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Samoan youths are critically under-studied in research on youth violence prevention and adolescent development. When Samoan adolescents are included in research investigations, they are typically obscured into the much larger aggregated categories of 'Pacific Islanders' or 'Asian Americans and Pacific Islanders.' The present study is one of the first to examine Samoans exclusively and compare the differences between Samoan youths residing in American Samoa and those residing in Hawaimodifier letter turned commai. In an effort to gauge the acculturative processes of adolescents in American Samoan and Hawaimodifier letter turned commai, the present study compared these two groups' self-reports of violence, substance use, grade-point average, scholastic aspirations, importance of religion, ethnic identity, parenting discipline style, and family support. Overall, the results indicated higher rates among Samoan adolescents in Hawaimodifier letter turned commai as compared to those in American Samoa on one violence item and on substance use indicators (i.e., alcohol and marijuana). Samoan adolescents in American Samoa also reported higher levels of protective factors related to the importance of religion (especially for girls), ethnic identity, and family support. However, Samoan adolescents in Hawaimodifier letter turned commai had higher scholastic aspirations than those in American Samoa, despite having lower grade-point averages. In general, Samoan students who did not self-report engaging in violence had higher rates of protective factors as compared to those who indicated engaging in violence. Statistically significant interactions reflected more complex effects. The implications of these findings in conjunction with the results of the Youth Risk Behavior Survey (YRBS) are discussed in the context of Samoan culture, acculturation, and youth development. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To determine the effectiveness of a clinic-based smoking cessation counseling curriculum on pediatric resident confidence, knowledge, counseling skills, and provision of counseling. METHODS: Twenty-six residents at a pediatric residency program completed a new smoking cessation counseling curriculum as part of continuity clinic training. We assigned residents to 2 groups (study group, n = 12 vs control group, n = 14) on the basis of clinic site. We used a quasi-experimental, crossover design with pre- and posttests for each group. Control-group residents served as an initial control before the intervention crossover. Residents were tested at baseline and at completion of each group's intervention. Standardized patients measured resident provision of counseling and quality of counseling during resident continuity clinic. Knowledge and confidence were measured by a written exam and self-administered survey. Analysis of variance with a mixed design assessed overall group differences and group performances over time. RESULTS: There were no baseline differences between groups. Across time, there were significant differences between study-group and control-group residents for confidence (F [2, 48] = 11.82; P <.01), knowledge (F [2, 48] = 6.24; P <.01), and provision of counseling (F [2, 48] = 3.60, P <.05) but not counseling skills (F [2, 48] = 2.44; P <.10). After each group's intervention, their confidence, knowledge, counseling skills, and inclusion of counseling increased significantly (P <.01 for all). CONCLUSIONS: Our findings suggest that a clinic-based curriculum in smoking cessation counseling can significantly increase knowledge, confidence, counseling skills, and provision of counseling. Future research should evaluate the long-term impact of such curricula on resident counseling behavior and patient outcomes. [ABSTRACT FROM AUTHOR]

The National Collegiate Athletic Association (NCAA) has implemented sweeping legislation for all high school students who desire to participate in Division I or II freshman college athletics. Cutoff scores have been set by the NCAA in two areas: grade-point average (GPA) in 'core' high school courses, and college-bound tests. High schools must obtain approval from the NCAA Initial-Eligibility Clearinghouse when determining core courses. Unfortunately, minimal attention has been given in the professional learning disability literature to the implications of the NCAA's policies, especially with regard to federal antidiscrimination legislation. Issues are raised regarding (a) the use of test score cutoffs, (b) a minimum GPA for core courses, (c) the responsibility of high schools, and (d) the lack of alternative eligibility procedures for accessing the essential elements of the NCAA's program. Options for consideration are provided in the context of meeting the needs of students with learning disabilities. [ABSTRACT FROM AUTHOR]

PURPOSE: This study investigates the prevalence rates of violent and deviant behaviors among a sample of Filipino, Hawaiian, Japanese, and Samoan public high school students residing in Hawai'i, and is the first relatively large-scale study of its kind regarding a disaggregated sample of Asian American and Pacific Islander (AAPI) youth. Filipino, Hawaiian, and Samoan adolescents were the chosen ethnic groups for this study's focus due to their over-representation in Hawai'i's juvenile justice system. METHODS: Data for this study were gathered collaboratively by researchers, community groups, and school officials who agreed that youth violence was a community concern worthy of deeper understanding and community response. The study's process included three phases: a focus group consultation phase, field-testing, and the final risk and protective factor study. For the final study, 326 randomly selected students representing three Hawai'i public high schools were surveyed on a one-on-one basis. A smaller sample of Japanese students was also included in the study, serving as a control group. RESULTS: Findings illustrate the importance of disaggregating specific ethnic and gender groups within the AAPI ethnic category when examining adolescent issues. As examples, Samoan youth reported significantly higher rates of violence than other ethnic groups surveyed, and Hawaiian girls reported higher rates of substance use than Hawaiian boys, which was not commensurate with other ethnic groups. Filipino, Hawaiian, and Samoan youth all reported significantly higher rates than Japanese on overall deviant behavior. CONCLUSIONS: Implications for further research and community development include enhancing minority youths' bicultural self-efficacy. [ABSTRACT FROM AUTHOR]

The Brief COPE (Coping Orientation to Problems Experienced) Inventory is a standardized and widely used scale that enables researchers to measure coping responses of persons in relation to stressors. The psychometric properties of this scale, however, have not been assessed for communities in Hawai'i. This study investigated the psychometric properties of the Brief COPE for diverse women from a rural community on the island of O'ahu in Hawai'i. This study was conducted in a federally qualified health center (FQHC) with 161 women who were of a childbearing age between the ages of 18 to 38 years. Contrary to previous research, the factor structure of the final model suggested six factors: Behavioral Disengagement, Denial, Venting, and Self-Blame; Action Coping, Positive Reframing, Acceptance, and Planning; Humor; Substance Use; Social Support; and Religion. The final model demonstrated good model fit with an RMSEA of .07 and CFI of .95. The reduced factor structure may be a more robust measure of coping strategies, which may allow for better resources and interventions that adequately address the way women of childbearing ages from rural communities respond to stressful situations. Exploring coping mechanisms of diverse women will better our understanding of the way people respond to stress and develop strengths and mechanisms that mediate stressors including those that are linked to social and cultural determinants of health. Findings from this study may also inform future research and policy that aim to foster coping, and thus, resiliency of diverse women, particularly in rural settings.

The present study describes 4 strategies for increasing response rates to a community-based survey on youth violence in an ethnically diverse population in Hawai'i. A total of 350 households were mailed a Safe Community Survey using 4 different randomly assigned incentive strategies. The strategies varied by length of survey and timing of incentive for completion (given before completion, after completion, or both). In univariate analyses, there were no significant differences across survey strategies on participant demographics, community perceptions of violence-related behaviors, or percent of missing items. However, in multivariate regressions, respondents' sex and percent of missing items on the surveys were consistently significant predictors across multiple outcomes. Although the use of strategies to increase response rates in community-based surveys might be desirable, resulting data need to be examined for the potential that strategies might recruit different populations, which may have an impact on the data obtained. This study offers lessons and recommendations for surveying Native and Indigenous communities., Competing Interests: None of the authors identify a conflict of interest., (©Copyright 2023 by University Health Partners of Hawai‘i (UHP Hawai‘i).)

Evergreening consists of multiple ways that pharmaceutical companies extend patent protection and prolong profitability of brand name drugs past patent expiration. In psychotropic medications, these strategies do not necessarily make more effective drugs, and often increase drug prices, which can result in lower access and utilization. There has not been a systematic literature review of evergreening strategies for psychiatric medications. Based on such a review, 11 strategies were identified and relevant examples were provided. Four case examples of commonly used psychiatric medications indicated evergreen prices 3 to 211 times the cost of the original medication, and the evergreen costs ranging from $132.00 to $10,125.24 higher than the original cost on an annual basis. The higher cost of evergreening medications can create inefficiencies and waste in healthcare resulting in lower-quality patient care. Healthcare providers, patient advocates, health insurance companies, and policy-makers should be aware of these practices to improve healthcare systems., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

The shift from punitive responses to restorative public health approaches to tackle the problem of youth substance use and justice system involvement follow a nationwide trend. Hawai'i has made significant strides towards transforming the justice system and developing effective substance abuse programs. However, these efforts require changes in policies, practices, and paradigms to be fully and permanently realized. Such a philosophical shift requires a major reallocation of resources from downstream, high-cost punitive modalities, such as incarceration, to upstream solutions that allow adolescents to heal past trauma and grow the understanding and tools to lead a healthy and meaningful life. Research and evaluation to support ongoing learning and system improvement will also be required. Most critically, taking an approach to work with youth so they can overcome the root problems they face holds the most promise of ending the cycle of justice involvement and substance use that the state has witnessed for far too long., (©Copyright 2022 by University Health Partners of Hawai‘i (UHP Hawai‘i).)

Hawai'i's Pacific Islander (PI) population has suffered a higher burden of coronavirus disease 2019 (COVID-19) infections, hospitalizations, and deaths compared to other groups in the state. The Hawai'i Emergency Management Agency Community Care Outreach Unit conducted an assessment across the state to gain an understanding of the impact of the COVID-19 pandemic on the health and social welfare of households. Survey data was collected from individuals across the state during a period of 3 weeks (August 12-September 5, 2020). The following are resulting recommendations from the Pacific Island community to mitigate the impact and disparities of the pandemic as immediate and medium-term structural requests: (1) ensure that Pacific Island communities are proactively represented in state and county committees that develop health interventions to ensure that relevant language and culturally tailored communications and strategies are included, (2) provide consistent funding and community centered support to ensure consistent COVID-19 impact services for the Pacific Island families, (3) enhance the capacity of PI health care navigators and interpreters through increased funding and program support, and (4) engage state policy makers immediately to understand and address the systemic structural barriers to health care and social services for Pacific Islanders in Hawai'i. These recommendations were developed to address the generational inequities and disparities that exist for Pacific islanders in Hawai'i which were exacerbated by the COVID-19 pandemic., (©Copyright 2021 by University Health Partners of Hawai‘i (UHP Hawai‘i).)

Background: The effects of cannabis use in vulnerable persons with schizophrenia or schizoaffective disorder, continues to be elucidated., Methods: We compared 55 cannabis-only users (Group 1) with 462 non-substance users (Group 2) on measures of length of stay and number of psychiatric hospitalizations with a primary discharge diagnosis of schizophrenia or schizoaffective disorder using the Wilcoxon-Mann-Whitney non-parametric test for non-normal distributions, analysis of variance (ANOVA), and Poisson regression analysis., Results: Group 1 had a mean length of stay of 6.15   days ( sd  = 5.32   days) and Group 2 had a mean length of stay of 8.66   days ( sd  = 11.14   days) (i.e. Wilcoxon-Mann-Whitney, p = .0347; log-transformed ANOVA, p = .0203). This difference was no longer statistically significant when controlling for three covariates ( p = .1543). Poisson regressions for the mean number of admissions (1.84) were not statistically significant., Conclusions: Cannabis use may not be a good predictor of length of stay, once covariates are considered, and mean number of hospitalizations in hospitalized patients with schizophrenia or schizoaffective disorder.

Resilience has conventionally focused on an individual's ability to overcome adversity. Recent research expands on this definition, making resilience a multi-dimensional construct. Native Hawaiians experience health disparities compared to the general population of Hawai'i. Despite the pressing need to address health disparities, minimal research examines resilience factors that serve as buffers for adverse experiences of Native Hawaiians. The purpose of this study was to estimate psychometric properties of scales that measured resilience-based factors through multiple levels using higher-order confirmatory factor analyses (CFA) and ascertain if this construct of resilience mediated or moderated adversity experienced by a sample of Native Hawaiians. Participants included 125 adults who participated in the Hawaiian Homestead Health Survey. Based on higher-order CFA, resilience comprised internal assets measured by hope, satisfaction with life, and environmental mastery, and external resources measured by social support and Native Hawaiian cultural identity. Results of the structural equation models were consistent with literature focusing on resiliency and health. Findings emphasized the importance of enhancing resilience by considering strengths and resources on the individual, interpersonal, and community levels. Findings also demonstrated the need to address adversity factors directly, with a specific need of addressing socio-economic status factors. According to structural equation models, resilience slightly mediated and moderated the effect of adversity related to socio-economic status. These findings have implications for future research exploring resilience as a mediator or moderator of adversity among Native Hawaiians and emphasize a multi-faceted construct of resilience to promote better health outcomes.

The authors present the development of the field of psychiatry with the evolution of patient safeguards. They address the recent publicized events involving sexual harassment and abuse perpetrated by mental health service providers who have harmed youth who were under their direct psychiatric care. Recommendations are provided for primary care physicians and parents and legal guardians to further ensure patient safety., Competing Interests: None of the authors identify any conflict of interest., (©Copyright 2020 by University Health Partners of Hawai‘i (UHP Hawai‘i).)

Background: A "boot camp" or senior preparatory course can help to bridge the gap between knowledge and skills attained in required clerkships and residency expectations. An under-researched area is in interventions across specialties and with student confidence as the outcome., Objective: A multi-specialty school-wide boot camp for 4th year medical students was evaluated with a curriculum that focused on specialty milestones and entrustable professional activities and the importance of student confidence as an outcome., Methods: A school-wide "boot camp" was developed to help 4th year students become ready for their matched specialty. Faculty resources were pooled to teach students from multiple specialties' common milestone topics. Surveys were collected from 3 academic years (2014-2015 to 2016-2017): pre-boot camp (Pre), immediately post-boot camp (Post 1), and 3 months after starting residency (Post 2). Dependent t -tests were employed to determine pre-post differences., Results: Over the 3-year study period, 185 students participated in boot camp, 162 (87.6%) completed the first 2 surveys, and 75 (40.5%) students provided data at all 3 points in time. With more robust findings between Pre and Post 1, students improved their confidence level in communicating with families and most specialty skills, and students felt more prepared to be an intern as a result of the boot camp., Conclusions: The robust increase in student confidence suggested that a multi-specialty, school-wide approach to a capstone curriculum should be considered by medical schools, which will not only benefit students but faculty as well. Future research should examine student competence in achieving specialty skills., Competing Interests: Conflict of InterestThe authors declare that they have no conflict(s) of interest., (© International Association of Medical Science Educators 2020.)

This paper presents Native Hawaiian cultural practices of prevention and mitigation of leptospirosis. Indigenous cultural practices are described. Relatively high prevalence of leptospirosis is found in Hawai'i. Standard diagnosis and treatment are outlined. Theories are offered of how it was introduced to the Hawaiian Islands.

While progress has been made in learning more about American Indians and Alaska Natives (AI/ANs) who reside in Hawai'i, much more research is needed regarding adolescents' mental health and the major life events that they encounter. Utilizing a large cross-sequential epidemiologic design (N = 7,214; 1992-1996), this study found AI/AN-Hawaiian youth self-reported higher risk of predominantly negative major life events and mental health symptoms than for the non-Indigenous adolescent ethnic group, with the AI/AN and Native Hawaiian ethnic groups falling generally in between. However, when statistically controlling for covariates, overall, Native Hawaiian youth self-reported higher mental-health-symptom risk than the other three ethnic groups. Implications are discussed, including protective factors, prevention, and future research.

Multivariate dynamic relationships among suicide attempts, anxiety and/or depressive symptoms, hope, and help-seeking were examined across time in Native Hawaiian and non-Hawaiian adolescents, using data from a 5-year longitudinal cohort study (N = 7,317). The rate of suicide attempts decreased over time, but this reduction was significantly less among Native Hawaiian youth than their non-Hawaiian peers. There were also significant differences between groups in hope and help-seeking, with Native Hawaiian youth increasing help-seeking and decreasing hope to a greater degree. Youth-centered, cultural approaches to suicide prevention are essential in enhancing well-being in indigenous communities., (© 2018 The American Association of Suicidology.)

Objectives: To provide one model for evaluating academic research centers, given their vital role in addressing public health issues., Methods: A theoretical framework is described for a comprehensive evaluation plan for research centers. This framework is applied to one specific center by describing the center's Logic Model and Evaluation Plan, including a sample of the center's activities., Results: Formative and summative evaluation information is summarized. In addition, a summary of outcomes is provided: improved practice and policy; reduction of risk factors and increase in protective factors; reduction of interpersonal youth violence in the community; and national prototype for prevention of interpersonal youth violence., Conclusions: Research centers are important mechanisms to advance science and improve people's quality of life. Because of their more infrastructure-intensive and comprehensive approach, they also require substantial resources for success, and thus, also require careful accountability. It is therefore important to comprehensively evaluate these centers. As provided herein, a more systematic and structured approach utilizing logic models, an evaluation plan, and successful processes can provide research centers with a functionally useful method in their evaluation., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

The objective of this study was to determine the longitudinal predictors of past-6-month suicide attempts for a diverse adolescent sample of Native Hawaiians, Pacific peoples, and Asian Americans. The study used longitudinal data from the Hawaiian High Schools Health Survey (N = 2,083, 9th to 11th graders, 1992-1993 and 1993-1994 school years). A stepwise multiple logistic regression was conducted. The final model consisted of three statistically significant predictors: (1) Time 1 suicide attempt, odds ratio = 30.6; (2) state anxiety, odds ratio = 4.9; and (3) parent expectations, odds ratio = 1.9. Past suicide attempt was by far the strongest predictor of future suicide attempts. Implications are discussed, including the need for screening of prior suicide attempts and focused interventions after suicide attempts.

American Indians and Alaska Natives (AI/ANs) constitute 2.2% of Hawai'i's population. Unfortunately, very little is known about the mental health of AI/AN youth in Hawai'i. The purpose of this study (N = 7,214; 1992-1996) was to describe AI/AN adolescents versus non-AI/AN youth regarding demographic, social, and mental health variables. The results suggested that AI/AN adolescents were more open to different types of social-emotional supports, had relatively more non-traditional families with a smaller social network, and may be more vulnerable to academic and health difficulties, with particular risk for mental health issues for mixed AI/AN-Native Hawaiians. Implications are discussed, including intervention, socio-political issues, and future research.

Mental health conditions are common, disabling, potentially life-threatening, and costly; however, they are mostly treatable with early detection and intervention. Unfortunately, mental healthcare is in significantly short supply both nationally and locally, and particularly in small, rural, and relatively isolated communities. This article provides physicians and other health practitioners with a primer on the basic rationale and principles of integrating behavioral healthcare - particularly psychiatric specialty care - in primary care settings, including effective use of teleconferencing. Referring to a local-based example, this paper describes the programmatic components (universal screening, telephone availability, mutually educational team rounds, as-needed consultations, etc) that operationalize and facilitate successful primary care integration, and illustrates how these elements are applied to population segments with differing needs for behavioral healthcare involvement. Lastly, the article discusses the potential value of primary care integration in promoting quality, accessibility, and provider retention; discusses how new developments in healthcare financing could enhance the sustainability of primary care integration models; and summarizes lessons learned., Competing Interests: None of the authors identity any conflicts of iterest.

Interpersonal youth violence is a growing public health concern in the United States. Having a high sense of school connectedness has been found to be a protective factor for youth violence. A high school course that aims to enhance school connectedness was developed and evaluated to investigate the students' sense of school connectedness and its association with violent attitudes and behaviors. Survey data from 598 students from a predominately Asian and Pacific Islander student body were analyzed to assess their level of school connectedness and violent attitudes and behaviors. Analysis of Variance was used to identify differences in the school connectedness and violence scores related to students' demographic characteristics. The role of school connectedness in the relationship between student demographic characteristics and violent attitudes and behaviors was examined with structural equation modeling. Overall, students reported a moderately high sense of school connectedness. School connectedness was found to be negatively associated with violent attitudes but not self-reported violent behaviors. Multiple-group analyses were conducted across the ethnic groups, which found differential associations between the school connectedness and violence variables. These results highlight the value of disaggregating the Asian and Pacific Islander category and the need for future research to further contextualize and clarify the relationship between school connectedness and interpersonal youth violence. This will help inform the development of evidence-based strategies and prevention programming that focus on school connectedness to address disparities in interpersonal youth violence outcomes.

Problem: The field of medical education is represented by a fairly wide variety of models for utilizing journal clubs as an effective teaching tool, each with varying levels of empirical support. Our own prior attempts at developing and implementing an effective journal club required improvements., Intervention: Our intervention consisted of an innovative, effective journal club model that has more well-defined elements that are readily adaptable for other residency programs. The collective strategies were based on the previous literature and our own experiences., Context: Our intervention was implemented in a department of psychiatry within a university-based medical school. Study participants came from a psychiatry department's residency programs (N = 36) during academic year 2011-2012 with senior residents having the option to attend journal club. Using a multifaceted approach, measures included attendance, presession quizzes, postsession evaluations, and a final postcourse evaluation of 11 dimensions (e.g., goals, objectives)., Outcome: Thirty-one (86%) trainees attended journal club-a substantial increase from previous years. The presession-quiz median was 4.4 total correct out of 6 questions (range = 3.3-5.3), indicating that the articles were generally read before the session. The postsession-evaluation median was 4.6 (1-5 scale, 5 the highest; range = 4.1-4.8), indicating sessions were well received. The final postcourse-evaluation overall mean was 3.9 (1-5 scale, 5 the highest; subscale M range = 3.4-4.5). Qualitative and quantitative analyses of the postcourse evaluation indicated the following positive aspects: educational objectives generally met, overall structured format, quality of discussions, individuals involved (e.g., course directors, trainees, faculty facilitators), and availability of food. Areas of possible improvement included time management within the sessions, more contemporary and clinically relevant articles, consistency in faculty moderators, and evaluation process. Engagement in learning appeared to have been dramatically increased through five strategies: (a) meaningful incentives; (b) assigned, engaged consistently prepared faculty; (c) meaningful evaluation; (d) prejournal club preparations that helped residents assimilate critical appraisal with time-and-task-management skills; and (e) a planning group that developed and improved curricula and instruction to meet the objectives of the course., Lessons Learned: Overall, effective, and successful journal clubs require systematic planning, implementation, modification, and refinement.

This study was the first to examine ethnic, sex, and ethnicity-by-sex differences for under-researched, Asian American and Pacific Islander, adolescent groups on youth violence outcomes other than cyberbullying. This effort included the less researched, emotional violence, and included socioeconomic status (SES) measures as covariates. The sample size from 2 high schools in spring 2007 was 881, using an epidemiologic survey design. The pattern of results was higher rates of violence victimization for ethnic groups, with lower representation in the 2 schools' population, and ethnic groups that more recently moved or immigrated to Hawai'i. For emotional victimization, girls of European American and "other", ethnicities self-reported higher rates than boys. Several implications (e.g., need for ethnically and gender-based approaches) and further research (e.g., ethnocultural identity) are discussed.

Intergenerational longitudinal studies over the lifespan provide valuable information for understanding the contexts and dynamic relations among cognition, family and health in adults and the elderly. The Hawai'i Family Study of Cognition (HFSC), initiated in the early 1970s, included a cohort of over 6500 individuals representing over 1800 families of parents and their offspring. The HFSC gathered data on cognitive, personality, biological and other psychosocial variables, and provided novel information on the nature of cognitive abilities, especially on family issues. Some families were reassessed with short-term retesting in the 1970s. A select sample of offspring and their siblings and spouses were re-measured in the 1980s. Decades later, a 40-year follow-up of the original HFSC cohort was facilitated by the availability of contemporary tracking and tracing methods and internet-based testing. A subgroup of the original HFSC participants was re-contacted and retested on contemporary cognitive as well as socio-demographic and health measures. In this paper, we describe the original HFSC cohort and the design and methodology of the re-contact and retest studies of the HFSC, plans for expanding the re-contact and retesting, as well as directions for future research and collaborations. The Principal Investigator may be contacted for more information regarding the application, review and approval process for data access requests from qualified individuals outside the project., (© The Author 2014; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association.)

The scientific literature consistently supports a negative relationship between adolescent depression and educational achievement, but we are certainly less sure on the causal determinants for this robust association. In this paper we present multivariate data from a longitudinal cohort-sequential study of high school students in Hawai'i (following McArdle, 2009; McArdle, Johnson, Hishinuma, Miyamoto, & Andrade, 2001). We first describe the full set of data on academic achievements and self-reported depression. We then carry out and present a progression of analyses in an effort to determine the accuracy, size, and direction of the dynamic relationships among depression and academic achievement, including gender and ethnic group differences. We apply three recently available forms of longitudinal data analysis: (1) Dealing with Incomplete Data -- We apply these methods to cohort-sequential data with relatively large blocks of data which are incomplete for a variety of reasons (Little & Rubin, 1987; McArdle & Hamagami, 1992). (2) Ordinal Measurement Models (Muthén & Muthén, 2006) -- We use a variety of statistical and psychometric measurement models, including ordinal measurement models to help clarify the strongest patterns of influence. (3) Dynamic Structural Equation Models (DSEMs; McArdle, 2009). We found the DSEM approach taken here was viable for a large amount of data, the assumption of an invariant metric over time was reasonable for ordinal estimates, and there were very few group differences in dynamic systems. We conclude that our dynamic evidence suggests that depression affects academic achievement, and not the other way around. We further discuss the methodological implications of the study.

Objective: Substance use is associated with suicidal ideation, planning and attempts among adolescents, but it is unclear how this association varies across different types and number of substances. This study examined the association between patterns of substance use and suicidality among a nationally representative sample of high school students in the United States during the last decade., Method: Data from the 2001 to 2009 Youth Risk Behavior Survey including 73,183 high school students were analyzed. Logistic regression analyses examined the association between lifetime use of ten common substances of abuse (alcohol, cocaine, ecstasy, hallucinogens, heroin, inhalants, marijuana, methamphetamines, steroids, and tobacco) and four measures of suicidality over the last year (suicidal ideation, suicide plan, suicide attempt, and severe suicide attempt requiring medical attention), controlling for potential confounders (socio-demographic variables, interpersonal violence, sexual intercourse, and symptoms of depression and eating disorder)., Results: Among the ten substances, univariate analysis demonstrates that adolescents reporting a history of heroin use have the strongest association with suicidal ideation, suicide plan, suicide attempts and severe suicide attempts in the last year (odds ratio = 5.0, 5.9, 12.0, and 23.6 compared to non-users), followed by users of methamphetamines (OR = 4.3-13.1) and steroids (OR = 3.7-11.8). Cocaine, ecstasy, hallucinogens and inhalants had a moderate association with suicidality (OR = 3.1-10.8). Users of marijuana, alcohol and tobacco also had an increased odds ratio of suicidality (OR = 1.9-5.2). The association between each of ten substances and the four measures of suicidality remained significant with multivariate analysis controlling for multiple confounders (p < 0.05), except for the association between alcohol use and severe suicide attempts. The seven illicit substances had a stronger association with severe suicide attempts as compared to all other confounding risk factors except depression. The number of substances used had a graded relationship to suicidality., Conclusions: Substance abuse is a strong risk factor for suicidal thoughts and behaviors among American high school students, with the strength of this relationship dramatically increasing with particular illicit drugs and a higher number of substances. The findings reinforce the importance of routine screening for substance abuse in the assessment of adolescent suicide risk.

This study assessed the prevalence of alcohol abuse and dependence rates among four major ethnic groups of Hawai'i and examined the relationship among risk factors, protective factors, and demographic variables related to underage drinking. A total of 196 students were administered the Diagnostic Interview Schedule for Children, the American Drug and Alcohol Survey, and the Prevention Planning Survey. Drinking rates for Native Hawaiian students were significantly higher than those for Japanese and Caucasian students. Multiple logistic regression models accounted for 49% of the variance for any alcohol use. Ethnic group differences were found when data were disaggregated for Asian and Pacific Islander students.

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.

Youth violence (YV) is a complex public health issue that spans geographic, ethnic, and socioeconomic lines. The Asian/Pacific Islander Youth Violence Prevention Center conducts qualitative and quantitative research on YV in Hawai'i. A critical element in YV prevention involves measuring YV and its risk-protective factors to determine the scope of the problem and to monitor changes across time. Under the Asian/Pacific Islander Youth Violence Prevention Center's (APIYVPC's) surveillance umbrella, a variety of methodologies are utilized. The major forms of active surveillance are a School-Wide Survey for youth, and a Safe Community Household Survey for adults. A variety of secondary data sources are accessed, such as the Centers for Disease Control and Prevention (Youth Risk Behavior Surveillance System), the Hawai'i State Department of the Attorney General, the Hawai'i State Department of Education, and the Hawai'i State Department of Health. State data are especially important for the Center, because most of these sources disaggregate ethnicity data for Asian Americans/Pacific Islanders. This paper details the surveillance methodologies utilized by the APIYVPC to monitor YV in one specific community and in Hawai'i, in comparison to the rest of the State and nation. Empirical results demonstrate the utility of each methodology and how they complement one another. Individually, each data source lends valuable information to the field of YV prevention; however, collectively, the APIYVPC's surveillance methods help to paint a more complete picture regarding violence rates and the relationship between YV and its risk-protective factors, particularly for minority communities.

There is a relatively consistent negative relationship between adolescent depressive symptoms and educational achievement (e.g., grade point average [GPA]). However, the causal direction for this association is less certain due to the lack of longitudinal data with both indicators measured across at least 2 time periods and due to the lack of application of more sophisticated contemporary statistical techniques. We present multivariate results from a large longitudinal cohort-sequential study of high school students (N = 7,317) with measures of self-reported depressive symptoms and self-reported GPAs across multiple time points (following McArdle, 2009, and McArdle, Johnson, Hishinuma, Miyamoto, & Andrade, 2001) using an ethnically diverse sample from Hawai'i. Contemporary statistical techniques included bivariate dynamic structural equation modeling (DSEM), multigroup ethnic and gender DSEMs, ordinal scale measurement of key outcomes, and imputation for incomplete longitudinal data. The findings suggest that depressive symptoms affect subsequent academic achievement and not the other way around, especially for Native Hawaiians compared with female non-Hawaiians. We further discuss the scientific, applied, and methodological-statistical implications of the results, including the need for further theorizing and research on mediating variables. We also discuss the need for increased prevention, early intervention, screening, identification, and treatment of depressive symptoms and disorders. Finally, we argue for utilization of more contemporary methodological-statistical techniques, especially when violating parametric test assumptions., (PsycINFO Database Record (c) 2012 APA, all rights reserved.)

Perception of safety is an important component to the well-being of community members in their own neighborhood. The present study was the first of its kind to model community perception of safety utilizing a primarily Native Hawaiian and Asian American community sample (N = 101) and with perceived youth violence and delinquency as prominent potential influences. The study found that the majority of participants felt that several types of youth violence and delinquency were problems in the community. The overall social-ecological model evidenced a strong fit and indicated that community perception of safety was adversely impacted by perceived youth violence and delinquency and increased through positive relations with neighbors. The implications included the need for a more comprehensive approach to positive youth development and community capacity-building, including incorporation of cultural components, and to determine whether the model is applicable to other minority communities.

This study compared self-reported risk factors for suicide among American high school students in the last decade. Data from the 1999-2009 Youth Risk Behavior Surveys was analyzed by 8 self-reported ethnicity groups across 6 suicide-related items: depression, suicide ideation, suicide planning, suicide attempts, and suicide attempts requiring medical attention). Native Hawaiian/Pacific Islander adolescents had the higher prevalence of risk factors for suicide. Multiracial adolescents were also at high risk for suicide-related behaviors, with a risk comparable to American Indian/Alaska Native adolescents. Overall, Native Hawaiian/Pacific Islander, multiracial, and American Indian/Alaska Native adolescents reported a significantly higher risk for suicide-related behaviors compared to their Asian, Black, Hispanic, and White peers. The ethnic disparities in risk factors for suicide dictate a need to understand the vulnerability of the Pacific Islander, American Indian, and growing multiracial adolescent populations, in an effort to develop and implement suicide prevention strategies.

Mixed martial arts' (MMAs) growing international popularity has rekindled the discussion on the advantages (e.g., exercise) and disadvantages (e.g., possible injury) of contact sports. This study was the first of its kind to examine the psychosocial aspects of MMA and youth violence using an epidemiologic approach with an Asian American and Pacific Islander (AAPI) adolescent sample (N = 881). The results were consistent with the increased popularity of MMA with 52% (adolescent males = 73%, adolescent females = 39%) enjoying watching MMA and 24% (adolescent males = 39%, adolescent females = 13%) practicing professional fight moves with friends. Although statistically significant ethnic differences were found for the two MMA items on a bivariate level, these findings were not statistically significant when considering other variables in the model. The bivariate results revealed a cluster of risk-protective factors. Regarding the multiple regression findings, although enjoying watching MMA remained associated with positive attitudes toward violence and practicing fight moves remained associated with negative out-group orientation, the MMA items were not associated with unique variances of youth violence perpetration and victimization. Implications included the need for further research that includes other diverse samples, more comprehensive and objective MMA and violence measures, and observational and intervention longitudinal studies.

In the field of youth violence prevention, there has been increasing emphasis on "evidence based" programs and principles shown through scientific research as reaching their intended outcomes. Community mobilization and engagement play a critical role in many evidence-based programs and strategies, as it takes a concerted effort among a wide range of people within a community to alter behavior and maintain behavioral change. How do concerned individuals and groups within a community engage others within and outside of that community to effectively plan, develop and implement appropriate EB programs as well as evaluate the outcomes and impacts of locally developed programs yet to be proven? The authors discuss five elements essential for community engagement in evidence-based youth violence prevention based on their work in a university-community partnership through the Asian/Pacific Islander Youth Violence Prevention Center (API Center), a National Academic Center for Excellence on Youth Violence Prevention Center supported by the Centers for Disease Control and Prevention. They include: (a) aligning EBPs with a community's shared vision and values; (b) establishing an inclusive environment for the planning, implementation and evaluation of EBPs; (c) nurturing collaboration for increased effectiveness and efficacy of EBPs; (d) building adequate leadership and community capacity to develop and sustain EBPs; and (e) building a learning community for evaluation and self-reflection. The authors propose placing greater emphasis on "evaluative thinking" and organizational capacity for evaluation as we pursue evidence-based practices for youth violence prevention. This is especially important for ethnic groups for which an evidence base is not well established.

Background: Among Filipino youth in Hawai'i, low Filipino cultural identification and low family support may be important risk factors for delinquency., Aims: To examine, in a sample of Filipino youth in Hawai'i, correlations between delinquent behaviour and the aforementioned - as well as other, potentially mediating - variables., Methods: A youth risk survey and Filipino Culture Scale were administered to Filipino students (N = 150) in Hawai'i. A parent risk survey was administered to available and consenting parents., Results: Delinquent behaviour correlated positively with acculturative stress, low cultural identification and adverse peer influences; and negatively with total Filipino Culture Scale score. Structural equation modelling suggested that absent/ineffective adults and adverse peer influences might be more important variables compared to low self-esteem and less religiosity, linking low cultural identification to delinquent behaviour., Conclusions: Although further studies are warranted, to be effective, efforts to prevent delinquency by enhancing Filipino youths' cultural connectedness may also need to enhance family connectedness and address adverse peer influences.

This study examined the relationship between stressful life events, drug use, and self-reported violence perpetration among 293 Native Hawaiian, Samoan, and Filipino adolescents. Data were collected using semistructured interviews with students in three high schools in Hawai'i. Stressful life events were delineated into three categories: transitions, discrete events, and victimization. Samoans reported more stressful life events than Native Hawaiians and/or Filipinos, depending on the subscale, but there were no sex differences in the stressful life events total scale or subscales. There were sex differences on several stressful life events items, including boys reporting more physical victimization and more life threatening illnesses and injuries than girls. Stressful life events were related to higher rates of violence perpetration for all groups, though specific types of events were significant for some groups but not others. Drug use moderated the influence of transitions on violent behaviors for boys and Samoan adolescents and also of discrete events on violence perpetration for Samoan adolescents. Additional research is needed to examine other risk factors, as well as types of protective factors that may moderate the relationship between life stressors and engaging in violent behaviors.

Youth violence is a serious public health problem affecting communities across the United States. The use of a social ecological approach has helped reduce its prevalence. However, those who have put the approach into practice often face challenges to effective implementation. Addressing social ecology in all its complexity presents one obstacle; the ability of private non-profit and public agencies to sustain such comprehensive efforts presents another. Here, we provide an example of our efforts to prevent youth violence. We worked with the Asian/Pacific Islander Youth Violence Prevention Center (APIYVPC) and two communities on O'ahu. We provide a case example from the Asian/Pacific Islander Youth Violence Prevention Center (APIYVPC) of our work, in collaboration with two communities on O;ahu, to develop and implement a youth violence prevention initiative that is becoming both comprehensive and sustainable. We illustrate the incremental nature of what it means to be comprehensive and we underscore the importance of reaching sustainability as the project unfolds.

Background: Studies of youth violence have usually examined social capital using qualitative methods, but remain limited by small sample sizes. In addition, few studies examine violence among Asian/Pacific Islander (API) youth, even though they are one of the fastest-growing youth populations in the USA., Aims: To contribute to a better understanding of culture and ethnicity in youth violence among Asian Americans and Pacific Islanders by quantifying ethnic forms of social capital., Methods: We use an n = 326 sample of three API groups from Oahu, Hawaii. Defining social capital as ethnic practice, we test Filipino, Hawaiian and Samoan forms of youth social capital on intimate and non-intimate violence., Results: Bivariate findings associate lower violence with language ability among Filipinos, coming-of-age practices among Hawaiians, and community leader engagement among Samoans. Multivariate tests showed language to be the strongest correlation. Bivariate tests also suggested potentially risky forms of social capital., Conclusions: results lead us to hypothesize that social capital that deliberately places individuals within their respective ethnic communities are risk-reducing, as are those that promote formal ethnic community structures. Those that formalize ethnic practice and social capital into commercial activities may be associated with higher risk of violence. Given the relatively small sample size and the exploratory approach for the present investigation, further research is needed to determine whether the findings can be replicated and to extend the findings of the present preliminary study.

This paper describes an educational model that provides opportunities in medicine to students from disadvantaged backgrounds that have a commitment to serve in areas of need, and it presents guidelines on how this model could be adapted to various settings. From 1973 to 2002, the Imi Ho'ola Program (Hawaiian for "Those Who Seek to Heal") of the University of Hawai'i John A. Burns School of Medicine (JABSOM) has provided opportunities in medicine to 379 students from disadvantaged backgrounds. In 1995-1996, Imi Ho'ola underwent a transformation from a pre-medical enrichment program to a post-baccalaureate program that included provisional acceptance and financial support into JABSOM for students who successfully completed the program. As a result, the acceptance rate increased from 47.6% to 98.0%. In addition to provisional acceptance to JABSOM and financial support, the program's educational model incorporates five components, the key factors of the program's success: 1) JABSOM commitment and the institutionalization of the program; 2) emphasis placed on a comprehensive approach and the implementation of a curriculum and learning process that are aligned with JABSOM curricula; 3) faculty and staff who support the instructional methodology and work as a team to address students' needs; 4) assessment of students and systematic feedback regarding individualized education plans and academic and non-academic progress; and 5) a positive learning environment for students. Guidelines are provided in this article for consideration in adapting this educational model to other academic settings.

Background: Minorities and indigenous peoples are likely to have poor mental health and physical outcomes. This study examines resiliency indicators in Hawaiian adolescents., Aims: Multiple resiliency indicators were examined across different domains including individual, family and community in relation to increased psychological well-being., Methods: Existing data from the Native Hawaiian Mental Health Research Development Program (NHMHRDP) were used. These data included information from a community sample of five high schools on three islands from the state of Hawai'i. The sample included 1,832 students, where 64% were Native Hawaiian and 36% were non-Hawaiian., Results: This study found that Native Hawaiian youth experienced more family adversity compared with non-Hawaiians, but Native Hawaiians were also more likely to have higher levels of family support. For internalizing symptomatology, the most robust resiliency factors were family support and physical fitness/ health for Native Hawaiian and non-Hawaiian adolescents. For externalizing symptomatology, achievement and family support were consistently strong resiliency factors. The indicator for physical fitness and health was more influential among Native Hawaiians than non-Hawaiians for externalizing symptoms, while academic achievement was more influential among non-Hawaiians than for Native Hawaiians for the protection against internalizing symptoms., Conclusions: Our findings support the need for intervention programs designed to promote resilience in adolescents, including highlighting the importance of the family. Further research is needed to design and evaluate programs that promote well-being, enhance resilience and improve mental health in culturally appropriate ways.

Background: Because of socioeconomic and acculturative challenges faced by immigrant families, Filipino adolescents in Hawai'i may be at risk for academic, behavioral and emotional difficulties., Aim: To determine, among Filipino adolescents in Hawai'i, whether measures of economic hardship and lower socioeconomic status (SES) correlate positively with poor school performance, aggressive behavior, substance use, anxiety, and depression; and whether family support and cultural identification correlate negatively with these difficulties., Methods: 216 Filipino adolescents from four public high schools in Hawai'i (1993-1994) were given surveys that assessed basic demographic information, measures of family support and other social variables, and measures of school performance, depression, anxiety, aggression and substance use., Results: In the total sample, low SES seemed to correlate with poor school performance and behavioral and emotional difficulties. In both the total sample and the sub-sample of adolescents with lower SES, family support was a universally strong protective factor. Learning genealogy was positively correlated with school performance, and speaking a language other than English was inversely correlated with substance use (in the whole sample) and depression (in the lower SES sub-sample)., Conclusions: For Filipino adolescents (in both the whole and lower-SES samples), family support was an important protective factor against academic, behavioral and emotional difficulties. The role of cultural identification as a risk or protective factor among Filipino adolescents deserves further investigation.

Objectives: The prevalence rates of disorders among a community-based sample of Hawaiian youths were determined and compared to previously published epidemiological studies., Method: Using a two-phase design, 7,317 adolescents were surveyed (60% participation rate), from which 619 were selected in a modified random sample during the 1992-1993 to 1995-1996 school years: 590 selected randomly and 29 at risk (i.e., Center for Epidemiologic Studies-Depression score of >or=35 and suicidal risk) from grades 9-12. The Diagnostic Interview Schedule for Children-Version 2.3, was used to determine DSM-III-R diagnoses. Prevalence rates, weighted for ethnicity, Center for Epidemiologic Studies-Depression scores, and suicide attempts, were calculated for any diagnosis and various disorders. Meta-analyses compared the Hawai'i sample to four community-based studies (randomly selected youths from community populations) and two high-risk studies (homeless, low-income, or high unemployment communities)., Results: Hawaiian females had the highest rate for any diagnosis (37.7%; 95% confidence interval [CI] 28.4%-48.0%) and non-Hawaiian males had the lowest rate (19.6%; 95% CI 14.8%-25.5%). Hawaiian males (26.8%; 95% CI 18.2%-37.5%) and non-Hawaiian females (27.9%; 95% CI 22.2%-34.4%) had intermediate and comparable rates. Overall, Hawaiians had significantly higher rates (32.7%; 95% CI 26.1%-40.1%) than non-Hawaiians (23.7%; 95% CI 19.9%-28.0%) when controlling for gender, and girls had significantly higher rates (30.8%; 95% CI 25.8%-36.3%) than boys (21.1%; 95% CI 16.8%-26.1%) when controlling for ethnicity. These findings were primarily the result of the significant differences in rates regarding anxiety disorders. Meta-analyses showed the Hawaiian youth rate for any diagnosis was comparable to high-risk studies and nearly three times higher than the community studies., Conclusions: Hawaiian youths, especially females, are at high risk. Research on the sociocultural factors that underpin both the genesis of and protection from psychopathology is imperative for Hawaiian and non-Hawaiian mixed-ethnicity youths.

The present research project is the first large-scale study (N = 5,051) that investigated the prevalence of victims of violence for an ethnically diverse Asian/Pacific Islander sample. The rate for the adolescent respondents of "was a victim of violence (was physically harmed by someone)" within the past 6 months was 3.33%. Over twice that rate was found for family members (6.97%) and over three times the adolescent-respondent rate was obtained for close friends (10.75%). Only partial support was found for the hypothesis that Asian groups would have the lowest rates, and Polynesian, African American, Hispanic, and Native American Indian/Alaska Native groups would have the highest rates. Higher rates were found for Whites (adolescent respondents, close friends) and the Portuguese (family members, close friends), suggesting a "minority" effect. There is a need to disaggregate ethnicity, engage in further research that considers risk and protective factors, and investigate culturally appropriate interventions.

Background: Research on the prevalence and correlates of adolescent misconduct, arrests, and juvenile delinquency has been greatly neglected for the ethnically diverse adolescent groups in Hawai'i (i.e. Asian Americans, Pacific Islanders)., Aims: The aims of the present study are three-fold: (1) to determine whether there are differential rates of adolescent misconduct based on ethnicity, gender, and socioeconomic (SES) factors; (2) on an exploratory basis, to ascertain the demographic, social-cultural, psychological-psychiatric, and school-related correlates of misconduct, with some focus on cultural identification; and (3) to derive a parsimonious model of the correlates for an ethnically diverse group of adolescents by disentangling cultural identification from other variables including ethnicity., Methods: Data were analyzed from the Native Hawaiian Mental Health Research Development Program, consisting of 2,732 Asian/Pacific Islander youths. Misconduct was operationally defined as 'was arrested or got in serious trouble with the law' within the past six months via adolescent self-report. Of added importance were the inclusion of a valid measure of Hawaiian cultural identification and actual school data., Results: Significantly higher rates were obtained for Native Hawaiians, males, and adolescents whose main wage earners' educational attainment was at the high school level or less. Absences may be a more important marker for females than males in the prediction of arrests and serious trouble with the law. The most parsimonious model of self-reported arrests/serious trouble with the law consisted of four variables in the following order of importance: substance use, actual grade-point average, aggressive symptoms, and gender., Conclusion: This is one of the first major studies to examine the prevalence and risk-protective factors of misconduct for adolescents of Asian/Pacific Islander ancestry, and the first to include a valid measure of cultural identification and actual school data. The findings indicated that gender-specific prevention and intervention programs are needed. However, the issues are also complex whereby the use of substances, school performance, and aggression must be taken into account in deriving successful programs. The lack of sustained association between culturally based factors (e.g., ethnicity, Hawaiian cultural identifi-cation) and misconduct in the final parsimonious model suggested that the culturally based variables are not direct causes of misconduct, but rather correlates of misconduct that are over-shadowed by more substantive factors, such as substance use and academic performance, the latter being variables that must be addressed for youths across the United States. The present results reaffirmed the common correlates of misconduct across different ethnic groups. Further research is needed in the causal relationships among these important associations with misconduct.

Background: Research on the prevalence and correlates of adolescent misconduct, arrests, and juvenile delinquency has been greatly neglected for the ethnically diverse adolescent groups in Hawai'i (i.e. Asian Americans, Pacific Islanders)., Aims: The aims of the present study are three-fold: (1) to determine whether there are differential rates of adolescent misconduct based on ethnicity, gender, and socioeconomic (SES) factors; (2) on an exploratory basis, to ascertain the demographic, social-cultural, psychological-psychiatric, and school-related correlates of misconduct, with some focus on cultural identification; and (3) to derive a parsimonious model of the correlates for an ethnically diverse group of adolescents by disentangling cultural identification from other variables including ethnicity., Methods: Data were analyzed from the Native Hawaiian Mental Health Research Development Program, consisting of 2,732 Asian/Pacific Islander youths. Misconduct was operationally defined as 'was arrested or got in serious trouble with the law' within the past six months via adolescent self-report. Of added importance were the inclusion of a valid measure of Hawaiian cultural identification and actual school data., Results: Significantly higher rates were obtained for Native Hawaiians, males, and adolescents whose main wage earners' educational attainment was at the high school level or less. Absences may be a more important marker for females than males in the prediction of arrests and serious trouble with the law. The most parsimonious model of self-reported arrests/serious trouble with the law consisted of four variables in the following order of importance: substance use, actual grade-point average, aggressive symptoms, and gender., Conclusion: This is one of the first major studies to examine the prevalence and risk-protective factors of misconduct for adolescents of Asian/Pacific Islander ancestry, and the first to include a valid measure of cultural identification and actual school data. The findings indicated that gender-specific prevention and intervention programs are needed. However, the issues are also complex whereby the use of substances, school performance, and aggression must be taken into account in deriving successful programs. The lack of sustained association between culturally based factors (e.g., ethnicity, Hawaiian cultural identification) and misconduct in the final parsimonious model suggested that the culturally based variables are not direct causes of misconduct, but rather correlates of misconduct that are over-shadowed by more substantive factors, such as substance use and academic performance, the latter being variables that must be addressed for youths across the United States. The present results reaffirmed the common correlates of misconduct across different ethnic groups. Further research is needed in the causal relationships among these important associations with misconduct.

This study focuses on diverse ethnic differences among adolescent substance use, utilizing selected items from the Substance Abuse Subtle Screening Inventory-Adolescent version (SASSI-A). Data were gathered from a large-scale, cross-sequential study of adolescents during the 1993-1996 school years. Exploratory analyses were conducted for 3,711 students on the basis of their responses to a self-administered survey. Results indicated significant ethnic and gender differences for specific SASSI-A items and factor scores, with Hawaiian, "Other," and Caucasian students reporting higher scores than Japanese students and greater scores for female than male students. These findings suggest the need to develop culturally sensitive substance use prevention and treatment strategies that should also take gender differences into consideration for adolescents in Hawai'i., ((c) 2005 APA)

A confirmatory model integrating Japanese ethnicity, cultural identity, and depression was developed (N = 140). The model incorporated the Center for Epidemiologic Studies-Depression Scale (CES-D), Major Life Events Scale, and Japanese Cultural Scale. Japanese American adolescents scored higher on the Japanese Cultural Scale and reported fewer depressive symptoms on the CES-D total and on 2 of the 3 CES-D factors than part-Japanese American adolescents. Predictors for depression were being Japanese American vs. part-Japanese American, female gender, and culturally intensified events. A significant interaction of behavior by self-identification was noted. The model had good overall fit and suggested that the formation of cultural identity may contribute to depressive symptoms experienced by adolescents, particularly adolescents of mixed heritage., (((c) 2005 APA, all rights reserved).)

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.

Background: A high prevalence rate of obsessive-compulsive disorder (OCD) among Hawaiian adolescents, particularly Native Hawaiians, has been reported. Because Native Hawaiian and other Polynesian youth are at an increased risk for rheumatic fever, caused by an autoimmune response to group A beta-hemolytic streptococci, we hypothesized that the genetic and environmental risk factors for streptococcal infections and their autoimmune sequelae potentially may be associated with the presence of OCD and may partially explain this high OCD prevalence., Objective: To describe, among the adolescents in Hawaii diagnosed as having OCD through a previous study, OCD prevalence by ethnicity, household crowding and other measures of socioeconomic status, various measures of physical health and health-seeking behavior, and comorbid psychopathologic features., Design: Six hundred nineteen adolescents from 5 high schools in the state of Hawaii were interviewed from April 15, 1993, to May 7, 1996. Interview instruments included the Diagnostic Interview Schedule for Children and other measurements of psychopathology. Obsessive-compulsive disorder diagnoses, based on current and past 6-month symptoms elicited via structured interview of the adolescents, were reported., Results: Relative to other ethnicities, Native Hawaiians had a 2-fold higher risk (odds ratio = 2.03) for OCD. Degree of Polynesian ancestry correlated positively with OCD prevalence. Obsessive-compulsive disorder prevalence also correlated positively with crowding in the household; measures of physical illness; and measures of depression, anxiety, aggression, and illicit substance use., Conclusions: The characteristics of OCD in this sample suggest the need to consider the possibility of a streptococcal origin and the need for further studies to clarify the genetic and environmental risk factors for OCD in Hawaiian and other Polynesian youth.