A Comparison of Strategies to Increase Household Survey Response Rates in a Predominantly Indigenous Community Population.

The present study describes 4 strategies for increasing response rates to a community-based survey on youth violence in an ethnically diverse population in Hawai'i. A total of 350 households were mailed a Safe Community Survey using 4 different randomly assigned incentive strategies. The strategies varied by length of survey and timing of incentive for completion (given before completion, after completion, or both). In univariate analyses, there were no significant differences across survey strategies on participant demographics, community perceptions of violence-related behaviors, or percent of missing items. However, in multivariate regressions, respondents' sex and percent of missing items on the surveys were consistently significant predictors across multiple outcomes. Although the use of strategies to increase response rates in community-based surveys might be desirable, resulting data need to be examined for the potential that strategies might recruit different populations, which may have an impact on the data obtained. This study offers lessons and recommendations for surveying Native and Indigenous communities.

Evergreening of Psychiatric Medications: A Systemic Literature Review of Strategies, Case Examples, and the Implications of Cost.

Evergreening consists of multiple ways that pharmaceutical companies extend patent protection and prolong profitability of brand name drugs past patent expiration. In psychotropic medications, these strategies do not necessarily make more effective drugs, and often increase drug prices, which can result in lower access and utilization. There has not been a systematic literature review of evergreening strategies for psychiatric medications. Based on such a review, 11 strategies were identified and relevant examples were provided. Four case examples of commonly used psychiatric medications indicated evergreen prices 3 to 211 times the cost of the original medication, and the evergreen costs ranging from $132.00 to $10,125.24 higher than the original cost on an annual basis. The higher cost of evergreening medications can create inefficiencies and waste in healthcare resulting in lower-quality patient care. Healthcare providers, patient advocates, health insurance companies, and policy-makers should be aware of these practices to improve healthcare systems.

Implications for a System of Care in Hawai'i for Youth Involved in the Justice System and Substance Use.

The shift from punitive responses to restorative public health approaches to tackle the problem of youth substance use and justice system involvement follow a nationwide trend. Hawai'i has made significant strides towards transforming the justice system and developing effective substance abuse programs. However, these efforts require changes in policies, practices, and paradigms to be fully and permanently realized. Such a philosophical shift requires a major reallocation of resources from downstream, high-cost punitive modalities, such as incarceration, to upstream solutions that allow adolescents to heal past trauma and grow the understanding and tools to lead a healthy and meaningful life. Research and evaluation to support ongoing learning and system improvement will also be required. Most critically, taking an approach to work with youth so they can overcome the root problems they face holds the most promise of ending the cycle of justice involvement and substance use that the state has witnessed for far too long.

A Historical and Contemporary Review of the Contextualization and Social Determinants of Health of Micronesian Migrants in the United States.

Hawai'i's Pacific Islander (PI) population has suffered a higher burden of coronavirus disease 2019 (COVID-19) infections, hospitalizations, and deaths compared to other groups in the state. The Hawai'i Emergency Management Agency Community Care Outreach Unit conducted an assessment across the state to gain an understanding of the impact of the COVID-19 pandemic on the health and social welfare of households. Survey data was collected from individuals across the state during a period of 3 weeks (August 12-September 5, 2020). The following are resulting recommendations from the Pacific Island community to mitigate the impact and disparities of the pandemic as immediate and medium-term structural requests: (1) ensure that Pacific Island communities are proactively represented in state and county committees that develop health interventions to ensure that relevant language and culturally tailored communications and strategies are included, (2) provide consistent funding and community centered support to ensure consistent COVID-19 impact services for the Pacific Island families, (3) enhance the capacity of PI health care navigators and interpreters through increased funding and program support, and (4) engage state policy makers immediately to understand and address the systemic structural barriers to health care and social services for Pacific Islanders in Hawai'i. These recommendations were developed to address the generational inequities and disparities that exist for Pacific islanders in Hawai'i which were exacerbated by the COVID-19 pandemic.

Psychiatric Hospitalization and Length of Stay Differences in Cannabis Users and Non-Users with a Primary Discharge Diagnosis of Schizophrenia or Schizoaffective Disorder.

BACKGROUND: The effects of cannabis use in vulnerable persons with schizophrenia or schizoaffective disorder, continues to be elucidated. METHODS: We compared 55 cannabis-only users (Group 1) with 462 non-substance users (Group 2) on measures of length of stay and number of psychiatric hospitalizations with a primary discharge diagnosis of schizophrenia or schizoaffective disorder using the Wilcoxon-Mann-Whitney non-parametric test for non-normal distributions, analysis of variance (ANOVA), and Poisson regression analysis. RESULTS: Group 1 had a mean length of stay of 6.15 days (sd = 5.32 days) and Group 2 had a mean length of stay of 8.66 days (sd = 11.14 days) (i.e. Wilcoxon-Mann-Whitney, p = .0347; log-transformed ANOVA, p = .0203). This difference was no longer statistically significant when controlling for three covariates (p = .1543). Poisson regressions for the mean number of admissions (1.84) were not statistically significant. CONCLUSIONS: Cannabis use may not be a good predictor of length of stay, once covariates are considered, and mean number of hospitalizations in hospitalized patients with schizophrenia or schizoaffective disorder.

Prevalence of Major Stressful Life Events and Mental Health Symptoms of American Indian and Alaska Native Adolescents in Hawai'i.

While progress has been made in learning more about American Indians and Alaska Natives (AI/ANs) who reside in Hawai'i, much more research is needed regarding adolescents' mental health and the major life events that they encounter. Utilizing a large cross-sequential epidemiologic design (N = 7,214; 1992-1996), this study found AI/AN-Hawaiian youth self-reported higher risk of predominantly negative major life events and mental health symptoms than for the non-Indigenous adolescent ethnic group, with the AI/AN and Native Hawaiian ethnic groups falling generally in between. However, when statistically controlling for covariates, overall, Native Hawaiian youth self-reported higher mental-health-symptom risk than the other three ethnic groups. Implications are discussed, including protective factors, prevention, and future research.

Protecting Youth in the Mental Health Service Settings.

The authors present the development of the field of psychiatry with the evolution of patient safeguards. They address the recent publicized events involving sexual harassment and abuse perpetrated by mental health service providers who have harmed youth who were under their direct psychiatric care. Recommendations are provided for primary care physicians and parents and legal guardians to further ensure patient safety.

A Resilience Model of Adult Native Hawaiian Health Utilizing a Newly Multi-Dimensional Scale.

Resilience has conventionally focused on an individual's ability to overcome adversity. Recent research expands on this definition, making resilience a multi-dimensional construct. Native Hawaiians experience health disparities compared to the general population of Hawai'i. Despite the pressing need to address health disparities, minimal research examines resilience factors that serve as buffers for adverse experiences of Native Hawaiians. The purpose of this study was to estimate psychometric properties of scales that measured resilience-based factors through multiple levels using higher-order confirmatory factor analyses (CFA) and ascertain if this construct of resilience mediated or moderated adversity experienced by a sample of Native Hawaiians. Participants included 125 adults who participated in the Hawaiian Homestead Health Survey. Based on higher-order CFA, resilience comprised internal assets measured by hope, satisfaction with life, and environmental mastery, and external resources measured by social support and Native Hawaiian cultural identity. Results of the structural equation models were consistent with literature focusing on resiliency and health. Findings emphasized the importance of enhancing resilience by considering strengths and resources on the individual, interpersonal, and community levels. Findings also demonstrated the need to address adversity factors directly, with a specific need of addressing socio-economic status factors. According to structural equation models, resilience slightly mediated and moderated the effect of adversity related to socio-economic status. These findings have implications for future research exploring resilience as a mediator or moderator of adversity among Native Hawaiians and emphasize a multi-faceted construct of resilience to promote better health outcomes.

Multi-Specialty Boot Camp: Enhancing Student Confidence in Residency Preparation.

BACKGROUND: A "boot camp" or senior preparatory course can help to bridge the gap between knowledge and skills attained in required clerkships and residency expectations. An under-researched area is in interventions across specialties and with student confidence as the outcome. OBJECTIVE: A multi-specialty school-wide boot camp for 4th year medical students was evaluated with a curriculum that focused on specialty milestones and entrustable professional activities and the importance of student confidence as an outcome. METHODS: A school-wide "boot camp" was developed to help 4th year students become ready for their matched specialty. Faculty resources were pooled to teach students from multiple specialties' common milestone topics. Surveys were collected from 3 academic years (2014-2015 to 2016-2017): pre-boot camp (Pre), immediately post-boot camp (Post 1), and 3 months after starting residency (Post 2). Dependent t-tests were employed to determine pre-post differences. RESULTS: Over the 3-year study period, 185 students participated in boot camp, 162 (87.6%) completed the first 2 surveys, and 75 (40.5%) students provided data at all 3 points in time. With more robust findings between Pre and Post 1, students improved their confidence level in communicating with families and most specialty skills, and students felt more prepared to be an intern as a result of the boot camp. CONCLUSIONS: The robust increase in student confidence suggested that a multi-specialty, school-wide approach to a capstone curriculum should be considered by medical schools, which will not only benefit students but faculty as well. Future research should examine student competence in achieving specialty skills.

Native Hawaiian Practices for Leptospirosis Prevention and Risk Mitigation.

This paper presents Native Hawaiian cultural practices of prevention and mitigation of leptospirosis. Indigenous cultural practices are described. Relatively high prevalence of leptospirosis is found in Hawai'i. Standard diagnosis and treatment are outlined. Theories are offered of how it was introduced to the Hawaiian Islands.

Change Pathways in Indigenous and Nonindigenous Youth Suicide.

Multivariate dynamic relationships among suicide attempts, anxiety and/or depressive symptoms, hope, and help-seeking were examined across time in Native Hawaiian and non-Hawaiian adolescents, using data from a 5-year longitudinal cohort study (N = 7,317). The rate of suicide attempts decreased over time, but this reduction was significantly less among Native Hawaiian youth than their non-Hawaiian peers. There were also significant differences between groups in hope and help-seeking, with Native Hawaiian youth increasing help-seeking and decreasing hope to a greater degree. Youth-centered, cultural approaches to suicide prevention are essential in enhancing well-being in indigenous communities.

Demographic, Social, and Mental Health Aspects of American Indian and Alaska Native Adolescents in Hawai'i.

American Indians and Alaska Natives (AI/ANs) constitute 2.2% of Hawai'i's population. Unfortunately, very little is known about the mental health of AI/AN youth in Hawai'i. The purpose of this study (N = 7,214; 1992-1996) was to describe AI/AN adolescents versus non-AI/AN youth regarding demographic, social, and mental health variables. The results suggested that AI/AN adolescents were more open to different types of social-emotional supports, had relatively more non-traditional families with a smaller social network, and may be more vulnerable to academic and health difficulties, with particular risk for mental health issues for mixed AI/AN-Native Hawaiians. Implications are discussed, including intervention, socio-political issues, and future research.

Longitudinal Prediction of Suicide Attempts for a Diverse Adolescent Sample of Native Hawaiians, Pacific Peoples, and Asian Americans.

The objective of this study was to determine the longitudinal predictors of past-6-month suicide attempts for a diverse adolescent sample of Native Hawaiians, Pacific peoples, and Asian Americans. The study used longitudinal data from the Hawaiian High Schools Health Survey (N = 2,083, 9th to 11th graders, 1992-1993 and 1993-1994 school years). A stepwise multiple logistic regression was conducted. The final model consisted of three statistically significant predictors: (1) Time 1 suicide attempt, odds ratio = 30.6; (2) state anxiety, odds ratio = 4.9; and (3) parent expectations, odds ratio = 1.9. Past suicide attempt was by far the strongest predictor of future suicide attempts. Implications are discussed, including the need for screening of prior suicide attempts and focused interventions after suicide attempts.

A model for evaluating academic research centers: Case study of the Asian/Pacific Islander Youth Violence Prevention Center.

OBJECTIVES: To provide one model for evaluating academic research centers, given their vital role in addressing public health issues. METHODS: A theoretical framework is described for a comprehensive evaluation plan for research centers. This framework is applied to one specific center by describing the center's Logic Model and Evaluation Plan, including a sample of the center's activities. RESULTS: Formative and summative evaluation information is summarized. In addition, a summary of outcomes is provided: improved practice and policy; reduction of risk factors and increase in protective factors; reduction of interpersonal youth violence in the community; and national prototype for prevention of interpersonal youth violence. CONCLUSIONS: Research centers are important mechanisms to advance science and improve people's quality of life. Because of their more infrastructure-intensive and comprehensive approach, they also require substantial resources for success, and thus, also require careful accountability. It is therefore important to comprehensively evaluate these centers. As provided herein, a more systematic and structured approach utilizing logic models, an evaluation plan, and successful processes can provide research centers with a functionally useful method in their evaluation.

Primary Care Integration of Psychiatric and Behavioral Health Services: A Primer for Providers and Case Report of Local Implementation.

Mental health conditions are common, disabling, potentially life-threatening, and costly; however, they are mostly treatable with early detection and intervention. Unfortunately, mental healthcare is in significantly short supply both nationally and locally, and particularly in small, rural, and relatively isolated communities. This article provides physicians and other health practitioners with a primer on the basic rationale and principles of integrating behavioral healthcare - particularly psychiatric specialty care - in primary care settings, including effective use of teleconferencing. Referring to a local-based example, this paper describes the programmatic components (universal screening, telephone availability, mutually educational team rounds, as-needed consultations, etc) that operationalize and facilitate successful primary care integration, and illustrates how these elements are applied to population segments with differing needs for behavioral healthcare involvement. Lastly, the article discusses the potential value of primary care integration in promoting quality, accessibility, and provider retention; discusses how new developments in healthcare financing could enhance the sustainability of primary care integration models; and summarizes lessons learned.

Understanding the Role of School Connectedness and Its Association With Violent Attitudes and Behaviors Among an Ethnically Diverse Sample of Youth.

Interpersonal youth violence is a growing public health concern in the United States. Having a high sense of school connectedness has been found to be a protective factor for youth violence. A high school course that aims to enhance school connectedness was developed and evaluated to investigate the students' sense of school connectedness and its association with violent attitudes and behaviors. Survey data from 598 students from a predominately Asian and Pacific Islander student body were analyzed to assess their level of school connectedness and violent attitudes and behaviors. Analysis of Variance was used to identify differences in the school connectedness and violence scores related to students' demographic characteristics. The role of school connectedness in the relationship between student demographic characteristics and violent attitudes and behaviors was examined with structural equation modeling. Overall, students reported a moderately high sense of school connectedness. School connectedness was found to be negatively associated with violent attitudes but not self-reported violent behaviors. Multiple-group analyses were conducted across the ethnic groups, which found differential associations between the school connectedness and violence variables. These results highlight the value of disaggregating the Asian and Pacific Islander category and the need for future research to further contextualize and clarify the relationship between school connectedness and interpersonal youth violence. This will help inform the development of evidence-based strategies and prevention programming that focus on school connectedness to address disparities in interpersonal youth violence outcomes.

One Model of Residency Journal Clubs With Multifaceted Support.

PROBLEM: The field of medical education is represented by a fairly wide variety of models for utilizing journal clubs as an effective teaching tool, each with varying levels of empirical support. Our own prior attempts at developing and implementing an effective journal club required improvements. INTERVENTION: Our intervention consisted of an innovative, effective journal club model that has more well-defined elements that are readily adaptable for other residency programs. The collective strategies were based on the previous literature and our own experiences. CONTEXT: Our intervention was implemented in a department of psychiatry within a university-based medical school. Study participants came from a psychiatry department's residency programs (N = 36) during academic year 2011-2012 with senior residents having the option to attend journal club. Using a multifaceted approach, measures included attendance, presession quizzes, postsession evaluations, and a final postcourse evaluation of 11 dimensions (e.g., goals, objectives). OUTCOME: Thirty-one (86%) trainees attended journal club-a substantial increase from previous years. The presession-quiz median was 4.4 total correct out of 6 questions (range = 3.3-5.3), indicating that the articles were generally read before the session. The postsession-evaluation median was 4.6 (1-5 scale, 5 the highest; range = 4.1-4.8), indicating sessions were well received. The final postcourse-evaluation overall mean was 3.9 (1-5 scale, 5 the highest; subscale M range = 3.4-4.5). Qualitative and quantitative analyses of the postcourse evaluation indicated the following positive aspects: educational objectives generally met, overall structured format, quality of discussions, individuals involved (e.g., course directors, trainees, faculty facilitators), and availability of food. Areas of possible improvement included time management within the sessions, more contemporary and clinically relevant articles, consistency in faculty moderators, and evaluation process. Engagement in learning appeared to have been dramatically increased through five strategies: (a) meaningful incentives; (b) assigned, engaged consistently prepared faculty; (c) meaningful evaluation; (d) prejournal club preparations that helped residents assimilate critical appraisal with time-and-task-management skills; and (e) a planning group that developed and improved curricula and instruction to meet the objectives of the course. LESSONS LEARNED: Overall, effective, and successful journal clubs require systematic planning, implementation, modification, and refinement.

Interpersonal youth violence perpetration and victimization in a diverse Asian American and Pacific Islander adolescent sample.

This study was the first to examine ethnic, sex, and ethnicity-by-sex differences for under-researched, Asian American and Pacific Islander, adolescent groups on youth violence outcomes other than cyberbullying. This effort included the less researched, emotional violence, and included socioeconomic status (SES) measures as covariates. The sample size from 2 high schools in spring 2007 was 881, using an epidemiologic survey design. The pattern of results was higher rates of violence victimization for ethnic groups, with lower representation in the 2 schools' population, and ethnic groups that more recently moved or immigrated to Hawai'i. For emotional victimization, girls of European American and "other", ethnicities self-reported higher rates than boys. Several implications (e.g., need for ethnically and gender-based approaches) and further research (e.g., ethnocultural identity) are discussed.

Cohort profile: the Hawai'i Family Study of Cognition.

Intergenerational longitudinal studies over the lifespan provide valuable information for understanding the contexts and dynamic relations among cognition, family and health in adults and the elderly. The Hawai'i Family Study of Cognition (HFSC), initiated in the early 1970s, included a cohort of over 6500 individuals representing over 1800 families of parents and their offspring. The HFSC gathered data on cognitive, personality, biological and other psychosocial variables, and provided novel information on the nature of cognitive abilities, especially on family issues. Some families were reassessed with short-term retesting in the 1970s. A select sample of offspring and their siblings and spouses were re-measured in the 1980s. Decades later, a 40-year follow-up of the original HFSC cohort was facilitated by the availability of contemporary tracking and tracing methods and internet-based testing. A subgroup of the original HFSC participants was re-contacted and retested on contemporary cognitive as well as socio-demographic and health measures. In this paper, we describe the original HFSC cohort and the design and methodology of the re-contact and retest studies of the HFSC, plans for expanding the re-contact and retesting, as well as directions for future research and collaborations. The Principal Investigator may be contacted for more information regarding the application, review and approval process for data access requests from qualified individuals outside the project.