Obesity, the most common chronic disease of childhood, is prevalent among economically disadvantaged children. The Chronic Care and Obesity Care Models are comprehensive health care strategies to improve outcomes by linking primary care best practices and community-based programs. Pediatric providers and community health centers are well positioned to design and implement coordinated and synergistic programs to address childhood health disparities. This article describes a comprehensive project based on the Obesity Care Model initiated at a rural community health center in Hawaii to address childhood obesity including: (1) the health care delivery changes constituting the quality improvement project; (2) capacity and team-building activities; (3) use of the project community level data to strengthen community engagement and investment; and (4) the academic-community partnership providing the project framework. We anticipate that these efforts will contribute to the long-term goal of reducing the prevalence of obesity and obesity associated morbidity in the community.

Produce prescriptions that provide vouchers to individuals to purchase fresh FVs at a specified retail outlet have the potential to positively impact food security status, diet, and chronic disease risk. However, maximizing program participation is vital to ensuring program success. This research describes motivators, barriers, and support for participation in a child produce prescription program among a population of Native Hawaiian and Other Pacific Islanders, who are underrepresented in this field of research. This qualitative grounded theory study was nestled within a quasi-experimental pilot intervention trial and included semi-structured interviews with pediatric program participants. Twenty-five interviews were conducted, which represented one-third of program participants. The top support factors for program participation included: ease of voucher use, program convenience, health center/pediatrician endorsement and positive communications with farmers’ market vendors. Key motivators for program participation were produce enjoyment, child support, financial support, and positive impacts on family. Three themes emerged consistently as barriers to participation amongst participants, (1) difficult use of vouchers, (2) conflicting schedules, and (3) online market concerns. (4) Conclusions: This research offers insight into policy implications as the number of produce prescription programs has grown. These findings suggest that key program design characteristics can enhance and support program participation.

Vaccine hesitancy remains a significant barrier to achieving herd immunity and preventing the further spread of COVID-19. Understanding contributors to vaccine hesitancy and how they change over time may improve COVID-19 mitigation strategies and public health policies. To date, no mechanism explains how trust in and consumption of different sources of information affect vaccine uptake. A total of 1594 adults enrolled in our COVID-19 testing program completed standardized surveys on demographics, vaccination status, use, reliance, and trust in sources of COVID-19 information, from September to October 2021, during the COVID-19 Delta wave. Of those, 802 individuals (50.3%) completed a follow-up survey, from January to February 2022, during the Omicron-wave. Regression analyses were performed to understand contributors to vaccine and booster uptake over time. Individuals vaccinated within two months of eligibility (early vaccinees) tended to have more years of schooling, with greater trust in and consumption of official sources of COVID-19 information, compared to those who waited 3–6 months (late vaccinees), or those who remained unvaccinated at 6 months post-eligibility (non-vaccinees). Most (70.1%) early vaccinees took the booster shot, compared to only 30.5% of late vaccinees, with the latter group gaining trust and consumption of official information after four months. These data provide the foundation for a mechanism based on the level of trust in and consumption of official information sources, where those who increased their level of trust in and consumption of official information sources were more likely to receive a booster. This study shows that social factors, including education and individual-level degree of trust in (and consumption of) sources of COVID-19 information, interact and change over time to be associated with vaccine and booster uptakes. These results are critical for the development of effective public health policies and offer insights into hesitancy over the course of the COVID-19 vaccine and booster rollout.

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A growing body of evidence links stress with mental illness and chronic disease. Existing scales of women's stress fail to capture the daily stressors of low-income, rural women. We explored the psychosocial stressors of local women residing in a rural Hawaii community with a large Native Hawaiian and Other Pacific Islander population. We recruited women, aged 18–35 years, at a community health center. We convened four focus groups to elicit information about women's stress. We identified key themes from the focus group data to generate questions that target concerns raised by participants. These were corroborated by additional focus groups. Thirty-six women participated in the study. Seven stressor themes emerged: intimate relationships—limited partner assistance, gender stereotype; family and home life—feeling like an outsider, lack of respect; childrearing—quality and affordable childcare, conflicting discipline styles; time for self—never-ending duties, being too tired to relax; neighborhood environment—safety concerns, not feeling part of the community; workplace—workload and transportation obstacles; and finances—making ends meet and arguments about money. Women in this study articulated a broad range of daily stressors. Sociocultural factors leading to feeling like an outsider within their own family, intercultural marriage conflicts, and perceptions of community discrimination are not included in other published scales. Our focus group investigations thus provided critical knowledge for developing a community-relevant scale. This is a prerequisite for developing and testing innovative intervention strategies designed to reduce stress in this population. We believe that reducing stress is necessary to mitigate the negative effects of stressors on physical and mental health among women in this rural community.