Ph.D. - Social Welfare

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https://hdl.handle.net/10125/2156

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Obesity and physical activity among Native Hawaiian adults
(2025) Park, Mei Linn N.; Hong, Seunghye; Social Welfare
Adverse Childhood Experiences and Resilience Among the Different Generations of Active Duty Military
(University of Hawaii at Manoa, 2020) Garrido, Matthew; Guo, Jing; Social Welfare
The rise in mental health disorders and suicide rates among active duty military (ADM) service members in the last decade prompted a surge in resilience research. Research has shown that exposure to adverse childhood experiences (ACEs) may impact the resilience of individuals and lead to increased rates of mental illness. Recent studies identified that increased suicidal behaviors and risk for the development of mental illness may partly be attributable to the changes in the characteristics of the newest generation of recruits such as lower attention and inhibitory control competencies. Despite the increased attention, few studies have focused on ACEs and resilience among the different generations of ADM. Acknowledging this lack of research, this dissertation study used quantitative methods to examine the profile of ACEs among ADM service members and the relationship of resilience and ACEs among the different generations of ADM service members. The three research questions asked what the profile of ACEs among ADM service members is, what is the association between exposure to ACEs with resilience, and how does generation of ADM impact the relationship between ACEs and resilience. This study draws data from the Warrior Resiliency Study (WRS), which included the demographic information, the ten question ACE questionnaire, and the Connor-Davidson Resilience Scale (CD-RISC) from 250 ADM service members from the U.S. Army. Data were analyzed using R Software for statistical computing of latent class analysis, latent class regression, and moderation analysis. Results of the study found four typologies or subgroups of ACEs among ADM service members that were named Class 1 Low Personal Risk/Low Environmental Risk, Class 2 Moderate Personal Risk/High Environmental Risk, Class 3 High Personal Risk/Moderate Environmental Risk, and Class 4 High Personal Risk/High Environmental Risk. Using latent class regression, resilience predicted membership for Class 3 and Class 4. Moderation analysis was conducted to examine the interaction between ACEs and age on resilience. The results showed that, at a specific age range (26.67 to 31.25 years), the impact of ACEs on resilience was greater with more ACEs. The results confirm the significance of any ACEs and high ACEs (3 or more) as predictors of resilience. Additional moderation analysis was conducted to examine the interaction between ACEs and generation on resilience. The non-significant interaction findings between ACEs and generations showed differences between Generation Z when exposed to a high number of ACEs (3-10) than their older generational cohorts. Overall, the results of this study point to the importance of examining ACEs for resilience and suggest that certain subgroups of ADM service members may need additional support as they continue with military service and rise in rank and responsibility. The results also point to the importance of examining ACEs and resilience among different generations and offer directions for future research on measuring generations among this population as increased number of Generation Z join the military as new recruits.
Understanding Caregivers of Native Hawaiian Kūpuna with Age-Related Memory Loss on One Hawaiian Homestead
(University of Hawaii at Manoa, 2018-08) Dillard, Adrienne Y.; Social Welfare
Understanding the concerns and challenges of caregivers of Native Hawaiian kūpuna or elders (age 55 years and older) with age-related memory loss conditions, specifically, Alzheimer’s Disease and Related Dementia (ADRD), on one Hawaiian Homestead is the focus of this doctoral research study. ADRD is known to affect memory, thinking, and behavior. This research is grounded in Community-Based Participatory Research (CBPR) principles and utilizes a mixed methods strategy to assess the needs and concerns of caregivers. This mixed methods study utilizes a quantitative arm of the study involving development and administration of a written survey eliciting sociodemographic characteristics, as well as knowledge-attitudes-behaviors on caregiving. The qualitative arm of the study is with focus groups intended to clarify and extend information learned through survey data. Study findings can assist a homestead community in determining the types of resources and support essential for long-term care to mitigate caregiver burnout and simultaneously provide services that enhance kūpuna care. Results will inform providing safe, compassionate, community-based culturally appropriate care in the community for kūpuna who prefer to age in place. This dissertation research aligns with the focus of social welfare on health equity and cultural competence focusing on Native Hawaiians, a marginalized population and the need to provide relevant ADRD services for all. Further, this research contributes to the growing literature on aging in place from an Indigenous (Native Hawaiian) cultural perspective. This research underscores the importance of community “self”-determination. Specifically, study results indicate the cultural preference is caring for kūpuna is a community kuleana (responsibility). By extension, there is a need for community training that strengthens the capacity to address this kuleana. Current and emerging community leaders from across the generational continuum would benefit from training that ensures community participation in identifying moreover, addressing kūpuna needs, as served in a spirit of caring and excellence. Findings from this study are community-specific and cannot be generalized to all Native Hawaiians and Native Hawaiian communities. Research performed in one urban homestead community may provide critical considerations for others interested in developing policy and research for/with elders and family caregivers in the context of ADRD.
Gender, Perceived Health Status, and Social Support Amongst Oahu's Homeless
(University of Hawaii at Manoa, 2018-05) Perumal, Vijaya; Social Welfare
Homelessness has been increasing on Oahu for the past several years. The health status of the homeless, sheltered population is unexplored because of the challenges in gathering data about their situations. This exploratory research has detailed the sociodemographic profile of this group, exploring the impact of race/ethnicity, gender, class, age, parental status, length of homelessness (LOH), and social support on the perceived health status of the homeless, sheltered population on Oahu, Hawai`i. This research surveyed 151 participants living in four shelters: two in urban and two in rural settings. The research explored the perceived health status, availability of social support and length of homelessness (LOH), respectively, using the Center for Disease Control (CDC)’s Healthy Days Core Module (HDC), Interpersonal Support Evaluation List (ISEL), and Length of Homelessness survey (LOH). The three models, the general health, physical and mental health statuses were analyzed using bivariate analysis, ordinal logistic regression, and negative binomial regression models. The results suggest that Micronesians are more likely to have fewer physically and mentally sick days than their White counterparts within the homeless population. It appears that Micronesians migrating from collectivistic society share similar cultural values and burdens of homeless situations. In contrast, the White participants with individualistic values face the challenges alone. Sheltered women are more likely to have poorer mental health status than men. The physically sick days model indicated that social support had a negative, not positive, impact on a participant’s health status. Implications for future research to focus on the type and frequency of social support resources that work well for Micronesians and explore the mechanism that will work well for the White participants.
Juvenile Sex Trafficking and Hawai'i Public Policy: Examining the Policy Image of Juveniles Involved with Commercial Sexual Activity in Hawai'i
(University of Hawaii at Manoa, 2018-05) Marshall, Sarah M.; Social Welfare
Juvenile sex trafficking is a grave social problem that involves the commercial sexual exploitation of children. At the beginning of 2016, Hawai‘i ranked among the states with the least amount of protective legislation for juvenile sex trafficking victims. A potential factor contributing to this state-level response was the way in which the issue was discussed and framed within Hawai‘i’s public communications. The purpose of this dissertation was to examine the policy image created within the communication frames used by policy elite actors in Hawai‘i. This study drew data from two distinct sources: Hawai‘i’s major newspapers (n = 102 articles) and written testimony submitted to the Hawai‘i State Legislature (n = 399 testimony). A mixed methods content analysis was utilized to analyze the data. Analysis was guided by framing theory and was based upon Entman’s four-part typology: problem definition, causal interpretation, moral evaluation, and policy recommendation. Specific attention was paid to the use of episodic and thematic frames. Within the newspaper article data set, the overall policy image of juveniles was a variable one. Most often an image of juveniles as victims of sexual exploitation was used (45%), although in almost a quarter of the articles (22%) juveniles were clearly portrayed as criminals, and in a third of the articles (33%) juveniles were portrayed as both criminals and victims. Within the legislative testimony data set, the overall policy image of juveniles involved with commercial sexual activity was unmistakably an image of juveniles as victims of sexual exploitation (90%). A gradual shift in the policy image of commercially sexually involved juveniles is emerging within Hawai‘i’s public communications. Juveniles are increasingly being framed as victims of sexual exploitation rather than as criminals offending society. A key conceptual change necessary for disrupting exploitation and addressing juvenile need is to view juveniles as victims deserving of social aid rather than as criminals undeserving of social aid. The trend that is emerging in Hawai‘i’s major newspapers and in State legislative records seems to indicate that this key conceptual change is occurring within the communication frames used by Hawai‘i’s policy elite actors.
Mental Health Service Users As Peer Providers In Hawai‘i: Understanding Recovery Paths And Perspectives
(University of Hawaii at Manoa, 2018-05) Rocchio, Christopher; Social Welfare
The purpose of this study was to examine the lived experiences of Hawaii’s mental health service users in becoming certified peer providers. Qualitative methods were used to understand the perspectives of eight (8) mental health service users trained and credentialed through the Hawaii Certified Peer Specialist (HCPS) program. Data were analyzed at two levels. At the first level, an inductive approach using grounded theory identified four themes across participants: (1) prior to training and certification, the prospect of participation instilled hope of moving forward in their own recovery and helping others with similar lived experiences; (2) subsequent to training and certification, the lack of follow-up support services and few employment opportunities resulted in feelings of frustration and hopelessness; (3) ongoing systemic stigma and discrimination maintain barriers to integration; and (4) completion of the program increased their confidence, decreased their feelings of isolation, increased their empathy towards others with mental illness, and broadened their perspectives and worldviews. At the second level, themes from the first-level analysis were examined through the lens of Critical Disability Theory. Together, the first and second-level analysis provide unique insights into potential motivation factors for Hawaii’s mental health service users applying to the HCPS program. Findings also highlight organizational barriers that hinder the integration of peer providers as employees in traditional mental health service settings. Implications for policy, social work practice, and future research are discussed.
Colorectal Cancer Screening among Chamoru on Guahan: Barriers and Access to Care
(University of Hawaii at Manoa, 2017-08) Diaz, Tressa P.; Social Welfare
Colorectal cancer (CRC) is the second most common cause of cancer death on Guahan (Guam). Chamoru, the Indigenous peoples of Guahan, have the highest mortality rates in CRC on island, which implicates the need for earlier detection. Limited research has been conducted on CRC screening behavior among Chamoru. To address the gap, this study seeks to understand, explore, and predict factors associated with CRC screening among Chamoru, and to address the research questions: (1) How does access to care impact colorectal cancer screening among Chamoru on Guam; and (2) What are barriers to colorectal cancer screening among Chamoru on Guam? Guided by Andersen’s Behavioral Model of Health Service Utilization, individual predictors were categorized as predisposing, enabling, and need factors that facilitate or hinder CRC screening. A mixed quantitative and qualitative methods approach was utilized. First, screening data from the 2010 Guam Behavioral Risk Factor Surveillance System were used to model the association between CRC screening and predisposing, enabling, and need factors. Second, semistructured in-depth interviews with Chamoru men and women were conducted on why they opted for or against CRC screening. Purposive and snowball sampling was implemented to recruit participants due to the potentially sensitive and stigmatizing subject of colon/rectum screening processes. Binary logistic regression was used in quantitative analysis to determine significant predictors of CRC screening utilization. Qualitative analysis implemented Grounded Theory to determine relevant themes and key findings. Quantitative results show that having an annual check-up and educational attainment of high school or greater significantly predicted CRC screening. Qualitative analysis points to five themes in CRC screening decision-making: (1) being proactive in one’s healthcare; (2) intergenerational consciousness of cancer diagnosis and related screening behaviors; (3) social stigma associated with colonoscopies; (4) “If I’m vi i gonna die, I’m gonna die”; and (5) negative perceptions of the medical system. Findings provide insight toward cultural and health beliefs as facilitators and barriers to CRC screening with broader implications for political status as a determinant of health. Further research toward culturally tailored screening interventions is recommended to address cancer disparities in the context of healthcare access and health equity for Chamoru.
Identification and Prediction of Child Behavior Trajectories among Children Who Have Experienced Maltreatment.
(University of Hawaii at Manoa, 2017-08) Alboroto, Richard B.; Social Welfare
Background. Child maltreatment affects almost 683,000 children annually. The consequences of child maltreatment range from physical and mental health issues, at the micro-level, to increased child welfare worker caseloads and overcrowded residential facilities at the mezzo-level, to increased costs and policy implications at the macro-level. Children who have been maltreated are at-risk for behavioral problems, yet little is known about the diverse problematic behaviors of these children or main factors causing behaviors. This study aims to identify internalizing and externalizing behavior pathways that follow over a 6-year period, and the predictors of membership in problematic pathways. Methods. Growth Mixture Modeling (GMM) was used to estimate the number of subgroups of children following distinct behavioral pathways. Standard T-scores from the CBCL subscales were entered into a series of unconditional GMM models. BIC, BLRT, and entropy were examined when considering model fit. Multinomial logistic regression was conducted to identify predictors of problematic behaviors over time. Results. There were no unconditional models that fit the data best. Several statistically significant (p < 0.05) factors at the level of the child, caregiver/parent, and environmental influence children’s problematic behaviors. Controlling for all other model variables constant, male children are more likely to exhibit behavioral problems than female children. Children with low social skills are more likely to engage in problematic behaviors. Caregivers with little or no support are more likely to report having children engaged in delinquent behavior. Finally, access to social services significantly lowers the children’s problematic behavior over time. Conclusions. Children differ regarding how they respond to maltreatment and other life events or situations depending upon child, caregiver, and environmental factors. Study results indicated that these factors influence the problematic behaviors of maltreated children. Study results also indicated that improving maltreated children’s social skills and increasing caregiver social support may be key in reducing child behavior problems. Furthermore, identifying early indicators of internalizing and externalizing behavior problems and addressing them with evidence-based interventions to reduce negative behaviors may avert long-term negative outcomes. Limitations of this current study are reviewed; practice and policy implications are discussed as are recommendations for future research.
Examining the Determinants of Colorectal Cancer Screening Practices among Asian Americans
(University of Hawaii at Manoa, 2017-05) Kim, Sophia B.; Social Welfare
Asian Americans (AA) are documented to have low colorectal cancer (CRC) screening rates. Recent studies have further revealed screening disparities among AA subgroups. Focused research on CRC screening among AA subgroups are needed to more effectively address the CRC burden experienced by this growing racial/ethnic population. The purpose of this dissertation was to examine the determinants of CRC screening among AA. Study 1 was a systematic review of the determinants to CRC screening among AA subgroups using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Study 2 used the 2012 Hawai‘i Behavioral Risk Factor Surveillance System dataset and examined the associations between CRC screening and ethnicity, controlling for socio-demographic and healthcare variables using multiple logistic regression. Study 3 used the 2009 California Health Interview Survey dataset and examined the associations between physician’s recommendation and ethnicity, controlling for socio-demographic, cultural, and healthcare related variables using multiple logistic regression. All reported odds ratios were considered statistically significant at the p ≤ 0.05 level. Study 1 found different determinants to CRC screening between the AA subgroups. Study 2 revealed ethnic and gender variances in CRC screening among the AA subgroups. Chi-square analyses showed gender variances in CRC screening among the total women sample and Japanese compared to their respective counterparts. Multiple logistic regression results further revealed ethnic and gender variances in CRC screening even after controlling for other covariates. Study 3 revealed that having high limited English proficiency decreased the odds for physician’s recommendation for Chinese; being employed decreased the odds for Filipino; and having insurance decreased the odds for Korean. Wide array of determinants influence AA subgroups’ colorectal cancer screening practice (CCSP). Implications for policy, social work practice, and future research are evident from this dissertation. Researchers should remain cognizant of unique factors that play an influential role in subgroup’s decision to complete CRC screening; and further investigate potentially important but understudied and misunderstood determinants of CCSP presented in this dissertation. In turn, intervention efforts should be tailored to highlight the cultural strengths of each distinct subgroup and to address their unique needs and barriers to CRC screening.
A Study of Immediate Sanction Effectiveness to Reduce New Conviction Post-Probation
(University of Hawaii at Manoa, 2016-05) Sensui, Leonard
The criminal justice system’s attempt to reduce new conviction of drug using individuals, through incarceration, has increased the national prison population rate by 3.2% from 1.526 million in 2005 to 1.575 million in 2013; also, between 2001 and 2013, more than 50% of federal prisoners were convicted of drug charges (Rabinowitz & Lurigio, 2009; Carson, 2014). The average cost to incarcerate an individual in Hawai‘i is about $44,895 annually (Lawrence, 2016). Nationally, in order to reduce the prison population and the associated costs, more individuals were placed into probation supervision. Research has shown that first and second time offenders who received probation supervision instead of prison terms were less likely to recidivate (Rabinowitz & Lurigio, 2009). However, according to Mauer (1999), as probation caseloads increased, individual supervision time declined, which caused drug using violations and non-compliant behaviors to increase. In order to increase probationers’ compliance levels, the First Circuit Court in the county of Honolulu (O‘ahu) incorporated a probation supervision model based on the theory of operant conditioning. The model included motivational interviewing techniques (to increase probationers’ good behaviors) and incorporated immediate sanctions (to reprimand probationers’ noncompliant behaviors). This study analyzes factors related to new convictions and it includes comparisons of supervision outcome of probationers who began 5-years of probation supervision between the periods of January 2007 through December 2007. Probationers’ supervision outcomes and new convictions were examined until December 2014. The post-probation outcome of reducing new conviction was significantly effective when immediate sanction was employed as a supervision mechanism. This research may provide valuable information to the social work field to improve probationers’ compliance, drug treatment outcomes, and to increase public safety through the reduction in drug related crime.

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