Kauilaonālani Tengan is inspired to encourage greater participation from Native Hawaiian, Pacific Islander and Filipino communities in diabetes clinical trials to ensure research better reflects the populations most affected by the disease.

Leave your assumptions and biases at the door and engage these communities with aloha.
—Kauilaonālani Tengan

He is translating that goal into practice through applied research. A master of science student in epidemiology at the University of �鶹��ý at ����ԴDz� , Tengan was part of a study team at The Queen’s Health Systems (QHS) whose findings were published in in the study Exploring Diabetes Clinical Trial Participation: A Diverse Group Interview Study.

“I have a family history of cardiometabolic diseases and I remember visiting extended family who had to fly from Molokaʻi just to receive quality care here on Oʻahu,” he said. “This [experience] instilled in me a desire to learn more about health issues so prevalent in our islands and contribute to innovative solutions.”

Research findings and lessons learned

While at QHS, Tengan split his time between health equity research and clinical data management, utilizing electronic medical records to address research questions. He helped conduct interviews with 56 hospitalized patients to explore what motivates—or prevents—patients from joining diabetes clinical trials.

Although 84% expressed willingness to participate, most had never been asked. Barriers included mistrust, concerns about medication risks, and lack of understanding, while many Native Hawaiian and Pacific Islander participants cited family and community benefit as key motivators.

“Engaging face-to-face with people in a clinical setting humanized health data for me,” Tengan said. “It reminded me that these are people, not statistics. I realized that my work has a lasting impact, so it is my responsibility to do things in a pono manner.”

Tengan hopes to carry these lessons forward. “Leave your assumptions and biases at the door and engage these communities with aloha,” he said. “It is vital that we do work in an ethically and culturally nuanced way because there are real world impacts in the data that we publish.”

The study was part of an Food and Drug Administration-funded project at The Queenʻs Medical Center, in collaboration with the UH ����ԴDz� , and clinical partners. also found that Native Hawaiian and Pacific Islander participants are consistently underrepresented in U.S. clinical trials.

“Kauilaonālani’s perspectives and real-life application from quantitative analyses are so important to building collective public health,” said Tetine Sentell, public health professor and study co-author.

While life expectancy across the U.S. declined significantly during the COVID-19 pandemic, a new study led by researchers at the University of �鶹��ý and the found that �鶹��ý experienced a smaller decline compared to national trends.

Yan Yan Wu, Michael Phillips and Kathryn L. Braun from the UH ��å�ԴDz� , along with Lance Ching and Claire Prieto from the , found that life expectancy in �鶹��ý declined by 1.4 years, from 82.1 in 2019 to 80.7 in 2021. Nationwide, the decline over the same period was 2.4 years, from 78.8 to 76.4. Their findings were published in the .

“The smaller magnitude and delayed timing of �鶹��ý’s decline may reflect the state’s geographic isolation and early implementation of public health interventions,” said Wu, the study’s lead author. “In 2022, life expectancy partially rebounded by 0.5 years in �鶹��ý and by 0.9 years nationally, with �鶹��ý remaining about four years higher than the U.S. average throughout the pandemic.”

“�鶹��ý ranks among the top U.S. states for COVID-19 vaccination coverage. By May 2023, data reported by the U.S. Centers for Disease Control and Prevention (CDC) showed that more than 90% of residents received at least one dose and more than 80% were considered fully vaccinated with the primary COVID-19 vaccine series,” said Ching, epidemiologist with the DOH Chronic Disease Prevention & Health Promotion Division. “These high vaccination levels—reached over the course of the pandemic—helped delay the peak of COVID-19 mortality in �鶹��ý by approximately six months compared to the national average and contributed to the state’s distinction of having the lowest age-adjusted COVID-19 death rate in the country.”

Key Findings

• Life expectancy in �鶹��ý remained stable from 2018 to 2020 (82.3, 82.1, and 82.0 years, respectively).
• A decline occurred in 2021 to 80.7 years, followed by a partial rebound to 81.2 years in 2022.
• Among males, life expectancy fell from 79.2 years in 2018 to 77.5 years in 2021, then rose to 78.2 years in 2022.
• Among females, life expectancy fell from 85.4 years in 2018 to 84.0 years in 2021, rebounding to 84.4 years in 2022.
• The gap between female and male life expectancy widened to 6.5 years in 2021 before narrowing to 6.2 years in 2022—the same as in 2019.
• Despite these fluctuations, �鶹��ý‘s overall decline in life expectancy remained less severe than the U.S. average throughout the pandemic.

Policy Implications

The researchers note that �鶹��ý‘s better outcomes underscore the effectiveness of early public health interventions, strong community engagement, and high vaccine uptake. They recommend that future policies build on these strengths by investing in rapid-response infrastructure and maintaining high vaccination coverage to better protect vulnerable communities during future disease outbreaks.

The at the University of �鶹��ý (ARL at UH) is known for its research in renewable energy, coastal defense for sea-level rise, cybersecurity and more but it has also been active in supporting the community, especially in times of crisis.

Maui wildfires

ARL at UH worked with the Maui tech community to distribute Starlink terminals to Lahaina as part of the wildfire recovery effort. Approximately 500 Starlink terminals were distributed over two days, reestablishing communications for emergency personnel and those affected by the wildfires. The team also developed an app to organize information about missing community members and coordinated financial and supply donations for the Lahaina community, acting as “boots on the ground” to support recovery on Maui.

“Our work is community-driven. We help meet the needs of many of the emerging problems �Ჹ�ɲ���ʻ��’s communities are facing,” said Margo Edwards, director of ARL at UH. “ARL at UH is at the forefront of technological innovation for disaster response, which will be crucial for �鶹��ý as climate change continues to impact our state.”

COVID-19 pandemic

ARL at UH partnered with the �鶹��ý Pandemic Applied Modeling Work Group to create a forecast tool that allowed epidemiologists to visualize the future state of the COVID-19 pandemic. The tool helped �鶹��ý’s medical professionals prepare for hospital capacity and overflow.

“Several online tools exist that incorporate the SEIR [model for infectious disease dynamics] model, however, what we did was take those tools and customize it for �鶹��ý to support �Ჹ�ɲ���ʻ��—a�����⾱�Բ� the lessons from around the world and also factoring in �Ჹ�ɲ���ʻ��’s unique circumstances,” said Baseem Missaghi, an application developer at ARL at UH who helped work on the forecasting tool. “It also allowed us to develop a strong relationship with other groups in �鶹��ý that had a shared passion for helping the community.”

With the UH Mānoa College of Engineering, ARL at UH assisted �鶹��ý physicians to develop a technique for ventilating up to four patients using a single ventilator with a “multi-split ventilator system.” ARL at UH also partnered with the UH Mānoa School of Nursing to develop and deploy an app to count how masks were being worn in �鶹��ý.

“ARL at UH has the ability to quickly build services, tools and apps,” said Missaghi. “Our work with the Department of Education on a check-in app and the UH Mānoa School of Nursing on the facemask tracking app allowed ARL at UH to help and serve the �鶹��ý community.”

ARL at UH is the fifth U.S. Navy-sponsored University-Affiliated Research Center, bringing in a total of $139 million since it was established in 2008.

Heart disease, stroke and diabetes are three of the leading causes of death in �鶹��ý. Many people do not know that they have a chronic condition, even those with regular healthcare.

To improve patient health and possibly prevent deaths from chronic conditions, a team of state partners and researchers with the University of �鶹��ý at ����ԴDz� collaborated to improve the assessment of undiagnosed conditions in patients through new algorithms and analysis that could help hundreds of people in the state.

Our work highlights the potential of a relatively simple health information technology intervention
—Catherine Pirkle

Among the important findings: 53% of adults receiving regular care at six primary clinics in The Queen’s Health System (QHS) had diagnosed hypertension and only 3% of adults exhibited high blood pressure readings without a formal diagnosis, showcasing the clinics’ effectiveness in diagnosing hypertension cases. Additionally, Medicaid beneficiaries with clinical evidence of hypertension were less likely to receive a diagnosis compared to those covered by other insurance types. Also, the COVID-19 pandemic led to underdiagnosis of hypertension.

Supported by two Centers for Disease Control and Prevention grants, the initiative was a collaboration with the �鶹��ý State Department of Health (DOH), The Queen’s Clinically Integrated Physician Network (QCIPN) and The QHS. The initiative was a part of national efforts to increase detection of chronic conditions and improve patient quality of care.

“This research is an excellent example of collaboration between academic, governmental and healthcare partners committed to improving the population’s health. Our work highlights the potential of a relatively simple health information technology intervention,” said Catherine M. Pirkle, associate professor and corresponding author.

Algorithms developed to assess undiagnosed hypertension

DOH developed automated algorithms, which were then implemented by The QHS in the electronic data warehouse of six primary care clinics. UH faculty and students conducted evaluations, assessing the effectiveness of the algorithms in identifying potentially undiagnosed conditions, while also exploring factors placing individuals at higher risk of not getting an appropriate diagnosis for hypertension.

“Understanding these factors can help to inform new clinical workflows to improve hypertension diagnosis, an important step to reducing the prevalence of hypertension in �鶹��ý,” said lead-author and epidemiology PhD student, Mika D. Thompson.

Results of the hypertension algorithm evaluation, presented at the American Public Health Association annual conference and published in the , revealed that 53% of adults at QCIPN clinics had diagnosed hypertension, which is higher than the 26% of adults who reported having hypertension in a .

Other co-authors of the study include Blythe Nett, Yanyan Wu, Tetine L. Sentell, Meghan D. McGurk, Lance K. Ching, Hermina Taylor and Tiffany Lemmen.

Back pain is a common problem that impacts more than 619 million people globally and remains the of disability worldwide. In the next three decades, that number is expected to jump to 840 million people.

“I don’t think this fact is widely known, and it became worse during the pandemic with people staying home and not having access to appropriate care,” said Eric Hurwitz, professor and director of the (OPHS) at the at the University of �鶹��ý at ����ԴDz�. Hurwitz is an epidemiologist who has studied back pain for 30 years.

In addition to known risks for back pain, including smoking, obesity and occupational ergonomic factors, a co-authored by Hurwitz found an association to depression. Those with back pain were more likely to report symptoms consistent with depression at subsequent follow-up, and those with depression were more likely to report subsequent back pain. The study surveyed more than 2,000 adults in the U.S. over a nine-year period.

“Similar to back and neck pain, depression is also a leading cause of disability worldwide,” noted Hurwitz.

In involving Hurwitz and colleagues, researchers used data from the U.S. National Health Interview Survey and found that cardiovascular conditions, hypertension, diabetes as well as poor mental health were associated with higher odds of spinal pain. The study also found links between spinal pain and cognitive impairment.

“The next steps in this research will be to figure out why these associations exist, if they have common causes that we can intervene on, and the effectiveness of these interventions,” said Hurwitz. “We need more studies that can help us better understand the causal relationships (if any) between these conditions.”

Chiropractic care, epidemiology

Hurwitz has led numerous studies on the effectiveness of spinal manipulation and other therapies for treating back pain and other conditions often seen by chiropractors throughout his career. In his research, he looks at what populations tend to be at higher or lower risk, what are the risk and protective factors, and what are the best ways to manage it.

His interest in back pain therapy stems from his time in chiropractic school where he earned his doctor of chiropractic from Los Angeles College of Chiropractic. He took the advice of his teachers to pursue epidemiology and earned his master’s and PhD from UCLA. Hurwitz joined the faculty at UH ����ԴDz� in 2006 where he has served as graduate chair of the in OPHS since 2010.

Keeping back pain away

So how does one deal with common back issues? Hurwitz advises, “Try to keep moving, find exercises or physical activities that you enjoy doing so you’ll keep at it. The important thing is to stay active and maintain a healthy weight so your back isn’t unduly strained. It not only helps physically, but for your mental well-being too, and being sedentary increases the risk for all of these musculoskeletal and non-musculoskeletal ailments.”

Hurwitz suggests walking, swimming and bicycling, as well as activities that aim to improve mobility and range of motion like stretching exercises, yoga and Tai Chi.

“Most back pain isn’t serious but if it’s persistent, and it keeps you from moving or sleeping, or goes down the leg, then it’s time to seek advice from a health care provider,” he said.

Big picture in public health

Hurwitz believes public health plays an important role in addressing back pain issues, and improving coordination efforts on multiple levels is needed.

“Interventions that motivate people in pain (either mentally or physically or both) to move more might have wide-ranging benefits,” Hurwitz said. “But what can we do not just individually, but as a community, society, organizationally, legislatively to promote health and well-being for all of us?”

He added, “We might have the motivation but societal or other constraints may get in the way, such as lack of safe spaces to exercise, the inability to afford gym membership and time constraints due to working multiple jobs.”

—by Arlene Abiang

Sometimes we have had a class where the subject material seems a bit tough to interpret. And sometimes a teaching assistant who has been in our place helps make the connections we could not initially see.

University of �鶹��ý at ����ԴDz� graduate students who have studied any life sciences field as an undergraduate or graduate student are invited to apply to become a teaching assistant (TA) in the .

According to School of Life Sciences Associate Director of Instruction Stephanie Kraft-Terry, the school is looking for approximately 64 TAs to assist in teaching undergraduate labs in the areas of biology, botany, marine biology, microbiology and molecular cell biology.

“We hire TAs with background in both undergraduate and graduate studies in the life sciences and encourage anyone with that background who is interested in providing excellent instruction to undergraduate students, regardless of their graduate program, to apply,” Kraft-Terry said.

The application review deadline is April 29. Applications will continue to be accepted but priority will be given to those students who submit an application by April 29. Visit the for more information and to apply.

Creating an impact for students

Breena Gaskov is working as a life sciences TA, while finishing up her first year as a student in the program. Gaskov holds an undergraduate degree in biology with a focus in microbiology.

“Being a TA for the School of Life Sciences allows me to make that impact on students who are looking for their passion in science, and guide them along the way,” Gaskov said. “For me, becoming a School of Life Sciences TA was a no brainer. I now get to come full circle and teach others in the same way that made me fall in love with science!”

Along with receiving a nine-month salary and tuition waiver, Gaskov said one of the major benefits is to be able to personalize your instruction to your skill set.

“I purposely teach in the same way that worked best for me when I was in my students’ place,” Gaskov said. “I have the ability to make even difficult subjects fun, for both me and the students! The biggest one though, for me, is the ability to see the impact being made on students. I have had multiple students walk into class and tell me ‘I was having a bad day today and this class made it better,’ and ‘I actually look forward to coming to this lab.’ I always leave the lab feeling full of happiness, every single time.”

Gaining self-confidence

Chris Nakano became a life sciences TA after hearing about the position from fellow peers in his classes. He earned his graduate degree in in fall 2021.

“Aside from the tuition exemption and stipends, the office staff, lab coordinators and principal investigators are incredibly supportive in both the sense of helping you excel as a budding educator and understanding of your busy schedule as a student,” Nakano said. “It’s a great introduction to scientific pedagogy, and you’ll nurture the self-confidence to troubleshoot the basic lab techniques prevalent in any scientific laboratory. You’ll also be surrounded by experts in the field that are generous in experience and wisdom, who are incredibly eager to share their counsel.”

Nakano recommends interested applicants to apply early, have enthusiasm and be committed.

This work is an example of UH ����ԴDz�’s goals of (PDF) and (PDF), two of four goals identified in the (PDF), updated in December 2020.

—By Marc Arakaki

Nutritional epidemiologists Rachel Novotny of the Department of Human Nutrition, Food and Animal Sciences, and Carol Boushey, of the , are two of only 20 nationally recognized scientists on the U.S. Department of Agriculture (USDA) independent advisory committee which published the .

• Related �鶹��ýNews story: UH epidemiologists to help develop U.S. dietary guidelines, February 26, 2019

The report is an in-depth review of the latest available science on specific nutrition topics. The report’s findings will help to shape the 2020–2025 Dietary Guidelines for Americans, which will provide hundreds of millions of Americans—and nutritionists around the world—with recommendations on what to eat and drink to promote health  and prevent chronic disease. An ongoing began on July 15, 2020, and will remain open until August 13, 2020, 11:59 p.m., Eastern time.

“The Dietary Guidelines translate current science into food and beverage intake guidance for the U.S. population, which is used as the basis for key federal food-assistance programs such as the School Breakfast and Lunch Program and the Supplemental Nutrition Assistance Program (SNAP, formerly Food Stamps),” explained Novotny.

“I chaired the Dietary Patterns Sub-Committee, which reviewed the relationship between dietary patterns and all-cause mortality for the first time,” said Boushey, who is also a registered dietitian. “The results, informed by data from �鶹��ý and around the world, show a reduced risk of all-cause mortality when food patterns are primarily comprised of vegetables, fruits, legumes, nuts, whole grains, unsaturated vegetable oils, fish and lean meat or poultry.”

Novotny added, “What’s interesting is that the 2020–2025 Dietary Guidelines are the first to include the whole life span, including 0–2 years of age, and to focus on patterns of food and beverage intake.”

The guidelines, co-developed by USDA and the U.S. Department of Health and Human Services (HHS), are the cornerstone of U.S. nutrition programs and policies, so the work of the advisory committee has far-reaching implications for years to come. The goal is to release the Dietary Guidelines by the end of 2020.

The committee’s work was informed by more than 62,000 public comments, a marker of USDA and HHS’s commitment to public involvement in the dietary guidelines process. In addition to co-developing the guidelines, USDA’s Food and Nutrition Service administers 15 nutrition-assistance programs to ensure children and low-income individuals and families have nutritious food to eat.

As the number of COVID-19 cases surge in cities like New York, some in �鶹��ý fear an exponential rise in the Aloha State is imminent. There is a statewide stay-at-home order in effect and practicing social distancing remains crucial to stem the spread. But ​Alan Katz​, an professor at the , said ​because a majority of �鶹��ýʻs communities are rural, it could help lessen the chance of a major outbreak.

“We only have one urban center in Honolulu and the rest of the islands are rural including any spot on Oʻahu that’s outside of Honolulu, that’s considered rural. So that’s good. People are less densely populated,” Katz explained. The UH Mānoa epidemiologist said it gives the state some leeway in minimizing the spread of the highly infectious virus.

Because the incubation period for COVID-19 is up to 14 days, Katz said �鶹��ý will inevitably see more cases during the statewide lockdown but is hopeful it won’t be a steep increase. In order to avoid a major outbreak, he urges everyone to take health guidelines seriously.

“The most important thing you can do is maintain social distancing. Stay 6 feet away from each other. That’s going to really dramatically mitigate person to person spread of this. If you’re not essential, if you’re supposed to be at home try to stay at home. Don’t aggregate in groups,” Katz said.

According to researchers, ​COVID-19 is much more contagious than the seasonal flu.

—By Moanikeʻala Nabarro

Health crisis restrictions such as social distancing, which government and top health officials are implementing across the nation, stem from data gathered by epidemiologists. Those experts across the globe are analyzing stats from hospitals in countries slammed by COVID-19 to formulate how to control the virus’ spread.

Thomas Lee, an assistant professor of at the , explained the trends epidemiologists are now looking at.

It’s going to be important as the virus spreads, and it’s going to spread to rural communities as well, how well we can screen all of our citizens. Not just the ones living in the current hotspots.
—Lee

“Because China is five to six weeks ahead of where everyone else’s response is, (epidemiologists) are now able to utilize that and shift some focus on looking at what caused it,” said Lee.

He said epidemiologists are looking at population trends and COVID-19’s infection rate to develop an aggressive approach toward containing it. Lee explains one of the findings experts arrived at regarding testing.

“It’s going to be important as the virus spreads, and it’s going to spread to rural communities as well, how well we can screen all of our citizens. Not just the ones living in the current hotspots,” Lee said.

Like thousands of UH faculty, Lee is transitioning all of his courses online for the remainder of the semester. He plans to focus epidemiology lectures on COVID-19 studies that continue to surface as the outbreak grips the globe.

When researchers work together with community members to conduct studies to address health disparities, both groups reap the benefits, says a new paper led by faculty in the Myron B. Thompson School of Social Work at the campus.

The in a recent issue of the .

Katherine Yang, a recent from the UH and a current in , and colleagues conducted detailed interviews with 12 leading local experts. The goal is to learn about their experiences in using a community-based participatory research (CBPR) approach to improve health outcomes and promote health equity.

“In CBPR, researchers take the time to get to know their communities by being present and listening to their concerns and priorities,” Yang said. “Our analysis showed that CBPR can serve as a bridge between academic researchers and the communities that they study.”

A true partnership

CBPR projects involve community members not as research “subjects,” but as active participants and co-leaders in all research phases. Community members work closely with researchers to conduct the study from beginning to end.

Research that uses a CBPR approach starts with an issue that is important to the community, values reciprocal learning and benefits and promotes social action.

For example, in one project, researchers who were developing a substance abuse prevention program worked with ōpio (teenagers) in a rural Hawaiian community. The teens took pictures of things that represented Native Hawaiian values to them, and then worked with the researchers to use the photos in designing a public health intervention to prevent substance use.

“Community members feel engaged when they know their voices matter and that research is relevant to their experiences, concerns and priorities,” said Jane J. Chung-Do, an associate professor with UH public health and co-author of the paper. “We wanted to better understand what makes these projects successful and what we can work on to advance CBPR in �鶹��ý.”

For the .

—By Theresa Kreif