Ruben Juarez

This report examines the health disparities between rural and non-rural areas in Hawai‘i, using data from the June 2023 UHERO Rapid Survey. While rural areas offer benefits like proximity to nature and strong community ties, they also face challenges such as reduced access to quality healthcare. Our analysis reveals significant health disparities, particularly among people with disabilities and those with low incomes. These findings highlight the need for targeted policy responses to address the unique health challenges faced by rural populations in Hawai‘i.

In June 2023, UHERO’s public health team, in partnership with the Pacific Alliance Against COVID-19, carried out the third wave of the UHERO Rapid Health Survey. The study engaged 1,575 adult residents of Hawai‘i and examined the links between mental health, food security and socio-economic determinants like housing conditions and poverty status. (July 2023)

Native Hawaiians and other Pacific Islanders (NHPIs) across the country have experienced significant disparities because of the COVID-19 pandemic. The Pacific Alliance Against COVID-19 used a community-based participatory approach involving academic and community partners to expand sustainable COVID-19 testing capacity and mitigate the severe consequences among NHPI communities in Hawaii (American Journal of Public Health, 2022)

The federal government’s response to the COVID-19 pandemic created a perfect storm in which private laboratories can earn huge profits from PCR testing while potentially impacting health care premium costs (Journal of General Internal Medicine, 2022)

An innovative diabetes study to understand how the social environment during early adulthood (20-50 years old) may underlie diabetes progression in Hawaii's diverse populations.

The Maui Wildfire Exposure Study (MauiWES) is the most comprehensive study focused on understanding and mitigating the health and social impacts of the Maui wildfires. It aims to fill a gap in knowledge about the effects of environmental hazards and socioeconomic challenges on the health and wellbeing of those exposed to the wildfires. Over at least ten years, the study aims to track and gather data from participants through questionnaires, health assessments, and biospecimen collection, helping the community to better understand resilience and reduce potential risks to short- and long-term adverse health outcomes. (May 2024)

This paper is the first to demonstrate that those who were infected and suffered from lingering symptoms from COVID-19 (i.e., long-COVID) had different employment outcomes than those who did not experience such symptoms. Using data from our longitudinal cohort in the state of Hawaii, we found that those who reported long COVID in May 2022 were 6.43% more likely to be unemployed at the time of the May survey and 7.07% more likely in November 2022. In addition, we showed that vaccination is associated with higher rates of employment. (International Journal of Environmental Research and Public Health, 2023)

Vaccine & booster hesitancy remains a significant barrier to achieving herd immunity and preventing the further spread of COVID-19. We uncover a mechanism that explains how trust in and consumption of different sources of information affect vaccine and booster uptake using a longitudinal cohort. These results are critical for the development of effective public health policies and offer insights into hesitancy over the course of the COVID-19 vaccine and booster rollout. (Vaccines, 2022)

Faced with the largest increase in cases since the beginning of the COVID-19 pandemic, Hawaii needs effective solutions that would reduce the number of cases disproportionately ravaging communities in the state. In August 2021, UHERO and PAAC conducted a representative survey of businesses and community organizations in the state to (1) understand their willingness to adopt restrictions at their workplaces for employees and customers and (2) understand barriers to effectively execute these restrictions if implemented.

Multidisciplinary policy study in Hawaii to evaluate COVID-19 Vaccine Hesitancy and effective messaging strategies. A follow-up study continues.

On November 20, 2021, a major fuel leak occurred at the Red Hill Bulk Fuel Storage Facility, releasing around 19,000 gallons of jet fuel into the Pearl Harbor aquifer, which serves as the primary source of drinking water for Oʻahu. In July 2023, UHERO, the Water Resources Research Center (WRRC), and the Department of Geography and Environment collaborated on a survey with Navy water users who had previously taken part in surveys in 2021 and 2022. This survey aimed to investigate the ongoing and potential long-term health and social impacts of the contamination. Here, we present some preliminary findings from this study. (January 2024)

A community-based research approach from a cohort enriched with NHPI residents in Oahu shows that age-related differences in gut bacteria may influence T2DM and obesity in NHPIs. (Frontiers, 2023)

The COVID-19 pandemic has had significant adverse impacts in the state of Hawai‘i beyond the direct effects of COVID-19 itself, including indirect effects on mental health, food security, job security, housing, poverty. We report these effects in the first UHERO Public Health Report.

The Pacific Alliance Against COVID-19 (PAAC) expands COVID-19 testing in the community and empowers educators, students and the community at large with education tools and connections with public health services, including those provided by the AHARO Community Health Centers. Learn more about our partnership. 

We study the recent development of a Mobile Money in Ecuador using a unique data set from all MM transactions in the country over the life of the project. We show how agents behave over time and how they react when given tax-incentives for the use of non-cash transactions. These findings offer important lessons that would be valuable to other governments and policymakers considering MM. (Humanities and Social Sciences Communications, 2022)

The Mauli Ola Study investigates health inequities in Native Hawaiians and Pacific Islanders by examining a youth leadership program at MA'O Organic Farms aimed at promoting food sovereignty and improving health. The study integrates community engagement and research to address high rates of obesity, diabetes, and mental health issues among the youth in Hawai'i. Preliminary findings highlight the significance of combining social and biomedical research to develop preventive health strategies for Indigenous populations. (November 2023)

As we enter a new phase of the pandemic, Hawai‘i’s populations are becoming more confident that the worst of the pandemic is behind us, driving COVID-19 booster uptake down. However, significant impacts exacerbated by the pandemic, including long COVID, mental health issues, and the negative effects of long COVID on unemployment pose significant challenges that warrant monitoring. (January 2023)

Native Hawaiians and other Pacific Islanders were disproportionately impacted by COVID-19 and remain significantly under-vaccinated against SARS-CoV-2. Data from our COVID-19 testing program revealed that a higher degree of trust in official sources of COVID-19 information increased the probability of vaccination whereas a higher trust in unofficial sources decreased the probability of vaccination.  These results revealed a dual and opposing role of trust on vaccine uptake. Interestingly, NHPIs were the only racial/ethnic group to exhibit a significant positive association between trust in and consumption of unofficial sources of COVID-19 information, which explained the vaccine hesitancy observed in this indigenous population. (Vaccines, 2022)

Despite the national attention around COVID-19 vaccination mandates for businesses, the actual impacts on vaccination uptake have yet to be reported. In September, two counties in Hawaii implemented mandates for employees in select businesses to be either vaccinated or enroll in a regular COVID-19 testing program. We estimate the increased vaccination rate of nearly 2000 businesses in Hawaii. 84.4% vaccination rate was reported among employees before mandates, and an additional 8% of employees were estimated to have been vaccinated as a result of the mandates. We also observed that 5.9% of employees elected regular COVID-19 testing, while 1.7% were either dismissed or resigned. This study shows the first quantification of the effects of the mandates on vaccine uptake. The increased vaccination rate observed is an encouraging indication of the efficacy of these mandates on businesses in Hawaii, with far-reaching implications for other parts of the country implementing similar strategies to mitigate COVID-19.

HI'A is a multidisciplinary team of researchers that uses the power of data to show the impact of ‘āina-based practices on community health. 

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Most of the community groups HI’A works with did not set out to be healthcare organizations. They are farms, food banks, or schools. Oftentimes, sustainability and malama ‘āina are baked into their mission and DNA. What they have in common is a deep commitment to people, and an understanding that true well-being is a community endeavor.