PILI 'Ohana Program University of Hawaii

Cardiovascular disease among Native Hawaiians is rampant in large part because between seventy and eighty percent of adults are overweight and/or obese. In addition to heart disease, obesity is linked to diabetes, hypertension and some forms of cancer – all diseases that disproportionately affect Native Hawaiians and Pacific Islanders. In fact, in Hawaii, Native Hawaiians have more than twice the rate of diabetes as whites and are more than 5 times more likely to die from diabetic complications.

“We felt if we were going to begin to eliminate these disparities in health, we would have to get help from the community,” said Dr. Marjorie Mau, Co-Director of the Center for Native and Pacific Health Disparities Research.

This is the backdrop for a program funded by the National Center on Minority Health and Health Disparities (NCMHD) called The Partnership for Improving Lifestyle Intervention (PILI) ‘Ohana Project. PILI is a unique Obesity Intervention Study at the University of Hawaii. The 3-year study used an innovative community-based approach to explore solutions for obesity in Hawaii.  The PILI ‘Ohana Project has just been awarded funding from the NCMHD to continue another 5 years of exploration in this area.

“This research project exemplifies the value of the community-academic partnership,” said Dr. Nathaniel Stinson, acting director, Office of Scientific Programs, NCMHD.  “Among other aspects of their research proposal, our reviewers were especially impressed with the way it integrated five community groups with the medical school and state department of health to focus on obesity health disparities.”

PILI is the John A. Burns School of Medicine's first formal Community Based Participatory Research (CBPR) initiative. One of its stated goals is to achieve social justice and community well being. PILI initially developed a pilot intervention to provide data for a more definitive research study. This first phase had four specific aims:

• Establishing a community – academic structure that will foster a co-learning environment,
• Conducting community assessments focused at understanding obesity related health disparities in Native Hawaiians and Pacific Peoples (NHPP) and potential interventions to address those disparities,
• Developing an intervention protocol integrating community expertise and scientific methods into the pilot study for addressing the maintenance of weight loss in NHPP,
• Implementing a pilot feasibility to determine whether a family plus community focused intervention will improve weight loss maintenance compared to standard protocols in NHPP.

Project Organization

The 5 community partners include the Association of Hawaiian Civic Clubs  Hawai‘i Maoli, Kalihi-Palama Health Center, Ke Ola Mamo, Kokua Kalihi Valley Comprehensive Family Services and Kula no na Po‘e Hawai‘i in Papakolea.

These community organizations that serve high-risk populations will provide unique contributions to find community driven solutions for the growing epidemic of obesity. Solutions will include culturally based lifestyle programs addressing diet and exercise.

“This grant is an opportunity for communities to develop their own solutions relating to obesity,” says Charlie Rose, Co-Director of the PILI ‘Ohana Project.

“The Department of Native Hawaiian Health (DNHH) is honored to work with the 5 organizations in this co-learning environment that brings everyone’s expertise to the table,” says Dr. Marjorie Mau, Chair of the DNHH.

Additional funding from the NCMHD also helped create a new Center for Native and Pacific Health Disparities Research at the University of Hawaii at Manoa. Located in the Department of Native Hawaiian Health at the John A. Burns School of Medicine, the center’s long-term mission goes beyond any single department or school. Its goal is the elimination of health disparities suffered by Native Hawaiians and other Pacific Peoples.

“We are excited by this opportunity to build upon earlier research by the Department of Native Hawaiian Health,” said Dr. Gary Ostrander, Interim Dean of the U.H. Medical School. “This is a critical part of our mission, to address needs that might go unmet without a Hawaii-based, Pacific-focused medical school.”

“Many wonderful scientists, community researchers and grassroots organizations have worked together to make this Center a reality,” said Dr. Marjorie Mau, Co-Director of the Center. “We really wouldn’t be here without strong support from within and outside of The University of Hawaii. We are honored to work with all of them in a co-learning environment. “

The Center’s scientific theme is Cardio-metabolic Health Disparities, which includes heart disease, diabetes, obesity and metabolic syndrome. Investigators are focusing on a wide range of activities such as:

• examining mitochondrial function in obese people who undergo a behavioral weight loss intervention,
• evaluating the impact of hula as a physical activity suitable for cardiac rehabilitation of patients who recently undergone coronary artery bypass surgery,
• evaluating the mechanisms involved in ameliorating obesity and hyperlipidemia by bitter melon, which is reported to improve plasma glucose and lipids and reduce body fat in animal studies.

PILI 'Ohana Community-Academic Partnership

In addition, the Community Engagement Core trains community health workers about diabetes and cardiovascular disease. Because most Native Hawaiians believe that the land, plants, animals, natural elements, spirits, and humans are all relatives and share a familial relationship, two community-based diabetes education programs initiated by Kokua Kalihi Valley Comprehensive Family Services and Hui Mālama Ola nā ‘Ōiwi are built around this cultural value called mālama ‘āina (caring for the land). This project helps community members strengthen their connection to the land as they learn to live and eat healthier. Previous pilot studies discovered that people at risk for diabetes who participated in 4-week educational sessions and a structured communal gardening project saw decreases in:

• Total cholesterol
• Blood pressure
• And a mean decrease of 1.5% in HbA1C

The new Center expands on this innovative idea of managing health and encouraging an active lifestyle through gardening and traditional food sharing practices. In addition to achieving positive clinical results, the Center hopes this approach will improve community cohesion, cultural knowledge and identity.

This kind of holistic-community approach will be key, “said NCMHD Director, John Ruffin, Ph.D., if we are to truly eliminate health disparities and not just reduce them.”

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