D.P.H. - Public Health
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Item MENTAL HEALTH SERVICE DELIVERY FOR AFGHAN REFUGEES IN THE U.S.(2024) Basij-Rasikh, Shugufa; Braun, Kathryn; Public HealthItem FORMATIVE RESEARCH FOR SNORKEL-RELATED DROWNING IN HAWAIʻI: A SOCIAL MARKETING APPROACH(2024) Kaumeheiwa, Bridget; Braun, Kathryn L.; Public HealthItem Age-Friendly Health Systems and cultural relevancy: Exploring the application of the geriatrics 4Ms model with Native Hawaiian elders(2023) Ibrao, Miquela; Braun, Kathryn L.; Public HealthItem Mana Health: Understanding the Role of Mana Exchange in Optimizing Native Hawaiian Health(University of Hawaii at Manoa, 2023) Makahi, Emily K.; Braun, Kathryn L.; Public HealthMauli Ola, or Native Hawaiian wellness, is a holistic view of health that includes physical, mental, emotional well-being, and spirituality (Wegner & University of Hawaii at Manoa: Department of Sociology, 1989). However, Mauli Ola was impacted by several historical moments that led to changes in the cultural, political, and national sovereignty of Hawaiian civilization. The introduction of colonial control affected the health status of the indigenous people, who now have a health status far below that of dominant White United States population groups (McCubbin & Marsella, 2009). Despite the importance of spirituality among Native Hawaiians and the potential of mana-filled interventions to improve well-being, no studies have been done to assess how Mana is defined and experienced on the individual level and best integrated into healthcare programs and systems and evaluation methods. This dissertation was comprised of three studies. Study 1 collected data using phenomenology methods to understand how Native Hawaiians experience Mana and with whom/what they interact with to acquire positive Mana. Findings helped to define Mana Exchange and identify six factors of Mana Exchange. The Mana Exchange Survey (MES), used as an instrument to measure frequency of Mana Exchange behaviors, was created and the following studies were used to test validity of MES instrument. Study 2 conducted cognitive interviews to test the face validity of the MES instrument and test its acceptability among Native Hawaiian adults. Interviews informed new versions of the MES by informing the researchers to add, revise, and retain items. The findings of this study led to a final MES instrument that is novel to Native Hawaiian spirituality evaluation that measures Mana Exchange as a quantitative behavior of Mana. Study 3 used psychometric testing of the MES to continue to test the instrument’s validity. Statistical analysis showed that the MES measured three factors of Mana Exchange, titled Ao, Pō, and Akua. Individuals can acquire positive Mana through Ao, the living, through Pō, the spiritual realm of deceased individuals, and through Akua, things and people regarded in high spiritual beings. Findings also suggest that the MES is a reliable and valid instrument worthy of further exploration and study. Overall, findings from this dissertation highlight the ability for Native Hawaiian health-related constructs to be captured through instrument development that is accepted by the community and statistically significant. This dissertation has added to the scholarship of Mana and continue highlight need to increase best practices to evaluating Native Hawaiian health.Item Building Evidence To Reduce Childhood Asthma Health Disparities In Hawai‘i(University of Hawaii at Manoa, 2021) Uchima, Olivia; Sentell, Tetine; Public HealthAsthma, a chronic lung disease that inflames and narrows the airways, affects about 6.2 million children in the United States (US). In 2013, childhood asthma was the leading cause of school absenteeism. Racial/ethnic disparities also exist, with Native Hawaiian children suffering from an extremely high prevalence of asthma. In Hawai‘i, important questions exist on this topic. The purpose of this dissertation was to shed light on childhood asthma disparities in Hawai‘i and provide evidence for developing asthma education programs to improve asthma-related health outcomes among children in Hawai‘i. This dissertation was comprised of three studies. Study 1 analyzed the Hawai‘i Health Information Corporation (HHIC) data (2015-2016) to establish the total direct cost of asthma-related emergency department (ED) visits among children with asthma in Hawai‘i. Findings showed Native Hawaiians had the largest proportion of all preventable ED visits compared to Asian Americans and Whites in Hawai‘i. Preventable ED visits also differed significantly by age, insurance provider, and island of residency. Study 2 was a systematic literature review assessing the effectiveness of school-based asthma education programs for children in the US in reducing acute health care services. The overall findings suggested school-based asthma education programs are associated with reductions in acute care services. Study 3 used qualitative methods through Photovoice to ascertain perceived factors that affect asthma management among children in Hawai‘i. Eight key themes (four supports and four barriers) were identified by students from the Wai‘anae Coast. The four supports were ‘āina (land), safe haven, alternative remedies, and communtiy support. The four barriers were various physical activity, food/edibile, environmental, and emotional triggers. Findings provided a better understanding on the role a student’s environment plays in asthma management. Overall, findings from this dissertation highlight the need for asthma education programs in Hawai‘i to reduce the financial burden on insurance payers, families, and health care systems from preventable acute asthma-related health care services, and provide evidence about the best ways to build such programs.Item Program Evaluation Of Accessurf Hawai‘i, An Adaptive Surf, Swim And Canoe Program For People With Disablities(University of Hawaii at Manoa, 2021) Schmid, Simone Maria; Braun, Kathryn L.; Public HealthApproximately 15% of the global population lives with disability (1). The proportion is even greater in the United States, where 1 in every 4 adults experienced disability in 2017 (2). People with disabilities have three times greater risk of developing non-communicable diseases than people without disabilities (3), in part because they are less active than their peers without disabilities (4). People with disabilities also are likely to experience social isolation and loneliness, which can lead to negative health consequences and even lower physcial activity levels (5–8). One approach to combating these health disparities is through community programming in adaptive sports. AccesSurf Hawai‘i provides people with disabilities the opportunity to participate in adaptive swimming, surfing, and canoeing. The purpose of my three-study dissertation was to evaluate AccesSurf’s impact on participants benefits, ability to assess community need during COVID-19, and program sustainability. Study 1 identified the benefits of aquatic physical activity and participation in AccesSurf programs for people with disabilities through a secondary data analysis of participant surveys (called “Fun Wall”) (n=442) and a Skills Tool (n=8). Results showed that participants improved in levels of aquatic physical activity, skills, independence, confidence, and community integration. Study 2 identified AccesSurf community’s need for programming during the COVID-19 pandemic through a mixed-method approach, first soliciting answers from open- ended questions (n=89), followed by a closed-ended questionnaire (n=149). There was high awareness and satisfaction across all programs, including the newly added virtual programs. The results provided insight into community needs, and showed differences between sub-groups, such as in feeling the effects of COVID-19 pandemic. Study 3 explored the contributing factors of AccesSurf’s sustainability, as well as opportunities for improvement, using a mixed-method approach. The closed-ended Program Sustainability Assessment Tool (PSAT) (n=15) was administered to governing members, followed by in-depth interviews (n=5). This study highlighted areas of strength, including AccesSurf’s adaptability, champions, and communications. Areas for improvement are strategic planning, stable funding, and partnerships with other community organizations and leaders. Taken together, findings confirm that the program was beneficial to participants, has high program satisfaction, and many characteristics supporting its sustainability, with some room for improvements, all of which benefits the AccesSurf community. Findings can inform similar organizations that are providing innovative, recreational physical activity options for people with disabilities and future research.Item The Prevalence, Economic, And Social Cost Of Methamphetamine Use; And The Effects Of Economic Recessions, Unemployment Rates, And Methamphetamine Arrests On Child Abuse In Hawai`i(University of Hawaii at Manoa, 2020) Linn, Nancy S. C.; Hurwitz, Eric; Public HealthThis is the first study in Hawai`i to estimate the prevalence and cost of methamphetamine (meth) use and the first investigation of the association of the impact of the periodicity of economic recessions, unemployment rates, and meth arrests on child abuse for the years 2007 to 2017, based on free, open source, and unrestricted data gathered for other purposes. The Hawai`i age-adjusted meth use prevalence was above the national estimates and ranged from 5,050 per 100,000 in 2007 to 3,387 per 100,000 in 2017, with a range from 3,114 to 5,219 per 100,000. The economic and social cost estimates were found to average between 41 to 68 billion dollars (range 15 to 105 billion dollars) when the lost potential from meth use and meth-related impacts were included. The quality-adjusted life-years approach, the Department of Transportation (DOT) Maximum Abbreviated Injury Scale (range 1-6, 6=death), and the DOT Value of a Statistical Life were included in the computation of lost potential of meth users and abused children using the RAND and state of Montana approach. When lost potential was not included, the cost of meth use was found to average between 120 to 173 million dollars per year (range 49 to 269 million dollars). The five factors for the cost estimates included: 1) treatment costs, 2) health burden, 3) child endangerment, 4) criminal justice costs, and 5) lost productivity attributable to meth. Meth arrests were found to lag unemployment rates by one year while child abuse lagged about four years behind unemployment and meth arrests, although the Granger causalities were not significant.Item The Effects of Early Life Factors on Elder Physical Activity Disparities in High and Middle Income Countries(University of Hawaii at Manoa, 2017-05) Hwang, Phoebe W.-N.; Public HealthTo delay chronic disease and promote general health among older adults, physical activity (PA) is often recommended and promoted in a public health setting. Unfortunately, there are a number multi-level factors associated with low PA that occur prior to old age, known as early life adversities. It is well established across the globe that social and economic adversity are associated with poor health outcomes and behaviors. This dissertation presents findings from two quantitative studies with a global sample and one qualitative study with a local sample to examine the effect of life course factors and older adult physical performance and PA behavior disparities. The first two studies utilized global health data from the International Mobility in Aging Study (IMIAS), and found that site location, gender, income, and sex were associated to PA. In addition, economic adversity transition is associated to physical performance. The third study found that neighborhood type (urban vs. rural) played a role in Native Hawaiian older adult PA type and physical performance. This relationship could possibly be mediated by how discrimination and poverty are perceived, as they were perceived differently by older adults from the two different neighborhoods. Results from this dissertation support targeting childhood and life course environmental and socio-demographic factors as effective ways to improve older adult PA and physical performance. Future PA promoting interventions should be tailored to their target population based on region, and not just ethnicity. To build on findings from this dissertation, future research is needed to further examine how childhood adversity and perceived discrimination plays a role in older adult physical performance and PA behaviors.Item Addressing Filipino American Cardiovascular Health Disparities in Hawai‘i(University of Hawaii at Manoa, 2017-05) Domingo, Jermy-Leigh B.; Public HealthCardiovascular Disease (CVD) is the leading cause of death in the United States (U.S.). Among Filipino Americans (FAs), CVD is the leading cause of death among males and second among females. Research indicates a high prevalence of hypertension and behavioral risk factors associated with CVD. Culturally relevant health interventions targeted for FAs can increase their participation in healthy behaviors, leading to an improvement in their overall health. The purpose of this dissertation was to advise the development of culturally targeted health interventions. Shedding light on FA CVD-related disparities allows for effective programming in Hawai‘i’s Federally Qualified Health Centers (FQHCs). This dissertation was comprised of three studies. Study 1 analyzed four years of Hawai‘i’s Behavioral Risk Factor Surveillance System (BRFSS) data (2011 to 2014). Findings confirmed that FAs in Hawai‘i were less physically active, smoked more, and were more obese than other Asian subgroups. Contrary to the national literature, FAs in Hawai‘i reported the lowest CVD prevalence of the five ethnic groups in the sample, after controlling for sociodemographic and health care access variables. Study 2 was a systematic literature review of CVD-related programs tailored to FAs. Few articles were found, confirming need for more published research on improving CVD health of FAs. Described interventions found success by attending to FA cultural values, food, social relationships, and family. Analysis of the articles also suggested that interventions should employ word of mouth recruitment strategies to successfully reach FA communities. Study 3 used qualitative methods to explore essential strategies to successfully attract FAs to CVD prevention programs in Hawai‘i’s Federally Qualified Health Centers (FQHCs). Three key themes emerged. First, FQHCs should understand FA issues, context, and culture. Next, multiple levels of buy-in are necessary when creating health programs and interventions. Last, FQHCs should follow specific tips for successful health interventions (e.g., employing FA staff, flexible scheduling). Taken together, findings confirm the need for culturally tailored programs to support FA populations. Further, FAs experience a high prevalence of disease-related (e.g., hypertension, diabetes) and behavioral risk factors associated with CVD. Hawai‘i’s FQHCs, are well positioned to implement CVD prevention interventions tailored to the FA community.Item Yoga for Veterans with Post-Traumatic Stress Disorder(University of Hawaii at Manoa, 2017-05) Cushing, Robin E.; Public HealthStudies have determined that approximately 15% to 20% of military service members are returning from deployment with Post-Traumatic Stress Disorder (PTSD) symptoms. The Department of Defense (DoD) and the Veterans Health Administration (VHA) have spent billions on post-9/11 veterans. However, many service members and veterans do not seek treatment due to the stigma of seeking care, side effects of treatment, or fear that a record of treatment will harm their professional military careers. These same individuals look for alternative options, such as mind-body therapies, to help in treating their PTSD symptoms. This dissertation research was comprised of three studies (papers) to address several research questions exploring the usefulness of the mind-body therapies on reducing PTSD symptoms in the military. The first study was a systematic literature review looking at the effect of mind-body therapies on combat veterans and service members suffering from PTSD (Study 1). The major finding of the systematic review was that mind-body therapies are promising therapies for reducing PTSD symptoms in veterans and service members. The second study was single-group pre-posttest study testing a military-tailored, trauma-sensitive yoga intervention with veterans suffering from PTSD (Study 2). I recruited 18 veterans with PTSD symptoms to participate in a 6-week intervention of 60-minute, weekly yoga classes. I compared their baseline and post-intervention responses on scales measuring PTSD symptoms as a primary measure and depression, anxiety, insomnia, and mindfulness as secondary measures. The participants demonstrated significant reductions in PTSD symptoms and all of the secondary measures. For Study 3, I conducted interviews with 9 veterans to explore their perceptions of the benefits and barriers to practicing a trauma-sensitive yoga. While Study 2 demonstrated that yoga can yield statistically significant improvements in wellbeing, study 3 provided me a deeper understanding of individual's perspectives of why veterans continue to practice or not practice yoga.