Pali Momi Medical Center
Community Health Needs Assessment— March 2016 —Produced by

Contents
Executive Summary ................................................................................................ v
Introduction ........................................................................................................ v
Summary of Findings .......................................................................................... v
Selected Priority Areas ..................................................................................... vii
1

Introduction..................................................................................................... 1
1.1
Summary of CHNA Report Objectives and Context .................................... 1
1.2
About the Hospital ..................................................................................... 1
1.2.1 Definition of Community + Map ............................................................. 1
1.2.2
Hawai‘i Pacific Health ........................................................................ 2
1.3
Healthcare Association of Hawaii ............................................................. 2
1.3.1 Member Hospitals ................................................................................. 3
1.4
Advisory Committee ................................................................................. 3
1.5
Consultants .............................................................................................. 4
1.5.1 Healthy Communities Institute ............................................................. 4
1.5.2
Storyline Consulting ...........................................................................52

Selected Priority Areas .................................................................................... 6

3

Evaluation of Progress since Prior CHNA......................................................... 7
3.1
Impact since Prior CHNA .......................................................................... 7
3.2
Community Feedback on Prior CHNA or Implementation Strategy ......... 12

4

Methods ......................................................................................................... 13
4.1
Quantitative Data Sources and Analysis .................................................. 13
4.1.1
Race/Ethnicity Disparities ................................................................ 14
4.1.2
Preventable Hospitalization Rates .................................................... 14
4.1.3
Shortage Area Maps .......................................................................... 15
4.1.4
External Data Reports....................................................................... 15
4.2
Qualitative Data Collection and Analysis ................................................. 15
4.3
Prioritization ........................................................................................... 16
4.4
Data Considerations ................................................................................ 17

5

Demographics ................................................................................................ 18
5.1
Population ............................................................................................... 18
5.1.1 Age ....................................................................................................... 18
5.1.2
Racial/Ethnic Diversity ..................................................................... 18
5.2
Social and Economic Determinants of Health.......................................... 21
5.2.1
Income .............................................................................................. 21
5.2.2
Poverty ............................................................................................. 21
5.2.3
Education .........................................................................................22
5.2.4
SocioNeeds Index® ............................................................................22

6

Findings ........................................................................................................ 24
Hospitalization Rates ........................................................................................ 27
Note to the Reader ............................................................................................ 29i

6.1
Access to Care ......................................................................................... 30
6.1.1
Access to Health Services ................................................................. 30
6.1.2
Mental Health ................................................................................... 31
6.1.3
Oral Health .......................................................................................32
6.2
Chronic Diseases .....................................................................................33
6.2.1
Exercise, Nutrition & Weight ............................................................33
6.2.2
Diabetes ............................................................................................ 35
6.2.3
Heart Disease & Stroke ..................................................................... 37
6.2.4
Other Chronic Diseases.................................................................... 39
6.2.5
Cancer ............................................................................................. 40
6.3
Environmental Health ............................................................................. 41
6.3.1
Environment..................................................................................... 41
6.3.2
Respiratory Diseases ........................................................................ 41
6.4
Mental Health & Health Risk Behaviors ................................................. 43
6.4.1
Mental Health & Mental Disorders .................................................. 43
6.4.2
Substance Abuse .............................................................................. 44
6.4.3
Wellness & Lifestyle ..........................................................................45
6.4.4
Prevention & Safety ..........................................................................45
6.4.5
Immunizations & Infectious Diseases .............................................. 46
6.5
Women’s, Infant & Reproductive Health ................................................ 48
6.5.1
Maternal, Fetal & Infant Health ....................................................... 48
6.5.2
Family Planning ............................................................................... 49
6.5.3
Women’s Health .............................................................................. 50
7

A Closer Look at Highly Impacted Populations............................................... 51
7.1
Children, Teens and Adolescents ............................................................. 51
7.2
Older Adults ............................................................................................ 52
7.3
Low-Income Population .......................................................................... 53
7.4
People with Disabilities ...........................................................................54
7.5
Homeless Population...............................................................................54
7.6
People from Micronesian Regions ........................................................... 55
7.7
Disparities by Race/Ethnic Groups ..........................................................56

8

Conclusion .....................................................................................................59ii

Tables
Table 6.1: Secondary Data Scoring for Health Topic Areas.......................................................26
Table 6.2: Secondary Data Scoring for Quality of Life Topic Areas ...........................................26
Table 6.3: Hospitalization Rates due to Preventable Causes, 2011 ..........................................28
Table 6.4: Workers Commuting by Walking by Race/Ethnicity ..................................................34
Table 6.5: Diabetic Testing........................................................................................................35
Table 6.6: Highly Impacted Populations, Cardiovascular Disease .............................................39
Table 6.7: Cervical and Colon Cancer Screening ......................................................................40
Table 6.8: Hospitalizations due to Mental Health.......................................................................43
Table 6.9: Hospitalizations due to Substance Abuse .................................................................44
Table 6.10: Highly Impacted Populations, Prevention and Safety .............................................46
Table 6.11: Vaccination Rates among Adults ............................................................................47iii

Figures
Figure 1.1: Pali Momi Service Area Map .................................................................................... 2
Figure 5.1 Population by Age, 2009-2013 .................................................................................18
Figure 5.2: Population by Race/Ethnicity, 2009-2013 ................................................................19
Figure 5.3: Population by One or Multiple Races, 2009-2013....................................................20
Figure 5.4: Population by Race: Breakdown of Asian Population, 2009-2013 ...........................20
Figure 5.5: Population by Race: Breakdown of Native Hawaiian and Other Pacific Islander
Population, 2013 .......................................................................................................................21
Figure 5.6: Persons Below Poverty Level by Race/Ethnicity, 2009-2013 ...................................22
Figure 5.7: 2015 SocioNeeds Index® for Honolulu County ........................................................23
Figure 6.1: Strength of Evidence of Need..................................................................................24
Figure 6.2: Topic Areas Demonstrating Strong Evidence of Need .............................................25
Figure 6.3: Word Cloud of Themes Discussed by Key Informants .............................................27
Figure 6.4: PQI Composite Hospitalization Rates......................................................................28
Figure 6.5: Layout of Topic Area Summary ...............................................................................29
Figure 6.6: Mental Health Professional Shortage Areas ............................................................31
Figure 6.7: Dental Health Professional Shortage Areas ............................................................32
Figure 6.8: Hospitalization Rates due to Diabetes, 2011 ...........................................................36
Figure 6.9: Hospitalization Rates due to Cardiovascular Disease, 2011 ....................................38
Figure 6.10: Hospitalization Rates due to Respiratory Diseases, 2011 .....................................41
Figure 6.11: Hospitalization Rates due to Bacterial Pneumonia, 2011 ......................................46
Figure 6.12 Percent of Hospitalizations due to Bacterial Pneumonia by Age and Gender, WestO‘ahu, 2009-2011 .....................................................................................................................47
Figure 6.13: Low Birth Weight, 2011 .........................................................................................48
Figure 7.1: Disparities by Race/Ethnicity ...................................................................................57
Figure 7.2: Key Informant-Identified Health Issues Impacting Racial/Ethnic Groups .................58

iv

Executive Summary
Introduction
Pali Momi Medical Center is pleased to present the 2015-2016 Community Health Needs
Assessment (CHNA). This CHNA report was developed through a collaborative process andprovides an overview of the health needs of residents in Pali Momi Medical Center’s (PMMC’s)West O‘ahu service area. Hawai‘i Pacific Health and PMMC partnered with Healthy
Communities Institute to conduct the CHNA.
The goal of this report is to offer a meaningful understanding of the health needs of the PMMC
service area (West O‘ahu), as well as to guide community benefit planning efforts anddevelopment of implementation strategies to address prioritized needs. The report provides afoundation for working collaboratively with community stakeholders to improve health. Special
attention has been given to identify health disparities, needs of vulnerable populations, unmet
health needs or gaps in services, and input from the community. Although this report focuses onneeds, community assets and the aloha spirit support expanded community healthimprovement.

Summary of Findings

Strong Evidence of Needin Qualitative Data

Children’s Health
Exercise, Nutrition, &WeightMental Health & Mental
DisordersOlder Adults & Aging
Substance Abuse

Strong Evidence of Needin Quantitative Data

Access to HealthServices
Diabetes
Maternal, Fetal &Infant HealthRespiratory
Diseases
Teen & Adolescent
HealthDisabilities
Environmental &Occupational Health
Immunizations &Infectious Diseases
Men’s Health
Other Chronic Diseases

The CHNA
findings
drawn
an analysis
of quantitative
datawere
specific
West O‘ahu
In qualitative
data,aretopic
areasfromdemonstrating“strong
evidence of need”
thosetodiscussed
in at (overleast two keydata
informantinterviews.
quantitative
data, topicdata
areasfromwith “strong
evidence ofhealthneed” were
80 secondary
indicators)
andInin-depth
qualitative
key community
leaders
those with secondary data scores in the top half of the distribution.
of organizations that serve and represent vulnerable populations and/or populations with unmet
health needs. These findings are supplemented with discussions of health findings for Honolulu
County for additional context.
CHECK # OF KEY INFORMANT INTERVIEWS FOR GEOGRAPHYv

The most severe health needs, based on the overlap between quantitative data (indicators) andqualitative data (interviews), include Access to Health Services; Diabetes; Disabilities; Maternal,
Fetal & Infant Health; Respiratory Disease; and Teen & Adolescent Health. Access to HealthServices exhibited the strongest evidence of need. Other significant health needs are based onstrong evidence from either quantitative or qualitative data, and span a range of topic areas.
Though West O‘ahu experiences better overall health, well-being, and economic vitality
compared to many parts of the U.S., several major themes emerged from the health needs:











Access to Care: Cultural and economic barriers prevent many West O‘ahu residents
from utilizing needed health care. Access to mental health services is limited for both
adults and children in the area.
Chronic Diseases: Increased risk and onset of chronic diseases are being observed inyounger children. Diabetes and obesity are especially burdensome in West O‘ahu.
Improved access to healthy foods and exercise opportunities could improve somechronic disease outcomes.
Environmental Health & Respiratory Diseases: Asthma is a pressing issue forchildren and adults in West O‘ahu, with high hospitalizations rates due to respiratoryrelated disorders compared to other geographies in Honolulu County.
Mental Health & Health Risk Behaviors: Poor access to care in mental health foradolescents and adults exacerbates the burden of mental health disorders in WestO‘ahu. The region also experiences high rates of hospitalizations due to vaccinepreventable bacterial pneumonia and large racial disparities in injury-related deaths.
Women’s, Infant & Reproductive Health: Poor birth outcomes, high teen birth rates,
and low cervical cancer screening are areas of concern for the region.
Highly Impacted Populations: The cross-cutting major themes are even more acute incertain geographical areas and subpopulation groups. Certain portions of the Leeward
Coast and Central O‘ahu – including the zip codes of 96792, 96857 and 96786 –emerged as areas of high socioeconomic need. These highly impacted populations tend
to experience poorer health status, higher socioeconomic need, and/or cultural andlinguistic barriers. For the highly impacted populations, a focus on the social
determinants of health in addition to topic specific needs is likely to lead to the mostimprovement in health status.

Native Hawaiian
Low-income
populations

Subpopulation Groups of High NeedChildren, teens,
Pacific Islander
Older adults
and adolescents
People from
People with
Homeless
Micronesian
disabilities
population
regions**This is intended to be a respectful reference that includes, but is not limited to, individuals from Micronesian states,
Marshall Islands, Palau, Nauru and other islands in the region. These individuals may have come to Hawai‘i througha Compact of Free Association agreement and may be provided health care benefits.

The isolation of many subpopulations and geographies presents spatial and/or cultural/social
challenges leading to the recommendations to increase the continuity of care and leveragevitelemedicine. Opportunities to prevent and intervene early with mental health issues, substanceabuse and the development of chronic disease are needed.
Upstream interventions to address the determinants of health are important for all healthimprovement approaches, but especially crucial for the highest-need geographies andpopulations that experience the greatest health inequities. Together, Hawai‘i hospitals andhealth stakeholders are working towards a community where safety, wellness and community
support exist for all residents.

Selected Priority Areas
PMMC has selected the following priority areas:Access to Health Services
Diabetes

A plan for addressing these priority areas will be further described in PMMC’s 2016
Implementation Strategy report.

vii

1 Introduction
1.1 Summary of CHNA Report Objectives and Context
In 2013, Hawai‘i community hospitals and hospital systems joined efforts to fulfill the newrequirements of the Affordable Care Act with guidelines from the IRS. Three years later, thegroup came together to repeat this process, in accordance with the final IRS regulations issued
December 31, 2014, and re-assess the needs of their communities. The Healthcare Associationof Hawaii (HAH) led both of these collaborations to conduct state- and county-levelassessments for its members. Building on this collaboration, Pali Momi Medical Center
developed a CHNA with a focus on the West O‘ahu service area to meet IRS requirements andto best serve their populations of focus.

1.2 About the HospitalIn the early 1980s, Dr. Joseph “Joe” Nishimoto returned to Hawai‘i from the mainland topractice medicine in ʻAiea and Pearl City. As the community grew, he envisioned a local,
state-of-the-art hospital so Leeward families would not have to drive into town for medical care.
The road to achieving that vision spanned eight years and took the efforts of many.
Pali Momi opened on July 31, 1989. Since its opening, the hospital has delivered many medical
firsts for Central and West O‘ahu, including: The first interventional cardiac catheterization unit to detect and treat heart disease.
 First retina center in Hawai‘i.
 Minimally invasive surgical technology featuring the da Vinci robot-aided system.
 A comprehensive women’s center.
 Hawai‘i’s only team triage approach to emergency medicine.
 A complete bariatric surgery program.
 The most advanced diagnostic imaging technology available.
Today, Pali Momi continues to provide award-winning care to thousands of patients each year.
Pali Momi has been recognized by the American Heart Association and American Stroke
Association for its stroke care program. The Bariatric Surgery Program offers complete patientcare, lifestyle transition and support, and has received Metabolic and Bariatric Surgery
Accreditation and is recognized as a Quality Improvement Program Accredited Center, a joint
program of the American College of Surgeons and the American Society for Metabolic andBariatric Surgery. With more than 1,200 employees and 400 physicians, Pali Momi is fully
accredited by The Joint Commission, an independent nonprofit organization that certifies healthcare organizations and programs in the United States.

1.2.1 Definition of Community + Map
The hospital service area is defined by a geographical boundary of West O‘ahu, including the
Census County Divisions of Ewa, Wahiawa, Waialua, and Waianae. This portion of Honolulu
1Figure 1.1: Pali Momi Service Area Map

County will serve as the unit of analysis for this CHNA. Hence, the health needs discussed inthis assessment will pertain to individuals living within this geographic boundary. Whenever data
specific to these sub-geographies of Honolulu County were not available, Honolulu County data
were discussed to provide context. The specific area served by Pali Momi Medical Center isindicated in Figure 1.1.

1.2.2 Hawai‘i Pacific Health
Hawai‘i Pacific Health (HPH) is a not-for-profit health care network of hospitals, clinics,
physicians and care providers dedicated to the mission of improving the health and well-being of
the people of Hawai‘i and the Pacific Region.
Anchored by its four hospitals—Kapi‘olani Medical Center for Women & Children, Pali Momi
Medical Center, Straub Clinic & Hospital and Wilcox Memorial Hospital—HPH includes morethan 50 convenient locations and service sites statewide. As the state’s largest health careprovider, Hawai‘i Pacific Health’s network of doctors and specialists provide a distinctive modelof coordinated care to treat everything from the common cold to the most complex medical
conditions. Its not-for-profit mission means all earnings are reinvested into improving medical
equipment and facilities, as well as invested in research, education, training, and charity care forunder-served people within the island community.

1.3 Healthcare Association of Hawai‘i
HAH is the unifying voice of Hawai‘i’s health care providers and an authoritative and respectedleader in shaping Hawai‘i’s health care policy. Founded in 1939, HAH represents the state’s
hospitals, nursing facilities, assisted living facilities, home health agencies, hospices, durable
medical equipment suppliers, and other healthcare providers who employ about 20,000 people
in Hawai‘i. HAH works with committed partners and stakeholders to establish a more equitable,
sustainable healthcare system driven to improve quality, efficiency, and effectiveness forpatients and communities.

21.3.1 Member Hospitals
Fifteen Hawai‘i hospitals,1 located across the state, participated in the CHNA project:
Castle Medical Center
Sutter Health Kahi Mohala Behavioral Health
Kaiser Permanente Medical Center
Kapi‘olani Medical Center for Women & Children
Kuakini Medical Center
Molokai General HospitalNorth Hawaii Community Hospital
Pali Momi Medical Center
Rehabilitation Hospital of the Pacific
Shriners Hospitals for Children - Honolulu
Straub Clinic & Hospital
The Queen’s Medical Center
The Queen’s Medical Center – West Oahu
Wahiawa General Hospital
Wilcox Memorial Hospital

1.4 Advisory Committee
The CHNA process has been defined and informed by hospital leaders and other key
stakeholders from the community who constitute the Advisory Committee. The following
individuals shared their insights and knowledge about health care, public health, and theirrespective communities as part of this group.
Kurt Akamine, Garden Isle Rehabilitation & Healthcare Center
Marc Alexander, Hawai‘i Community Foundation
Gino Amar, Kohala Hospital
Maile Ballesteros, Stay At Home Healthcare Services
Joy Barua, Kaiser Permanente Hawaii
Dan Brinkman, Hawaii Health System Corporation, East Hawaii Region
Rose Choy, Sutter Health Kahi Mohala Behavioral Health
Kathy Clark, Wilcox Memorial Hospital
R. Scott Daniels, State Department of HealthThomas Driskill, Spark M. Matsunaga VA Medical Center
Tom Duran, CMS
Laurie Edmondson, North Hawaii Community Hospital
Lynn Fallin, State Department of Health
Brenda Fong, Kohala Home Health Care of North Hawaii Community
Andrew Garrett, Healthcare Association of Hawaii
Beth Giesting, State of Hawaii, Office of the Governor
Kenneth Graham, North Hawaii Community Hospital
George Greene, Healthcare Association of Hawaii
Robert Hirokawa, Hawaii Primary Care Association
Mari Horike, Hilo Medical Center
Janice Kalanihuia, Molokai General Hospital
1Tripler Army Medical Center, the Hawaii State Hospital, and the public hospital system of Hawaii Health

Systems Corporation (HHSC) are not subject to the IRS CHNA requirement and were not a part of thisinitiative.
3

Lori Karan, MD; State Department of Public Safety
Darren Kasai, Kula and Lanai Hospitals
Nicole Kerr, Castle Medical CenterPeter Klune, Hawaii Health Systems Corporation, Kauai Region
Tammy Kohrer, Wahiawa General Hospital
Jay Kreuzer, Kona Community Hospital
Tony Krieg, Hale Makua
Eva LaBarge, Wilcox Memorial Hospital
Greg LaGoy, Hospice Maui, Inc.
Leonard Licina, Sutter Health Kahi Mohala Behavioral Health
Wesley Lo, Hawaii Health Systems Corporation, Maui Region
Lorraine Lunow-Luke, Hawai‘i Pacific Health
Sherry Menor-McNamara, Chamber of Commerce of Hawaii
Lori Miller, Kauai Hospice
Pat Miyasawa, Shriners Hospitals for Children – Honolulu
Ramona Mullahey, U.S. Department of Housing and Urban Development
Jeffrey Nye, Castle Medical Center
Quin Ogawa, Kuakini Medical Center
Don Olden, Wahiawa General Hospital
Ginny Pressler, MD, State Department of Health
Sue Radcliffe, State Department of Health, State Health Planning and Development
AgencyMichael Robinson, Hawai‘i Pacific Health
Linda Rosen, MD, Hawaii Health Systems Corporation
Nadine Smith, Ohana Pacific Management Company
Corinne Suzuka, CareResource Hawaii
Brandon Tomita, Rehabilitation Hospital of the PacificSharlene Tsuda, The Queen’s Medical Centers
Stephany Vaioleti, Kahuku Medical Center
Laura Varney, Hospice of Kona
Cristina Vocalan, Hawaii Primary Care Association
John White, Shriners Hospitals for Children – Honolulu
Rachael Wong, State of Hawaii Department of Human Services
Betty J. Wood, State Department of Health
Barbara Yamashita, City and County of Honolulu, Department of Community Services
Ken Zeri, Hospice Hawaii

1.5 Consultants
1.5.1 Healthy Communities Institute
Based in Berkeley, California, Healthy Communities Institute was retained by HAH as
consultants to conduct foundational community health needs assessments for HAH’s member
hospitals in 2013 and again in 2015. Healthy Communities Institute, now known as Xerox
Community Health Solutions, developed the community health needs assessments for HAH
member hospitals first in 2013, to support hospitals in meeting the first cycle of IRS 990 CHNA
reports, and again in 2015 to support the second CHNA cycle. Hawai‘i Pacific Health and its Pali
Momi Medical Center requested a custom CHNA report that comprehensively addresses the4specific health needs of West O‘ahu residents; the Institute analyzed a unique dataset to identify
needs among this population.
The organization provides customizable, web-based information systems that offer a full rangeof tools and content to improve community health, and developed
www.HawaiiHealthMatters.org in partnership with the Hawaii Department of Health. The
organization is composed of public health professionals and health IT experts committed tomeeting clients’ health improvement goals.
To learn more about Healthy Communities Institute please visit
www.HealthyCommunitiesInstitute.com.
Report authors from Healthy Communities Institute:
Muniba Ahmad
Jenny Belforte, MPH
Florence Reinisch, MPH
Jennifer M. Thompson, MPH
Rebecca Yae
Diana Zheng, MPH

1.5.2 Storyline Consulting
Dedicated to serving and enhancing Hawai‘i’s nonprofit and public sectors, Storyline Consulting
assisted with collecting community input in the form of key informant interviews. Storyline isbased in Hawai‘i and provides planning, research, evaluation, grant writing, and otherorganizational development support and guidance. By gathering and presenting data andtestimonies in a clear and effective way, Storyline helps organizations to improve decisionmaking, illustrate impact, and increase resources.
To learn more about Storyline Consulting please visit www.StorylineConsulting.com.
Key informant interviewers from Storyline Consulting:
Lily Bloom Domingo, MS
Kilikina Mahi, MBA

52 Selected Priority Areas
In January 2016, Pali Momi Medical Center’s Community Benefit team came together toprioritize the significant community health needs of West O‘ahu considering several criteria:






Alignment with CHNA
Opportunity for partnership
Availability of existing resources or programs
Opportunities to address disparities or race/ethnic sub-groups
Community input

The following two topics were selected as the top priorities:Access to Health Services
Diabetes

A plan for addressing these priority areas will be further described in Pali Momi’s 2016
Implementation Strategy report.

6

3 Evaluation of Progress since Prior CHNA
3.1 Impact since Prior CHNA
Over the past three years, Pali Momi Medical Center conducted the following programs toaddress the two priority community health needs identified in the hospital’s 2013 Community
Health Needs Assessment: Heart Disease and Stroke and Exercise, Nutrition and Weight. In
addition, Pali Momi worked to improve Access to Health Services for low-income,disadvantaged, minority and medically underserved residents.

Priority 1: Heart Disease and Stroke
Strategy 1.1: Increase education about and screenings for heart disease and strokerisk factors.
Free Screenings: Pali Momi partnered with Pearlridge Center (the community’s largest
shopping mall) to provide free bi-monthly blood pressure and diabetes screenings.
Individuals at risk for disease were provided with educational materials andrecommendations for follow-up. More than 4,500 screenings were conducted over the
past three years.
At the annual American Heart Association Heart Walk, Pali Momi nurses and clinicalpersonnel conducted a total of 1,004 screenings, providing participants with theirscreening results, educational materials and a list of cardiologists. A Pali Momi
cardiologist also offered free consultations on-site during the event through the “Ask aDoc” service. Pali Momi also conducted free screenings annually at the Pali Momi
Health Fair and the Mililani Town Association Get Fit Fair.



Heart Disease and Stroke Education Forums:o Valentine in Paradise: This free annual community health forum educates the
public about heart disease prevention and treatment. Held at a centrally-locateddowntown Honolulu venue, it was also made available to residents of Central andWest O‘ahu via video-conference at Pali Momi Medical Center. Over the past
three years, 2,500 individuals attended Valentine in Paradise with an additional
250 attending at the Pali Momi site. The forum was presented in collaboration
with Straub Clinic & Hospital, Kapi‘olani Medical Center for Women & Children
and Wilcox Memorial Hospital.
o Be Heart Smart: Pali Momi presented a four-part speaker series in February
2015 and 2016 to promote heart health and a heart healthy lifestyle. Speakers
included Pali Momi physicians and registered dieticians. Free health screenings
and cooking demonstrations were provided to the 440 people who attended.
o Neurology Series: This special speaker series presented in June 2015 provided
education about a variety of neurological topics including migraines, tension
headaches and neuralgia, warning signs of a stroke, and understanding
dementia. Speakers included Pali Momi neurologists and registered dieticians.
7oFree health screenings and cooking demonstrations were provided to the 297
attendees.
Pali Momi Medical Center Health Fair: This annual day-long health fair provided
education on chronic disease prevention, health and wellness, and screenings
for heart disease and stroke risk, and follow-up recommendations to more than
2,500 attendees each year. Partners included the American Heart Association,
the American Cancer Society and the American Diabetes Association.

Strategy 1.2: Increase community capacity to provide emergency response to
cardiac events.


CPR Training: According to the American Red Cross, essential first links in the “Chainof Survival” for victims of cardiac arrest are: recognition of cardiac arrest and activationof the emergency response system, early cardiopulmonary resuscitation (CPR) and
rapid defibrillation. As part of its strategy to decrease deaths from heart attack andstroke, Pali Momi worked to increase the number of individuals trained in CPR and theavailability of AEDs in the community.
Pali Momi’s health care team conducted Hands-Only CPR training for 400 students at‘Aiea High School. The program was created and conducted in partnership with the
Hawai‘i State Department of Education, ‘Aiea High School, the Hawaii Heart Foundationand local firefighters and emergency responders.
Pali Momi also provided funding and other support for students at Kalani High School toconduct their own CPR training for their community. In addition, Pali Momi offered CPR
training at a series of Hawai‘i State Department of Education Fitness Meets held forstudents at schools in Central, Leeward and Windward O‘ahu. Over the past three
years, 1,150 students throughout the community were trained in Hands-Only CPR.

AED Donations: Pali Momi purchased and donated automated external defibrillators(AEDs) to make this life-saving device more available in public locations in thecommunity.

Priority 2: Exercise, Nutrition and Weight
Strategy 2.1: Promote increased physical activity.
“Steps to Health” Walking Path: Pali Momi and Pearlridge Center collaborated tocreate an indoor walking path that winds through Pearlridge Center’s Uptown Mall. Signs
guide walkers along a one-third of a mile or half-mile route. The path is promoted toresidents as a free, safe and convenient air-conditioned location to exercise. Evidenceshows that having access to safe, free places for physical activity in a community
increases regular exercise for residents.
On an intercept survey conducted in March 2016, 25 percent of shoppers said they were
aware of the “Steps to Health” walking path. After hearing a description, 65 percent of
all respondents said they were likely to participate in the future, with 30 percent saying
8they were very likely to participate. This indicates usage could be increased further byincreasing awareness of the path in partnership with Pearlridge Center.

Strategy 2.2: Implement programs to reduce obesity.


NEW Keiki: The N.E.W. (Nutrition Exercise Weight) Keiki child and adolescent weight
management program was created by the YMCA of Honolulu and Kapi‘olani Medical
Center for Women & Children. Pali Momi partnered to bring the program to O‘ahu’s
Leeward side.
N.E.W. Keiki is a nine-week, intensive, family-based intervention to combat childhood
obesity. Based on best practices identified by the U.S. Preventive Services Task Force,the program is Hawai‘i’s only family-based multi-disciplinary intervention working with thechild and family unit to develop a healthy lifestyle for the whole family. The program is
supported by a multi-disciplinary team composed of a pediatrician, registered dieticians,
fitness trainers, a physical therapist, a behavioral health specialist, chef and programfacilitator. The curriculum includes education on proper nutrition, cooking classes for thewhole family, an exercise program that includes hikes and other outings, mental healthinterventions, family support, healthy home environments, and community building. In
addition to formal follow-ups during the year following completion, regular activities areplanned throughout the year and are open to all previous and current program
participants to support continued progress.
Twelve cohorts were conducted over the past three years, enrolling 78 families, totaling
262 participants (85 enrolled youth, and 177 family members). Two of the cohorts were
held in Leeward O‘ahu with the support of Pali Momi. Among the children enrolled, 71
percent were of Native Hawaiian, Pacific Islander or Filipino ancestry, which are
population groups that have disproportionately high rates of obesity and are medicallyunderserved. Completion of the nine-week intensive phase of the program was 87
percent, surpassing national data for multi-disciplinary pediatrics programs where
retention rates are usually below 70 percent.
Upon completion of the nine-week intensive phase of the program, 75 percent ofenrolled youth maintained or lost weight, 80 percent decreased their BMI, and 100
percent reported initiating lifestyle changes. The adults who participated with theirchildren also experienced a decrease in their overall BMI scores. BMI rates continued
to decrease for those participants who returned for follow-up visits at six and twelve
months after program completion.

Wellness Challenge at Pearlridge: Pali Momi partnered with Pearlridge Center andPowerhouse Gym to sponsor free weight loss classes. The 12-week program included
education on proper nutrition, exercise and weight management strategies. As part ofthe program, Pali Momi’s dietician conducted food demonstrations, shared healthy
recipes and provided other information to help participants make healthier eating
choices. A total of 559 individuals participated.

9Strategy 2.3: Provide community health education about disease prevention
and healthy lifestyles.
Pali Momi Wellness Station at Pearlridge Center: Pali Momi Medical Center installeda technology bar at Pearlridge Center Uptown that promotes health and wellness topics
using multimedia displays and interactive technology. A different health topic is featured
each quarter highlighting issues such as stroke care, heart health, women’s health,nutrition, first aid and emergency tips. Materials and displays are regularly refreshed,providing the community with pertinent health education on a continual basis. The
station is also the starting point for the “Steps to Health” walking path, a measured patharound the shopping center designed to encourage people to exercise (discussed
above).
Thanks to its location, the Pali Momi Wellness Station has a constant flow of traffic
seven days a week. An intercept survey was conducted by a professional research firmin March 2016 to evaluate the effectiveness of the station. About 42 percent of shoppers
have stopped at the Wellness Station or looked at materials there, and 87 percent foundthe station to be either very helpful or somewhat helpful in providing information on wellbeing. While many shoppers found the station and informational tools to be helpful, more
can be done to improve wellness information and reach. Opportunities include working
with Pearlridge Center to increase awareness of the Wellness Station and encourage
shoppers to visit it, providing health-related classes and experts onsite on regular daysof the week, tailoring wellness information to segments that found the station information
least helpful, and resolving technical difficulties with the tablet computers to make themmore useful.



School Fitness Meets: Pali Momi provided education about healthy living at six Fitness
Meets attended by fifth graders at public schools in Central, Leeward, and WindwardO‘ahu. The objectives of the event were to promote health and wellness among
students, align fitness and performance goals to national standards, and increase
student participation in fitness activities. A total of 4,200 students participated in 2016.



Kids Fest: This annual health fair for children and families is a collaboration of Hawai‘i
Pacific Health’s four hospitals – Pali Momi Medical Center, Straub Clinic & Hospital,
Kapi‘olani Medical Center for Women & Children and Wilcox Memorial Hospital. Handson activities, such as a Teddy Bear Clinic, Keiki Zumba, Balloon Olympics, Wheel of
Nutrition and Fire Safety House, aim to teach attendees about healthy lifestyles,
wellness, nutrition and injury prevention. More than 6,000 children and adults attend
each year.



Health Fairs: Pali Momi provided health education about optimum exercise, nutrition,
chronic disease prevention and healthy living at a variety of community health fairs,
including Mililani Town Get Fit Fair, Kamaile Academy, American Heart Association
Heart Walk, and Pride for Ewa, in addition to the above described Pali Momi Health Fair.

10Community Health Education Forums: Pali Momi partnered with the other Hawai‘i
Pacific Health hospitals – Straub Clinic & Hospital, Kapi‘olani Medical Center for Women& Children and Wilcox Memorial Hospital – to conduct a series of free community healthforums. Each event addressed a health topic identified as an important community
health need: women’s health, cancer care, arthritis and heart health. The conferenceswere held at a centrally located Honolulu venue. Pali Momi brought the conferences toresidents of Central and West O‘ahu by hosting a video teleconference of each event at
the hospital’s campus.

Priority 3: Access to Health Services
Strategy 3.1: Increase access to medical care for low-income, disadvantaged,
minority, and medically underserved residents.
Physician Recruitment: In 2015, the Hawai‘i Physician Workforce Assessment Project
calculated a 20 percent shortage of physicians statewide. This shortage is especiallyacute in rural areas such as Central and West O‘ahu, where Pali Momi is located. To
improve access to quality specialty care for residents of its service area, Pali Momi
actively recruited physicians for specialties where O‘ahu has shortages. Over the past
three years, Pali Momi successfully attracted nine physicians with specialties in
cardiology, urology, general surgery, family practice, palliative care, bariatrics, andoncology to serve its community.



Health Professionals Education: Pali Momi provided clinical training and continuing
education for physicians, nursing students and allied health professionals to increase thecapacity of the local health care workforce and improve the availability of and access toquality specialty medical care in West O‘ahu. Over the past three years, Pali Momi
provided residencies and training for 372 medical students and residents, 324 nursing
students, and 262 allied health professionals in such fields as ultrasound, surgical
technology, pharmacy, radiology, medical laboratory services, and respiratory
technology.

Continuing Medical Education for Physicians: Pali Momi offered 28 continuing
medical education presentations annually, open to all physicians in the community, on
pertinent medical topics to help keep them apprised of the latest developments in healthcare. Each session was attended by 50-60 physicians.



Wahiawa Center for Community Health: Pali Momi contributed $20,000 to support
development of the Wahiawa Center for Community Health (WCCH), a proposed newFederally Qualified Health Center (FQHC) in Wahiawa, one of the most economicallydisadvantaged areas of O‘ahu, and a federally-designated Medically Underserved
Population area. Federally Qualified Health Centers are important community-based
safety net providers that offer comprehensive primary care services on a sliding fee
scale. Establishment of an FQHC will make primary care, oral health, and mental health11

services more accessible to low-income, under- and uninsured residents of this rural,
medically underserved community.
Pali Momi’s support enabled WCCH to complete its financial feasibility assessment, anecessary step for the clinic to receive federal funding and designation. WCCH will begin
offering limited services June 1, 2016, to 6,000 patients in Wahiawa. It is on track to
expand to offer a full range of services to 12,000 to 14,000 patients over the next three
years. Pali Momi will continue its support for the center by partnering to provide inpatient and specialty care for WCCH patients.

3.2 Community Feedback on Prior CHNA or Implementation
Strategy
Pali Momi Medical Center did not receive any written feedback from the community regarding its
2013 CHNA and Implementation Strategy.

12

4 Methods
Two types of data were analyzed for this Community Health Needs Assessment: quantitative
data (indicators) and qualitative data (interviews). Each type of data was analyzed using aunique methodology, and findings were organized by health or quality of life topic areas. Thesefindings were then synthesized for a comprehensive overview of the health needs for the Pali
Momi service area of West O‘ahu.

4.1 Quantitative Data Sources and Analysis
All quantitative data used for this needs assessment are secondary data, or data that havepreviously been collected. The Hawaii Department of Health supplied 67 indicators of health in
the Pali Momi service area of West O‘ahu, which includes the Census County Divisions (CCDs)
of ʻEwa, Wahiawa, Waialua, and Waiʻanae. Together, these CCDs encompass the following ZIP
Code Tabulation Areas (ZCTAs):





96701
96706
96707
96712











96759
96782
96786
96789

96791
96792
96797
96818




96857
96860

In addition, 16 indicators from the American Community Survey were calculated for the WestO‘ahu service area. In total, 83 indicators specific to the Pali Momi service area were included in
the quantitative data scoring.

Secondary Data Score

Each of these indicators
received a secondary datascore; the indicator scores werethen averaged for broader health
topics to generate topic areascores. The scores range from 0
to 3, with 0 meaning the best
possible score and 3 the worst
possible score, and summarize
how health in West O‘ahu
compares to the state, the U.S.
overall, Healthy People 2020
targets, and between the twomost recent time periods ofmeasure. Please see Appendix
A for further details on thequantitative data scoring
methodology.

Figure 4.1 Secondary Data Methods

Hawaii State
US Value
HP 2020
Trend

Indicator Score

Score range:
Good

0

Bad

1

2

3

Topic Score

13Throughout the report, data for Honolulu County are presented when data specific to WestO‘ahu were unavailable. However, these data were not incorporated in the secondary data
scoring, and are clearly labeled as county-level observations when presented in the discussionof findings. The source for the county-level secondary data is Hawaii Health Matters,2 a publicly
available data platform that is maintained by the Hawaii Department of Health, the Hawaii
Health Data Warehouse, and Healthy Communities Institute. As of March 31, 2015, there were
336 indicators related to the health of Honolulu County on the Hawaii Health Matters dashboard.
For each indicator, the online platform includes several ways (or comparisons) by which toassess Honolulu County’s status, including comparing to other Hawai‘i counties, all U.S.
counties, the Hawai‘i state value, the U.S. value, the trend over time, and Healthy People 2020
targets. Findings for Honolulu County are summarized here to provide context for the WestO‘ahu region.

4.1.1 Race/Ethnicity Disparities
Indicator data were included for race/ethnicity groups when available from the source. The
race/ethnicity groups used in this report are defined by the data sources, which may differ intheir approaches. For example, some sources present data for the Native Hawaiian groupalone, while other sources include this group in the larger Native Hawaiian or Other PacificIslander population. Additionally, some race/ethnicity data may be based on small sample sizes
due to relatively small populations within Hawai‘i.
The health needs disparity by race/ethnicity was quantified by calculating the Index of Disparity3
for all indicators with at least two race/ethnic-specific values available. This index represents astandardized measure of how different each subpopulation value is compared to the overall
population value. Indicators for which there is a higher Index of Disparity value are those where
there is evidence of a large health disparity.

4.1.2 Preventable Hospitalization Rates
Indicators of preventable hospitalization rates were provided by Hawaii Health Information
Corporation (HHIC). These Prevention Quality Indicators (PQIs)4 were defined by the Agency
for Healthcare Research and Quality (AHRQ) to assess the quality of outpatient care.
Unadjusted rates of admission due to any mental health condition are also presented as an
assessment of the relative utilization of services among subpopulations due to mental healthconditions.
Sub-county hospitalization rates are presented for Hospital Service Areas (HSA), which were
defined in 1995 by hospital CEOs and are composed of contiguous zip codes surrounding ahospital’s self-defined service area. Hospitalization rate area maps were created by HCI using
HHIC-provided Hospital Service Area maps, where darker shading of Hospital Service Areas
reflects higher rates.

2 http://www.hawaiihealthmatters.org
3 Pearcy JN, Keppel KG. A summary measure of health disparity. Public Health Reports.

2002;117(3):273-280.
4 For more about PQIs, see http://qualityindicators.ahrq.gov/Modules/pqi_resources.aspx
144.1.3 Shortage Area Maps
Access to care findings are supplemented with maps illustrating the following types of federallydesignated shortage areas and medically underserved populations5:Mental health professional shortage areas and/or populations
Dental health professional shortage areas and/or populations

4.1.4 External Data Reports
Finally, several health topic areas were supplemented with quantitative data collected frompreviously published reports. This additional content was not incorporated in secondary data
scoring due to the limited number of comparisons possible, but is included in the narrative of
this report for context.

4.2 Qualitative Data Collection and Analysis
The qualitative data used in this assessment consists of key informant interviews collected by
Storyline Consulting. Key informants are individuals recognized for their knowledge ofcommunity health in one or more health areas. Initially, one key informant with specificknowledge of the West O‘ahu service area was nominated and selected by the HAH Advisory
Committee in September 2014. Nine additional key informants were nominated by Hawai‘i
Pacific Health and interviewed in August and September 2015 for their knowledge of the WestO‘ahu community’s health needs, barriers, strengths, and opportunities (including the needs forvulnerable and underserved populations as required by IRS regulations). In many cases, thevulnerable populations are defined by race/ethnic groups, and this assessment will place a
special emphasis on these findings. Interview topics were not restricted to the health area forwhich a key informant was nominated.
West Oahu Key Informants from:
Filipino Community Center
Hawaii House of Representatives
Institute for Human Services
Pali Momi Medical Center

Sutter Pacific Health dba Kahi Mohala
The Wahiawa Center for Community Health
University Women's Health Specialists
Waianae Coast Comprehensive Health Center

Excerpts from the interview transcripts were coded by relevant topic areas and other key terms
using the qualitative analytic tool Dedoose.6 The frequency with which a topic area wasdiscussed in key informant interviews was one factor used to assess the relative urgency of that
topic area’s health and social needs.
Throughout the report, key informant testimony on Honolulu County’s needs is presented whendata specific to West O‘ahu are unavailable. However, these data were not incorporated in the
5 Criteria for medically underserved areas and populations can be found at: http://www.hrsa.gov/shortage/

Data included in this report were accessed June 9, 2015
6
Dedoose Version 6.0.24, web application for managing, analyzing, and presenting qualitative and mixed
method research data (2015). Los Angeles, CA: SocioCultural Research Consultants, LLC(www.dedoose.com).
15

primary data analysis of West O‘ahu’s major needs, as summarized in the word cloud and Venn
diagram in Section 6. Within each findings section, county-level observations are labeled assuch and kept separate from observations shared by informants nominated for their specificknowledge of West O‘ahu. These observations are sourced from interviews with 16 key
informants who were nominated by the HAH Advisory Committee, and represented the following
organizations:
Honolulu County Key Informants from:
Aloha United Way

Honolulu City & County,
Emergency Medical Services
Department

Sutter Pacific Health dba Kahi
MohalaAlohaCare

I.H.S.

Waianae Coast Comprehensive
Health Center

CareResource Hawaii

Hawaii State Department of
HealthHelping Hands Hawaii
Hilopaʻa Family to Family Health
Information Center

John A. Burns School of
Medicine, Hawaii Initiative forChildhood Obesity Research and
Education
John A. Burns School of
Medicine, University of Hawaiʻi at
Mānoa
Mental Health America Hawaii

Waikiki Health

Waimanalo Health Center

State Senate

Please see Appendix A for a list of interview questions.

4.3 Prioritization
On January 25, 2016, HCI presented the CHNA findings for Pali Momi Medical Center’s service
area. After the findings were reviewed, the prioritization session focused on those topics thatwere mentioned most from the community input (qualitative data) as well as those topics that
had the highest scores from the secondary data analysis (quantitative data). These topics listed
here are found in the overlapping section of the Venn diagram presented in Figure 6.2:






Access to Health Services
Diabetes
Maternal, Fetal & Infant HealthRespiratory Diseases
Teen & Adolescent Health

Following the review of CHNA findings, HCI facilitated a prioritization ranking process whereby
the Community Benefit team narrowed down these five topic areas of need from the CHNA
report to two priorities. These two priorities will be the focus for Pali Momi’s implementation
strategy planning.
HPH established uniform, systemwide prioritization criteria and methods that Pali Momi
followed.

16

HPH Prioritization Criteria:






Alignment with CHNA
Opportunity for partnership
Availability of existing resources or programs
Opportunities to address disparities or race/ethnic sub-groups
Community input

The Prioritization Matrix method was used to select the priority topic areas for the
Implementation Strategy. For each of the prioritization criteria listed above, the top five topic
areas were scored using a scale of 1-3, and scores were totaled to establish ranks for each of
the five topic areas. These ranking results were tabulated across the Community Benefit Teamparticipants to establish the top two Pali Momi Medical Center priorities.
After reviewing the scoring and ranking, the top two topic areas selected as priorities were:Access to Health Services
Diabetes

4.4 Data Considerations
Several limitations of the data should be considered when reviewing the findings presented inthis report. Although the topics by which data are organized cover a wide range of health andhealth-related areas, within each topic there is a varying scope and depth of quantitative data
indicators and qualitative findings. In some topics there is a robust set of quantitative data
indicators, but in others there may be a limited number of indicators for which data are collected,
or limited subpopulations covered by the indicators. The breadth of qualitative data findings isdependent on who was nominated and selected to be a key informant, as well as the availabilityof selected key informants to be interviewed during the time period of qualitative data collection.
Since the interviews were conducted, some policies may have changed and new programs may
have been implemented. The Index of Disparity is also limited by data availability: for someindicators, there is no subpopulation data, and for others, there are only values for a selectnumber of race/ethnic groups. For both quantitative and qualitative data, efforts were made toinclude as wide a range of secondary data indicators and key informant expertise areas as
possible.
There are also limitations for particular measures and topics that should be acknowledged.
Measures of income and poverty, sourced from the U.S. Census American Community Survey,
do not account for the higher cost of living in Hawai‘i and may underestimate the proportion ofresidents who are struggling financially. Additionally, many of the quantitative indicators
included in the findings are collected by survey, and though methods are used to best represent
the population at large, these measures are subject to instability—especially among smaller
populations.
Finally, a relatively few number of indicators are available for the West O‘ahu service area
specifically, when compared to the number of health and quality of life measures available for
Honolulu County. Some topic areas, such as Oral Health, lack data at the sub-county level
entirely. When this occurs, county-level data is discussed to provide context.

17

5 Demographics
The demographics of a community significantly impact its health profile. Different race/ethnic,
age, and socioeconomic groups may have unique needs and require varied approaches tohealth improvement efforts. All estimates are sourced from the U.S. Census Bureau’s American
Community Survey unless otherwise indicated.

5.1 Population
In 2009-2013, West O‘ahu had a population of 476,408, nearly half of the total population in
Honolulu County during that time (964,678).

5.1.1 Age
West O‘ahu’s population is younger than the rest of the county and state. As shown in Figure5.1, children under 18 made up 25.5 percent of the region’s population (compared to 21.9
percent in Honolulu County and 22.2 percent in Hawai‘i) and adults over 65 made up 11.8
percent of the population (compared to 14.9 percent in the county and 14.8 percent in the state).
Figure 5.1 Population by Age, 2009-2013

5.1.2 Racial/Ethnic Diversity
At 17.5 percent, the foreign-born population in West O‘ahu as of 2009-2013 was smaller than in
Honolulu County (19.6 percent) and Hawai‘i overall (17.9 percent). However, it was still much18

higher than the national average of 12.9 percent. Over a quarter (26.1 percent) of West O‘ahu
residents spoke a language other than English at home, comparable to the county (27.8
percent) and the state (25.4 percent), and again higher than the U.S. as a whole (20.7 percent).
Figure 5.2: Population by Race/Ethnicity, 2009-2013

The race/ethnicity breakdown of West O‘ahu is generally comparable to the rest of the county
and state, with a few notable exceptions. In Figure 5.2, racial identity is displayed to the left ofthe line, while Hispanic/Latino ethnicity (of any race) is shown to the right. Residents reportingas White only in 2009-2013 made up just a fifth of the West O‘ahu population, compared to aquarter of the state overall. The Black/African American, multiracial, and Hispanic populations
are relatively larger in West O‘ahu than both Honolulu County and Hawai‘i overall.
A closer examination of the multiracial population shows that the majority (59.8 percent) of WestO‘ahu residents identified as any part Asian, while 37.2 percent were any part White, and 26.2
percent were any part Native Hawaiian or Pacific Islander.

19

Figure 5.3: Population by One or Multiple Races, 2009-2013

The largest single race group in Hawai‘i is Asian, of which the majority comprises Filipino (19.6
percent) and Japanese (12.2 percent) populations (Figure 5.4).
Figure 5.4: Population by Race: Breakdown of Asian Population, 2009-201320

Among the Native Hawaiian and Other Pacific Islander group, the majority identify as Native
Hawaiian (Figure 5.5).

Figure 5.5: Population by Race: Breakdown of Native Hawaiian and Other Pacific Islander
Population, 2013

5.2 Social and Economic Determinants of Health5.2.1 Income
The 2008-2012 median household income in West O‘ahu ($77,045) was relatively highcompared to the county ($72,292) and the state ($67,492). However, per capita income was just$27,652 in West O‘ahu in 2009-2013, lower than Honolulu County ($30,361), Hawai‘i ($29,305),
and the U.S. ($28,155). Larger household sizes account for this juxtaposition. While the average
household has 3.0 members in Hawai‘i and Honolulu County, the average West O‘ahu
household has over 3.3 members.

5.2.2 Poverty
Certain race/ethnic groups are more affected by poverty, as seen in Figure 5.6. 9 percent ofWest O‘ahu’s population lived below poverty level in 2009-2013, which was lower than the
county (9.8 percent), state (11.2 percent) and national averages (15.4 percent). It is important tonote, however, that federal definitions of poverty are not geographically adjusted, so the data
may not adequately reflect the proportion of residents across the state of Hawai‘i who struggle
to provide for themselves due to the high cost of living in the state. For instance, the 201321

median gross monthly rent was $905 in the U.S. but $1,414 in Hawai‘i. Key informants also
highlighted the high cost of living in West O‘ahu specifically.
Figure 5.6: Persons Below Poverty Level by Race/Ethnicity, 2009-2013

Note: Populations making up <1 percent of the total population are not included in this graph5.2.3 Education
In 2009-2013, 90.4 percent of West O‘ahu residents ages 25 and older had at least a highschool degree, which was comparable to Honolulu County (90.3 percent) and Hawai‘i (90.4
percent). However, rates of completing higher education were lower: only 25.9 percent of WestO‘ahu residents ages 25 and older had at least a bachelor’s degree, compared to 32.1 percent
in the county and 30.1 percent in the state.

5.2.4 SocioNeeds Index®
Healthy Communities Institute developed the SocioNeeds Index® to easily compare multiplesocioeconomic factors across geographies. This index incorporates estimates for six different
social and economic determinants of health that are associated with health outcomes. The data,
which cover income, poverty, unemployment, occupation, educational attainment, and linguistic
barriers, are then standardized and averaged to create one composite index value for every zip
code in the United States with a population of at least 300. Zip codes have index values ranging
from 0 to 100, where zip codes with higher values are estimated to have the highest
socioeconomic need and are correlated with poor health outcomes, including preventable
hospitalizations and premature death. Within Honolulu County, zip codes are ranked based on
their index value to identify the relative level of need within the county.

22Within the West O‘ahu service area, the zip codes of 96792, 96857 and 96786 experience thehighest levels of socioeconomic need, as seen in Figure 5.7. These areas are more likely toexperience poor health outcomes.

Figure 5.7: 2015 SocioNeeds Index® for Honolulu County

23

6 Findings
Together, qualitative and quantitative data provided a breadth of information on the healthneeds of West O‘ahu residents. Figure 6.1 shows where there is strong evidence of need inqualitative data (in the upper half or the graph); in quantitative data (towards the right side of thegraph); or in both qualitative and quantitative data (in the upper right quadrant).
Figure 6.1: Strength of Evidence of Need24

Figure 6.2: Topic Areas Demonstrating Strong Evidence of Need

Strong Evidence of Needin Qualitative Data

Children’s Health
Exercise, Nutrition, &WeightMental Health & Mental
DisordersOlder Adults & Aging
Substance Abuse

Strong Evidence of Needin Quantitative Data

Access to HealthServices
Diabetes
Maternal, Fetal &Infant HealthRespiratory
Diseases
Teen & Adolescent
HealthDisabilities
Environmental &Occupational Health
Immunizations &Infectious Diseases
Men’s Health
Other Chronic Diseases

In qualitative data, topic areas demonstrating “strong evidence of need” were those discussed in atleast two key informant interviews. In quantitative data, topic areas with “strong evidence of need” were
those with secondary data scores in the top half of the distribution.

Across both data types, there is distinctly strong evidence of need in the area of Access to
Health Services. Topic areas demonstrating “strong evidence of need” in the qualitative data are# OF
KEY
INFORMANT
INTERVIEWSFOR GEOGRAPHY
thoseCHECK
in the top
halfof thedistributionof topic frequency
in key informant interviews. In thisanalysis, this includes topic areas discussed in at least two key informant interviews. Topic
areas demonstrating “strong evidence of need” in the quantitative data are those with secondary
data scores in the top half of the distribution.
Although key informants gave Mental Health & Mental Disorders a high level of importance, thetopic did not score high in quantitative data, which is likely due to the poor data availability inthis area. Several indicators in the topic Environmental & Occupational Health contributed to ahigh quantitative score – but were not mentioned by key informants, likely due to the specificnature of the health topic.
Each type of data included in the analysis contributes to the findings. Typically, there is either astrong set of secondary data indicators revealing the most dire health needs, or powerful
qualitative data from key informant interviews providing great insight to the health needs of thecommunity. On rare occasion, because quantitative data and qualitative data have theirrespective strengths and weaknesses, there can be both a strong set of secondary data25

indicators and qualitative data from interviews enhancing and corroborating the quantitative
data. Findings are discussed in detail in the report by theme.
Below are tables that list the results of the secondary data scoring, for both Health and Qualityof Life topic areas. Topics with higher scores indicate poor comparisons or greater need.
Table 6.1: Secondary Data Scoring for Health Topic Areas

Health Topic
Environmental & Occupational Health
Men's Health
Other Chronic Diseases
Teen & Adolescent HealthRespiratory Diseases
Disabilities
Diabetes
Access to Health Services
Maternal, Fetal & Infant Health
Immunizations & Infectious Diseases
CancerOlder Adults & Aging
Heart Disease & Stroke
Exercise, Nutrition & Weight
Family Planning
Wellness & Lifestyle
Women's Health
Substance Abuse
Prevention & Safety
Mental Health & Mental Disorders

Secondary
Data Score
2.63
1.94
1.88
1.63
1.60
1.54
1.49
1.32
1.32
1.22
1.17
1.17
1.15
1.07
1.01
0.92
0.91
0.67
0.55
0.32

Table 6.2: Secondary Data Scoring for Quality of Life Topic Areas
Secondary
Data Score
1.42
1.35
1.27
1.13
0.50

Quality of Life Topic
Education
Transportation
EconomySocial Environment
Public Safety

Please see Appendix A for additional details on indicators within these
Health and Quality of Life topic areas.

26

Below is a word cloud, created using the tool Wordle.7 The word cloud illustrates the themesthat were most prominent in the community input. Themes that were mentioned more frequently
are displayed in larger font. Key informants discussed the areas of Access to Health Services,
Mental Health & Mental Disorders, Oral Health, Compacts of Free Association, Children’s
Health and Diabetes most often.
Figure 6.3: Word Cloud of Themes Discussed by Key Informants“People from Micronesian regions” is used throughout this report and intended to be a respectfulreference that includes, but is not limited to, individuals from Micronesian states, MarshallIslands, Palau, Nauru, and other islands in the region. These individuals may have come to
Hawai‘i through a Compact of Free Association agreement and may be provided health carebenefits.

Hospitalization Rates
PQI composite hospitalization rates, which are summary measures of preventable
hospitalization rates (Section 4.1.2), indicate Leeward O‘ahu and Wahiawa as geographic areasof need. In 2011, these two West O‘ahu service areas emerged with the highest total composite
hospitalization rates within Honolulu County.

7 Wordle [online word cloud applet]. (2014). Retrieved from http://www.wordle.net

27

Figure 6.4: PQI Composite Hospitalization Rates

The West O‘ahu service areas also had the highest composite hospitalization rate due tochronic conditions, which include preventable hospitalizations caused by heart failure, COPD or
asthma, diabetes, hypertension and angina. The highest overall rates of preventable
hospitalizations are attributed to COPD or Asthma in Older Adults and Heart Failure, as shown
Table 6.3: Hospitalization Rates due to Preventable Causes, 2011
in Table 6.3.
Preventable Risk-Adjusted Hospitalization Rates
per 100,000 Population in 2011 due to:Heart Failure§
Bacterial Pneumonia†
COPD or Asthma in Older Adults (Ages 40+)§
Low Birth Weight*
Urinary Tract Infection†
Diabetes Long-Term Complication§
Dehydration†
Diabetes Short-Term Complication§
Perforated Appendix**Hypertension§
Rate of Lower-Extremity Amputation§
Angina Without Procedure§
Asthma in Younger Adults (Ages 18-39) §Uncontrolled Diabetes§

Leeward O‘ahu

Wahiawa

454.9
283.9
409.7
6.6
129.4
110.1
71
60.7
24.3
31
32.1
20.8
33.6
9.2

405.3
248.8
339.8
6.4
137.7
83.1
58.7
30
14.4
30.5
-----

*Rate is per 100 live births**Rate is per 100 appendicitis admissions† Included in Acute Conditions Composite Rate
§ Included in Chronic Conditions Composite Rate

Hospitalization data on mental health were available as crude (i.e. not risk-adjusted) rates,making it difficult to compare this cause for hospitalization with the others. In 2011, there were28

346.9 hospitalizations per 100,000 population in Leeward O‘ahu, and 481.6 hospitalizations per
100,000 population in Wahiawa.

Note to the Reader
Readers may choose to study the entire report or alternatively focus on a specific major theme.
Each section reviews the qualitative and quantitative data for each major theme and explores
the key issues and underlying drivers within the theme. Due to the abundance of quantitative
data, only the most pertinent and impactful pieces are discussed in the report. For a complete
list of quantitative data included in the analysis and considered in the report, see Appendix A.

Navigation within the themes
At the beginning of each thematic section, key issues are summarized and opportunities andstrengths of the community are highlighted. The reader can jump to subthemes, whichcorrespond with the topic area categories, and to the discussion of findings for West O‘ahu
specifically, or Honolulu County more generally, as illustrated in .
Figures, tables and extracts from qualitative and quantitative data substantiate findings
throughout. Within each subtheme, special emphasis is also placed on populations that arehighly impacted, such as the low-income population or people with disabilities.
1.1 Major theme
Key issues· Summarized key issues
Opportunities and strengths
Community strengths

Available opportunities

1.1.1 Subtheme
West Oahu

Extract from Key Informant
Interview

Text here discusses key issue A.

Honolulu County
Text here discusses key issue B.
Table 1.1: Quantitative Data
Quantitative data
Data indicator A,
2012
Data indicator B,
2011-2013

Figure 1.1: Chart, Map, or Other
Graphic Representation

Value
12.2%
Kauai

10.0%
Honolulu
Maui
Hawaii29

6.1 Access to Care
Key issues
 Substantial economic barriers to accessing care.
 Limited use of preventive services due to different cultural perspectives on
utilizing care.
 Severe lack of mental health services available for adolescents and adults.
Opportunities and Strengths
Community Health Centers are critical toreaching people.
Need for culturally competent care andtranslation services.

Many residents have health insurance
coverage.
More mental health services are needed forboth adults and adolescents.

6.1.1 Access to Health Services
West O‘ahu
According to key informant testimony, the costs associated with
There is accessible care,
medical care – even with insurance coverage – are continuallybutpeople don’t access. It
increasing and becoming more unaffordable. Health careis generational. If Mom
institutions serving large Medicare and Medicaid populations
and Dad didn’t go, why
particularly struggle within the current system of health carewould you go?
financing. In addition to material obstacles, a key informant forWest O‘ahu emphasized that communities currently treat accessto care as an afterthought, a cultural attitude that persists in the next generation.

The cost of medical
services is continually
increasing and a cost we
have to bear, even though
we have insurance

Quantitative data suggests older adults need better accessto services: a slightly lower proportion of adults 65+ had ausual source of health care in 2013 compared to 2012. In
addition, fewer men over 65 sought preventive services in2013 than in 2012; the proportion failed to meet the Healthy
People 2020 Target and was lower than both the state value
and national value.

Honolulu County
Qualitative and quantitative data indicate the physician shortage as a problem in the county,
which disproportionately affects the indigent population. In addition, too few older adults utilize
preventive services and too few teens receive regular physicals. Although Honolulu County
performs well on indicators of insurance coverage, key informants identified other significant
access and affordability issues, including the high cost of co-pays or prescription refills andinsurance plans not meeting health needs. The insured may also delay seeking care until theirhealth issues worsen. Key informants also identified the need for more culturally competent carefor residents and migrants of diverse backgrounds.

30

Highly impacted populations
Low-income individuals: Access to care disproportionately affects low-income individuals, who
use emergency care for preventive services.
Race/ethnic groups: Within Honolulu County, access to care disproportionately affected
residents of Pacific Islander and Native Hawaiian descent, who had the lowest measures of
insurance coverage and highest reported likelihood of not seeing a doctor due to cost.

6.1.2 Mental HealthWest O‘ahu
Many key informants commented on the lack of mental healthservices for adolescents and adults in the community. As one
elaborated, mental health care lacks parity with other medical
We are now paying
the price for 10
services: there is a need for more providers, public beds foryears
of decreased
inpatient mental health services, preventive services andstate funding of
coordination of care. Adults who are severely mentally ill gain
mental healthaccess to state hospital care too late, after they are already in crisis.
services andAnother key informant believed that mental health would becomerebuilding thosean increasingly serious challenge as a result of budgetary decisions
resourcesin the past. The shift in the configuration of mental health services
in West O‘ahu, with new hospital programs opening and roles inmental health care shifting between institutions within the region, may also
impact access to services in the future. Access to mental health care disproportionately affects
different race/ethnic groups: in particular, some groups are reluctant to seek mental healthservices due to cultural factors, and language barriers only compound the problem.

Honolulu County
Quantitative data identified serious shortages in
Figure 6.5: Mental Health Professional Shortage
mental health infrastructure and providers.
Areas
According to the Health Resources and Services
Administration (HRSA), a portion of the North Shore is
identified as a Mental Health Health Professional
Shortage Area, where there are 30,000 or moreindividuals per psychiatrist.8 The HPSA metric does notaccount for higher need for services among specificpopulations, such as low-income residents, in its
analysis. Key informants also noted a need for
improved coordination integration of mental healthservices with other health care, in addition to
wraparound services to serve the longer-term needs ofthe mentally ill homeless population.
8

Health Resources and Services Administration Data Warehouse. (Accessed June 9, 2015). HPSA Find.
Retrieved from http://datawarehouse.hrsa.gov/tools/analyzers/hpsafind.aspx
31

Highly impacted populations
Children, teens and adolescents: Key informants identified a shortage of child and adolescent
psychiatric behavioral health services. One key informant suggested that better care needs tobe provided to teens following release from the hospital for suicide attempts, as thesevulnerable youth are often sent back to the same situations that contributed to their mental
health stress in the first place.
Homeless population: A key informant identified homelessness as a significant barrier toreceiving mental health services.
Figure 6.6: Dental Health Professional Shortage Areas

6.1.3 Oral Health
Honolulu County
As seen in Figure 6.6, HRSA has
identified the rural population of Honolulu
County as experiencing dental healthprofessional shortages that areexacerbated by economic barriers.9
Qualitative data corroborates this finding,indicating needs for improved oral healthservices in rural communities, increased
state coverage of dental services, andmore providers who accept Medicaid.

Highly impacted populations
Children, teens and adolescents: According to the 2011 Pew Center on the States report onchildren’s dental health, the state of Hawai‘i meets only one out of eight policy benchmarks
aimed at improving children’s oral health, resulting in a score of F (on a scale of A-F) andmaking Hawai‘i one of the worst overall performers across the nation.10
Race/ethnic groups: According to a key informant, residents of Native Hawaiian and PacificIslander descent are not receiving effective oral health interventions like fluoride treatments.
Another key informant noted that dental problems are more severe among new immigrants,
especially Micronesians and Filipinos, which is likely due to a lack of routine dental care being
practiced in their home countries.

9

Health Resources and Services Administration Data Warehouse. (Accessed June 9, 2015). HPSA Find.
Retrieved from http://datawarehouse.hrsa.gov/tools/analyzers/hpsafind.aspx
10
The Pew Center on the States. (2011). The State of Children's Dental Health: Making Coverage Matter.
Retrieved fromhttp://www.pewtrusts.org/~/media/legacy/uploadedfiles/pcs_assets/2011/TheStateofChildrensDentalhealt
hpdf.pdf
32

6.2 Chronic Diseases
Key issues
 Limited access to healthy foods and exercise opportunities.
 Rising chronic disease risk among younger children.
 Heavy burden of diabetes.
 Poor disease management and outcomes among Native Hawaiian and PacificIslander residents.
Opportunities and Strengths
The Department of Parks and Recreation
There is a culture of healthy eating andoffers many free recreational programs andhealthy living in Hawai‘i.
activities for adolescents and adults.
Health care providers are beginning to partner
Need to continue improving access to healthy
with schools to better manage and monitor
foods and exercise equipment.
chronic conditions.

6.2.1 Exercise, Nutrition & WeightWest O‘ahu
Fruit and vegetable consumption is low among adults in West O‘ahu. In 2013, only 15.1 percent
of West O‘ahu adults consumed five or more servings of fruits and vegetables per day, which
was a decrease from 2011 levels and a poor comparison to the state average of 18.1 percent.
Physical activity is also an area for improvement. Across the state, 77.9 percent of adults
participated in physical activity outside of work in 2013, while only 76 percent did in West O‘ahu.
The percentage of West O‘ahu workers who commuted by walking (2.9 percent) in 2009-2013
also falls short of the Healthy People 2020 target (3.1 percent) and the state average (4.7
percent).
Qualitative data indicate obesity is a growing concern for children andadults in the region. Providers reported that obesity and other chronic
diseases are developing in children at an early age. Lack of access tofresh produce and other healthy foods was identified as a major
contributor to the growing obesity epidemic. The fresh, local andorganic produce that is available in the area is not affordable for many
residents. In addition, a key informant observed that consumption ofhealthier traditional foods has declined as consumption of processedand sugary foods has risen.

If we are going topromote healthyeating, we needmore places forpeople topurchase healthyfood

Key informants called for more walking paths and more exercise equipment to be installed inpark and school settings to encourage physical activity. While there are plans in the county for
additional recreational facilities, one expert interviewed lamented that none are in the LeewardO‘ahu area. Many facilities that already exist in the area require membership access. In
addition, the key informant observed that many residents do not have time before or after workfor physical activity.

33

Highly impacted populations
If parents don’t
participate in healthy
activities, the children
won’t either

Children, teens and adolescents: Key informants have observedthat childhood obesity is rising in West O‘ahu. Making school
lunches healthier and providing more physical activity
opportunities in the summertime would be two ways of addressing
this negative trend. One key informant noted the importance ofparents modeling healthy behaviors for their children.

Older adults: A key informant identified a need to integrate more physical activity opportunities
into existing programs for older adults.
Low-income population: The costs ofpurchasing fresh and healthy foods areprohibitive for low-income residents.
Additionally, these residents often cannot
easily access healthy grocery stores intheir neighborhoods.
Race/ethnic groups: As discussed above,
the percentage of workers commuting by
walking is already low in West O‘ahu, but
this healthy method of transportation is
utilized even less among certain
race/ethnic groups.

Honolulu County

Table 6.4: Workers Commuting by Walking by
Race/Ethnicity
Workers Commuting by Walking, 2009-2013
West O‘ahu
2.9%
Am. Indian or Alaskan
Native
16.3%
Asian
1.2%
Black
5.7%
Hispanic or Latino
4.7%
Nat. Hawaiian or Other
Pac. Islander
1.6%
Other
8.4%
Two or more races
1.9%
White, non-Hispanic
6.2%

Many teens in Honolulu County do not meet recommendations for fruit and vegetableconsumption. Few teens and adults consumed five or more servings of fruits and vegetables
daily, and few adults ate more than one serving of vegetables per day. A key informant stressed
the importance of proximity to healthy food choices, and praised farmers markets for theirpositive impact on access to nutritious foods.

Highly impacted populations
Children, teens and adolescents: Most teens and young teens (defined as those in grades 9-12
and grades 6-8, respectively) in the county failed to meet physical activity guidelines. The U.S.
Department of Health and Human Services recommends at least 60 minutes of aerobic physicalactivity every day and muscle strengthening at least three days a week for children andadolescents. In addition, many young teens reported spending more than the maximum twohours of screen time recommended by the American Academy of Pediatrics, an indicatorassociated with low physical activity levels.
Low-income population: A key informant noted the link between poverty and increased risk ofchronic diseases and obesity. Compared to other U.S. counties, Honolulu County has relatively
few stores certified to accept Supplemental Nutrition Assistance Program (SNAP) benefits. At
0.6 stores per 1,000 population in 2012, this put the county at the low end of the distribution in
the state and in the nation. In addition, only 9.8 percent of farmers markets in the county
34

accepted SNAP Electronic Benefit Transfer (EBT) transactions in 2012, roughly a third of thestate average of 27 percent.
Homeless population: Key informants indicated that poor nutrition impedes healing among thehomeless population, and that this group also struggles with obesity due to access barriers tohealthy foods.
Race/ethnic groups: Quantitative data show that obesity prevalence is especially high amongresidents of Pacific Islander or Native Hawaiian descent. Key informants echoed this finding,noting that these groups are more affected by poorer nutrition and obesity because theyexperience higher rates of poverty. A key informant called for increased cultural awareness,such as offering culturally sensitive cooking classes, to effectively change health behaviors.
Another suggested tactic was to focus on nutrition education for children to help behavioral
changes take root in families.

6.2.2 Diabetes
West O‘ahu
Both quantitative and qualitative data indicate that diabetes is a concern in West O‘ahu. 10.8
percent of adults in the area had diabetes in 2013, higher than the state average of 8.4 percent,the national average of 9.7 percent, and the previous West O‘ahu measurement of 10 percent in2012. Along with other chronic conditions, diabetes is increasingly being observed in young
children, and a key informant tied the rising incidence of diabetes to poor access to healthcare
in the region.
A crucial part of managing diabetes is testing, as controlling blood glucose levels helps delay
diabetic complications, such as eye disease, kidney disease and nerve damage. The
glycosylated hemoglobin (HbA1C) test allows health providers to see how well blood glucose
levels were controlled in the previous few months. Rates of testing among diabetic residents ofWest O‘ahu were low in 2013 compared to Healthy People 2020 targets and/or state averages.
Table 6.5: Diabetic Testing
Diabetic Testing, 2013
Diabetics who Test Their Blood Glucose Daily
Diabetics who have a Biannual HbA1c CheckWest O‘ahu
50.8%
66.0%

Hawai‘i
50.7%
67.7%

HP202070.4%
71.1%

In addition, the percentage of West O‘ahu adults with diabetes who had taken a course indiabetes self-management in 2013 fell to 49.3 percent from 52.3 percent in 2012, and failed tomeet the Healthy People 2020 target of 62.5 percent.
In 2011, all hospitalization rates due to complications of diabetes were higher in Leeward O‘ahu
than any other hospital service area in Honolulu County. Wahiawa had the lowest
hospitalization rate due to short-term complications of diabetes and second lowest rate due tolong-term complications of diabetes compared to elsewhere in Honolulu County.

35

Figure 6.7: Hospitalization Rates due to Diabetes, 2011

Highly impacted populations
Children, teens and adolescents: As with other chronic diseases, providers observed a rise in
pre-diabetes in children at an early age.
Race/ethnic groups: Key informants observed a heavy diabetes burden among Native Hawaiian
residents.

36

Honolulu County
Multiple key informants identified the related issues of obesity and diabetes as major healthconcerns in Honolulu County, and one suggested both conditions needed to be addressed in acommunity setting. As of 2012, diabetes prevalence was high among Honolulu County’s
Medicare population relative to other U.S. counties.

Highly impacted populations
Low-income population: Key informants noted that individuals with diabetes face additional
barriers to staying healthy if they are low-income. One expert observed that lower-income
residents are being diagnosed with chronic diseases like diabetes in late, rather than early,
stages, and that these communities are impacted by social and environmental determinants
such as poor housing, low education, high poverty, and streets and sidewalks that are unsafe
for pedestrians.
Race/ethnic groups: Multiple key informants identified Native Hawaiians and Pacific Islanders as
disproportionately impacted by diabetes and other preventable chronic diseases, which is
corroborated by quantitative data. One informant also noted that rates of improvement inchronic disease indicators are lower in this group than in others.

6.2.3 Heart Disease & StrokeWest O‘ahu
High blood pressure is a major modifiable risk factor for heart disease and stroke and isprevalent among West O‘ahu adults. Between 2012 and 2013, the percentage of adults told thatthey have high blood pressure rose from 27.7 percent to 28.8 percent, putting West O‘ahu
further from meeting the Healthy People 2020 target of 26.9 percent.
In 2011, the highest rates of hospitalization due to hypertension and heart failure were in
Leeward O‘ahu and Wahiawa, O‘ahu. Windward O‘ahu had the highest hospitalization rate due
to angina without procedure (Figure 6.8).

37

Figure 6.8: Hospitalization Rates due to Cardiovascular Disease, 2011

Highly impacted populations
Children, teens and adolescents: As with other chronic diseases, cardiovascular risk is risingamong children in West O‘ahu, according to a key informant.
Race/ethnic groups: While death rates due to heart disease and stroke are relatively low forWest O‘ahu as a whole, certain race/ethnic groups are disproportionately impacted by thesecauses of death. Native Hawaiian and Other Pacific Islanders experience the highest death
rates due to these cardiovascular diseases.

38

Table 6.6: Highly Impacted Populations, Cardiovascular Disease
Cardiovascular Disease
Death Rates, 2011-2013*

West
O‘ahu

Stroke Death Rate

24.5

Heart Disease Death Rate

44.1

Highly impacted groups
Native Hawaiian and Other Pacific Islander (71.3)
Black (26.6)
Asian (24.7)
Native Hawaiian and Other Pacific Islander (189.0)
White (49.7)
Black (47.3)*per 100,000 population

Honolulu County
Overall, Honolulu County did not meet 12 of the 16 Healthy People 2020 Goals for Heart
Disease and Stroke, indicating that this is a health area in need of improvement.
Cholesterol prevalence among adults in Honolulu County fail to meet Healthy People 2020
targets, and prevalence of other cardiovascular disease risk factors among the county’s
Medicare population compare unfavorably to the state and the nation. The prevalence of stroke
is slightly higher among Honolulu County’s adult and Medicare populations compared to Hawaii.
Recognizing the early signs and symptoms of a stroke and responding quickly is imperative topreventing disability and death. As of 2009, 42.9 percent of Honolulu County adults could
correctly identify five early symptoms of a stroke, which fails to meet the Healthy People 2020
target of 59.3 percent. Among survivors of stroke in Honolulu County, only 21.9 percent werereferred to any kind of outpatient rehabilitation to help regain lost skills and independence in2013, comparing unfavorably to the national average (30.7 percent).

6.2.4 Other Chronic Diseases
West O‘ahu
Arthritis is a common cause of disability across the U.S. In West O‘ahu, over a third of adults
with arthritis reported in 2013 that the condition affects their ability to work (34.9 percent) or
participate in their usual activities (41.3 percent); these figures compared poorly to the state
overall.

Honolulu County
Highly impacted populations
Older adults: Among Medicare beneficiaries, a large proportion in Honolulu County had beentreated for chronic kidney disease in 2012, compared to Hawai‘i and the U.S. Prevalence ofosteoporosis was also higher in the county than the state and nation. Osteoporosis is a
progressive disease that weakens bones, but further bone loss can be prevented with healthy
diet, exercise, and certain medications.
Race/ethnic groups: A key informant indicated that demand for dialysis units exceeds supplies
in Honolulu County, and that many renal patients on the island are Native Hawaiian or Filipino.
39

6.2.5 Cancer
West O‘ahu
Screening rates for cervical and colon cancers are low among West O‘ahu residents whencompared to Hawai‘i, the U.S., and Healthy People 2020 targets. In 2013, 76.4 percent of
women ages 18 and older had a Pap test (which can detect early signs of cervical cancer)
within the past three years; 64.9 percent of residents ages 50-75 had adhered to recommended
screening procedures for colorectal cancer (blood stool test within the past year, sigmoidoscopy
in the past five years and a blood stool test in the past three years, or a colonoscopy in the past
10 years).
Table 6.7: Cervical and Colon Cancer Screening
Cancer Screening, 2013

West O‘ahu

Hawai‘iU.S.

Pap Test History
Colon Cancer Screening

76.4%
64.9%

79.1%
66.4%

78.0%
65.1%

Healthy
People 2020
93.0%
70.5%

While the percentage of West O‘ahu men ages 40 years and older who had discussed prostatecancer screening with their doctor (19.5 percent) as of 2013 met the Healthy People 2020 targetof 15.9 percent, this proportion had dropped substantially from the prior year (25.3 percent in2012).

Highly impacted populations
Race/ethnic groups: As with many other chronic diseases, West O‘ahu residents of Native
Hawaiian and Other Pacific Islander descent experience higher cancer death rates. In 20112013, the death rate due to colon cancer among this population was more than three times theregional average (32.1 vs. 10.2 deaths per 100,000 population); the breast cancer death rate forthis race/ethnic group was over four times the West O‘ahu average (36.2 vs. 7.8 deaths per
100,000 females).

Honolulu County
As of 2012, five-year cancer survivorship among adults in Honolulu County did not meet the
Healthy People 2020 target (64.5 percent vs. 71.7 percent), and was lower than the state
average of 66.7 percent. A higher percentage of Medicare beneficiaries in the county weretreated for cancer in 2012 than in Hawai‘i overall. Quantitative data indicate that liver and bileduct, breast, colorectal and cervical cancers are concerns for Honolulu County.

Highly impacted populations
Race/ethnic groups: The Native Hawaiian and Pacific Islander group experiences the highest
mortality rates from breast, cervical and prostate cancers. Melanoma indicators show that White
residents in the county are the most impacted race group.

406.3 Environmental Health
Key issues
 Asthma affects both adults and children, and impacts school attendance.
 Housing problems affect many residents across the county.

6.3.1 Environment
Honolulu County
Air quality, which impacts respiratory health, is an area of particular concern in the state of
Hawai‘i due to active volcanoes producing sulfur dioxide. The American Lung Association gave
Honolulu County a B grade for the number of days that exceeded U.S. standards for particle
pollution in 2011-2013. Over a quarter of households in Honolulu County (26.5 percent in 20062010) experienced severe housing problems compared to other U.S. counties. These problems
include overcrowding, high housing costs, lack of kitchen or lack of plumbing facilities.

6.3.2 Respiratory Diseases
West O‘ahu
The prevalence of asthma among West O‘ahu adults (10.9 percent) in 2013 compared poorly toboth the state (9.4 percent) and the nation (9.0 percent), and had increased from 8.6 percent in
the region in 2012. Key informants described the heavy burden of asthma among children inWest O‘ahu and how the condition impacts their school attendance. However, partnerships
between schools and the medical community are being forged to improve the management andmonitoring of health issues such as asthma. In 2011, respiratory disease-related hospitalization
rates were highest in Leeward O‘ahu for both younger and older adults.
Figure 6.9: Hospitalization Rates due to Respiratory Diseases, 201141

Honolulu County
As in West O‘ahu, asthma cuts across multiple segments of the Honolulu County population,from children to adults to the elderly. Chronic obstructive pulmonary disease (COPD),
emphysema and chronic bronchitis are also slightly more prevalent in Honolulu County than therest of the state and nation.

Highly impacted populations
Race/ethnic groups: County residents of Native Hawaiian and Pacific Islander descent areheavily burdened by high death rates due to asthma and COPD.

42

6.4 Mental Health & Health Risk Behaviors
Key Issues
 Lack of psychiatric care and preventive services.
 Injury-related deaths disproportionately impact the Native Hawaiian or Other
Pacific Islander group.
 High rate of preventable hospitalizations due to bacterial pneumonia.
Opportunities and Strengths
Clinicians are more consistently screening for
Increased community training for recognizing
depression and suicide risk in children.
mental health issues in children.
Need autism services and psychiatricprograms for children and adolescents.

6.4.1 Mental Health & Mental Disorders
West O‘ahu
Adolescent and adult residents of West O‘ahu face a lack of mental healthservices, including provider shortages, lack of coordinated care andpreventive services, and insufficient public beds for inpatient mental healthservices, as discussed previously in section 6.1.2. Mental health is a frequentcause for hospitalization: according to data provided by Hawaii Health
Information Corporation, 1,176 hospitalizations were due to mental health inWest O‘ahu in 2011. Table 6.15 shows the percent of total hospital
admissions due to various mental illnesses and disorders in the West O‘ahu
region.

People whoare severely
mentally ill
present
complexproblems

Table 6.8: Hospitalizations due to Mental Health11
Percent of Hospital
Admissions in 20062010 due to:
Schizophrenia
Mood Disorder
Delirium/Dementia
Anxiety DisorderʻEwa

Wahiawa

Waiʻanae

Waialua

HonoluluCountyHawai‘i

1.7%
4.6%
8.5%
2.2%

1.7%
6.2%
5.5%
3.0%

2.8%
5.2%
5.1%
1.9%

1.5%
5.2%
6.5%
2.5%

2.3%
5.7%
9.0%
2.5%

2.3%
6.1%
8.4%
2.6%

Honolulu County
Access to mental health care is also a countywide problem: multiple key informants noted thelack of services, shortage of psychiatrists and insufficient psychiatric beds. Many also noted theneed to screen for depression and provide treatment. Key informant testimony for Honolulu

11

The Hawaii Department of Health. (Accessed August 4, 2015). State of Hawaii Primary Care Needs
Assessment Data Book, 2012. Retrieved fromhttp://health.hawaii.gov/about/files/2013/06/pcna2012databook.pdf
43

County highlighted the need for better population-based mental health data to improveunderstanding of the disease burden.

Highly impacted populations
Children, teens and adolescents: Concerns for teens include eating disorders, cyber-bullying
and suicide. Key informants also identified a need for more mental health resources tailored forchildren and adolescents, such as autism programs, behavioral health programs, and improved
care following release from the ER for suicide attempts. There is also a need to improve carecoordination, social support, and early intervention for families with a child who has complex
medical needs.
Homeless population: Mental illness is a driving factor behind increasing rates of homelessness
in Hawai‘i. This population often utilizes the emergency room for mental health issues that could
be treated through regular, preventive mental health care.
Race/ethnic groups: Residents of Native Hawaiian and Pacific Islander descent had a suicide
death rate nearly three times higher than the overall population in Honolulu County in 2013.
Low-income: According to a key informant, low-income children and their families havecompounded unmet mental health needs. Maternal stress resulting from relationships, finances,and overwhelming responsibilities may adversely affect children’s mental health.

6.4.2 Substance Abuse
West O‘ahu
Many people with mental illness have co-occurring issues with substance abuse. Table 6.16
shows the percent of total hospital admissions due to various mental illnesses and disorders in
the West O‘ahu region.
Table 6.9: Hospitalizations due to Substance Abuse12
Percent of Hospital
Admissions in 20062010 due to:
Substance-relateddisorderʻEwa

Wahiawa

Waiʻanae

Waialua

HonoluluCountyHawai‘i

4.9%

6.7%

9.2%

8.1%

8.0%

8.9%

Highly impacted populations
Race/ethnic groups: 5.6 percent of Pacific Islander adults used smokeless tobacco in 2013,nearly four times the overall rate of West O‘ahu (1.4 percent).

Honolulu County
In 2013, almost one in three Honolulu County public high school students were offered, sold or
given illegal drugs on school property. In 2012, 6 percent of adults in Honolulu County reported
12

The Hawaii Department of Health. (Accessed August 4, 2015). State of Hawaii Primary Care Needs
Assessment Data Book, 2012. Retrieved fromhttp://health.hawaii.gov/about/files/2013/06/pcna2012databook.pdf
44drinking and driving at least once in the past 30 days, compared to 1.8 percent of adults
nationwide. In June 2015, Hawai‘i raised the smoking age to 21, becoming the first U.S. state to
do so.13
Key informants noted the need for improved delineation between mental health and substanceabuse diagnoses and treatments, and case management services for substance abuse alone.
Many individuals with substance abuse problems who are not mentally ill try to obtain mental
illness diagnoses in order to access services otherwise unavailable to them. A key informant
voiced concern that the current reimbursement system may contribute to misdiagnoses.

Highly impacted populations
Race/ethnic groups: Residents of Native Hawaiian and Pacific Islander descent had a druginduced death rate that was nearly three times higher than the overall population in Honolulu
County in 2013 (30.1 vs. 11.0 deaths/100,000 population. According to a key informant, Native
Hawaiian women have a higher smoking rate than women of other racial and ethnic
backgrounds. Quantitative data shows that mothers of Native Hawaiian descent and Other
Pacific Islander descent were most likely to continue smoking during pregnancy in 2013, which
can lead to adverse birth outcomes. Binge drinking among teen girls also disproportionately
affects Native Hawaiians.

6.4.3 Wellness & Lifestyle
Honolulu County
In 2013, only 56.7 percent of adults and 23.6 percent of teens in Honolulu reported sufficient
sleep, defined as 7 or more hours of sleep on average for adults and 8 or more hours on
average for teens. As a result of insufficient sleep, these residents may be at higher risk ofchronic disease, depression and accidents. Many teens in Honolulu County also engaged inexcessive screen time, with 43.5 percent of teens reporting playing video games or using acomputer for more than three hours per day in 2013.

6.4.4 Prevention & Safety
West O‘ahu
Accidental deaths can typically be averted through behavioral change or improved safety
education.

Highly impacted populations
Race/ethnic groups: Although West O‘ahu compares favorably to the state in injury-related
death rates, a close examination of race/ethnic breakout data reveals severe disparities forthese indicators, where the Native Hawaiian or Other Pacific Islander population frequently
experiences the highest rates of injury-related death.

13 Skinner, C. (2015, June 20). Hawaii becomes first U.S. state to raise smoking age to 21. Reuters.

Retrieved from: http://www.reuters.com/article/2015/06/20/us-usa-hawaii-tobaccoidUSKBN0P006V20150620
45

Table 6.10: Highly Impacted Populations, Prevention and Safety
Injury-Related Death Rates,
2011-2013*

West O‘ahu

Highly Impacted Groups
Native Hawaiian or Other Pacific Islander (4.9)
Asian (1.1)
Native Hawaiian or Other Pacific Islander (69.3)
White (23.9)

Drowning Death Rate

1.0

Injury Death Rate

21.0

Motor Vehicle Collision Death
Rate

3.2

Native Hawaiian or Other Pacific Islander (12.1)

Poisoning Death Rate

4.8

Native Hawaiian or Other Pacific Islander (16.0)
White (7.1)

Unintentional Injury Death
Rate

15.0

Native Hawaiian or Other Pacific Islander (48.8)*per 100,000 population

Honolulu County
According to qualitative data, the major challenge is improving public understanding that injuries
are preventable. In 2011, Honolulu County had the highest rate of all counties in Hawai‘i for
hospitalizations due to injuries. The county was far from meeting the Healthy People 2020 target
rate for nonfatal pedestrian injuries in 2007-2011, and the hospitalization rate due to falls among
seniors was high in 2009, at 927 per 100,000 population. Seniors in particular suffer high death
rates due to unintentional injuries, and expanding services for older adults now would keep thegrowing aging population in Honolulu County healthy and well for longer.

Highly impacted populations
Race/ethnic groups: Large disparities are evident for many injury-related indicators. For
example, the Native Hawaiian or Other Pacific Islander group are disproportionately impacted
and experience the highest injury rates compared
Figure 6.10: Hospitalization Rates due toto other subgroups. A key informant noted that
Bacterial Pneumonia, 2011
different approaches are needed to counter some
cultures’ beliefs that injury prevention is not possible.

6.4.5 Immunizations & Infectious Diseases
West O‘ahu
In both Leeward O‘ahu and Wahiawa, hospitalizations
due to bacterial pneumonia were the third most frequentcause of hospitalization in 2011 among the 14
preventable causes studied. These two West O‘ahu
service areas had the highest bacterial pneumonia
hospitalization rates within Honolulu County.

46

A much higher proportion of bacterial pneumonia hospitalizations were among adults 65 andolder in 2009-2011.

Figure 6.11 Percent of Hospitalizations due to Bacterial Pneumonia by Age and Gender,West O‘ahu, 2009-2011

Honolulu County
Influenza and pneumonia vaccination rates among adults ages 65 and older was far below the
Healthy People 2020 targets in 2013. Influenza vaccination rates were also very low among
younger adults.
Table 6.11: Vaccination Rates among Adults
Rates of vaccination, 2013
Influenza
Adults 18-64
Adults 65+
Pneumonia
Adults 65+

HonoluluCountyHealthy People
2020 Target

44.0%
73.0%

80.0%
90.0%

68.4%

90.0%

Out of the four counties in Hawai‘i, Honolulu County had the highest incidence rates forchlamydia, gonorrhea and syphilis. These sexually transmitted infections can be controlled
through the use of condoms.

47

6.5 Women’s, Infant & Reproductive Health
Key Issues
 Poor birth outcomes, including low birth weight.
 High teen birth rates, especially among Native Hawaiian and Other PacificIslanders.
 Low rates of testing for cervical cancer.

6.5.1 Maternal, Fetal, & Infant HealthWest O‘ahu
In 2013, 9.3 percent of babies were born with low birth weight in West O‘ahu, falling short ofmeeting the Healthy People 2020 target of 7.8 percent. The percentage of low birth weightbirths in West O‘ahu was also higher than the state average (8.3 percent) and the national
average (8 percent). Key informant testimony stressed the importance of the mother’s physicaland mental health, from pregnancy through motherhood, to improving outcomes for her
children.
According to 2011 hospitalization data, the highest rates of low birth weight among newborns in
Honolulu County were in Leeward O‘ahu and Wahiawa.
Figure 6.12: Low Birth Weight, 2011

Honolulu County
Honolulu County experienced a high percentage of poor birth outcomes in 2011-2013 (including
very early and early preterm births, very low birth weight and low birth weight births, and infantmortality rates) compared to other Hawai‘i counties, the state, and/or the Healthy People 2020
target. Only 93 percent of pregnant women in Honolulu County abstained from alcohol in their
third trimester in 2011, which was lower than the state percentage and was a negative trend48

over time. In addition, breastfeeding in 2011 was low compared to other Hawai‘i counties andthe state.

Highly impacted populations
Race/ethnic groups: A key informant noted that there are race/ethnic disparities in infantmortality rates, which need to be addressed. Disparities emerged for Native Hawaiians andOther Pacific Islanders among mothers who smoked during pregnancy in 2013, and infant
deaths due to all birth defects disproportionately affected Black residents at a rate over twice ashigh as the county rate in 2009-2013.

6.5.2 Family PlanningWest O‘ahu
At 26.7 births per 1,000 women aged 15-19 in 2013, West O‘ahu compared poorly against thestate value and national value for teen birth rate (25.0 and 26.5 births per 1,000 women aged
15-19, respectively).

Highly impacted populations
Births to mothers with fewer than 12 years of education (4.8 percent in West O‘ahu)
disproportionately affected women of Native Hawaiian (8.8 percent) and Other Pacific Islander
descent (15.1 percent) in 2013. Similarly, the teen birth rate was highest among women of theserace groups: births to teen mothers of Native Hawaiian and Other Pacific Islander descent(117.9 births/1,000 women ages 15-19) occurred at over four times the West O‘ahu rate. Teenbirth rates were also higher among teenage mothers identifying as Black and White (43.6 and28.9 births/1,000 women ages 15-19, respectively).

Honolulu County
In 2013, condom usage was much lower among adolescents in Honolulu County thannationwide. Among adolescent males in public school grades 9-12 who had sex in the pastmonth, only 51.3 percent (vs. 65.8 percent nationally) used a condom; among females, thevalue is even lower: 42.3 percent (vs. 53.1 percent nationally). Delayed sexual initiation among
young teen girls, as measured by abstinence from sex, was also low. In addition, the percent ofintended pregnancies in Honolulu County failed to meet the Healthy People 2020 target in 2011.

Highly impacted populations
Race/ethnic groups: Births to teen mothers of Native Hawaiian and Other Pacific Islander
descent (112.9 births/1,000 women ages 15-19) occurred at nearly five times the averagecounty rate. Births to mothers with fewer than 12 years of education were also the highest
among women of these race groups, at 9.1 percent for Native Hawaiians and 17.5 percent for
Other Pacific Islanders.

496.5.3 Women’s HealthWest O‘ahu
Only 76.4 percent of women aged 18 and over had a Pap smear in the past three years in 2013
in West O‘ahu, falling short of the state average of 79.1 percent and the Healthy People 2020
target of 93 percent.

Highly impacted populations
Although the breast cancer death rate per 100,000 women was lower in West O‘ahu (7.8) than
the state (15.1) and Healthy People 2020 target (20.7), the rate among women of Native
Hawaiian or Other Pacific Islander descent was 36.2, over five times the regional rate.

Honolulu County
Indicators of women’s preventive care show that Honolulu County must improve in order tomeet Healthy People 2020 targets, especially in regards to preventive services for older womenand Pap smears among women. Breast cancer incidence rates and cervical cancer death rates
are also areas of concern countywide.

50

7 A Closer Look at Highly Impacted Populations
Several subpopulations emerged from the qualitative and quantitative data for their disparities inaccess to care, risk factors and health outcomes. This section focuses on these subpopulations
and their unique needs.

7.1 Children, Teens, and AdolescentsKey Issues
 Health issues affect school attendance.
 Insufficient mental and behavioral health resources.
 High teen birth rates among certain race/ethnic groups.
 Asthma among children.
Opportunities and Strengths
An early education family participation
program is having positive impacts.

Team sports and beach activities give children
opportunities to stay active.

West O‘ahu
According to qualitative data, an area of concern for West O‘ahu children with health issues isthe difficulty of maintaining school attendance. Lack of capacity to administer needed
medications during the school day was identified as a major contributing factor to school
absences.
Mental and behavioral health needs were described in key informant testimony as other crucial
child health issues. Not enough counseling and other mental health services for youth exist, andbuilding up the needed resources has been a challenge.
A key informant discussed how health care costs are rising due to an aging population, and tied
it back to concerns that today’s children could face enormous financial burdens in the future to
pay for their parents’ and grandparents’ care.
As discussed in Section 6.5.2, the teen birth rate in West O‘ahu is high, especially in teens
identifying as Native Hawaiian and Other Pacific Islander, Black, and White.

Honolulu County
In 2013, only 46.7 percent of young teens and 62.8 percent of teens had a physical in the past
year in Honolulu County, failing to meet the Healthy People 2020 target. One key informant
identified a shortage of oral health professionals who are skilled at serving children. Key
informants also noted the need for more support services for caring for children with complex
medical needs, especially in low-income communities.
Less than a quarter of teens in Honolulu County get sufficient sleep on school nights, comparedto 31.7 percent nationally. A key informant explained that sleep is an overlooked issue inchildren with a domino effect in nutrition and school performance: lack of sleep causes
consumption of foods high in carbohydrates and fats, and sugar crashes, which in turn affect51

school performance. Quantitative data corroborate that few Honolulu County teens consume
enough fruits and vegetables or get sufficient physical activity.
A key informant connected asthma to poverty and overcrowded home environments, and notedthat poor management of asthma can lead to chronic absenteeism, creating a cycle of hospital
visits and lost days in school.
In 2013, nearly one in three public school students in grades 9-12 were offered, sold or given
illegal drugs on school property in the past year. A key informant commented that youth
education, especially on relationships, anger management, smoking and drugs, is key toimproving future health outcomes and reducing poverty. Condom use is low among both teenboys and girls in Honolulu County. Eating disorders, cyber-bullying and suicide attempts areother issues for Honolulu County’s teens. Follow-up care after teens are released from theemergency department for attempted suicide is an area for improvement, noted a key informant,
as is improved adolescent depression screening and follow-up services, commented anotherkey informant. Key informants also described the need for more screening of developmental
delays and autism in children, especially in rural areas and in low-income populations.

7.2 Older Adults
Key Issues
 Limited utilization of preventive services among older men.
 Poor access to and coordination of care.
 Growing population of older adults puts strain on health care system.
Opportunities and Strengths
Need for improved care coordination between
different health care providers.

More outpatient geriatric care, health careplanning services, and legal services areneeded.

West O‘ahu
While many women ages 65 and over in West O‘ahu are utilizing preventive services, few older
men are taking advantage of certain health services that can improve health and wellness. For
men ages 65 and over, these include a pneumonia vaccination, a flu shot within the past year,
and either a colonoscopy/sigmoidoscopy in the past 10 years or a fecal occult blood test in thepast year.
Multiple key informants highlighted issues impacting older residents of West O‘ahu. A common
perspective is that the baby boomer generation is aging and putting a strain on the health caresystem—both in terms of financing and access to services—as well as other social services, likehousing.
One key informant posited that many poor health outcomes among older West O‘ahu adults canbe traced back to limited access to care. Another elaborated that there are too few geriatricproviders in the area, and so older adults are not getting the care they need. Complex caremanagement and continuity of care are two related issues that profoundly affect this population.

52

While the quality of care provided by hospice, home care and nursing facilities were praised,
there is little coordination between the different types of services. A key informant noted a needfor more outpatient geriatric care and legal services for the elderly.

Honolulu County
Key informants reported seeing increasingly more of Honolulu County’s older residents withbehavioral health needs and complex medication requirements. Additionally, a growing number
are unable to afford the cost of medications due to insufficient insurance coverage.
Honolulu County’s Medicare population experiences high rates of certain chronic diseases—
including chronic kidney disease, hyperlipidemia, diabetes and hypertension—compared to thestate. The asthma death rate among Honolulu County residents ages 65 and over fails to meet
the Healthy People 2020 target, and is especially high among Native Hawaiian and PacificIslander older adults (201.2 deaths per 1,000,000 population over 65 in 2004-2013, compared
to 54.4 in the county overall).
A key informant identified falls as the most common reason for 911 calls, and emphasized theimportance of collaborating with families, doctors and patients to prevent injuries among theelderly. As of 2011-2013, the rate of fall-related deaths per 100,000 adults ages 65 and overwas much higher in Honolulu County (52.2) than Hawai‘i (40.1) and the Healthy People 2020
target (47.0). The Native Hawaiian or Other Pacific Islander population again had the highest
rates of death within the county: at 109.3 deaths per 100,000 population in 2011-2013, it wasover twice the county rate of 52.2 deaths per 100,000 population.
Key informants identified a growing need for behavioral health care. Dementia prevalence wasobserved to be on the rise, and accordingly, so was the need for psychiatric nursing. One
informant observed that patients with Alzheimer’s or dementia struggle with taking the correct
dosages of medications. Another informant noted that geriatric depression is an issue in thecommunity.

7.3 Low-Income Population
West O‘ahu
Multiple key informants discussed the close ties between poverty and health, and described
how each influences the other. One key informant noted that medical bills are among the top
five reasons for bankruptcy, while another observed how deeply social determinants impact
health and well-being, and make it harder for those born into poverty to break out of the cycle.
Socioeconomic status often falls along racial/ethnic lines, with Native Hawaiians often
experiencing the poorest outcomes, the key informant described. As discussed in Section 6.2.1,
most low-income residents often cannot afford to shop at the few options available for fresh andnutritious foods in West O‘ahu. Another individual interviewed was hopeful that more
opportunities to develop mixed-income housing units would materialize.
The share of renters who spend more than 30 percent of their household income on rent is
exceptionally high in West O‘ahu. In 2009-2013, 61.6 percent of West O‘ahu residents spentover this threshold, compared to 56.3 percent in Hawai‘i overall and 52.3 percent across the53

U.S. In addition, per capita income is lower in this region than in the state and nation overall.
Finally, a much larger share of households receive cash public assistance income (3.9 percent)compared to the U.S. (2.8 percent), indicating greater need and poverty.

Honolulu County
Many key informants noted that low-income patients are more reluctant to seek care or adhere
to treatment regimens, which may exacerbate health issues. Oral health was identified as aparticular area of need for the low-income population, as the uninsured do not receive financial
support for preventive dental care like basic cleaning and exams.

7.4 People with Disabilities
West O‘ahu
As described in Section 6.2.4, arthritis imposes work and activity limitations on many WestO‘ahu residents. As in the rest of the county, there is a need for more programs and services forchildren with autism.

Honolulu County
In 2013, 17.6 percent of adults had a disability in Honolulu County, compared to 10.8 percent in
the United States. Common causes of disability range from medical – including arthritis, backpain, heart disease, cancer, depression and diabetes – to developmental, such as Down
syndrome, attention-deficit/hyperactivity disorder and autism spectrum disorder. According to
the American Community Survey,14 22.3 percent of people with disabilities in Honolulu County
aged 20-64 were living in poverty in 2013.
Data collection for many health areas can be challenging, and a key informant noted a particularlack of data about disability, elaborating that disabilities are often treated as an afterthought. In
addition, disabilities among the elderly may be disguised as frailty and not be properly
addressed.
Several key informants commented on the lack of programs available for developmental
disabilities. They noted the need for more screening in children, especially in rural areas and in
low-income populations. A key informant specified that there is a particular lack of programs for
autism in children and adolescents.

7.5 Homeless Population
West O‘ahu
Key informants described how homelessness often intersects with other issues, such as
substance abuse, mental health and other health conditions, medication adherence, legal status
and employment. There was a common acknowledgement that this vulnerable population
utilizes the emergency room for non-emergency services due to lack of access to other14 American Community Survey. (2013). Poverty Status in the Past 12 Months by Disability Status by

Employment Status for the Population 20 to 64 Years. Available from http://factfinder.census.gov
54

resources. This not only detrimentally impacts the homelessindividuals, but also unnecessarily increases public health carespending. One solution proposed was to build up a team ofhomeless service providers who could identify the high utilizers,
navigate them through the care system, and connect them toappropriate resources.
One key informant described how the configuration of mental healthservices is changing in Section 6.1.2, which could have adownstream effect on homelessness.

The homelessindividuals we serve
are very vulnerable;
many are dealing
with multiple issues
and are very sick,and require a lot of
resources

Honolulu County
According to the National Alliance to End Homelessness, 45.1 individuals per 10,000 population
experienced homelessness in the state of Hawai‘i in 2013, which was nearly twice as high as
the national rate (19.3 per 10,000 population).15 The Homeless Service Utilization Report sheds
more light on this population in Honolulu County: in fiscal year 2014, there were 9,548 homelessservice clients, of whom 50 percent were families and approximately 25 percent were children.
One in five of the population utilizing homeless services in Honolulu County were chronicallyhomeless individuals, defined as adults who have a disabling health or mental health condition
and who have been homeless for one year or more or have had at least four homeless episodes
in the past three years.16 More recently, initiatives like the Mayors Challenge to End VeteranHomelessness have set goals to combat homelessness in Hawai‘i.17
One key informant noted that more local people are becoming homeless. In addition, more
adults were identified as chronically homeless in fiscal year 2014 compared to the prior year.16
However, as a key informant noted, many homeless people are not chronically homeless, but
simply need housing that is affordable. In addition, the key informant suggested job training for
those who have been placed into affordable housing programs.
A key informant elaborated that challenges to access to care include staying in touch with thehomeless population and potential theft of medication on the streets. Key informants alsocommented that the homeless population struggles with the nutritional and behavioral changes
required to prevent obesity, which in turn affects general well-being.

7.6 People from Micronesian Regions
West O‘ahu
A key informant shared that over the past year, the number of individuals coming fromMicronesian regions who arrived in West O‘ahu and did not find housing has increased. Someof these individuals have settled in homeless encampments in the area. Another key informant
observed that the growing Micronesian community presents many medical and social needs,
15 National Alliance to End Homelessness. (2014).The State of Homelessness in America 2014.

Retrieved from http://www.endhomelessness.org/library/entry/the-state-of-homelessness-2014
16 Yuan, S., Vo, H., & Gleason, K. (2014). Homeless Service Utilization Report: Hawai‘i 2014. Retrieved
from: http://uhfamily.hawaii.edu/publications/brochures/60c33_HomelessServiceUtilization2014.pdf
17 http://www.honolulu.gov/housing/mayorschallenge.html
55

although these needs are not as overwhelming as in other parts of O‘ahu. However, tensions
exist between different ethnic groups and more could be done to resolve those issues.
Language is a common barrier preventing these recently arrived residents from seeking care,but even beyond that, there is a need for more education on the importance of prevention andchildcare.

Honolulu County
Multiple key informants noted that people from Micronesian regions face cultural and linguistic
barriers that impede their access to care. Among children, cultural differences were linked topoor school attendance and educational outcomes. One recommendation was to develop
resettlement assistance to help ease the transition and introduce these residents to newservices, including oral health care. Another suggestion was to recruit more individuals from thecommunities to provide translation and culturally competent services. A key informant voiced
concerns about state policy changes that restrict Micronesians’ access to care and called for
greater transparency in the decision-making process. Informants also shared that people fromMicronesian regions often struggle with lifestyle changes, financial difficulties and stigmatization.
One key informant stressed the importance of affordable housing with respect to health, andobserved that many people arriving from Micronesian regions are put into the homeless system
when resettlement assistance would be more effective.

7.7 Disparities by Race/Ethnic Groups
Both quantitative and qualitative data illustrate the health disparities that exist across WestO‘ahu’s many racial and ethnic groups. Figure 7.1 identifies all health topics for which a group isassociated with the poorest value for at least one quantitative indicator. Within each list, Health
Topic Areas are presented before the Quality of Life measures. The lists are particularly long for
Native Hawaiians and Pacific Islanders.

56Figure 7.1: Disparities by Race/Ethnicity

Native Hawaiian

Native Hawaiian/Pacific Islander

CancerDiabetes
Exercise, Nutrition & WeightHeart Disease & Stroke
Immunizations & Infectious Diseases
Mental Health & Mental Disorders
Respiratory Diseases
Substance Abuse
Wellness & Lifestyle
Women's Health--Education

CancerFamily Planning
Heart Disease & Stroke
Maternal, Fetal & Infant Health
Mental Health & Mental Disorders
Prevention & Safety
Teen & Adolescent Health
Women's Health--Economy
Education
Public Safety

Pacific Islander
Access to Health Services
Exercise, Nutrition & Weight
Family Planning
Heart Disease & Stroke
Maternal, Fetal & Infant Health
Substance Abuse--Education

Black/African American
Maternal, Fetal & Infant Health

Filipino
CancerDisabilities
Exercise, Nutrition & Weight
Men's Health
Other Chronic Diseases
Women's HealthWhite
Access to Health Services
Heart Disease & Stroke
Immunizations & Infectious Diseases
Older Adults & Aging
Respiratory Diseases--Transportation

ChineseJapanese
Disabilities
Exercise, Nutrition & WeightHeart Disease & Stroke
Immunizations & Infectious
Diseases
Older Adults & Aging

Maternal, Fetal & Infant Health

AsianTransportation--Exercise, Nutrition & Weight57

Qualitative data collected from public health experts in West O‘ahu corroborate the poor healthstatus of many Native Hawaiians. Individuals from Micronesian regions were also identified as
facing substantial cultural and linguistic challenges to improving health and well-being. Below
are a few excerpts taken from conversations with key informants that highlight the issues
impacting different racial and ethnic groups in Honolulu County.
Figure 7.2: Key Informant-Identified Health Issues Impacting Racial/Ethnic Groups

Blue: Socioeconomic
factors
Orange: Language/culturalbarriers
Green: Poor outcomes

Native Hawaiians
generally havepoorer healthoutcomes and havehigher rates ofdiabetes and otherpreventableconditions.

The most
significant issue islanguage.

Native Hawaiians andsome other race/ethnic
groups are greatly
impacted by the cycle ofpoverty.

barriers
Some groups are
reluctant to seek
mental healthservices becauseof cultural barriers.

The Micronesian community
is growing and we could do a
better job of addressing someethnic tensions between
different groups.

Many immigrants
experiencelanguage barriers.

West O‘ahu is ethnically
mixed but poverty andunderemployment arecommon.

58

8 Conclusion
While there are many areas of need, there are also innumerable community assets and a truealoha spirit that motivates community health improvement activities. This report provides anunderstanding of the major health and health-related needs in West O‘ahu and guidance forcommunity benefit planning efforts and positively impacting the community. Further investigation
may be necessary for determining and implementing the most effective interventions.
Community feedback is an important step in the process of improving community health. To
submit comments regarding this Community Health Needs Assessment, please email:communitybenefits@hawaiipacifichealth.org. You also may mail your written comments to:
Community Health Needs Assessment, Attention: Community Benefits Manager, 55 MerchantStreet, 27th Floor, Honolulu, HI 96813.

59Appendix

Table of Contents
Appendix A. Quantitative Data ............................................................................ A-1
Methodology.................................................................................................... A-1
Sources ............................................................................................................ A-1
Data ................................................................................................................. A-1
Appendix B. Key Informant Interviews ............................................................... B-1
Appendix C. Community Resources .....................................................................C-1

Note: Hawai‘i Pacific Health and its member hospitals honor the Hawaiian language and its useof diacritical marks, the glottal stop and the macron (ʻokina and kahakō). While we normally use
these marks in our communication materials, we have omitted them from the charts and graphs
in this appendix as they are limited in their ability to display in these formats.

Appendix A. Quantitative Data
Secondary Data Scoring
Each indicator available for the Pali Momi service area (West Oahu) was assessed using up to
four comparisons as possible. Each one is scored from 0-3 depending on how the area’s value
compares to the relevant benchmarks as described below.

Comparison to Hawai‘i value and U.S. value
For the comparisons to a single value, the scoring depends on whether West Oahu has a betteror worse value, and the percent difference between the two values. The same method is used
to score the comparison to the value for the state of Hawai‘i and for the comparison to the U.S.
value.

Comparison to Healthy People 2020 Target
For a comparison to a Healthy People 2020 target, the scoring depends on whether the target is
met or unmet, and the percent difference between the indicator value and the target value.

Comparison to Trend
For each indicator with values available for at least two time periods, scoring was determined bydirection of the trend in the two most recent comparable values for the state.

Missing Values
Indicator scores are calculated using the comparison scores, availability of which depends onthe data source. All missing comparisons are substituted with a neutral score for the purposesof calculating the indicator’s weighted average.

Indicator and Topic Scores
Indicator scores are calculated by averaging all comparison scores. Topic scores are calculated
as an average of all relevant indicator scores, and indicators may be included in multiple topics
as appropriate.

Secondary Data Sources
Key Source
1 American Community Survey
2 Behavioral Risk Factor Surveillance System (courtesy Hawaii State Department of Health)3 Hawaii State Department of Health, Vital Statistics

Data
The following tables present the data used in the quantitative data analysis. The first table on
the next page presents topic scores, with higher scores indicating higher need. The tables
A-1

following the topic scoring contain a comprehensive list of the indicators that comprise each
topic. For individual indicators, values for specific race/ethnic groups are presented if they werepoorer than the overall indicator value, and if the indicator had a high index of disparity. To
identify the source for each indicator, please consult the source key table in the previous
section.
Data Scoring Appendix: Topic Scores
Health or Quality of Life Topic

Secondary Data
Score

Environmental & Occupational Health

2.63

Men's Health

1.94

Other Chronic Diseases

1.88

Teen & Adolescent Health1.63

Respiratory Diseases

1.60

Disabilities

1.54

Diabetes

1.49

Education

1.42

Transportation

1.35

Access to Health Services

1.32

Maternal, Fetal & Infant Health

1.32

Economy1.27

Immunizations & Infectious Diseases

1.22

Cancer

1.17

Older Adults & Aging

1.17

Heart Disease & Stroke

1.15

Social Environment

1.13

Exercise, Nutrition, & Weight

1.07

Family Planning

1.01

Wellness & Lifestyle

0.92

Women's Health

0.91

Substance Abuse

0.67

Prevention & Safety

0.55

Public Safety

0.50

Mortality Data

0.45

Mental Health & Mental Disorders

0.32

A-2

Pali Momi Medical Center
Data Scoring Appendix: Indicator Scores by Topic

SourceMeasurement
PeriodWest
Oahu

Previous
Value

Units

Score High Race Disparity*

ACCESS TO HEALTH SERVICES
Preventive Services for Older Men
Diabetics who have a Biannual HbA1c Check
Adults 65+ with a Usual Source of Health Care
Adults with a Usual Source of Health Care
Preventive Services for Older Women
Adults without Health Insurance

2
2
2
2
2
2

2013
2013
2013
2013
2013
2013

40.0
72.2
97.7
87.8
34.7
12.6

percent
percent
percent
percent
percent
percent

2.25
1.88
1.63
1.00
0.75
0.38

CANCER
Pap Test History
Colon Cancer Screening
PSA Test- Discussed With Doctor
Mammogram History

2
2
2
2

93.0
70.5
15.9

73.8
62.5
25.3
81.3

percent
percent
percent
percent

2.00
1.75
1.63
0.88

Colon Cancer Death Rate

14.6

14.5

7.6

deaths/100,000
population

0.75

NHPI (32.1) White (11.0)

15.1

20.8

20.7

9.1

deaths/100,000
females

0.00

NHPI (36.2)

10.8
50.8

8.4
50.7

9.7
70.4

10.0
58.0

percent
percent

2.38
2.13

2013

49.3

46.9

62.5

52.3

percent

1.88

2
2
2
2

2013
2013
2013
2013

66.0
78.9
79.9
19.6

67.7
71.6
77.9
20.8

71.1
74.8
58.7
30.8

72.2
72.9
68.7
27.8

percent
percent
percent
percent

1.88
0.88
0.63
0.63

2
2
2

2013
2013
2013

34.9
41.3
19.0

31.1
37.8
19.9

43.0
25.3

35.5

33.8
42.2
20.6

percent
percent
percent

2.00
1.75
0.88

1

2009-2013

61.6

56.3

52.3

61.2

percent

2.13

1
1
1

2009-20132009-20132009-2013

3.9
27652
55.2

3.8
29305
49.7

2.8
28155
56.9

4.0
27382
56.0

percent
dollars
percent

1.88
1.63
1.38

People Living Below Poverty Level1

2009-2013

9.0

11.2

15.4

7.0

percent

1.13

Families Living Below Poverty Level1

2009-2013

6.9

7.9

11.3

6.8

percent

0.88

HawaiiU.S.

HP2020

38.6
66.0
96.8
86.2
44.0
8.2

40.5
67.7

41.8

44.6
71.1

85.1
40.2
10.0

76.6
39.2
20.0

83.9
46.8

2013
2013
2013
2013

76.4
64.9
19.5
84.4

79.1
66.4
19.7
80.4

78.0
65.1

3

2011-2013

10.2

14.0

Breast Cancer Death Rate3

2011-2013

7.8

DIABETES
Adults with Diabetes
Diabetics who Test Their Blood Glucose Daily

2
2

2013
2013

Diabetics who Receive Formal Diabetes Education

2

Diabetics who have a Biannual HbA1c Check
Diabetics Who Have Their Feet Checked
Diabetics who have an Annual Eye Exam
Diabetics With Vision Problems
DISABILITIESWork Limitations due to Arthritis
Activity Limitations due to Arthritis
Adults with Arthritis
ECONOMYRenters Spending 30% or More of Household
Income on Rent
Households with Cash Public Assistance Income
Per Capita Income
Homeownership

74.0

AIAK (15.3) Hisp (14.3) NHPI
(19.5) Other (18.1) Mult (12.0)*Note: AIAK = American Indian/Alaskan Native, NH = Native Hawaiian, PI = Pacific Islander, API = Asian or Pacific Islander, NHPI = Native Hawaiian/Pacific islander, JPN = Japanese, CHN = Chinese, FIL =Filipino, Mult = Multiracial, Hisp = Hispanic/Latino

Data Scoring Appendix - 1

Pali Momi Medical Center
Data Scoring Appendix: Indicator Scores by Topic

People 65+ Living Below Poverty Level
Children Living Below Poverty LevelMedian Household Income

1
1
1

Measurement
Period2009-20132009-20132008-2012

EDUCATION
People 25+ with a Bachelor's Degree or Higher
People 18+ without a High School Degree
Infants Born to Mothers with <12 Yrs Education

1
2
3

2009-2013
2013
2013

25.9
9.3
4.8

30.1
9.8
6.6

28.8
14.4
17.0

ENVIRONMENTAL & OCCUPATIONAL HEALTH
Adults with Asthma

2

2013

10.9

9.4

9.0

EXERCISE, NUTRITION, & WEIGHT
Adult Fruit and Vegetable Consumption

2

2013

15.1

18.1

Workers Commuting by Walking

12009-2013

2.9

4.7

2.8

2

2013

76.0

77.9

74.7

2
2
2

2013
2013
2013

24.0
32.7
24.6

22.1
33.6
21.8

25.3
35.4
29.4

32.6
30.5

20.2
32.2
29.3

2

2013

55.9

60.2

50.8

47.9

54.0

percent

0.75

2

2013

36.3

39.5

31.6

31.3

33.9

percent

0.75

1
1
2

2009-20132009-2013
2013

0.7
61.7
40.7

0.8
11.1
42.3

0.6
7.8
33.4

0.6
33.9

0.6
56.8
36.0

percent
percent
percent

0.75
0.63
0.50

2

2013

27.3

26.5

20.5

20.1

21.2

percent

0.25

2

2013

36.8

35.0

29.8

24.1

30.5

percent

0.25

Teen Birth Rate

3

2013

26.7

25.0

26.5

29.2

births/1,000 women
aged 15-19 years

1.63Black (43.6) NHPI (117.9) White(28.9)

Infants Born to Mothers with <12 Yrs Education

3

2013

4.8

6.6

17.0

6.0

percent

0.38

AIAK (6.0) NH (8.8) PI (15.1)

2

2013

21.4

23.5

30.7

37.1

percent

2.38

2
2

2013
2013

28.8
76.2

28.5
75.8

31.4
76.4

27.7
74.2

percent
percent

1.75
1.50

2

2013

22.6

19.1

34.7

13.5

percent

1.13

SourceAdults who Participate in Physical Activity Outsideof Work
Adults Not Engaging in Physical Activity
Adults who are Overweight
Adults who are Obese
Adults who Meet Aerobic Physical Activity
Guidelines
Adults who Meet High Aerobic Physical Activity
Guidelines
Workers Commuting by Bicycling
Workers Commuting by Active Transportation
Adults with a Healthy Body Weight
Adults who Meet Aerobic and Strengthening Activity
Guidelines
Adults who Meet Muscle Strengthening Guidelines

West
Oahu
6.7
13.1
77045

Hawaii

U.S.

7.4
15.4
67402

9.4
21.6
53046

HP20202.1

3.1

Previous
Value
7.0
12.3
76321

Units

Score High Race Disparity*

percent
percent
dollars

0.88
0.88
0.63

25.5
8.4
6.0

percent
percent
percent

2.13
1.75
0.38

8.6

percent

2.63

17.8

percent

2.25

2.8

percent

1.75

79.8

percent

1.63

percent
percent
percent

1.50
1.38
0.75

AIAK (6.0) NH (8.8) PI (15.1)

Asian (1.2) NHPI (1.6) Mult (1.9)

FAMILY PLANNING

HEART DISEASE & STROKE
Stroke Survivors Referred to Outpatient
Rehabilitation
High Blood Pressure Prevalence
Cholesterol Tested in Past 5 Years
Heart Attack Survivors Referred to Outpatient
Rehabilitation

Data Scoring Appendix - 2

26.9
82.1

Pali Momi Medical Center
Data Scoring Appendix: Indicator Scores by Topic

SourceMeasurement
PeriodWest
Oahu

Hawaii

2

2013

28.5

25.8

2
2

2013
2013

32.3
81.8

34.9
78.8

2

2013

31.1

25.7

Stroke Death Rate3

2011-2013

24.5

33.6

36.2

34.8

Heart Disease Death Rate3

2011-2013

44.1

68.9

105.4

IMMUNIZATIONS & INFECTIOUS DISEASES
Pneumonia Vaccination Rate 65+
Influenza Vaccination Rate 18-64 yrs
HIV Testing among Adults
Influenza Vaccination Rate 65+

2
2
2
2

2013
2013
2013
2013

69.9
43.7
36.8
77.7

68.2
40.3
36.6
69.9

MATERNAL, FETAL & INFANT HEALTH
Babies with Low Birth Weight

3

2013

9.3

8.3

Aspirin Use among Men 45-79 years with No
History of Cardiovascular Disease
High Cholesterol Prevalence
Hypertension Medication Compliance
Aspirin Use among Women 55-79 years with No
History of Cardiovascular DiseaseU.S.

HP2020Previous
Value

Units

Score High Race Disparity*

percent

1.00

percent
percent

1.00
1.00

percent

0.75

22.1

deaths/100,000
population

0.75

Asian (24.7) Black (26.6) NHPI
(71.3)

103.4

45.3

deaths/100,000
population

0.25

Black (47.3) NHPI (189.0) White(49.7)

69.5
33.1
35.2
62.8

90.0
80.0
90.0

66.5
45.4
33.6
67.5

percent
percent
percent
percent

1.50
1.50
1.13
0.75

8.0

7.8

8.4

percent

3.00

29.2

births/1,000 women
aged 15-19 years

1.63

22.1

10.8
23.7
6.0
12.3

percent
percent
percent
percent

1.50
1.13
0.38
0.25

44.6
15.9

40.0
25.3

percent
percent

2.25
1.63

51.9

percent

0.63
0.00

Black (8.5) NHPI (15.0) White
(6.7)

28.4
38.4
77.3

13.5
69.5

38.8
84.0

28.3

Teen Birth Rate

3

2013

26.7

25.0

26.5

Preterm Births
Births Delivered by Cesarean Section
Infants Born to Mothers with <12 Yrs Education
Mothers who Received Late or No Prenatal Care

3
3
3
3

2013
2013
2013
2013

11.1
24.1
4.8
11.2

10.1
25.6
6.6
14.1

11.4
26.9
17.0
26.3

MEN'S HEALTH
Preventive Services for Older Men
PSA Test- Discussed With Doctor

2
2

2013
2013

38.6
19.5

40.5
19.7

41.8

MENTAL HEALTH & MENTAL DISORDERS
Self-Reported Good Physical and Mental Health

2

2013

57.8

55.6

49.6

11.4

Black (43.6) NHPI (117.9) White(28.9)

AIAK (6.0) NH (8.8) PI (15.1)

3

2011-2013

4.4

10.9

12.6

10.2

5.0

deaths/100,000
population

Colon Cancer Death Rate3

2011-2013

10.2

14.0

14.6

14.5

7.6

deaths/100,000
population

0.75

NHPI (32.1) White (11.0)

Stroke Death Rate3

2011-2013

24.5

33.6

36.2

34.8

22.1

deaths/100,000
population

0.75

Asian (24.7) Black (26.6) NHPI
(71.3)

Drowning Death Rate3

2011-2013

1.0

2.0

1.2

1.1

0.7

deaths/100,000
population

0.75

Asian (1.1) NHPI (4.9)

Injury Death Rate3

2011-2013

21.0

42.4

58.8

53.7

20.9

deaths/100,000
population

0.50

NHPI (69.3) White (23.9)

Poisoning Death Rate3

2011-2013

4.8

10.8

15.2

13.2

4.8

deaths/100,000
population

0.50

NHPI (16.0) White (7.1)

Suicide Death Rate
MORTALITY DATA

Data Scoring Appendix - 3

Pali Momi Medical Center
Data Scoring Appendix: Indicator Scores by Topic

SourceMeasurement
PeriodWest
Oahu

HawaiiU.S.

HP2020Previous
Value

Units

Unintentional Injury Death Rate3

2011-2013

15.0

27.5

39.4

36.4

14.6

deaths/100,000
population

0.50

NHPI (48.8)

Motor Vehicle Collision Death Rate3

2011-2013

3.2

8.6

10.9

12.4

3.1

deaths/100,000
population

0.50

NHPI (12.1)

Heart Disease Death Rate3

2011-2013

44.1

68.9

105.4

103.4

45.3

deaths/100,000
population

0.25

Black (47.3) NHPI (189.0) White(49.7)

Breast Cancer Death Rate3

2011-2013

7.8

15.1

20.8

20.7

9.1

deaths/100,000
females

0.00

NHPI (36.2)

Suicide Death Rate3

2011-2013

4.4

10.9

12.6

10.2

5.0

deaths/100,000
population

0.00

Black (8.5) NHPI (15.0) White(6.7)

OLDER ADULTS & AGING
Preventive Services for Older Men
Pneumonia Vaccination Rate 65+
Adults with Arthritis
People 65+ Living Below Poverty Level
Influenza Vaccination Rate 65+
Preventive Services for Older Women

2
2
2
1
2
2

2013
2013
2013
2009-2013
2013
2013

38.6
69.9
19.0
6.7
77.7
44.0

40.5
68.2
19.9
7.4
69.9
40.2

41.8
69.5
25.3
9.4
62.8
39.2

44.6
90.0

90.0
46.8

40.0
66.5
20.6
7.0
67.5
34.7

percent
percent
percent
percent
percent
percent

2.25
1.50
0.88
0.88
0.75
0.75

OTHER CHRONIC DISEASESWork Limitations due to Arthritis
Activity Limitations due to Arthritis

2
2

2013
2013

34.9
41.3

31.1
37.8

43.0

35.5

33.8
42.2

percent
percent

2.00
1.75

Drowning Death Rate3

2011-2013

1.0

2.0

1.2

1.1

0.7

deaths/100,000
population

0.75

Asian (1.1) NHPI (4.9)

Injury Death Rate3

2011-2013

21.0

42.4

58.8

53.7

20.9

deaths/100,000
population

0.50

NHPI (69.3) White (23.9)

Poisoning Death Rate3

2011-2013

4.8

10.8

15.2

13.2

4.8

deaths/100,000
population

0.50

NHPI (16.0) White (7.1)

Unintentional Injury Death Rate3

2011-2013

15.0

27.5

39.4

36.4

14.6

deaths/100,000
population

0.50

NHPI (48.8)

Motor Vehicle Collision Death Rate3

2011-2013

3.2

8.6

10.9

12.4

3.1

deaths/100,000
population

0.50

NHPI (12.1)

Motor Vehicle Collision Death Rate3

2011-2013

3.2

8.6

10.9

12.4

3.1

deaths/100,000
population

0.50

NHPI (12.1)

RESPIRATORY DISEASES
Adults with Asthma
Pneumonia Vaccination Rate 65+
Influenza Vaccination Rate 18-64 yrs
Influenza Vaccination Rate 65+

2
2
2
2

2013
2013
2013
2013

10.9
69.9
43.7
77.7

9.4
68.2
40.3
69.9

9.0
69.5
33.1
62.8

90.0
80.0
90.0

8.6
66.5
45.4
67.5

percent
percent
percent
percent

2.63
1.50
1.50
0.75

Score High Race Disparity*

PREVENTION & SAFETY

PUBLIC SAFETY

SOCIAL ENVIRONMENT

Data Scoring Appendix - 4

Pali Momi Medical Center
Data Scoring Appendix: Indicator Scores by Topic

Single-Parent Households
Children Living Below Poverty Level

1
1

Measurement
Period2009-20132009-2013

SUBSTANCE ABUSE
Adults Who Attempted to Quit Smoking
Adults who Binge Drink
Adults who Smoke Cigarettes
Adults who use Smokeless Tobacco
Excessive Drinking
Adults Who Recently Quit Smoking

2
2
2
2
2
2

2013
2013
2013
2013
2013
2013

66.4
19.3
13.1
1.4
20.1
19.0

61.6
18.3
13.3
1.6
19.7
15.3

51.8
26.9
19.0
4.2
28.0
6.3

Teen Birth Rate

3

2013

26.7

25.0

26.5

29.2

births/1,000 women
aged 15-19 years

1.63

TRANSPORTATION
Mean Travel Time to Work1

2009-2013

30.3

26.0

25.5

30.1

percent

2.38

Workers Commuting by Walking

12009-2013

2.9

4.7

2.8

3.1

2.8

percent

1.75

Workers Commuting by Bicycling
Workers Commuting by Active Transportation
Workers Commuting by Public Transportation

1
1
1

2009-20132009-20132009-2013

0.7
61.7
6.7

0.8
11.1
6.4

0.6
7.8
5.0

0.6

0.6
56.8
6.6

percent
percent
percent

0.75
0.63
0.50

WELLNESS & LIFESTYLE
Self-Reported Health Status of Good or Better
Excessive Drinking
Self-Reported Good Physical and Mental Health

2
2
2

2013
2013
2013

85.3
20.1
57.8

86.2
19.7
55.6

83.3
28.0
49.6

83.5
20.7
51.9

percent
percent
percent

1.38
0.75
0.63

WOMEN'S HEALTH
Pap Test History
Mammogram History
Preventive Services for Older Women

2
2
2

2013
2013
2013

76.4
84.4
44.0

79.1
80.4
40.2

78.0
74.0
39.2

93.0
46.8

73.8
81.3
34.7

percent
percent
percent

2.00
0.88
0.75

Breast Cancer Death Rate3

2011-2013

7.8

15.1

20.8

20.7

9.1

deaths/100,000
females

0.00

Source

West
Oahu
31.7
13.1

Hawaii

U.S.

29.9
15.4

33.3
21.6

HP2020

80.0
24.4
12.0
0.3
25.4
8.0

Previous
Value
33.4
12.3

Units

Score High Race Disparity*

percent
percent

1.38
0.88

55.7
19.3
16.1
1.9
20.7
7.2

percent
percent
percent
percent
percent
percent

1.00
0.75
0.75
0.75
0.75
0.00

NH (1.5) PI (5.6) White (2.6)

TEEN & ADOLESCENT HEALTH

Data Scoring Appendix - 5

5.5

25.4

Black (43.6) NHPI (117.9) White(28.9)

Asian (1.2) NHPI (1.6) Mult (1.9)

NHPI (36.2)

Appendix B. Key Informant Interviews
Between November 2014 and September 2015, Storyline Consulting conducted key informant
interviews with community health experts in Honolulu County with knowledge of issues
impacting West Oahu. The following questions were used to guide the conversations.
Q1: Could you tell me a little bit about yourself, your background, and your organization?
Q2: You were selected for this interview because of your specialized knowledge in the areaof [topic area]. What are the biggest needs or concerns in this area?
Q3: What is the impact of this health issue on low income, underserved/uninsured persons?
Q4: Could you speak to the impact on different ethnic groups of this health concern?
Q5: Could you tell me about some of the strengths and resources in your community that
address [topic area], such as groups, initiatives, services, or programs? What about thebarriers to receiving care in the community?
Collect Resource Info: Resource Name Serves which geography
 Resource Type (clinic, hotline, etc.)
 Topic Focus Areas Serves Low-Income, Underserved/Uninsured
 Focus on minority Race/Ethnic groups
Q6: Are there opportunities for larger collaboration with hospitals and/or the healthdepartment that you want us to take note of?
Q7: What advice do you have for a group developing a community health improvement plan
to address these needs?
Q8: What are the other major health needs/issues you see in the community?

B-1

Appendix C. Community Resources
Community Resources Identified through Key Informant Interviews
Location
Hawaii
Hawaii
HawaiiCommunity Resource
Affordable Housing and Homeless AllianceBlue Zones ProjectCommunity Health Centers

HawaiiConnecting for Success

HawaiiFederally Qualified Healthcare Centers

Hawaii
Hawaii
Hawaii

Hawaii
Hawaii
Hawaii
Hawaii

Gregory House
Hale Kipa
Hawai‘ian Islands Oral Health Task Force
Hawaii Disability Rights Center - Client Assistance
Program
Hawaii Families As Allies
Hawaii Health Information Exchange
Hawaii Health Systems Corporation
Hawaii Initiative for Childhood Obesity Research and
Education (HICORE)
Hawaii Medical Services Association
Hawaiian Community Assets
Hina Mauka
HOPE Services Hawaii

Hawaii

Injury Prevention Advisory Committee

Hawaii
Hawaii
Hawaii

Keiki Injury Prevention Coalition
Legal Aid Society of Hawaii
Life Foundation for HIV

Hawaii
Hawaii
Hawaii
Hawaii
HawaiiC-1

For more information:
http://www.hawaiihomeless.org/
https://hawaii.bluezonesproject.com/
http://www.hawaiipca.net/6/community-health-centers
http://www.hawaiicommunityfoundation.org/communityimpact/connecting-for-successhttps://npidb.org/organizations/ambulatory_health_care/fe
derally-qualified-health-center-fqhc_261qf0400x/hi/
http://www.gregoryhouse.org/
https://www.halekipa.org/
http://www.hawaiipca.net/41/dental
http://www.hawaiidisabilityrights.org/programs_cap.aspx
http://www.hfaa.net/
https://www.hawaiihie.org/
http://www.hhsc.org/
http://www.hicore.org/
https://www.hmsa.com/
www.hawaiiancommunity.net/
http://hinamauka.org/
http://hopeserviceshawaii.org/
http://health.hawaii.gov/injuryprevention/home/partnerships/injury-prevention-advisory-committee-ipac/
http://kipchawaii.org/
http://www.legalaidhawaii.org/
http://lifefoundationorg.ipage.com/

Hawaii
Hawaii
Hawaii
Hawaii
Hawaii
Hawaii
Hawaii
Hawaii
Hawaii
Hawaii
Hawaii
HonoluluCountyHonoluluCountyWest Oahu
West Oahu
West Oahu

McKenna Recovery Center
Micronesian Community Network
PACT: Parents and Children Together
Partners in Development Foundation
Pono Choices
Project KealahouSpecial Supplemental Nutrition Program for Women,
Infants and Children (WIC)The Institute for Native Pacific Education and Culture(INPEACE)
Tutu and Me
University of Hawaii Center on the Family
City and County of Honolulu Department of Parks andRecreation – Programs and Classes

http://www.honolulu.gov/parks/program.html

HCAP Head Start
Hoomau Ke Ola
Ka Pua Initiative

http://www.hcapweb.org/headstart/
http://www.hoomaukeola.org/
http://www.ksbe.edu/kapua/
http://www.malamalearningcenter.org/index.php/resources/mlc-partners/38-kaala-farm
http://www.kahumana.org/
http://www.wcchc.com/Services/Dental-Care-WaianaeKapolei-Children-Adult
http://www.kkv.net/

Kahumana FarmWest Oahu

Kapolei Keiki Smile CenterWest Oahu

Kokua Kalihi Valley Comprehensive Family Services
Mala Ai Opio Community Food Systems Initiative(MAO)
Place-Based After-School Literacy Support (PALS)Red Raider Health Center at Kahuku High &Intermediate School
Surfing the NationsWest Oahu

http://www.pidf.org/programs/tutu_and_me/about
http://uhfamily.hawaii.edu/

http://www.honolulu.gov/housing/ohou-first.html

West Oahu

West Oahu

http://www.inpeace.org/

Housing First

Kaala FarmWest Oahu

http://health.hawaii.gov/wic/
http://health.hawaii.gov/substance-abuse/preventiontreatment/treatment/treatment-services/

Substance Abuse Treatment Centers

West Oahu

West Oahu

http://www.mckennarecoverycenter.com/
http://micronesiancommunitynetwork.blogspot.com/
http://www.pacthawaii.org/
http://www.pidf.org/
http://www.cds.hawaii.edu/ponochoices/
http://projectkealahou.org/

C-2

http://www.maoorganicfarms.org/
http://www.palshawaii.org/
http://www.kahukuhigh.org/apps/pages/index.jsp?type=d&uREC_ID=250603&pREC_ID=608639
http://www.surfingthenations.com/

West Oahu

http://www.wcchc.com/Services/Dental-Care-WaianaeKapolei-Children-Adult

Waianae Dental Clinic

Medicare-Approved Healthcare Facilities, West Oahu
The following list presents select Provider of Services (POS) facilities identified by the Centers for Medicare & Medicaid Services forWest Oahu. However, it is not an exhaustive directory of all facilities in the county. For the most recent POS file, please visit:
http://www.cms.gov/Research-Statistics-Data-and-Systems/Downloadable-Public-Use-Files/Provider-of-Services/index.html
Facility Type
Ambulatory Surgery
CenterAmbulatory Surgery
CenterCommunity Clinic

Facility NameCity

Street Address

PACIFIC ENDOSCOPY CENTERPEARL CITY1029 MAKOLU ST STE H,I,J

HAWAIIAN EYE CENTERWAHIAWA606 KILANI AVENUEQUEEN'S HEALTH CARE CENTERS, THE

KAPOLEI

Community Clinic

MILILANI FAMILY CLINICMILILANI

Community Clinic

HEATHER L BOOKS, MD, MPH, TM

PEARL CITY

Community Clinic

JAMES & ABIGAIL CAMPBELL CLINICWAIANAE

Community Clinic

STRAUB KAPOLEI FAMILY HEALTH CENTER

WAIANAE

Community Clinic

WAIANAE DISTRICT COMPREHENSIVEWAIANAE

Community Clinic

WCCHC WAIOLA SPECIALTY CLINICWAIANAE

Community Clinic

EKAHI URGENT CARE WAIPAHU

WAIPAHU

Community Clinic
End Stage Renal
Disease Dialysis
End Stage Renal
Disease Dialysis

OAHU SUGAR FMLY HLTH CTR

WAIPAHUDIALYSIS NEWCO INC

AIEA

599 FARRINGTON HWY #201
95-1249 MEHEULA PKWY,#B-10
98-1238 KAAHUMANU
STREET SUITE 200
87-2070 FARRINGTON HWY
STE N
590 FARRINGTON HWY
SUITE 526A
86-260 FARRINGTONHIGHWAY86-120 FARRINGTON HWY
STE 305A
94-229 WAIPAHU DEPOTROAD SUITE 101
94-916 WAIPAHU STREET
98-1005 MOANALUA RD,#420

LIBERTY DIALYSIS HAWAII LLC

EWA BEACH

C-3

91-2137 FORT WEAVER RD

End Stage Renal
Disease Dialysis
End Stage Renal
Disease Dialysis
End Stage Renal
Disease Dialysis
End Stage Renal
Disease Dialysis
End Stage Renal
Disease Dialysis
Federally QualifiedHealth Center
Hospital
Hospital
Hospital
HospitalIntermediate Care
Facility/Individuals
with Intellectual
Disabilities
Intermediate Care
Facility/Individuals
with Intellectual
Disabilities
Rural Health Clinic
School/Student
Health Service
Skilled
Nursing/Nursing
Facility

ST FRANCIS MEDICAL CENTER-ESRD

EWA BEACH

91 2137 FORT WEAVERROAD

DIALYSIS NEWCO INCKAPOLEI

555 FARRINGTON HWY

DIALYSIS NEWCO INCWAHIAWA

850 KILANI AVENUE

LIBERTY DIALYSIS HAWAII LLC

WAIANAE80-080 FARRINGTON HWY

DIALYSIS NEWCO INC

WAIPAHU

94-862 KAHUILANI ST

WAIANAE COAST COMP HLTH CNTR

WAIPAHUQUEEN'S MEDICAL CENTER WEST OAHU
POCT, THE
THE QUEEN'S MEDICAL CENTER WESTOAHU LABTHE QUEEN'S MEDICAL CENTER WESTOAHU PATHOLOGYWAHIAWA GENERAL HOSPITALEWA BEACH
EWA BEACH

94-428 MOKUOLA STREET#108B
91-2141 FORT WEAVER
ROAD
91-2135 FORT WEAVER RDWAHIAWA

91-2135 FORT WEAVER
ROAD
128 LEHUAWAIMANO TRAINING SCHOOL & HOSPITALPEARL CITY

2201 WAIMANO HOME RDOPPORTUNITIES AND RESOURCES INC

WAHIAWA

64-1510 KAMEHAMEHA HWY

KAPOLEI HEALTH CARE CENTERKAPOLEI

599 FARRINGTON HWY STE
100

LEEWARD COMMUNITY COLLEGEPEARL CITY

96-045 ALA IKE ST

AIEA HEIGHTS SENIOR LIVING

AIEA

99-1657 AIEA HEIGHTS DR

C-4

EWA BEACH

Skilled
Nursing/Nursing
Facility
Skilled
Nursing/Nursing
Facility
Skilled
Nursing/Nursing
Facility
Skilled
Nursing/Nursing
Facility
Skilled
Nursing/Nursing
Facility
Skilled
Nursing/Nursing
Facility

AIEA SRSP

AIEA

98-839 KAAMILO ST

PEDIAHEALTH CORP KULANA MALAMAEWA BEACH

91-1360 KARAYAN ST

KA PUNA WAI OLAKAPOLEI

91-575 FARRINGTON HWYPEARL CITY NURSING HOMEPEARL CITY

919 LEHUA AVEPEARL CITY SRSPPEARL CITY

1668 HO'OHULU ST

PUUWAI O MAKAHAWAIANAE84-390 JADE

Additional Community Resources
To find more community resources, please visit the Aloha United Way 211 site: http://www.auw211.org/

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