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1.
Hawaii J Health Soc Welf ; 82(6): 141-143, 2023 06.
Article in English | MEDLINE | ID: covidwho-20239486
2.
Hawaii J Health Soc Welf ; 82(6): 127-134, 2023 06.
Article in English | MEDLINE | ID: covidwho-20234978

ABSTRACT

Racial and ethnic minorities experience high rates of disease morbidity and mortality. Filipinos in Hawai'i have the second-highest coronavirus disease 2019 (COVID-19) cases and deaths. This exploratory study examined barriers to compliance with COVID-19 prevention practices for Filipino immigrants residing in O'ahu and Maui. Cross-sectional data were collected using mixed methods involving surveys and key informant interviews with Filipino community members. Survey responses (n=50) were collected identifying crucial factors to be addressed and preferences for receiving information related to COVID-19. Some Filipino customs and practices were a barrier to complying with COVID-19 prevention practices; nevertheless, cultural sensitivity was stressed for education messaging. In addition, family and community navigators should be equipped with the training and resources to disseminate COVID-19 information within their communities. Attitudinal, cultural, and linguistic barriers to promote health persist for Filipinos in Hawai'i. The COVID-19 pandemic has exacerbated these barriers due to the circulation of misinformation and lack of information among the Filipino communities of O'ahu and Maui regarding COVID-19 and local policies. Culturally appropriate support including providing tailored and linguistically appropriate COVID-19 information is recommended. Equipping or training a household member to help navigate COVID-19 policies as they change aligns with this community's emphasis on familial and social relationships.


Subject(s)
COVID-19 , Health Promotion , Humans , Hawaii/epidemiology , Cross-Sectional Studies , Pandemics , Preliminary Data
3.
Int J Environ Res Public Health ; 20(4)2023 Feb 13.
Article in English | MEDLINE | ID: covidwho-2312615

ABSTRACT

Optimal health from a Native Hawaiian worldview is achieved by being pono (righteous) and maintaining lokahi (balance) with all our relations, including our relationships as Kanaka (humankind) with 'Aina (land, nature, environment, that which feeds) and Akua (spiritual realm). The purpose of this study is to explore the role of 'Aina connectedness in Native Hawaiian health and resilience to inform the development of the 'Aina Connectedness Scale. Qualitative methods were conducted with 40 Native Hawaiian adults throughout Hawai'i. Three themes emerged: (1) 'Aina is everything; (2) Connection to 'Aina is imperative to health; and (3) Intergenerational health, healing, and resilience are reflected through intergenerational connectedness with 'Aina. Qualitative findings, supplemented with a scoping review of land, nature, and cultural connectedness scales, led to the development of the 'Aina Connectedness Scale, which examined the degree to which people feel connected to 'Aina, with implications for future research. 'Aina connectedness may address concerns related to health disparities that stem from colonization, historical trauma, and environmental changes and better our understanding of Native Hawaiian health by fostering stronger ties to land. Resilience- and 'Aina-based approaches are critically important to health equity and interventions that aim to improve Native Hawaiian health.


Subject(s)
Health Status , Adult , Humans , Hawaii , Environment , Resilience, Psychological , Health Equity , Nature
4.
Int J Environ Res Public Health ; 19(24)2022 12 15.
Article in English | MEDLINE | ID: covidwho-2310396

ABSTRACT

Limited information exists about social network variation and health information sharing during COVID-19, especially for Native Hawaiians (NH), Other Pacific Islanders (OPI), and Filipinos, who experienced COVID-19 inequities. Hawai'i residents aged 18-35 completed an online survey regarding social media sources of COVID-19 information and social network health information measured by how many people participants: (1) talked to and (2) listened to about health. Regression models were fit with age, gender, race/ethnicity, chronic disease status, pandemic perceptions, and health literacy as predictors of information sources (logistic) and social network size (Poisson). Respondents were 68% female; 41% NH, OPI, or Filipino; and 73% conducted a recent COVID-19 digital search for themselves or others. Respondents listened to others or discussed their own health with ~2-3 people. Respondents who talked with more people about their health were more likely to have larger networks for listening to others. In regression models, those who perceived greater risk of acquiring COVID-19 discussed their health with more people; in discussing others' health, women and those with chronic diseases listened to a greater number. Understanding young adults' social networks and information sources is important for health literacy and designing effective health communications, especially to reach populations experiencing health inequities.


Subject(s)
COVID-19 , Pandemics , Humans , Female , Young Adult , Male , Hawaii/epidemiology , White People , COVID-19/epidemiology , Ethnicity
5.
Hawaii J Health Soc Welf ; 82(3): 59-65, 2023 03.
Article in English | MEDLINE | ID: covidwho-2286918

ABSTRACT

In response to the COVID-19 pandemic, federal and state recommendations included the postponement of elective arthroplasties until adequate safety measures could be implemented. Following resumption of arthroplasties, exposure fears and financial concerns may have restricted access for some demographics. Therefore, the purpose of this study was to (1) investigate how the COVID-19 pandemic impacted the incidence of arthroplasty, both overall and by various demographics, and (2) evaluate if pre-operative patient-reported measures were different throughout the pandemic. Data were collected prospectively as part of an on-site joint registry between January 2019 and April 2021. Phase 1 (N=518) included all patients prior to the cancelation of elective procedures (average 36 cases/month), Phase 2 (N=121) was defined from restart until monthly caseload met/surpassed the average Phase 1 caseload (5 months), and Phase 3 (N=277) included all remaining cases. Multiple analysis of variance and chi-squared tests were performed to compare patient demographics and outcomes between phases. No significant differences were noted in patient demographics, with the exception of a decrease in Native Hawaiian/Pacific Islander patients and an increase in Asian patients during Phase 2 (P =.004). Length of stay decreased for unilateral arthroplasty from Phase 1 (0.9±1.1 days) to Phase 2 (0.4±0.6 days) and Phase 3 (0.6±0.7 days) (P <.001), while pre-operative patient reported outcomes remained similar across the 3 time periods. By implementing proper safety measures, the current orthopedic center achieved a timely recovery with no long-lasting inconsistencies in patient cohorts upon resumption of arthroplasties.


Subject(s)
Arthroplasty , COVID-19 , Humans , COVID-19/epidemiology , Hawaii , Pandemics , Prospective Studies
6.
PeerJ ; 11: e14994, 2023.
Article in English | MEDLINE | ID: covidwho-2261143

ABSTRACT

Using social media, we collect evidence for how nearshore fisheries are impacted by the global COVID-19 pandemic in Hawai'i. We later confirm our social media findings and obtain a more complete understanding of the changes in nearshore non-commercial fisheries in Hawai'i through a more conventional approach-speaking directly with fishers. Resource users posted photographs to social media nearly three times as often during the pandemic with nearly double the number of fishes pictured per post. Individuals who fished for subsistence were more likely to increase the amount of time spent fishing and relied more on their catch for food security. Furthermore, individuals fishing exclusively for subsistence were more likely to fish for different species during the pandemic than individuals fishing recreationally. Traditional data collection methods are resource-intensive and this study shows that during times of rapid changes, be it ecological or societal, social media can more quickly identify how near shore marine resource use adapts. As climate change threatens additional economic and societal disturbances, it will be necessary for resource managers to collect reliable data efficiently to better target monitoring and management efforts.


Subject(s)
COVID-19 , Social Media , Animals , Humans , Hawaii/epidemiology , Fisheries , Pandemics , Conservation of Natural Resources/methods , COVID-19/epidemiology
7.
Front Cell Infect Microbiol ; 12: 1035641, 2022.
Article in English | MEDLINE | ID: covidwho-2198715

ABSTRACT

Native Hawaiians and Pacific Islanders (NHPIs) suffer from higher prevalence of and mortality to type 2 diabetes mellitus (T2DM) than any other major race/ethnic group in Hawaii. Health inequities in this indigenous population was further exacerbated by the SARS-CoV-2 pandemic. T2DM progression and medical complications exacerbated by COVID-19 are partially regulated by the gut microbiome. However, there is limited understanding of the role of gut bacteria in the context of inflammation-related diseases of health disparities including T2DM and obesity. To address these gaps, we used a community-based research approach from a cohort enriched with NHPI residents on the island of Oahu, Hawaii (N=138). Gut microbiome profiling was achieved via 16s rDNA metagenomic sequencing analysis from stool DNA. Gut bacterial capacity for butyrate-kinase (BUK)-mediated fiber metabolism was assessed using quantitative PCR to measure the abundance of BUK DNA and RNA relative to total bacterial load per stool sample. In our cohort, age positively correlated with hemoglobin A1c (%; R=0.39; P<0.001) and body mass index (BMI; R=0.28; P<0.001). The relative abundance of major gut bacterial phyla significantly varied across age groups, including Bacteroidetes (P<0.001), Actinobacteria (P=0.007), and Proteobacteria (P=0.008). A1c was negatively correlated with the relative levels of BUK DNA copy number (R=-0.17; P=0.071) and gene expression (R=-0.33; P=0.003). Interestingly, we identified specific genera of gut bacteria potentially mediating the effects of diet on metabolic health in this cohort. Additionally, α-diversity among gut bacterial genera significantly varied across T2DM and BMI categories. Together, these results provide insight into age-related differences in gut bacteria that may influence T2DM and obesity in NHPIs. Furthermore, we observed overlapping patterns between gut bacteria and T2DM risk factors, indicating more nuanced, interdependent interactions among these factors as partial determinants of health outcomes. This study adds to the paucity of NHPI-specific data to further elucidate the biological characteristics associated with pre-existing health inequities in this racial/ethnic group that is significantly underrepresented in biomedical research.


Subject(s)
Diabetes Mellitus, Type 2 , Gastrointestinal Microbiome , Obesity , Humans , Diabetes Mellitus, Type 2/epidemiology , Diabetes Mellitus, Type 2/microbiology , Glycated Hemoglobin , Hawaii/epidemiology , Native Hawaiian or Other Pacific Islander , Obesity/epidemiology , Obesity/microbiology
8.
Am J Public Health ; 112(S9): S896-S899, 2022 Nov.
Article in English | MEDLINE | ID: covidwho-2141092

ABSTRACT

Native Hawaiians and other Pacific Islanders (NHPIs) across the country have experienced significant disparities because of the COVID-19 pandemic. The Pacific Alliance Against COVID-19 used a community-based participatory approach involving academic and community partners to expand sustainable COVID-19 testing capacity and mitigate the severe consequences among NHPI communities in Hawaii. We describe the approach of this one-year study, some of the results, and how the data are being used to inform next steps for the communities. Clinical Trials.gov identifier: NCT04766333. (Am J Public Health. 2022;112(S9):S896-S899. https://doi.org/10.2105/AJPH.2022.306973).


Subject(s)
COVID-19 , Vaccines , Humans , Hawaii/epidemiology , Native Hawaiian or Other Pacific Islander , COVID-19/epidemiology , COVID-19/prevention & control , SARS-CoV-2 , COVID-19 Testing , Pandemics
9.
PLoS One ; 17(12): e0278287, 2022.
Article in English | MEDLINE | ID: covidwho-2140698

ABSTRACT

Using genomics, bioinformatics and statistics, herein we demonstrate the effect of statewide and nationwide quarantine on the introduction of SARS-CoV-2 variants of concern (VOC) in Hawai'i. To define the origins of introduced VOC, we analyzed 260 VOC sequences from Hawai'i, and 301,646 VOC sequences worldwide, deposited in the GenBank and global initiative on sharing all influenza data (GISAID), and constructed phylogenetic trees. The trees define the most recent common ancestor as the origin. Further, the multiple sequence alignment used to generate the phylogenetic trees identified the consensus single nucleotide polymorphisms in the VOC genomes. These consensus sequences allow for VOC comparison and identification of mutations of interest in relation to viral immune evasion and host immune activation. Of note is the P71L substitution within the E protein, the protein sensed by TLR2 to produce cytokines, found in the B.1.351 VOC may diminish the efficacy of some vaccines. Based on the phylogenetic trees, the B.1.1.7, B.1.351, B.1.427, and B.1.429 VOC have been introduced in Hawai'i multiple times since December 2020 from several definable geographic regions. From the first worldwide report of VOC in GenBank and GISAID, to the first arrival of VOC in Hawai'i, averages 320 days with quarantine, and 132 days without quarantine. As such, the effect of quarantine is shown to significantly affect the time to arrival of VOC in Hawai'i. Further, the collective 2020 quarantine of 43-states in the United States demonstrates a profound impact in delaying the arrival of VOC in states that did not practice quarantine, such as Utah. Our data demonstrates that at least 76% of all definable SARS-CoV-2 VOC have entered Hawai'i from California, with the B.1.351 variant in Hawai'i originating exclusively from the United Kingdom. These data provide a foundation for policy-makers and public-health officials to apply precision public health genomics to real-world policies such as mandatory screening and quarantine.


Subject(s)
COVID-19 , SARS-CoV-2 , Humans , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/virology , Genomics , Hawaii/epidemiology , Health Policy , Phylogeny , Public Policy , SARS-CoV-2/genetics
10.
Prev Chronic Dis ; 19: E72, 2022 Nov 17.
Article in English | MEDLINE | ID: covidwho-2119419

ABSTRACT

INTRODUCTION: The true extent of racial and ethnic disparities in COVID-19 hospitalizations may be hidden by misclassification of race and ethnicity. This study aimed to quantify this inaccuracy in a hospital's electronic medical record (EMR) against the gold standard of self-identification and then project data onto state-level COVID-19 hospitalizations by self-identified race and ethnicity. METHODS: To identify misclassification of race and ethnicity in the EMRs of a hospital in Honolulu, Hawaii, research and quality improvement staff members surveyed all available patients (N = 847) in 5 cohorts in 2007, 2008, 2010, 2013, and 2020 at randomly selected hospital and ambulatory units. The survey asked patients to self-identify up to 12 races and ethnicities. We compared these data with data from EMRs. We then estimated the number of COVID-19 hospitalizations by projecting racial misclassifications onto publicly available data. We determined significant differences via simulation-constructed medians and 95% CIs. RESULTS: EMR-based and self-identified race and ethnicity were the same in 86.5% of the sample. Native Hawaiians (79.2%) were significantly less likely than non-Native Hawaiians (89.4%) to be correctly classified on initial analysis; this difference was driven by Native Hawaiians being more likely than non-Native Hawaiians to be multiracial (93.4% vs 30.3%). When restricted to multiracial patients only, we found no significant difference in accuracy (P = .32). The number of COVID-19-related hospitalizations was 8.7% higher among Native Hawaiians and 3.9% higher among Pacific Islanders when we projected self-identified race and ethnicity rather than using EMR data. CONCLUSION: Using self-identified rather than hospital EMR data on race and ethnicity may uncover further disparities in COVID-19 hospitalizations.


Subject(s)
COVID-19 , Ethnicity , Humans , Self Report , Hawaii/epidemiology , Hospitalization , Hospitals , Surveys and Questionnaires
11.
Public Health Rep ; 138(1): 164-173, 2023.
Article in English | MEDLINE | ID: covidwho-2038481

ABSTRACT

OBJECTIVES: Minimal research has assessed COVID-19's unique impact on the Native Hawaiian/Pacific Islander (NH/PI) population-an Indigenous-colonized racial group with social and health disparities that increase their risk for COVID-19 morbidity and mortality. To address this gap, we explored the scope of COVID-19 outcomes, vaccination status, and health in diverse NH/PI communities. METHODS: NH/PI staff at partner organizations collected survey data from April through November 2021 from 319 community-dwelling NH/PI adults in 5 states with large NH/PI populations: Arkansas, California, Oregon, Utah, and Washington. Data were analyzed with descriptive statistics, Pearson χ2 tests, independent and paired t tests, and linear and logistic regression analyses. RESULTS: During the COVID-19 pandemic, 30% of survey participants had contracted COVID-19, 16% had a close family member who died of the disease, and 64% reported COVID-19 vaccine uptake. Thirty percent reported fair/poor health, 21% currently smoked cigarettes, and 58% reported obesity. Survey participants reported heightened COVID-19-related psychosocial distress (mean score = 4.9 on 10-point scale), which was more likely when health outcomes (general health, sleep, obesity) were poor or a family member had died of COVID-19. Logistic regression indicated that age, experiencing COVID-19 distress, and past-year use of influenza vaccines were associated with higher odds of COVID-19 vaccine uptake (1.06, 1.18, and 7.58 times, respectively). CONCLUSIONS: Our empirical findings highlight the acute and understudied negative impact of COVID-19 on NH/PI communities in the United States and suggest new avenues for improving NH/PI community health, vaccination, and recovery from COVID-19.


Subject(s)
COVID-19 , Native Hawaiian or Other Pacific Islander , Adult , United States/epidemiology , Humans , COVID-19 Vaccines , Pandemics , Hawaii , Obesity
12.
Drug Alcohol Rev ; 41(7): 1653-1663, 2022 11.
Article in English | MEDLINE | ID: covidwho-1992768

ABSTRACT

INTRODUCTION: Before COVID-19, Native Hawaiians/Pacific Islanders (NH/PI) endured a heavy burden of alcohol, tobacco and other drug (ATOD) use in prior US data. Responding to reports that many NH/PI communities experienced severe COVID-19 disparities that could exacerbate their ATOD burden, we partnered with NH/PI communities to assess the substance use patterns and treatment needs of diverse NH/PIs during COVID-19. METHODS: Collaborating with NH/PI community organisations across five states with large NH/PI populations, we conducted a large-scale investigation of NH/PI ATOD use, mental health and treatment need during COVID-19. Between April and November 2021, NH/PI-heritage research staff from our community partners collected data involving 306 NH/PI adults using several community-based recruitment methods (e-mail, telephone, in-person) and two survey approaches: online and paper-and-pencil. Multivariate regressions were conducted to examine potential predictors of NH/PI alcohol use disorder and need for behavioural health treatment. RESULTS: During COVID-19, 47% and 22% of NH/PI adults reported current alcohol and cigarette use, while 35% reported lifetime illicit substance use (e.g., cannabis, opioid). Depression and anxiety were high, and alcohol use disorder, major depression and generalised anxiety disorder prevalence were 27%, 27% and 19%, respectively. One-third of participants reported past-year treatment need with lifetime illicit substance use, COVID-19 distress and major depression respectively associating with 3.0, 1.2, and 5.3 times greater adjusted odds for needing treatment. CONCLUSIONS: NH/PI adults reported heavy ATOD use, depression, anxiety and treatment need during COVID-19. Targeted research and treatment services may be warranted to mitigate COVID-19's negative behavioural health impact on NH/PI communities.


Subject(s)
Alcoholism , COVID-19 , Substance-Related Disorders , Tobacco Products , Adult , United States , Humans , Native Hawaiian or Other Pacific Islander , Tobacco , Asian/psychology , Mental Health , Substance-Related Disorders/epidemiology , Hawaii , Prevalence
13.
Int J Environ Res Public Health ; 19(15)2022 07 30.
Article in English | MEDLINE | ID: covidwho-1969249

ABSTRACT

In response to the second surge of COVID-19 cases in Hawaii in the fall of 2020, the Hawaii State Department of Health Behavioral Health Administration led and contracted a coalition of agencies to plan and implement an isolation and quarantine facility placement service that included food, testing, and transportation assistance for a state capitol and major urban center. The goal of the program was to provide safe isolation and quarantine options for individual residents at risk of not being able to comply with isolation and quarantine mandates. Drawing upon historical lived experiences in planning and implementing the system for isolation and quarantine facilities, this qualitative public health case study report applies the plan-do-study-act (PDSA) improvement model and framework to review and summarize the implementation of this system. This case study also offers lessons for a unique opportunity for collaboration led by a public behavioral health leadership that expands upon traditionally narrow infectious disease control, by developing a continuum of care that not only addresses immediate COVID-19 concerns but also longer-term supports and services including housing, access to mental health services, and other social services. This case study highlights the role of a state agency in building a coalition of agencies, including a public university, to respond to the pandemic. The case study also discusses how continuous learning was executed to improve delivery of care.


Subject(s)
COVID-19 , Quarantine , COVID-19/epidemiology , COVID-19/prevention & control , Hawaii/epidemiology , Humans , Public Health , SARS-CoV-2
14.
Hawaii J Health Soc Welf ; 81(7): 201-208, 2022 07.
Article in English | MEDLINE | ID: covidwho-1929544

ABSTRACT

The Next Gen Hawai'i social media project was initiated in the fall of 2020 to address ongoing public health concerns and the need for accessible and reliable information across Hawai'i's diverse communities by strategically amplifying the voices of Hawai'i's youth in their Native languages. The collaborative effort arose from conversations within the Hawai'i's Native Hawaiian & Pacific Islander COVID-19 Response, Recovery, and Resilience Team, composed of diverse public and private organizations involved in statewide COVID-19 response efforts for Native Hawaiian and Pacific Islander communities. Next Gen Hawai'i's focus was on Native Hawaiian, Pacific Islander, Filipino, and other populations disproportionately suffering from COVID-19. Five social media platforms were developed to spread messaging to youth and young adults about COVID-19. Public Health Ambassadors (from high school to young adults) were recruited and engaged to create culturally and linguistically rooted messaging to promote public health and prevention-based social norms. This strength-based approach recognized youth as important community leaders and ambassadors for change and empowered them to create content for dissemination on platforms with national and global reach. Messaging was designed to build individual, community, and digital health literacy while integrating core cultural values and strengths of Native Hawaiian, Pacific Islander, and Filipino communities. Over 250 messages have been delivered across Next Gen Hawai'i social media channels on topics including vaccine information, mask-wearing, staying together over distances, mental health, and in-languages resources in Chuukese, Chamorro, Marshallese, Samoan, Hawaiian, Ilocano, Tagalog, and other Pacific-basin languages. Reach has included more than 75 000 views from various social media channels, media features, successful webinars, and relevant conference presentations. This Public Health Insights article provides an overview of Next Gen Hawai'i's activities and achievements as well as lessons learned for other youth-focused public health social media campaigns and organizations.


Subject(s)
COVID-19 , Social Media , Adolescent , Asian People , Hawaii/epidemiology , Humans , Native Hawaiian or Other Pacific Islander
15.
PLoS One ; 17(5): e0263866, 2022.
Article in English | MEDLINE | ID: covidwho-1923669

ABSTRACT

BACKGROUND: It is critical to capture data and modeling from the COVID-19 pandemic to understand as much as possible and prepare for future epidemics and possible pandemics. The Hawaiian Islands provide a unique opportunity to study heterogeneity and demographics in a controlled environment due to the geographically closed borders and mostly uniform pandemic-induced governmental controls and restrictions. OBJECTIVE: The goal of the paper is to quantify the differences and similarities in the spread of COVID-19 among different Hawaiian islands as well as several other archipelago and islands, which could potentially help us better understand the effect of differences in social behavior and various mitigation measures. The approach should be robust with respect to the unavoidable differences in time, as the arrival of the virus and promptness of mitigation measures may vary significantly among the chosen locations. At the same time, the comparison should be able to capture differences in the overall pandemic experience. METHODS: We examine available data on the daily cases, positivity rates, mobility, and employ a compartmentalized model fitted to the daily cases to develop appropriate comparison approaches. In particular, we focus on merge trees for the daily cases, normalized positivity rates, and baseline transmission rates of the models. RESULTS: We observe noticeable differences among different Hawaiian counties and interesting similarities between some Hawaiian counties and other geographic locations. The results suggest that mitigation measures should be more localized, that is, targeting the county level rather than the state level if the counties are reasonably insulated from one another. We also notice that the spread of the disease is very sensitive to unexpected events and certain changes in mitigation measures. CONCLUSIONS: Despite being a part of the same archipelago and having similar protocols for mitigation measures, different Hawaiian counties exhibit quantifiably different dynamics of the spread of the disease. One potential explanation is that not sufficiently targeted mitigation measures are incapable of handling unexpected, localized outbreak events. At a larger-scale view of the general spread of the disease on the Hawaiian island counties, we find very interesting similarities between individual Hawaiian islands and other archipelago and islands.


Subject(s)
COVID-19 , COVID-19/epidemiology , Hawaii/epidemiology , Humans , Islands , Pandemics , SARS-CoV-2
16.
Int J Environ Res Public Health ; 19(10)2022 05 18.
Article in English | MEDLINE | ID: covidwho-1862784

ABSTRACT

In the face of great uncertainty and a global crisis from COVID-19, mathematical and epidemiologic COVID-19 models proliferated during the pandemic. Yet, many models were not created with the explicit audience of policymakers, the intention of informing specific scenarios, or explicit communication of assumptions, limitations, and complexities. This study presents a case study of the roles, uses, and approaches to COVID-19 modeling and forecasting in one state jurisdiction in the United States. Based on an account of the historical real-world events through lived experiences, we first examine the specific modeling considerations used to inform policy decisions. Then, we review the real-world policy use cases and key decisions that were informed by modeling during the pandemic including the role of modeling in informing planning for hospital capacity, isolation and quarantine facilities, and broad public communication. Key lessons are examined through the real-world application of modeling, noting the importance of locally tailored models, the role of a scientific and technical advisory group, and the challenges of communicating technical considerations to a public audience.


Subject(s)
COVID-19 , COVID-19/epidemiology , Hawaii/epidemiology , Health Policy , Humans , Pandemics/prevention & control , Policy Making , United States
17.
PLoS One ; 17(2): e0263472, 2022.
Article in English | MEDLINE | ID: covidwho-1854995

ABSTRACT

Health inequalities based on race are well-documented, and the COVID-19 pandemic is no exception. Despite the advances in modern medicine, access to health care remains a primary determinant of health outcomes, especially for communities of color. African-Americans and other minorities are disproportionately at risk for infection with COVID-19, but this problem extends beyond access alone. This study sought to identify trends in race-based disparities in COVID-19 in the setting of universal access to care. Tripler Army Medical Center (TAMC) is a Department of Defense Military Treatment Facility (DoD-MTF) that provides full access to healthcare to active duty military members, beneficiaries, and veterans. We evaluated the characteristics of individuals diagnosed with SARS-CoV-2 infection at TAMC in a retrospective, case-controlled (1:1) study. Most patients (69%) had received a COVID-19 test within 3 days of symptom onset. Multivariable logistic regression analyses were used to identify factors associated with testing positive and to estimate adjusted odds ratios. African-American patients and patients who identified as "Other" ethnicities were two times more likely to test positive for SARS-CoV-2 relative to Caucasian patients. Other factors associated with testing positive include: younger age, male gender, previous positive test, presenting with >3 symptoms, close contact with a COVID-19 positive patient, and being a member of the US Navy. African-Americans and patients who identify as "Other" ethnicities had disproportionately higher rates of positivity of COVID-19. Although other factors contribute to increased test positivity across all patient populations, access to care does not appear to itself explain this discrepancy with COVID-19.


Subject(s)
COVID-19 Testing/methods , COVID-19/diagnosis , Ethnicity/statistics & numerical data , Military Personnel/statistics & numerical data , SARS-CoV-2/isolation & purification , COVID-19/epidemiology , COVID-19/virology , Case-Control Studies , Female , Hawaii/epidemiology , Humans , Male , Retrospective Studies
18.
Front Public Health ; 10: 771844, 2022.
Article in English | MEDLINE | ID: covidwho-1847228

ABSTRACT

Service-learning is a high-impact educational practice at the core of the undergraduate public health degree at the University of Hawai'i at Manoa (UHM). This practice provides an invaluable learning experience and professional opportunity for students to collaborate with community partners and make significant contributions in the field. The COVID-19 pandemic halted or disrupted service-learning experiences as community partners adapted to shifting mandates and emergency orders. Surveying the rapidly evolving landscape of partner organizations to support service-learning is a challenge. Assessing changes to the program mentorship or satisfaction is the first step to developing protocols to ensure standardization of service-learning during times of crisis. This study will address if and how the pandemic impacted students' satisfaction with required service-learning experiences. Furthermore, authors hope to create a comprehensive list of practicum partnering organizations, both focused on pandemic response and, more generally, of the service-learning students at UHM, with the intent to increase students and community partners in local service-learning. Assessments were conducted to assess the impact of COVID-19 on undergraduate students' experiences with service-learning through use of a program exit survey. The authors hypothesized pandemic-related adjustments would not affect student satisfaction or skill development. Despite challenges associated with the pandemic and emergency online transitions, students persisted in personal and professional growth associated with service-learning. This developed resilience supports students as they graduate and enter a workforce adapting to remote work demands and community needs.


Subject(s)
COVID-19 , COVID-19/epidemiology , Hawaii/epidemiology , Humans , Pandemics , Students , Students, Public Health
19.
Hawaii J Health Soc Welf ; 81(4 Suppl 2): 4-10, 2022 04.
Article in English | MEDLINE | ID: covidwho-1824540

ABSTRACT

The Hawai'i Physician Workforce project, launched in 2010, investigates state physician workforce trends. Over the past decade, workforce demands have continued to climb as the state struggles to maintain the physician supply. This article describes the current state of the physician workforce, the physician age landscape, past trends, as well as initial changes to the physician supply with the COVID-19 pandemic. Data on practice location, full time equivalency of time spent providing patient care in Hawai'i, and specialty of non-military physicians were clarified and informed via survey, internet search, and direct calling methodologies. A proprietary microsimulation modeling methodology was used to assess physician demand. The current estimated physician shortage is between 710 and 1,008 full time equivalents, the largest shortage in a decade. The unmet demand for numbers of additional physicians is greatest on the largely urban island of O'ahu, however O'ahu's neighboring islands have the largest shortages by percentage of demand. In fact, Hawai'i island has over a 50% shortage of physicians for the first time since the supply has been calculated starting in 2010. Primary care has the greatest demand with a statewide shortage of 412 full time equivalents. The average age of physicians in Hawai'i is 54 compared to the national average of 52. The authors estimate that more than 52% of providers are utilizing telehealth and that 10% of providers have retired or closed their practices since the start of the COVID-19 pandemic. Hawai'i is now in an urgent state of need for recruitment and retention of physicians.


Subject(s)
COVID-19 , Physicians , COVID-19/epidemiology , Hawaii , Humans , Pandemics , Workforce
20.
Hawaii J Health Soc Welf ; 81(5): 142-143, 2022 05.
Article in English | MEDLINE | ID: covidwho-1824236
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