An assessment of community capacity to prevent adolescent alcohol consumption.

To effectively address the issue of youth alcohol use, communities need to have sufficient infrastructure and capacity in place to operate effective prevention programs. This study evaluates community capacity in the state of Hawai'i, using the Capacity Assessment Survey administered to stakeholders in the youth alcohol prevention system. Capacity is quantified with gap scores, which measure the discrepancy between an agency's performance of an attribute and the attribute's relative importance. Six assessment areas, termed capacity domains, are defined. Results are given for each county and the state overall. Based on these results, communities need to prioritize capacity-building efforts specifically in the domains of effectiveness, funding/resource availability, and sustainability. Organization, workforce skills/knowledge, and cultural competency were categorized as relative strengths in comparison, but gap scores are nevertheless significantly greater than 0 ("ideal"; p < .001), indicating these areas need improvement as well. Suggestions for improvement in each capacity domain are given. This assessment is the first step in a five-step planning process to implement youth alcohol prevention programs in communities in Hawai'i.

Patients' reports about medical doctors' inquiries on their mental health: do generational status, ethnicity and mental health/substance use disorders matter?

Immigrants are less likely than others to use mental health (MH) services. Physicians' limited time often precludes inquiry about MH. This study investigated the influence of generational status, ethnicity, and mental/substance use disorders on physicians' inquiries about Asian American (AA) MH. Data from the National Latino and Asian American Study were analyzed (n=1,853). The outcome was past year physician's inquiry regarding MH. Results revealed that AA with U.S.-born parents had significantly greater odds compared to AA born outside the U.S. to report that their doctors inquired about their MH (OR=218, 95% CI: 1.28, 3.73). Past year mental/substance use disorder increased the odds of AA reporting that their doctors inquired about their MH (OR=8.41; 95% CI: 3.28, 21.66). This increase differed by ethnicity, with Chinese less affected than Vietnamese (OR=0.17; 95% CI: 0.05, 0.59). The reasons for these associations warrant further exploration.

Fire prevention in Delaware: a case study of fire and life safety initiatives.

CONTEXT: Injuries resulting from residential house fires are a significant public health issue. The fire service is engaged in fire prevention activities aimed at preventing fire-related morbidity and mortality. The fire service in Delaware is regarded by some leaders in the field as a model for fire and life safety education (FLSE). OBJECTIVE: We identified 3 questions to guide this research. What is the culture and context of fire prevention in Delaware? What prevention programs and policies constitute Delaware's fire prevention efforts? What can be learned from select model programs regarding their impact, sustainability, strengths, limitations, and general applicability? A discussion of the lessons learned from Delaware's experience with FLSE initiatives concludes the article. DESIGN: We used a single case study design and collected and analyzed data from in-depth interviews, documents, and participant observation notes to address the research questions. SETTING: Data were collected in Delaware. PARTICIPANTS: Interviewees included a purposeful sample of members of the Delaware fire service. MAIN OUTCOME MEASURES: Descriptions of the context in which fire prevention occurs, the initiatives underway, and the factors associated with successfully supporting fire prevention in the state. RESULTS: Data from 16 key informant interviews, relevant documents, and direct observations of FLSE events revealed a fire service rooted in tradition, dedication, and community. A compilation of state and local FLSE initiatives illustrates the diversity of FLSE in Delaware. Thematic analysis of the data emphasize the importance of a strategic, comprehensive, and coordinated approach to realizing success in Delaware's approach to FLSE. CONCLUSIONS: The fire service is an important part of the public health infrastructure. While their role as first responders is evident, their contributions to prevention are also significant. This research suggests ways to support fire service prevention efforts and more fully integrate their FLSE work into the public health infrastructure.

Trends in alcohol use among Hawai'i adolescents.

It is important to review trends in youth alcohol use over time in order to effectively tailor prevention programs to address those trends. This article reviews data on alcohol use behaviors from the Centers for Disease Control and Prevention's Youth Risk Behavior Survey in Hawai'i from 1993 to 2007. Five alcohol use indicators were examined and stratified by grade level, from 9th grade through 12th grade. Significant drops in nearly all indicators are seen among 9th through 11th graders, but not among 12th graders. This suggests that Hawaii youth are responding well to anti-alcohol messaging as young teens, but a different approach may be needed to target older teens.

Generational status and family cohesion effects on the receipt of mental health services among Asian Americans: findings from the National Latino and Asian American Study.

OBJECTIVES: We investigated the relative strengths of generational status and family cohesion effects on current use of mental health services (past 12 months) among Asian Americans. METHODS: We conducted a secondary data analysis with data from the National Latino and Asian American Study, 2002 to 2003, restricted to Asian American respondents (n=2087). The study's outcome was current use (past 12 months) of any mental health services. Respondents included Chinese, Filipino, Vietnamese, and other Asian Americans. RESULTS: Multivariate analyses suggest no significant interaction exists between second- versus first-generation Asian Americans and family cohesion. The impact of generational status on mental health service use was significant for third- or later-generation Asian Americans (versus first-generation Asian Americans) and varied with family cohesion score. CONCLUSIONS: Family cohesion and generational status both affect the likelihood of Asian Americans to seek mental health services. Our findings also highlight the need for primary care and other providers to consistently screen for mental health status particularly among first-generation Asian Americans. Mental health service programs should target recent immigrants and individuals lacking a strong family support system.

Disparities in self-reported postpartum depression among Asian, Hawaiian, and Pacific Islander Women in Hawaii: Pregnancy Risk Assessment Monitoring System (PRAMS), 2004-2007.

Postpartum depression affects 10-20% of women and causes significant morbidity and mortality among mothers, children, families, and society, but little is known about postpartum depression among the individual Asian and Pacific Islander racial/ethnic groups. This study sought to indentify the prevalence of postpartum depression among common Asian and Pacific Islander racial/ethnic groups. Data from the Hawaii Pregnancy Risk Assessment and Monitoring System (PRAMS), a population-based surveillance system on maternal behaviors and experiences before, during, and after the birth of a live infant, were analyzed from 2004 through 2007 and included 7,154 women. Questions on mood and interest in activities since giving birth were combined to create a measure of Self-reported Postpartum Depressive Symptoms (SRPDS). A series of generalized logit models with maternal race or ethnicity adjusted for other sociodemographic characteristics evaluated associations between SRPDS and an intermediate level of symptoms as possible indicators of possible SRPDS. Of all women in Hawaii with a recent live birth, 14.5% had SRPDS, and 30.1% had possible SRPDS. The following Asian and Pacific Islander racial or ethnic groups were studied and found to have higher odds of SRPDS compared with white women: Korean (adjusted odds ratio [AOR] = 2.8;95% confidence interval [CI]: 2.0-4.0), Filipino (AOR = 2.2;95% CI: 1.7-2.8), Chinese (AOR = 2.0;95% CI: 1.5-2.7), Samoan (AOR = 1.9;95% CI: 1.2-3.2), Japanese (AOR = 1.6;95% CI: 1.2-2.2), Hawaiian (AOR = 1.7;95% CI: 1.3-2.1), other Asian (AOR = 3.3;95% CI: 1.9-5.9), other Pacific Islander (AOR = 2.2;95% CI: 1.5-3.4), and Hispanic (AOR = 1.9;95% CI: 1.1-3.4). Women who had unintended pregnancies (AOR = 1.4;95% CI: 1.2-1.6), experienced intimate partner violence (AOR = 3.7;95% CI: 2.6-5.5), smoked (AOR = 1.5;95% CI: 1.2-2.0), used illicit drugs (AOR = 1.9;95% CI: 1.3-3.9), or received Women, Infant, and Children (WIC) benefits during pregnancy (AOR = 1.4;95% CI: 1.2-2.6) were more likely to have SRPDS. Several groups also were at increased risk for possible SRPDS, although this risk was not as prominent as seen with the risk for SRPDS. One in seven women reported SRPDS, and close to a third reported possible SRPDS. Messages about postpartum depression should be incorporated into current programs to improve screening, treatment, and prevention of SRPDS for women at risk.

Racial differences in the association between partner abuse and barriers to prenatal health care among Asian and native Hawaiian/other Pacific Islander women.

OBJECTIVES: Prenatal health care (PNC) is associated with positive maternal and infant health outcomes. There is limited knowledge regarding Native Hawaiians/Other Pacific Islanders (NHOPI) and Asian women's access to PNC especially among those with partner abuse (PA) experience. The objectives of this paper were to (1) describe and examine factors associated with PNC access barriers among mothers, by race; and, (2) determine the association between PA and PNC access, by race. METHODS: We analyzed 2004-2007 data from Hawai'i's Pregnancy Risk Assessment Monitoring System (n = 7,158). The outcome is > or = 1 experience with a PNC access barrier. PA is experience with physical violence from a partner. Descriptive statistics, and bivariate and multivariate logistic regression analyses stratified by race were conducted. RESULTS: The respondents included 35.7% NHOPI, 37.4% Asian, 20.1% White and 6.6% Other. More than 6% experienced PA, and 25.9% reported > or = 1 PNC access barrier. Experience with PA was significantly associated with NHOPI and Asians reporting > or = 1 barrier to accessing PNC, but was non-significant with Whites. CONCLUSIONS: Programs should address barriers to accessing PNC, and target NHOPI and Asian mothers with PA experience to reduce the healthcare disparity and improve quality of life.

Social connections, immigration-related factors, and self-rated physical and mental health among Asian Americans.

Focusing on Asian Americans, this study examines how self-rated physical and mental health depends on the layered social connections (including 4 types: family cohesion, relative support, friend support, and neighborhood cohesion), socioeconomic status, and immigration-related factors (including nativity, length of residence in the U.S., and proficiency of the English language). It draws on the 2002-2003 National Latino and Asian American Study, a nationally representative household survey of Latino and Asian Americans. Findings of this study include: (1) there are significant differences in self-rated physical health among Asian Americans of different national origin, but their self-rated physical health differences diminish after indicators of socioeconomic status and immigration-related factors are considered; (2) four types of social connections are all related to the self-rated physical and mental health of Asian Americans, but the patterns of the associations as well as the mechanisms linking the associations vary; and (3) family cohesion has independent and direct effects on both self-rated physical and mental health over and above controls and mediators, whereas the effects of other social connection measures are partially mediated by socioeconomic status and immigration-related factors. In sum, this study indicates the significant effects of social connections, socioeconomic status, and immigration-related factors on the self-rated physical and mental health of Asian Americans.

A longitudinal analysis of depressive symptoms among Asian and Pacific Islander mothers at-risk for child maltreatment.

This longitudinal study examined racial differences in depressive symptoms at three time points among Asian, Native Hawaiian/Other Pacific Islander (NHOPI) and white mothers at-risk for child maltreatment (n = 616). The proportion of mothers with depressive symptoms ranged from 28 to 35% at all time points. Adjusted analyses revealed that Asian and NHOPI mothers were significantly more likely than white mothers to have depressive symptoms but this disparity was present only among families at mild/moderate risk for child maltreatment. Future research should identify ways to reduce this disparity and involve the Asian and NHOPI communities in prevention and treatment program design and implementation.

The implementation and utility of fire incident reporting systems: the Delaware experience.

Fires and burns are the fifth most common cause of unintentional injury deaths in the United States. To address fires and fire deaths, the National Fire Data Center (NFDC) established the National Fire Incident Reporting System (NFIRS) as a surveillance system for fires. Delaware implemented NFIRS as the Delaware Fire Incident Reporting System (DFIRS), and is currently capturing all fires reported in the system. The objectives of this study are to: 1) understand the implementation of DFIRS; 2) analyze data from DFIRS to describe fire incidents; and 3) inform other states' fire surveillance efforts. We interviewed Delaware State Fire Marshal's Office personnel to understand the implementation of DFIRS and analyzed DFIRS data from May 2003 to December 2004 to examine data completeness, and characteristics of fires, smoke alarms, and fire injuries and deaths. DFIRS captures 100% of Delaware fires reported to fire departments. Data completeness for the fields examined ranged from 33% to 100%. Fires in which smoke alarms alerted occupants were significantly less likely to result in injury or death than fires in which smoke alarms did not. DFIRS has the potential to serve as a valuable fire prevention and fire analysis tool. For DFIRS to reach its full potential as a surveillance system, increased attention to data completeness is necessary.

Substance abuse among native Hawaiian women in the United States: a review of current literature and recommendations for future research.

Information about and understanding of Native Hawaiian substance abuse and utilization of substance abuse treatment services is limited. This article reviews the literature on the prevalence and factors associated with substance abuse and use of health services among Native Hawaiian women in the U.S. The literature review included three review and 13 nonreview articles that were published through December 2006. The majority of the articles reviewed did not present findings by gender-ethnic group. The review of the literature suggested a high prevalence of substance abuse, especially among those who were incarcerated. Risk factors for substance abuse included not being married and young age.Native Hawaiian women also had significantly lower health care utilization rates compared to other groups, and were less likely to have seen a health care provider in the past year. Programs should consider involving Kupunas ("elders") in the design and implementation of culturally appropriate programs in order to better serve the needs of Native Hawaiian women. Further research is needed about the rates of substance abuse and barriers and facilitators to treatment so that effective and culturally competent treatment can be provided for this population.

Disparities in use of mental health and substance abuse services by Asian and Native Hawaiian/other Pacific Islander women.

The purpose of this study was to determine if disparities exist in lifetime utilization of mental health/substance abuse services among Asian, Native Hawaiian/Other Pacific Islander (NHOPI) and white mothers. The study sample was comprised of mothers assessed to be at-risk (n = 491) and not at-risk (n = 218) for child maltreatment in the Hawaii Healthy Start Program study. Multiple logistic regression models were used to test the effects of predisposing, need, and enabling factors on utilization of services. Results revealed that, among mothers with depressive symptoms, compared with whites, Asians and NHOPI were significantly less likely to have received services. There were no significant racial differences in use of mental health/substance use services by other factors. These results suggest that racial disparities exist in utilization of mental health/substance abuse services among mothers with depressive symptoms. Future research is needed to identify barriers and facilitators to accessing needed services for Asian and NHOPI women.

Evaluated community fire safety interventions in the United States: a review of current literature.

The purpose of the study was to assess the state of fire prevention research, provide an updated synthesis of evaluated fire prevention programs, and discuss the role of fire fighters and data systems in prevention efforts. The review included all evaluations of U.S. based fire prevention interventions published between January 1998 and September 2004 and any earlier articles about U.S. fire prevention interventions not included in two prior review articles. We retrieved information from each identified study including evaluation findings, involvement of fire service personnel and use of existing data systems. We identified twelve articles: seven reported on smoke alarm interventions, three on multi-faceted programs, and two other programs. Five programs involved fire service personnel in the design, implementation, and/or evaluation, and three used existing data systems. Studies reviewed suggest that canvassing and smoke alarm installations are the most effective means of distributing alarms and increasing the functional status of distributed alarms. The functionality of smoke alarms, an issue noted in earlier reviews, remains a problem. Programs involving partnerships with fire departments have indicated success in preventing fires and deaths, improving smoke alarm ownership and functional status, and improving children's fire safety knowledge. Using existing data systems to target and to evaluate interventions was effective. In the years since prior reviews, some improvements in the rigor of evaluation designs have been made, but there is still a need for high quality evaluations that will inform fire injury prevention efforts.