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.

Physical activity modulates mononuclear phagocytes in mammary tissue and inhibits tumor growth in mice.

The risk for breast cancer is significantly reduced in persons who engage in greater amounts of physical activity, and greater physical activity before or after diagnosis associates with reduced disease-specific mortality. Previous mechanistic studies indicate that components of innate immunity can mediate an inhibitory effect of physical activity on several types of tumor. However, in breast cancer specifically, the myeloid compartment of innate immunity is thought to exhibit high propensity for an immunosuppressive role that obstructs anti-tumor immunity. Thus, we tested the notion that greater physical activity alters mononuclear phagocytes in mammary tissue when inhibiting nascent tumor in a murine model of breast cancer. To model greater physical activity, we placed an angled running wheel in each mouse's home cage for two weeks before tumor engraftment with EO771 mammary cancer cells that express luciferase for bioluminescent detection. Fully immunocompetent mice and mice with compromised adaptive immunity showed significantly less mammary tumor signal when given access to running wheels, although the effect size was smaller in this latter group. To investigate the role of the myeloid compartment, mononuclear phagocytes were ablated by systemic injection of clodronate liposomes at 24 h before tumor engraftment and again at the time of tumor engraftment, and this treatment reversed the inhibition in wheel running mice. However, clodronate also inhibited mammary tumor signal in sedentary mice, in conjunction with an expected decrease in gene and protein expression of the myeloid antigen, F4/80 (Adgre1), in mammary tissue. Whole transcriptome digital cytometry with CIBERSORTx was used to analyze myeloid cell populations in mammary tissue following voluntary wheel running and clodronate treatment, and this approach found significant changes in macrophage and monocyte populations. In exploratory analyses, whole transcriptome composite scores for monocytic myeloid-derived suppressor cell (M-MDSC), macrophage lactate timer, and inflammation resolution gene expression programs were significantly altered. Altogether, the results support the hypothesis that physical activity inhibits nascent mammary tumor growth by enhancing the anti-tumor potential of mononuclear phagocytes in mammary tissue.

Do demographic disparities exist in the diagnosis and surgical management of otitis media?

OBJECTIVE: Determine if demographic disparities exist between the diagnosis of otitis media (OM) and the provision of myringotomy and tubes in children. STUDY DESIGN: Cross-sectional analysis of a national database. METHODS: The National Ambulatory Medical Care Survey 2010 and the National Hospital Ambulatory Medical Care Survey-Ambulatory Surgery 2010 were abstracted for cases with a diagnosis of OM and myringotomy and tube (MT) procedures in children, respectively. Sex, race, ethnic, and insurance distributions were computed for OM and MT and then compared for healthcare disparities between rates of OM diagnoses and MT procedures. RESULTS: A total of 13.6 million ambulatory pediatric OM diagnoses were identified in 2010 (55.9% male; 82.4% white, 11.3% black, and 6.3% other; 14.3% Hispanic, 85.7% non-Hispanic). A total of 413 thousand ambulatory myringotomy procedures were identified (59.6% male; 86.0% white, 11.0% black, and 3.0% other; 13.0% Hispanic, 87.0% non-Hispanic). There was no statistically significant difference in the provision of MT versus OM diagnosis according to sex (P = 0.400), race (P = 0.313), or ethnicity (P = 0.228). There was also no statistically significant difference in the percentage of Medicaid coverage for OM children (37.0%) versus those undergoing MT (31.1%; P = 0.376). There does, however, appear to be a statistically higher percentage of non-Hispanic children being diagnosed with otitis media than Hispanic children (P = 0.049). CONCLUSION: There were no significant demographic differences in the incidence of children with OM undergoing MT with respect to sex, race, ethnicity, or insurance status. As a specialty, otolaryngology does not appear to exhibit any disparate healthcare access bias in providing MT to children with OM. LEVEL OF EVIDENCE: NA Laryngoscope, 128:2898-2901, 2018.

Electro-tactile stimulation (ETS) enhances cochlear-implant Mandarin tone recognition.

OBJECTIVE: Electro-acoustic stimulation (EAS) is an effective method to enhance cochlear-implant performance in individuals who have residual low-frequency acoustic hearing. To help the majority of cochlear implant users who do not have any functional residual acoustic hearing, electro-tactile stimulation (ETS) may be used because tactile sensation has a frequency range and perceptual capabilities similar to that produced by acoustic stimulation in the EAS users. METHODS: Following up the first ETS study showing enhanced English sentence recognition in noise,1 the present study evaluated the effect of ETS on Mandarin tone recognition in noise in two groups of adult Mandarin-speaking individuals. The first group included 11 normal-hearing individuals who listened to a 4-channel, noise-vocoded, cochlear-implant simulation. The second group included 1 unilateral cochlear-implant user and 2 bilateral users with each of their devices being tested independently. Both groups participated in a 4-alternative, forced-choice task, in which they had to identify a tone that was presented in noise at a 0-dB signal-to-noise ratio via electric stimulation (actual or simulated cochlear implants), tactile stimulation or the combined ETS. RESULTS: While electric or tactile stimulation alone produced similar tone recognition (∼40% correct), the ETS enhanced the cochlear-implant tone recognition by 17-18 percentage points. The size of the present ETS enhancement effect was similar to that of the previously reported EAS effect on Mandarin tone recognition. Psychophysical analysis on tactile sensation showed an important role of frequency discrimination in the ETS enhancement. CONCLUSION: Tactile stimulation can potentially enhance Mandarin tone recognition in cochlear-implant users who do not have usable residual acoustic hearing. To optimize this potential, high fundamental frequencies need to be transposed to a 100-200 Hz range.

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.

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.

Developing a comprehensive school connectedness scale for program evaluation.

BACKGROUND: Evidence show that school connectedness is important to youth wellness. However, considerable inconsistency in the concepts and measures of school connectedness exists across studies. In addition, many measures do not capture the multifaceted dimensions of the school connectedness construct. This study examined the psychometric properties of a school connectedness scale that aimed to measure comprehensively the key constructs of school connectedness. METHODS: The scale was developed with teachers and tested with an ethnically diverse sample of 717 high school students enrolled in a school connectedness course using confirmatory factor analysis. RESULTS: Confirmatory factor analyses demonstrated the association of the 15 items with the 5 factors identified in the literature-school involvement, academic motivation, school attachment, teacher support, and peer relations (χ(2) = 439.99, df = 83, p < .0001, Comparative Fit Index = 0.991, Tucker-Lewis index = 0.988, root mean square error of approximation = 0.077). Cronbach coefficient alphas for the factors ranged from 0.73 to 0.93. CONCLUSIONS: Although further tests need to be conducted to assess its validity and reliability, this newly developed scale may provide researchers a tool to measure comprehensively school connectedness for program evaluation.

Longitudinal Dynamic Analyses of Depression and Academic Achievement in the Hawaiian High Schools Health Survey using Contemporary Latent Variable Change Models.

The scientific literature consistently supports a negative relationship between adolescent depression and educational achievement, but we are certainly less sure on the causal determinants for this robust association. In this paper we present multivariate data from a longitudinal cohort-sequential study of high school students in Hawai'i (following McArdle, 2009; McArdle, Johnson, Hishinuma, Miyamoto, & Andrade, 2001). We first describe the full set of data on academic achievements and self-reported depression. We then carry out and present a progression of analyses in an effort to determine the accuracy, size, and direction of the dynamic relationships among depression and academic achievement, including gender and ethnic group differences. We apply three recently available forms of longitudinal data analysis: (1) Dealing with Incomplete Data -- We apply these methods to cohort-sequential data with relatively large blocks of data which are incomplete for a variety of reasons (Little & Rubin, 1987; McArdle & Hamagami, 1992). (2) Ordinal Measurement Models (Muthén & Muthén, 2006) -- We use a variety of statistical and psychometric measurement models, including ordinal measurement models to help clarify the strongest patterns of influence. (3) Dynamic Structural Equation Models (DSEMs; McArdle, 2009). We found the DSEM approach taken here was viable for a large amount of data, the assumption of an invariant metric over time was reasonable for ordinal estimates, and there were very few group differences in dynamic systems. We conclude that our dynamic evidence suggests that depression affects academic achievement, and not the other way around. We further discuss the methodological implications of the study.

Systematic assessment of noise amplitude generated by toys intended for young children.

OBJECTIVE: To systematically evaluate the noise generated by toys targeted for children and to compare the results over the course of 4 consecutive holiday shopping seasons. STUDY DESIGN: Experimental study. SETTING: Academic medical center. SUBJECTS AND METHODS: During 2008-2011, more than 200 toys marketed for children older than 6 months were screened for loudness. The toys with sound output of more than 80 dBA at speaker level were retested in a soundproof audiometry booth. The generated sound amplitude of each toy was measured at speaker level and at 30 cm away from the speaker. RESULTS: Ninety different toys were analyzed. The mean (SD) noise amplitude was 100 (8) dBA (range, 80-121 dBA) at the speaker level and 80 (11) dBA (range, 60-109 dBA) at 30 cm away from the speaker. Eighty-eight (98%) had more than an 85-dBA noise amplitude at speaker level, whereas 19 (26%) had more than an 85-dBA noise amplitude at a 30-cm distance. Only the mean noise amplitude at 30 cm significantly declined during the studied period (P < .001). There was no significant difference in mean noise amplitude of different toys specified for different age groups. CONCLUSION: Our findings demonstrate the persistence of extremely loud toys marketed for very young children. Acoustic trauma from toys remains a potential risk factor for noise-induced hearing loss in this age group, warranting promotion of public awareness and regulatory considerations for manufacture and marketing of toys.

Prevalence of youth violence in the U.S., 1999-2009: ethnic comparisons and disaggregating Asian Americans and Pacific Islanders.

This study examined ethnic and gender differences in youth violence in the U.S. across time, especially when disaggregating Asian Americans and Pacific Islanders and examining adolescents with mixed ancestry. National data from 1999 to 2009 of the Centers for Disease Control and Prevention's Youth Risk Behavior Surveillance System were analyzed. The analyses were performed on individual items and three factors (i.e., carry weapon, felt unsafe, fights). Overall, 43.9 % responded to at least one indicator of violence. In general, males reported higher rates than females. American Indians/Alaska Natives and Native Hawaiians/Pacific Islanders tended to have the highest rates, while Asians and Whites tended to have the lowest rates. However, significant interaction effects between ethnicity and sex indicated a more complex relationship. The findings highlight the (1) parsimony in utilizing the three factors; (2) importance of disaggregating the heterogeneous "Asian/Pacific Islander" population; and (3) need to conduct more research on youth of mixed ancestry. These findings better inform program design and implementation, as well as policy making in youth violence prevention.

Ethnic differences in risk factors for suicide among American high school students, 2009: the vulnerability of multiracial and Pacific Islander adolescents.

This study compared self-reported risk factors for suicide among American high school students in the last decade. Data from the 1999-2009 Youth Risk Behavior Surveys was analyzed by 8 self-reported ethnicity groups across 6 suicide-related items: depression, suicide ideation, suicide planning, suicide attempts, and suicide attempts requiring medical attention). Native Hawaiian/Pacific Islander adolescents had the higher prevalence of risk factors for suicide. Multiracial adolescents were also at high risk for suicide-related behaviors, with a risk comparable to American Indian/Alaska Native adolescents. Overall, Native Hawaiian/Pacific Islander, multiracial, and American Indian/Alaska Native adolescents reported a significantly higher risk for suicide-related behaviors compared to their Asian, Black, Hispanic, and White peers. The ethnic disparities in risk factors for suicide dictate a need to understand the vulnerability of the Pacific Islander, American Indian, and growing multiracial adolescent populations, in an effort to develop and implement suicide prevention strategies.

Tinnitus suppression by electric stimulation of the auditory nerve.

Electric stimulation of the auditory nerve via a cochlear implant (CI) has been observed to suppress tinnitus, but parameters of an effective electric stimulus remain unexplored. Here we used CI research processors to systematically vary pulse rate, electrode place, and current amplitude of electric stimuli, and measure their effects on tinnitus loudness and stimulus loudness as a function of stimulus duration. Thirteen tinnitus subjects who used CIs were tested, with nine (70%) being "Responders" who achieved greater than 30% tinnitus loudness reduction in response to at least one stimulation condition and the remaining four (30%) being "Non-Responders" who had less than 30% tinnitus loudness reduction in response to any stimulus condition tested. Despite large individual variability, several interesting observations were made between stimulation parameters, tinnitus characteristics, and tinnitus suppression. If a subject's tinnitus was suppressed by one stimulus, then it was more likely to be suppressed by another stimulus. If the tinnitus contained a "pulsating" component, then it would be more likely suppressed by a given combination of stimulus parameters than tinnitus without these components. There was also a disassociation between the subjects' clinical speech processor and our research processor in terms of their effectiveness in tinnitus suppression. Finally, an interesting dichotomy was observed between loudness adaptation to electric stimuli and their effects on tinnitus loudness, with the Responders exhibiting higher degrees of loudness adaptation than the Non-Responders. Although the mechanisms underlying these observations remain to be resolved, their clinical implications are clear. When using a CI to manage tinnitus, the clinical processor that is optimized for speech perception needs to be customized for optimal tinnitus suppression.

Epidemiology of mixed martial arts and youth violence in an ethnically diverse sample.

Mixed martial arts' (MMAs) growing international popularity has rekindled the discussion on the advantages (e.g., exercise) and disadvantages (e.g., possible injury) of contact sports. This study was the first of its kind to examine the psychosocial aspects of MMA and youth violence using an epidemiologic approach with an Asian American and Pacific Islander (AAPI) adolescent sample (N = 881). The results were consistent with the increased popularity of MMA with 52% (adolescent males = 73%, adolescent females = 39%) enjoying watching MMA and 24% (adolescent males = 39%, adolescent females = 13%) practicing professional fight moves with friends. Although statistically significant ethnic differences were found for the two MMA items on a bivariate level, these findings were not statistically significant when considering other variables in the model. The bivariate results revealed a cluster of risk-protective factors. Regarding the multiple regression findings, although enjoying watching MMA remained associated with positive attitudes toward violence and practicing fight moves remained associated with negative out-group orientation, the MMA items were not associated with unique variances of youth violence perpetration and victimization. Implications included the need for further research that includes other diverse samples, more comprehensive and objective MMA and violence measures, and observational and intervention longitudinal studies.

Perception of Mandarin Chinese with cochlear implants using enhanced temporal pitch cues.

A cochlear implant (CI) signal processing strategy named F0 modulation (F0mod) was compared with the advanced combination encoder (ACE) strategy in a group of four post-lingually deafened Mandarin Chinese speaking CI listeners. F0 provides an enhanced temporal pitch cue by amplitude modulating the multichannel electrical stimulation pattern at the fundamental frequency (F0) of the incoming speech signal. Word and sentence recognition tests were carried out in quiet and in noise. The responses for the word-recognition test were further segmented into phoneme and tone scores. Off-line implementations of ACE and F0mod were used, and electrical stimulation patterns were directly streamed to the CI subject's implant. To focus on the feasibility of enhanced temporal cues for tonal language perception, idealized F0 information that was extracted from speech tokens in quiet was used in the F0mod processing of speech-in-noise mixtures. The results indicated significantly better lexical tone perception with the F0mod strategy than with ACE for the male voice (p<0.05). No significant differences in sentence recognition were found between F0mod and ACE.

Monitoring the multi-faceted problem of youth violence: the Asian/Pacific Islander Youth Violence Prevention Center's surveillance system.

Youth violence (YV) is a complex public health issue that spans geographic, ethnic, and socioeconomic lines. The Asian/Pacific Islander Youth Violence Prevention Center conducts qualitative and quantitative research on YV in Hawai'i. A critical element in YV prevention involves measuring YV and its risk-protective factors to determine the scope of the problem and to monitor changes across time. Under the Asian/Pacific Islander Youth Violence Prevention Center's (APIYVPC's) surveillance umbrella, a variety of methodologies are utilized. The major forms of active surveillance are a School-Wide Survey for youth, and a Safe Community Household Survey for adults. A variety of secondary data sources are accessed, such as the Centers for Disease Control and Prevention (Youth Risk Behavior Surveillance System), the Hawai'i State Department of the Attorney General, the Hawai'i State Department of Education, and the Hawai'i State Department of Health. State data are especially important for the Center, because most of these sources disaggregate ethnicity data for Asian Americans/Pacific Islanders. This paper details the surveillance methodologies utilized by the APIYVPC to monitor YV in one specific community and in Hawai'i, in comparison to the rest of the State and nation. Empirical results demonstrate the utility of each methodology and how they complement one another. Individually, each data source lends valuable information to the field of YV prevention; however, collectively, the APIYVPC's surveillance methods help to paint a more complete picture regarding violence rates and the relationship between YV and its risk-protective factors, particularly for minority communities.

Potential causal relationship between depressive symptoms and academic achievement in the Hawaiian high schools health survey using contemporary longitudinal latent variable change models.

There is a relatively consistent negative relationship between adolescent depressive symptoms and educational achievement (e.g., grade point average [GPA]). However, the causal direction for this association is less certain due to the lack of longitudinal data with both indicators measured across at least 2 time periods and due to the lack of application of more sophisticated contemporary statistical techniques. We present multivariate results from a large longitudinal cohort-sequential study of high school students (N = 7,317) with measures of self-reported depressive symptoms and self-reported GPAs across multiple time points (following McArdle, 2009, and McArdle, Johnson, Hishinuma, Miyamoto, & Andrade, 2001) using an ethnically diverse sample from Hawai'i. Contemporary statistical techniques included bivariate dynamic structural equation modeling (DSEM), multigroup ethnic and gender DSEMs, ordinal scale measurement of key outcomes, and imputation for incomplete longitudinal data. The findings suggest that depressive symptoms affect subsequent academic achievement and not the other way around, especially for Native Hawaiians compared with female non-Hawaiians. We further discuss the scientific, applied, and methodological-statistical implications of the results, including the need for further theorizing and research on mediating variables. We also discuss the need for increased prevention, early intervention, screening, identification, and treatment of depressive symptoms and disorders. Finally, we argue for utilization of more contemporary methodological-statistical techniques, especially when violating parametric test assumptions.

Social ecological determinants of youth violence among ethnically diverse Asian and Pacific Islander students.

This study assesses the relative fit of risk/protective and social ecological models of youth violence among predominantly Asian and Pacific Islander students. Data from a 2007 survey of two multi-ethnic high schools in Hawai'i were used. The survey assessed interpersonal youth violence, suicidality and risk and protective factors. Two models of youth violence (risk/protective and social ecological) were tested using structural equation modeling. We found good fits for the risk/protective model (χ(2) = 369.42, df = 77, P < .0001; CFI = .580; RMSEA = .066) and the ecological model (χ(2) = 1763.65, df = 292, P < .0001; CFI = .636; RMSEA = .076). The risk/protective model showed the importance of coping skills. However, the ecological model allowed examination of the interconnectivity among factors. Peer exposure to violence had no direct influence on individuals and peer influence was fully mediated by school climate. Furthermore, family factors directly contributed to peer exposure, community, and individual risk/protection. These findings have significant implications for intervention and prevention efforts and for the promotion of positive, competent, and healthy youth development. While few family and school-based programs have been developed and evaluated for adolescents, they have the greatest potential for success.

Community perceptions of safety in relation to perceived youth violence-delinquency in a primarily native Hawaiian and Asian American community in Hawai'i.

Perception of safety is an important component to the well-being of community members in their own neighborhood. The present study was the first of its kind to model community perception of safety utilizing a primarily Native Hawaiian and Asian American community sample (N = 101) and with perceived youth violence and delinquency as prominent potential influences. The study found that the majority of participants felt that several types of youth violence and delinquency were problems in the community. The overall social-ecological model evidenced a strong fit and indicated that community perception of safety was adversely impacted by perceived youth violence and delinquency and increased through positive relations with neighbors. The implications included the need for a more comprehensive approach to positive youth development and community capacity-building, including incorporation of cultural components, and to determine whether the model is applicable to other minority communities.

The impact of cyberbullying on substance use and mental health in a multiethnic sample.

The objective of this study was to examine the relationship between cyberbullying and mental health problems among a multiethnic sample of high school students in Hawai'i. A University-Community partnership was established to direct the research. Using a mixed-methods approach, we explored violence among Asian and Pacific Islander youth. In the first phase, focus groups were conducted to identify areas of youth concern and develop survey questions. Responses from 677 high school students on interpersonal youth violence and risk and protective factors were utilized in this study. More than 1 in 2 youth (56.1%) had been victims of cyberbullying in the last year. Filipino and Samoan youth were more likely to report feeling badly about themselves as a result of cyberbullying. While cyberbullying and mental health problems varied by sex and ethnicity, we found that cyberbullying is widespread with serious potential consequences among Asian and Pacific Islander youth. A multifaceted approach is needed to reduce and prevent cyberbullying. School, family and community programs that strengthen positive relationships and promote safe use of technology provide promise for reducing cyberbullying.

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.