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.

Underage drinking among Asian American and Pacific Islander adolescents.

This study assessed the prevalence of alcohol abuse and dependence rates among four major ethnic groups of Hawai'i and examined the relationship among risk factors, protective factors, and demographic variables related to underage drinking. A total of 196 students were administered the Diagnostic Interview Schedule for Children, the American Drug and Alcohol Survey, and the Prevention Planning Survey. Drinking rates for Native Hawaiian students were significantly higher than those for Japanese and Caucasian students. Multiple logistic regression models accounted for 49% of the variance for any alcohol use. Ethnic group differences were found when data were disaggregated for Asian and Pacific Islander students.

A confirmatory model for substance use among Japanese American and part-Japanese American adolescents.

Few studies have examined the effect of ethnicity and cultural identity on substance use among Asian and Pacific Islander adolescents. A cross-sequential study conducted in Hawai'i with 144 Japanese and part-Japanese American adolescents assessed a model integrating Japanese ethnicity, cultural identity, substance use, major life events, and social support. Japanese American adolescents scored higher on the Japanese Culture Scale and on the Peers' Social Support than the part-Japanese American adolescents. Significant associations for substance use and impairment included culturally intensified events and Japanese cultural identity-behavior subset. Models had good overall fits and suggested that conflict surrounding cultural identity may contribute to substance use.

Disparities in psychiatric emergency department visits among youth in Hawai'i, 2000-2010.

OBJECTIVE: To describe the frequency and patient characteristics of emergency department encounters for mental health among youth, and to examine differences in utilization and treatment patterns. STUDY DESIGN: Data were obtained from the Hawai'i Health Information Corporation database of emergency department records between January 1, 2000, and December 31, 2010. Analyses were limited to records of visits by patients aged <18 years with a diagnosis of mental disorder or a suicide attempt. RESULTS: The annual average rate was 49.7 emergency department visits related to mental health issues per 10 000 youth, accounting for 2.1% of all emergency department visits among youth. Rates of mental health-related visits significantly and steadily increased, from a low of 25.8 in 2000 to a high of 67.4 in 2010. Rural areas consistently exhibited higher rates and acceleration at a steeper incline across time. Rural youth were more likely to be discharged or transferred for inpatient care or outpatient services compared with urban youth (6.3% vs 12.4%; χ(2) = 61.42; df = 3; P < .001). CONCLUSION: The trend in emergency department utilization for mental health-related issues in adolescents is apparently increasing, with significantly higher rate and morbidity for youth in rural areas. Several recommendations are described for creating a responsive and integrated system of mental health care for youth, covering training, consultation, screening, and brief interventions.

Rural mental health: implications for telepsychiatry in clinical service, workforce development, and organizational capacity.

In Hawai'i, rural residents suffer disproportionately from poor health and mental health outcomes. Hawai'i's island geography makes rural health service disparities especially compelling. Physician workforce shortages are projected to increase, despite 30 years of programs aimed at recruiting physicians to rural areas. Telepsychiatry has been shown to be a feasible way to provide a variety of health services to individuals living in rural areas with limited access to healthcare. The University of Hawai'i Rural Health Collaboration (UHRHC) was established by the Department of Psychiatry to address the need for workforce development and rural access to mental health services across the State of Hawai'i by using telepsychiatry. Partnerships with community health clinics have been formed to provide patient care and consultation-liaison services through telepsychiatry technology. In addition, UHRHC focuses on workforce development in its residency training curriculum by utilizing a service-learning approach to rural mental health. Evaluation of these efforts is currently underway, with preliminary evidence suggesting that UHRHC is a promising strategy to increase access to critical mental health services and reduce health disparities in rural Hawai'i.

Low cultural identification, low parental involvement and adverse peer influences as risk factors for delinquent behaviour among Filipino youth in Hawai'i.

BACKGROUND: Among Filipino youth in Hawai'i, low Filipino cultural identification and low family support may be important risk factors for delinquency. AIMS: To examine, in a sample of Filipino youth in Hawai'i, correlations between delinquent behaviour and the aforementioned - as well as other, potentially mediating - variables. METHODS: A youth risk survey and Filipino Culture Scale were administered to Filipino students (N = 150) in Hawai'i. A parent risk survey was administered to available and consenting parents. RESULTS: Delinquent behaviour correlated positively with acculturative stress, low cultural identification and adverse peer influences; and negatively with total Filipino Culture Scale score. Structural equation modelling suggested that absent/ineffective adults and adverse peer influences might be more important variables compared to low self-esteem and less religiosity, linking low cultural identification to delinquent behaviour. CONCLUSIONS: Although further studies are warranted, to be effective, efforts to prevent delinquency by enhancing Filipino youths' cultural connectedness may also need to enhance family connectedness and address adverse peer influences.

Exploring the hypothesis of ethnic practice as social capital: violence among Asian/Pacific Islander youth in Hawaii.

BACKGROUND: Studies of youth violence have usually examined social capital using qualitative methods, but remain limited by small sample sizes. In addition, few studies examine violence among Asian/Pacific Islander (API) youth, even though they are one of the fastest-growing youth populations in the USA. AIMS: To contribute to a better understanding of culture and ethnicity in youth violence among Asian Americans and Pacific Islanders by quantifying ethnic forms of social capital. METHODS: We use an n = 326 sample of three API groups from Oahu, Hawaii. Defining social capital as ethnic practice, we test Filipino, Hawaiian and Samoan forms of youth social capital on intimate and non-intimate violence. RESULTS: Bivariate findings associate lower violence with language ability among Filipinos, coming-of-age practices among Hawaiians, and community leader engagement among Samoans. Multivariate tests showed language to be the strongest correlation. Bivariate tests also suggested potentially risky forms of social capital. CONCLUSIONS: results lead us to hypothesize that social capital that deliberately places individuals within their respective ethnic communities are risk-reducing, as are those that promote formal ethnic community structures. Those that formalize ethnic practice and social capital into commercial activities may be associated with higher risk of violence. Given the relatively small sample size and the exploratory approach for the present investigation, further research is needed to determine whether the findings can be replicated and to extend the findings of the present preliminary study.

Dating violence victimization: associated drinking and sexual risk behaviors of Asian, Native Hawaiian, and Caucasian high school students in Hawaii.

Ethnic minority groups such as Asian/Pacific Islanders (APIs) and native populations in Hawaii are seldom studied in the area of intimate relationships. Using the 1999 Hawaii Youth Risk Behavior Survey, this study examined gender and ethnic differences in experiencing physical dating violence and whether drinking (early initiation, binge drinking), unsafe sexual behaviors (early initiation, multiple partners, use of alcohol and drugs with sex, history of sexual abuse), and suicidality constitute risk for victimization among APIs, Native Hawaiian (NH), and Caucasian high school students in multiethnic state of Hawaii. The final analysis included 559 boys and 683 girls. The overall rate of experiencing physical violence was 7.8% with both genders reporting similar rates (boys 7.6%, girls 8.0%). Although not significantly different, NH students reported a higher rate (11.6%) than Caucasians (7.3%) and APIs (6.5%). Significant bivariate associations were found between victimization and many of the risk factors. Regression analyses indicated that students 16 years or older were nearly 3 times more at risk for experiencing dating violence. The risk was 8-fold if youth were sexually active by age 13 compared to those who abstained. The risk is 3-fold for those who reported prior sexual abuse. Early initiation of drinking (<12 years) and suicidality doubled the risk of being a victim. Clearly, the study highlights the risk of experiencing dating violence when a teen engages in sex very early or uses alcohol. Schools must routinely educate youth about various forms of dating violence, the effects of engaging in early sex, and drinking. Screening adolescents for associated risk factors such as drinking and depression is crucial to identify victimization. Dating violence is an antecedent for adult partner violence. Thus, by reducing youth dating violence, we may consequently reduce the incidence of adult partner violence.

Asian/Pacific Islander youth violence prevention center: interpersonal violence and deviant behaviors among youth in Hawai'i.

PURPOSE: This study investigates the prevalence rates of violent and deviant behaviors among a sample of Filipino, Hawaiian, Japanese, and Samoan public high school students residing in Hawai'i, and is the first relatively large-scale study of its kind regarding a disaggregated sample of Asian American and Pacific Islander (AAPI) youth. Filipino, Hawaiian, and Samoan adolescents were the chosen ethnic groups for this study's focus due to their over-representation in Hawai'i's juvenile justice system. METHODS: Data for this study were gathered collaboratively by researchers, community groups, and school officials who agreed that youth violence was a community concern worthy of deeper understanding and community response. The study's process included three phases: a focus group consultation phase, field-testing, and the final risk and protective factor study. For the final study, 326 randomly selected students representing three Hawai'i public high schools were surveyed on a one-on-one basis.A smaller sample of Japanese students was also included in the study, serving as a control group. RESULTS: Findings illustrate the importance of disaggregating specific ethnic and gender groups within the AAPI ethnic category when examining adolescent issues. As examples, Samoan youth reported significantly higher rates of violence than other ethnic groups surveyed, and Hawaiian girls reported higher rates of substance use than Hawaiian boys, which was not commensurate with other ethnic groups. Filipino, Hawaiian, and Samoan youth all reported significantly higher rates than Japanese on overall deviant behavior. CONCLUSIONS: Implications for further research and community development include enhancing minority youths' bicultural self-efficacy.

The National Center on Indigenous Hawaiian Behavioral Health study of prevalence of psychiatric disorders in native Hawaiian adolescents.

OBJECTIVES: The prevalence rates of disorders among a community-based sample of Hawaiian youths were determined and compared to previously published epidemiological studies. METHOD: Using a two-phase design, 7,317 adolescents were surveyed (60% participation rate), from which 619 were selected in a modified random sample during the 1992-1993 to 1995-1996 school years: 590 selected randomly and 29 at risk (i.e., Center for Epidemiologic Studies-Depression score of >or=35 and suicidal risk) from grades 9-12. The Diagnostic Interview Schedule for Children-Version 2.3, was used to determine DSM-III-R diagnoses. Prevalence rates, weighted for ethnicity, Center for Epidemiologic Studies-Depression scores, and suicide attempts, were calculated for any diagnosis and various disorders. Meta-analyses compared the Hawai'i sample to four community-based studies (randomly selected youths from community populations) and two high-risk studies (homeless, low-income, or high unemployment communities). RESULTS: Hawaiian females had the highest rate for any diagnosis (37.7%; 95% confidence interval [CI] 28.4%-48.0%) and non-Hawaiian males had the lowest rate (19.6%; 95% CI 14.8%-25.5%). Hawaiian males (26.8%; 95% CI 18.2%-37.5%) and non-Hawaiian females (27.9%; 95% CI 22.2%-34.4%) had intermediate and comparable rates. Overall, Hawaiians had significantly higher rates (32.7%; 95% CI 26.1%-40.1%) than non-Hawaiians (23.7%; 95% CI 19.9%-28.0%) when controlling for gender, and girls had significantly higher rates (30.8%; 95% CI 25.8%-36.3%) than boys (21.1%; 95% CI 16.8%-26.1%) when controlling for ethnicity. These findings were primarily the result of the significant differences in rates regarding anxiety disorders. Meta-analyses showed the Hawaiian youth rate for any diagnosis was comparable to high-risk studies and nearly three times higher than the community studies. CONCLUSIONS: Hawaiian youths, especially females, are at high risk. Research on the sociocultural factors that underpin both the genesis of and protection from psychopathology is imperative for Hawaiian and non-Hawaiian mixed-ethnicity youths.

Correlations among socioeconomic and family factors and academic, behavioral, and emotional difficulties in Filipino adolescents in Hawai'i.

BACKGROUND: Because of socioeconomic and acculturative challenges faced by immigrant families, Filipino adolescents in Hawai'i may be at risk for academic, behavioral and emotional difficulties. AIM: To determine, among Filipino adolescents in Hawai'i, whether measures of economic hardship and lower socioeconomic status (SES) correlate positively with poor school performance, aggressive behavior, substance use, anxiety, and depression; and whether family support and cultural identification correlate negatively with these difficulties. METHODS: 216 Filipino adolescents from four public high schools in Hawai'i (1993-1994) were given surveys that assessed basic demographic information, measures of family support and other social variables, and measures of school performance, depression, anxiety, aggression and substance use. RESULTS: In the total sample, low SES seemed to correlate with poor school performance and behavioral and emotional difficulties. In both the total sample and the sub-sample of adolescents with lower SES, family support was a universally strong protective factor. Learning genealogy was positively correlated with school performance, and speaking a language other than English was inversely correlated with substance use (in the whole sample) and depression (in the lower SES sub-sample). CONCLUSIONS: For Filipino adolescents (in both the whole and lower-SES samples), family support was an important protective factor against academic, behavioral and emotional difficulties. The role of cultural identification as a risk or protective factor among Filipino adolescents deserves further investigation.

Resilience, family adversity and well-being among Hawaiian and non-Hawaiian adolescents.

BACKGROUND: Minorities and indigenous peoples are likely to have poor mental health and physical outcomes. This study examines resiliency indicators in Hawaiian adolescents. AIMS: Multiple resiliency indicators were examined across different domains including individual, family and community in relation to increased psychological well-being. METHODS: Existing data from the Native Hawaiian Mental Health Research Development Program (NHMHRDP) were used. These data included information from a community sample of five high schools on three islands from the state of Hawai'i. The sample included 1,832 students, where 64% were Native Hawaiian and 36% were non-Hawaiian. RESULTS: This study found that Native Hawaiian youth experienced more family adversity compared with non-Hawaiians, but Native Hawaiians were also more likely to have higher levels of family support. For internalizing symptomatology, the most robust resiliency factors were family support and physical fitness/ health for Native Hawaiian and non-Hawaiian adolescents. For externalizing symptomatology, achievement and family support were consistently strong resiliency factors. The indicator for physical fitness and health was more influential among Native Hawaiians than non-Hawaiians for externalizing symptoms, while academic achievement was more influential among non-Hawaiians than for Native Hawaiians for the protection against internalizing symptoms. CONCLUSIONS: Our findings support the need for intervention programs designed to promote resilience in adolescents, including highlighting the importance of the family. Further research is needed to design and evaluate programs that promote well-being, enhance resilience and improve mental health in culturally appropriate ways.

Prevalence and correlates of misconduct among ethnically diverse adolescents of Native Hawaiian/ part-Hawaiian and non-Hawaiian ancestry.

BACKGROUND: Research on the prevalence and correlates of adolescent misconduct, arrests, and juvenile delinquency has been greatly neglected for the ethnically diverse adolescent groups in Hawai'i (i.e. Asian Americans, Pacific Islanders). AIMS: The aims of the present study are three-fold: (1) to determine whether there are differential rates of adolescent misconduct based on ethnicity, gender, and socioeconomic (SES) factors; (2) on an exploratory basis, to ascertain the demographic, social-cultural, psychological-psychiatric, and school-related correlates of misconduct, with some focus on cultural identification; and (3) to derive a parsimonious model of the correlates for an ethnically diverse group of adolescents by disentangling cultural identification from other variables including ethnicity. METHODS: Data were analyzed from the Native Hawaiian Mental Health Research Development Program, consisting of 2,732 Asian/Pacific Islander youths. Misconduct was operationally defined as 'was arrested or got in serious trouble with the law' within the past six months via adolescent self-report. Of added importance were the inclusion of a valid measure of Hawaiian cultural identification and actual school data. RESULTS: Significantly higher rates were obtained for Native Hawaiians, males, and adolescents whose main wage earners' educational attainment was at the high school level or less. Absences may be a more important marker for females than males in the prediction of arrests and serious trouble with the law. The most parsimonious model of self-reported arrests/serious trouble with the law consisted of four variables in the following order of importance: substance use, actual grade-point average, aggressive symptoms, and gender. CONCLUSION: This is one of the first major studies to examine the prevalence and risk-protective factors of misconduct for adolescents of Asian/Pacific Islander ancestry, and the first to include a valid measure of cultural identification and actual school data. The findings indicated that gender-specific prevention and intervention programs are needed. However, the issues are also complex whereby the use of substances, school performance, and aggression must be taken into account in deriving successful programs. The lack of sustained association between culturally based factors (e.g., ethnicity, Hawaiian cultural identification) and misconduct in the final parsimonious model suggested that the culturally based variables are not direct causes of misconduct, but rather correlates of misconduct that are over-shadowed by more substantive factors, such as substance use and academic performance, the latter being variables that must be addressed for youths across the United States. The present results reaffirmed the common correlates of misconduct across different ethnic groups. Further research is needed in the causal relationships among these important associations with misconduct.

Prevalence of victims of violence among ethnically diverse Asian/Pacific Islanders.

The present research project is the first large-scale study (N = 5,051) that investigated the prevalence of victims of violence for an ethnically diverse Asian/Pacific Islander sample. The rate for the adolescent respondents of "was a victim of violence (was physically harmed by someone)" within the past 6 months was 3.33%. Over twice that rate was found for family members (6.97%) and over three times the adolescent-respondent rate was obtained for close friends (10.75%). Only partial support was found for the hypothesis that Asian groups would have the lowest rates, and Polynesian, African American, Hispanic, and Native American Indian/Alaska Native groups would have the highest rates. Higher rates were found for Whites (adolescent respondents, close friends) and the Portuguese (family members, close friends), suggesting a "minority" effect. There is a need to disaggregate ethnicity, engage in further research that considers risk and protective factors, and investigate culturally appropriate interventions.

Ethnicity and adolescent substance use.

This study focuses on diverse ethnic differences among adolescent substance use, utilizing selected items from the Substance Abuse Subtle Screening Inventory-Adolescent version (SASSI-A). Data were gathered from a large-scale, cross-sequential study of adolescents during the 1993-1996 school years. Exploratory analyses were conducted for 3,711 students on the basis of their responses to a self-administered survey. Results indicated significant ethnic and gender differences for specific SASSI-A items and factor scores, with Hawaiian, "Other," and Caucasian students reporting higher scores than Japanese students and greater scores for female than male students. These findings suggest the need to develop culturally sensitive substance use prevention and treatment strategies that should also take gender differences into consideration for adolescents in Hawai'i.

A confirmatory model for depression among Japanese American and part-Japanese American adolescents.

A confirmatory model integrating Japanese ethnicity, cultural identity, and depression was developed (N = 140). The model incorporated the Center for Epidemiologic Studies-Depression Scale (CES-D), Major Life Events Scale, and Japanese Cultural Scale. Japanese American adolescents scored higher on the Japanese Cultural Scale and reported fewer depressive symptoms on the CES-D total and on 2 of the 3 CES-D factors than part-Japanese American adolescents. Predictors for depression were being Japanese American vs. part-Japanese American, female gender, and culturally intensified events. A significant interaction of behavior by self-identification was noted. The model had good overall fit and suggested that the formation of cultural identity may contribute to depressive symptoms experienced by adolescents, particularly adolescents of mixed heritage.

Prevalence and Correlates of Misconduct Among Ethnically Diverse Adolescents of Native Hawaiian/Part-Hawaiian and Non-Hawaiian Ancestry.

BACKGROUND: Research on the prevalence and correlates of adolescent misconduct, arrests, and juvenile delinquency has been greatly neglected for the ethnically diverse adolescent groups in Hawai'i (i.e. Asian Americans, Pacific Islanders). AIMS: The aims of the present study are three-fold: (1) to determine whether there are differential rates of adolescent misconduct based on ethnicity, gender, and socioeconomic (SES) factors; (2) on an exploratory basis, to ascertain the demographic, social-cultural, psychological-psychiatric, and school-related correlates of misconduct, with some focus on cultural identification; and (3) to derive a parsimonious model of the correlates for an ethnically diverse group of adolescents by disentangling cultural identification from other variables including ethnicity. METHODS: Data were analyzed from the Native Hawaiian Mental Health Research Development Program, consisting of 2,732 Asian/Pacific Islander youths. Misconduct was operationally defined as 'was arrested or got in serious trouble with the law' within the past six months via adolescent self-report. Of added importance were the inclusion of a valid measure of Hawaiian cultural identification and actual school data. RESULTS: Significantly higher rates were obtained for Native Hawaiians, males, and adolescents whose main wage earners' educational attainment was at the high school level or less. Absences may be a more important marker for females than males in the prediction of arrests and serious trouble with the law. The most parsimonious model of self-reported arrests/serious trouble with the law consisted of four variables in the following order of importance: substance use, actual grade-point average, aggressive symptoms, and gender. CONCLUSION: This is one of the first major studies to examine the prevalence and risk-protective factors of misconduct for adolescents of Asian/Pacific Islander ancestry, and the first to include a valid measure of cultural identification and actual school data. The findings indicated that gender-specific prevention and intervention programs are needed. However, the issues are also complex whereby the use of substances, school performance, and aggression must be taken into account in deriving successful programs. The lack of sustained association between culturally based factors (e.g., ethnicity, Hawaiian cultural identifi-cation) and misconduct in the final parsimonious model suggested that the culturally based variables are not direct causes of misconduct, but rather correlates of misconduct that are over-shadowed by more substantive factors, such as substance use and academic performance, the latter being variables that must be addressed for youths across the United States. The present results reaffirmed the common correlates of misconduct across different ethnic groups. Further research is needed in the causal relationships among these important associations with misconduct.