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Clifford Bersamira, PhD, AM, Assistant Professor
Thompson School of Social Work & Public Health, University of Hawaii at Manoa

Perceptions of Substance-Use and Treatment in the Filipino Community

Filipinos, the second largest ethnic group in Hawai‘i and the third largest Asian ethnic group in the United States, have high substance-use service need, yet have low engagement in substance use disorder (SUD) treatment and other behavioral health services. Using semi-structured interviews in the pakikipagkwentuhan method and brief surveys with members of the Filipino community and substance-use service providers who work with the Filipino community, this study aims to 1) identify Filipino cultural beliefs, practices, and values related to substance-use, addiction, and service seeking; 2) understand barriers in the Filipino community to substance-use service seeking; and 3) identify the successful strategies of substance-use service providers actively engaging the Filipino community.

Gary Glauberman, PhD, RN, Assistant Professor
Nancy Atmospera-Walch School of Nursing & Dental Hygiene

Impact of the COVID-19 Pandemic on Emergency Preparedness Among Hawaii’s Families

Public health emergencies, such as natural disasters or disease outbreaks, can occur at any time and with little warning. Emergency Preparedness (EP) can save lives, and has been identified as a national public health priority, with the goal of ensuring individuals, communities, and organizations are prepared for disasters, disease outbreaks, and medical emergencies. Hawaii’s Indigenous Pacific People (IPP, defined as Native Hawaiians, Pacific Islanders and Filipinos) are also vulnerable to emergencies, due to being disproportionately affected by factors that complicate their EP, such as underlying health conditions, economic instability, and poorer access to health/social services. The proposed study seeks to develop a comprehensive understanding of the influence of the pandemic on EP, and primary caregivers’ decision-making related to routine and COVID-19 vaccines among IPP families with young children. The project is relevant as 1) natural disasters are expected to increase in number/severity, 2) new and/or persistent disease outbreaks are likely, and 3) families may be threatened with multiple emergencies concurrently.

Uliana Kostareva, PhD, Assistant Professor
Nancy Atmospera-Walch School of Nursing & Dental Hygiene

Interpreters’ perspectives on effective communication with Filipino patients

Effective communication is the foundation of safe medical care, but it is hard to establish if the provider and patient do not speak the same language. There is a large Filipino population in Hawaii and 20% speak English less than “very well.” Limited English proficiency (LEP) is associated with higher risks of miscommunications, lower access to care, worse health outcomes, and increased costs. Significance: Current use of interpreters is not in line with the national standards of culturally and linguistically appropriate services (CLAS) due to the frequent use of family members or untrained individuals as interpreters, which could be linked to Filipino cultural beliefs and family traditions. Objective: Considering health and linguistic health inequities among Hawaii’s Filipino population exacerbated by the Covid-19 pandemic, there is a need to investigate how CLAS could be adjusted to meet those needs. Innovation: Understanding the perspectives of professional medical interpreters for Filipino languages could provide unique and important insights into barriers and facilitators to effective patient-provider communication and help to define the extent of the problem. Central hypothesis: Professional medical interpreters will be able to describe key factors that act as barriers and facilitators to effective patient-provider communication with Filipino patients with LEP. Specific aims: We will conduct interviews (n = 10-15) with professional medical interpreters for Filipino languages. Aim 1 – we will examine context-specific factors that influence the use of medical interpreters for Filipino LEP patients, including interpreters’ experiences and perspectives regarding patient, provider, and system levels issues and Covid-19 impact. Aim 2 – we will categorize results into barriers and facilitators of effective patient-provider communication with Filipino LEP patients and will work with a community collaborator to develop an action plan/recommendations for more equitable communication. Expected results: Findings on barriers and facilitators will be shared with key organizations (medical interpreters and Filipino health professional organizations) to guide the development of a larger research grant proposal to develop and test an intervention to increase CLAS for LEP Filipino patients in Hawaii.

Melissa Faith Q. Natavio, MD, MPH, Associate Professor
John A. Burns School of Medicine

Factors underlying maternal health disparities among Filipinos in Hawaii

Hawaii statewide data suggest that Filipino women have high rates of poor obstetric outcomes and are more likely to be admitted to the intensive care unit during pregnancy when compared to non-Hispanic White women. Compared to other racial/ethnic groups in the state, Filipino women are more likely to have unplanned pregnancies, are less likely to receive early and adequate prenatal care, and are less likely to attend a childbirth class, all of which may contribute to poor pregnancy outcomes. Our objective is to understand how Filipino women perceive the influence of individual and community factors on prenatal care utilization and maternal morbidity. Qualitative data will be collected from Filipino women and men through focus groups and key informant interviews.

Saguna Verma, PhD, Professor
John A. Burns School of Medicine

Association of SARS-CoV-2 proteins with COVID-19 disease in Indigenous people of Hawaii

In the ongoing COVID-19 pandemic, Indigenous Pacific People (IPP), defined as Native Hawaiians, Other Pacific Islanders, and Filipinos, have suffered the highest COVID-19 hospitalization and death rates of all ethnic groups in the US. The reasons underlying this health disparity include social factors and the higher prevalence of comorbid conditions. A major hallmark of severe COVID-19 is the presence of elevated cytokines in the blood plasma that is linked to the injury of multiple tissues, like the lung, heart, kidney, and brain. Other potential mechanisms of tissue injury can be either because the virus can directly infect them or because they are exposed to one or more viral proteins (not active replicating virus with genomic material) secreted by the infected cells. Protein particles of SARS-CoV-2 like spike subunit 1 (S1) and nucleocapsid (N) have already been shown to be detected in the plasma of COVID-19 patients. However, it is not known if envelope (E) protein is also secreted and if there is any link between plasma levels of these proteins and inflammation and comorbid conditions. Our preliminary data shows that exposure of human cells to E protein leads to the production of cytokines and induces cell death, suggesting that these proteins can cause cell injury independent of other factors. This study will address the hypothesis that SARS-CoV-2 S1, E, and N proteins are secreted in the plasma and their levels are higher in severe IPP and non-IPP COVID-19 patients and correlate with higher plasma cytokine levels and comorbid conditions. Aim 1 will assess the levels of SARS-CoV-2 proteins (S1, E, and N) in the plasma of COVID-19 patients at the early and late stages of diseas and compare them to disease severity and plasma cytokine levels in both IPP and non-IPP patients. We will use de-identified plasma samples already collected from COVID-19 patients on the island through two ongoing IRB-approved studies. In Aim 2, we will assess the cytopathic effects of SARS-CoV-2 proteins (S1, E, and N) on different human cells using a cell culture system. This aim will confirm that exposure of cells to different viral proteins can lead to inflammation and cell death and will provide relevance to the clinical observations found in Aim 1. The data will collectively provide new insights into the mechanisms underlying severe COVID-19, especially the impact of virus factors in people with comorbid conditions. The data will be disseminated to the IPP community, and since chronic diseases like diabetes and obesity are more prevalent in IPP, this knowledge will ultimately emphasize the importance of protective measures among both IPP and non-IPP with comorbid conditions.

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