A quasi-experimental prospective study was conducted to assess the stage of change progression an... more A quasi-experimental prospective study was conducted to assess the stage of change progression and elimination of unhealthy behaviors among active duty Army soldiers and their spouses (N = 245) before and after attending a community-based wellness program. Significant differences in stage progression between the intervention group and a comparison group was seen in the fitness (p = 0.05) and communication risk categories (p = 0.03) immediately after the intervention; significant differences in stage progression in fitness (p = 0.05) and spirituality (p = 0.005) risk categories 6 months after baseline. There was a significant increase in seat belt use (p = 0.008), a decrease in reported tobacco use (p < 0.05), and a reduction in family stress (p = 0.06) and personal stress (p < 0.02) in the intervention group. Targeting multiple behavior changes and risk reduction in a single intervention program presents several challenges. In this pilot study, there were many positive nonsignificant trends in risk reduction that might translate into significant changes with a larger sample.
Objective The purpose of this study was to examine primary cesarean delivery rates among women wi... more Objective The purpose of this study was to examine primary cesarean delivery rates among women with low risk pregnancies in urban and rural hospitals in Hawaii. Methods This is a retrospective study of all low-risk women (term, vertex, singleton) who had a primary cesarean delivery in any Hawaii hospital from 2010 to 2011 using a statewide health information database. Hospitals were divided into two categories: rural and urban. Results Of the 27,096 women who met criteria for this study, 7105 (26.2 %) delivered in a rural hospital. Low-risk women who delivered in a rural hospital had a primary cesarean delivery rate of 18.5 % compared to 11.8 % in the urban hospitals, p < .0001. Low-risk women who delivered at rural hospitals had significantly higher unadjusted and adjusted odds ratios for cesarean delivery. The association with rural hospital was stronger after adjusting for confounders, aOR 2.47 (95 % CI 2.23-2.73) compared to unadjusted OR 1.70 (95 % CI 1.58-1.83) for primary cesarean delivery. Conclusions on practice In a geographically isolated population, rates of primary cesarean delivery among low-risk women are significantly higher in rural hospitals. This disparity should be investigated further.
With rapid economic development in China, traditional patterns of health behaviors are changing, ... more With rapid economic development in China, traditional patterns of health behaviors are changing, concurrent with a rise in childhood obesity. While the home environment and parenting behaviors are modifiable factors that could be targeted for intervention, little is known about their relationship with children's health behaviors. Therefore, the purpose of this study was to investigate the relationship between obesity and home and parenting factors in Chinese children. A cross-sectional survey was conducted in Nanchang, China in 2013 with caregivers (N = 470) of a child between the ages of 2 and 10 years. Regression analyses were conducted to determine risk factors for childhood obesity. Obesity prevalence (21.7%) did not differ by demographic variables. Eight physical activity, nutrition, and sedentary variables had significant relationships to obesity status. Logistic regression analysis revealed three significant predictors of obesity: the number of days the family eats meals ...
This article reports the outcomes of a systematic review of observational park-based physical act... more This article reports the outcomes of a systematic review of observational park-based physical activity (PA) studies. Five electronic databases and the Active Living Research website were searched in July 2015 to identify relevant articles. Studies were included if they: a) reported observational data collected at outdoor park-based settings during free living conditions, b) reported results of a park audit, c) included PA as an outcome measure of the park audit, and d) were published after 1990 in English-language peer-review journals. Thirty-two articles, reporting outcomes of 26 unique studies, met inclusion criteria for review. Most studies (n=20, 87%) had cross-sectional or non-interventional study designs, while 6 (23%) employed quasi-experimental designs. Studies were predominately conducted in the U.S. (n=19, 76%). The median number of park users across studies was 4558 (Range=815 to 76,632). Approximately half (51%) of all park users were female. Eighty-one percent of studies (n=21) reported PA outcomes for individuals of all ages, while 4 studies (15%) reported PA outcomes for children only and 1 study (4%) for adults only. Moderate-to-vigorous physical activity (MVPA) of park users ranged from 31% to 85% (Median=55.0%). Studies conducted in the U.S. reported a slightly higher median number of park-users engaging in MVPA than those outside the U.S. (60.5% vs. 52.8%). Fifteen studies examined gender differences in MVPA. Among these, 12 (87%) reported more males engaging in MVPA than females. Results of this review highlight the need for innovative strategies to promote MVPA among park users and to increase park use among children.
Hawai'i journal of medicine & public health : a journal of Asia Pacific Medicine & Public Health, 2015
Schools of Public Health have a wide variety of essential stakeholders. Broad input in program pl... more Schools of Public Health have a wide variety of essential stakeholders. Broad input in program planning should assist in ensuring well-developed plans and strong community buy-in. The planning of a school can better address the needs of multiple stakeholders from systematic broad-based input from these constituents using concept mapping. In this study, we used concept mapping to prioritize a set of recommendations from diverse stakeholders to assist in the process of planning a school. A set of statements was generated on essential elements for the proposed school from a broad group of stakeholders. The statements were then distilled into unique themes, which were then rated on importance and feasibility. Cluster maps and pattern matches were used to analyze the ratings. Unique themes (N = 147) were identified and grouped into 12 clusters. Cluster themes included leadership, faculty, culture, school, and curriculum. Pattern matches revealed a significant, modest correlation between ...
Hawai'i journal of medicine & public health : a journal of Asia Pacific Medicine & Public Health, 2015
In 2011, a small pilot bike share program was established in the town core of Kailua, Hawai'i... more In 2011, a small pilot bike share program was established in the town core of Kailua, Hawai'i, with funding from the Hawai'i State Department of Health. The Kailua system consisted of two stations with 12 bicycles, and the goal was to secure additional funding to expand the station network in the future. Community feedback consistently indicated support for the bike share program. However, system metrics showed low levels of usage, averaging 41.5 rides per month (2011-2014). From observational data, users were primarily tourists. With minimal local staff, the bike share program had limited resources for promotion and education, which may have hindered potential use by local residents. Management of station operations and bike maintenance were additional, ongoing barriers to success. Despite the challenges, the pilot bike share program was valuable in several ways. It introduced the bike share concept to Hawai'i, thereby helping to build awareness and connect an initial n...
ABSTRACT BACKGROUND: The State of Hawaii Departments of Health and Education developed a three-ye... more ABSTRACT BACKGROUND: The State of Hawaii Departments of Health and Education developed a three-year Model Schools program in which seven schools agreed to enhance their physical education (PE) curricula and increase opportunities for physical activity (PA) during non-instructional time. The objective was to assess the amount of PA in schools and to identify if PA policies and guidelines are being implemented in schools. METHODOLOGY: This study utilizes standardized observation tools (SOFIT/SOPLAY), a pre/post student survey, and an annual survey for principals to determine students' activity levels during PE and non-instructional time (e.g., recess). RESULTS: Principals at all seven schools reported meeting the recommended instructional minutes for PE. Only one school did not offer 20 minutes of daily supervised recess and one school withheld PA as punishment. Baseline student surveys (n~1000) indicated that most students enjoy PE and feel good about themselves after working hard in PE. SOFIT results showed that three out of seven schools met the recommended minutes of moderate-to-vigorous physical activity (MVPA) in Year 1, but this decreased to two schools in Year 2. SOPLAY data revealed that most students were sedentary during non-instructional time. CONCLUSION: Although students' attitudes towards PE were positive and principals self-reported meeting instructional minutes, observational data showed that most schools did not meet recommended MVPA levels. No major changes were identified in PA levels over time, but it is hoped that at the end of the Model Schools program, these schools will be able to share their best practices for increasing PA opportunities.
ABSTRACT Some studies have demonstrated hospital and geographic variation in cesarean delivery ra... more ABSTRACT Some studies have demonstrated hospital and geographic variation in cesarean delivery rates. Our objective is to compare primary cesarean delivery rates in urban and rural hospitals. We examined all hospital admissions of women who delivered a singleton live-born neonate in the state of Hawaii from January 2010 to December 2011 using the Hawaii Health Information Corporation database. Women with a history of prior cesarean delivery were excluded. Hospitals were divided into two categories: rural and urban. Primary cesarean delivery rates as well as common reasons for primary cesarean deliveries were examined. Of the 30,647 women who met criteria for our study, 7,717 (25.3%) delivered in rural hospitals. Women who delivered at rural hospitals had fewer risk factors for cesarean delivery, including advanced maternal age, preterm delivery, pregestational diabetes, and hypertensive disease. However, rural hospitals had a higher primary cesarean delivery rate of 21.1% compared with 15.3% in the urban hospitals (P<.001). Even after adjusting for maternal risk factors and common indications for cesarean delivery, women who delivered at rural hospitals had a more than twofold risk for cesarean delivery (adjusted odds ratio 2.46, 95% confidence interval 2.26-2.70). In a geographically isolated population, rates of cesarean delivery are significantly higher in rural hospitals. Because reasons for this finding are unclear, this disparity should be investigated further.
ABSTRACT Introduction: Many states developed obesity, nutrition, or other physical activity (PA) ... more ABSTRACT Introduction: Many states developed obesity, nutrition, or other physical activity (PA) related plans in an attempt to coordinate statewide efforts. Increasing this complex behavior warrants transdisciplinary stakeholder involvement in both development and implementation. Focusing on community-scale and street-scale urban design and land use policies are recommended for increasing population PA through improved or redesigned infrastructure. The purpose of this presentation is to explore the level of involvement of the transportation and community design sectors in development of state PA-related plans and to summarize goals, objectives, and strategies related to built environment, transportation, land use or community design. Methods: For this study, PA-related plans were collected and analyzed for the participation of these sectors on the development team. Additionally, the goals, objectives, and strategies with a focus on the built environment, transportation, or land use and community design were summarized across states. Results: Less than half of the plans had transportation representatives and fewer included the land use and community design sector. Most state PA-related plans did not emphasize infrastructure improvement as a means to increasing population PA. A majority of plans included goals and objectives focused on active transportation to school, and less frequently, aspects of complete streets. Conclusion: Even though transportation and urban design offer important means of improving opportunities to be physically active, representatives of these disciplines are not always present in state PA-related plan development. Purposeful engagement of these sectors, including identification of common goals, is necessary for the enhancement and implementation of infrastructure goals and objectives.
ABSTRACT BACKGROUND: Smoking in Hawaii’s beach parks poses a serious health risk to smokers and n... more ABSTRACT BACKGROUND: Smoking in Hawaii’s beach parks poses a serious health risk to smokers and non-smokers exposed to secondhand smoke and generates litter in the form of cigarette butts which are toxic, costly to retrieve and harmful to marine life. To alleviate this problem the City and County of Honolulu passed Bill 25 in July 2013 prohibiting smoking in all City and County operated beaches and parks on the island of Oahu as of January 1, 2014. This observational study was designed to collect information about smoking in Oahu beach parks prior to the implementation of the law. METHODS: A systematic observation protocol of smoking on beaches was adapted from previously validated observational studies of sun protection factors and physical activity in neighborhood parks. The protocol used paired observers to assess smoking among park visitors by zone (beach front, grassy areas, playing fields, parking lots and sidewalks), sex and age group (child, teen, adult, and senior), and smoking type (cigarette, electronic cigarette, cigar or other). Observations were made at 6 beaches, 4 times per day for a period of 3 days each (two weekdays and one weekend day) in December 2013. Results presented are the average findings between the paired observers. RESULTS: A total of 12,341 people were observed (24,682 observations). Correlation between observers was 0.99 on the number of people in each zone, 0.99 on the sex of those observed, 0.88 for smoking and 0.93 fo rage group. Beach park users were 53.2% male and adults made up the largest group by age (70.0%) followed by children 13.5%, teens 13.0%, and seniors 6.5%. There were 275 observations of smoking with none among children. The observed smoking rate was 1.3% among adults and teens with 0.7% among females and 1.8% among males. Smoking varied by beach zone from 0.3% and 0.4% on sidewalks and beaches to 2.0% and 2.2% in parking lots and green areas. Smoking prevalence also varied by beach park from 0.7% to 10.0%. CONCLUSIONS: Systematic observation is a novel and effective method to assess smoking behavior on beaches. Results of this study indicate that smoking point prevalence in beach parks is already lower than the overall population prevalence (14.6%). However, smoking does vary within parks with parking lots and green areas having the highest smoking prevalence. Education efforts and signage to support the smoke free beaches and parks should be targeted to these areas.
ABSTRACT Background: National physical activity plans from around the world have rarely been eval... more ABSTRACT Background: National physical activity plans from around the world have rarely been evaluated. Specifically, we are not aware of any efforts to evaluate the organizations responsible for developing national physical activity plans. Physical activity coalitions are increasingly forming to meet the demands associated with increasing population levels of physical activity, and are often formed to develop national, regional, and local physical activity plans. Little is known about what makes physical activity coalitions successful, however some evidence suggests that factors related to each organization that joins a coalition may explain coalition success or failure. Purpose: The purpose of this study was to employ qualitative methods to understand the factors related to organizations’ decisions to commit to the coalition that developed the U.S. National Physical Activity Plan (NPAP). Having this information may prove to be useful in developing and maintaining physical activity coalitions focused on developing physical activity plans at local-, regional-, or national-levels. Methods: Qualitative semi-structured interviews were conducted with key informants from the NPAP’s partner organizations. The interview guide was designed to elucidate the key factors explaining why and how partner organizations decided to commit to the NPAP coalition. Interviews were transcribed verbatim and were coded separately by two members of the research team. Results: Five primary factors emerged; identified and defined as follows: (1) Strategic Alignment - the strategic initiatives (eg, strategic plan, mission, vision, goals, objectives, projects, or plans) of the partner organization were congruent with the vision, mission, and goals of the NPAP coalition (2) Organizational Alignment - the partner organization recognized the importance of aligning with other organizations involved with the NPAP coalition; (3) Provide Input – the partner organization expected to lend expertise in developing the NPAP and/or to ensure that their organization’s viewpoints were represented in the NPAP. (4) Seminal Event - development and launch of the NPAP was a significant event in which involvement was viewed important; (5) Cost/Benefit Ratio - the partner organization realized more positive than negative effects from having been involved in the NPAP coalition.
ABSTRACT CDC data show that 75% of Hawaii adults do not meet fruit and vegetable (FV) recommendat... more ABSTRACT CDC data show that 75% of Hawaii adults do not meet fruit and vegetable (FV) recommendations and 48% do not meet physical activity (PA) guidelines. The purpose of this study was to examine if associations exist between enablers and barriers of health behavior (FV consumption and PA) and various stages of change in the Transtheoretical Model. A statewide cross-sectional telephone survey was conducted from September through November 2007. The majority of respondents were female (65.3%), had some college education (72%), and incomes >$40,000 (67.8%). The average age was 53.9+15.8. Largest participant ethnic groups were Caucasian (38.2%), Japanese (18.2%), and Hawaiian/Part Hawaiian (17.7%). Enablers to meeting FV recommendations included increased vitamins and minerals intake and improved health. Barriers included expense, time constraints, and meal planning difficulties. Enablers to meeting PA recommendations included built environments conducive to PA: bad weather, personal stress, and time constraints were barriers. Positive correlations were seen between the enablers to meeting recommendations and the stages of change for FV consumption; similarly, negative correlations were seen with barriers. As expected, those meeting FV and PA recommendations were more likely to be in the action and maintenance stages of change while those that did not meet the recommended servings were in the precontemplation, contemplation, and preparation stages. Tailoring health education to target perceived enablers and barriers for those at various stages of change may prove useful in health interventions.
ABSTRACT BACKGROUND: As part of the Healthy Hawaii Initiative Model Schools Program, one pilot sc... more ABSTRACT BACKGROUND: As part of the Healthy Hawaii Initiative Model Schools Program, one pilot school is focusing on enhancing the quality of its nutrition education program over a three-year period. PURPOSE: To identify what foods elementary students selected in the cafeteria and to assess the amount of plate waste. SIGNIFICANCE: The school food environment is an important setting to address childhood nutrition. Results will be used to evaluate the impact of the nutrition intervention on students' food choices and eating habits. METHODOLOGY: Three methods were used to analyze food preferences and consumption patterns on two random days in 2012: observations using handheld counters, plate waste using digital scales, and photographs of lunch trays after consumption. A total of 683 trays were evaluated at baseline. Follow-up data will be collected in early 2013. RESULTS: Most students selected fruit (83.9%) and bread (81.5%), and all students selected the entre (100%). Vegetables were selected the least, although more students chose vegetables on Day 2 (corn/green beans59.7%) than on Day 1 (salad53.2%). A similar amount of students selected chocolate milk (51%) and unflavored white milk (49%). When assessing plate waste, 49.6% of food (161 grams) was discarded from each tray. Students also consumed more of the entre and fruit than vegetables or bread. CONCLUSION: More than half of the students selected fruits and vegetables when given the option, but students also discarded approximately half of the food on their tray. Even though healthy options are served in cafeterias, students are not necessarily consuming this food.
ABSTRACT Background: This study analyzed the nature of PA-related elements included in state obes... more ABSTRACT Background: This study analyzed the nature of PA-related elements included in state obesity-related plans. Specifically, we examined whether plans reflected an active living approach to PA (e.g., inclusion of land use/planning, transportation, and parks/recreation). Methods: Plans for each state and D.C. were obtained. A qualitative content analysis coding tool and decision rules were developed with all plans double-coded by two reviewers. Results: Forty-three states (84%) had a statewide plan by June 2010. Most plans were developed with partners in public health (98%), education (88%), health care (79%), academia (81%), non-profits (81%), advocacy/coalition groups (79%), and parks/recreation/fitness (63%). Transportation (49%), land use/community design (30%), and elected officials (21%) were less likely to be included. In assessing both the PA specific goals and strategies, 58% of plans addressed workforce development, 67% coalition building, 67% surveillance, 49% evaluation, 84% policy change and 82% environmental change. Few plans included specific goals/strategies on land use/urban design (19%) parks and recreation (19%), or transportation infrastructure (16%). Conclusions: Of 43 states with a state plan, many were broad in scope but lacked an in-depth PA orientation. While some plans addressed sectors in the National PA plan, many focused on traditional PA elements as opposed to sectors affecting the built environment and active living (i.e., parks and recreation, land use/community design, and transportation). This analysis provides data on where state plans are in comparison to the National PA Plan and can serve as a starting point for states as they begin to revise plans in the future.
ABSTRACT Background/Significancy: Obesity is a major health concern and is linked to metabolic sy... more ABSTRACT Background/Significancy: Obesity is a major health concern and is linked to metabolic syndrome, diabetes and other adverse outcomes. Native Hawaiians are particularly impacted with 31.3% of high school students and 75.5% of adults being overweight or obese. While soda has been identified as contributor to obesity, the extent of consumption of other sugar-sweetened beverages (SSBs) is unclear. Objective/Purpose: The purpose of this study was to assess consumption of sweetened and beverages among an ethnically diverse group of Hawaii teens. Respondents were asked about consumption, including soda, sports or energy drinks, coffees or teas, and juice drinks (not 100% juice), in the past week. Methods: Researchers used a random-digit dial telephone survey in the summer of 2012 to interview 602 Hawaii youth ages 12-18. The sampling frame included cell phones and landlines, parental consent and participant assent where obtained. Results: In the past week, 67.1% reported drinking at least one soda, followed by juice drinks (63.9%), coffee or tea drinks (48.8%) and sports or energy drinks (41.5%). In all, 93% drank at least one SSB in the past 7 days with 47.8% drinking at least one SSB per day. Overall SSB consumption was higher among males, Native Hawaiians and Filipinos than among whites and Japanese. Overweight and obese teens were more likely to drink soda and sports/energy drinks daily. Discussion/Conclusions: Teens consume a wide variety of SSBs each week. Interventions in this population need to address juice drinks, sweetened coffee and teas, and sports/energy drinks in addition to soda.
Internationally, parks have been shown to be an important community asset for physical activity (... more Internationally, parks have been shown to be an important community asset for physical activity (PA), but little is known about the relationship between park usage and physical activity in China. The purpose of this study was to determine the association between park user characteristics and PA in Nanchang, China. In June 2014, 75,678 people were observed in eight parks over 12 days using SOPARC, a validated systematic observation tool. A logistic regression analysis was used to determine the association between PA and park user characteristics. Most park users were older adults (53.5%) or adults (34.6%). Overall, 55% of park users engaged in moderate-to-vigorous physical activity (MVPA). Fewer women were observed in parks than men, but were 66% more likely to be engaged in MVPA than men. Park users were more likely to be observed in MVPA between 6-9 am and when the temperature was below 30 °C. Chinese park users were more active (55%) than US studies in Tampa (30%), Chicago (49%), and Los Angeles (34%). More research is necessary to identify features of parks that are associated with greater PA so that effective interventions can be developed to promote active park use in Chinese citizens.
A quasi-experimental prospective study was conducted to assess the stage of change progression an... more A quasi-experimental prospective study was conducted to assess the stage of change progression and elimination of unhealthy behaviors among active duty Army soldiers and their spouses (N = 245) before and after attending a community-based wellness program. Significant differences in stage progression between the intervention group and a comparison group was seen in the fitness (p = 0.05) and communication risk categories (p = 0.03) immediately after the intervention; significant differences in stage progression in fitness (p = 0.05) and spirituality (p = 0.005) risk categories 6 months after baseline. There was a significant increase in seat belt use (p = 0.008), a decrease in reported tobacco use (p < 0.05), and a reduction in family stress (p = 0.06) and personal stress (p < 0.02) in the intervention group. Targeting multiple behavior changes and risk reduction in a single intervention program presents several challenges. In this pilot study, there were many positive nonsignificant trends in risk reduction that might translate into significant changes with a larger sample.
Objective The purpose of this study was to examine primary cesarean delivery rates among women wi... more Objective The purpose of this study was to examine primary cesarean delivery rates among women with low risk pregnancies in urban and rural hospitals in Hawaii. Methods This is a retrospective study of all low-risk women (term, vertex, singleton) who had a primary cesarean delivery in any Hawaii hospital from 2010 to 2011 using a statewide health information database. Hospitals were divided into two categories: rural and urban. Results Of the 27,096 women who met criteria for this study, 7105 (26.2 %) delivered in a rural hospital. Low-risk women who delivered in a rural hospital had a primary cesarean delivery rate of 18.5 % compared to 11.8 % in the urban hospitals, p < .0001. Low-risk women who delivered at rural hospitals had significantly higher unadjusted and adjusted odds ratios for cesarean delivery. The association with rural hospital was stronger after adjusting for confounders, aOR 2.47 (95 % CI 2.23-2.73) compared to unadjusted OR 1.70 (95 % CI 1.58-1.83) for primary cesarean delivery. Conclusions on practice In a geographically isolated population, rates of primary cesarean delivery among low-risk women are significantly higher in rural hospitals. This disparity should be investigated further.
With rapid economic development in China, traditional patterns of health behaviors are changing, ... more With rapid economic development in China, traditional patterns of health behaviors are changing, concurrent with a rise in childhood obesity. While the home environment and parenting behaviors are modifiable factors that could be targeted for intervention, little is known about their relationship with children's health behaviors. Therefore, the purpose of this study was to investigate the relationship between obesity and home and parenting factors in Chinese children. A cross-sectional survey was conducted in Nanchang, China in 2013 with caregivers (N = 470) of a child between the ages of 2 and 10 years. Regression analyses were conducted to determine risk factors for childhood obesity. Obesity prevalence (21.7%) did not differ by demographic variables. Eight physical activity, nutrition, and sedentary variables had significant relationships to obesity status. Logistic regression analysis revealed three significant predictors of obesity: the number of days the family eats meals ...
This article reports the outcomes of a systematic review of observational park-based physical act... more This article reports the outcomes of a systematic review of observational park-based physical activity (PA) studies. Five electronic databases and the Active Living Research website were searched in July 2015 to identify relevant articles. Studies were included if they: a) reported observational data collected at outdoor park-based settings during free living conditions, b) reported results of a park audit, c) included PA as an outcome measure of the park audit, and d) were published after 1990 in English-language peer-review journals. Thirty-two articles, reporting outcomes of 26 unique studies, met inclusion criteria for review. Most studies (n=20, 87%) had cross-sectional or non-interventional study designs, while 6 (23%) employed quasi-experimental designs. Studies were predominately conducted in the U.S. (n=19, 76%). The median number of park users across studies was 4558 (Range=815 to 76,632). Approximately half (51%) of all park users were female. Eighty-one percent of studies (n=21) reported PA outcomes for individuals of all ages, while 4 studies (15%) reported PA outcomes for children only and 1 study (4%) for adults only. Moderate-to-vigorous physical activity (MVPA) of park users ranged from 31% to 85% (Median=55.0%). Studies conducted in the U.S. reported a slightly higher median number of park-users engaging in MVPA than those outside the U.S. (60.5% vs. 52.8%). Fifteen studies examined gender differences in MVPA. Among these, 12 (87%) reported more males engaging in MVPA than females. Results of this review highlight the need for innovative strategies to promote MVPA among park users and to increase park use among children.
Hawai'i journal of medicine & public health : a journal of Asia Pacific Medicine & Public Health, 2015
Schools of Public Health have a wide variety of essential stakeholders. Broad input in program pl... more Schools of Public Health have a wide variety of essential stakeholders. Broad input in program planning should assist in ensuring well-developed plans and strong community buy-in. The planning of a school can better address the needs of multiple stakeholders from systematic broad-based input from these constituents using concept mapping. In this study, we used concept mapping to prioritize a set of recommendations from diverse stakeholders to assist in the process of planning a school. A set of statements was generated on essential elements for the proposed school from a broad group of stakeholders. The statements were then distilled into unique themes, which were then rated on importance and feasibility. Cluster maps and pattern matches were used to analyze the ratings. Unique themes (N = 147) were identified and grouped into 12 clusters. Cluster themes included leadership, faculty, culture, school, and curriculum. Pattern matches revealed a significant, modest correlation between ...
Hawai'i journal of medicine & public health : a journal of Asia Pacific Medicine & Public Health, 2015
In 2011, a small pilot bike share program was established in the town core of Kailua, Hawai'i... more In 2011, a small pilot bike share program was established in the town core of Kailua, Hawai'i, with funding from the Hawai'i State Department of Health. The Kailua system consisted of two stations with 12 bicycles, and the goal was to secure additional funding to expand the station network in the future. Community feedback consistently indicated support for the bike share program. However, system metrics showed low levels of usage, averaging 41.5 rides per month (2011-2014). From observational data, users were primarily tourists. With minimal local staff, the bike share program had limited resources for promotion and education, which may have hindered potential use by local residents. Management of station operations and bike maintenance were additional, ongoing barriers to success. Despite the challenges, the pilot bike share program was valuable in several ways. It introduced the bike share concept to Hawai'i, thereby helping to build awareness and connect an initial n...
ABSTRACT BACKGROUND: The State of Hawaii Departments of Health and Education developed a three-ye... more ABSTRACT BACKGROUND: The State of Hawaii Departments of Health and Education developed a three-year Model Schools program in which seven schools agreed to enhance their physical education (PE) curricula and increase opportunities for physical activity (PA) during non-instructional time. The objective was to assess the amount of PA in schools and to identify if PA policies and guidelines are being implemented in schools. METHODOLOGY: This study utilizes standardized observation tools (SOFIT/SOPLAY), a pre/post student survey, and an annual survey for principals to determine students' activity levels during PE and non-instructional time (e.g., recess). RESULTS: Principals at all seven schools reported meeting the recommended instructional minutes for PE. Only one school did not offer 20 minutes of daily supervised recess and one school withheld PA as punishment. Baseline student surveys (n~1000) indicated that most students enjoy PE and feel good about themselves after working hard in PE. SOFIT results showed that three out of seven schools met the recommended minutes of moderate-to-vigorous physical activity (MVPA) in Year 1, but this decreased to two schools in Year 2. SOPLAY data revealed that most students were sedentary during non-instructional time. CONCLUSION: Although students' attitudes towards PE were positive and principals self-reported meeting instructional minutes, observational data showed that most schools did not meet recommended MVPA levels. No major changes were identified in PA levels over time, but it is hoped that at the end of the Model Schools program, these schools will be able to share their best practices for increasing PA opportunities.
ABSTRACT Some studies have demonstrated hospital and geographic variation in cesarean delivery ra... more ABSTRACT Some studies have demonstrated hospital and geographic variation in cesarean delivery rates. Our objective is to compare primary cesarean delivery rates in urban and rural hospitals. We examined all hospital admissions of women who delivered a singleton live-born neonate in the state of Hawaii from January 2010 to December 2011 using the Hawaii Health Information Corporation database. Women with a history of prior cesarean delivery were excluded. Hospitals were divided into two categories: rural and urban. Primary cesarean delivery rates as well as common reasons for primary cesarean deliveries were examined. Of the 30,647 women who met criteria for our study, 7,717 (25.3%) delivered in rural hospitals. Women who delivered at rural hospitals had fewer risk factors for cesarean delivery, including advanced maternal age, preterm delivery, pregestational diabetes, and hypertensive disease. However, rural hospitals had a higher primary cesarean delivery rate of 21.1% compared with 15.3% in the urban hospitals (P<.001). Even after adjusting for maternal risk factors and common indications for cesarean delivery, women who delivered at rural hospitals had a more than twofold risk for cesarean delivery (adjusted odds ratio 2.46, 95% confidence interval 2.26-2.70). In a geographically isolated population, rates of cesarean delivery are significantly higher in rural hospitals. Because reasons for this finding are unclear, this disparity should be investigated further.
ABSTRACT Introduction: Many states developed obesity, nutrition, or other physical activity (PA) ... more ABSTRACT Introduction: Many states developed obesity, nutrition, or other physical activity (PA) related plans in an attempt to coordinate statewide efforts. Increasing this complex behavior warrants transdisciplinary stakeholder involvement in both development and implementation. Focusing on community-scale and street-scale urban design and land use policies are recommended for increasing population PA through improved or redesigned infrastructure. The purpose of this presentation is to explore the level of involvement of the transportation and community design sectors in development of state PA-related plans and to summarize goals, objectives, and strategies related to built environment, transportation, land use or community design. Methods: For this study, PA-related plans were collected and analyzed for the participation of these sectors on the development team. Additionally, the goals, objectives, and strategies with a focus on the built environment, transportation, or land use and community design were summarized across states. Results: Less than half of the plans had transportation representatives and fewer included the land use and community design sector. Most state PA-related plans did not emphasize infrastructure improvement as a means to increasing population PA. A majority of plans included goals and objectives focused on active transportation to school, and less frequently, aspects of complete streets. Conclusion: Even though transportation and urban design offer important means of improving opportunities to be physically active, representatives of these disciplines are not always present in state PA-related plan development. Purposeful engagement of these sectors, including identification of common goals, is necessary for the enhancement and implementation of infrastructure goals and objectives.
ABSTRACT BACKGROUND: Smoking in Hawaii’s beach parks poses a serious health risk to smokers and n... more ABSTRACT BACKGROUND: Smoking in Hawaii’s beach parks poses a serious health risk to smokers and non-smokers exposed to secondhand smoke and generates litter in the form of cigarette butts which are toxic, costly to retrieve and harmful to marine life. To alleviate this problem the City and County of Honolulu passed Bill 25 in July 2013 prohibiting smoking in all City and County operated beaches and parks on the island of Oahu as of January 1, 2014. This observational study was designed to collect information about smoking in Oahu beach parks prior to the implementation of the law. METHODS: A systematic observation protocol of smoking on beaches was adapted from previously validated observational studies of sun protection factors and physical activity in neighborhood parks. The protocol used paired observers to assess smoking among park visitors by zone (beach front, grassy areas, playing fields, parking lots and sidewalks), sex and age group (child, teen, adult, and senior), and smoking type (cigarette, electronic cigarette, cigar or other). Observations were made at 6 beaches, 4 times per day for a period of 3 days each (two weekdays and one weekend day) in December 2013. Results presented are the average findings between the paired observers. RESULTS: A total of 12,341 people were observed (24,682 observations). Correlation between observers was 0.99 on the number of people in each zone, 0.99 on the sex of those observed, 0.88 for smoking and 0.93 fo rage group. Beach park users were 53.2% male and adults made up the largest group by age (70.0%) followed by children 13.5%, teens 13.0%, and seniors 6.5%. There were 275 observations of smoking with none among children. The observed smoking rate was 1.3% among adults and teens with 0.7% among females and 1.8% among males. Smoking varied by beach zone from 0.3% and 0.4% on sidewalks and beaches to 2.0% and 2.2% in parking lots and green areas. Smoking prevalence also varied by beach park from 0.7% to 10.0%. CONCLUSIONS: Systematic observation is a novel and effective method to assess smoking behavior on beaches. Results of this study indicate that smoking point prevalence in beach parks is already lower than the overall population prevalence (14.6%). However, smoking does vary within parks with parking lots and green areas having the highest smoking prevalence. Education efforts and signage to support the smoke free beaches and parks should be targeted to these areas.
ABSTRACT Background: National physical activity plans from around the world have rarely been eval... more ABSTRACT Background: National physical activity plans from around the world have rarely been evaluated. Specifically, we are not aware of any efforts to evaluate the organizations responsible for developing national physical activity plans. Physical activity coalitions are increasingly forming to meet the demands associated with increasing population levels of physical activity, and are often formed to develop national, regional, and local physical activity plans. Little is known about what makes physical activity coalitions successful, however some evidence suggests that factors related to each organization that joins a coalition may explain coalition success or failure. Purpose: The purpose of this study was to employ qualitative methods to understand the factors related to organizations’ decisions to commit to the coalition that developed the U.S. National Physical Activity Plan (NPAP). Having this information may prove to be useful in developing and maintaining physical activity coalitions focused on developing physical activity plans at local-, regional-, or national-levels. Methods: Qualitative semi-structured interviews were conducted with key informants from the NPAP’s partner organizations. The interview guide was designed to elucidate the key factors explaining why and how partner organizations decided to commit to the NPAP coalition. Interviews were transcribed verbatim and were coded separately by two members of the research team. Results: Five primary factors emerged; identified and defined as follows: (1) Strategic Alignment - the strategic initiatives (eg, strategic plan, mission, vision, goals, objectives, projects, or plans) of the partner organization were congruent with the vision, mission, and goals of the NPAP coalition (2) Organizational Alignment - the partner organization recognized the importance of aligning with other organizations involved with the NPAP coalition; (3) Provide Input – the partner organization expected to lend expertise in developing the NPAP and/or to ensure that their organization’s viewpoints were represented in the NPAP. (4) Seminal Event - development and launch of the NPAP was a significant event in which involvement was viewed important; (5) Cost/Benefit Ratio - the partner organization realized more positive than negative effects from having been involved in the NPAP coalition.
ABSTRACT CDC data show that 75% of Hawaii adults do not meet fruit and vegetable (FV) recommendat... more ABSTRACT CDC data show that 75% of Hawaii adults do not meet fruit and vegetable (FV) recommendations and 48% do not meet physical activity (PA) guidelines. The purpose of this study was to examine if associations exist between enablers and barriers of health behavior (FV consumption and PA) and various stages of change in the Transtheoretical Model. A statewide cross-sectional telephone survey was conducted from September through November 2007. The majority of respondents were female (65.3%), had some college education (72%), and incomes >$40,000 (67.8%). The average age was 53.9+15.8. Largest participant ethnic groups were Caucasian (38.2%), Japanese (18.2%), and Hawaiian/Part Hawaiian (17.7%). Enablers to meeting FV recommendations included increased vitamins and minerals intake and improved health. Barriers included expense, time constraints, and meal planning difficulties. Enablers to meeting PA recommendations included built environments conducive to PA: bad weather, personal stress, and time constraints were barriers. Positive correlations were seen between the enablers to meeting recommendations and the stages of change for FV consumption; similarly, negative correlations were seen with barriers. As expected, those meeting FV and PA recommendations were more likely to be in the action and maintenance stages of change while those that did not meet the recommended servings were in the precontemplation, contemplation, and preparation stages. Tailoring health education to target perceived enablers and barriers for those at various stages of change may prove useful in health interventions.
ABSTRACT BACKGROUND: As part of the Healthy Hawaii Initiative Model Schools Program, one pilot sc... more ABSTRACT BACKGROUND: As part of the Healthy Hawaii Initiative Model Schools Program, one pilot school is focusing on enhancing the quality of its nutrition education program over a three-year period. PURPOSE: To identify what foods elementary students selected in the cafeteria and to assess the amount of plate waste. SIGNIFICANCE: The school food environment is an important setting to address childhood nutrition. Results will be used to evaluate the impact of the nutrition intervention on students' food choices and eating habits. METHODOLOGY: Three methods were used to analyze food preferences and consumption patterns on two random days in 2012: observations using handheld counters, plate waste using digital scales, and photographs of lunch trays after consumption. A total of 683 trays were evaluated at baseline. Follow-up data will be collected in early 2013. RESULTS: Most students selected fruit (83.9%) and bread (81.5%), and all students selected the entre (100%). Vegetables were selected the least, although more students chose vegetables on Day 2 (corn/green beans59.7%) than on Day 1 (salad53.2%). A similar amount of students selected chocolate milk (51%) and unflavored white milk (49%). When assessing plate waste, 49.6% of food (161 grams) was discarded from each tray. Students also consumed more of the entre and fruit than vegetables or bread. CONCLUSION: More than half of the students selected fruits and vegetables when given the option, but students also discarded approximately half of the food on their tray. Even though healthy options are served in cafeterias, students are not necessarily consuming this food.
ABSTRACT Background: This study analyzed the nature of PA-related elements included in state obes... more ABSTRACT Background: This study analyzed the nature of PA-related elements included in state obesity-related plans. Specifically, we examined whether plans reflected an active living approach to PA (e.g., inclusion of land use/planning, transportation, and parks/recreation). Methods: Plans for each state and D.C. were obtained. A qualitative content analysis coding tool and decision rules were developed with all plans double-coded by two reviewers. Results: Forty-three states (84%) had a statewide plan by June 2010. Most plans were developed with partners in public health (98%), education (88%), health care (79%), academia (81%), non-profits (81%), advocacy/coalition groups (79%), and parks/recreation/fitness (63%). Transportation (49%), land use/community design (30%), and elected officials (21%) were less likely to be included. In assessing both the PA specific goals and strategies, 58% of plans addressed workforce development, 67% coalition building, 67% surveillance, 49% evaluation, 84% policy change and 82% environmental change. Few plans included specific goals/strategies on land use/urban design (19%) parks and recreation (19%), or transportation infrastructure (16%). Conclusions: Of 43 states with a state plan, many were broad in scope but lacked an in-depth PA orientation. While some plans addressed sectors in the National PA plan, many focused on traditional PA elements as opposed to sectors affecting the built environment and active living (i.e., parks and recreation, land use/community design, and transportation). This analysis provides data on where state plans are in comparison to the National PA Plan and can serve as a starting point for states as they begin to revise plans in the future.
ABSTRACT Background/Significancy: Obesity is a major health concern and is linked to metabolic sy... more ABSTRACT Background/Significancy: Obesity is a major health concern and is linked to metabolic syndrome, diabetes and other adverse outcomes. Native Hawaiians are particularly impacted with 31.3% of high school students and 75.5% of adults being overweight or obese. While soda has been identified as contributor to obesity, the extent of consumption of other sugar-sweetened beverages (SSBs) is unclear. Objective/Purpose: The purpose of this study was to assess consumption of sweetened and beverages among an ethnically diverse group of Hawaii teens. Respondents were asked about consumption, including soda, sports or energy drinks, coffees or teas, and juice drinks (not 100% juice), in the past week. Methods: Researchers used a random-digit dial telephone survey in the summer of 2012 to interview 602 Hawaii youth ages 12-18. The sampling frame included cell phones and landlines, parental consent and participant assent where obtained. Results: In the past week, 67.1% reported drinking at least one soda, followed by juice drinks (63.9%), coffee or tea drinks (48.8%) and sports or energy drinks (41.5%). In all, 93% drank at least one SSB in the past 7 days with 47.8% drinking at least one SSB per day. Overall SSB consumption was higher among males, Native Hawaiians and Filipinos than among whites and Japanese. Overweight and obese teens were more likely to drink soda and sports/energy drinks daily. Discussion/Conclusions: Teens consume a wide variety of SSBs each week. Interventions in this population need to address juice drinks, sweetened coffee and teas, and sports/energy drinks in addition to soda.
Internationally, parks have been shown to be an important community asset for physical activity (... more Internationally, parks have been shown to be an important community asset for physical activity (PA), but little is known about the relationship between park usage and physical activity in China. The purpose of this study was to determine the association between park user characteristics and PA in Nanchang, China. In June 2014, 75,678 people were observed in eight parks over 12 days using SOPARC, a validated systematic observation tool. A logistic regression analysis was used to determine the association between PA and park user characteristics. Most park users were older adults (53.5%) or adults (34.6%). Overall, 55% of park users engaged in moderate-to-vigorous physical activity (MVPA). Fewer women were observed in parks than men, but were 66% more likely to be engaged in MVPA than men. Park users were more likely to be observed in MVPA between 6-9 am and when the temperature was below 30 °C. Chinese park users were more active (55%) than US studies in Tampa (30%), Chicago (49%), and Los Angeles (34%). More research is necessary to identify features of parks that are associated with greater PA so that effective interventions can be developed to promote active park use in Chinese citizens.
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