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Article: Neighborhood level facilitators and barriers to hypertension management: A Native Hawaiian perspective.

Ing, Claire Townsend / Park, Mei Linn N / Vegas, J Kahaulahilahi / Haumea, Stacy / Kaholokula, Joseph Keawe'aimoku

2023 Volume 9, Issue 2, Page(s) e13180

Abstract: Native Hawaiians have a disproportionately high prevalence of hypertension, which is an important and modifiable risk factor for cardiovascular disease (CVD). To reduce CVD among Native Hawaiians, we must better understand facilitators and barriers to ... ...

Abstract	Native Hawaiians have a disproportionately high prevalence of hypertension, which is an important and modifiable risk factor for cardiovascular disease (CVD). To reduce CVD among Native Hawaiians, we must better understand facilitators and barriers to hypertension management (i.e., diet, physical activity, stress reduction) unique to Native Hawaiians. Despite evidence of neighborhood-level facilitators and barriers to hypertension management in other populations, there is limited research in Native Hawaiians. Participants from a randomized controlled trial (
Language	English
Publishing date	2023-01-24
Publishing country	England
Document type	Journal Article
ZDB-ID	2835763-2
ISSN	2405-8440
ISSN	2405-8440
DOI	10.1016/j.heliyon.2023.e13180
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Neighborhood level facilitators and barriers to hypertension management: A Native Hawaiian perspective

Ing, Claire Townsend / Park, Mei Linn N. / Vegas, J. Kahaulahilahi / Haumea, Stacy / Kaholokula, Joseph Keaweʻaimoku

Heliyon. 2023 Feb., v. 9, no. 2 p.e13180-

2023

Abstract	Native Hawaiians have a disproportionately high prevalence of hypertension, which is an important and modifiable risk factor for cardiovascular disease (CVD). To reduce CVD among Native Hawaiians, we must better understand facilitators and barriers to hypertension management (i.e., diet, physical activity, stress reduction) unique to Native Hawaiians. Despite evidence of neighborhood-level facilitators and barriers to hypertension management in other populations, there is limited research in Native Hawaiians. Participants from a randomized controlled trial (n = 40) were recruited for 5 focus groups. All participants were self-reported Native Hawaiians and had uncontrolled hypertension. Discussions elicited experiences and perceptions of neighborhood-level stressors as they relate to participants' hypertension management efforts. Audio recordings were transcribed and analyzed using ATLAS.ti for emergent themes. Five themes were identified: neighborhood description, community resources, neighborhood change, safety, and social connectedness. Novel barriers to hypertension control included loss of culture and loss of respect for elders, change in community feel, and over-development. Facilitators included social cohesion and collective power. These data provide a deeper understanding of how Native Hawaiians experience neighborhood factors and how those factors impact their efforts to improve their diets, physical activity, and stress management. The findings help to inform the development of multilevel CVD prevention programs. Further research is needed to explore the subtheme of social and emotional stress related to neighborhood change and CVD health risk due to cultural and historic trauma references.
Keywords	diet ; hypertension ; physical activity ; psychological stress ; randomized clinical trials ; risk factors ; social cohesion ; stress management ; Native Hawaiian ; Neighborhood stressors ; Cultural trauma ; Cardiovascular disease ; Body Mass Index
Language	English
Dates of publication	2023-02
Publishing place	Elsevier Ltd
Document type	Article ; Online
Note	Use and reproduction
ZDB-ID	2835763-2
ISSN	2405-8440
ISSN	2405-8440
DOI	10.1016/j.heliyon.2023.e13180
Database	NAL-Catalogue (AGRICOLA)

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Article: Ethnic differences in fast-food advertising exposure and body mass index among Asian American/Pacific Islander and White young adults.

Flisco, Victoria Diana Cruz / O'Shea, Ciara / Ing, Claire Townsend / Boushey, Carol J / Pokhrel, Pallav

Obesity research & clinical practice

2022 Volume 16, Issue 4, Page(s) 295–300

Abstract: Background: Fast-food advertising (FFA) is a potential contributor to obesity. Few studies have examined the relationship between FFA exposure and body mass index (BMI) among young adults. Furthermore, these studies have rarely examined ethnic ... ...

Abstract	Background: Fast-food advertising (FFA) is a potential contributor to obesity. Few studies have examined the relationship between FFA exposure and body mass index (BMI) among young adults. Furthermore, these studies have rarely examined ethnic differences in the relationship between FFA exposure and BMI, specifically across Asian American/Pacific Islander (AAPI) subgroups. Objective: This study aimed to investigate ethnic differences in the association between FFA exposure and BMI in a sample of predominantly AAPI young adults. Methods: Cross-sectional data were collected in 2018 from 2622 young adult college students (ages 18-25 years; 54% women) on O'ahu, Hawai'i. FFA exposure was assessed using a cued-recall measure. Multiple regression and analysis of covariance were used to analyze the data. Results: A significant association was found between higher FFA exposure and higher BMI (p < 0.05; 2-tailed) in the entire sample, adjusting for ethnicity, other demographic variables, and levels of physical activity. However, when examined by ethnic group, the association between FFA exposure and BMI was not statistically significant. A statistically significant main effect of ethnicity on BMI was found. Native Hawaiian/other Pacific Islanders (NHPI) reported the highest mean BMI [27.07 (SD ± 7.74) kg/m Conclusion: FFA exposure appears to adversely influence BMI in a population of predominantly AAPI young adults. Although we did not find ethnic differences in FFA exposure or in the association between FFA exposure and BMI, the current data make a case for similar future investigation with larger subgroup sample sizes. Regulations that curtail FFA exposure among young adults may be needed.
MeSH term(s)	Adolescent ; Adult ; Female ; Humans ; Male ; Young Adult ; Advertising/statistics & numerical data ; Body Mass Index ; Cross-Sectional Studies ; Asian American Native Hawaiian and Pacific Islander/statistics & numerical data ; White/statistics & numerical data ; Fast Foods/adverse effects ; Fast Foods/statistics & numerical data
Language	English
Publishing date	2022-08-12
Publishing country	Netherlands
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2274031-4
ISSN	1878-0318 ; 1871-403X
ISSN (online)	1878-0318
ISSN	1871-403X
DOI	10.1016/j.orcp.2022.07.004
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Article ; Online: Food Insecurity and Blood Pressure in a Multiethnic Population.

Ing, Claire Townsend / Clemens, Brettany / Ahn, Hyeong Jun / Kaholokula, Joseph Keawe'aimoku / Hovmand, Peter S / Seto, Todd B / Novotny, Rachel

International journal of environmental research and public health

2023 Volume 20, Issue 13

Abstract: Food insecurity is a social determinant of health and is increasingly recognized as a risk factor for hypertension. Native Hawaiians bear a disproportionate burden of hypertension and known risk factors. Despite this, the relative effects of food ... ...

Abstract	Food insecurity is a social determinant of health and is increasingly recognized as a risk factor for hypertension. Native Hawaiians bear a disproportionate burden of hypertension and known risk factors. Despite this, the relative effects of food insecurity and financial instability on blood pressure have yet to be investigated in this population. This study examines the relative effects of food insecurity and financial instability on blood pressure, controlling for potential confounders in a multiethnic sample. Participants (
MeSH term(s)	Child ; Humans ; Female ; Blood Pressure ; Food Supply ; Diet ; Food Insecurity ; Hypertension/epidemiology
Language	English
Publishing date	2023-06-28
Publishing country	Switzerland
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	2175195-X
ISSN	1660-4601 ; 1661-7827
ISSN (online)	1660-4601
ISSN	1661-7827
DOI	10.3390/ijerph20136242
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Article ; Online: Neighborhood-Level Stressors and Individual-Level Cardiovascular Disease Risk in Native Hawaiians: a Cross-Sectional Study.

Ing, Claire Townsend / Ahn, Hyeong Jun / Antonio, Mapuana C K / Dillard, Adrienne Y / Kekauoha, Bridget Puni / Cassel, Kevin / Abrigo, Scott / Kauhane, Michelle / Halzel, Melody S / Keaweʻaimoku Kaholokula, Joseph

Preventing chronic disease

2024 Volume 21, Page(s) E11

Abstract: Introduction: Native Hawaiian people have higher rates of illness and death related to cardiovascular disease (CVD) than non-Hispanic White people. Research in other populations has shown that individual-level CVD risk factors (ie, high-fat diet, ... ...

Abstract	Introduction: Native Hawaiian people have higher rates of illness and death related to cardiovascular disease (CVD) than non-Hispanic White people. Research in other populations has shown that individual-level CVD risk factors (ie, high-fat diet, physical inactivity, obesity, and tobacco use) are associated with neighborhood characteristics (ie, social cohesion, walkability, availability of healthy food, and safety). This association has yet to be examined among Native Hawaiians. Methods: We conducted a cross-sectional survey of community-dwelling Native Hawaiian people in 2020. Three multiple regression models and 1 logistic regression model were assessed. Each model included individual-level CVD risk factors, age, sex, education, income, and neighborhood characteristics. Results: The regression models for body mass index (BMI) and physical activity showed significant results. The BMI model (R Conclusions: We found that neighborhood-level factors improved the model's ability to explain variance in BMI. Efforts to decrease BMI would benefit from improving the availability of healthy foods in neighborhoods, a finding supported by research in other populations.
MeSH term(s)	Humans ; Cross-Sectional Studies ; Cardiovascular Diseases/epidemiology ; Native Hawaiian or Other Pacific Islander ; Obesity ; Residence Characteristics
Language	English
Publishing date	2024-02-15
Publishing country	United States
Document type	Journal Article
ZDB-ID	2135684-1
ISSN	1545-1151 ; 1545-1151
ISSN (online)	1545-1151
ISSN	1545-1151
DOI	10.5888/pcd21.220341
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Article: An Examination of the Relationship between Discrimination, Depression, and Hypertension in Native Hawaiians.

Ing, Claire Townsend / Antonio, Mapuana / Ahn, Hyeong Jun / Cassel, Kevin / Dillard, Adrienne / Kekauoha, B Puni / Kaholokula, Joseph Keawe'aimoku

Asian American journal of psychology

2020 Volume 10, Issue 3, Page(s) 249–257

Abstract: Native Hawaiians bear a disproportionate burden of hypertension. Discrimination and depression are potential hypertension risk factors. Although the relationship between discrimination and depression is well established, how these factors affect ... ...

Abstract	Native Hawaiians bear a disproportionate burden of hypertension. Discrimination and depression are potential hypertension risk factors. Although the relationship between discrimination and depression is well established, how these factors affect hypertension risk in indigenous populations remains unknown. We examined the relationship between discrimination, depression, and hypertension in adult Native Hawaiians. We hypothesized that greater frequency of perceived discrimination and greater frequency of depressive symptoms would independently increase the likelihood of having hypertension. Surveys were mailed to 540 adult Native Hawaiians residing on five Hawaiian Homesteads. The surveys measured: hypertension status, sociodemographic factors (age, gender, income, employment status), body mass index (BMI), physical activity frequency, smoking, Hawaiian cultural affiliation, American cultural affiliation, perceived discrimination, and depressive symptoms. Respondents (n=171) were mostly female (71%), a mean age of 57yrs, and 54% reported having hypertension. The logistic regression model included perceived discrimination, depression, BMI, frequency of vigorous physical activity, and Hawaiian cultural affiliation, and sociodemographic variables. The model showed that Hawaiian cultural affiliation and discrimination were significantly related to hypertension status. Depression was not related to hypertension status. Interaction analysis found that for individuals with lower Hawaiian cultural affiliation, frequent perceived discrimination was significantly associated with lower odds of having hypertension. The negative association between perceived discrimination and hypertension status was opposite from hypothesized. However, the interaction suggests this relationship holds only for less culturally affiliated individuals. These results underscore the varied nature of hypertension determinants and may have clinical implications for the treatment of hypertension in Native Hawaiians.
Language	English
Publishing date	2020-08-27
Publishing country	United States
Document type	Journal Article
ZDB-ID	2541812-9
ISSN	1948-1993 ; 1948-1985
ISSN (online)	1948-1993
ISSN	1948-1985
DOI	10.1037/aap0000151
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Article ; Online: Ethnic and Gender Differences in 10-Year Coronary Heart Disease Risk: a Cross-Sectional Study in Hawai'i.

Ing, Claire Townsend / Ahn, Hyeong Jun / Kawakami, Rachel / Grandinetti, Andrew / Seto, Todd B / Kaholokula, Joseph Keawe'aimoku

Journal of racial and ethnic health disparities

2020 Volume 8, Issue 4, Page(s) 943–952

Abstract: Background: Cardiovascular disease (CVD) is the leading cause of death in the US. In Hawai'i, Filipinos and Native Hawaiians have the highest rates of CVD-related risk factors. CVD risk across these ethnic groups has not been examined. This cross- ... ...

Abstract	Background: Cardiovascular disease (CVD) is the leading cause of death in the US. In Hawai'i, Filipinos and Native Hawaiians have the highest rates of CVD-related risk factors. CVD risk across these ethnic groups has not been examined. This cross-sectional study examines 10-year CVD risk as determined by the Framingham Risk Score (FRS) across ethnic groups in Hawai'i, controlling for clinical, demographic, and psychosocial factors. Methods: This study includes secondary data analysis of the Kohala Health Research Project dataset. All non-pregnant adults (≥ 18 years of age) who resided in the community of interest during the study period were eligible to participate with 1462 participants completing the clinical examination and surveys. This analysis included clinical, demographic, and psychosocial variables. Ethnic differences were examined using the chi-squared test and one-way ANOVA. Multiple linear regression on FRS was conducted and least square means of FRS were calculated. Results: Data from 1146 individuals were analyzed. Participants were 44.4% Native Hawaiian, 15.4% Filipino, 15.3% Japanese, and 25% non-Hispanic White; 55.4% were female and had a mean age of 48.8 years. For males, the unadjusted Japanese mean FRS was significantly higher compared with the other ethnic groups. For females, Filipino and Japanese mean FRS were significantly higher compared with Native Hawaiians and non-Hispanic Whites. In the fully adjusted model, there were no ethnic group differences in FRS among males and Filipinos had significantly higher FRS compared with non-Hispanic White among females. Conclusions: This cross-sectional community-based epidemiological study examined ethnic differences in CVD risk after adjusting for age, depression, social support, and acculturation. The results suggest that some ethnic differences in CVD risk persist even after controlling for confounders but that recalibration of risk assessment is necessary.
MeSH term(s)	Adult ; Coronary Disease/ethnology ; Cross-Sectional Studies ; Ethnicity/statistics & numerical data ; Female ; Hawaii/epidemiology ; Health Status Disparities ; Humans ; Male ; Middle Aged ; Race Factors ; Risk Factors ; Sex Factors
Language	English
Publishing date	2020-08-31
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2760524-3
ISSN	2196-8837 ; 2197-3792
ISSN (online)	2196-8837
ISSN	2197-3792
DOI	10.1007/s40615-020-00851-2
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Article ; Online: Culturally responsive approaches to health promotion for Native Hawaiians and Pacific Islanders.

Kaholokula, Joseph Keawe'aimoku / Ing, Claire Townsend / Look, Mele A / Delafield, Rebecca / Sinclair, Ka'imi

Annals of human biology

2018 Volume 45, Issue 3, Page(s) 249–263

Abstract: Context: Obesity, diabetes and cardiovascular disease (CVD) have reached epidemic proportions among Native Hawaiians/Pacific Islanders (NHPI). Culturally responsive interventions that account for their interpersonal, sociocultural and socioeconomic ... ...

Abstract	Context: Obesity, diabetes and cardiovascular disease (CVD) have reached epidemic proportions among Native Hawaiians/Pacific Islanders (NHPI). Culturally responsive interventions that account for their interpersonal, sociocultural and socioeconomic realities are a public health priority. Objective: To describe cultural adaptation and culturally grounded approaches to developing health interventions for NHPI and to review the culturally responsive approaches used by, and outcomes from, two long-standing community-based participatory research projects (CBPR) in Hawai'i: PILI 'Ohana and KāHOLO Projects. Methods: A literature review of 14 studies from these two projects was done to exemplify the methods applied to culturally adapting existing evidence-based interventions and to developing novel interventions from the 'ground up' to address health disparities in NHPI. Of the 14 studies reviewed, 11 were studies of the clinical and behavioural outcomes of both types of interventions. Results: Both culturally adapted and culturally grounded approaches using community-based assets and NHPI cultural values/practices led to establishing sustainable and scalable interventions that significantly improved clinical measures of obesity, diabetes and hypertension. Conclusion: Several recommendations are provided based on the lessons learned from the PILI 'Ohana and KāHOLO Projects. Multidisciplinary and transdisciplinary research using CBPR approaches are needed to elucidate how human biology is impacted by societal, environmental and psychological factors that increase the risk for cardiometabolic diseases among NHPI to develop more effective health promotion interventions and public health policies.
MeSH term(s)	Cardiovascular Diseases/prevention & control ; Cardiovascular Diseases/psychology ; Community-Based Participatory Research/statistics & numerical data ; Diabetes Mellitus/prevention & control ; Diabetes Mellitus/psychology ; Hawaii ; Health Promotion/methods ; Humans ; Native Hawaiian or Other Pacific Islander ; Obesity/prevention & control ; Obesity/psychology
Language	English
Publishing date	2018-05-29
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	186656-4
ISSN	1464-5033 ; 0301-4460
ISSN (online)	1464-5033
ISSN	0301-4460
DOI	10.1080/03014460.2018.1465593
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Article ; Online: Comparing Weight Loss-Maintenance Outcomes of a Worksite-Based Lifestyle Program Delivered via DVD and Face-to-Face: A Randomized Trial.

Ing, Claire Townsend / Miyamoto, Robin E S / Fang, Rui / Antonio, Mapuana / Paloma, Diane / Braun, Kathryn L / Kaholokula, Joseph Keawe'aimoku

Health education & behavior : the official publication of the Society for Public Health Education

2018 Volume 45, Issue 4, Page(s) 569–580

Abstract: Background: Native Hawaiians and other Pacific Islanders have high rates of overweight and obesity compared with other ethnic groups in Hawai'i. Effective weight loss and weight loss-maintenance programs are needed to address obesity and obesity-related ...

Abstract	Background: Native Hawaiians and other Pacific Islanders have high rates of overweight and obesity compared with other ethnic groups in Hawai'i. Effective weight loss and weight loss-maintenance programs are needed to address obesity and obesity-related health inequities for this group. Aims: Compare the effectiveness of a 9-month, worksite-based, weight loss-maintenance intervention delivered via DVD versus face-to-face in continued weight reduction and weight loss maintenance beyond the initial weight loss phase. Method: We tested DVD versus face-to-face delivery of the PILI@Work Program's 9-month, weight loss-maintenance phase in Native Hawaiian-serving organizations. After completing the 3-month weight loss phase, participants ( n = 217) were randomized to receive the weight loss-maintenance phase delivered via trained peer facilitators or DVDs. Participant assessments at randomization and postintervention included weight, height, blood pressure, physical functioning, exercise frequency, and fat intake. Results: Eighty-three face-to-face participants were retained at 12 months (74.1%) compared with 73 DVD participants (69.5%). There was no significant difference between groups in weight loss or weight loss maintenance. The number of lessons attended in Phase 1 of the intervention (β = 0.358, p = .022) and baseline systolic blood pressure (β = -0.038, p = .048) predicted percent weight loss at 12 months. Discussion and conclusion: Weight loss maintenance was similar across groups. This suggests that low-cost delivery methods for worksite-based interventions targeting at-risk populations can help address obesity and obesity-related disparities. Additionally, attendance during the weight loss phase and lower baseline systolic blood pressure predicted greater percent weight loss during the weight loss-maintenance phase, suggesting that early engagement and initial physical functioning improve long-term weight loss outcomes.
MeSH term(s)	Adult ; Exercise ; Female ; Hawaii/epidemiology ; Health Promotion ; Humans ; Life Style ; Male ; Middle Aged ; Obesity/epidemiology ; Oceanic Ancestry Group ; Risk Factors ; Weight Loss/physiology ; Weight Reduction Programs/methods ; Workplace
Language	English
Publishing date	2018-03-04
Publishing country	United States
Document type	Journal Article ; Randomized Controlled Trial ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	1362906-2
ISSN	1552-6127 ; 1090-1981
ISSN (online)	1552-6127
ISSN	1090-1981
DOI	10.1177/1090198118757824
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Article: A Resilience Model of Adult Native Hawaiian Health Utilizing a Newly Multi-Dimensional Scale.

Antonio, Mapuana C K / Hishinuma, Earl S / Ing, Claire Townsend / Hamagami, Fumiaki / Dillard, Adrienne / Kekauoha, B Puni / Solatorio, Cappy / Cassel, Kevin / Braun, Kathryn L / Kaholokula, Joseph Keaweʻaimoku

Behavioral medicine (Washington, D.C.)

2020 Volume 46, Issue 3-4, Page(s) 258–277

Abstract: Resilience has conventionally focused on an individual's ability to overcome adversity. Recent research expands on this definition, making resilience a multi-dimensional construct. Native Hawaiians experience health disparities compared to the general ... ...

Abstract	Resilience has conventionally focused on an individual's ability to overcome adversity. Recent research expands on this definition, making resilience a multi-dimensional construct. Native Hawaiians experience health disparities compared to the general population of Hawai'i. Despite the pressing need to address health disparities, minimal research examines resilience factors that serve as buffers for adverse experiences of Native Hawaiians. The purpose of this study was to estimate psychometric properties of scales that measured resilience-based factors through multiple levels using higher-order confirmatory factor analyses (CFA) and ascertain if this construct of resilience mediated or moderated adversity experienced by a sample of Native Hawaiians. Participants included 125 adults who participated in the Hawaiian Homestead Health Survey. Based on higher-order CFA, resilience comprised internal assets measured by hope, satisfaction with life, and environmental mastery, and external resources measured by social support and Native Hawaiian cultural identity. Results of the structural equation models were consistent with literature focusing on resiliency and health. Findings emphasized the importance of enhancing resilience by considering strengths and resources on the individual, interpersonal, and community levels. Findings also demonstrated the need to address adversity factors directly, with a specific need of addressing socio-economic status factors. According to structural equation models, resilience slightly mediated and moderated the effect of adversity related to socio-economic status. These findings have implications for future research exploring resilience as a mediator or moderator of adversity among Native Hawaiians and emphasize a multi-faceted construct of resilience to promote better health outcomes.
MeSH term(s)	Adult ; Aged ; Female ; Hawaii/epidemiology ; Health Status Disparities ; Health Surveys/methods ; Humans ; Male ; Middle Aged ; Models, Theoretical ; Native Hawaiian or Other Pacific Islander/psychology ; Psychometrics/methods ; Reproducibility of Results ; Resilience, Psychological/ethics ; Social Support
Language	English
Publishing date	2020-05-01
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	623101-9
ISSN	0896-4289
ISSN	0896-4289
DOI	10.1080/08964289.2020.1758610
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