Donald Hayes

Racial Differences in the Association Between Partner Abuse and Barriers to Prenatal Health Care Among Asian and Native Hawaiian/Other Pacific Islander Women

Objectives Prenatal health care (PNC) is associated with positive maternal and infant health outcomes. There is limited knowledge regarding Native Hawaiians/Other Pacific Islanders (NHOPI) and Asian women’s access to PNC especially among those with partner abuse (PA) experience. The objectives of this paper were to (1) describe and examine factors associated with PNC access barriers among mothers, by race; and, (2) determine the association between PA and PNC access, by race. Methods We analyzed 2004–2007 data from Hawai‘i’s Pregnancy Risk Assessment Monitoring System (nxa0=xa07,158). The outcome is ≥1 experience with a PNC access barrier. PA is experience with physical violence from a partner. Descriptive statistics, and bivariate and multivariate logistic regression analyses stratified by race were conducted. Results The respondents included 35.7% NHOPI, 37.4% Asian, 20.1% White and 6.6% Other. More than 6% experienced PA, and 25.9% reported ≥1 PNC access barrier. Experience with PA was significantly associated with NHOPI and Asians reporting ≥1 barrier to accessing PNC, but was non-significant with Whites. Conclusions Programs should address barriers to accessing PNC, and target NHOPI and Asian mothers with PA experience to reduce the healthcare disparity and improve quality of life.

Adverse Childhood Events and Current Depressive Symptoms Among Women in Hawaii: 2010 BRFSS, Hawaii

Research on the association between adverse childhood events (ACEs) and depression among women in Hawaii is scarce. ACEs have been linked to unfavorable health behaviors such as smoking and binge drinking which are more prevalent in the state compared to the US overall. The concomitant presence of ACEs with smoking or binge drinking may explain the excess depression prevalence in Hawaii compared to the national average. Using data of women residing in the state (2010 Hawaii Behavioral Risk Factor Surveillance System Survey), we examined the association between ACEs count or type (household dysfunction and physical, verbal and sexual abuse) and current depressive symptoms (CDS), in addition to modification by current smoking status (smoked >100 cigarettes in a lifetime and currently smoke) and binge drinking (consumed ≥4 alcoholic beverage within the past month and in ≥1 occasion(s)). Evaluation of ACEs before age 18 consisted of 11 indicators. Eight indicators of the Patient Health Questionnaire (PHQ-8) were used to assess CDS. All analyses utilized logistic regression taking into account sampling design. The odds ratio of having CDS between those with versus without ACEs increased per increasing number of ACEs (1 ACE: ORxa0=xa02.11, CIxa0=xa01.16–3.81; 2 ACEs: ORxa0=xa02.90, CIxa0=xa01.51–5.58; 3 or 4 ACEs: ORxa0=xa03.94, CIxa0=xa02.13–7.32; 5+ ACEs: ORxa0=xa04.04, CIxa0=xa02.26–7.22). Household dysfunction (OR = 2.10, CI = 1.37–3.23), physical abuse (OR = 1.67, CI = 1.08–2.59), verbal abuse (OR = 3.21, CI = 2.03–5.09) and sexual abuse (ORxa0=xa01.68, CIxa0=xa01.04–2.71) were all positively associated with CDS. Verbal abuse had the strongest magnitude of association. Neither current smoking status nor binge drinking modified the relationship between ACEs count (or type) and CDS. In conclusion, the presence of ACEs among women in Hawaii was indicative of CDS in adulthood, notably verbal abuse. Further, a dose response existed between the number of ACEs and the odds for CDS. The concomitant exposure to ACEs and current smoking status or binge drinking did not elevate odds for CDS.

Characteristics of overweight and obesity at age two and the association with breastfeeding in Hawai'i Women, Infants, and Children (WIC) participants.

Childhood obesity is associated with many adverse health effects during childhood and is linked to an increased risk for obesity in adulthood. The objective of this study was to determine the characteristics of early childhood overweight and obesity and assess the impact of breastfeeding. Data from Hawai’i’s Special Supplemental Nutrition Program for Women, Infants and Children (WIC) were analyzed for children 2xa0years of age born between 2005 and 2009 and their mothers. Childhood overweight and obesity was examined using a log-binomial regression model to estimate prevalence ratios. In the sample population, 12.5xa0% of children were overweight and 8.5xa0% of children were obese. Significant differences in childhood overweight and obesity were seen between breastfeeding duration and other socio-demographic groups. Children who were breastfed for 6xa0months or more had a lower risk of childhood obesity at age two compared to those who were never breastfed (APR 0.79, 95xa0% CI 0.69–0.91) with adjustment for child race/ethnicity, maternal age, trimester of prenatal care entry, maternal smoking status, and child birth weight. The prevalence of early childhood overweight and obesity is associated with shorter durations of breastfeeding. Early and continued breastfeeding support and education for mothers in the WIC program that improves duration of breastfeeding may help reduce the risk of early childhood obesity.

Adverse Childhood Events are Related to the Prevalence of Asthma and Chronic Obstructive Pulmonary Disorder Among Adult Women in Hawaii

AbstractPurposenIn the US, women surpass men in the prevalence of lung diseases. Limited studies exist on the association of adverse childhood events (ACEs) to asthma and chronic obstructive pulmonary disorder (COPD) particularly among women and cohorts of understudied populations (e.g., Pacific Islanders). This study evaluated the ACEs–asthma and ACEs–COPD relationships among women in Hawaii and the contribution of poor health factors (smoking, binge drinking, and obesity) in these associations.MethodsUsing data from 3363 women in the Behavioral Risk Factor Surveillance System-Hawaii, we assessed how self-reported ACEs [count and type (household dysfunction, and physical, verbal and sexual abuse)] relate to asthma and COPD. Multivariable log-binomial regression, accounting for the sampling design, and model adjustments for socio-demographics, healthcare access, emotional support, current smoking, binge drinking, and BMI status were used to generate prevalence ratios.ResultsFor every increase in ACE count, the likelihood for asthma increased by 7xa0% (CIxa0=xa01.02–1.13), and for COPD, by 21xa0% (CIxa0=xa01.12–1.31) accounting for socio-demographics, healthcare access, and emotional support. Verbal abuse was also associated with greater likelihood for asthma independent of these covariates (PRxa0=xa01.43, CIxa0=xa01.14–1.79). Household dysfunction (PRxa0=xa01.82, CIxa0=xa01.15–2.82) and physical (PRxa0=xa02.01, CIxa0=xa01.20–3.37), verbal (PRxa0=xa02.24, CIxa0=xa01.38–3.65) and sexual (PRxa0=xa01.81, CIxa0=xa01.10–2.97) abuse were all associated with COPD using similar adjustments. Additional adjustment for smoking, binge drinking, and BMI status did not impact the ACE–asthma associations and only modestly attenuated the ACE–COPD relationships.ConclusionsPrimary and secondary prevention of ACEs may optimize the health of young girls in Hawaii, and reduce the burden of asthma and COPD among women in the state.

Physician Survey Assessing Pelvic Inflammatory Disease Knowledge and Attitudes to Identify Diagnosing and Reporting Barriers

BACKGROUNDnPelvic inflammatory disease (PID) is a notifiable disease in Hawaii with legal implications for noncompliance. A previous study comparing PID diagnoses in Hawaiis hospitals and state surveillance data confirmed underreporting in Hawaii. Reasons for noncompliance and underreporting are not well understood.nnnMETHODSnAll licensed primary care physicians in Hawaii were mailed a survey addressing PID diagnosis and reporting attitudes and practices. Hierarchical logistic regression was used to determine if physician characteristics, PID knowledge, or attitudes related to the diagnosis or reporting of PID, increased the odds of diagnosing and reporting PID.nnnRESULTSnAmong survey respondents (486 of 1,062; response rate of 45.8%), 104 (21.4%) had diagnosed PID. The PID reporting rate was 55.8% (58 of 104). The majority of physicians who diagnosed PID reported that PID reporting was time consuming. In hierarchical regression, obstetrician/gynecologists and family practitioners had the highest odds of diagnosing PID and internists had the lowest odds of reporting PID, those 15 years or longer since residency were less likely to report PID than those fewer than 15 years since residency, and increased PID diagnosing and reporting knowledge increased the odds of PID reporting by 1.63 times.nnnCONCLUSIONnOur findings suggest the need for training of all physicians on reportable diagnoses on a regular basis. There is a need to simplify the reporting process, because the time burden of reporting may present a modifiable barrier to reporting. Increased PID-related communication between local health departments and physicians is essential, and physicians should be provided technical assistance with reporting.

In memoriam: Loretta "Deliana" Fuddy (1948-2013).

The Maternal and Child Health Journal recognizes the substantial contributions of Loretta ‘‘Deliana’’ Fuddy from the State of Hawaii Department of Health (DOH) to the well-being of women, children, and families in Hawaii and nationally. On December 11, 2013, Director Fuddy died after the plane she was a passenger in made an emergency water landing shortly after take-off. The plane was returning to Honolulu from Kalaupapa, Molokai where Director Fuddy had visited the Kalaupapa Leprosy Settlement and National Historical Park as honorary ‘‘Mayor’’ of Kalawao County as part of her role as Director of Health. Deliana began her public health career in 1975 as a medical social worker in the Crippled Services Branch which evolved into the Family Health Services Division (FHSD). She advanced and held several positions within FHSD that included serving as FHSD Chief for 10 years, until her appointment as Director of the Hawaii State Department of Health in March 2011. Her degrees included work in sociology, social work, and public health from the University of Hawaii and she completed doctoral studies (all but dissertation) at the Johns Hopkins Bloomberg School of Public Health. Deliana was a defining part of Hawaii’s Healthy Start Program (HHSP). HHSP is designed to prevent child abuse and neglect and to promote child health and development in newborns of families at risk for poor child outcomes. She worked closely with community partners among them, Parents and Children Together, Hawaii Family Support Center and with Dr. Calvin Sia of the Hawaii Chapter of the American Academy of Pediatrics, to build state and national support for home visiting services for struggling families. By the 1990’s her advocacy and leadership helped to build a statewide service system that included identification and engagement of families eligible for services and a system of care to support them. The collaborations and partnerships she helped to shape remain as examples of how states can design and develop systems of care to improve child health and eliminate disparities. HHSP inspired national and international adaptations, including Healthy Families America, an evidenced-based home visiting program operating across the country and endorsed by the Health Resources and Services Administration’s Maternal Infant and Early Childhood Home Visiting (MIECHV) program. D. Hayes (&) Family Health Services Division, Hawaii Department of Health, Honolulu, HI, USA e-mail: don.hayes@doh.hawaii.gov