Native Hawaiian Grandparents: Exploring Benefits and Challenges in the Caregiving Experience

Background: Increasingly, U.S. grandparents are raising their grandchildren. In Hawai‘i, 12% of Native Hawaiian grandparents live with grandchildren, compared to 7% of grandparents in all races combined in the state, and to 3.6% of grandparents in the total U.S. Although strong family-centric cultural values may provide Native Hawaiian grandparents with caregiving benefits, a generally poor health profile suggests they may also face challenges in this role. In this study, we talked to Native Hawaiian grandparents raising grandchildren (GRG) about the benefits and challenges of their caregiving experiences. Method: Three focus groups were conducted with Native Hawaiian grandparents (n=33) in Hawai‘i who were 55 years of age or older and caregivers to their grandchildren. Findings: The most prevalent themes voiced by grandparents spoke of the benefits of being a grandparent caregiver (the greatest being the experience of mutual, unconditional love) and the enjoyment of passing on “life lessons” to their grandchildren. Grandparents identified concrete examples of what they provided to grandchildren and also spoke of their role in transmission of Native Hawaiian cultural values, practices, and stories to their grandchildren. A number of challenges pertaining to grandparent caregiving were identified along with needed services—respite care, financial assistance, children’s programs, and information on grandparent legal rights. Despite these challenges, grandparents preferred to seek help from extended family rather than from formal supports. Our results support previous research on a number of universal GRG needs and services (i.e., legal rights of GRG) but also suggest potential directions to meeting the needs of Native Hawaiian GRG that are responsive to indigenous cultural values and preferences. Given the number of unmet needs expressed, further research is needed to design interventions for this population of grandparents raising grandchildren

Established Risk Factors Account for Most of the Racial Differences in Cardiovascular Disease Mortality

BACKGROUND: Cardiovascular disease (CVD) mortality varies across racial and ethnic groups in the U.S., and the extent that known risk factors can explain the differences has not been extensively explored. METHODS: We examined the risk of dying from acute myocardial infarction (AMI) and other heart disease (OHD) among 139,406 African-American (AA), Native Hawaiian (NH), Japanese-American (JA), Latino and White men and women initially free from cardiovascular disease followed prospectively between 1993–1996 and 2003 in the Multiethnic Cohort Study (MEC). During this period, 946 deaths from AMI and 2,323 deaths from OHD were observed. Relative risks of AMI and OHD mortality were calculated accounting for established CVD risk factors: body mass index (BMI), hypertension, diabetes, smoking, alcohol consumption, amount of vigorous physical activity, educational level, diet and, for women, type and age at menopause and hormone replacement therapy (HRT) use. RESULTS: Established CVD risk factors explained much of the observed racial and ethnic differences in risk of AMI and OHD mortality. After adjustment, NH men and women had greater risks of OHD than Whites (69% excess, P<0.001 and 62% excess, P = 0.003, respectively), and AA women had greater risks of AMI (48% excess, P = 0.01) and OHD (35% excess, P = 0.007). JA men had lower risks of AMI (51% deficit, P<0.001) and OHD (27% deficit, P = 0.001), as did JA women (AMI, 37% deficit, P = 0.03; OHD, 40% deficit, P = 0.001). Latinos had underlying lower risk of AMI death (26% deficit in men and 35% in women, P = 0.03). CONCLUSION: Known risk factors explain the majority of racial and ethnic differences in mortality due to AMI and OHD. The unexplained excess in NH and AA and the deficits in JA suggest the presence of unmeasured determinants for cardiovascular mortality that are distributed unequally across these populations

Ike Hawai‘i – A Training Program for Working with Native Hawaiians

Native Hawaiians in Hawai‘i experience multiple health and social problems and are highly represented in the child welfare system, in particular. There is increasing attention to the argument that some problems derive from historic trauma. The importance of the relationship of history to contemporary problems was a fundamental premise in the development of a training model for social work students. This paper describes ‘Ike Hawai‘i, a training model intended to improve the cultural competency of social work students working with Native Hawaiian clients in the public child welfare system. There are six main elements of this training: 1) Self-Disclosure, 2) Hawaiian Worldview, 3) Grief and Loss, 4) Hawaiian Historical Events, with a focus on the Mahele and the overthrow of the Hawaiian Monarchy, 5) Current Day Strengths and Challenges, and 6) Cultural Ways of Healing and Practical Suggestions for Working with Native Hawaiians. Evaluative scores and comments from students indicate that the training program has been found to be useful and helpful in their work with Native Hawaiian clients. Such a model, with its emphasis on experiential learning, self-awareness, cultural knowledge, and service implications, may have applicability for other populations and, in particular, other native peoples

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