Research Projects

Liko: Maile Tauali'i, PhD

September 2013: Dr. Maile Tauali'i received her PhD in Health Services, with an emphasis in Public Health Informatics, with an emphasis in Public Health Informatics and Public Health Genetics from the University of Washington, where she also completed her Master's degree in Public Health. Dr. Tauali'i is the founding Director fo the Native Hawaiian Epidemiology Center performs targeted and coordinated epidemiological investigations. It also works in partnership with communities, agencies, health officials, and others in crafting strategic interventions to retard or reverse health problems.

Prior to returning to Hawai'i, Dr. Tauali'i was the Scientific Director for the Urban Indian Health Institute, an Indian Helth Service designted Tribal Epidemiology Center. She is the recipient of a Bioinformatics/Public Health Informatics Fellowship and has expertise in development, evaluation, and utilization of data and data systems.

A primaryresearch focus for Dr. Tauali'i is the utility and validity of helath information for racial minorities. Dr. Tauali'i is the Immediate Past Co-Chair for the Native Research Network, the Chair-Elect for the American Public Health Association, American Indian/Alaska Native/Native Hawaiian Caucus a Board member of the Natie Hawaiian and Pacific Islander Health Alliance, and Vice Chair of the International Indegenious Centre for Health Intelligence.

In 2011, Dr. Tauali'i developed and added questions on biospecimen collection to the
Hawai'i Health Survey. These survey questions were answered by 2,866 residents in Hawai'i, including 496 Native Hawaiians, 921 Caucasians, 370 Filipinos, and 652 Japanese. Findings suggest that about 75% of Native Hawaiian respondents would agree to donate tissue to a specific medical research study to better understand a disease that they had or that someone they knew had.

Next, Dr. Tauali'i conducted 10 focus groups with a total of 92 Native Hawaiians. They were asked to suggest guidelines for biospecimen collection, storage, and research. Six themes emerged.

Education should be provided to Native Hawaiian communities to raise awareness and understanding of biospecimen banking and research.
Priority should be given to research to address Native Hawaiian health concerns.
Research using biospecimens should be fully "transparent" to participants and communities.
Biospecimen research involving Hawaiians should be led by Native Hawaiian scientists who are accountable to community.
Native Hawaiians should be included in governing biorepositories in Hawai'i.

Finding from this study have been presented at a number of local, national, and international forums, for example, at the United Nations Permanent Forum on the Rights of Indigenous Issues (New York, May 2013) and at the Australasian Biospecimens Network Association (Tasmania, December 2012).

Furthurmore, Dr. Tauali'i is also involved in a biobanking consenting study. Bio-repositories are being developed to store cancer tissue to support research on cancer causes and cures. Donors must consent, but hospitals do not know the best protocol for consenting potential donors. This research study asked cancer patients 1) if they would agree to donate their tissue to science, 2) when, where, and how they should be asked, and 3) who should ask them.

30 cancer survivors referred by cancer physicians were interviewed. Participants ranged in age from 44 to 85, and most were women. Participants represented Hawai'i's ethnic groups and were survivors of breast, gynecological, lung, thyroid, and prostate cancers.

We learned that:

Only 13% of participants knew what happened to their cancer tissue once it was removed. In fact, laboratories traditionally keep cancer tissue specimens in formalin for up to 10 years after surgery. Biorepositories will sotre frozen cancer tissue, which is better for research.
100% of participants would be willing to donate their cancer tissue to science. Common reasons were to help others and to support finding a cure.
87% of participants thought their physician should introduce the concept of biobanking and ask patients for the donation directly or to alert them that someone else would be asking.
77% of participants would give "blanket" approval for use of their specimen in any relevant research approved by bio-repository ethics and scientific advisory committees. 10% would want to be reconsented for each study that might use their tissue.
77% would appreciate receiving communication, like a newsletter or an update about the repository's growth, challenges, and successes.
Participants had very different opinions about when they should be asked to donate their cancer tissue. 37% said they would want to be asked before surgery. 33% felt they should be asked at a post-op. 20% said there were too many stresses pre-op and immediately post-op, and would prefer to be asked after completion of treatment. 10% recommended they be asked during survivorship planning.

The recommended next steps: Because the physician is a key messenger, biorepositories should educate cancer physicians and staff about the importance of tissue-related research. They should create and distribute educational brochures and/or videos for cancer patients and their families. Protocol for consenting potential donors should allow patients multiple opportunities to donate.

Liko: Denis Nelson-Hurwitz, PhD

September 2013: Papa Ola Lokahi/'Imi Hale recently received a two-year Supplepment to Promote Diversity in Health-Related Reseach Award from the NCI's Center to Reduce Cancer Health Disparities, Diversity Training Branch to provide 2 years of research experience to Dr. Denise Nelson-Hurwitz to develop into an independent researcher. Dr. Nelson received her PhD in Microbiology from the University of Hawai'i at Manoa in May 2013 and after five years of working primarily with influenza virus, for her masters and doctorate degrees, she will now apply her epidemiology background to investigate breast cancer in Native Hawaiians and the potential influences of obesity, diabetes, and nutritional factors.

Dr. Nelson-Hurwitz's programn of research is consistent with the goals and objectives of 'Imi Hale in several ways. It will provide 'Imi Hale with data about the relationship between breast cancer and diabetes, obesity and nutritional factors in Native Hawaiian populations It will also foster a stronger working relationship between 'Imi Hale and other Hawai'i-based cancer researchers, and will potentially provide 'Imi Hale with culturally appropriate community interventions and educational efforts to be used for education regarding the cancer-related risks associated with diabetes, obesity and nutritional factors.

'Imi Hale welcomes Dr. Nelson-Hurwitz and we look forward to supporting and mentoring her on this project.

Liko: Tetine Lynn Sentell, PhD

April 2013: Dr. Sentell is an Associate Professor in Health Policy and Management in the Office of Public Health Studies at The University of Hawai'i at Manoa. Her research focuses on the complex relationship between racial/ethnic health disparities and communication factors such as literacy and English language proficiency.

Dr. Sentell first became interested on these topics as an English major undergraduate when she returned from her small, liberal arts college in Vermont to her hometown in Shreveport, Louisiana to work on a research project in a hospital. The contrast between the hospital where patients struggled to read the labels on prescription medication for their children and the literature-rich environment she was exposed to in college was striking. This experience fueled her to understand these inequities, and to discover ways to change them.

While exploring this topic, she obtained a master's degree in Experimental Psychology where her research focused on the pervasive problems of limited literacy in psychological testing Her research focused specifically on the impact of literacy and education on comprehension of the Beck Dpression Inventory (BDI), on of the most commonly used mental health measures. She found that, though literacy was a better predictor of comprehension than education, even adults who read above an eighth grade level did not understand many BDI items that was written on a 4th-5th grade level.

Her interdisciplinary PhD program in Health Services and Policy Analysis from the School of Public Health at The University of California, Berkeley allowed her to continue to study these issues within the broader frames of different disciplines. During this time, she was able to widen her perspective by completing a second MA degree in Political Science from UC Berkeley. The in-depth study in political science increased her understanding of the larger political system in which health and mental health are administerd. Of particular concern is finding effective policy solutions for the numerous Americans who are low literate and in government sponsored health care. Because these adults are less likely to vote, as Dr. Sentell demonstrated in her political science MA thesis, these individuals' interests may oftern be left our of the policy making process.

After receiving her PhD, Dr. Sentell continued to work in the area of literacy and health inequities as a NIMH Mental Health Services Post-Doctoral Fellow in the Department of Psychiatry at the University of California, San Francisco. There she considered the impact of limited English proficiency (LEP) on access to mental health care. She found that individuals with LEP were less likely to receive needed mental health services compared to those who spoke English well, even when other associated factors such as race/ethnicity, poverty, insurance status, US nativity, and length of time in the US were controlled. Because individuals who do not speak English well are largely concentrated in Asian/Pacific Islander and Latino racial/ethnic groups, LEP may contribute to racial/ethnic disparities in mental health care.

Dr. Sentell cam to The University of Hawai'i in 2009 to join the Health Policy and Management faculty in the Office of Public Health Studies. Dr. Sentell was the PI for a recent 'Imi Hale sponsored project to consider the relationship of health literacy to cancer health information among Native Hawaiians and Filipinos. She is also an 'Imi Hale liko (trainee).

Dr. Sentell is currently the PI for an NCI R03 considering disparities in cancer screening amond Asian Americans by health literacy and for an AHRQ R21 considering maternal quality information for Asian Americans and Pacific Islanders, especially those with limited English proficiency and low health literacy. She is also the PI for a 5-year study funded by NIMHD under the Center for Native and Pacific Health Disparities Research concerning racial/ethnic differences in preventable hospitalizations and re-hospitalizations. She also teaches Introduction to U.S. Health Care Services, Introduction to Health Policy, and Social Determinants of Health and advises graduate students.

Dr. Sentell and her husband have two fabulous children ages 6 and 9 and one giant puppy.

Liko: Francisco Conde, PhD, APRN, AOCNS

May 2012: Dr. Francisco Conde is an oncology advanced practice registered nurse (APRN) who joined The Queen's Medical Center in 2009 and helped launch their Cancer Survivorship Program. With funding from The Queen's Medical Center's Native Hawaiian Health Proigram, Hearst Foundation, NCI Community Cancer Centers Program (NCCCP), and the Hawai'i Komen Foundation, this program provides survivorship services to cancer survivors at no charge.

Dr. Conde meets with cancer survivors and their family members, face-to-face, to address any ongoing cancer or treatment-related side effects; discuss potential late effects, surveillance guidelines, and health promotion activities, such as nutrition and physical activity. He also provides patients with an individualized cancer survivorship care plan. Dr. Conde explains, "At the end of their cancer treatment, survivors continue to face unique physical, emotional, psychosocial, and financial issues that are often ignored, and the durvivorship program helps address those issues and improce quality oflife of survivors."

Dr. Conde was born in the Philippines and has 2 siblings. At the age of 2, his father died from a tragic plane crash. He and his siblings were raised by a single mom, who later re-married. At the age of 10, he and his family moved to Los Angeles to seek a better life. He grew up in south central L.A. where gangs and violence were a normal part of life. He remembers his mother saying, "I can't give you money, but I can give you education." With that, Dr. Conde went to UCLA where he obtained his undergraduate, Masters, and PhD degrees.

In 2005, Dr. Conde came to Hawai'i where he worked as an Assistant Professor at the UH School of Nursing. There, he secured over $900,000 from HRSA to implement the Adult Health Clinical Nurse Specialist program at UH. With additional funds from the HMSA Foundation, he purchased simBaby, a high fidelity mannequin, which is used by both undergraduate and graduate nursing students. He was a principal investigator in an NIH-funded study that explored the barriers and facilitators to prostate cancer screening among Filipino men in Hawai'i. Dr. Conde reported that Filipinos in Hawai'i have the highest rate of advanced prostate cancer at diagnosis and have the lowest rate of prstate cancer screening participation.

In addition to his clinical work, Dr. Conde remains active in research and community/professional service and is an affiliate faculty at UH School of Nursing. He recently received a grant from 'Imi Hale to examine the quality of life and needs of breast cancer survivors. Results from this stury will be used to develop interventions offered through The Queen's Cancer Survivorship Program. He is currently the Secratary of the Hawai'i Prostate Cancer Coalition and has served as past President of the Hawai'i Oncology Nurses Society. He is an active volunteer for Nurses Alliance Mentors, Inc, (NAMI), a non-profit organization that provides free NCLEX-RN reviews to nurses who graduated from foreign countries, and the National Kidney Foundation of Hawai'i.

Liko: Lana Ka'opua, PhD, DCSW, LSW

November 2011: Dr. Lana Ka'opua, associate professor at The University of Hawai', School of Social Work, has an established research career spanning health/mental health practice, intervention research, Native Hawaiian and Pacific Islander populations, and medically underserved women.

On July 20, 2011, Dr. Ka'opua and Mr. Raymond Alejo, presented to 'Imi Hale's joint councils ('Imi Hale Center Steering Committee and Community Advisory Group) at The Queen's Harkness Board Room about their community-based research project, "Increasing Cancer Screening Among Those Living with HIV."

Mr. Raymond Alejo, from Life Foundation, is a member of the community advisory panel advising Lana on the project. He shared his personal experiences living with HIV and being a nurse working with other people living with HIV. He described many barriers encountered by people living with HIV in Hawai'i, including stigma, discrimination, and lack of resources.

Dr. Ka'opua reported that people living with HIV were now being diagnosed with Non-AIDS Defining Malignancies (NADM). These are cancers that everyone can get -- Like breast cancer and colorectal cancer-- due to the fact that HIV treatments now extend the lives of individuals with HIV. This treatment is called Highly Active Antiretroviral Therapy (HAART). Unfortunately, NADM are more aggresive and occur at a younger age in people with HIV compared to the rest of the population. Among those who have HIV in Hawai'i, 9% are Native Hawaiian of Pacific Islander (NH/PI). Many NH/PI HIV patients also exose who have HIV in Hawai'i, 9% are Native Hawaiian of Pacific Islander (NH/PI). Many NH/PI HIV patients also experience poor socioeconomic status and live in rural areas, with limited access to HIV and primary care.

The community advisory panel for the project decided that they would pursue an educational intervention to increase colorectal cancer screening among individuals that have HIV. Lana and her team, which includes Kevin Patrick and Talita Bowen of the AIDS Community Care Team, will be developing and testing this educational intervention in the coming year.

Liko: Keawe Kaholokula, PhD

July 2011: Dr. Keawe'aimoku Kaholokula is an Associate Professor and the Chair for the Department of Native Hawaiian Health and Deputy Director for the Center for Native and Pacific Health Disparities Research in the John A. Burns School of Medicine at the Univeristy of Hawai'i. Dr. Kaholokula recently presented at the 'Imi Hale Joint Councils Meeting on April 19 on his 5-year Controlled Trial to address obesity disparities in Hawai'i called the PILI@Work Program. This project has two phases: Phase 1 -- Intervention Adaptiation and, Phase 2 -- Controlled Trial.

The specific aims for Phase 1 are to adapt and implement PILI Weight Loss and PILI Maintenance (collectively called PILI@Work) in Native HAwaiian-serving organizations, working with employee representattives to determine how the interventin can be best implemented with employees in worksites.

Phase 2's specific aims include employees participating in the PIIL@Work Program and to test whther PILI Maintenance in DVD is as effective as PILI Maintenance in Group in Maintaining weigt loss for employees who complete PILI Weight Loss.

Currently, facilitators are being trained to implement the program which is set to start Fall 2011. Theu have three sites enrolled in the study, but are seeking more to participate...

This project builds on more than 5 years of research in obesity prevention and control. We look forward to seeing this study progress.

Liko: