Search Results (122)

Background: This study examined treatment outcomes for cannabis use disorder (CUD) among adolescents (12–17 years old) in the United States. Methods: Data from the 2018–2021 Treatment Episode Data Set-Discharges (TEDS-D) included 40,054 adolescents diagnosed with CUD. Descriptive statistics, Chi-square tests, and multivariable logistic regression assessed treatment outcomes and factors associated with treatment completion. Results: Only 36.8% of adolescents completed treatment. The most common reasons for not completing treatment were dropping out (28.4%) and transferring to another facility/program (17.0%). Males and Black non-Hispanic adolescents had lower odds of completing treatment (OR = 0.79, 95%CI: 0.75–0.84), while Hispanic (OR = 1.13, 95%CI: 1.08–1.18), Asian (OR = 1.56, 95%CI: 1.3–1.86) and Native Hawaiian/Pacific Islander adolescents (OR = 2.31, 95%CI: 2.04–2.61) had higher odds of completion compared to their White counterparts. Independent living arrangements, homelessness, arrests in the past 30 days and younger age (<15 years old) decreased the likelihood of treatment completion. Adolescents with co-occurring mental health and substance use disorders also had lower completion rates (OR = 0.79, 95%CI: 0.77–0.86). Referral from schools/employers and treatment settings were associated with a higher success, particularly with stays of 4–6 months and 7–12 months. Conclusion: This study highlights the need for targeted CUD treatment programs that support at-risk adolescents, especially those experiencing homelessness or facing legal issues. High dropout and transition rates suggest a need for continuity of care and program integration between facilities. Strengthening coordination among public health officials, community organizations, and stakeholders is essential to developing culturally responsive treatment interventions that address social determinants of health, substance use, and mental health in this vulnerable population. Full article

Introduction: Cannabis use disorder (CUD) is being increasingly diagnosed in the United States, but access to treatment remains unequal, particularly in New York. Identifying the factors that contribute to disparities in receiving treatment for CUD among different population groups is essential for ensuring effective and targeted interventions. This study explores the sociodemographic factors influencing treatment utilization for CUD in New York. Methods: Data for this study were retrieved from the 2018 Treatment Episode Data Set—Discharges (TEDS-D) of the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA). Sample size for the study is 422,319 people with CUD. Logistic regression analysis was performed to examine the odds of receiving treatment for CUD based on demographic and socioeconomic factors, as well as the type of treatment setting. Results: The results revealed significant disparities in treatment utilization. Asians/Pacific Islanders and Hawaiian Natives had lower odds of receiving treatment compared to African Americans (OR = 0.367, 95% CI 0.341–0.394). Similarly, Caucasians had the lowest odds of receiving treatment (OR = 0.270, 95% CI 0.266–0.275). Females were less likely to receive treatment compared to males (OR = 0.756, 95% CI 0.744–0.768). Those with higher educational attainment (over four years of college) had the lowest odds of receiving treatment, while individuals with 9–11th grade education had the highest odds. Employment status also influenced treatment access, with the unemployed having the highest odds, and full-time employees having the lowest. Additionally, individuals with no source of income had significantly lower odds of receiving treatment. Conclusions: This study highlights significant disparities in the provision of treatment for CUD in New York, influenced by sociodemographic factors such as race, gender, age, education, and employment status. These findings emphasize the need for targeted interventions to reduce these disparities and improve treatment access for underserved populations. Full article

Aprostocetus nitens Prinsloo & Kelly (Hymenoptera: Eulophidae) was identified as one of four hymenopteran ectoparasitoids utilizing three erythrina gall wasps, Quadrastichus bardus, Q. erythrinae, and Q. gallicola) (Hymenoptera: Eulophidae) in the native eastern Africa. In Hawaiʻi, the eurytomid wasp, Eurytoma erythrinae Gates & Delvare (Hymenoptera: Eurytomidae), was introduced and approved for statewide release in 2008 to control the erythrina gall wasp (EGW) Q. erythrinae Kim. EGW has devastated the wiliwili trees, Erythrina sandwicensis Degener (Fabaceae), an ecologically and culturally important native Hawaiian tree species. However, the parasitoid’s impact on the galled inflorescences and shoots was not adequate to ensure adequate seed set and maturation for successful tree recruitment. Aprostocetus nitens was thus evaluated as a prospective natural enemy to enhance the biological control of EGW to further protect the wiliwili trees in Hawaiʻi. Both choice and no-choice host specificity tests were conducted on seven non-target gall formers in the Hawaii Department of Agriculture, Insect Containment Facility, and showed that the parasitoid was extremely specific to EGW. The potential for competition between this parasitoid and the established E. erythrinae was also investigated, showing that the release of a second parasitoid will potentially complement the success of the eurytomid wasp for control of EGW. Unlike what was found in the native region, the Hawaiian laboratory colony is thelytokous, producing only female offspring. The life cycle took 20.1 ± 0.28 days under the laboratory conditions. Non-ovipositing female survived for 102.5 ± 2.9 days when fed honey and laid eggs for 25.1 ± 2.3 days with average fecundity of 156.7 ± 22.3 offspring/female. This value is 3.9-fold higher than offspring produced by E. erythrinae. Aprostocetus nitens, host specificity, competition with E. erythrinae, and its tri-trophic association with 15 Erythrina host plants and 5 gall wasp assemblages in the native African regions were defined. Implications to reduce frequent galls on the native Erythrina plants and likely domination over E. erythrinae, are discussed. Full article

Background: The quality of healthcare experiences for Indigenous communities is worse when compared to non-Indigenous patients. Bias and discrimination within healthcare systems relate to worsened care and worsened health outcomes for Indigenous patients. The purpose of this study was to learn about the experiences of Indigenous people within healthcare settings, as well as their viewpoints for improving healthcare delivery to this population. Methods: Indigenous research methods were employed in this study as clinic administrators and staff, elders, and Indigenous researchers collaborated on the study purpose, design, and analysis. Twenty Indigenous patients participated in one of four focus groups regarding their experiences with healthcare systems. Results: Seven main themes emerged, highlighting participants’ experiences during health encounters, in relation to healthcare systems, and Indigenous health beliefs. Participants discussed challenges and barriers in each area and offered recommendations for care delivery to this population. Conclusions: Participants in this study highlighted that biased care results in poor quality of healthcare delivery and that there are actionable steps that providers and systems of healthcare can take to reduce bias within healthcare systems. The provision of culturally congruent care is imperative in improving the health and well-being of Indigenous communities. Full article

Indigenous women experience disproportionately higher rates of adverse health outcomes. Few studies have explored the root of these problems or defined health and wellness from the perspectives of Indigenous women. Our objective was to elicit views on Indigenous women’s health from women who are Indigenous and/or have experience working with Indigenous communities across Turtle Island and Hawai‘i (e.g., United States). Informed by intersectionality as a social critical theory, we convened a workshop to engage in a co-creative consensus-building and expert decision process using design thinking. The two-day workshop embraced Indigenous values of land, sacred spaces, genealogy, family, rituals, and culture. Participants included United States-based Native and Indigenous women (n = 16) and allies (n = 7). Participants focused on answering key questions such as “What are priority areas for Indigenous women’s health”? and “What are the key facilitators and barriers to improving Indigenous women’s health”? Co-created priority lists for each of these topics were generated. Participants overwhelmingly reported satisfaction with the workshop process and emphasis on a strength-based, culturally driven approach to share their stories, which contextualized the ideas, concerns, and priorities of Indigenous women who self-reflected on their own health and wellness. Creating culturally safe spaces for Indigenous people to reflect on their own hopes for the future relates to the theme by describing a process to bridge traditional healing with modern-day practices to build pilina. Full article

Background/Objectives: This study examines the factors associated with U.S. adolescents’ obesity and overweight status. Methods: Using a multivariable logistic regression, we analyzed the data from the 2021 Youth Risk Behavior Surveillance System (YRBSS), comprising 17,232 students. Results: The odds of being obese or overweight were significantly higher (p ≤ 0.05) for the participants who perceived themselves as slightly overweight (AOR, 13.31; 95% CI [11.83, 14.97]) or very overweight (AOR, 39.29; 95% CI [30.12, 51.25]) compared to those who perceived their weight as about right. The participants with significantly higher odds included those aged 14 years (AOR, 2.53) compared to those aged 13 years or younger; male students (AOR, 1.63) compared to female students; and American Indian/Alaska Native and Native Hawaiian/Other Pacific Islander students (AOR, 2.11), Black or African American students (AOR, 2.63), Hispanic/Latino students (AOR, 1.54), and students of multiple races (AOR, 1.56), compared to White students. The odds were also significantly higher for the participants who did not eat breakfast on all seven days of a week (AOR, 1.21) and for the students who did not report their mental health status (AOR, 2.07) compared to those who reported their mental health as mostly or always not good. Conclusions: These findings suggest schools are uniquely positioned to implement strategies for healthier behaviors designed and implemented with a focus on health equity. Full article

This study examines predictors of life satisfaction in Native Hawaiian and Pacific Islander (NH/PI) college students, who form an underrepresented group in well-being research. In a sample of 128 NH/PI students from a public university in Hawaii, self-report measures of life satisfaction, affect, stress, and mood were analyzed. The results indicate that positive affect and mood are significant positive predictors for life satisfaction, while negative affect predicts lower satisfaction. By contrast with other racial/ethnic groups, perceived stress did not significantly impact life satisfaction in NH/PI students. These findings suggest that emotional well-being is a key determinant for life satisfaction in NH/PI students, and stress is not. Culturally responsive interventions that focus on positive emotions and community support can enhance well-being and academic success in this population. This study contributes to the understanding of unique cultural influences on well-being in NH/PI students and provides implications for targeted interventions. Full article

Given rising mental health concerns among Pacific Islander (PI) adolescents, this population remains underserved by available mental health resources. This interpretative phenomenological analysis with focus groups (IPA-FG) examined the lived experiences and perceptions of 19 male PI adolescents (ages 14–16) from Native Hawaiian, Maori, Samoan, and Tongan backgrounds regarding mental health help-seeking behaviors. Four overarching themes emerged: stigma and judgment, cultural misalignment in professional services, impact of disclosure and perceived punitive consequences, and a complex ecosystem of trusted relationships as mental health support. Notably, participants expressed belief that disclosing mental health challenges would “ruin their lives” and held misconceptions about adults’ ability to address mental health concerns. These findings are particularly significant given high suicidality rates among PI adolescents. This study provides insights for developing culturally responsive mental health interventions and highlights the urgent need to address mental health stigma within PI communities. Implications for practice are discussed. Full article

Native Hawaiians (NHs) are a historically oppressed population disproportionately burdened by diabetes and related complications. The Kilolani Project, a patient navigator-centered, chronic disease management program, targets upstream drivers of health among vulnerable NH adult patients with diabetes within an urban academic safety-net clinic. To investigate the impact of the Kilolani Project, we performed a qualitative study to examine patient perspectives. Our goal is to ensure that their values, needs, and priorities drive future navigator-based strategies and healthcare delivery. Fifteen current Kilolani Project patients participated in one of three focus group sessions. Each session followed a semi-structured format with open-ended questions regarding their experiences with the Kilolani Project, patient navigators, and healthcare in general. Iterative transcript readings and coding revealed seven core themes: (1) Humanistic approach, (2) Trusting relationships, (3) Improved access, (4) Trauma-informed care, (5) Self-efficacy, (6) Resilience, and (7) Ethnic concordance. The Kilolani Project created a safe and culturally relevant experience for NH patients. They felt seen, heard, and valued, which resulted in an improved healthcare experience, engagement, and empowerment. Importantly, trust was the cornerstone to building a provider–patient relationship. Such culturally informed approaches are necessary to close the gap in health disparities faced by our NH communities. Full article

Performance methodologies take many forms—performative writing, poetic transcription, and co-performative witnessing, to name only a few—and can be both process and product, differentiating and unifying a group between and across differences. As a social work researcher committed to decolonial, liberatory methodologies that make and bring meaning to the communities I work with, performance methodologies fill a gap that other qualitative research methods can only begin to approach. This project is an exploration in performance methodologies and Critical Suicidology through the lens of social work research, with a case study derived from a performance documenting suicide prevention research with Native Hawaiians. This study sought to understand connections between suicide risk and experiences of colonization among Native Hawaiians and among LGBTQ Native Hawaiians. The findings point to the importance of relationships, cultural understandings of identity and identification, and healing through cultural practices. Sections from the performative text, including voices from the participants, as well as feedback gathered from performances of the research, are woven together with academic narrative to form a creative and critical report of the research. Full article

Once scarred by decades of military exploitation, Kahoʻolawe has become a symbol of resilience and cultural healing for the Kanaka Maoli, Native Hawaiian. Through Kahoʻolaweʻs ongoing restoration, the island has emerged as a cultural kīpuka (an oasis of life within a barren landscape), offering pathways for Kanaka Maoli to reconnect with their ancestral roots and foster resilience in the face of historical and contemporary trauma. Grounded in personal experiences and cultural reflections, this essay explores how reconnecting with Kahoʻolawe as a place of cultural resurgence can deepen one’s understanding of the restorative power of land connection. Aloha ʻāina, a deeply held Kanaka Maoli worldview that emphasizes a sacred, reciprocal relationship with the land. By engaging in cultural protocols and land stewardship practices on Kahoʻolawe, practitioners of aloha ʻāina contribute to the healing of intergenerational trauma rooted in colonial dispossession and ecological degradation. Thus, traditional practices, such as oli (chant), mālama ʻāina (land care), and kūkākūkā (deep discussions/processing) on Kahoʻolawe facilitate a powerful process of healing that connects individuals with ancestral knowledge and cultivates resilience across generations. These practices serve as an alternative to Western trauma healing modalities by asserting a culturally specific framework that validates the inseparability of land and identity for Indigenous healing. Full article

Historical trauma has been established as a determinant of health among all Hawaiians, but limited research exists on how Wāhine (Native Hawaiian women) uniquely experience historical trauma. A phenomenological qualitative study was conducted to primarily understand how historical trauma, trauma response, and the transmission and modes of intergenerational trauma intersect with sexism and patriarchy among contemporary Wāhine, as described in the Historical Trauma Conceptual Model. With partnership and approval of the Waimānalo Pono Research Hui, interviews were conducted with 13 Wāhine from various generations in Hawai’i. The structural, institutional, interpersonal, and internal levels of ‘Eha (loosely translated as hurt/suffering/to inflict pain/cause hurt or suffering) were generated as prominent themes from the data. Findings from this project communicate the urgency for change to heal Wāhine with radical aloha and to support them in reimagining a world that is inclusive of their needs. Full article

Compared to the general population of Hawai‘i, Native Hawaiians and Other Pacific Islanders (NHPI) shoulder a disproportionately high risk for obesity-related cardiometabolic disorders, such as type 2 diabetes and cardiovascular disease. The gut microbiome is an area of rapid research interest for its role in regulating adjacent metabolic pathways, offering novel opportunities to better understand the etiology of these health disparities. Obesity and the gut microbiome are influenced by regional, racial–ethnic, and community-specific factors, limiting the generalizability of current literature for understudied populations. Additionally, anthropometric and directly measured obesity indices are variably predictive of adiposity and metabolic health risk in this diverse population. Thus, further NHPI-inclusive research is required to adequately characterize community-specific factors in the context of obesity-related disease etiology. Culturally responsible research ethics and scientific communication are crucial to conducting such research, especially among indigenous and understudied populations. In this review, we explore these limitations in current literature, emphasizing the urgent need for NHPI-inclusive research to assess community-specific factors accurately. Such accuracy in Indigenous health research may ensure that findings relevant to individual or public health recommendations and/or policies are meaningful to the communities such research aims to serve. Full article

The purpose of this study is to describe the development and initial validation of a survey focused on problematic situations involving e-cigarette use by rural Native Hawaiian and Pacific Islander (NHPI) youths. A 5-phase approach to test development and validation was used. In Phase 1 (Item Generation), survey items were created from a series of focus groups with middle school youths on Hawai‘i Island (N = 69). In Phase 2 (Item Refinement and Selection), situational items were reduced to 40 e-cigarette offer situations that were selected for inclusion in the survey. In Phase 3 (Item Reduction), items were administered to 257 youths from 11 middle, intermediate, or multi-level public or public-charter schools on Hawai‘i Island. Exploratory factor analysis indicated the presence of three factors accounting for 50% of the variance: E-Cigarette Offers from Friends (24%), E-Cigarette Offers from Non-Friends (16%), and Coercive Pressure to Use E-Cigarettes (10%). Hypothesized relationships between offer situations and e-cigarette use were partially confirmed, supporting the construct validity of the survey. This survey helps to fill the scientific and practice gap in measuring ecodevelopmental risk and protection for e-cigarette use and has implications for e-cigarette use prevention with rural, NHPI, and/or Indigenous youth populations. Full article

Background: Differences in the incidence of breast cancer subtypes among racial/ethnic groups have been evaluated as a contributing factor in disparities seen in breast cancer prognosis. We evaluated new breast cancer cases in Hawai’i to determine if there were subtype differences according to race/ethnicity that may contribute to known disparities. Methods: We reviewed 4591 cases of women diagnosed with breast cancer from two large tumor registries between 2015 and 2022. We evaluated breast cancer cases according to age at diagnosis, self-reported race, breast cancer subtype (ER, PR, and HER2 receptor status), histology, county, and year. Results: We found both premenopausal and postmenopausal Native Hawaiian women were less likely to be diagnosed with triple-negative breast cancer (OR = 0.26, 95% CI 0.12–0.58 p = 0.001; OR = 0.54, 95% CI 0.36, 0.80 p = 0.002, respectively). Conclusions: The results of our study support that there are racial/ethnic differences in breast cancer subtypes among our population, which may contribute to differences in outcomes. Further evaluation of clinical and pathological features in each breast cancer subtype may help improve the understanding of outcome disparities seen among different racial/ethnic groups. Full article