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Asthma, diabetes, and high blood pressure are common maternal conditions that can impact birth outcomes. Data from hospital discharges in Hawai'i were analyzed for 107,034 singleton births from 2003-2008. Categories were determined using the International Statistical Classification of Diseases, ninth revision (ICD-9) from linked delivery records of mother and infant. Prevalence estimates of asthma (ICD-9: 493), diabetes (ICD-9: 250,648.0, 648.8), high blood pressure (ICD-9: 401-405,642) as coded on the delivery record, low birth weight (<2500 grams), high birth weight (>4500 grams), Cesarean delivery, and median hospital charges were calculated. Median regression analysis assessed total hospital charges adjusting for maternal age, maternal race, insurance, and Cesarean delivery. Maternal asthma was present in 4.3% (95% confidence interval=4.1-4.4%), maternal diabetes was present in 7.7% (95% CI=7.6-7.9%), and maternal high blood pressure was present in 9.2% (95% CI=9.0-9.3%) of births. In the adjusted median regression analysis, mothers with asthma had $999 (95% CI: $886 to $1,112) higher hospital charges compared to those without; mothers with diabetes had $743 (95% CI: $636 to $850) higher charges compared to those without; and mothers with high blood pressure had $2,314 (95% CI: $2,194 to $2,434) higher charges compared to those without. Asthma, diabetes, and high blood pressure are associated with higher hospital delivery charges and low birth weight. Diabetes and high blood pressure were also associated with Cesarean delivery. An increased awareness of the impact of these conditions on both adverse birth outcomes and the development of chronic disease is needed.

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Breastfeeding is nurturing, cost-effective, and beneficial for the health of mother and child. Babies receiving formula are sick more often and are at higher risk for childhood obesity, diabetes, asthma, and other conditions compared with breastfed children. National and international organizations recommend exclusive breastfeeding for 6 months. Exclusive breastfeeding in Asian and Native Hawaiian or Other Pacific Islander (NHOPI) subgroups is not well characterized. Data from the 2004-2008 Hawaii Pregnancy Risk Assessment Monitoring System, a population-based surveillance system on maternal behaviors and experiences before, during, and after pregnancy, were analyzed for 8,508 mothers with a recent live birth. We examined exclusive breastfeeding status for at least 8 weeks. We calculated prevalence risk ratios across maternal race groups accounting for maternal and socio-demographic characteristics. The overall estimate of exclusive breastfeeding for at least 8 weeks was 36.3%. After adjusting for maternal age, pre-pregnancy weight, cesarean delivery, return to work/school, and self-reported postpartum depressive symptoms, the racial differences in prevalence ratios for exclusive breastfeeding for each ethnic group compared to Whites were: Samoan (aPR = 0.54; 95% CI 0.43-0.69), Filipino (aPR = 0.58; 95% CI 0.53-0.63), Japanese (aPR = 0.58; 95% CI 0.52-0.65), Chinese (aPR = 0.64; 95% CI 0.58-0.70), Native Hawaiian (aPR = 0.67; 95% CI 0.61-0.72), Korean (aPR = 0.72; 95% CI 0.64-0.82), and Black (aPR = 0.79; 95% CI 0.65-0.96) compared to white mothers. Providers and community groups should be aware that just over one-third of mothers breastfeed exclusively at least 8 weeks with lower rates among Asian, NHOPI, and Black mothers. Culturally appropriate efforts to promote exclusive breastfeeding are recommended particularly among Asian subgroups that have high breastfeeding initiation rates that do not translate into high exclusivity rates.

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To investigate the relationship between gestational weight gain (GWG) and birthweight outcomes among a low-income population in Hawaii using GWG recommendations from the 2009 Institute of Medicine (IOM) guidelines. Data were analyzed for 19,130 mother-infant pairs who participated in Hawaii's Special Supplemental Nutrition Program for Women, Infants, and Children from 2003 through 2005. GWG was categorized as inadequate, adequate, or excessive on the basis of GWG charts in the guidelines. Generalized logit models assessed the relationship between mothers' GWG and their child's birthweight category (low birthweight [LBW: < 2,500 g], normal birthweight [2,500 g ≤ BW < 4,000 g], or high birthweight [HBW: ≥ 4,000 g]). Final models were stratified by prepregnancy body mass index (underweight, normal weight, overweight, or obese) and adjusted for maternal age, education, race/ethnicity, smoking status, parity, and marital status. Overall, 62% of the sample had excessive weight gain and 15% had inadequate weight gain. Women with excessive weight gain were more likely to deliver a HBW infant; this relationship was observed for women in all prepregnancy weight categories. Among women with underweight or normal weight prior to pregnancy, those with inadequate weight gain during pregnancy were more likely to deliver a LBW infant. Among the low-income population of Hawaii, women with GWG within the range recommended in the 2009 IOM guidelines had better birthweight outcomes than those with GWG outside the recommended range. Further study is needed to identify optimal GWG goals for women with an obese BMI prior to pregnancy.

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OBJECTIVES: We identified potential determinants and cause-specific sources of excess infant mortality among Native Hawaiians. METHODS: We compared infant mortality rates among Native Hawaiians and Whites by using data from the 2002 to 2009 Hawai'i State Linked Birth/Infant Death Cohort File. We evaluated the components of excess infant mortality by age and underlying cause of death as well as maternal sociodemographic, behavioral, and chronic condition disparities. RESULTS: The Native Hawaiian infant mortality rate was more than twice that for Whites (7.9 vs 3.5/1000 live births). Excess Native Hawaiian infant mortality was equally apportioned to neonatal and postneonatal deaths. Preterm-related causes of death accounted for 43.9% of the infant mortality disparity, followed by sudden unexpected infant death (21.6%) and injury (5.6%). In multivariable models, maternal educational inequality accounted for the largest portion of the neonatal mortality disparity (20.9%); younger maternal age (12.2%) and smoking (9.5%) were the only significant contributors to the postneonatal mortality disparity. CONCLUSIONS: Addressing educational inequalities, promoting safe sleep practices, and reducing smoking among Native Hawaiian mothers would help to eliminate excess infant mortality.

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Obesity in both adults and children is a critical issue in Hawai'i, as well as nationally and internationally. Today in Hawai'i, 57 percent of adults are overweight or obese as are almost 1 in 3 children entering kindergarten. Each year, obesity costs Hawai'i more than $470 million in medical expenditures alone.(1) These staggering human and economic costs underscore the serious need for Hawai'i to address obesity now. Due to the urgent need to reverse the current trends in obesity Senate Bill 2778 was signed into law, on July 6, 2012, as Act 269 by Governor Neil Abercrombie, creating The Childhood Obesity Prevention Task Force. The task force was charged with developing policy recommendations and proposed legislation for the 2013 legislature. The task force ultimately identified eleven recommendations for the 2013 legislative session and one recommendation for the 2014 legislative session. When implemented together, these recommendations could profoundly reshape Hawai'i's school, work, community, and health care environments, making healthier lifestyles obtainable for all Hawai'i residents.

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To examine the associations among social-emotional support, life satisfaction, and mental health with not having a routine checkup among women of reproductive age in the US, data from the 2009 Behavioral Risk Factor Surveillance System, a population-based telephone survey of health behaviors, were analyzed among reproductive aged (18-44 years) women in the US. Prevalence estimates were calculated for not having a routine checkup in the past year with measures of social-emotional support, life satisfaction, and mental distress. Independent multivariable logistic regressions for each measure assessed not having a routine checkup within the past year with adjustment for age, race/ethnicity, education level, and health care coverage. Among women of reproductive age, 33.7 % (95 % CI 33.0-34.4) did not have a routine checkup within the past year. Factors associated with not having a routine checkup included: having social-emotional support most of the time (AOR = 1.29, 95 % CI 1.20-1.38) or sometimes or less (AOR = 1.47, 95 % CI 1.34-1.61) compared to those who reported always having the social-emotional support they need; reporting life satisfaction as being satisfied (AOR = 1.27, 95 % CI 1.19-1.36) or dissatisfied (AOR = 1.65, 95 % CI 1.43-1.91) compared to being very satisfied; and frequent mental distress (AOR = 1.19, 95 % CI 1.09-1.30) compared to those without. Women who report lower levels of social-emotional support, less life satisfaction, and frequent mental distress are less likely to see a doctor for a routine checkup. Targeted outreach that provides appropriate support are needed so these women can access clinical services to increase exposure to preventive health opportunities and improve overall health.

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Obesity is a widespread national issue that affects the health and well-being of millions of people; particular attention has been focused on the burden among children. The National Survey of Children's Health data from 2007 was used to examine the relationship of child health status and unhealthy weight (overweight/obese defined as body mass index in ≥ 85 th percentile) among 874 children aged 10 to 17 years of age in Hawai'i. In particular, the parentally reported child's general health status was assessed comparing those with a poorer health status (defined as "good/fair/poor") to those with a better one (defined as "excellent/very good"). Descriptive analysis and multiple logistic regression analysis examined risk for overweight/obese with child's general health status, accounting for gender, race, and socioeconomic factors. More children with a poorer health status (46.5%; 95%CI=33.2-60.2) were overweight/obese compared to those of better health status (25.8%; 95%CI=21.9-30.2). Estimates of overweight/obese were high in Native Hawaiian/Pacific Islander (38.6%; 95%CI: 28.9-49.4), multiracial (30.9%; 95%CI=24.2-38.6) children, and children whose parents had less than 12 years education (56.8%; 95%CI=32.8-78.0). Multivariate logistic regression modeling showed a 2.92 (95%CI=1.52-5.61) greater odds for overweight/obese status in children with a poorer health status compared to those of better health status after accounting for age, race, gender, and parental education. Gender, race, and parental education were also significant factors associated with overweight/obese in the final adjusted model. It is important that children that are overweight or obese receive appropriate health screenings including assessments of general health status. Children in high risk socioeconomic groups should be a particular focus of prevention efforts to promote health equity and provide opportunities for children to reach their potential.

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Postpartum depression affects 10-20% of women and causes significant morbidity and mortality among mothers, children, families, and society, but little is known about postpartum depression among the individual Asian and Pacific Islander racial/ethnic groups. This study sought to indentify the prevalence of postpartum depression among common Asian and Pacific Islander racial/ethnic groups. Data from the Hawaii Pregnancy Risk Assessment and Monitoring System (PRAMS), a population-based surveillance system on maternal behaviors and experiences before, during, and after the birth of a live infant, were analyzed from 2004 through 2007 and included 7,154 women. Questions on mood and interest in activities since giving birth were combined to create a measure of Self-reported Postpartum Depressive Symptoms (SRPDS). A series of generalized logit models with maternal race or ethnicity adjusted for other sociodemographic characteristics evaluated associations between SRPDS and an intermediate level of symptoms as possible indicators of possible SRPDS. Of all women in Hawaii with a recent live birth, 14.5% had SRPDS, and 30.1% had possible SRPDS. The following Asian and Pacific Islander racial or ethnic groups were studied and found to have higher odds of SRPDS compared with white women: Korean (adjusted odds ratio [AOR] = 2.8;95% confidence interval [CI]: 2.0-4.0), Filipino (AOR = 2.2;95% CI: 1.7-2.8), Chinese (AOR = 2.0;95% CI: 1.5-2.7), Samoan (AOR = 1.9;95% CI: 1.2-3.2), Japanese (AOR = 1.6;95% CI: 1.2-2.2), Hawaiian (AOR = 1.7;95% CI: 1.3-2.1), other Asian (AOR = 3.3;95% CI: 1.9-5.9), other Pacific Islander (AOR = 2.2;95% CI: 1.5-3.4), and Hispanic (AOR = 1.9;95% CI: 1.1-3.4). Women who had unintended pregnancies (AOR = 1.4;95% CI: 1.2-1.6), experienced intimate partner violence (AOR = 3.7;95% CI: 2.6-5.5), smoked (AOR = 1.5;95% CI: 1.2-2.0), used illicit drugs (AOR = 1.9;95% CI: 1.3-3.9), or received Women, Infant, and Children (WIC) benefits during pregnancy (AOR = 1.4;95% CI: 1.2-2.6) were more likely to have SRPDS. Several groups also were at increased risk for possible SRPDS, although this risk was not as prominent as seen with the risk for SRPDS. One in seven women reported SRPDS, and close to a third reported possible SRPDS. Messages about postpartum depression should be incorporated into current programs to improve screening, treatment, and prevention of SRPDS for women at risk.

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INTRODUCTION: The Women, Infants, and Children (WIC) branch of the Hawaii Department of Health encourages and assists mothers in breastfeeding. A study was done to determine whether an electric breast pump (vs. a manual pump) would increase breastfeeding duration in those returning to work or school full-time. MATERIALS AND METHODS: During 2002-2003, a randomized trial was conducted among 280 women, with the duration of breastfeeding analyzed in 229 of these women. Descriptive analyses and a multivariate logistic regression analysis assessed factors associated with breastfeeding at 6 months. Unadjusted and adjusted survival analyses were performed to estimate the duration of breastfeeding. RESULTS: In all, 76.8% of women using the manual breast pump and 72.3% of those using the electric breast pump breastfed for at least 6 months. This difference did not reach statistical significance. In the survival analysis adjusted for pump assignment, maternal age, race/ethnicity, marital status, and parity, women with at least some college education breastfed for a 38% shorter time than women with a high school or lower education. CONCLUSIONS: Our findings suggest that the manual breast pump may work as well as the electric breast pump when breastfeeding is encouraged and supported among women returning to work or school full-time. Particular attention should be given to examining reasons why women with greater education breastfed for a shorter duration. Further research is needed to validate these results to better inform breastfeeding women returning to work or school.

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PURPOSE: This study examines the relationship between perinatal substance use and adverse pregnancy outcomes among a select group of high risk women residing in the state of Hawaii. METHODS: Participants were the 2,750 women who had live births during 1994 and 1995 and were enrolled in Hawaii's Perinatal Support Services (PSS) program. Demographic and behavioral risk factors associated with selection for participation in the PSS program were examined along with patterns of substance use and adverse perinatal outcomes. PRINCIPAL FINDINGS: After adjustment for demographic factors, Hawaiian/part Hawaiian women compared to non-Hawaiian women were 1.5 times as likely to drink alcohol (p<0.01) and 1.8 times as likely to smoke (p<0.001). Among these women, the relative risk (RR) for preterm delivery was significantly higher for those who used alcohol (RR=1.7, p=0.027), tobacco (RR=1.6, p=0.027), or illicit drugs (RR=1.8, 0.029). Among the same women, the relative risk for low birth weight was significantly higher for those who smoked (RR=1.6, p=0.010) or used illicit drugs (RR=1.7, p=0.046). CONCLUSION: Hawaiian/part Hawaiian PSS women had a higher prevalence of substance use than non-Hawaiian PSS women, even after adjusting for age, education, and marital status. RELEVANCE TO ASIAN AMERICAN AND PACIFIC ISLANDER POPULATIONS: Special attention must be paid to the reasons why Hawaiian/part Hawaiian pregnant women use tobacco and alcohol at higher rates than women of other ethnic groups enrolled in Hawaii's PSS Program. Furthermore, services to assist pregnant women refraining from using illicit drugs should be supported.

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