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The purpose of this study was to examine whether school experiences, school performance, and other risk-protective factors were related to violence among Hawaiian, Filipino, and Samoan youths residing in Hawai'i. This study analyzed survey data (N = 325) collected in three high schools having concentrations of Filipino, Hawaiian, and Samoan youths, as well as a smaller number of Japanese students, which served as a comparison group. The analyses consisted of bivariate and multivariate analyses of risk protection for violence. Two- and three-way interactions were tested to examine whether there were specific gender and/or ethnic effects. The final model explained 29.3% of the variance in violent behavior. Five variables were significant: grade point average, pressure to choose between school and friends, favorable school attitude, feeling safe, and importance of college. Schools serving these populations should focus on fostering positive bonds between teachers and students and building bridges to families and neighborhoods. (Contains 3 tables.)

Background: Factors associated with Asian/Pacific-Islander adolescent adjustment is a greatly neglected research area. Aims: The purpose of the present study was to investigate the relation between demographic, social and adjustment measures based on a large-scale investigation of Asian/Pacific-Islander youths. Method: A total of 2577 adolescents were surveyed across 4 public schools in Hawai'i during the 1992-1993 school year. Results: Three social variables (number of relatives frequently seen, family support and friends' support) exhibited statistically significant but low correlations. Family support had the highest negative association with the four psychiatric symptoms (depression, anxiety, aggression, substance use). Friends' support was inconsistently associated with the adjustment measures, and the number of relatives frequently seen resulted in negligible effects. In contrast, demographic variables, especially ethnicity, played a much greater role in the association with the four school-related measures (grade-point average, absences, suspensions, conduct infractions). Discussion: For Asian/Pacific-Islander youths, the quality of the social supports, including family relations, may be particularly important in the adolescents' adjustment. When examining school-related outcomes, demographic variables, with particular emphases on ethnicity and culture, must be considered. When developing and implementing prevention and intervention services and programs, consideration of family and ethnic-cultural influences should be taken into account, with further research needed in several related domains: other SES influences, life stressors, migration-generational effects, ethnic identity, self-concept indicators and socio-political aspects.

The Medicaid program was enacted in 1965 for the purpose of providing federal cost sharing in the payment for medical services for the indigent. Although there are major differences among the states in eligibility criteria and benefits, the federal law requires that benefits include payment for long-term care services. The article notes that certain provisions of the law enable middle-class individuals to transfer assets and to use other means of qualifying for Medicaid. These practices, especially Medicaid estate planning, enable middle-class persons to retain their assets in their families rather than 'spending down' to qualify for Medicaid benefits. This article argues that these practices constitute a form of legal welfare fraud. The reality of the long-term care provisions of the Medicaid program can be seen as backfiring in ways that undermine the intended purpose of the program and that have negative consequences for the general social good. Keywords: Medicaid estate planning; financing long-term care; asset transfer; long-term care insurance

This study examines rates of low birth weight (LBW) in the state of Hawaii and changes in the association of LBW with socioeconomic status from 1970 to 1990. The analysis is based on aggregate data for census tracts. Rates of low birth weight were calculated for each census tract. Relative socioeconomic scores were calculated from average household income and years of education. The results show that (1) there was a decrease in the rate of low birth weight infants in Hawaii; and (2) that the correlation between socioeconomic status and low birth weight was substantially reduced, though a significant correlation remains. The paper suggests likely ceiling effects, but that the progressive public health policies and expansion of access to primary health care in Hawaii during this period played a major role in reducing the rate of low birth weight infants and in decreasing socioeconomic inequality on this important health indicator.

This article provides an evaluation of Germany's health insurance law regarding the long term care of the elderly. The author, maintaining Germany began to implement new laws in 1995, states that the laws have provided affordable long term care, have restructured community based care, and has created hundreds of new agencies.

The article presents a discussion on the development of legally mandated patient consent procedures in the formalization of the doctor-patient relationship. It addresses the limitations of law to transform the nature of social transactions between doctors and patients. It is based on the studies conducted to determine the effects of the law passed in Hawaii which require all physicians treating breast cancer patients to present a standardized patient education form about alternative treatment. The law increases the patient's role in the decision making process.

The article discusses the recommendations for more effective health care in the state of Hawaii. Health care services can help to protect ethnic groups in Hawaii from disease and to reduce the negative effects of illness. Native Hawaiians suffer disproportionately from the most significant chronic diseases which underlie disability and mortality in later life, such as diabetes, heart disease, hypertension, and cancer. The pursuit of better health necessitates social changes which would improve the life situation of the Native Hawaiian. In this sense, any steps taken to empower this group, to increase the level of self-efficacy, and to improve their economic situation, must be regarded as important to the promotion of health.

The article features a discussion on hypertension and heart disease in the state of Hawaii. Mortality statistics show that in the early twentieth century, heart disease was insignificant in Hawaii as a cause of death compared to infectious diseases for all ethnic groups. Native Hawaiians have significantly higher rates of heart disease than other ethnic groups. In 1920 the mortality rate from arteriosclerotic disease among Native Hawaiians was 3.4 per 100,000 population, but by 1960 it was 287.2 per 100,000, twice as high as the combined rate for other racial groups.

The article features a framework for assessing the health needs of Hawaiians. Systematic medical information on the population of Hawaii is available since the early 20th century. A report from the US Office of Technology Assessment in 1987 showed that the overall death rate of Native Hawaiians is 34% higher than for the total US population, with higher rates for diseases of the heart, cancer, cerebrovascular disease, and diabetes mellitus. Thus, epidemiological data provide clear evidence that Native Hawaiians are a high risk population for many serious health problems.