Hospice utilization of Medicare beneficiaries in Hawai‘i compared to other states

The objective is to examine hospice utilization among Medicare beneficiaries in Hawai‘i compared to other states. Data were from the 2014 Medicare Hospice Utilization and Payment Public Use File, which included information on 4,025 hospice providers, more than 1.3 million hospice beneficiaries, and over $15 billion in Medicare payments. Multivariable linear regression models were estimated to compare hospice utilization in Hawai‘i to that of other states. Control variables included age, gender, and type of Medicare coverage. Medicare beneficiaries using hospice in Hawai‘i differed significantly from beneficiaries in other states in several ways. Hawai‘i beneficiaries were more likely to be Asian (57% vs. 1%, p \u3c .001) and “other race” (10% vs. 0.1%, p \u3c .001), and less likely to be White (28% vs. 84%, p \u3c .001). Hawai‘i beneficiaries were also more likely to have Medicare Advantage (55% vs. 30%, p = .05). Regarding primary diagnoses, hospice users in Hawai‘i were significantly more likely to have a primary diagnosis of stroke (11% vs. 8%, p = .03) and less likely to have respiratory disease (5% vs. 11%, p = .003). In addition, hospice users in Hawai‘i were more likely to use services in their homes (74% vs. 52%, p = .03). Hawai‘i hospice users were also less likely to die while in hospice (42% vs. 47%, p = .002). Characteristics of Medicare beneficiaries in Hawai‘i differ from those in other states, regarding demographic characteristics, type of coverage, primary diagnoses, likelihood of using services in their homes, and death rates. Further research is needed to better understand factors affecting these differences and whether these differences warrant changes in policy or practice

Emergency department use among Asian adults living in the United States: Results from the National Health Interview Survey (2006 – 2013)

This paper presents secondary analyses of the National Health Interview Survey data focused on emergency department (ED) utilization among Asian adults residing in the United States. National Health Interview Survey data provided from survey years 2006-2013 was pooled and disaggregated by single-race Asian ethnic subgroups (Filipino, Chinese, Asian Indian, other Asian). We explored trends in reports of an ED visit over the survey years for the purpose of determining whether reports of an ED visit increased or decreased over survey years. We also explored background/biologic, environment, access to care, and behavior factors and their associations with having an ED visit. The majority of respondents were foreign-born (75.9%) and had lived in the United States for ten or more years (54.3%). Estimates for reports of any ED visits ranged from 8.3% for the Chinese to 15.3% for the Filipino subgroups. Filipinos were more likely to have an ED visit compared to the Chinese and other Asians (except Asian Indians). For the eight years of survey data, estimates indicate a trend of fewer reports of any ED visit among the Asian Indian and Filipino subgroups. Among Filipinos, having diabetes and a smoking history were associated with an ED visit. The odds of an ED visit were higher among Asians in the youngest age category, among other Asians born in the United States, and among those who saw/talked to a mental health professional within the previous year. As there is a paucity of information available about ED use among Asians or Asian subgroups, this report adds to the literature on patterns of health care utilization among Asian subgroups living in the United States with a specific focus on ED utilization

“Making do, as best as we can” Cancer in American Samoa: Qualitative Methods and Results

Purpose/Background: The United Nation outlines a blueprint for addressing social determinants of health (SDOH), reconciling disparities between and within countries. Indigenous people living in Small Island Developing States like the U.S. territories experience health disparities. In American Samoa (AS), SDOH involving political, social, and data limitations provide challenges to in-country research and health services delivery capacity including cancer prevention and treatment. For example, in AS less than 7% of age-eligible adults participated in colorectal cancer (CRC) screening, while the Healthy People 2020 target is 70% screened. In 2004 a cancer awareness and service needs assessment in AS funded by the National Cancer Institute reporting descriptive qualitative results was published. Cancer specific resources, as a SDOH, was found to be lacking in AS. As a response to building cancer resources , the American Samoa Community Cancer Coalition (ASCCC), a community-based organization in AS, partnered with academic researchers in Hawaii and California. In 2015 the INdigenous Samoan Partnership to Initiate Research Excellence (INSPIRE) conducted by the ASCCC was funded through the National Institute of Minority Health Disparities to improve research capacity addressing colorectal cancer disparities. Objective: To obtain an updated cancer resources assessment, a similar qualitative methodology was conducted in 2015-2016. This abstract reports on the methods and results of an updated cancer resources qualitative assessment assessing cancer resources in AS and SDOH to compare progress and priorities in cancer prevention and treatment since the 2004 assessment. Materials & Methods: A semi-structured interview guide derived from a priori codes related to cancer services and needs was co-developed by the INSPIRE community and academic research team covering areas from the 2004 assessment: data, personnel and training, equipment and supplies, prevention and treatment programs and services. INSPIRE researchers used this interview guide comprised of four questions, interviewed and audio-recorded each session. 10 key informant interviews and two focus group (N=9) were conducted. Thematic coding followed Braun and Clarke’s six step framework that involved two coders, an AS based community researcher, and an academic Hawaii based researcher, which strengthened coding from varying perspectives. A Hawaii based academic INSPIRE co-investigator served as the coding arbiter. Key informants provided rich discussion on the cancer services landscape in AS with some interviews lasting up to 90 minutes. Results: Preliminary results indicate that key informants discussed themes around medical services, personnel, and communication and collaboration as common resource limitations in cancer prevention and treatment in AS. “I feel that screening is an area that we can improve, and we have the capability to improve that, but there is very poor coordination, and it’s almost like screening something that, is broken, and there is no continuity and no communication.” Discussion/Conclusion: This qualitative assessment demonstrates some improvements on cancer prevention, treatment, resources, and SDOH, but barriers still remain since the 2004 needs assessment. Further development and planning are needed to problem solve, including identifying effective strategies, to increase cancer awareness and prevention

Community Assessment on Colorectal Cancer Screening Knowledge, Attitudes, Behavior, and Health Literacy in American Samoa: Methods and Results

urpose/Background: “Weaving” Indigenous and Western knowledges are understood to advance health equity for the Indigenous community whose own knowledge and values are often subsumed. Partnerships that support Indigenous leadership and bring Indigenous knowledge to greater parity with Western knowledge are imperative. Indigenous people living in Small Island Developing States like the U.S. territories experience health disparities. The WHO has declared non- communicable diseases as a global health epidemic, including cancer disparities. In American Samoa (AS) less than 7% of age-eligible adults participated in colorectal cancer (CRC) screening, while the Healthy People 2020 target is 70% screened. CRC may be prevented through screening and early detection. The relationship between CRC screening with knowledge, attitudes, beliefs (KAB), and health literacy has never been locally assessed in AS. AS based community researchers partnered with regional academic researchers in local research training, instrument development, data collection, and data analysis. Community relevant approaches guided assessment of CRC screening rates, CRC screening KAB, and health literacy. Objective: This abstract describes the community engaged approaches and results through the National Institute of Minority Health Disparities funded INdigenous Samoan Partnership to Initiate Research Excellence (INSPIRE), introduced at the 2015 CTR-IN annual meeting. Materials & Methods: INSPIRE principal Investigators are based in AS, operated through the American Samoa Community Coalition, a community-based organization, partnering with academic co-investigators in Hawaii and California. To assess CRC KAB and health literacy, two validated assessment instruments were adapted: The KAB survey, from self-developed and population-based instruments, and Short Test for Functional Health Literacy in Adults (S-TOFHLA). Community partners translated then back translated both surveys with three focus groups. Twenty cognitive interviews were conducted to test translation cogency. Seven AS INSPIRE research trainees participating in year-long workshops were trained on Respondent Driven Sampling (RDS). Initial participants (seeds) were recruited by social characteristics. Upon survey completion participants received coupons to each recruit three eligible participants. 713 community respondents participated in three months. An INSPIRE researcher (epidemiologist) analyzed data, with technical assistance from an academic biostatistician in Hawaii when needed fostering research capacity training. Bivariate and multivariate statistics analyzed CRC knowledge, attitudes, health literacy as correlates and predictors of self-reported screening. Results: About 65 percent of respondents finished high school; 68.9% had no insurance. Only 2 respondents completed CRC screening, but 63.3% and 82.3% of English vs Samoan survey respondents respectively would get colonoscopy. Among the 11 knowledge questions, 5 items were “don’t know” while 2 items were incorrect responses on English and Samoan surveys respectively. Almost twice as many Samoan compared to English survey respondents (81% vs. 44%) scored “inadequate” in the S-TOFHLA. Correlates and predictors of CRC screening behavior and differences in results between the respondents who took English vs Samoan surveys will be reported. Discussion/Conclusion: Almost all participants have not received CRC screening, lower than other reported AS nationwide figures. This first ever study, led by and for American Samoans obtained robust results on knowledge, attitudes, and health literacy of CRC screening to allow continued research and interventions to increase very low CRC screening rates

Academic-Community Partnership to Explore High-Smoking Prevalence in Filipina Girls

Smoking prevalence for Asian-Americans (AA) is low compared to non-AAs; however in Hawai`, the prevalence of smoking among Filipina high school girls is more than double that of Japanese high school girls. This study explored socio-cultural factors facilitating or serving as barriers against tobacco use among Filipina girls. Representatives from four community organizations, recognized for their work with Filipinos, were engaged throughout the research to facilitate the project and to ensure cultural relevance. Eleven focus groups (n=88), led by peer facilitators, discussed smoking. Twelve cultural key informants interpreted results presented from the transcripts. Results: Self-reported reasons why Filipina girls may smoke included the need to cope and to fit in. School and family responsibilities were commonly stated as barriers to smoking among Filipina girls. Nonetheless, many girls said they were given cigarettes from family members who smoked. Cultural key informants recommended conducting research on a larger sample of Filipina girls and offering family and school-based tobacco prevention programs. Conclusion: Collaboration with a variety of community partners helped provide rich qualitative data and findings regarding socio-cultural factors associated with smoking and recommendations to prevent smoking among Filipina girls. The role of family in preventing and promoting tobacco use needs further exploration. Family appears to be a promising area to explore future interventions to prevent smoking among Filipina girls

Modeling Anti-HIV-1 HSPC-Based Gene Therapy in Humanized Mice Previously Infected with HIV-1.

Investigations of anti-HIV-1 human hematopoietic stem/progenitor cell (HSPC)-based gene therapy have been performed by HIV-1 challenge after the engraftment of gene-modified HSPCs in humanized mouse models. However, the clinical application of gene therapy is to treat HIV-1-infected patients. Here, we developed a new method to investigate an anti-HIV-1 HSPC-based gene therapy in humanized mice previously infected with HIV-1. First, humanized mice were infected with HIV-1. When plasma viremia reached >107 copies/mL 3 weeks after HIV-1 infection, the mice were myeloablated with busulfan and transplanted with anti-HIV-1 gene-modified CD34+ HSPCs transduced with a lentiviral vector expressing two short hairpin RNAs (shRNAs) against CCR5 and HIV-1 long terminal repeat (LTR), along with human thymus tissue under the kidney capsule. Anti-HIV-1 vector-modified human CD34+ HSPCs successfully repopulated peripheral blood and lymphoid tissues in HIV-1 previously infected humanized mice. Anti-HIV-1 shRNA vector-modified CD4+ T lymphocytes showed selective advantage in HIV-1 previously infected humanized mice. This new method will be useful for investigations of anti-HIV-1 gene therapy when testing in a more clinically relevant experimental setting

Generational Differences and Determinants of Purchase Behavior towards Sustainable Clothing in a Developing Economy

The fashion industry contributes significant plastic pollution and greenhouse gas emissions globally. One approach to minimize the industry’s environmental impact is through a shift to sustainable clothing. This study determined the predictors of purchase behavior towards sustainable clothing in a developing economy, which is the Philippines. Furthermore, this paper compared Filipinos from Generations X and Z. Results of a multiple regression analysis from a sample of 212 participants in an online survey showed that generation and environmental knowledge predicted the purchase of sustainable clothing. Moreover, Gen Z scored higher in environmental knowledge and purchase of sustainable clothing. The findings provide insights on increasing the usage of sustainable clothing, which can significantly reduce the environmental impact of the fashion industry

Minority Health and Health Disparities Research Training (MHRT) Program at the University of Hawaii

The objective of the Minority Health Research Training (MHRT) program at the University of Hawaii at Manoa (UHM) is to encourage students from underrepresented (including minority) backgrounds to pursue careers in science; and expose students to biomedical, clinical, and behavioral health research and global health issues that relate to health disparities. The program also aims to enable collaborations between colleges/universities and out-of-state research programs. Funded by the National Institute of Minority Health and Health Disparities (NIMHD), National Institutes of Health (NIH), the UHM MHRT program is in its ninth year. The MHRT program is a short-term research training opportunity offered to undergraduate, post-baccalaureate, and pre-doctoral students from under-represented backgrounds. MHRT students are from various academic disciplines at UH and have diverse ethnic backgrounds. To date, the MHRT program has trained eight (8) cohorts of students totaling 85 students. Selected students learn to conduct research during the spring semester and spend 8-9 weeks during the summer at their international training sites under the guidance of their assigned in-country mentor and their UH mentor. In addition to life-changing research and cultural experiences, program benefits include up to10 credits of directed research courses in the spring and summer semesters, and while abroad students are provided with a stipend, travel, and living expenses.NIMHD/NIH-T37MD008636-0

Evaluating Research Centers In Minority Institutions: Framework, Metrics, Best Practices, and Challenges

The NIH-funded Research Centers in Minority Institutions (RCMI) program is currently funding 18 academic institutions to strengthen the research environment and contribution to health disparities research. The purpose of this multiphase mixed-methods study was to establish a uniform evaluation framework for demonstrating the collective success of this research consortium. Methods included discussions of aims and logic models at the RCMI Evaluators’ Workshop, a literature review to inform an evaluation conceptual framework, and a case study survey to obtain evaluation-related information and metrics. Ten RCMIs participated in the workshop and 14 submitted responses to the survey. The resultant RCMI Evaluation Conceptual Model presents a practical ongoing approach to document RCMIs’ impacts on health disparities. Survey results identified 37 common metrics under four primary categories. Evaluation challenges were issues related to limited human resources, data collection, decision-making, defining metrics, cost-sharing, and revenue-generation. There is a need for further collaborative efforts across RCMI sites to engage program leadership and community stakeholders in addressing the identified evaluation challenges and measurement. Program leadership should be engaged to apply the Evaluation Conceptual Framework and common metrics to allow for valid inter-institutional comparisons and consortium-wide evaluations. Stakeholders could ensure evaluation metrics are used to facilitate community impacts