Real-World Evaluation of an Automated Algorithm to Detect Patients With Potentially Undiagnosed Hypertension Among Patients With Routine Care in Hawai'i.

BACKGROUND: This real-world evaluation considers an algorithm designed to detect patients with potentially undiagnosed hypertension, receiving routine care, in a large health system in Hawai'i. It quantifies patients identified as potentially undiagnosed with hypertension; summarizes the individual, clinical, and health system factors associated with undiagnosed hypertension; and examines if the COVID-19 pandemic affected detection. METHODS AND RESULTS: We analyzed the electronic health records of patients treated across 6 clinics from 2018 to 2021. We calculated total patients with potentially undiagnosed hypertension and compared patients flagged for undiagnosed hypertension to those with diagnosed hypertension and to the full patient panel across individual characteristics, clinical and health system factors (eg, clinic of care), and timing. Modified Poisson regression was used to calculate crude and adjusted risk ratios. Among the eligible patients (N=13 364), 52.6% had been diagnosed with hypertension, 2.7% were flagged as potentially undiagnosed, and 44.6% had no evidence of hypertension. Factors associated with a higher risk of potentially undiagnosed hypertension included individual characteristics (ages 40-84 compared with 18-39 years), clinical (lack of diabetes diagnosis) and health system factors (clinic site and being a Medicaid versus a Medicare beneficiary), and timing (readings obtained after the COVID-19 Stay-At-Home Order in Hawai'i). CONCLUSIONS: This evaluation provided evidence that a clinical algorithm implemented within a large health system's electronic health records could detect patients in need of follow-up to determine hypertension status, and it identified key individual characteristics, clinical and health system factors, and timing considerations that may contribute to undiagnosed hypertension among patients receiving routine care.

Intersections between adolescent fertility and obesity-pathways and research gaps focusing on Latin American populations.

Latin America has notably elevated rates of adolescent fertility and obesity in women. Although numerous studies document associations between adolescent fertility and obesity across the life course, the pathways explaining their association are insufficiently theorized, especially regarding the factors in Latin America that may underpin both. Additionally, much of the existing research is from high-income countries, where fertility and obesity are trending down. In this paper, we review the various complex pathways linking adolescent fertility and obesity, highlighting research gaps and priorities, with a particular focus on Latin American populations. We carefully consider pregnancy's distinct impact on growth trajectories during the critical period of adolescence, as well as the cumulative effect that adolescent fertility may have over the life course. We also articulate a pathway through obesity as it may contribute to early puberty and thus, to adolescent fertility. If obesity is a cause of adolescent fertility, not a result of it, or if it is a mediator of early-life exposures to adulthood obesity, these are critical distinctions for policy aiming to prevent both obesity and early fertility. Research to better understand these pathways is essential for prevention efforts against obesity and undesired adolescent fertility in Latin America.

Exploring Challenges and Opportunities for Breastfeeding in Hawai'i During the COVID-19 Pandemic.

Increasing exclusive breastfeeding rates is an established public health strategy to reduce chronic disease and protect infants from illness. The role of breastfeeding in addressing health disparities takes on new significance as the COVID-19 pandemic has disproportionately impacted some communities in Hawai'i, and those with chronic conditions face increased risk of hospitalization and death. However, there are myriad policy, systemic, and environmental barriers that make it difficult for parents to breastfeed, some of which have been exacerbated by the COVID-19 pandemic. This editorial discusses the importance of breastfeeding in reducing chronic disease, reviews the status of breastfeeding in Hawai'i, explores the challenges parents face in breastfeeding their infants, especially in the time of COVID-19, and presents opportunities for improved access to lactation care to reduce health disparities.

Sugar-Sweetened Beverage Fee: A Model to Address Health Disparities in Hawai'i.

Sugar-sweetened beverage (SSB) consumption is associated with increased risk of obesity, diabetes, and other chronic diseases. SSB consumption is also a health equity issue, as rates of consumption and related chronic diseases vary by race, ethnicity, and income in Hawai'i. The COVID-19 pandemic has highlighted the need for greater investment in public health and the well-being of communities experiencing health disparities because individuals with chronic diseases are more likely to develop complications from the virus. It has also created economic hardships for the people of Hawai'i, especially the state's most vulnerable populations. Amid this health and economic crisis, an opportunity exists to implement an SSB fee in Hawai'i. An SSB fee would impose a fee on SSB distributors that would be passed on to consumers in the form of price increases that influence purchasing behavior. Jurisdictions with SSB taxes or fees have seen reductions in SSB purchases and consumption and have generated millions of dollars in revenues to support health initiatives and reduce socioeconomic disparities. Models predict that a $0.02 SSB fee in Hawai'i could generate $60.5 million and significantly reduce healthcare costs and chronic diseases. This commentary will present an SSB fee policy as a viable model for Hawai'i to reduce SSB consumption, lower chronic disease risks, and generate needed revenues to support health, reduce inequities, and rebuild the state's economy.

Reinventing health promotion for healthy default beverage laws in the face of COVID-19.

Shortly after a healthy default beverage (HDB) law took effect in Hawai'i, requiring restaurants that serve children's meals to offer healthy beverages with the meals, the COVID-19 pandemic struck. Efforts to contain the virus resulted in changes to restaurants' operations and disrupted HDB implementation efforts. Economic repercussions from containment efforts have exacerbated food insecurity, limited access to healthy foods, and created obstacles to chronic disease management. Promoting healthy default options is critical at a time when engaging in healthy behaviors is difficult, but important, to both prevent and manage chronic disease and decrease COVID-19 risk. This commentary discusses COVID-19's impact on restaurant operations and healthy eating, and the resulting challenges and opportunities for this promising health promotion intervention.

Baseline Assessment of Children's Meals and Healthy Beverage Options Prior to a State-Level Healthy Default Beverage (HDB) Law.

In January 2020, Hawai'i became the second state with a healthy default beverage (HDB) law, requiring restaurants to offer HDBs with their children's meals. This observational study presents baseline characteristics of restaurants with a children's menu and meal. The study describes pre-law beverage options to inform future HDB policy language, implementation, and evaluation. Between November and December 2019, data were collected from a statewide sample of unique restaurants (N = 383) with health inspection permits. Restaurants were assessed separately for a children's menu and meal using website reviews, telephone calls, and in-person visits. Meals were evaluated for pre-law beverage type and compliance. Logistic regression was used to estimate the likelihood of having a children's menu and meal. Most of the restaurants were full-service (70.2%) and non-chains (67.9%). While 49.3% of restaurants had a children's menu, only 16.7% had a children's meal. Significant predictors of having a children's menu were being full-service, national/international or local chains, neighbor island (non-Honolulu) locations, and hotel locations. Only being a national/international chain significantly predicted having a children's meal. Although 35.9% of children's meals offered a non-sugar-sweetened beverage (SSB) option, only 3.1% offered law-compliant beverages. Inclusion of an SSB default option (60.9%) and not specifying the type of default beverage were the predominant factors for pre-law non-compliance. Results support the need for HDB regulations, especially for national/international chains, which were most likely to have children's meals, and provide data to inform policies in other jurisdictions.

Insights in public health: Promoting healthy snack and beverage choices in Hawai'i worksites: the Choose Healthy Now! pilot project.

Over half of the adults in Hawai'i are overweight or obese, exposing them to increased risk for chronic diseases and resulting in higher health care expenses. Poor dietary habits and physical inactivity are important contributors to obesity and overweight. Because adults spend most of their waking hours at work, the workplace is an important setting for interventions to solve this growing problem. Changing the nutrition environment to support healthy eating is a recommended practice for worksite wellness interventions. Following this recommendation, the Hawai'i State Department of Health (DOH) launched the Choose Healthy Now! Healthy Vending Pilot Project to increase access to healthy options in worksites. Choose Healthy Now! utilized an education campaign and a traffic light nutrition coding system (green = go, yellow = slow, red = uh-oh), based on federal nutrition guidelines, to help employees identify the healthier options in their worksite snack shops. Inventory of healthy items was increased and product placement techniques were used to help make the healthy choice the easy choice. DOH partnered with the Department of Human Services' Ho'opono Vending Program to pilot the project in six government buildings on O'ahu between May and September of 2014. Vendors added new green (healthy) and yellow (intermediate) options to their snack shop and cafeteria inventories, and labeled their snacks and beverages with green and yellow point-of-decision stickers. The following article outlines background and preliminary findings from the Choose Healthy Now! pilot.

Increasing access to places for physical activity through a joint use agreement: a case study in urban Honolulu.

BACKGROUND: To increase levels of physical activity (PA), interventions that create or enhance access to places for PA are recommended. Establishing a joint use agreement is one way to increase access to existing PA and recreational facilities. The purpose of this article is to present a case study of In-Motion, a pilot joint use agreement project at one urban high school in Honolulu, Hawaii. CONTEXT: Residents of urban Honolulu are underserved by the amount of parkland and recreational facilities available for their use. The Honolulu County Department of Parks and Recreation sought to implement a joint use agreement to use the facilities of one urban high school for a recreational program. The high school selected for the pilot project has a student population primarily from low-income and ethnic minority backgrounds. METHODS: An assessment of the potential of 7 urban high schools to implement a joint use agreement was conducted to select the pilot site. In-Motion developed and implemented a joint use agreement. PA preferences of students, staff, and community members were assessed to guide recreational program offerings. Various recreational classes were offered free to the school community. CONSEQUENCES: Several barriers to implementing the joint use agreement and recreational program were encountered. However, participants were satisfied with the recreational classes they attended and said that the In-Motion program helped them to engage in more PA. Program awareness by high school students and staff was high. INTERPRETATION: In-Motion has successfully modeled a pilot joint use agreement and provided new opportunities for PA to the high school's students, teachers, and staff, and to community residents.