M.S. – Public Health

Permanent URI for this collectionhttps://hdl.handle.net/10125/24281

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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.
The Association between Menopause Status, Age, and Cholesterol: The Hilo Women's Health Study
(University of Hawaii at Manoa, 2015-05) Rahberg, Nichole
Cardiovascular diseases (CVDs) are the number one killer worldwide, in the United States, and in the state of Hawai’i. Women’s risk for CVDs increases after menopause, partially due to changing cholesterol levels. The Hilo Women’s Health Study seeks to advance knowledge of women going through the menopausal transition in the multiethnic population of Hilo, Hawai’i, including Asian Americans, Native Hawaiians, and Pacific Islanders. The two phase, cross-sectional study obtained information on 189 women from the ages of 45 to 55. Menopausal status was divided into premenopause, perimenopause, and postmenopause, and regressed on total cholesterol, HDL-C, LDL-C, triglycerides, and the triglyceride to HDL-C ratio. After adjusting for potential confounders, menopause status was significantly associated with total cholesterol and LDL-C. However, ethnicity was significantly associated with all of the cholesterol measures. Conversely, age was not found to be associated with any of the measures.
Development of optimal methods for effective detection and recovery of infectious enteric viruses from the environmental water
(University of Hawaii at Manoa, 2013-08) Wang, Zi
Human enteric viruses have been used as alternative indicators for water quality monitoring since the current used bacterial indicators do not always corresponded with true health risk. Effective laboratory methods for viral detection and concentration are essential since these human enteric pathogens exist in an extremely low number in environmental water. Our laboratory has recently established a molecular technique, i.e. PCR, for effective concentration and sensitive detection of these viruses. However, this method has limitations for differentiating between infectious and non-infectious viruses. Therefore, this study is aimed to establish optimized laboratory conditions for concentration and recovery of infectious viruses from environmental waters. For effective recovery of concentrated infectious viruses from negatively charged filter membranes, three different elution buffers: NaOH, KH2PO4 and beef extract (BE) solution were compared. And for viral isolation and infectivity from shellfish tissues, PEG precipitation method and ultracentrifugation method were compared by using Poliovirus type 1 as a viral model. Viral infectivity was conducted through plaque formation assay and demonstrated that 3% BE in 50 mM glycine is the most effective buffer for virus recovery (>90%). And over 77% of infectious viruses were recovered from shellfish tissue homogenates through PEG 6000 precipitation. The established viral plaque assay was also used to determine the stability of spiked Poliovirus 1 under various experimental conditions including seawater, fresh water, PBS, 50% raw sewage, 50% sewage effluent, 100% raw sewage, 100% sewage effluent and also in the indigenous bivalve mollusk tissue. It showed that Poliovirus 1 is less stable in sea water than the other aquatic environments. Viral survival curves revealed no significant difference in the stability of infectious Poliovirus 1 between raw sewage and sewage effluent. However, they illustrated that Poliovirus 1 is more stable in 100% raw sewage/sewage effluent than it in 50% raw sewage/sewage effluent. Additionally, the indigenous shellfish (isognomon spp.) was observed to have an accumulation function for infectious Poliovirus 1 in their tissue and could retain the virus for a longer time than in the surrounding water which enhanced the use of shellfish as a natural bio-indicator for environmental water quality monitoring. This study has established optimized laboratory conditions for the concentration and recovery of infectious enteric virus and the determination of viral stability in different environments. This provides the essential information for the facilitation of current tests using enteric viruses and shellfish as indicators for aquatic environmental monitoring and for assessing contamination-associated health risks.
Asthma health disparities among Native Hawaiians and other Pacific Islander adults of the United States, 2001-2009
(University of Hawaii at Manoa, 2011-08) Jessop, Holly
Elimination of health disparities is a public health priority. Asthma is a serious and often debilitating health condition, with well-documented racial disparities in prevalence. Because asthma is a substantial health problem, with markedly increasing prevalence and mortality rates, there is an urgent need to adequately characterize asthma in high-risk populations such as Native Hawaiians and other Pacific Islanders (NHOPI) who may be disproportionately affected. However, little is known about the burden of asthma in NHOPI compared to other races in the United States (U.S.). This study is an investigation of the prevalence of asthma amongst NHOPI within the U.S., using nine years of data (2001-2009) from complete telephone survey responses of the Behavioral Risk Factor Surveillance System. Crude lifetime weighted asthma prevalence was significantly greater in NHOPI (17.22%; 95% confidence interval [CI]: 15.36, 19.25%) than in Whites (12.49%; 95% CI: 12.40%, 12.57%), and the NHOPI asthma prevalence point estimates were higher than in Whites in all age, sex, education, health care coverage, smoking status, body mass index, place of residence (Hawaiʻi vs. Mainland U.S.), and time period strata examined. Regardless of race, younger age (especially 18-24 years), female sex, education attainment less than a college degree, smoking, overweight/obese body mass index, residence in the State of Hawaiʻi, and later time periods (i.e., 2004-2006 and 2007-2009 vs. 2001-2003) were all independently associated with asthma. After controlling for these socio-demographic, geographic, and temporal factors, NHOPI odds of asthma remained significantly greater than for Whites (odds ratio [OR] 1.33; 95% CI: 1.16, 153). While adjusted odds of asthma increased with time overall (1.16; 95% CI: 1.14, 1.18 for 2007-2009 vs. 2001-2003), adjusted odds of asthma
Determinants of maternal health care seeking behavior in Bangladesh
(University of Hawaii at Manoa, 2011-08) Anwar, MD Mahabub Ul
Although maternal mortality in Bangladesh declined almost one-fourth from 1329 in 1980 to 338 in 2008 per 100,000 live births, it is still one of the highest in the world. Most of these deaths can be avoided by providing maternal health care services. The Government of Bangladesh is providing free maternal health care service at the community level, yet the utilization is very low. This study tried to determine the causes of underutilization of services by using secondary data from three nationally representative Demographic Health Surveys. Results show that age, different time periods, place of residence, education, wealth, mass media exposure, age at marriage, and time wanted pregnancy are the determinants of underutilization of antenatal care, institutional delivery and postnatal care. In addition, field workers visit to pregnant women was found to be significant determinant for utilizing antenatal and postnatal care. The study suggests that the government needs to target poor and rural women who have lower education and lower age at first marriage. The government needs to make them aware of the necessity and availability of maternal health care services, which can be done through mass media and field workers.
HIV associated neurocognitive disorders and lentiviral vector-mediated stable expression of anti-HIV-1 Tat intrabodies in human macrophage, neuronal, and primary peripheral blood mononuclear cells as a potential therapy for neuroAIDS
(University of Hawaii at Manoa, 2012-05) Byron, Mary Margaret
HIV-1 Tat is required for HIV replication and is also a known potent neurotoxin causing HIV-Associated Dementia. To test whether stable production of secreted Tat antibody in the brain could be an effective approach to inactivate Tat and thus provide protection from neuroAIDS, our research integrates HIV-1 Tat single chain variable fragment (scFv) intrabodies with a novel gene therapy approach utilizing monocytes, which naturally cross the blood-brain barrier, for gene delivery. HIV-based defective lentiviral vectors were constructed to express one of two different HIV-Tat scFv antibodies or control scFvs with a CMV promoter and Fc-fusion protein and GFP as indicator genes. High titer vectors (2x107) were generated through calcium phosphate precipitation mediated transfection of human embryonic kidney 293T packaging cells, and tested for transduction of established human neuroblastoma (HTB-11) and microglial (CHME-5) cells, as well as primary peripheral blood mononuclear cells (PBMC). Expression of anti-HIV-Tat scFv in transduced cell lines was detected using optimized ELISA, Western Blot, and Immunofluorescent staining. Immunoblot and Neuroprotection assays were performed to assess anti-HIV-1 Tat scFv function and multiplex genetic expression analysis of 24 common reference genes was utilized to determine any cellular gene expression changes. Efficient transduction ranging from 80% to 100% in HTB-11 and CHME-5 cell lines, determined by GFP quantification, was achieved at a multiplicity of infection of 10 and confirmed by PCR. Long-term observation of transduced cells revealed no apparent change as compared to normal cells in terms of cell growth and morphology. Multiplex genetic expression analysis revealed similar gene expression levels in non-transduced and transduced cells. The expression of transgenes (GFP and anti-HIV-1 Tat scFv) in transduced cells was stable long term (>20 cell passages) and intracellular production of these genes was confirmed through Immunofluorescent staining. Western Blot assays confirmed anti-HIV-1 Tat scFv expression and ELISA quantitatively assessed secreted anti-HIV-1 Tat scFv concentrations to range from 350ng/mL in transduced CHME-5 to 700ng/mL in transduced HTB-11 cell lines. In addition, Immunoblot assays demonstrated the accurate biological function of secreted anti-HIV-1 Tat scFv by its specific binding to HIV-1 Tat protein in vitro and Neuroprotection assays against HIV-1 Tat and gp-120 demonstrated that anti-HIV-1 Tat scFv, both in transduced cells and conditioned media provided significant protection from both neurotoxins (p<0.01). Primary PBMCs were isolated and transduced at a multiplicity of infection of 10, achieving 10% transduction efficiency as determined by GFP quantification and confirmed by PCR. ELISA detected secreted anti-HIV-1 Tat scFv, which provided significant protection from HIV-1 Tat and Gp120 neurotoxins (p<0.01). Multiplex genetic expression analysis revealed similar gene expression levels in both transduced and non-transduced PBMC cultures. Findings from this study support the in-depth study of anti-HIV-1 Tat scFv, which will facilitate the development and potential use of the constructed lentiviral vectors to deliver anti-HIV-1 Tat scFv into the brain for neuroprotective intervention using genetically modified macrophage cells as a vehicle.
A field and laboratory study of the storage and preservation of breadfruit as practiced in the South Pacific islands
(University of Hawaii at Manoa, 1967) Parker, Robert Davis Rickard
The purpose of the investigation is to shed more light on the process and to gather information to add to the limited scientific knowledge of the fermentation process of breadfruit during the period of preservation in the ground in the South Pacific area. It is also the purpose of this study to contribute to limited Public Health knowledge of the reported occurrence of reactions or disorders attributed to consumption of fermented breadfruit taken from earth pits in the ground and to stimulate further study in the field of food-borne diseases in which the causative agent has not been fully delineated.
Dietary factors and the risk of non-hodgkin lymphoma: the multiethnic cohort
(University of Hawaii at Manoa, 2008) Erber, Eva
Emergency room utilization by ethnicity and alternative health care practices in Hawaii
(University of Hawaii at Manoa, 2007) Alimineti, Kavitha
Between 1992 and 2002, emergency department (ED) hospitalization in the United States increased 23%, from 89.8 million to 110 million visits.[1] Various factors contribute to increased demand in ED utilization, such as insurance status, lack of usual source of care, general health status and economic statos.[2] Sorondo et al., for example, found that statistically significant factors associated with those utilizing ED services included females, unmarried persons who are lacking prescription medical insurance, and the poor who have less than a college education.[3] Race and/or ethnicity are also factors Sorondo et al reported influencing ED hospital visits; [4,5] however, others reported that it was not an important determinant of ED visitation status after adjusting for age, insurance, regular source of care, and difficulty obtaining transportation to physician's office.[6] Stratmann and Ullman found, after adjusting for insurance and health status, that race was not significantly associated with ED visitation status.[7] The use of complimentary and alternative medicine (CAM) increased substantially during the 1990's in the United States. The 2002 National Health Interview Survey (NHIS) conducted by the Centers for Disease Control and Prevention (COC) reported that 74% of people have engaged in some forms of CAM therapy while 62% of adults have been treated with CAM in the last 12 months.[8] Complimentary and alternative medicines are being used by a majority of ED patients.[8] An examination of the association of ED and CAM use indicates that CAM users do not differ in their utilization of ED when compared to non-users. A prospective observational study found that many ED patients have either tried or are willing to use alternative medicine. [10] Among ED users, 54% bad tried alternative medicine. Also, 87% of ED users felt alternative medicine was effective. Most patients were willing to try alternative medicine (63%) for their current problems, and wanted their personal physicians to know more about alternative medicine (75%), and also wanted their physicians to use alternative medicine (84%).[10] These authors (Singer AJ, Gulla J) suggested that emergency room physicians should specifically query patients regarding prior use of alternative medicine and explore the use of alternative medicine for their patients. These studies have limitations and the results cannot be generalized to a broad population since most of these studies were done in a clinical setting or an individual department. So far, there is limited research on the use of ED and CAM in the general population in Hawai'i, particularly among native Hawai'ians and Pacific Islanders. A better understanding of the relationship between ethnicity and the use of CAM in an emergency department is essential for directing or re-directing resources in order to improve health care services. Also, cultora1 beliefs may influence a particular individual's utilization of CAM and ER. This thesis analyzes the Hawai'i Health Survey data to provide a deeper understanding of ED and CAM use in Hawai'i
The relationship between socioeconomic status, stress, and substance use among women of childbearing age
(University of Hawaii at Manoa, 2007) Westling, Jessi
Substance use is associated with many health problems. Alcohol use is associated with high blood pressure, stroke, cardiovascular diseases, liver disease, and neurological damage (Center for Disease Center and Prevention (CDC), 2006a). Cancer, which is the second leading cause of death in the U.S., was among the first diseases to be casually linked to smoking (CDC, 2006b). Smoking also causes coronary heart disease and increases a person's risk for stroke (CDC, 2006b). Use of illicit drugs (e.g., marijuana, cocaine. heroin, and methamphetamine) is associated with chronic depression, psychosis, and higher risk of contracting human immunodeficiency virus (HIV) (Department of Health and Human Services, 2000). Women face unique health effects from substance use in relation to menstrual and reproductive functions. Evidence also shows that for some substances, like alcohol and tobacco, women may be more vulnerable than men in regards to both acute and long-term effects (as cited in United Nations Office on Drugs and Crime, 2004). Substance use bas been found to be influenced by both socioeconomic status and stress. Substance use varies across groups of differing socioeconomic status. For example, excessive alcohol consumption is more common among lower educational groups (Droomers, Schrijvers, Karien, van de Mheen, & Mackenbach, 1999). Smoking prevalence is also related to educational level. Women with 9-11 years of education are nearly three times more likely than women with sixteen or more years of education to smoke (CDC, 2006b). Stress bas also been found to be associated with substance use. It bas been shown that as stress increases, drinking increases as well (Abbey, Smith, & Scott, 1993; Cole, Tucker, & Friedman, 1990). Associations have also been found between a variety of indices of stress and increased risk for smoking uptake. Current smokers report smoking more when stressed and report experiencing more stress than non-smokers (as cited in Kassel, Stroud, & Paronis, 2003). Stress also plays a role in the decision to begin using drugs (Ladwig & Anderson, 1989; Lindenberg, Reiskin, & Gendrop, 1994). The Stress Process Model developed by Pearlin (1989) provides the opportunity to study the effects the social structure and its stratification based on social and economic class, race and ethnicity, gender, and age bas on the stress process. The overarching strategy of social stress research is to identify the many links that join forms of social organization to individual stress. The stress process is continually being influenced by the social structure and its interrelated levels including social stratification, social institutions, and interpersonal relationships. Therefore, to the extent to which these different systems embody the unequal distribution of opportunities, resources, power, and prestige, a low status within them may in and of itself be a source of stressful life conditions (Pearlin, 1989). Stress is generally divided into two distinct types of stress: eventful stressors and chronic stress. Eventful stressors surface at discrete points in time while chronic stressors may either surface repeatedly or remain over a considerable amount of time. Eventful and chronic stressors may originate from the relatively stable systems of inequality like social class and from the many domains of social and economic organizations (Pearlin, 2002). Overall, stress could be acting as a mediator between socioeconomic status and substance use. A mediator is a third variable whose function is to represent the mechanism through which the independent variable, in this case socioeconomic status, is able to influence the dependent variable, substance use. Therefore, it is essential to take a closer look into the relationship between socioeconomic status, stress, and substance use.
Cultural considerations in development church-based programs to reduce cancer health disparities among Samoans
(University of Hawaii at Manoa, 2007) Aitaoto, Nia
We examined receptivity to developing church-based cancer programs with Samoans. Cancer is a leading cause of death for Samoans, and investigators who have found spiritually linked beliefs about health and illness in this population have suggested the Samoan church as a good venue for health-related interventions. We interviewed 12 pastors and their wives, held focus groups with 66 Samoan church members, and engaged a panel of pastors to interpret data. All data collection was conducted in culturally appropriate ways. For example, interviews and meetings started and ended with prayer, recitation of ancestry, and apology for using words usually not spoken in group setting (like words for body parts), and focus groups were scheduled to last 5 hours, conferring value to the topic and allowing time to ensure that cancer concepts were understood (increasing validity of data collected). We found unfamiliarity with the benefits of timely cancer screening, but an eagerness to learn more. Church-based programs were welcome, if they incorporated fa'aSamoa (the Samoan way of life )-including a strong belief in the spiritual, a hierarchical group orientation, the importance of relationships and obligations, and traditional Samoan lifestyle. This included training pastors to present cancer as a palagi (white man) illness vs. a Samoan (spiritual) illness about which nothing can be done, supporting respected laity to serve as role models for screening and witnesses to cancer survivorship, incorporating health messages into sermons, and sponsoring group education and screening events. Our findings inform programming, and our consumer-oriented process serves as a model for others working with minority churches to reduce cancer health disparities.

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