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Orchid Club Hosts Rat Lungworm Disease Presentation

Rat lungworm disease is carried by slugs and snails. Hawai‘i Department of Health photo.

Prevention and control of Rat Lungworm Disease is the topic of a presentation by Jason Dela Cruz of the Hawai‘i State Department of Health at the Wednesday, March 14, 2018, meeting of the Kona Daifukuji Orchid Club (KDOC).

The meeting begins at 7 p.m. A potluck starts off the meeting and guests are invited to participate at the Daifukuji Soto Mission Hall.

“Since a lot of our orchids are outside in the environment, we should be diligent in controlling conditions promoting the spread of the disease,” said Joyce Hancock, KDOC program chair.

The Kona Daifukuji Orchid Club is West Hawai‘i’s oldest orchidaceae organization, with a mission to learn and foster orchid culture and promote fellowship among orchid collectors. The club meets the second Wednesday of every month at the Daifukuji Soto Mission Hall on Highway 11 at Mile Marker 114, just north of Kainaliu.

For information, visit online or phone (808) 328-8375.

Hawai‘i Mumps Outbreak: 770 Confirmed Cases

The total number of confirmed mumps cases in Hawai‘i as of Thursday, Jan. 4, 2018, stands at 770, with 108 on Hawai‘i Island, 610 on O‘ahu, 49 on Kaua‘i and three on Maui.

The ongoing mumps outbreak is by far the worst in several decades for Hawai‘i, which typically has fewer than 10 cases a year.

State Epidemiologist and Chief of the Disease Outbreak Control Division Dr. Sarah Park noted that in previous years, mumps cases were imported, but recently outbreak cases have been acquired locally. What began in March 2017 as two clusters of cases involving nine individuals on O‘ahu, increased to 500, with confirmed cases in all counties by late October 2017.

Commonly considered a disease that affects only young children, mumps, is affecting primarily adults and adolescents in Hawai‘i. Adults between the ages of 20 and early 40s, and adolescents 10 years old and above make up the majority of Hawai‘i’s recent mumps cases, according to the Hawai‘i Department of Health (DOH).

However, the DOH offers practical ways to avoid getting the disease.

“We strongly recommend getting an outbreak dose of the MMR (measles, mumps and rubella) vaccine, especially for those who live, work or socialize regularly in crowded settings,” said Dr. Park. “It’s also important to stay home when sick and even consider methods of social distancing, which includes avoiding crowded settings and gatherings, and not hugging or kissing when greeting others.”

“Based on the cases that we have been able to track, the common denomination has been exposure to some type of gathering, whether school, work, church, family gathering or other social event,” she said.

Hawai‘i is not the only state that has experienced a mumps epidemic. According to the Centers for Disease Control and Prevention (CDC), from Sunday, Jan. 1, through Saturday, Dec. 2, 2017, 48 states and the District of Columbia, reported mumps infections. In addition to Hawai‘i, Washington, Texas, Arkansas, Missouri and New York each reported more than 300 cases in 2017.

The MMR vaccine prevents most cases of mumps and complications caused by the disease. Individuals who have been appropriately vaccinated with a routine two-dose series can still get mumps, especially if they have prolonged, close contact with someone who has the disease, but those who are vaccinated and get the mumps will likely have less severe illness than unvaccinated individuals.

“If it were not for our highly vaccinated population, we would expect to see many more cases in individuals exposed to the mumps virus, more severe illness in those who have been sick, and more complications from the disease,” Dr. Park said.

The most common symptoms of mumps include swollen glands in front of ears or jaw on one or both sides, fever, muscle aches, headache, loss of appetite, and tiredness. Persons with symptoms of mumps should contact their healthcare provider for testing.

Complications from mumps include orchitis (swelling of the testicles), oophoritis (swelling of the ovaries), meningitis (infection of the covering of the brain and spinal cord), encephalitis (swelling of the brain), and temporary or permanent hearing loss. In rare cases, death may also occur.

The MMR vaccine is available at local pharmacies. To locate a vaccinating pharmacy nearest you, go online or call the Aloha United Way information and referral line at 2-1-1.

Additional information about mumps can be found on the DOH website.

Former Hawaiʻi County Paramedic Receives National Recognition

Michael Brigoli has followed a career path from Army medic to Hawaiʻi County firefighter paramedic to medical student.

His next step is to become a doctor at the John A. Burns School of Medicine (JABSOM) at the University of Hawaiʻi at Mānoa.

Brigoli is earning national accolades on the way.

The 43-year-old, non-traditional student is one of only seven future physicians selected by the American Association of Medical Colleges to appear on its Anatomy of an Applicant: Demonstrating Core Competencies website.

He was nominated by JABSOM Admissions Director Ivy Nip-Asano.

Michael Brigoli. Courtesy photo.

Brogoli enlisted in the U.S. Army after leaving college without a degree. He was trained as a medic and after his military commitment, he became a Hawaiʻi County firefighter. As a paramedic in the rural community where he grew up, he resolved to become a doctor.

“I would arrive at emergency scenes [as a paramedic] and ask a patient who their doctor was, and they would tell me the name of the emergency room physician,” said Brigoli. “They didn’t have their own doctor. Hawaiʻi Island has the least amount of physicians taking care of our population. After a while I just thought, we need to do something.”

Doing something took audacity. With the support of his wife and two sons, Brigoli sold the family’s Big Island home and moved everyone to Oʻahu, where he completed his college degree at the University of Hawaiʻi–West Oʻahu. He was accepted into the medical school in 2015.

Brigoli was impressed by JABSOM’s strong commitment to Native Hawaiian health and to training and graduating Native Hawaiian physicians.

Michael Brigoli is congratulated at JABSOM for being named a Kahanamoku Scholar, 2017. Courtesy photo.

“When I was growing up, I didn’t think that being a physician was something that I could do,” said Brigoli. “I didn’t know any Native Hawaiian physicians. I didn’t know anybody from my background, having attended three different public high schools (Pāhoa High, Castle High and Waipahu High, from which he graduated). There weren’t a lot of people from my demographic that went on to become physicians.”

Brigoli is scheduled to graduate with his medical degree in May 2019. After completing his post-graduate training, everyone knows where he will likely be practicing medicine—on Hawaiʻi Island, where he is needed the most.

See Brogoli’s complete profile here.

See the full story, which includes a video, on the JABSOM website.

Governor Ige Releases $3 Million in CIP Funding for East Hawaii Region

Sen. Ruderman

Senator Russel Ruderman announces the following release of Capital Improvement Funds:

I am pleased to announce that Governor David Ige’s administration has released Capital Improvement Project (CIP) funding for Hawai‘i Health Systems Corporation, to fund construction and equipment costs for renovation, acquisition, and installation of radiology equipment in the East Hawai‘i Region (Hilo Medical Center, Hale Hoola Hamakua, and Kau Hospital).

Amount Released: $3,000,000.

Thank you Governor Ige for your efforts on Senate District 2’s behalf.

Projects such as these are critical components of the public infrastructure and contribute to building a better home for our kupuna, keiki, and all the residents of Hawai‘i.

DOH Approves ALS as Qualifying Condition for Medical Marijuana Use

The Hawaii Department of Health has added Amyotrophic Lateral Sclerosis (ALS) to the list of qualifying conditions for medical cannabis use. The decision was based on a rigorous review and analysis of written and oral testimony, a public hearing, and peer-reviewed scientific evidence.

Of the 29 states and U.S. jurisdictions that permit medical cannabis, 19 include ALS as a qualifying health condition.

Although the Hawaii Department of Health found little evidence to support the value of medical cannabis for ALS; DOH determined medical cannabis may be appropriate for patients diagnosed with ALS after receiving a comprehensive assessment by a patient’s physician or APRN and a risk-benefit discussion.

The Petition Process

In April 2017, the Department of Health opened the petition process to allow patients, physicians, and advance practice registered nurses (APRNs) to petition the department to add new debilitating medical conditions to the existing list of conditions that could benefit from the use medical cannabis.

Unlike prescription medications that undergo rigorous clinical trials for the treatment of certain health conditions before being released to consumers, medical cannabis does not have that same level of evaluation by the U.S. Food and Drug Administration.

Under Hawaii Revised Statutes, all new conditions must be thoroughly reviewed from an evidence-based perspective and be subject to a public hearing. This year, the Department of Health received two such requests and began the review process.

The other condition submitted for consideration was general anxiety disorder (GAD). The Department of Health declined this request because at this time there is inconclusive medical evidence that cannabis has beneficial use in the treatment or alleviation of symptoms of anxiety, social phobia, and social anxiety disorder (SAD), and no evidence specific to GAD.

In addition, because the prevalence of GAD, high rate of comorbidities, and dearth of scientific evidence to support the use of cannabis in the treatment of GAD, the potential for adverse outcomes is a public health concern.

Next Year’s Petition Process Deadline

Next year’s deadline to request the addition of new health conditions is Feb. 19, 2018. The petition form is available online for patients, physicians, and APRNs and must be submitted by the deadline to be included in the public hearings tentatively scheduled for May 2018. Any petitions received after Feb. 19 may be considered the following year.

DOH Identifies 14 Priority Areas for Cesspool Upgrades to Protect Drinking Water

The Hawai‘i State Department of Health (DOH) has filed a report with the Legislature identifying 14 priority areas of the state where cesspool upgrades are critically needed to protect public health and the environment. The report indicates about 43,000 cesspools – half of Hawai‘i’s total 88,000 cesspools – are located in the 14 priority areas in all counties and need urgent action.

Click to read report

“The report findings are troubling and show wastewater from cesspools is beginning to impact drinking water in some parts of upcountry Maui,” said Health Director Dr. Virginia Pressler. “The water in these areas is still safe to drink, with no evidence of bacterial contamination; however, there are early warning signs that tell us we must act now to protect the future of our drinking water and the environment.”

Hawai‘i has about 88,000 cesspools, far more than any other state. Cesspools provide no treatment and inject about 53 million gallons of raw sewage into Hawai‘i’s groundwater every day, potentially spreading disease and harming the quality of drinking water supplies and recreational waters. Hawai‘i gets over 90 percent of its drinking water from groundwater.

“In areas, such as Kahulu‘u on Oahu and Kapoho and Puako on Hawai‘i Island, cesspools harm recreational waters and precious coral reefs,” said Keith Kawaoka, DOH deputy director of the Environmental Health Administration. “All cesspools pose a serious threat to our natural environment, and the 14 priority areas are our greatest concern as we are seeing the start of potential impacts to Hawai‘i’s shoreline and drinking water resources.”

The DOH report was ordered by the Legislature earlier this year in Act 125 of 2017. The 14 priority areas with maps of cesspool locations are: Upcountry Maui; Kahalu‘u, Diamond Head, Waimanalo, Waialua and Ewa on O‘ahu; Kapoho, Kea‘au, Puako, Hilo Bay and Kailua/Kona coastal areas on Hawai‘i Island; and Kapa‘a/Wailua, Poipu/Koloa, and Hanalei Bay on Kauai.

In 2016, Governor Ige signed Wastewater System rules that banned all new cesspools statewide. Prior to the ban, there were approximately 800 new cesspools per year. The rules also provided tax credits under Act 120. The Act provides a temporary income tax credit for the cost of upgrading or converting a qualified cesspool to a septic tank system or an aerobic treatment system, or connecting to a sewer system. A taxpayer may apply for a tax credit of up to $10,000 for cesspools upgraded to a sewer or septic system during the next five years. The program is limited to a total of $5 million or about 500 cesspool upgrades per year. Under the law, owners of cesspools located within 500 feet of the ocean, streams or marsh areas, or near drinking water sources can qualify for the tax credit. To date, about 50 taxpayers have used the program.

“The state began taking action last year, and today’s report clearly highlights the need for greater measures to tackle this impending threat to our drinking and recreational waters,” said Kawaoka. “With 88,000 systems currently affecting our environment, it will take a concerted effort by our entire community to convert existing systems to safer alternatives.”

The cost to upgrade all of the state’s roughly 88,000 cesspools is estimated at $1.75 billion. State law currently requires the elimination of cesspools in Hawai‘i by year 2050. DOH presented its report on cesspools and prioritization for replacement to legislators and will begin community meetings in impacted areas of the state in January 2018, beginning with Makawao on Jan. 9 and Kahulu‘u on Jan. 12. For more information on cesspools in Hawai‘i and the Tax Credit Program for Qualifying Cesspools go to http://health.hawaii.gov/wastewater/.

STUDY: 94% of the Rats in Hilo Are Infected With Rat Lungworm Disease

A University of Hawaiʻi at Hilo research group supported by Hawai‘i Island legislators is urging more control measures be taken to lower the risks of the spread of rat lungworm (RLW) disease.

UH Hilo Rat Lungworm Lab

Findings of a study headed by the Rat Lungworm Working Group at the UH Hilo Daniel K. Inouye College of Pharmacy (DKICP) are described in a paper entitled “High prevalence of Angiostrongylus cantonensis (rat lungworm) on eastern Hawai‘i Island: a closer look at life cycle traits and patterns of infection in wild rats” published in the journal PLOS ONE.

Our study showed almost 94 percent of the rats in the Hilo area are infected with RLW,” said Susan Jarvi, director of the working group who has been researching the progress of the disease for more than six years.

More than 30 other countries report data on RLW, including Australia, Brazil, Thailand and China. Jarvi suggests that due to the lack of diagnostic tools and difficulty in diagnosis, the disease may be underreported. Her group has been adding to the scientific evidence that gives legislators in Hawai‘i the proof they need to become more involved.

“Hawai‘i is able to take the lead globally on assessing the effects of this debilitating disease thanks to this scientific evidence from UH Hilo,” said Senator Kai Kahele, who represents Hawai‘i Senate District 1, which includes Hilo. “The first step in conquering a threat is in knowing the enemy. We can get ahead of the terrifying risks, but these results certainly show the urgency for more research.”

RLW disease is a parasitic infection that reproduces in rats and is transferred to slugs and snails, which can, if ingested intentionally or not, infect people. While symptoms can be mild and flu-like, there have been cases that have resulted in long-term disability and even death.

“UH Hilo continues to support Dr. Jarvi’s efforts to safeguard public health through her research on the system of this disease,” noted UH Hilo Interim Chancellor Marcia Sakai. “We are exploring alternatives with state agencies that will continue to fund this important research, which reflects our commitment to help maintain the health of the community.”

Researchers in this study examined a total of 545 wild rats from multiple sites in the South Hilo District of east Hawai‘i Island. Through evaluation of multiple stages and locations of development of the infection with A. cantonensis, they were able to determine prevalence, and examine patterns of infection. The purpose was to determine how these data can be used to improve risk assessment and guide research development to better prevent and control human infection.

“Defeating this threat to our islands is essential to perpetuating our way of life,” said Representative Chris Todd, who represents Hilo in the Hawai‘i State House of Representatives. “I believe in the research being done at UH Hilo; their work will help us ensure a healthy future for our keiki – we, as a legislature, need to do more to support their mission.”

DKICP and the Hawai‘i Community Foundation – Medical Research supported research in this study. Authors were from DKICP: Jarvi, Stefano Quarta, Steven Jacquier, Kathleen Howe, Deniz Bicakci, Crystal Dasalla, Noelle Lovesy, Kirsten Snook and Robert McHugh; and Chris N. Niebuhr from the U.S. Department of Agriculture Animal Plant Health Inspection Service’s National Wildlife Research Center, Hawai‘i Field Station in Hilo.

“The clear and present danger of this difficult-to-eradicate disease warrants increased measures to control its spread in both snails, slugs and rodents,” Jarvi said. “Only by deliberate management can we hope to protect human and animal populations.”

DOH Launches First Statewide Media Campaign on Rat Lungworm Disease Prevention

The Hawaii State Department of Health (DOH) recently launched a statewide broadcast media campaign to educate residents and visitors about rat lungworm disease, a potentially devastating illness that can have debilitating effects on an infected person’s brain and spinal cord. Through a partnership with the Hawaii Association of Broadcasters, the campaign aims to increase awareness and prevention of rat lungworm disease through a series of television and radio public education announcements, which are now on air.

Earlier this year, the 2017 Hawaii State Legislature appropriated one million dollars to DOH over the next two years to deliver enhanced response and outreach activities to control the spread of rat lungworm disease. As part of this effort, public education announcements are now running on 40 radio stations and seven television stations to build awareness and inform the public-atlarge about rat lungworm disease and how to prevent it.

“The risk of rat lungworm disease is present on all islands and there are basic steps we can take each day to reduce this risk and help prevent infection,” said Keith Kawaoka, deputy director of environmental health. “Knowledge is the best defense we can provide people with to collectively protect our communities from rat lungworm disease in Hawaii.”

Additionally, visitors to local movie theatres on Hawaii Island, Maui and Oahu can expect to see rat lungworm disease prevention announcements prior to movie showings in December and January. Shopping centers and malls across the state have also posted large-scale announcements reminding patrons to always wash produce before eating and to control rat, slug, and snail populations around their homes and gardens.

Community education was highlighted as a high priority by the Governor’s Rat Lungworm Disease Task Force, a group of local experts from medical, scientific, environmental, and public health fields gathered to actively work on developing guidelines for schools, farms, food
establishments, physicians and other groups on best practices to prevent, control, and manage rat lungworm disease.

Public education has been a collaborative multi-agency effort, involving many partners such as the Hawaii Department of Agriculture (HDOA), the University of Hawaii College of Tropical Agriculture and Human Resources, and John A. Burns School of Medicine, for example. Several informative pieces were created and have been used during informational meetings hosted in all counties by the department throughout the year as well as shared with partners for further distribution into the community.

To date, in 2017, Hawaii has experienced 18 confirmed cases of rat lungworm disease. The most recent case was a Hawaii Island adult resident in Hilo. It is believed the individual accidently ingested an infected slug while drinking from a garden watering hose in late November. The public is urged to take the following precautions to prevent rat lungworm disease:

  • Wash all produce thoroughly under clean and potable running water before eating, especially when eating raw fruits and vegetables;
  • Cook food completely by boiling for 3-5 minutes or heating to 165°F for 15 seconds;
  • Store food and drinks in sealed containers, especially when outdoors;
  • Control and eliminate rats, slugs and snails around the home and garden;
  • Inspect water catchment tanks regularly and always keep them covered;
  • Watch children carefully while playing on the ground and keep them away from areas with slugs and snails;
  • Do not drink from the garden watering hose since slugs and snails that may be inside could be dislodged and swallowed.

DOH will continue its outreach and education efforts centered on rat lungworm disease prevention, especially with the rainy season well upon the state. For more information about rat lungworm disease and DOH’s education campaign, visit: http://health.hawaii.gov/docd/disease_listing/rat-lungworm-angiostrongyliasis/.

Hawaii Caregivers Now Eligible for Financial Help of $70 Per Day

Working caregivers who pay for services to support their kupuna may now be eligible for financial help of up to $70 per day to cover the cost of adult day care, chore services, home-delivered meals, homemaker services, personal care, respite, or transportation. The Hawaii Executive Office on Aging (EOA) is launching the state’s Kupuna Caregivers Program which was signed into law earlier this year by Gov. David Ige to help Hawaii’s working caregivers.

“The landmark initiative is a first step in recognizing the significant contributions and sacrifices of Hawaii’s working caregivers as they celebrate and honor their kupuna,” said Gov. David Ige. “Support for our caregivers is critically needed as Hawaii’s population is aging more rapidly than the national average and our seniors live longer than seniors in any other state.”

Under Act 102, qualified caregivers who apply for the program may receive up to $70 per day in services (subject to the availability of funds and paid directly to contracted service providers, not the caregiver). To be eligible, caregivers must be employed at least 30 hours a week by one or more employers and provide direct care to a care recipient who is a citizen of the US or a qualified alien, 60 years of age or older, and not covered by any comparable government or private home and community-based care service, except kupuna care services. The care recipient cannot reside in a long-term care facility and must have impairments of at least two activities of daily living or two instrumental activities of daily living or one activity of daily living and one instrumental activity of daily living or substantive cognitive impairment requiring substantial supervision.

“We are hopeful that this program will provide working caregivers with the opportunity to continue working and with peace of mind knowing that their loved ones are safe and are receiving services and supports that maximize their independence and quality of life,” said Terri Byers, director of the Hawaii Executive Office on Aging. “EOA is looking forward to analyzing the data we collect during this first six-month pilot period to evaluate demand for services, provider capacity, and how effective the program is in helping caregivers retain employment and ease financial burden.”

Interested caregivers should contact the Aging and Disability Resource Center (ADRC) as soon as possible to apply for the program. Program funding is limited to a total of $600,000 available until June 30, 2018 unless a subsequent appropriation is made by the Hawaii State Legislature. Applying for the program includes employment verification, assessment of the care recipient, and a caregiver burden assessment. For further information or to apply, call the ADRC statewide phone number (808) 643-2372, ADRC TTY line (808) 643-0899, or go to http://www.hawaiiadrc.org

Teen Mothers May Have Higher Heart Risks

Women who became first-time mothers as teens were significantly more likely than older mothers to have greater risks for heart and blood vessel disease later in life, according to a new study in the Journal of the American Heart Association. Catherine Pirkle, an assistant professor in the Office of Public Health Studies at the University of Hawaiʻi at Mānoa, served as lead author.

Catherine Pirkle

“If adolescent childbirth increases the risk of cardiovascular disease risk, then our findings reinforce the need to assure that girls and adolescents have sufficient sexual education and access to contraception to avoid adolescent childbearing in the first place,” Pirkle said. “If the association is mediated by lower educational attainment, poorer health behaviors and other factors caused by young motherhood, then our findings also suggest a need to provide more support to young mothers.”

Researchers found that women reporting a first birth before the age of 20 scored significantly higher on the Framingham Risk Score, a measure commonly used to estimate the 10-year cardiovascular risk. In comparison, women whose first births occurred at older ages had lower average risk scores.

The lowest cardiovascular risk, however, was among women who had never given birth.

“Adolescent mothers may need to be more careful about lifestyle factors that increase the risk of cardiovascular disease, including maintaining a healthy body weight and sufficient physical activity,” said Pirkle. “Clinicians may need to pay more careful attention to women’s reproductive characteristics, and more intensive screening of cardiovascular-disease risk may be required of women reporting early childbirths.”

While previous studies found that women who had several pregnancies had higher cardiovascular risks, in the most recent study, the number of lifetimes births did not affect cardiovascular risk.

Pirkle notes that women who had never given birth may have miscarried or terminated pregnancies, but would have experienced dramatically lower average levels of pregnancy-related complications. Therefore, they would have no, or much shorter durations, of pregnancy-related stress on the body, which may explain the lower average risk scores in that group.

Investigators obtained information about age at first birth for 1,047 women participating in the International Mobility in Aging Study in 2012. Study participants were between the ages of 65 and 74 and were from Canada, Albania, Colombia and Brazil.

Read more at the American Heart Association story.

Hawaii Ranks 5th in Funding Programs that Prevent Kids from Smoking

Hawaii ranks 5th nationwide in funding programs that prevent kids from smoking and help smokers quit, according to a report released today by leading public health organizations. Hawaii is spending $6.6 million this year on tobacco prevention and cessation programs, which is 48.1 percent of the $13.7 million recommended by the Centers for Disease Control and Prevention (CDC).

The report challenges states to do more to fight tobacco use – the nation’s leading cause of preventable death – and make the next generation tobacco-free. In Hawaii, 9.7 percent of high school students smoke, and 500 kids become regular smokers each year. Tobacco use claims 1,400 Hawaii lives and costs the state $526 million in health care bills annually.

Other key findings in the report include:

  • Hawaii will collect $163.9 million in revenue this year from the 1998 tobacco settlement and tobacco taxes, but will spend only 4 percent of the money on tobacco prevention programs.
  • Tobacco companies spend $25.5 million each year to market their deadly and addictive products in Hawaii – almost 4 times what the state spends on tobacco prevention. Nationwide, tobacco companies spend $8.9 billion a year on marketing – that’s $1 million every hour.

The report – “Broken Promises to Our Children: A State-by-State Look at the 1998 Tobacco Settlement 19 Years Later” – was released by the Campaign for Tobacco-Free Kids, American Cancer Society Cancer Action Network, American Heart Association, American Lung Association, the Robert Wood Johnson Foundation, Americans for Nonsmokers’ Rights and Truth Initiative.

Hawaii has been a leader in the fight against tobacco. It has a high cigarette tax ($3.20 per pack, 5th among the states), a comprehensive smoke-free law, and in 2015 became the first state to raise the tobacco age to 21. This year Hawaii increased tobacco prevention funding by 25 percent (to $6.6 million), the first increase since 2012. However, total funding is still less than half what the CDC recommends.

Hawaii has made tremendous progress, but needs to continue and increase its investment in preventing kids from smoking and helping smokers quit,” said Matthew L. Myers, President of the Campaign for Tobacco-Free Kids. “We can win the fight against tobacco and make the next generation tobacco-free, but Hawaii must keep doing its part to help achieve these goals.”

The U.S. has reduced smoking to record lows – 15.1 percent among adults and 8 percent among high school students. But tobacco use still kills more than 480,000 Americans and costs the nation about $170 billion in health care bills each year.

Today’s report also highlights large disparities in who smokes and who suffers from tobacco-related diseases in the United States. Smoking rates are especially high in a swath of 12 states in the Midwest and South, an area called “Tobacco Nation” in a recent Truth Initiative report. Nationwide, smoking rates are highest among people who live below the poverty level and have less education, American Indians/Alaska Natives, LGBT Americans, those who are uninsured or on Medicaid, and those with mental illness. These differences are in large part due to the tobacco industry’s targeting of vulnerable populations through advertising, price discounting and other marketing strategies.

By funding tobacco prevention and cessation programs at the CDC’s recommended levels, states can reduce tobacco use among all Americans. But most states are falling far short:

  • The states will collect $27.5 billion this year from the tobacco settlement and tobacco taxes, but will spend less than 3 percent of it ($721.6 million) on tobacco prevention programs.
  • The $721.6 million that the states have budgeted for tobacco prevention is a small fraction of the $3.3 billion the CDC recommends. Not a single state funds tobacco prevention programs at CDC-recommended levels, and only two states – California and Alaska – provide more than 90 percent of the recommended funding.
  • States with well-funded, sustained tobacco prevention programs have seen remarkable progress. Florida, with one of the longest-running programs, has reduced its high school smoking rate to 5.2 percent, one of the lowest rates ever reported by any state.

The report and state-specific information can be found at tfk.org/statereport.

Hawaii Second Healthiest State

America’s health is challenged by an increase in premature death and uneven concentration of health care providers, according to key findings in United Health Foundation’s America’s Health Rankings Annual Report.

America’s Health Rankings

America’s Health Rankings Annual Report, now in its 28th year, provides a holistic view of the health of the nation and of each state by analyzing 35 measures of behaviors, community and environment, policy, clinical care and outcomes data.

Disturbing Trends in U.S. Mortality: Increases in Premature Deaths, Drug Deaths and Cardiovascular Deaths
The report finds increases in the rates for three key mortality indicators.

  • The premature death rate increased for the third year in a row. The rate increased by 3 percent from 2015. Premature death is defined as the years of potential life lost before age 75.
  • In the past year, the rate of drug deaths continued an upward trend, increasing by 7 percent to its highest level ever as measured by the America’s Health Rankings Annual Report.
  • Cardiovascular deaths increased for the second consecutive year, with the rate among African Americans significantly higher than the rate among whites, Hispanic- and Asian-Americans, and Native Americans.

Even Healthy States Are Experiencing Increases in Mortality
Increases in key mortality indicators are being felt even in the nation’s healthiest states.

  • In the past five years, some of the healthiest states by overall rank have experienced large increases in drug death rates, including New Hampshire (a 118 percent increase, with an additional 13-plus deaths per 100,000 people), Rhode Island (a 56 percent increase, with an additional 8-plus deaths per 100,000 people) and Massachusetts (a 69 percent increase, with an additional 8-plus deaths per 100,000 people).
  • In the past five years, Utah (ranked as the fourth healthiest state) experienced one of the largest increases in the rate of cardiovascular deaths (10 percent, with additional 21-plus deaths per 100,000 people).

Continued Variation in the Concentration of Health Care Providers
The wide variation in health care providers across the country may contribute to differences in overall health.

  • The state with the highest concentration of mental health care providers, Massachusetts, has six times the number of mental health care providers than the state with the least amount, Alabama, Massachusetts has 547 care providers per 100,000 people vs. Alabama, which has 85 care providers per 100,000 people.
  • There is also a significant variation in primary care physicians, with a nearly two-to-one ratio between the states with the highest and lowest concentrations.  Rhode Island, Massachusetts, New York and Connecticut have more than 200 primary care physicians per 100,000 people, compared to fewer than 100 physicians per 100,000 people in Utah and Idaho.
  • Similarly, the concentration of dentists varies by almost two to one across states. Massachusetts and New Jersey have more than 80 dentists per 100,000 people. Arkansas, Mississippi, Alabama and Delaware have fewer than 45 dentists per 100,000 people.

State Rankings in 2017: Massachusetts Ranks 1st, Mississippi Ranks 50th

  • Massachusetts ranks as the healthiest state in 2017 for the first time, followed by Hawaii (2), Vermont (3), Utah (4) and Connecticut (5).
  • Mississippi is ranked 50th for the second year in a row with Louisiana (49), Arkansas (48), Alabama (47) and West Virginia (46) rounding out the states with greatest opportunities for improvement.

“This report serves as an important tool for health care professionals, policymakers and communities in their collaborative efforts to address these challenges, and help build healthier communities across the nation,” said Rhonda Randall, D.O., senior adviser to United Health Foundation, and chief medical officer, UnitedHealthcare Retiree Solutions. “This is a call to action for each of us to make changes in our own lifestyles that can help improve our overall health and well-being.”

DOE & Partners Aim to Promote Oral Health

The Hawai‘i Dental Association (HDA) and the Hawai‘i State Department of Education (HIDOE) are renewing their commitment to educating kids about the importance of dental hygiene. The agencies have continued their Memorandum of Agreement (MOA) to promote oral health by teaching students proper dental hygiene techniques and providing information about access to free dental health services.

HDA will conduct informational presentations in HIDOE first and second grade classes on O‘ahu, Maui, Kaua‘i and Hawai‘i Island through December 2017 and again from January through February 2018, which is National Children’s Dental Health Month.

“Our goal with establishing healthcare partnerships, like this one with the Hawai‘i Dental Association, is to provide access to health services for our students so they can show up to school healthy, engaged and ready to learn,” said Superintendent Dr. Christina Kishimoto. “Mahalo to everyone involved in this partnership—from the dentists to our teachers—it is an important step to ensuring our students are getting proper oral healthcare.”

These efforts are also part of a national initiative from the American Dental Association to bring preventative education and dental services to underserved children, which includes 92,000 economically disadvantaged public school students in Hawai‘i.

“During the first year of this partnership, we had 10 dentists educate more than 700 students,” added Hawai‘i Public Policy Advocate President Melissa Pavlicek. “We look forward to continuing the success of this partnership and expanding outreach even further this year. We encourage schools and teachers that are interested to contact Danny Cup Choy at (808) 447-1840.”

This partnership highlights the work that has been done by the department to ensure that all students come to school healthy and ready to learn.

Other healthcare partners include the University of Hawai‘i at Mānoa, which launched the “Hawai‘i Keiki” program with the department in 2014 and has increased school-based health services.

Department of Health Conducts TB Testing at Lihikai Elementary School

The Hawaii State Department of Health (DOH) is notifying the parents of students and staff members of Lihikai Elementary School on Maui of possible exposure to tuberculosis (TB) at the school. An informational session for affected families and employees will be held next week. Precautionary TB testing will be offered to roughly 80 individuals who may have had exposure.

“The risk of catching TB from someone at school is very low,” said Dr. Elizabeth MacNeill, chief of the DOH Tuberculosis Branch. “TB is not as contagious as many other illnesses such as colds or the flu. Testing may help us find others with early, noncontagious TB and gives us the opportunity to prevent TB for those who might have been exposed. The school screening is an extra measure of safety, and everyone who may have been exposed is being notified.”

DOH conducted an extensive investigation and evaluation of potential contacts and possible exposure immediately after being notified of the active TB case at the end of October. Information on the individual and their case is confidential and protected by law. DOH will be testing only those persons with regular close contact to the patient, and all student families and school employees are receiving a letter describing the situation and whether testing is recommended.

Informational meetings will be held in the cafeteria at Lihikai Elementary School to give families and employees the opportunity to ask questions and discuss their concerns. Meetings will be held on Tuesday, Nov. 21 at 2:30 p.m. for school employees, and at 6 p.m. for families and the general public. TB screening at the school is scheduled to begin on Monday, Nov. 27.

TB is a disease that is commonly seen in the lungs and can be spread from person-to- person through the air with close, continuous contact. When a person with active TB disease in the lung or throat coughs, sneezes, speaks, or sings, tiny drops containing M. tuberculosis may be spread into the air. If another person inhales these drops, there is a chance that they may become infected with TB. Two forms of TB exist, both of which are treatable and curable:

  1. Latent TB infection – when a person has TB bacteria in their body but the body’s immune system is protecting them and they are not sick. Someone with latent TB infection cannot spread the infection to other people.
  2. Active TB disease – when a person becomes sick with TB because their immune system can no longer protect them from active TB infection. Someone with active TB disease may be able to spread the infection to other people.

For more information on tuberculosis or TB testing, please call the DOH Hawaii Tuberculosis Control Program at 832-5731 or visit http://health.hawaii.gov/tb/.

The Tuberculosis Control Program works to reduce the incidence of TB in the state by providing effective prevention, detection, treatment, and educational services. The program offers diagnosis and treatment of TB; ensures that all cases and suspected cases of TB are identified and appropriate therapy is provided; and provides preventive therapy for patients at high risk of developing TB disease including contacts of active cases, persons who are HIV positive, and those with evidence of untreated TB. Through its clinics located in four counties, the program conducts direct TB services including chest X-ray, sputum smear and culture for mycobacteria, tuberculin skin testing, treatment with anti-tuberculosis therapy, and directly observed therapy.

Ride So They Can Walk – A Biking Event to End Polio Now

The Hawaii Rotary Club is sponsoring statewide bike rides that will be happening from Saturday, Nov. 11 through Saturday, Nov. 18. The purpose of these rides is to help to put an end to polio.

During this week, there will be Rotarians, individual community members, biking groups and clubs riding bikes and those on stationary bikes in health clubs and gyms all riding in the support of eradicating polio. This ride is different in that no roads need be closed as everyone will ride on their own schedule and desired distance.

Each rider will pay a $20.00 registration fee and will also have friends and family sponsor their ride with all those donations going to Rotary’s Polio Plus program. When Rotary started the campaign to eradicate polio in 1988 there were 350,000 cases a year in the world. As of the date of this writing there are 10 cases worldwide – 6 in Afghanistan and 4 in Pakistan. This isn’t good enough – Zero is the magic number. Each rider will receive a commemorative towel with the specially designed logo once they complete their ride and bring in a minimum of $100.00 in sponsor donations. Do even more by challenging another rider to see how many sponsor dollars you can bring in.

Join in the fun by becoming a rider and/or sponsoring a rider to help Rotary End Polio Now.

Register to ride, Sponsor a rider for $20, or Donate now: http://bit.ly/2wSMMi1

Hawaii State Department of Health Leads Oral Health Screening Initiative for Every Head Start and Early Head Start Student

The Hawaii Department of Health (DOH), in collaboration with the Hawaii Children’s Action Network, Head Start Collaboration Office, and Hawaii Head Start and Early Head Start programs, is conducting a statewide oral health screening project, beginning this fall. The project, which focuses on Hawaii keiki who are most at risk for cavities, builds upon the foundation set by the DOH’s Hawaii Smiles statewide third-grade screening project two years ago. The current project will look at younger children and include an oral health screening for every child enrolled in the Head Start and Early Head Start programs.The first screening is scheduled at the Parents and Children Together (PACT) headquarters at The Towers at Kuhio Park on Tuesday, Oct. 17, beginning at 10 am. Altogether, more than 2,970 children at more than 100 Head Start and Early Head Start sites statewide will have a dental screening in this school year. The health department will use this data on the oral health of these young children to inform the U.S. Centers for Disease Control and Prevention (CDC) and develop policies and programs to improve the oral health of children across Hawaii.

The Hawaii Smiles statewide screening team is composed of dentists and dental hygienists from the public and private sectors who will evaluate the extent of cavities in these children, provide oral health educational materials for parents and teachers, and offer recommendations for follow-up dental care.

“This project will allow us to better understand the patterns that surround dental decay in families and communities in our state,” said Dr. Gavin Uchida, DOH dental director. “On a community level, we know we must all do much more to improve the oral health of the residents of our state, and this information is foundational in helping us create the smartest, most effective plans for positive change.”

Previously, DOH issued the 2015/2016 Hawaii Smiles report, which validated that Hawaii’s third grade children have the highest prevalence of tooth decay in the nation. The baseline results were based on data collected from more than 3,000 third grade students in 67 public elementary schools during the 2014-2015 school year.

The findings from the Hawaii Smiles report were disappointing, but not surprising:

  • 71 percent of third graders in Hawaii have tooth decay, which is higher than the national average of 52 percent;
  • 22 percent of third graders have untreated tooth decay, indicating they are not receiving dental care;
  • About 7 percent of third graders are in need of urgent dental care because of pain or infection; and
  • There are significant oral health disparities by income as well as by race/ethnicity among third grade students in Hawaii.

“We are grateful that the HDS Foundation is being proactive and funding early solutions to Hawaii’s oral health problems,” said Deborah Zysman, executive director of the Hawaii Children’s Action Network. “These problems are often preventable when addressed in early childhood through screening, public education and outreach, and public policy. We are excited for the opportunity to make a difference in the health of Hawaii children.”

As part of the outreach efforts, parents and teachers will receive oral health educational materials and classroom supplies to reinforce the importance of good oral health to children.

The Hawaii Smiles report recommended community-based prevention programs that focus on oral health promotion and prevention services in early childhood programs to reach children at a younger age. The Early Head Start and Head Start programs were identified because of their extensive reach to children from birth to five years old.

“While this project is organized by the Department of Health, it actually is a growing coalition of local and national community partners who are taking action,” said Dr. Uchida. “We’re seeing the result of partnerships that start with caring individuals and small community groups, and extends to local businesses and associations, and even to national leadership at the CDC. A lot of people are now coming together to address the oral health problems we’re seeing in Hawaii, and this current project is just the beginning of good things to come.“

“We’re pleased to be able to continue our support for the Hawaii Smiles project,” said

Mark Yamakawa, president and CEO of Hawaii Dental Service (HDS). “Prevention is the key to good oral health especially for our young children, and we appreciate the collaborative effort to tackle this important issue in our state.”

The CDC awarded the DOH a $1.1 million grant to rebuild its oral health program, a portion of which is being used for these oral health screenings for 1,450 children at 50 Head Start and Early Head Start sites throughout the state.

The HDS Foundation gave a $45,000 grant to the Hawaii Children’s Action Network, which is helping to coordinate the logistics of this project, to expand the outreach efforts to an additional 59 sites and to conduct dental screenings for an additional 1,520 infants, toddlers and preschoolers for a total of more than 2,970 children.

Children will be referred to their dentist for follow-up care.  If they do not have a dentist, the DOH and the Head Start and Early Head Start programs will refer families to Community Case Management Corp., which assists Medicaid beneficiaries with finding dentists for treatment.

October Brown Bag Lunch Series – “Conflict Resolution Day: Mediation as a Tool for Peace”

With a focus on “Finding Solutions, Growing Peace,” this monthly lunch-and-learn series features interesting speakers discussing topics related to communication, dispute prevention and resolution, and transforming conflict.

This month’s speaker is Julie Mitchell on “Conflict Resolution Day: Mediation as a Tool for Peace.”

“Conflict Resolution Day is an annual international celebration held every third Thursday in October,” says Julie. “It promotes awareness of peaceful means of resolving disagreements and encourages the use of conflict resolution in schools, families, businesses, communities, government, and the legal system.”

During this talk, professionally trained volunteer mediators will conduct a ‘Live Action Mediation’ to demonstrate how mediators empower people to find their own best solutions.

Ku‘ikahi’s Brown Bag Lunch Series is free and open to the public. Attendees are encouraged to bring their own lunch, enjoy an informal and educational talk-story session, and meet others interested in “Finding Solutions, Growing Peace.”

For more information, contact Ku‘ikahi Mediation Center Program Coordinator Al-Qawi Majidah at (808) 935-7844 x 3 or majidah@hawaiimediation.org. No RSVP needed – walks ins welcome!

Hospice of Hilo to Offer Presentation for Professionals

Hospice of Hilo will be offering a free presentation for community professionals serving those whose lives are affected by loss  “Grief Touches Everyone.” Participants will meet at Hospice of Hilo’s Community Room located at 1011 Waiānuenue Ave in Hilo, on Wednesday, October 25, from 3:00 pm to 4:30 pm.

Facilitated by Hospice of Hilo bereavement counselors, participants will learn about common responses to loss, and how grief can affect adults and children emotionally, cognitively, physically, socially and spiritually. An overview of the organization’s free community Bereavement Services will also be provided.

The workshop is highly recommended for teachers, counselors, case managers, social workers, and caregivers.“ This well organized and informative workshop is a good introduction to grief and the resources that can help,” said a past participant.

To register or for further information contact: Anjali Kala at 961-7306 or email anjalik@hospiceofhilo.org. Please RSVP no later than October 24th.

Hawai‘i Telehealth Summit Moves State Toward Increasing Access to Healthcare Using Innovative Technology

More than 150 healthcare and information technology professionals from throughout the state will gather for the Hawaiʻi Telehealth Summit this week to explore ways to improve access to care for Hawaiʻi residents through telehealth technology.

The two-day Hawaiʻi Telehealth Summit, co-sponsored by the Hawaiʻi Department of Health (DOH) and the University of Hawai‘i at Mānoa, will be held at the John A. Burns School of Medicine and the Dole Cannery Ballrooms on Oct. 12 and 13.

“Today, we have technology capable of improving access to healthcare services for Hawai‘i residents who are homebound or living in rural areas, including the neighbor islands where there is a shortage of specialists,” said Dr. Virginia Pressler, director of the Hawai‘i Department of Health. “The Department of Health has adopted telehealth for adolescent psychiatric counseling and has piloted teledentistry for West Hawai‘i residents, but as a state, we’ve only just begun to scratch the surface.

The event will feature exhibits and hands-on demonstrations of the latest telehealth technologies, equipment, and services.

On the first day, summit attendees will hear a keynote address, “Telepresence Skills: How to build and maintain authentic and effective provider-patient relationships when practicing telemedicine,” by Dr. David Roth of Mind and Body Works.  The second day of the summit will feature keynote addresses from Gov. David Ige and Congressman Brian Schatz. The event will culminate in facilitated discussions to establish a statewide telehealth strategic plan.

Hawai‘i has adopted new payment models to keep pace with advances in telehealth technology. In July 2016, Gov. Ige signed a law that allows healthcare providers to receive the same reimbursements for patient care, whether it is through a telehealth consultation or a face-to-face office visit. These types of changes are expected to further accelerate telehealth’s popularity in Hawai‘i.

“It is exciting that the telehealth law paves the way for tremendous opportunity for providers and communities in Hawaiʻi, but there is still a lot of work to be done,” said Denise Konan, the dean of the UH Mānoa College of Social Sciences. “The university is fully supportive of the summit and committed to bringing people together to keep the momentum going.”

Currently, about 15 percent of Hawaiʻi physicians use electronic communications to deliver health care, according to the Hawaiʻi Physician Workforce Assessment Project’s 2017 report to the state legislature.

“Telehealth is changing the way providers interact with patients,” Dr. Pressler said. “Telehealth is particularly convenient for our island state, where many segments of our population face challenges in accessing quality healthcare due to geographical constraints. Telehealth can be a cost-effective alternative to the more traditional face-to-face way of providing medical care and provides greater access to healthcare.”

For example, the state’s physician shortage often forces neighbor islands residents to fly to Oʻahu for treatment. These patients — or government programs such as Medicaid — must absorb the added cost of travel and patients must endure long wait times. With telehealth, medical specialists on Oʻahu can treat patients at smaller, neighbor island hospitals that lack such specialists.

Pressler added, “We look forward to working with our partners in the community to develop a strategic plan for telehealth and ultimately improve the way we deliver healthcare for Hawaiʻi’s people.”

For additional information on the summit, call the DOH Office of Planning, Policy and Program Development at (808) 586-4188.

Hawai‘i Ranks Third in Nation in U.S. News’ Best States for Aging Ranking

The State of Hawai‘i ranks third in the country when it comes to states that are best at serving their older population. U.S. News and World Report based its rankings on the cost of care, nursing home quality, primary care and life expectancy.The publication says that Hawai‘i’s residents have the longest life expectancy in the U.S., with its 65-and-older population expected to live 20 years longer than in other states. U.S. News has also found that Hawai‘i has the best nursing home quality in the country.

“It’s part of our culture in Hawai‘i to respect and honor our kupuna or elders. Our programs reflect these values and aim to keep our older population active and contributing members of society,” said Gov. David Ige.

Colorado ranked first, with one of the healthiest and most physically active older populations in the country. Maine is second, where a fifth of the population consists of residents 65 and older, a higher percentage than in any other state.

Rounding out the top 10 are: Iowa, South Dakota, Wisconsin, Minnesota, Vermont, New Hampshire and Florida.

In 2016, Americans 65 and older accounted for 15.2 percent of the total population, an increase of 2.8 percent from 2000. Not only are baby boomers aging, but advances in medicine and technology are resulting in a longer life expectancy.

The U.S. Census Bureau predicts that one in five Americans will be 65 years and older by 2030.