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Rhythm and intonation are suprasegmental features that are considered important in assessing the intelligibility of English as a Foreign Language (EFL) learners. Japanese has a syllabletimed rhythm, while English has a stress-timed rhythm, which poses challenges for Japanese EFL learners in mastering English suprasegmental features. Further, few studies have been conducted on Japanese children who are EFL learners. This study involves eleven fifth-grade elementary school students from Osaka, Japan, and eleven from Hawaii, USA. Students from both countries read an English script aloud and their recordings were analyzed using the phonetic analysis software "Praat." Three hypotheses were examined: 1) Japanese EFL elementary students have longer unstressed vowel duration in interstress intervals (ISIs) compared to U.S. native English-speaking elementary students; 2) ISI duration is longer for Japanese EFL elementary students compared to U.S. native English-speaking elementary students; 3) The fundamental frequency (Hz) range is significantly narrower for Japanese EFL elementary students than for U.S. native English-speaking elementary students. With respect to the three hypotheses, we found significant differences in unstressed vowel duration and ISIs between Japanese and American children, with some sentences having longer ISIs for Japanese children. However, there were no significant differences in the fundamental frequency ratio, which was similar for both groups. The present study provides valuable insights for enhancing English pronunciation instruction in Japanese elementary schools, emphasizing the importance of shortening unstressed vowel durations in ISIs to improve intelligibility among students. Educators can use these findings to design more effective strategies for enhancing students' English language skills. [ABSTRACT FROM AUTHOR]

We consider the conditional treatment effect for competing risks data in observational studies. We derive the efficient score for the treatment effect using modern semiparametric theory, as well as two doubly robust scores with respect to (1) the assumed propensity score for treatment and the censoring model, and (2) the outcome models for the competing risks. An important property regarding the estimators is rate double robustness, in addition to the classical model double robustness. Rate double robustness enables the use of machine learning and nonparametric methods in order to estimate the nuisance parameters, while preserving the root‐n$$ n $$ asymptotic normality of the estimated treatment effect for inferential purposes. We study the performance of the estimators using simulation. The estimators are applied to the data from a cohort of Japanese men in Hawaii followed since 1960s in order to study the effect of mid‐life drinking behavior on late life cognitive outcomes. The approaches developed in this article are implemented in the R package "HazardDiff". [ABSTRACT FROM AUTHOR]

Background: Few studies have compared factors related to cognitive function among people with similar genetic backgrounds but different lifestyles.Objective: We aimed to identify factors related to lower cognitive scores among older Japanese men in two genetically similar cohorts exposed to different lifestyle factors.Methods: This cross-sectional study of community-dwelling Japanese men aged 71-81 years included 2,628 men enrolled in the Kuakini Honolulu-Asia Aging Study based in Hawaii and 349 men in the Shiga Epidemiological Study of Subclinical Atherosclerosis based in Japan. We compared participant performance through Cognitive Abilities Screening Instrument (CASI) assessment in Hawaii (1991-1993) and Japan (2009-2014). Factors related to low cognitive scores (history of cardiovascular disease, cardiometabolic factors, and lifestyle factors) were identified with questionnaires and measurements. Multivariable logistic regression analysis was used to calculate the adjusted odds ratios (ORs) of a low (< 82) CASI score based on different factors.Results: CASI scores were lower in Hawaii than in Japan [21.2%(n = 556) versus 12.3%(n = 43), p < 0.001], though this was not significant when adjusted for age and educational attainment (Hawaii 20.3%versus Japan 17.9%, p = 0.328). History of stroke (OR = 1.65, 95%confidence interval = 1.19-2.29) was positively associated with low cognitive scores in Hawaii. Body mass index ≥25 kg/m2 tended to be associated with low cognitive scores in Japan; there was a significant interaction between the cohorts.Conclusion: Cognitive scores differences between cohorts were mostly explained by differences in educational attainment. Conversely, cardiovascular diseases and cardiometabolic factors differentially impacted cognitive scores among genetically similar older men exposed to different lifestyle factors. [ABSTRACT FROM AUTHOR]

To investigate the association of alcohol intake with colorectal cancer risk according to race/ethnicity as well as sex, lifestyle-related factors, alcoholic beverage type, and anatomical subsite, we analyzed data from 190,698 black, Native Hawaiian, Japanese-American, Latino, and white persons in Hawaii and California in the Multiethnic Cohort Study, with 4,923 incident cases during a 16.7-year follow-up period (1993–2013). In multivariate Cox regression models, the hazard ratio was 1.16 (95% confidence interval (CI): 1.01, 1.34) for 15.0–29.9 g/day of alcohol and 1.28 (95% CI: 1.12, 1.45) for ≥30.0 g/day among men, and 1.06 (95% CI: 0.85, 1.32) and 1.15 (95% CI: 0.92, 1.43), respectively, among women, compared with nondrinkers (P for heterogeneity according to sex = 0.74). An increased risk was apparent among Native Hawaiians, Japanese Americans, Latinos, and white persons and among individuals with body mass index <25.0 (calculated as weight (kg)/height (m)2), never-users of nonsteroidal antiinflammatory drugs, and those with lower intake of dietary fiber and folate. Beer and wine, but not liquor, consumption was positively related to colorectal cancer risk. The association was stronger for rectum and left-colon tumors than for right-colon tumors. Our findings suggest that the positive association between alcohol and colorectal cancer varies according to race/ethnicity, lifestyle factors, alcoholic beverage type, and anatomical subsite of tumors. [ABSTRACT FROM AUTHOR]

Abstract: Recent scholarship has brought together the study of Imperial Japan and its colonies with the movements of people West across the Pacific and East into Asia. The result has been the opening of new fields of enquiry in the history of Japan's emergence as a modern nation state and imperial power. This article contributes to such scholarship by showing how Japan's overseas expansion was connected to local as well as national and global changes, via an investigation into the origins, nature, and destinations of Fukuoka's Meiji migrants in the years between 1876 and 1905. It reveals the qualitative differences between Fukuokans' overseas migration to Hawai'i and their travel to Korea, via 'networks of regional migration'. It shows how these movements connected the dual processes of domestic urbanization and industrial growth with Japan's expansion into Asia. Ultimately, the movement of Fukuoka's Meiji migrants helped to transform their home from a domestic periphery into a staging ground for Japan's 'imperial urbanization' and brought Fukuoka within a new region spanning the Tsushima Strait. [ABSTRACT FROM AUTHOR]

Introduction Comprehension of healthcare terminology across diverse populations is critical to patient education and engagement. Methods Women in Oahu, Hawai‘i with a recent delivery were interviewed about their understanding of ten common obstetric terms. Health literacy was assessed by the rapid estimate of adult literacy in medicine (REALM). Multivariable models predicted total terms comprehended by demographic factors. Results Of 269 participants, self-reported primary race was 20.5% Japanese, 19.0% Native Hawaiian, 19.0% White, 16.7% Filipino, 11.5% other Asian, 9.7% other Pacific Islander, and 3.7% other race/ethnicity; 12.7% had low health literacy. On average, participants understood 6.0 (SD: 2.2) of ten common obstetric terms. Comprehension varied by term, ranging from 97.8% for “Breastfeeding” to 27.5% for “VBAC routinely available.” Models showed (1) being Filipino, Japanese, Native Hawaiian, or other Pacific Islander (vs. white); (2) having low (vs. adequate) health literacy; (3) having a high school (vs. a college) degree; and (4) being under 25-years-old (vs. 35 +) were significantly associated with less comprehension. Discussion Participants were unfamiliar with common obstetrics terminology. Comprehension struggles were more common among populations with maternal health disparities, including Asian and Pacific Islander subgroups, and those with low health literacy. [ABSTRACT FROM AUTHOR]

Recent genome-wide association studies have identified various obesity or metabolic syndrome (MetS) susceptibility loci. However, most studies were conducted in a cross-sectional manner. To address this gap, we performed a longitudinal exome-wide association study to identify susceptibility loci for obesity and MetS in a Japanese population. We traced clinical data of 6,022 Japanese subjects who had annual health check-ups for several years (mean follow-up period, 5 yr) and genotyped ~244,000 genetic variants. The association of single nucleotide polymorphisms (SNPs) with body mass index (BMI) or the prevalence of obesity and MetS was examined in a generalized estimating equation model. Our longitudinal exome-wide association studies detected 21 BMI- and five MetS-associated SNPs (false discovery rate, FDR <0.01). Among these SNPs, 16 have not been previously implicated as determinants of BMI or MetS. Cross-sectional data for obesity- and MetS-related phenotypes in 7,285 Japanese subjects were examined in a replication study. Among the 16 SNPs, three (rs9491140, rs145848316, and rs7863248) were related to BMI in the replication cohort (P<0.05). In conclusion, three SNPs [rs9491140 of NKAIN2 (FDR = 0.003, P = 1.9 × 105), rs145848316 of KMT2C (FDR = 0.007, P = 4.5 × 105), and rs7863248 of AGTPBP1 (FDR = 0.006, P = 4.2 × 105)] were newly identified as susceptibility loci for BMI. [ABSTRACT FROM AUTHOR]

Research to date on child and adolescent anxiety and depression have focused predominantly on major ethnic groups. Very few studies to date have been conducted on specific ethnic minority groups and the relatively few studies on these ethnic minority samples have produced mixed findings. The following question therefore still remains: Do specific ethnic subgroups differ with respect to their expression of anxiety and depression? And do these differences differ as a function of reporter type (i.e., youth versus parent)? If the expression of internalizing symptoms differs across specific ethnic subgroups, these differences could inform approaches to assessing and treating these populations. In the current study, we therefore examined ethnic differences in anxiety and depression symptoms in ethnic subgroups. A total of 629 children and adolescents from various public and private schools, aged 8-18 years ( M = 12.37, SD = 2.8) and their caregivers completed anxiety and depression scales. Multiple indicators, multiple causes confirmatory factor analysis revealed that the following specific ethic subgroups were associated with significantly greater anxiety and depression relative to Caucasian youth: Chinese American, Filipino American, Japanese American, and Native Hawaiian. These results were found only among parent (but not youth) reports. Age and low SES status was also associated with more internalizing problems among Chinese, Filipino, and Japanese American youth. Implications related to ethnic minority subgroup differences and the role of multi-informant reports in understanding the relationship between anxiety, depression and ethnic minority subgroups are discussed. [ABSTRACT FROM AUTHOR]

Objective To assess differences in the rates of preeclampsia among a multiethnic population in Hawaii. Methods We performed a retrospective study on statewide inpatient data for delivery hospitalizations in Hawaii between January 1995 and December 2013. Multivariable logistic regression was used to assess the impact of maternal race/ethnicity on the rates of preeclampsia after adjusting for age, multiple gestation, multiparity, chronic hypertension, pregestational diabetes, obesity and smoking. Results A total of 271,569 hospital discharges for delivery were studied. The rates of preeclampsia ranged from 2.0 % for Chinese to 4.6 % for Filipinos. Preeclampsia rates were higher among Native Hawaiians who are age <35 and non-obese (OR 1.54; 95 % CI 1.43-1.66), age ≥35 and non-obese (OR 2.31; 95 % CI 2.00-2.68), age ≥35 and obese (OR 1.80; 95 % CI 1.24-2.60); other Pacific Islanders who are age <35 and non-obese (OR 1.40; 95 % CI 1.27-1.54), age ≥35 and non-obese (OR 2.18; 95 % CI 1.79-2.64), age ≥35 and obese (OR 1.68; 95 % CI 1.14-2.49); and Filipinos who are age <35 and non-obese (OR 1.55; 95 % CI 1.43-1.67), age ≥35 and non-obese (OR 2.26; 95 % CI 1.97-2.60), age ≥35 and obese (OR 1.64; 95 % CI 1.04-2.59) compared to whites. Pregestational diabetes (OR 3.41; 95 % CI 3.02-3.85), chronic hypertension (OR 5.98; 95 % CI 4.98-7.18), and smoking (OR 1.19; 95 % CI 1.07-1.33) were also independently associated with preeclampsia. Conclusions for Practice In Hawaii, Native Hawaiians, other Pacific Islanders and Filipinos have a higher risk of preeclampsia compared to whites. For these high-risk ethnic groups, more frequent monitoring for preeclampsia may be needed. [ABSTRACT FROM AUTHOR]

This paper investigates the popularity of hula in contemporary Japanese society in order to understand how Native Hawaiian images and traditions play a role in constructing the image of a ‘paradise’ in Hawai`i. By drawing on the personal experience of the author as a participant observer in hula lessons and performance in Tokyo, it argues that aiming for the sense of cultural authenticity is integral to the Japanese practitioners’ attraction to hula. It also shows how Native Hawaiian hula teachers and performers skillfully appropriate the Japanese desire to discover an ‘authentic’ Hawai`i for their cultural as well as personal gain. Today’s Japanese discourse of ‘Hawai`i as paradise’ derives from the contemporary socio-cultural context of a Japanese society that longs for the authentic culture of the indigenous ‘other’ as well as from the shrewd use of that longing by the ‘other.’ [ABSTRACT FROM PUBLISHER]

Hawai`i occupies a special place in the imaginations of Japanese people. Ever since the end of World War II, Japanese media have portrayed Hawai`i as a paradisical dreamland. This does not mean the cultural meanings attributed to Hawai`i have remained constant over the past 70 years. Both the notion of ‘paradise’ and the content of the Hawaiian ‘dream’ have transformed along with changing socio-economic conditions and ideas about how Japanese people view themselves in relation to the outside world. This article examines Japanese films from the early postwar period to the present that portray Hawai`i as a ‘paradise’ in which ‘adoration’ and ‘yearning’ play out and ‘dreams’ are fulfilled. These cinematic discourses of ‘paradise’ and ‘dream’ first portrayed Japanese individuals as modern, wealthy national subjects during the postwar economic boom period that ended in the 1980s. In response to changing socio-economic conditions in the early twenty-first century, the dream of Hawai`i came to represent a more relaxed paradise and Japanese individuals were shown embracing an alternative ‘local’ lifestyle. [ABSTRACT FROM PUBLISHER]

The article describes the diaspora of Kibei, which refers to U.S.-born individuals of Japanese ancestry who have lived for a period of time in Japan before returning to the U.S., particularly prior to World War II, is presented, as indicated in Masao Yamashiro's "The Kibei Nisei." Topics include a rendering of a Kibei caught between Hawai'i and Okinawa, problematizing what Japanese American and Japanese identify and the Pacific as a realm of fragmentation as of unity.

Almost a century after the end of the period of Japanese immigration to Hawaii plantations, the Japanese language is no longer the main medium of communication among local Japanese in Hawaii. Today, use of the Japanese language and associated traditional images are often used symbolically rather than literally to convey their meanings, and this is becoming more prevalent among locals through the medium of tattooing. Furthermore, tattooed texts and visual images now are imbued with additional local-specific indexicals that distance them from native Japanese from Japan. These tattoos are not just a fashion statement as the tattooees are committed to their own identity as represented by them. These inked identities have a value in the local community that draws on Japaneseness, but a form of Japaneseness does not necessarily share native Japanese values. Based on the data used for this study, it is clear that this method of declaring ‘true’ Japaneseness is decried as unthinkable and unacceptable to native Japanese. These different perceptions of Japanese text and images in tattoos suggest that because of their mobility, the immigrant Japanese group went through a radical transition and created new cultural values in a new homeland. [ABSTRACT FROM PUBLISHER]

Objectives To study the association between total and differential white blood cell ( WBC) count and incident stroke in an older Asian population. Design Prospective population-based study with 8 years of follow-up. Setting The Honolulu Heart Program, Oahu, Hawaii. Participants Japanese-American men aged 71 to 93 who were free of stroke and had baseline WBC counts measured in 1991-93 (N = 3,342). Measurements Participants were divided into quartiles of total and differential WBC count for analysis and were followed for incident stroke (thromboembolic and hemorrhagic (hemorrhagic)) for 8 years using data from a comprehensive hospital surveillance system. Results Age-adjusted incident stroke rates increased significantly with increasing WBC quartile (Q1, 7.68; Q2, 9.04; Q3, 9.26; Q4, 14.10 per 1,000 person-years of follow-up, P = .001). Hazard ratios ( HRs) for stroke for each quartile of total and differential WBC count were obtained using Cox regression analysis, with the lowest quartile as the reference group. After full adjustment, including age; cardiovascular risk factors; fibrinogen; prevalent coronary heart disease, cancer, or chronic obstructive pulmonary disease, and nonsteroidal anti-inflammatory drug use, HRs were 1.62 (95% confidence interval ( CI) = 1.04-2.52, P = .03) in the highest quartile of total WBC and 2.19 (95% CI = 1.41-3.39, P < .001) in the highest quartile of neutrophil counts. Significant associations were also seen for thromboembolic but not for hemorrhagic strokes. No significant associations were found between lymphocyte or monocyte counts and incident stroke or subtypes. Conclusion In elderly Japanese-American men, higher total WBC and neutrophil counts were independent predictors of overall stroke, as well as thromboembolic stroke. [ABSTRACT FROM AUTHOR]

Data on dementia in Native Hawaiians and many Asian subgroups in the United States are limited. Inpatients with dementia have higher costs, longer stays, and higher mortality than those without dementia. This study compared rates of inpatients with a dementia diagnosis for disaggregated Asian and Pacific Islanders (Native Hawaiian, Chinese, Japanese, Filipino) with those of whites according to age (18-59, 60-69, 70-79, 80-89, ≤90) for all adults hospitalized in Hawai'i between December 2006 and December 2010; 13,465 inpatients with a dementia diagnosis were identified using International Classification of Diseases, Ninth Revision, codes. Rates were calculated using population size denominators derived from the U.S. Census. In all age categories, Native Hawaiians had the highest unadjusted rates of inpatients with dementia and were more likely to have a dementia diagnosis at discharge at younger ages than other racial and ethnic groups. In adjusted models (controlling for sex, residence location, and insurer), Native Hawaiian inpatients aged 18 to 59 ( aRR = 1.50, 95% CI = 0.84-2.69), 60 to 69 ( aRR = 2.53, 95% CI = 1.74-3.68), 70 to 79 ( aRR = 2.19, 95% CI = 1.78-2.69), and 80 to 89 ( aRR = 2.53, 95% CI = 1.24-1.71) were significantly more likely to have dementia than whites, as were Japanese aged 70 to 79 ( aRR = 1.30, 95% CI = 1.01-1.67), 80 to 89 ( aRR = 1.29, 95% CI = 1.05-1.57), and 90 and older ( aRR = 1.51, 95% CI = 1.24-1.85). Japanese aged 18 to 59 had were significantly less likely to have dementia than whites ( aRR = 0.40, 95% CI = 0.17-0.94). These patterns have important public health and clinical care implications for Native Hawaiians and older Japanese populations. Future studies should consider whether preventable medical risk, caregiving, socioeconomic conditions, genetic disposition, or a combination of these factors are responsible for these findings. [ABSTRACT FROM AUTHOR]

This article investigates the relationship between Asian American and modern Japanese history by analyzing the image of Japanese Americans in postwar Japan. Based on a book of photographs featuring Japanese immigrants in Hawai'i published in 1956, it analyzes how their image was appropriated and redefined in Japan to promote as well as reinforce the nation's political and cultural alliance with the United States. The photographs showed the successful acculturation of Japanese in Hawai'i to the larger American society and urged the Japanese audience to see that their nation's postwar reconstruction would come through the power and protection of the United States. Japanese Americans in Hawai'i served as a lens through which the Japanese in Japan could imagine their position under American hegemony in the age of Cold War. [ABSTRACT FROM AUTHOR]

Objectives To identify potentially modifiable late-life biological, lifestyle, and sociodemographic factors associated with overall and healthy survival to age 85. Design Prospective longitudinal cohort study with 21 years of follow-up (1991-2012). Setting Hawaii Lifespan Study. Participants American men of Japanese ancestry (mean age 75.7, range 71-82) without baseline major clinical morbidity and functional impairments (N = 1,292). Measurements Overall survival and healthy survival (free from six major chronic diseases and without physical or cognitive impairment) to age 85. Factors were measured at late-life baseline examinations (1991-1993). Results Of 1,292 participants, 1,000 (77%) survived to 85 (34% healthy) and 309 (24%) to 95 (<1% healthy). Late-life factors associated with survival and healthy survival included biological (body mass index, ankle-brachial index, cognitive score, blood pressure, inflammatory markers), lifestyle (smoking, alcohol use, physical activity), and sociodemographic factors (education, marital status). Cumulative late-life baseline risk factor models demonstrated that age-standardized (at 70) probability of survival to 95 ranged from 27% (no factors) to 7% (≥5 factors); probability of survival to 100 ranged from 4% (no factors) to 0.1% (≥5 factors). Age-standardized (at 70) probability of healthy survival to 90 ranged from 4% (no factors) to 0.01% (≥5 factors). There were nine healthy survivors at 95 and one healthy survivor at 100. Conclusion Several potentially modifiable risk factors in men in late life (mean age 75.7) were associated with markedly greater probability of subsequent healthy survival and longevity. [ABSTRACT FROM AUTHOR]

Variation in outcomes by race, ethnicity, and socioeconomics in adults with heart failure (HF) has been previously observed. We evaluated the association of these factors with HF outcome as assessed by frequency of emergency department (ED) visits over the last 2 and 10 years in a contemporary HF cohort in Hawaii. A retrospective chart review from 2011 to 2021 was performed to identify all adult patients (≥18 years old) with HF from any cause as defined by a serum BNP >200, NT proBNP >200, or a positive history of HF as defined by ICD codes. Ethnicities were self-reported at time of intake at the ED. Meth use was defined as a positive urine toxicology screen or by ICD codes. MethHF was defined as HF in a patient with meth use. A regression model was made to evaluate the relative risk of patients with HF to present to the ED over the last 2 years and 10 years adjusted for age, gender, ethnicity, presence of methamphetamine associated cardiomyopathy (MethHF). Homelessness was analyzed as a secondary subgroup. 46,849 patients were included for analysis. Over the last 10 years (Table 1) Filipino and Japanese patients had a lower risk for presentation to the ED: 17% and 34% respectively. Pacific Islanders, patients with MethHF, and homelessness had a higher risk for presentation to the ED: 44%, 152%, and 160% respectively. Over the last 2 years (Table 2) Japanese patients had a 34% lower risk for presentation to the ED. Black and Pacific Islander patients, those with MethHF, and homelessness had a higher risk for presentation to the ED, 66%, 52%, 28%, and 249% respectively. The relative risk of presentation to the ED in the last 10 years and 2 years differs greatly by ethnicity and presence of MethHF regardless of gender and age. Homelessness had the highest relative risk of ED presentation. Future research is needed to identify explanatory mechanisms underlying racial, ethnic, socioeconomic variations to target potential interventions. [ABSTRACT FROM AUTHOR]

Background To describe the sources of meat and their contributions to vitamin B12, iron and zinc in five ethnic groups in the USA. Methods Dietary data for the Multiethnic Cohort, established in Hawaii and Los Angeles, were collected using a quantitative food frequency questionnaire from more than 215 000 subjects, aged 45-75 years at baseline (1993-1996). Participants included African American, Latino, Japanese American, Native Hawaiian and Caucasian men and women. Servings of meat items were calculated based on the US Department of Agriculture recommendations and their contributions to intakes of total meat, red meat, vitamin B12, iron and zinc were determined. Results Of all types of meat, poultry contributed the most to meat consumption, followed by red meat and fish among all ethnicities, except for Latino (born in Mexico and Central/ South America) men who consumed more beef. Lean beef was the most commonly consumed red meat for all ethnic-sex groups (9.3-14.3%), except for Native Hawaiian and Japanese American men, and Japanese American women whose top contributor was stew/curry with beef/lamb and stir-fried beef/pork with vegetables, respectively. The contribution of meat was most substantial for zinc (11.1-29.3%) and vitamin B12 (19.7-40%) and, to a lesser extent, for iron (4.3-14.2%). Conclusions This is the first large multiethnic cohort study to describe meat sources and their contributions to selected nutrients among ethnic minorities in the USA. These findings may be used to develop ethnic-specific recommendations for meat consumption aiming to improve dietary quality among these groups. [ABSTRACT FROM AUTHOR]

Few studies have examined the effect of ethnicity and cultural identity on substance use among Asian and Pacific Islander adolescents. A cross-sequential study conducted in Hawai'i with 144 Japanese and part-Japanese American adolescents assessed a model integrating Japanese ethnicity, cultural identity, substance use, major life events, and social support. Japanese American adolescents scored higher on the Japanese Culture Scale and on the Peers' Social Support than the part-Japanese American adolescents. Significant associations for substance use and impairment included culturally intensified events and Japanese cultural identity-behavior subset. Models had good overall fits and suggested that conflict surrounding cultural identity may contribute to substance use. [ABSTRACT FROM AUTHOR]

Most humans desire a good death, but the nursing literature on culture-specific responses to older life, especially on issues of death and dying among Japanese Americans, is still limited. The pattern of beliefs about a good death held by elderly Japanese Americans living in Hawaii was explored. A qualitative study using ethnography and in-depth interviewing was employed. Eighteen healthy and active elderly participants were interviewed, and data analyzed using ethnography to extract categories and themes, and four supplementary interviews with experts were held for triangulation of the data. Four themes emerged, however, in this paper, the predominate one, not being a burden to family, was discussed. The participants believed burdening someone in their culture has an extremely negative implication. Sufficient preparation for older life and death, family support, friends support, and finance were their strategies to avoid being a burden. Nurses need to understand that the concept of good death is unique to every culture. Such knowledge will help them to plan and provide appropriate end-of-life care, and will reduce the risk of living wills being ignored. [ABSTRACT FROM AUTHOR]

An essay is presented on the impact of the U.S. occupation of Okinawa on Okinawans living in Hawaii during the 1940s and 1950s. Particular focus is given to the relationship between Okinawan immigrant subjectivity and U.S. colonialism. Details on the U.S. federal court case United States v. Ushi Shiroma are presented. Other topics include identity, liminality, and sovereignty.

Objectives To determine whether adhering to a healthy lifestyle in midlife may reduce the risk of dementia. Design Case-control study nested in a prospective cohort. Setting The Honolulu-Asia Aging Study, Oahu, Hawaii. Participants Three thousand four hundred sixty-eight Japanese- American men (mean age 52 in 1965-1968) examined for dementia 25 years later. Measurements Men at low risk were defined as those with the following midlife characteristics: nonsmoking, body mass index (BMI) less than 25.0 kg/m2, physically active, and having a healthy diet (based on alcohol, dairy, meat, fish, fruits, vegetables, cereals, and ratio of monounsaturated to saturated fat). Logistic regression was used to calculate odds ratios ( ORs) and 95% confidence intervals ( CIs) for developing overall dementia, Alzheimer's disease ( AD), and vascular dementia ( VaD), adjusting for potential confounders. Results Dementia was diagnosed in 6.4% of men (52.5% with AD, 35.0% with VaD). Examining the risk factors individually, BMI was most strongly associated with greater risk of overall dementia ( OR = 1.87, 95% CI = 1.26-2.77; BMI > 25.0 vs <22.6 kg/m2). All of the individual risk factors except diet score were significantly associated with VaD, whereas none were significantly associated with AD alone. Men with all four low-risk characteristics (7.2% of the cohort) had the lowest OR for overall dementia ( OR = 0.36, 95% CI = 0.15-0.84). There were no significant associations between the combined low-risk characteristics and the risk of AD alone. Conclusion Among Japanese-American men, having a healthy lifestyle in midlife is associated with a lower risk of dementia in late life. [ABSTRACT FROM AUTHOR]

In this study the authors investigated stress, anticipatory mourning, and cultural practices among family caregivers from independent and interdependent cultural groups. Focus groups were used to collect data from 56 caregivers providing care to family members with terminal cancer, representing four cultural groups in Hawai‘i: Chinese, European Americans, Japanese, and Native Hawaiians. Participants from all four cultural groups identified similar stressors and agreed that support groups helped them cope with the stresses and sadness they were experiencing and differed in culturally based motivations for caregiving, perceived roles, and processing of grief. The findings of this study indicated a need for additional conceptual models of the caregiving trajectory and more culturally sensitive strategies, particularly indirect methods, for working with diverse populations of caregivers. [ABSTRACT FROM PUBLISHER]

For nearly a century, immigration researchers have focused on immigrant adjustment largely in terms of relationships in/to the host country. More recently, some have used the concept of transnationalism to understand how ties with places beyond the host country impact immigrants' experiences. The diversity of Hawai'i's immigrant labor force in the nineteenth and twentieth centuries and the associated ethnic/national hierarchy on the sugar plantations created a situation where the global status of workers' homelands impacted their daily experiences and survival strategies. This paper examines the effects of transnational political context on the expression of ethnic/national identity on gravestones in the Japanese plantation workers' cemetery in Pāhala, Hawai'i. Results of the gravestone analysis indicate that expressions of ethnic/national identity in the cemetery co-varied with the fluctuation of Japan's status on the global stage, suggesting that immigrant workers' status was continually affected by homeland politics, and that immigrants were therefore strategic in deploying their ethnic/national identity locally. [ABSTRACT FROM AUTHOR]

The purpose is to identify the motivations and barriers to physical activity (PA) among the three largest ethnic groups in Hawaii (Hawaiians/part-Hawaiians, Japanese, and Filipinos). University of Hawai'i students (N = 32, aged 18+) self-identified as one of those ethnicities participated in focus groups. There are more common themes than ethnic-specific variations in factors influencing PA. PA is understood as exercise among all groups; leisure time PA like running and surfing are common activities. Results were more similar among Hawaiian and Japanese than with Filipino participants. The findings offer an opportunity for improving cross-cultural and culture-specific PA interventions for those ethnicities. [ABSTRACT FROM AUTHOR]

Background: Current data suggest that low density lipoprotein (LDL) and high density lipoprotein (HDL) subclass concentrations relate directly to the risk of coronary heart disease (CHD). Earlier Studies indicated that Japanese in Japan had lower rates of CHD than Japanese Americans in Hawaii. Rates of CHD appear to continue to be lower in Japan despite increasing cholesterol levels in Japan and decreasing CHD rates in the United States. Objective: To provide insight into CHD rate differences. Methods: Nuclear Magnetic Resonance (NMR) measurements of lipoprotein subclasses were used to assess lipoprotein particle concentration and size in samples from these two genetically similar populations in Japan and Hawaii. Results: Japanese Americans had significantly higher age- and risk factor- adjusted concentrations of lipoprotein particles implicated in atherogenesis, including large very low density lipoprotein (VLDL; P < 0.001), small LDL (P < 0.001), and small HDL (women, P < 0.001; men, P < 0.01), and significantly lower concentrations of large LDL (P < 0.001) and the putative cardio-protective large HDL (P < 0.05) than Japanese in Japan. Average age- and risk factor- adjusted LDL and HDL particle sizes were also significantly (P < 0.001) smaller in Japanese Americans. Adjustment for body mass index markedly reduced the differences in some lipoprotein measures, including total LDL and large HDL particle concentrations for both genders, total VLDL particle concentration for women, and large VLDL concentration and average HDL particle size for men. Conclusions: Differences in lipoprotein subclass distributions and lifestyle factors such as body weight may contribute to differences in CHD incidence for Japanese in Japan and Japanese Americans. [ABSTRACT FROM AUTHOR]

This study examined the impact of various forms of social capital drawn from social, cultural, and family resources on self-employment in the state of Hawaii. Data came from the U.S. 2000 Census involving all immigrants in Hawaii with particular interest given to the five Asian-immigrant groups (Japanese, Chinese, Korean, Filipino, and Vietnamese) aged between 18 and 65. The study found that social and cultural resources (i.e., presence of extended family, length of stay in the U.S., and ethnicity) and family resources (i.e., marital status, presence of children under 18 years of age, and number of children under 18 years of age) had a positive impact on the likelihood of self-employment. Finally, this study revealed that the role of social capital can enhance self-employment among immigrants in Hawaii. [ABSTRACT FROM AUTHOR]

An essay is presented on the role of Japanese immigrants in the development of fisheries in Hawai'i during the early 20th century. Particular focus is given to of ethnic and racial tensions between Japanese, native Hawaiian, and white participants in the fisheries industry. Fishing companies, which according to the author played a large role in the success of Japanese fishing activities including the financing of Japanese fishermen and fleets, are also discussed.

This paper investigates changes in the dialect of a group of northern Japanese immigrants from the Tôhoku dialect speaking areas who migrated to Hawai‘i. The speakers moved to Hawai‘i as sugar plantation workers between 1899 and 1923 and the data were recorded between 1972 and 1975. Being latecomers to the plantations as well as a linguistic minority in the Japanese community in Hawai‘i, Tôhoku immigrants experienced dialect discrimination by other Japanese immigrants. The data tell us that the traditional Tôhoku dialect forms were replaced almost completely by the non-Tôhoku dialect forms after the speakers’ immigration. This study suggests that obvious dialect stigmatization led to the Tôhoku dialect speakers’ adoption of non-Tôhoku dialect features in order to gain acceptance in the local Japanese communities. Interestingly, however, the speakers transferred their Tôhoku dialect phonology to the newly acquired non-Tôhoku dialect forms. The findings support current second dialect acquisition studies that adult speakers acquire lexically-bound features more easily than phonological features. [ABSTRACT FROM AUTHOR]

The purpose of this study was to assess the economic benefits from Japanese participants of the 2008 Honolulu Marathon. The island of Oahu has hosted the Honolulu Marathon since 1973 and has continued since the race conception. With the rapid development of sporting events throughout the tourism industry, Honolulu has created a popular event for sport tourists. Data for this study was comprised of participants from the 2008 Honolulu Marathon through surveys that were administered to Japanese participants while attending the Honolulu Marathon Expo. The instrument consisted of 18 questions regarding accommodations, length of stay, as well as the amount of money that was spent by marathon participants on their lodging, food, souvenirs and other miscellaneous items while attending the marathon activities in Honolulu. Examination of these results is necessary for determining the economic effects that Japanese participants of the Honolulu Marathon have on the state of Hawaii. [ABSTRACT FROM AUTHOR]

Japanese tourists are the largest and most important international segment of tourists to Hawaii. Over the past few years, the number of Japanese tourists to Hawaii has declined significantly. The purpose of this study is to explore the differences in attitudinal and behavioral characteristics, and preferences of Japanese tourists in Hawaii according to key sociodemographic variables. The results of this study conclude that sociodemographic variables show significant differences in attitudinal or behavioral characteristics. For example, compared with those with a high school diploma or lower level of education, respondents with a higher level of education were likely to have greater interest in Hawaiian culture. Those who had some college education or a higher level of education showed a greater preference for swimming and taking a cruise tour than respondents with a lower level of education. The results of this study are likely to be beneficial for understanding Japanese tourists and establishing marketing policies to enhance their satisfaction and raise their intention to revisit Hawaii. The findings of this study could be helpful for all stakeholders, including local tour operators, the Japanese Tourism Board (JTB), and Hawaii's tourism officials. [ABSTRACT FROM AUTHOR]

With the explosion of casino development in the Asia Pacific as well as the USA, casino gambling has become more culturally embraced as a recreational activity. The purpose of this study was to re-examine the legalization of casino gambling in Hawaii from Japanese-speaking tourists' perspective and compare these results with a previous study completed a decade before. With the continuing decrease of Japanese visitors to Hawaii, and with the importance of the Japanese market to Hawaii's economy, state officials are considering other forms of tourism to help revive the Japanese tourism market and increase Hawaii's global competitiveness. By analyzing the responses of the current Japanese-speaking tourists to Hawaii and comparing these responses with the Japanese tourists surveyed 10 years previously (1996), an attempt can be made to determine whether Japanese tourists in 2006 have changed their perception of the legalization of casino gambling in Hawaii. This research examines a number of challenges to consider concerning the legalization of gaming in an established tourism destination such as of Hawaii. Although the findings of this study indicate that the Japanese-speaking tourists have changed their perspective from past studies on the effects that legalization of casino gambling has in Hawaii, future research should focus on other segments of the tourist market. [ABSTRACT FROM AUTHOR]

The article discusses a study on the association between a single-nucleotide polymorphism (SNP) (rs235326) in the gene encoding human integrin β2 subunit (ITGB2) with obesity in ethnic Japanese. The study involved 651 ethnic Japanese, 274 of which were Japanese Americans in Hawaii and 377 were native Japanese. The risk of obesity was 3.26-fold higher in TT homozygotes than in C carriers in Japanese-Americans. It was also found that SNP in the ITGB2 gene is linked with obesity in Japanese in the U.S. whose diet has become westernized.

This study will focus on Japanese tourists who make up the largest international tourist market for Hawaiian tourism. The goal of this study was to explore the potential of the segmentation of Japanese tourists by their specific tour purpose. Respondents indicated five main purposes such as honeymoon tourism (10.8%), fraternal association tourism (17.8%), sports tourism (33.8%), tourism for rest and relaxation (7.6%), and business/VFR tourism (29.9%). According to results of one-way ANOVA test, chi-square test, and correspondence analysis, respondents' characteristics were differently shown on the basis of tour purpose-based segments. Thus, it is concluded that tour purpose-based segmentation is very useful and straightforward in practical application. Finally, the results of this study are expected to establish marketing strategies for attracting more Japanese tourists and providing satisfaction through differentiating demands according to the main purpose of their tour. [ABSTRACT FROM AUTHOR]

The purpose of this study is to investigate which kinds of stress women experience during childbirth in a foreign country and to explore whether childbirth in a foreign country influences women’s mental health. The study was a quantitative and qualitative mixed study. Forty-five Japanese women, born and raised in Japan and who gave birth in Hawaii, USA, were telephone-interviewed within 1 year after childbirth. The stress factors that emerged were: language barrier, distance from family and friends, different culture, and health-care attitude about childbirth. Half of the participants experienced emotional dysfunction during their pregnancy. All primiparas experienced postpartum depression. The participants who had the maternity blues tended to have postpartum depression. Help from the participants’ mothers after childbirth decreased postpartum depression. The importance of mental health for foreign-born primiparas emerges during the perinatal period. [ABSTRACT FROM AUTHOR]

Seniors are a growing segment among Japanese outbound travelers. Given that Hawaii is one of the most visited destinations by Japanese travelers, it is expected that the proportion of seniors will continue to grow in accordance with social trends of aging adults in Japan. The purpose of this article is to examine the satisfaction of Japanese senior travelers based on their expectations of important destination attributes of the Hawaiian Islands in relation to the travelers' performance judgment of these attributes. This study employs an Importance-Performance Analysis (IPA) to determine critical attributes of this destination. A focus group with tourism industry professionals resulted in 15 distinct attributes of Hawaii as a tourist destination. Respondents rated the importance level of each attribute on a 6-point Likert scale ranging from 1 = not important to 6 = extremely important. In addition, respondents evaluated Hawaii's performance of these same destination attributes on another 6-point Likert scale, ranging from 1 = very poor to 6 = excellent. Questions also focused on the travelers' trip-related characteristics and demographics. Respondents were selected from Japanese travelers who were 20 years or older, and had visited Hawaii for pleasure travel. Of the 211 questionnaires collected. 73 of the surveys were completed by Japanese travelers over the age of 50. Of this group, senior travelers were mostly satisfied with the destination attributes of Hawaii, specifically those factors that were related to Hawaii's natural resources as well as the characteristics related to a comfortable trip. Interestingly, the features related to physical activities such as golfing, water sports, and outdoor activities were not viewed as important travel destination attributes for Hawaii for both seniors and the younger Japanese travelers. On the other hand, improvement in local transportation and accommodations were destination attributes that travelers felt needed attention. These results provide some useful insights for developing effective marketing strategies to attract Japanese senior travelers to Hawaii. as well as the usefulness of using the IPA methodology. [ABSTRACT FROM AUTHOR]

The article reports on research on substance abuse and sexual behaviors among Japanese nationals in Honolulu, Hawaii. Researchers surveyed Japanese tourists, students, and temporary workers, and found experiences, behaviors, and attitudes that make traveling Japanese youth and temporary workers vulnerable to HIV and other sexually transmitted diseases. More than 80 percent of respondents engaged in sex under the influence of alcohol, for example. Research implications can inform future HIV prevention intervention programs for the studied populations.

This article investigates product and service consumption between first-time and repeat Japanese visitors in Hawaii. Overall, the empirical results reveal that repeat visitors to Waikiki are likely to be Japanese females, in their mid-thirties, who relish in fun, self-indulgent, overall hedonic consumption. during their stay. Unlike first-time visitors, who take sightseeing tours and who express interest in purchasing products reminiscent of the local culture, repeat visitors are likely to engage in shopping, golfing, and in patronizing spas during their Hawaiian vacation. [ABSTRACT FROM AUTHOR]

This article provides a two-part, exploratory analysis of planned spending on shopping, dining, and other recreational activities among Japanese tourists in Hawaii. The empirical findings from the first study reveal that Japanese tourists primarily plan to engage in duty-free shopping during their stay in Hawaii. In contrast, American tourists plan to engage in cultural activities and fine dining opportunities during their Hawaiian vacation. A second study was used to explore the propensity of Japanese tourists in Hawaii to shop at both high-end boutiques and discounted retail outlets. The results of a two-step cluster analysis reveal that Japanese tourists may be classified into two exclusive groups, shopping enthusiasts and nonshoppers. The data support the conclusion that shopping enthusiasts plan to patronize three types of retail outlets in Hawaii: duty-free stores, factory outlets, and designer boutiques. Managerial implications and directives for future theoretical development are provided. [ABSTRACT FROM AUTHOR]

The purpose of this research note is to extend Agrusa's (2000) philosophical inquiry into the possible effects of gambling offerings on Japanese tourists visiting Hawaii. More specifically, the researchers empirically assess attitudinal and behavioral responses among American and Japanese tourists vacationing in Waikiki Beach to the possible implementation of gambling in the island state. The results indicate that both Japanese and American tourists view gambling in Hawaii negatively, or with ambivalence, regardless of their country-of-origin or gender. Overall, this note provides evidence that supports Agrusa's inquiry. [ABSTRACT FROM AUTHOR]

Objective . To examine ethnic differences in the relationship between depressive symptoms and specific aspects of heath-related quality of life in people with type 2 diabetes. Design . Cross-sectional data from 190 people with type 2 diabetes of Native Hawaiian (50%), Filipino (16%), Japanese (18%), and mixed-ethnic (16%) ancestries from the rural community of North Kōhala, Hawai‘i were examined in this study. Depressive symptoms were measured with the Center for Epidemiological Studies—Depression (CES-D) scale. Health-related quality of life was measured with the Short Form-36 Health Survey (SF-36). Eight health-related quality of life constructs were examined: Physical Functioning, Role-Physical Functioning, Role-Emotional Functioning, Social Functioning, Bodily Pain, Vitality, General Health, and Health Transition. Results . Hierarchical regression analyses of the interaction between ethnicity and the SF-36 subscales of Physical Functioning, Role-Emotional Functioning, Bodily Pain, Vitality, and General Health indicated statistically significant associations with CES-D scores after controlling for sociodemographic factors, glycemic status, and social support. Conclusion . Ethnicity moderated the relationship between depressive symptoms and the health-related quality of life aspects of physical and role-emotional functioning, bodily pain, vitality, and general health perception in people with type 2 diabetes. This relationship was strongest for Filipinos followed by Native Hawaiians and people of mixed-ethnic ancestries. [ABSTRACT FROM AUTHOR]

With close to 7 million visitors annually and approximately $10 billion in total expenditures per year, Hawaii has become very dependent on the tourism industry. Traditionally, Japanese visitors have dominated tourism in Hawaii, but lately their numbers have declined from the record high levels of the 1990s. As the Japanese tourism market has dropped considerably, Hawaii is searching for innovative ways to help revive this economically significant tourism market. One solution may be to strategically market sports tourism in Hawaii. The purpose of this study was to assess the economic benefits of the 2003 Honolulu Marathon by runners from Japan and their traveling companions on the city of Honolulu. Data used in this study was collected by distributing a research instrument in Japanese to Japanese-speaking marathon participants. The examination and analysis of the results from this survey will assist in determining the economic significance of runners from Japan in the Honolulu Marathon on the state of Hawaii. [ABSTRACT FROM AUTHOR]

Spectral analysis is used to investigate the sensitivity of the Hawaiian tourist industry to fluctuations in the Japanese economy. The number of Japanese visitors to Hawaii comoves most strongly with fluctuations in relative prices as measured by the ratio of the Japanese wholesale price index to the Honolulu consumer price index. Compared to qualitative factors, fluctuations in Japanese gross domestic expenditures and in consumer confidence are not strongly correlated with movements in the volume of Japanese tourism to Hawaii. [ABSTRACT FROM AUTHOR]

The article focuses on Japanese theater in Hawaii. The Issei or first generation of Japanese in Hawaii, traveled thousands of miles to a few isolated islands in the middle of the Pacific Ocean in search of wealth. The Issei brought all kinds of Japanese performances with them. Theatrical presentations varied, ranging from professional to educational, from pure entertainment to political propaganda. Most of the information about Japanese theater in Hawaii is found in photographs, oral histories, newspaper clippings and so forth.

Our aim was to report clinical and biochemical outcomes of transperineal interstitial permanent prostate brachytherapy in the treatment of Japanese patients with clinically organ-confined prostate cancer in Hawaii.Ninety-five Japanese patients underwent transperineal interstitial permanent prostate brachytherapy using either iodine-125 or palladium-103 for clinical T1c–T2b N0 M0 prostate cancer. These procedures were carried out between December 1998 and December 2002 at The Queen's Medical Center in Honolulu, Hawaii. Prostate-specific antigen measurements were collected from all patients at follow up. Biochemical failure was defined by three consecutive rises in prostate-specific antigen levels, based on the criteria of the American Society for Therapeutic Radiology and Oncology Consensus panel.The median patient age was 71 years (range, 46–87 years). Thirty-six patients were implanted with either iodine-125 or palladium-103 as monotherapy; 59 patients received moderate-dose external beam irradiation first, followed by a prostate brachytherapy boost. The median follow-up length, calculated from the day of implantation, was 801 days (range, 237–1421 days). During this follow-up period, The Kaplan–Meier estimate of freedom from biochemical failure in this series was 94%. No major complications were observed.Clinical and biochemical outcomes in the treatment of Japanese patients in Hawaii suffering from localized prostate cancer, using transperineal interstitial permanent prostate brachytherapy, with or without external beam irradiation, compared favorably to results in similarly treated patients in the general US population. [ABSTRACT FROM AUTHOR]

Discusses the history of popular Japanese discourse about Hawaii, particularly of Japanese tourism in the islands. Cultural politics of Japan's fascination with Hawaii; Implications of the romanticized, idealized image of the islands for the geopolitical relations between Japan and the U.S.; Ways by which Japanese tourism has shaped Hawaii residents' attitudes toward Japanese tourists.

Despite increase in serum total cholesterol, high smoking rate, and frequency of adverse blood pressure levels in Japan, coronary heart disease (CHD) incidence and mortality apparently remain substantially lower at all ages in Japan than in the US and other Western societies. To better understand these differences, we compared CHD biomedical risk factors and dietary variables in Japanese living in Japan and 3rd and 4th generation Japanese emigrants living a primarily Western lifestyle in Hawaii, in an ancillary study of the INTERMAP. Men and women aged 40-59 years were examined by common standardized methods-four samples in Japan (574 men, 571 women) and a Japanese-American sample in Hawaii (136 men, 131 women). Average systolic (SBP) and diastolic (DBP) blood pressures were significantly higher in men in Japan than in Hawaii; there were no significant differences in women. The treatment rate of hypertension was much lower in Japan than Hawaii. Smoking prevalence was higher, markedly so for men, in Japan than Hawaii. Body mass index, serum total and low-density lipoprotein cholesterol, HbA1c, and fibrinogen were significantly lower in Japan than in Hawaii; high-density lipoprotein cholesterol was higher in Japan. Total fat, saturated fatty acid intake, and Keys dietary lipid score were lower in Japan than in Hawaii. Polyunsaturated/saturated fatty acid ratio and omega-3 fatty acid intake were higher in Japan than in Hawaii. In conclusion, levels of several, especially lipid, CHD risk factors were generally lower in Japanese in Japan than in Japanese in Hawaii. These differences were smaller for women than men between Japan and Hawaii. They may partly explain lower CHD incidence and mortality in Japan than Western industrialized countries.Journal of Human Hypertension (2003) 17, 631-639. doi:10.1038/sj.jhh.1001606 [ABSTRACT FROM AUTHOR]

The article presents an overview of the identity of Uchinanchu in Hawaii, which is considered as quite complex issue since it is extremely personal to interpret and conveyed. It will partly present how Uchinanchu identity was formed. In relation, the early history of Okinawa, Japan, as well as Okinawa's trading with neighboring countries, specifically China was provided. The importance of the relationship between China and Rhukyu and how Japan took control of Okinawa were given emphasis. It is inferred that the problem related to Uchinanchu in Hawaii is multiplied by numerous identities from which they can choose.

Health characteristics were compared among 1193 Japanese in Hiroshima, and 2306 Japanese-Americans in Hawaii. Japanese women experienced later menarche, earlier menopause, and a shorter interval between menarche and menopause than Japanese-Americans. Japanese men and women were shorter and lighter and the men bad lower body mass index than Japanese-Americans. Differences between populations were also found for the prevalence of artificial menopause, number of live births, lactation period, smoking, and alcohol consumption. Within one or both populations, significant trends with birth year were found for age at menarche, age at menopause, interval between menarche and menopause, lactation period, height, weight, and body mass index, suggesting the existence of cohort effects. Some of these trends may also reflect age-related changes. Environmental factors likely contribute to the differences in physique and reproductive factors, which may explain differences in frequency of osteoporosis, cardiovascular diseases, and cancer between the two populations. [ABSTRACT FROM AUTHOR]