Freshwater Fish–Consumption Relations With Total Hair Mercury and Selenium Among Women in Eastern China

Wild fish from Qiandao Hu, a reservoir in the Zhejiang Province in eastern China, have increased mercury (Hg) concentrations exceeding the World Health Organization’s (WHO) recommended guidelines. Due to the importance of freshwater biota in the local cuisine, dietary exposure to increased neurotoxic Hg is a concern in this region. An environmental hair-marker study was undertaken coincident with a cross-sectional epidemiologic study with 50 women age 17–46 years living in a Qiandao Hu fishing village. Diet, occupation, and other possible sources of Hg were recorded by way of questionnaires. Total mercury (THg) and selenium (Se) concentrations were measured in human hair samples and in important market fish species. Fish THg and Se concentrations were increased, with some fish concentrations >200 ng/g THg and 500 ng/g Se (wet weight [ww]). However, the average hair THg was low at 0.76 ± 0.51 μg/g dry weight, lower than the WHO’s no observable–adverse effect level (50 μg/g), whereas the average hair Se was 1.0 μg/g. Hair THg concentration was positively associated with the average mass of fish consumed weekly, indicating that fish consumption is the main contributor to hair THg in this geographic area. The age-related hair THg trend was not linear but instead demonstrated a rapid increase in THg before age 25 years, followed by consistent concentrations in all ages after age 25 years. There was a positive correlation (p < 0.001) between molar Se and Hg in the hair samples, suggesting a possible antagonistic relation. This is the first study examining the relation between dietary Hg exposure and hair THg in an eastern China community where freshwater fish, as opposed to marine fish, dominates the cuisine.     

Profile of Methicillin-resistant Staphylococcus aureus Among Nursing Home Residents in Hawai‘i

Residing in long-term care facilities has long been identified as a risk factor for methicillin-resistant Staphylococcus aureus (MRSA) carriage and infection. The objective of this study was to describe MRSA epidemiology among residents in skilled nursing and intermediate care facilities (SNF/ICF) in Hawai‘i, using a statewide, population-based antimicrobial resistance surveillance system. From 2000 to 2005, proportions of MRSA increased significantly during the 6-year study period, from 35.0% in 2000 to 58.6% in 2005 (p<0.001). High levels of MRSA resistance to several commonly used antibiotics were observed, e.g., the level of MRSA resistance to clindamycin, ciprofloxacin, and erythromycin was at 77%, 90%, and 89% respectively. Nevertheless, there is a significant difference in the MRSA resistance pattern against certain antimicrobials in different geographic areas. For example, the level of MRSA resistance to trimethoprim-sulfamethoxazole was close to zero in Hawai‘i County, but 13% in Kaua‘i County. In contrast, the MRSA resistance to tetracycline was 46% in Hawai‘i County, but 5% in Kaua‘i County. Multi-drug resistant MRSA was well-established among nursing homes in Hawai‘i. Regional antibiograms are important in the assistance of empirical therapy.     

Large-scale weather patterns favorable for volcanic smog occurrences on O’ahu,Hawai’i

Kīlauea Volcano, located on the Island of Hawai’i, released approximately 3700 t of sulfur dioxide (SO₂) per day from April 2009 through 2014. Within the atmosphere, SO₂ is oxidized and converted to sulfuric-acid aerosols, and this volcanic smog is commonly referred to as vog. This study focuses on large-scale weather patterns that bring vog to O’ahu. The Hawai’i State Department of Health PM_2.5 measurements were used to identify elevated vog conditions, and a total of 101 vog days were found. European Centre for Medium-Range Weather Forecasts ERA-Interim reanalysis data were used to determine weather patterns. These 101 vog days were the result of 57 distinct vog events lasting from 3 h up to 4 days. The 57 events were further categorized into three large-scale weather patterns: pre-cold fronts (37 cases), upper-level disturbances (17 cases), and Kona lows (3 cases). The pre-cold front events had variable duration lasting up to 4 days, and the largest vog concentrations occurred during long-duration pre-cold front events. Trade winds did not transport vog to O’ahu. As part of this effort, ERA-Interim data were downscaled to a resolution of 10 km and then 3.3 km using the Weather Research and Forecasting (WRF) model. The downscaled reanalysis data were used as input by the Hybrid Single-Particle Lagrangian Integrated Trajectory (HYSPLIT) model. The HYSPLIT model allowed for a visual representation of how vog is advected by large-scale wind patterns.     

Translational Research Education and Training Needs in Hawai‘i

The purpose of this needs assessment was to identify the translational research education and training needs of researchers and administrators working in Hawai‘i''s communities and to use the finding to develop an education and training plan. The assessment was led by a community advisory board with members from community health centers, social agencies, hospitals, and academia on O‘ahu. The survey, developed with input of the community advisory board, was sent to 94 administrators and researchers involved or affiliated with research being conducted in Hawai‘i. Forty-one respondents (43%) completed the survey. Respondents wanted education and training in research processes, specific research-related skills, and facilitating interactions between community and academic researchers. Sixty-one percent were interested in training related to community-engaged research and yearly seminars on “collaborative mentoring.” Popular topics of interest were related to data monitoring, networking with different cultural groups, statistics, and human subjects review. A majority of respondents wanted to attend workshops, seminars, and presentations rather than take a class. Approximately 50% of the respondents wanted to gain information through on-line training. Findings guided the development of a translational research education and training plan for the University of Hawai‘i National Institute of Health (NIH) Research Centers in Minority Institutions Multidisciplinary and Translational Research Infrastructure Expansion (RMATRIX) grant.Major Terms: community-engaged research, translational research education, translational research, health disparities     

Piliwaiwai: Problem Gambling in Hawai‘i

Gambling is illegal in Hawai‘i, but it is accessible through technology (eg, the internet), inexpensive trips to Las Vegas, and illegal gaming such as lottery sales, internet gambling, and sports betting. Where there are opportunities to gamble, there is a probability that problem gambling exists. The social costs of gambling are estimated to be as high as $26,300,000 for Hawai‘i. Because no peer-reviewed research on this topic exists, this paper has gathered together anecdotal accounts and media reports of illegal gambling in Hawai‘i, the existence of Gamblers Anonymous meetings operating on some of the islands, and an account of workshops on problem gambling that were provided by the author on three Hawaiian Islands. Through these lenses of gambling in Hawai‘i, it is suggested that there are residents in Hawai‘i who do experience problem gambling, yet it is unknown to what extent. Nonetheless, this paper argues that research and perhaps a public health initiative are warranted.     

The Paradox of Discrimination,the “Aloha Spirit,” and Symptoms of Depression in Hawai‘i

It remains to be determined whether the “aloha spirit” is a cultural resource that influences psychological well-being in Hawai‘i. Thus, the purpose of this study is to investigate whether the aloha spirit is associated with levels of psychological distress and the risk of depression, while taking into account various risk factors. Data for this study were drawn from an anonymous survey of undergraduate students (N = 1,028) at the University of Hawai‘i. Regression results revealed that having learned the aloha spirit was associated with significantly lower levels (b = −1.76; P < .01) of psychological distress and a reduced odds of depression (OR = .69; P < .01) over and above the effects of perceived discrimination, local identity, levels of ethnic identification, race/ethnicity, immigrant status, duration of residence in Hawai‘i, and other sociodemographic factors. In contrast, everyday discrimination was associated with significantly higher levels (b = 0.41; P < .001) of psychological distress and a greater odds of depression (OR = 1.08; P < .001). Together, these findings highlight the paradox of discrimination and the aloha spirit in Hawai‘i by documenting their distinct relationships with mental health. Overall, this study contributes to medical and public health research on mental health disparities during the transition to adulthood by delving into the social context of daily life in the understudied, multicultural location of Hawai‘i.     

Dietary Intake Among Native Hawaiian,Filipino, and White Children and Caregivers in Hawai‘i

Little is published about dietary intake of children of ethnic populations found in Hawai‘i, due to an absence of national statistics collected on Hawai‘i''s population. This information is needed to focus planning of food, agriculture and health programs aimed to prevent obesity and related chronic disease and to improve health. Dietary patterns of 156 Native Hawaiian (n=110), Filipino (n=28) and White (n=18) children and their caregivers were compared using socio-demographic, annual “food season,” and 24 hour dietary recall data from a baseline survey of four lower income communities selected for an intervention program in rural Hawai‘i. Ethnic differences were found in the Healthy Eating Index (HEI) dairy component, and in calcium and vitamin C nutrient intakes among caregivers only (adjusting for food season). Whites always had higher intakes of these foods and nutrients than Filipinos or Native Hawaiians. Vitamin C intake remained significantly different among ethnic groups after further adjusting for dairy food group intake. Dietary patterns showed low intake of fruits and vegetables, fiber and dairy foods among these understudied populations.     

Prevalence of Intimate Partner Violence Victimization and Perpetration Among Youth in Hawai‘i

Objective

The purpose of the current study was to examine the prevalence of intimate partner violence (IPV) among teens in Hawai‘i.

Methods

Youth from two O‘ahu high schools (N = 623) were asked to complete a quantitative survey about their experiences, as victims and perpetrators, of IPV.

Results

The most frequently reported type of violence was monitoring/controlling behaviors. Girls reported higher rates of victimization and perpetration than boys for most violence types.

Conclusions

Future research should examine the contexts in which teen IPV occurs. It will also be important to engage community-based organizations in prevention efforts. Therefore, a train-the-trainer curriculum for IPV prevention and intervention is proposed.Reducing violence within intimate relationships has been a research focus for many years, though most studies have been on preventing violence in adult relationships. Attention has shifted to the need to address violence in adolescent dating relationships as these experiences likely are precursors to later relationship violence and have been associated with poor school and health outcomes for teens.^1–5 In particular, adolescent intimate partner violence (IPV) has been linked with drug and alcohol abuse, eating disorders, and attempting suicide.²Recent studies have shown that adolescent IPV is prevalent in the United States, with rates ranging from 10–65% depending on the definitions of violence and the research methods used.^5–8 Using a conservative definition where only severe forms of physical and sexual aggression were included, results from one probability sample showed that one in five adolescent high school girls have experienced dating violence.⁹ By contrast, using a broader definition that includes acts of verbal and psychological abuse, studies showed that almost half of adolescents reported experiences as a victim, perpetrator, or both.^10–12Data are limited regarding the prevalence of IPV among Native Hawaiian, Pacific Islander, and Asian American youth, with the exception of a few studies that have shed light on these populations. According to Hawai‘i-based research conducted in 2003, 58% of the sample, which included Filipino American, Japanese American, Native Hawaiian, and Samoan adolescents, reported experiencing emotional dating violence, including verbal abuse and controlling behaviors.¹³ Ramisetty-Mikler, Goebert, Nishimura, and Caetano found in a sample of Asian American, Native Hawaiian, Pacific Islander, and European American adolescents that almost 8% reported physical dating violence, with no sex differences in the rates.¹⁴ Furthermore, according to the Hawai‘i Youth Risk Behavioral Survey (YRBS), which is completed by youth in grades 9–12, 14% of girls and 17% of boys reported experiencing physical violence by their partners in the previous 12 months¹⁵ An important caveat with the last two studies on physical dating violence is that they are based on data from the YRBS, which includes a single question on IPV victimization; participants are asked: “During the past 12 months, did your boyfriend or girlfriend ever hit, slap, or physically hurt you on purpose?”Therefore, to fill the gap in our understanding of IPV victimization and perpetration of emotional, physical, and sexual violence among Hawai‘i adolescents, this study presents data collected in 2007 from a high school-based sample. Also, given the increased attention on teens'' use of social electronic media (e.g., MySpace, Facebook, YouTube), as well as one national online survey showing that dating abuse via technology is a problem,^16–18 the current study will present data on the rates of adolescent IPV victimization and perpetration involving the use of social electronic media.     

Marijuana Use and Maternal Experiences of Severe Nausea During Pregnancy in Hawai‘i

Recreational use of marijuana is relatively common in the United States, and medicinal use is gaining popular and legal support. Marijuana has been proposed as a potential treatment for hyperemesis gravidarum. Research into this topic is complicated by associations between marijuana use and poor birth outcomes. Cannabinoid hyperemesis syndrome, which can cause severe nausea and vomiting in marijuana users, is another complicating factor. Hawai‘i Pregnancy Risk Assessment Monitoring System data from 4,735 respondents were used to estimate prevalence of self-reported marijuana use during and in the month before pregnancy, as well as severe nausea during pregnancy. Data were weighted to be representative of all pregnancies resulting in live births in Hawai‘i between 2009 and 2011. Prevalence ratios (PR) and 95% confidence intervals (CI) were computed to estimate associations. Of recently-pregnant women in Hawai‘i, 6.0% reported using marijuana in the month before pregnancy, and 2.6% reported using marijuana during pregnancy. Approximately 21.2% reported severe nausea during pregnancy. Women who reported severe nausea during pregnancy were significantly more likely to report marijuana use during pregnancy (3.7% vs 2.3%; PR=1.63, 95% CI: 1.08–2.44). More research is needed to investigate the relationship between marijuana use and severe nausea during pregnancy, and to quantify associated risks to mother and fetus.     

Predictors of 25-hydroxyvitamin D Levels in HIV-infected Patients in Hawai‘i

HIV-infected individuals are at increased risk for several metabolic diseases, including low 25-hydroxyvitamin D [25(OH)D]. Data on the prevalence and risk factors for low 25(OH)D in HIV patients living in the tropics is scarce. Patients ≥ 40 years old on stable antiretroviral therapy were enrolled from March 2009 to July 2011 in Hawai‘i (latitude 21° North). Chemiluminescent immunoassay (DiaSorin) was used to determine plasma 25(OH)D levels. Patients were grouped by whether 25(OH)D was collected in summer (May 1 – September 30) or winter (October 1 – April 30). Of 158 patients enrolled, 88 (56%) and 70 (44%) were enrolled in winter and summer, respectively. There were 57.6% Caucasians and 88% men. Over-all median (quartile1, quartile3) age was 51 (46, 57) years and median 25(OH)D was 32.4 (24.0, 41.0) ng/ml. Forty-three percent (n=68) had 25(OH)D<30.0 ng/ml. Median 25(OH)D levels were 29.6 (22.0, 38.0) ng/ml in winter and 36.9 (25.0, 44.5) ng/ml in summer (P = .01). Median body mass index (BMI) of winter patients was significantly higher (P = .03). By simple linear regression, log-transformed 25(OH)D was significantly associated with winter visit (β = −.0737, P = .01), ethnicity (Caucasian versus non-Caucasian, β = .1194, P < .01), BMI (β = −.0111, P < .01) and current use of zidovudine (β = −.1233, P = .03). In multiple linear regression, only Caucasian ethnicity (β = .1004, P < .01) and BMI (β = −.0078, P = .02) retained statistical significance. Seasonal variation in 25(OH)D was observed but the significance of winter visit was not preserved in the final multivariate model. Ethnicity and BMI were better predictors of 25(OH)D levels than season in the tropics.     

Neuropsychological Test Performance of Hawai‘i High School Athletes: Updated Hawai‘i Immediate Post-Concussion Assessment and Cognitive Testing Data

The present study reviewed the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) baseline test scores of 247 high school athletes ages 13 to 18 from a private school in Hawai‘i. The aim of the research was to update a prior exploratory investigation conducted in 2008 that compared the test scores of Hawai‘i public high school athletes with the normative data provided by the ImPACT publishers. The results of this study provide assurance that the present ImPACT scores of the Hawai‘i high school athletes are similar to the general ImPACT norms. The present study is a rare effort to compare the ImPACT scores of high school athletes from an ethnically diverse region with the ImPACT norms. The findings offer further support for the use of the ImPACT norms when evaluating high school athletes from Hawai‘i. Future research in various regions of the United States and with other sociocultural backgrounds is encouraged.     

Assessing Physical Activity and Related Correlates Among Adults in Hawai‘i

Regular physical activity has been shown to reduce the risk of cardiovascular disease, stroke, some mental illnesses and some cancer. Despite the well-known benefits of physical activity, about half of the adults in the United States and Hawai‘i do not get enough. Rates of physical activity differ greatly among ethnic groups and interventions to increase physical activity may need to be tailored for specific ethnicities. In this study, 3,588 adults living in Hawai‘i completed a random digit dial survey on their physical activity level. Native Hawaiians and Whites were more likely to be active than Chinese, Filipino and Japanese respondents. Multivariate logistic regressions analyses eliminated differences between Whites, Filipinos and Chinese respondents; however, Native Hawaiians were still more likely to report meeting physical activity guidelines and Japanese were less likely. Other significant predictors included being younger, male, having a job involving heavy labor, being in the normal weight range, being in good or excellent health, having high self-efficacy, spending less time sitting, and walking a dog more frequently. Differences in meeting physical activity guidelines can be used in planning future public health campaigns.     

Detection of BRCA1 and BRCA2 Mutations in a Selected Hawai‘i Population

Objective

To examine BRCA1 and BRCA2 gene sequence testing results, specifically variants of uncertain clinical significance in the BRCA1 and/or BRCA2 sequences of an ethnically diverse population within a particular time constraint.

Methods

A retrospective chart analysis of BRCA1 and BRCA2 gene sequence testing cases was reviewed at Kapi‘olani Medical Center for Women and Children from October 1996 to November 2007. Information was extracted and categorized regarding each patient''s age, age of cancer onset, types of cancer in family history, ethnicity/ancestry, type of test used for analysis, and specific characteristics of each variant.

Results

Of the 273 patients who received BRCA1/BRCA2 gene sequence testing, 45 patients demonstrated variants of uncertain clinical significance. A total of 48 variants of uncertain clinical significance were reported and 9 of the variants had previously never been observed before. Of the 45 patients, 33.3% were Caucasian, 40% were Asian, and 26.67% were of mixed ethnicity.

Conclusions

Within the local population at Kapi‘olani Medical Center for Women and Children, a significantly higher proportion of patients exhibited variants compared to the national average. A high percentage of variants existed among the ethnically diverse as well as the Caucasian population. Gene sequence testing is a valuable asset for physicians treating patients who are at risk for inherited cancer: however, the direction of treatment remains clinically questionable for patients with variants of unknown significance.     

A Case of Septic Arthritis from Rat-Bite Fever in Hawai‘i

Background

Infection associated with a rat bite has been known for centuries. Streptobacillus moniliformis is a zoonotic organism identified in the 20th century as the causative agent of most cases of rat bite fever outside of mainland Asia. There are no previously published cases of this pathogen in Hawai‘i.

Case Presentation

The authors present a case of Streptobacillus moniliformis causing septic polyarthritis in a 59-year-old Hawaiian man with a history of alcohol abuse and recurrent exposure to rodents in his apartment. Blood cultures from the patient were negative. The organism was isolated after three days only in thioglycolate broth from a synovial fluid culture. 16S rRNA sequencing of extracted and purified DNA confirmed the organism as Streptobacillus moniliformis.

Conclusion

Diagnosis of infection from Streptobacillus moniliformis is difficult to make because of the fastidious nature of the organism''s growth, as well as inhibitors present in standard blood culture bottles. The use of bacterial 16S rRNA sequencing may aid in an earlier diagnosis for this disease. More research is required to identify host and virulence risk factors for involvement of specific organ systems.     

Trends in Alcohol Use among Hawai‘i Adolescents

It is important to review trends in youth alcohol use over time in order to effectively tailor prevention programs to address those trends. This article reviews data on alcohol use behaviors from the Centers for Disease Control and Prevention''s Youth Risk Behavior Survey in Hawai‘i from 1993 to 2007. Five alcohol use indicators were examined and stratified by grade level, from 9th grade through 12th grade. Significant drops in nearly all indicators are seen among 9th through 11th graders, but not among 12th graders. This suggests that Hawai‘i youth are responding well to anti-alcohol messaging as young teens, but a different approach may be needed to target older teens.     

Insights in Public Health: The Hawai‘i Home Visiting Network: Evidence-Based Home Visiting Services in Hawai‘i

Home visiting services are cost-effective and improve the health of children and families among those at increased risk. From 1985–2008, home visiting services in Hawai‘i were provided primarily through state funding of the Hawai‘i Healthy Start Program, but the program was severely reduced due to the economy and state budget changes over the past decade. The Maternal and Child Health Branch (MCHB) in the Family Health Services Division responded to these changes by seeking out competitive grant opportunities and collaborations in order to continue to promote home visiting services to those children and families in need. In 2010, the MCHB was awarded a federally funded Maternal, Infant and Early Childhood Home Visiting (MIECHV) grant for home visiting services to promote maternal, infant, and early childhood health, safety and development, strong parent-child relationships, and responsible parenting. In 2011, the MCHB was also awarded a competitive MIECHV development grant that funded the re-establishment of the hospital Early Identification program. Families in need of additional support identified through this program are referred for family strengthening services to a network of existing home visiting programs called the Hawai‘i Home Visiting Network (HHVN). The HHVN is supported by MIECHV and a small amount of state funds to assist programs with capacity building, training, professional development, quality assurance, and accreditation/certification support. The MIECHV grant requires that programs are evidence-based and address specific outcome measures and benchmarks. The HHVN provides home visiting services to families prenatally through 5 years of age that reside in specific at-risk communities, and is aimed at fostering positive parenting and reducing child maltreatment using a strength-based approach by targeting six protective factors: (1) social connections, (2) nurturing and attachment, (3) knowledge of parenting and child development, (4) parental resilience, (5) social and emotional competence of children, and (6) concrete supports for parents. This article provides an introduction to the HHVN as a diverse network of evidence-based home visiting programs with services currently available on all islands, and highlights aspects of home visiting programs that support the Family-Centered Medical Home (FCMH) model. The HHVN provides important services to families at risk and uses evidence-based practices to yield positive results. Health care professionals can support this network to promote the health of children and families by being aware that these home visiting services exist and encouraging families at-risk to participate. Continued collaboration and expanded partnerships with health providers can help strengthen the home visiting network and improve outcomes for children and families in Hawai‘i.     

Disparities in Health,Obesity and Access to Care Among an Insured Population of Asian and Pacific Islander Americans in Hawai‘i

Objective

To examine differences in health status, obesity, and access among Asian and Pacific Islander Americans in Hawai‘i using data from a 2007 health plan survey, including Caucasians, Puerto Ricans, American Indian and Alaska Natives, Chinese, Filipinos, Japanese, Koreans, Native Hawai‘ians, Samoans, and Other Pacific Islanders.

Methods

Data were collected through a stratifified random sample of adult members of a health plan in Hawai‘i (n=119,563) who saw a physician in the past 12 months. Multivariable logistic and ordinary least squares regression analyses were used to examine racial/ethnic differences in health status, access, and obesity and the impact of obesity and access on health status, after controlling for age, gender, and education.

Results

The highest obesity rates were found among Samoans (50%), Puerto Ricans (37%), Native Hawai‘ians (36%), and Other Pacific Islanders (35%). Puerto Ricans and Samoans reported the highest number of poor physical health days (5.4). Samoans reported the highest number of poor mental health days (4.4). Obesity had a stronger impact than access on self-reported health status.

Conclusion

Samoans had the highest rate of obesity, low health ratings, and a high number of days of poor health. Targeted interventions may be needed for this group.