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Hawaii

Current Assignee: Since October 1996, there has been a state assignee located in the
State of Hawai`i, Department of Health.

Current Fellow: Since 2002, there has been a fellow working with the assignee.

Projects/Impact:

• Through analysis of Pregnancy Risk Assessment Monitoring System data, the Hawaii MCH EPI assignee and fellow identified that uninsured women were more likely to receive no prenatal care or to enter prenatal care late (44.5%) compared to insured women (17.3%). In addition, pregnant women without health insurance entered care three weeks later than those with insurance coverage adjusting for other risk factors including maternal race and education. In fact, over the last two years, the delay increased from two to three weeks. Recently, the Department of Human Services has reduced some of the barriers for enrollment in Medicaid programs by streamlining the application form and allowing self-declaration of pregnancy. Further, the Medicaid program will now offer coverage to non-resident, immigrant pregnant women, even though federal matching funds are not available to assist with the effort.
  
• Malama A Ho`opili Pono (Caring for Mothers and Children in the Right Way): On the Big Island of Hawaii, although perinatal services are available, access is still a major concern, especially among Native Hawaiian, Filipina and other Pacific Islander women. These women report that the current system of care does not adequately address their needs within the framework of their culture. This project is an effort to integrate perinatal programs into a collaborative model which will lead to new standards of care for the delivery of services to pregnant women. Some of the unique strategies proposed to improve perinatal health and to create a culturally congruent perinatal system of care include the use of aloha talk story style of communication and focus groups; and the integration of cultural healing practices, cross cultural training, and the Native Hawaiian health care system with standard prenatal and infant care.
  
• Evaluation of Breastfeeding Promotion and Support Programs: In January 2000, the Hawai`i WIC program instituted an electric breast pump loan program for its clients. The purpose of the study is to compare the breastfeeding duration rates of women in WIC who are using electric breast pumps on loan from WIC with a control population of women chosen from within WIC who are not using electric breast pumps. At this point in time, the cohort of women for the study has been recruited, data collection is complete, and data cleaning and preliminary analysis is in progress. Answers to the questions regarding impact of the electric breast pump loan program are anticipated next year.
  
• Improved the quality of data on Hawai`i's birth certificate: The project was to develop an integrated Perinatal Data System (PDS) based on multiple needs and building on existing resources. The goal of this project was to assure current and accurate perinatal data dissemination reflecting state-wide as well as selected community and/or ethnic perinatal health status. This would help to assist in program and policy development and in the prioritization of perinatal health issues in Hawai`i. The birth certificate data are provided in an electronic format, with all of the hospitals using the new DOH Internet-based birth record program. As we have met with individual hospitals we learned about different reporting techniques which influenced the changing profile of our data and contributed to a number of the NCHS 1999-2001 outliers. In the future, we plan to continue holding annual workshops with the birth certificate clerks to ensure that the quality assurance improvements which have occurred will remain consistent.

State-Related Publications:

Phares TM, Morrow B, Lansky A, Barfield WD, Prince CB, Marchi KS, Braveman PA, Williams LM, Kinniburgh B. Surveillance for disparities in maternal health-related behaviors – selected states, Pregnancy Risk Assessment Monitoring System (PRAMS), 2000-2001. In: Surveillance Summaries, July 2, 2004. MMWR 2004;53(No. SS–4):1–13.

Prince CB, Song L, Quadri N, Baker KK. The epidemiology of low birth weight and preterm delivery in Hawai`i, 2000–2001. Californian J Health Promotion 2003;1(Special Issue:Hawai`i):83–90.

Simmons CS, Budhiraja P, Prince CB. Hawai`i WIC’s unique breastfeeding initiatives. Californian J Health Promotion 2003;1(Special Issue:Hawai`i):149–159.

Fuddy LJ, Prince CB, Tang MC. Perinatal substance use among high risk women in Hawai`i: patterns and impact on pregnancy outcomes. Asian Am Pac Isl J Health 2003;10:50–57.

Prince CB, Miyashiro L, Weirather Y, Heu P. The Epidemiology of Early Hearing Loss Detection in Hawai`i. Pediatrics 2003;111:1202–1206.

Carmichael SL, Prince CB, Burr R, Nakamoto F, Vogt RL. Breastfeeding among WIC participants in Hawaii, 1997. J Am Diet Assoc 2001;101:57–6.

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Page last reviewed: 2/8/08
Page last modified: 3/6/06
Content source: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion