate partner violence and child abuse and neglect incidents to determine effectiveness and describe the details of incidents occurring in Hawai‘i. The data source was proven to be quite effective with some gaps such as missing information. Overall, incident details such as sex of patient, perpetrator information, and incident/dispatch location were consistent with existing data reporting prevalence in Hawai‘i.
"Dump the Plump": A 5-year Hawaii Department of Health Worksite Wellness Program, A Pilot Study
(University of Hawaii at Manoa, 2016-12) Calimlim, Precilia
The increased prevalence of obesity and overweight in the United States and Hawaii are just some of the underlying factors leading to catastrophic death rates due to heart disease. Hence, a worksite wellness Program entitled “Dump The Plump” (DTP) was conceptualized, implemented, and sustained at the State Laboratories Division (SLD) for a period of five years, 2010-2015 to reverse or prevent these risk factors. With the University of Hawaii Institutional Review Board approval, SLD employees were recruited and self-identified as a Player or Cheerleader into the DTP intervention which initially lasted for 1 year then shortened to six months thereafter. The objective of this study was to determine whether or not participation in DTP lead to weight loss in SLD employees decreasing obesity and overweight prevalence at SLD. In 2014, a prospective cohort study was implemented at SLD. DTP participants who consented to receive the DTP intervention were defined as “cases”, while other SLD employees who consented not to receive the DTP intervention were defined as “controls”. A paired t-test was investigated to determine if there was significant weight loss in study subjects after the DTP intervention by comparing their before weight (M=153.73, SD=34.04), and after weight (M=152.33, SD=34.37). The paired t-test indicated a t (24) =1.3807 p= 0.1801 and a 95% confidence interval (CI) for weight loss (-0.6947, 3.5027). This indicated an average weight loss of 1.38 pounds by study subjects, since the p-value was greater than the alpha value of 0.05, the weight loss was not significant. A Fisher’s exact test indicated that weight loss was not significantly associated with study status (cases vs. controls), gender (male vs. female) or DTP status (Player vs. Cheerleader) p=1.0. Also, a two sample t-test for independent groups was performed on the cases (N=23) to determine if their weight loss (M=1.3826, SD=5.2624) was associated with DTP intervention, compared to the controls (N=2) who didn’t receive DTP intervention (M=1.6500, SD=3.3234). The independent samples t-test was not associated with a statistically significant effect of weight loss with cases compared to controls, t (1.48) = -0.10, p=0.930. This indicated that there was no significant difference in weight loss in the cases compared to the controls. Lastly an odds ratio (OR) was computed to estimate the association between DTP intervention (case vs. control status) and weight loss and showed an OR=1.88 (0.10,34.13). The odds of weight loss was 1.88 times greater in cases compared to controls, since the CI includes 1, the results are not statistically significant. In 2015, a longitudinal study was approved for retrospective data for years 2010-2015 of SLD employees who participated in DTP during the five year period. Several variables were investigated to determine if a linear relationship existed in determining weight loss in study subjects. Data analysis exploring a linear model, Model 1, showed no significant linear relationship between weight loss and gender p=0.06 or weight loss and DTP status p= 0.14. Moreover, a linear mixed-effect model, Model 2, showed there was no significant linear relationship between weight loss and the fixed effects of gender p= 0.21 or DTP status p= 0.25, when coupled with the random effect of subject id. However, a paired t-test was performed to compare DTP participants before weight (M=160.35, SD=39.97), to their after weight (M=157.24,SD=37.85) to determine if weight loss did not occur after DTP intervention. Results indicated an average weight loss of 4.6011 pounds of study subjects with a p-value<0.0001 with 95% confidence intervals of weight loss (1.7725, 4.4510). The results suggest that the DTP intervention resulted in significant weight loss in DTP participants at the SLD and Maui District Health Lab.
Fall Prevention and Risk Factors - Hawai‘i 2014
(University of Hawaii at Manoa, 2016-05) Romero Romero, Yesid
This study is based on self reported information from the Behavioral Risk Factor Surveillance System – Hawai‘i 2014. A perspective of current prevention measures is presented and the association to demographics, behavioral and health conditions were unveiled to determine risk groups to target for prevention. The study examined current status of fall prevention programs, behavioral, demographic, and health factors associated with falls and fall-related injuries in adults 45 years of age and older. A total of 4614 respondents 45 years of age and older participated in the fall prevention measures survey. The year 2014 BRFSS – Hawai‘i survey indicates an overall survey’s response of 84.1% for landline and cell phones. Results of the study indicate that the prevalence of falls and injuries related to fall were higher for the following groups: women, age groups 55-64 and 45-54, White and Japanese ethnic groups, those with income equal or higher than $75,000 or less than $35,000, college 1 to 3 years, and those with specific health conditions or behavior. The increased odds for falling for certain health conditions or behaviors can increase as high as 6.2 times (95% CI 4.3-8.8) and as high as 2.9 times (95% CI 1.8-4.7) for injury related to fall. Older groups had increasingly higher odds for falls after adjusting for sex, ethnicity, education level, and annual household income while 65-74 and 85 and older age groups had higher adjusted odds for injuries related to fall. Other information useful to guide and help better customize combination of evidence-based preventive intervention to the local population of Hawai‘i is also presented. Results on specific preventive measures of the program indicate that about 90% of the respondents selected at least one prevention intervention to reduce the risk of falls emphasizing the interest of the community in general in the fall prevention program but also showing warning signs for disparities in knowledge translation.

Browse

Recent Submissions