While life expectancy across the U.S. declined significantly during the COVID-19 pandemic, a new study led by researchers at the University of Hawaiʻi and the found that Hawaiʻi experienced a smaller decline compared to national trends.

Yan Yan Wu, Michael Phillips and Kathryn L. Braun from the ¶«¾«Ó°Òµ ²ÑÃ¥²Ô´Ç²¹ , along with Lance Ching and Claire Prieto from the , found that life expectancy in Hawaiʻi declined by 1.4 years, from 82.1 in 2019 to 80.7 in 2021. Nationwide, the decline over the same period was 2.4 years, from 78.8 to 76.4. Their findings were published in the .

“The smaller magnitude and delayed timing of Hawaiʻi’s decline may reflect the state’s geographic isolation and early implementation of public health interventions,” said Wu, the study’s lead author. “In 2022, life expectancy partially rebounded by 0.5 years in Hawaiʻi and by 0.9 years nationally, with Hawaiʻi remaining about four years higher than the U.S. average throughout the pandemic.”

“Hawaiʻi ranks among the top U.S. states for COVID-19 vaccination coverage. By May 2023, data reported by the U.S. Centers for Disease Control and Prevention (CDC) showed that more than 90% of residents received at least one dose and more than 80% were considered fully vaccinated with the primary COVID-19 vaccine series,” said Ching, epidemiologist with the DOH Chronic Disease Prevention & Health Promotion Division. “These high vaccination levels—reached over the course of the pandemic—helped delay the peak of COVID-19 mortality in Hawaiʻi by approximately six months compared to the national average and contributed to the state’s distinction of having the lowest age-adjusted COVID-19 death rate in the country.”

Key Findings

• Life expectancy in Hawaiʻi remained stable from 2018 to 2020 (82.3, 82.1, and 82.0 years, respectively).
• A decline occurred in 2021 to 80.7 years, followed by a partial rebound to 81.2 years in 2022.
• Among males, life expectancy fell from 79.2 years in 2018 to 77.5 years in 2021, then rose to 78.2 years in 2022.
• Among females, life expectancy fell from 85.4 years in 2018 to 84.0 years in 2021, rebounding to 84.4 years in 2022.
• The gap between female and male life expectancy widened to 6.5 years in 2021 before narrowing to 6.2 years in 2022—the same as in 2019.
• Despite these fluctuations, Hawaiʻi‘s overall decline in life expectancy remained less severe than the U.S. average throughout the pandemic.

Policy Implications

The researchers note that Hawaiʻi‘s better outcomes underscore the effectiveness of early public health interventions, strong community engagement, and high vaccine uptake. They recommend that future policies build on these strengths by investing in rapid-response infrastructure and maintaining high vaccination coverage to better protect vulnerable communities during future disease outbreaks.

The COVID‑19 pandemic revealed just how vital Hawaiʻi’s public health workers are—from keeping water safe to tracking disease outbreaks. A new (HJH&SW) Special Issue maps out challenges, innovations, and opportunities shaping the future of public health in the islands.

Guest edited by University of Hawaiʻi at ²ÑÄå²Ô´Ç²¹ faculty members Tetine Sentell and Rebekah Rodericks from the in the , and Lola Irvin from the (DOH) along with many statewide partners, this special issue serves as a roadmap for sustaining and expanding Hawaiʻi’s diverse public health workforce. Conceived in response to the extraordinary efforts and capacity strains experienced during the pandemic, it highlights the urgency and opportunity to grow a workforce in ways that reflect and serve ±á²¹·É²¹¾±ʻ¾±â€™s communities.

Workforce challenges and urgent needs

Public health professionals help ensure clean air and water, safe food, and healthy environments for all residents. Yet, chronic underfunding, staff shortages, and burnout threaten this essential work. A recent DOH survey found that 43% of DOH employees (compared to 36% of other state employees) were considering leaving within a year. The department also reported a 30% vacancy rate, highlighting the ongoing workforce shortage. Nationally, public health and prevention make up less than 5% of all health spending and are often a target for budget cuts.

Areas of innovation and resilience

Despite these challenges, the special issue also provides solutions and successes:

• (PDF): providing policymakers with data to plan for future needs.
• (PDF): expanding career pathways and training for students in water, toxicology, and other areas of environmental health.
• (PDF): meeting the needs of kÅ«puna (elders) and caregivers.
• (PDF): social workers contributing through advocacy, disaster response, grief counseling, health promotion, and policy change to advance health equity.
• (PDF): the Department of Public Health Sciences strengthening workforce capacity, diversity, and connectedness by centering students and community.
• (PDF): integrating Indigenous knowledge in student training to support public health workforce diversity.
• (PDF): building future leaders through training and leadership opportunities.

“This issue articulates the multifaceted importance of this workforce in the state, as well as its size, needs, opportunities and areas of innovation and achievement,” said Sentell, professor and chair of the Department of Public Health Sciences. “We thank the journal, our amazing expert editorial board, and the reviewers and authors of the special issue for their time and expertise that made this possible.”

At the Hawaiʻi Health Workforce Summit on September 6, 2025, ¶«¾«Ó°Òµ and DOH hosted a session on supporting Hawaiʻi’s public health workforce. A follow-up webinar on October 7, co-hosted with the Hawaiʻi Public Health Institute, continued the discussion and shared resources, including a .

Hanauma Bay Nature Preserve, a popular snorkeling destination that attracts nearly a million annual visitors, underwent a remarkable and rapid recovery when tourism ceased during the 2020 COVID-19 pandemic. A study from the University of Hawaiʻi at Mānoa (HIMB), published in , found that this period of human absence led to clearer water, increased sightings of endangered Hawaiian monk seals, and more active fish populations.

“We took advantage of a unique ‘natural experiment’ created by the COVID-19 pandemic,” said Aviv Suan, project manager in HIMB’s Elizabeth Madin Lab, which leverages cutting-edge technology to research human impacts on marine ecosystems. “Hanauma Bay is normally a heavily visited site, but was completely closed to the public for seven months. We collected data on water quality, monk seal sightings, fish abundance, and fish behavior before, during, and after the closure. This allowed us to directly compare how the reef responded to different levels of human activity.”

By measuring the physical and biological health of the ecosystem, the research team found that when human visitors were absent, the reef in Hanauma Bay quickly returned to more natural levels. Fish densities changed, and vital herbivores such as parrotfish became more active in grazing algae.

“The ecosystem responded in remarkable ways,” said Elizabeth Madin, lead author of the study and principal investigator of the Elizabeth Madin Lab. “These kinds of changes happened quickly, suggesting that everyday human presence can have a real and measurable impact on reef health. It’s a powerful reminder of just how sensitive and responsive coral reef ecosystems are to our activity.”

Resilience and recovery

This research serves as a valuable case study for marine managers around the world, and provides a science-based roadmap for sustainable tourism and effective conservation strategies that can benefit both the environment and the economy.

“Putting caps on the number of visitors to reefs—especially those that are currently unregulated—could help restore lost ecological function and ease human pressures while still maintaining access,” said Madin. “Protecting these ecosystems doesn’t have to come at the cost of the economy. Yes, reef tourism brings in billions of dollars each year, both globally and here in Hawaiʻi. In fact, research shows that many visitors are willing to pay more to experience healthier, more vibrant reefs. That means we can potentially reduce crowding and still support the tourism industry and everyone who depends on it–if we manage it wisely.”

The team’s findings provide a clear and powerful message: coral reef ecosystems are incredibly resilient, and at least some key parts of the ecosystem can begin to recover quickly when human pressures are reduced.

“This study is an example of how research at the ¶«¾«Ó°Òµ can directly serve the people of Hawaiʻi by helping to guide reef management, protect natural resources, and support a more sustainable future for both ecosystems and local communities,” said Suan.

A new drug delivery system developed by researchers at the University of Hawaiʻi at ²ÑÄå²Ô´Ç²¹ (JABSOM) and Sungkyunkwan University in South Korea may significantly reduce serious lung damage. The study was recently published in the .

The team designed tiny particles, called lipid nanoparticles (LNPs), to carry two drugs directly to immune cells in the lungs called neutrophils. Using COVID-19 as a model, they showed that the LNPs only targeted these lung cells, didn’t cause harm and reduced inflammation and early signs of scarring in mice.

The researchers hope this new method can also be used to treat other lung conditions like the flu and sepsis by targeting different immune cells or delivering other types of medicine.

“This project is a great example of how interdisciplinary research can facilitate the development of novel drug delivery platforms and evaluate their efficiency in animal models,” said Saguna Verma, JABSOM professor of tropical medicine. “Recently, LNP-based selective organ targeting (SORT) has been developed for specifically targeting the liver, lung or spleen. However, the strength of this study is that our LNPs are designed not only to target the lung but specifically to lung neutrophils.”

Researchers used ¶«¾«Ó°Òµâ€™s high-security lab to safely study the virus. For the first time, they were able to send two drugs—DNase I and Sivelestat—directly to infection-fighting cells in the lungs using a new delivery method.

Normally, these immune cells release web-like traps (called NETs) to catch germs. However, when too many are made, they can harm the lungs and lead to serious problems, especially in illnesses like COVID-19, explained Juwon Park of ¶«¾«Ó°Òµ ²ÑÄå²Ô´Ç²¹.

“Although drugs that block NETs exist, they often require high doses due to instability in the body and nonspecific off-target effects,” Park said. “Our new approach overcomes these limitations by delivering both drugs directly to lung neutrophils using lipid nanoparticles, which improves drug effectiveness and minimizes side effects.”

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New research on weakened COVID-19 vaccine responses in people with obesity and diabetes is the featured study in the latest issue of , conducted by the University of Hawaiʻi at ²ÑÄå²Ô´Ç²¹â€™s (JABSOM), accompanied by cover art from a post-doctoral fellow.

The study, led by JABSOM third year medical student Brent Fujimoto and PhD alumna Olivia Smith in Professor Axel Lehrer’s lab, examines how different COVID-19 vaccines perform in individuals with obesity and diabetes—two conditions that increase vulnerability to the virus. Brien Haun, a postdoc fellow at Kapiʻolani CC, also contributed to the research and designed the cover art.

Funded by the Victoria S. and Bradley L. Geist Foundation via the Hawaiʻi Community Foundation, the study tested vaccine responses in mice with obesity and Type 1 and Type 2 diabetes. Results showed that all three conditions weakened immune responses post-vaccination, particularly in diabetic mice. However, mRNA vaccines produced strong antibody responses in all cases. Additionally, an enhanced protein vaccine developed at JABSOM (adjuvanted subunit vaccine) helped boost antibody strength in obese and diabetic mice.

mRNA vaccines remain highly effective, but people with obesity or diabetes may need additional doses or tailored interventions to enhance immune protection.
—Brent Fujimoto

“This shows us that mRNA vaccines can still be good at blocking virus responses and the CoVaccine adjuvanted subunit vaccine (enhanced protein vaccine) helps strengthen the quality of antibodies in obese and diabetic mice, making them better at recognizing and attaching to the virus,” said Smith.

Fujimoto emphasized the real-world impact. “mRNA vaccines remain highly effective, but people with obesity or diabetes may need additional doses or tailored interventions to enhance immune protection.”

Haun’s cover art, inspired by Zen philosophy and the Roman god Janus (god of beginnings and endings, gates and doors), symbolizes the delicate balance between resilience and fragility in immune responses.

“I’m so proud that our collaborative efforts in the middle of the Pacific are not only advancing our understanding of the virus, but it’s also earned us a spot on the cover of COVID,” Lehrer said. “These are achievements we can all be proud of and it’s a testament to the power of teamwork in research.”

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A study from the at the University of Hawaiʻi at ²ÑÄå²Ô´Ç²¹, reveals the crucial role that Filipino cultural values played in fostering resilience and empowerment within the community during the COVID-19 pandemic.

The research, conducted by Clifford Bersamira, assistant professor, and Jethro Macaraeg, a master of social work graduate, was published in .

“Intersecting Kapwa, Resilience, and Empowerment: A Case Study of Filipinos in Hawaiʻi During the COVID-19 Pandemic” addressed a significant gap in the existing literature on Filipino American resilience. Traditionally, the role of Filipino values in navigating adversity has been overlooked, but this study aims to bring these cultural values into the spotlight.

Focusing on the Filipino population in Hawaiʻi, which Bersamira describes as a “unique context compared with other Filipinos in the U.S.,” the study emphasized the community’s ability to overcome challenges through deeply ingrained cultural values.

“We often hear these narratives about how hardworking and resilient Filipinos are in light of the conditions they face, such as during the pandemic,” Bersamira said. “This study helps us understand the role of our culture and values in overcoming challenges and transforming our circumstances.”

This research highlighted not only the resilience of the Filipino community during the pandemic but also serves as a call to action for integrating cultural values into the broader discourse on empowerment and resilience.

Key values emerged from interviews

The study utilized data from 17 semi-structured interviews and employed narrative analysis to identify key Filipino values that emerged in stories of resilience and empowerment. Among these values, kapwa (shared identity) and karangalan-dangal (internal dignity) were found to be central. In the context of resilience, values such as kagandahang-loob (acts of goodwill), pakikisama (companionship), lakas ng loob (inner strength), hiya (propriety), and bahala na (determination) were highlighted. Meanwhile, values like pakikibaka (resistance), pakiramdam (shared inner perception), karangalan-puri (external dignity), utang ng loob (debt of gratitude), and katarungan (justice) were associated with empowerment.

“Our research highlights how Filipino cultural values like kapwa (shared identity) and karangalan-dangal (internal dignity) are vital for fostering both resilience and empowerment, helping the community not just endure challenges but actively transform the systems that create them,” said Macaraeg.

The study’s findings suggest that a deeper understanding of Filipino American resilience and empowerment requires an appreciation of these specific cultural values. For researchers and service providers, the study advocates for developing resources that are grounded in these cultural traditions, ultimately inviting a rethinking of strategies to support the Filipino American community.

—By Maria Pou

Assistant Professor Frankie B. Hale of the (SONDH) at the University of Hawaiʻi at ²ÑÄå²Ô´Ç²¹ earned an award for writing excellence of a first-time school nurse author.

Hale, who teaches pathophysiology, among other undergraduate and graduate courses at NAWSON, served as first author of the manuscript, “Effects of the COVID-19 pandemic on school nurses’ resiliency and ability to cope: A mixed methods study in the state of Hawaiʻi.” Co-authors included Deborah Mattheus, Betty Fletcher, Alexandra Michel and Holly B. Fontenot.

Hale’s honor is the First Publication Award from The Journal of School Nursing (JOSN).

“Winning this award from JOSN/Sage was humbling, and I am incredibly thankful for everyone involved,” Hale said. “I believe when we think of frontline nurses, school nurses should be among them. We need to know about the hard work school nurses input daily, from their front line, in their everyday effort to promote a healthy and safe school environment.”

Hale is now working on a follow-up study with Mattheus, exploring school nurses’ stress, resilience and workplace issues in the aftermath of the COVID-19 pandemic.

The manuscript was chosen from eligible manuscripts in 2023 in JOSN, a bi-monthly, peer-reviewed journal that focuses on improving the health of school children and the health of the school community, published by SAGE Publications.

Before joining academia in 2010, Hale served as a registered nurse for 14 years. She earned her bachelor of science in nursing from Howard University, specialized in nursing education for her master of science from Georgetown University and earned her PhD in nursing from ¶«¾«Ó°Òµ ²ÑÄå²Ô´Ç²¹.

An analysis of the COVID-19 pandemic’s effect on food supply chains in Hawaiʻi and Fiji has earned a faculty member in the (DURP) at the a national award.

Subhashni Raj, a DURP assistant professor, is one of 11 recipients of the ’s (FFAR’s) 2023 New Innovator Awards. Raj’s projects focus on understanding the role of Indigenous and ancestral food pathways in maintaining food security during a crisis.

“Establishing food security post-disaster is critically important, yet marginalized or vulnerable communities—especially island communities—are less likely to be prioritized in these scenarios,” said Raj. “My hope is that, through this comparative research we will undertake In Fiji and Hawaiʻi, we can demonstrate that creating space for traditional, cultural, ancestral, and Indigenous foodways in our communities is central to building resilience.”

Raj, who has a PhD in urban and regional planning from the State University of New York at Buffalo, was a Fulbright scholar and Kaufman doctoral fellow in food systems planning.

The New Innovator Award is bestowed on early-career scientists supporting research in one of FFAR’s research priority areas. Cumulatively, the recipients share a total of $4.8 million over three years.

Amid the aftermath of heightened xenophobia and racism toward Asian Americans during the COVID-19 pandemic, faculty from the University of Hawaiʻi at ²ÑÄå²Ô´Ç²¹ exposed the challenges and resilience of these communities in three publications.

Yeonjung Jane Lee, Sophia Lau and Clifford Bersamira, alongside master of social work student Jaron Yamauchi, aimed to address anti-Asian racism by understanding the experiences of Asian American social workers with the current climate of division and hostility.

“We saw community members in action, mobilizing, advocating and supporting one another,” Lau said. “We felt it was imperative that, as frontline workers during the COVID-19 pandemic, Asian American social workers’ stories, experiences, as well as their recommendations on advocacy efforts to combat anti-Asian racism were heard.”

The team interviewed 17 social workers across the nation. Their collaborative efforts helped shed light on the multifaceted nature of discrimination and its implications. Their findings were published in , and .

Among the findings:

• The damaging impact of stereotypes, such as the model-minority and perpetual foreigner tropes, which perpetuate unfair pressures and ostracization.
• The urgent need for social work education to better equip students with tools for supporting marginalized communities and for workplaces to address bias and discrimination.
• The call for specialized support for older generations of Asian Americans, who are more vulnerable to mistreatment yet may hesitate to report incidents.

“Our hope is that this study encourages future research on how we can support Asian American social workers and those from other marginalized communities and address their needs,” Bersamira said.

Lau added, “Raising visibility about the unique circumstances that Asian Americans experience that includes their strengths and resiliency is critical on so many levels. In addition to the diverse ways bias and discrimination can look and be experienced, understanding the scope and intensity of these issues can support more meaningful interventions and outcomes.”

—By Maria Pou

One of the largest studies on wildlife activity—involving more than 220 researchers, 163 mammal species and 5,000 camera traps worldwide—reveals that wild animals react differently to human activity levels depending on where the animals live and what they eat. Hawaiʻi-based authors include University of Hawaiʻi at Mānoa researchers Melissa Price and Derek Risch.

The study used data from before and during the COVID-19 lockdowns to examine wild mammal behavior amid changing human activity levels. Bigger herbivores—plant-eating animals such as deer—tend to become more active when humans are around, while meat-eaters such as wolves tend to be less active, preferring to avoid risky encounters. Hawai‘i lacks native land-based mammals other than the Hawaiian Hoary Bat, an insectivore. Herbivores such as Axis Deer and feral goats, and small predators such as feral cats, were introduced by humans in the last few centuries.

“The tendency for large herbivores to become more active near humans presents a number of challenges especially here in Hawaiʻi where nearly all of our terrestrial mammals are non-native,” said Risch, a researcher in the . “Animals being more active and increasingly nocturnal around humans increases the likelihood of harmful human-wildlife conflicts like car strikes and disease transmission. People can help by appropriately disposing of trash and refraining from feeding wild animals.”

Why it matters

These findings highlight the importance of measures to minimize any detrimental effects of human disturbance on wildlife, especially in Hawaiʻi where many of our wildlife are endangered with less than a few thousand or even a few hundred individuals remaining.

“In the Hawaiian Islands, people are very active in coastal areas where our native seabirds and sea turtles are impacted by human activity, artificial lights, plastic pollution, and invasive cats, rats, and mongoose,” said Price, a ¶«¾«Ó°Òµ Mānoa professor of wildlife. “Knowing that our choices matter is the first step in taking better care of our native plants and animals.”

Communities can help by turning off artificial lights during the seabird fledgling season in October and November, participating in beach clean-ups and other mālama ‘āina volunteer days, and keeping pets on a leash when outside.

In more remote areas, keeping human activity low may be necessary to protect sensitive species. In areas where people and animals overlap more, such as cities, nighttime is an important refuge for wildlife, and keeping it that way can help species survive—and humans thrive. For example, efforts such as the Dark Skies Initiative protect seabirds and sea turtles while improving human health and our ability to see the stars.

Unique opportunity

Urban animals such deer or feral pigs may become more active around people, as they get used to human presence and find food like garbage or plants, which they can access at night. But animals living farther from cities and other developed areas are more wary of encountering people.

“COVID-19 mobility restrictions gave researchers a truly unique opportunity to study how animals responded when the number of people sharing their landscape changed drastically over a relatively short period,” said lead author Cole Burton, an associate professor of forest resources management at University of British Columbia and Canada Research Chair in Terrestrial Mammal Conservation.

The study was published March 18, in .

Antibodies are versatile proteins that identify and eliminate microbial invaders, toxins and cancer cells. Monoclonal antibodies (mAbs)—highly purified antibodies developed in laboratories using biotechnology—have played an instrumental role in developing immunotherapies that have curbed the severity or prevented outbreaks of critical illnesses. Since the COVID-19 pandemic, global awareness and understanding of the benefits and potential of antibodies have become commonplace, and the market for antibodies is exponentially growing.

Decades before the COVID-19 pandemic, ’s Monoclonal Antibody Service Facility and Training Center (MASFTC) had been developing antibodies for public impact research and educational purposes. MASFTC has worked with researchers across the state and the country to develop hundreds of antibodies to support the development of potential immunotherapies for cancer, Zika, COVID-19 and the Ebola virus.

MASFTC has also provided antibodies to illuminate research related to wildlife diseases. In partnership with Thierry Work, wildlife disease specialist and project leader for the National Wildlife Health Center Honolulu Field Station, MASFTC developed mAbs that led to novel discoveries about Hawaiʻi’s endangered green sea turtles.

“As a fundamental tool for biomedical research, we are incredibly fortunate to have a facility in Hawaiʻi that operates as a partner and an engaged, constructive member of Hawaiʻi’s scientific community,” said Work. “I would find it hard to see how we could do some of this specialized research here without them.”

Expanding educational and training opportunities

In 1994, Kapiʻolani CC microbiology Professor John Berestecky expanded the facility into a training center to provide undergraduate and graduate students opportunities to engage in higher level laboratory activities through federal funding. Since then, more than 70 students have graduated from the program into advanced degrees or careers with biotech companies, the Hawaiʻi State Department of Health, clinical diagnostic labs and COVID-19 testing facilities.

“Our hope is to transform MASFTC into a ¶«¾«Ó°Òµ core facility to be able to service any ¶«¾«Ó°Òµ campus or department as well as other local companies and organizations that need antibody research and development,” said Berestecky. “I’m hoping our efforts allow us to eventually run a research lab to support and develop our antibody therapeutics capacity and initiatives.”

For more on MASFTC, . Noelo is ¶«¾«Ó°Òµâ€™s research magazine from the .

While Hawaiʻi’s economic reliance on tourism took a major hit during the COVID-19 pandemic, the industry has periodically been punctured by shocks. For example, the 1991 recession, 9/11, the 2001 recession and the Great Recession all led to sharp declines in tourist numbers and spending.

A new and by Assistant Professor Steven Bond-Smith provides insights into how the state can diversify its economy, so when tourism contracts, other sectors expand. Bond-Smith has provided a short list of industries with potential to “make use of uniquely Hawaiʻi capabilities and are appropriate for our small scale.”

Economic opportunities

Based on recent research, Bond-Smith said economies grow by diversifying into related industries. Two industries are related if they both use similar capabilities, such as a shared pool of workers with particular skills. For example, Hawaiʻi’s expertise in caring for visitors could transfer to health support and rehabilitation in the healthcare industry, which would have very different demand dynamics than the tourism industry.

According to Bond-Smith, if some of those conditions to be successful are uniquely tied to Hawaiʻi, then those industries cannot easily shift somewhere else. For example, Hawaiʻi is located on the trans-Pacific internet cables. This makes it a potential location for data centers to host international web-based services that would act as a stepping stone for U.S. start-ups seeking to expand internationally.

“In this way, Hawaiʻi becomes a gateway to Asia for bits and bytes,” Bond-Smith said. “Similarly, Hawaiʻi could be the ideal stopover location for transit between Asia and South America, specifically targeting business travel. China and Brazil are two of the fastest growing economies in the world. And astronomy relies on Hawaiʻi’s high mountains and clear air, which brings a unique STEM industry that is otherwise difficult to come by.”

Hawaiʻi’s economy is small, so Bond-Smith said that we need to find industries that suit small economies. Finance is more suited to very large cities, such as London, New York and San Francisco. However, professional, scientific and technical services are much more common in metro areas of around one million people, such as Honolulu. Similarly, food manufacturing is common in smaller cities with surrounding agriculture, such as around Hilo.

Evolution of tourism

For a long time, tourism in Hawaiʻi experienced significant growth in both visitor numbers and expenditures. Technologies such as the jet engine, and a growing and increasingly wealthy middle class who wanted to vacation in Hawaiʻi, made tourism a lucrative industry. This translated into substantially higher real GDP per capita in Hawaiʻi than in the rest of the U.S. However, visitor spending stopped growing in recent decades while the number of tourists continued to increase. For several decades, the tourism industry has not contributed to growth in per capita GDP in the same way that it had in the past.

“All of this research agenda aims to identify which industries we should expect to see in Hawaiʻi and each of its counties, but are currently missing or weak,” Bond-Smith said. “Then policy makers and entrepreneurs can take a closer look at those industries to see what is preventing them from being stronger. Initiatives need to be designed with a commitment by governments and community organizations to address these barriers.”

To read the entire blog, visit .

¶«¾«Ó°ÒµERO is housed in ¶«¾«Ó°Òµ ²ÑÄå²Ô´Ç²¹â€™s .

More than three years since COVID-19 was introduced to the world, most Hawaiʻi residents consider their health to be good or excellent. But there are significant differences across socio-economic and demographic categories, including ethnicity, according to the results of a (¶«¾«Ó°ÒµERO).

The ¶«¾«Ó°ÒµERO Public Health Report, “Shaping Health in Hawaiʻi: The Influences of Poverty, Housing and Food Insecurity,” surveyed 1,575 adult residents across the state. The study examined the links between mental health, food security and socio-economic determinants, such as housing conditions and poverty status. The report shows that those experiencing housing insecurity, food insecurity and poverty were more likely to have been negatively impacted by the pandemic and reported worse physical and mental health.

“The survey underscores the intricate links among health, socio-economic status and lifestyle conditions in shaping individual well-being,” said lead researcher Ruben Juarez, ¶«¾«Ó°ÒµERO-HMSA Endowed Professor in Health Economics. “The pervasive impacts of the COVID-19 pandemic, particularly Long-COVID, highlight the continuous need for multifaceted interventions that address economic stability, housing security and equitable healthcare.”

Long-COVID affected 35% of respondents, up from 30% in 2022. Juarez said that there is a clear association between long-COVID and unemployment, with 49% of unemployed vs. 28% of employed individuals reporting long-COVID in May 2023.

Other key findings include:

• General health outcomes. More than 70% of participants considered their health to be good to excellent, but Native Hawaiians and Filipinos tended to report lower health ratings in comparison to Whites and Non-Filipino Asians. Individuals with high income or food security tended to have more positive health perceptions, while those dealing with the long-term effects of COVID-19, or who had delayed healthcare, especially mental health services, reported lower health scores.
• Mental health and well-being. One-third of participants reported symptoms of depression, with significant risk factors being unemployment and recent COVID-19 positivity. Housing instability, housing cost burden and poverty were also correlated with higher rates of depression symptoms. About 80% of respondents reported no food security issues, but—compared to findings in 2022—there was a small increase in those reporting very low food security. Unemployment, recent COVID-19 positivity, younger age, certain ethnicities such as Native Hawaiians and Filipinos, poverty and housing instability all correlated with increased food insecurity.

This report is based on results from the third wave of the ¶«¾«Ó°ÒµERO Rapid Health Survey conducted in June 2023 by ¶«¾«Ó°ÒµERO’s public health team, in partnership with the . In future reports, the team aims to increase the sample size of survey respondents and deepen its exploration of these findings, including exploring causality and cost, to offer a more thorough understanding of these complex social determinants of health.

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Nearly 100% of Hawaiʻi residents aged 18—35 surveyed, utilized some form of digital or social media to find information about COVID-19 or related topics, according to by the University of Hawaiʻi at ²ÑÄå²Ô´Ç²¹ . Researchers hope their findings, published in the International Journal of Environmental Research and Public Health, will help to guide future policy and create equitable public health programs.

Led by Thompson School faculty member Michael Phillips and Professor and Interim Dean Tetine Sentell, the study was conducted by an interdisciplinary research team that included both doctoral and undergraduate public health students. The overall objective was to describe and better understand the health information pathways of young adults in the state of Hawaiʻi to provide practical insights for achieving health equity.

“With so much reliance on social media for health information searching and sharing there has been a continual growth in the need to develop active social media-based health promotion campaigns to combat misinformation,” said Phillips. “Our study supports that goal with practical information.”

Of the 324 participants surveyed for the study, 99.7% used digital or social media as a resource for COVID-19 or health-related topics. The two main digital media sources were Facebook and Instagram being used by the majority of participants; however, Twitter, TikTok, Reddit, Snapchat and YouTube were also mentioned. With the understanding that Facebook and Instagram tend to be heavily utilized by young adults, researchers found this information can be leveraged in public health interventions targeting young adults.

This study also highlighted the increasingly well known fact that health information searching and engagement is a distributed effort across social networks and not siloed for individuals. It was discovered that on average, the participants were discussing their own health with 2–3 people and listening to roughly the same number of people talk about health issues.

Respondents reported searching for digital health information themselves, as well as for parents, grandparents and children among others. The Pacific Islander group had the highest percentage of searching for “others” specifically.

Health communications within communities

Native Hawaiian, Pacific Islander and Filipino communities have experienced deep COVID-19 inequalities and are considered priority populations in public health planning and action in the state of Hawaiʻi. The study revealed insights into young adults’ social networks and information sources that can support and designing effective health communication.

“Creating public health communications that acknowledge and build from community strengths is critical to achieve goals of health equity,” said Sentell. “For Native Hawaiian, Pacific Islander, Filipino, as for many communities in Hawaiʻi, this includes intergenerational and communal perspectives of health and wellbeing.”

Enhancing trustworthiness of online content

This study highlighted and quantified characteristics in social networks across our communities. It found that many are left out of social networks, with more than 28% indicating they shared their health concerns with no one. In addition, social relationships can have both negative and positive influence on health information or health behaviors. Social networks can also have limited information in them. Thus, it is important to introduce trusted information into these networks.

“There is a need to expand the frequency and sophistication of health interventions utilizing digital media to enhance the trustworthiness of online content and digital health literacy,” said Phillips.

Other study authors include: Rosana Hernandez Weldon, Anam Maniar and Uday Patil, ; Uliana Kostareva, ; Julia Finn, Thompson school; and Joy Agner, University of Southern California.

More Hawaiʻi residents are contracting COVID-19, fewer are getting COVID-19 booster shots and the number of those impacted by long-COVID illnesses remain high, according to a new comprehensive report released on January 5 by researchers in the (¶«¾«Ó°ÒµERO).

The report is based on survey responses from 1,627 Hawaiʻi residents over the age of 18 in fall 2022. In partnership with the , this was the second survey developed to inform the design and execution of public health programs in Hawaiʻi for COVID-19 and other disasters while addressing systemic health disparities. Researchers have a statewide cohort of more than 2,000 adult residents in the state that are being surveyed regularly over time.

The first report was released on June 20, 2022 and was based on survey responses conducted in May 2022.

Highlights of the January 5 report:

COVID-19 outcomes and vaccination

• COVID-19 positivity has increased since the last report. In November, 45.5% of respondents had tested positive for COVID-19 at least once, compared to only 24.8% in May. Higher rates continue to be seen among younger adults, Native Hawaiian, Pacific Islander, and Filipino populations, as well as among unvaccinated and unboosted individuals.
• High vaccination rate and low booster shots among adults. 94.5% of respondents are vaccinated but only 27% of the sample received the bivalent booster shot.
• Long-COVID outcomes remain high. The overall rate of long-COVID remained stable at close to 30%, but more individuals reported severe or very severe symptoms in the fall compared to the spring. The expected length of long-COVID symptoms increased by almost one month since the last report to 4.42 months.
• Flu shot uptake is correlated with COVID-19 vaccination. 62% of respondents have already gotten their flu shots, with an additional 8.4% planning to get one. 77.3% of COVID-vaccinated individuals have or plan to get a flu shot, compared to only 21.8% of those COVID-unvaccinated.

Perceptions and views of COVID-19

• Perceptions of neighborhood/community safety against COVID-19 have risen. More people felt safe or very safe in the fall (68.7%) compared to the spring (61%).
• Some people feel COVID-19 fatigue. Signs of COVID fatigue are present in our populations. The highest levels were found among those unvaccinated and those vaccinated without booster shots.

COVID-19 Impacts

• The impact of the COVID-19 pandemic continues to increase since May 2022. 28.6% of the individuals reported having their savings depleted, 13.6% were unable to pay bills and 9% did not have enough food in their household. 4.4% of the individuals lost their jobs, and 7.2% of the individuals were furloughed or reduced their working hours since May 2022.
• Long-COVID is negatively affecting employment. Despite the rate of long-COVID being about 30%, unemployed individuals have a 47% rate of long-COVID, a 5-point increase since May.
• Depression symptoms remain high but stable. Rates of depression symptoms remained stable since May, at about 1 in 3 adults reporting depression symptoms, with higher levels of depression reported by those affected by the pandemic.
• Race disparities were observed in mental health outcomes. Korean and Japanese respondents had the best mental health outcomes, while Native Hawaiian, Latino and Native American respondents had the lowest mental health outcomes.
• Food insecurity remained high but stable. The percentage of respondents reporting low food security reduced slightly to 8.2% from 8.4% in May.

“Overall, as we enter a new phase of the pandemic, Hawaiʻi’s populations are becoming more confident that the worst of the pandemic is behind us, driving COVID-19 booster uptake down,” according to Ruben Juarez, HMSA Endowed Professor in Health Economics at ¶«¾«Ó°ÒµERO. “Significant impacts exacerbated by the pandemic, including long-COVID, mental health issues and the impact of long-COVID on unemployment, may pose significant challenges that warrant monitoring.”

¶«¾«Ó°ÒµERO is housed in ¶«¾«Ó°Òµ ²ÑÄå²Ô´Ç²¹â€™s .

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Hawaiʻi has the highest life expectancy at birth, according to the Centers for Disease Control and Prevention. Still, that success is not reflected in Native Hawaiian and other Pacific Islander (NHOPI) populations. State data show NHOPI have seven to 10 years less in life expectancy than other Hawaiʻi residents, and researchers from the University of Hawaiʻi at ²ÑÄå²Ô´Ç²¹ (JABSOM) and other ¶«¾«Ó°Òµ health sciences units are investigating the sources of the disparities and ways to close the gap.

The National Institutes of Health (NIH) awarded researchers a five-year, $22,557,840-million U54 grant to foster research into health disparities and to conduct three large studies to explore genetic, environmental and socio-economic related disparities in health and health-care access for specific communities in Hawaiʻi. Specifically, the studies focus on the long-term impact of COVID-19, the role of exercise with type 2 diabetes and dietary impacts on the Native Hawaiian population.

JABSOM Dean Jerris Hedges and Thompson School of Social Work & Public Health Dean Emeritus Noreen Mokuau serve as multiple principal investigators for Ola HAWAIʻI.

Hedges said, “This grant helps unite ¶«¾«Ó°Òµ and community members seeking to improve health in Hawaiʻi through sound science.”

“Funding from the NIH is the premiere form of health research funding because everything you do for NIH connects back to the larger, national agenda on public health and healthcare,” said Mokuau.

Based at JABSOM, Ola HAWAIʻI (Ola means health or to heal in Hawaiian, and HAWAIʻI stands for Health And Wellness Achieved by Impacting Inequalities) collaborates with community and ¶«¾«Ó°Òµ ²ÑÄå²Ô´Ç²¹ partners. Ola HAWAIʻI investigators seek to close the health and longevity gap between NHOPI and the rest of Hawaiʻi‘s population through biomedical, behavioral and clinical research.

“It’s about seeding ideas that best benefit the people of Hawaiʻi, in areas such as cardiovascular health, diabetes and COVID-19,” Mokuau added. “The John A. Burns School of Medicine is the essential leader in the state of Hawaiʻi for health, in general, and in reducing health care disparities in particular. Ola HAWAIʻI‘s work focuses on the kinds of research that help us find new interventions and treatments to support underserved populations who sometimes have less direct access to health care.”

“As we conduct research that will lead to interventions which help people, at some point, we begin to extend and enhance lives. That’s what this is about.”

The three projects part of the grant include:

Exercise, Exosomes & Metabolic Health in Type-2 Diabetes

Native Hawaiians and other Pacific Islanders are disproportionately affected by type 2 diabetes. While exercise can successfully reduce the risk of developing type 2 diabetes, the exercise benefits for the NHOPI population are not as significant when compared to Whites. This study will investigate the role that nano-sized sacs play in lowering the risk of diabetes while identifying exercise and lifestyle guidelines that could be tailored for the NHOPI population. Noemi Polgar, Nicholas James and Scott Ferguson are the principal investigators.

MALAMA: Backyard Aquaponics to Promote Healthy Eating & Reduce Cardiometabolic Risk

Native Hawaiians have the highest mortality rates of cardiometabolic diseases, like heart disease and diabetes. Researchers are testing the efficacy of MALAMA, a culturally-grounded, family-centered backyard aquaponics program that’s planted in multiple Native Hawaiian communities. The goal is to reduce food insecurity, while increasing the consumption of healthy foods, which could lower the risk of cardiometabolic diseases in the Native Hawaiian population. Jane Chung-Do and Heidi Ilima Ho-Lastimosa are the principal investigators.

Factors Responsible for the Development of Post-Acute Sequelae of Acute COVID Infection in Hawaiʻi

Nearly a third of people who recover from acute COVID-19 will have what’s known as long-COVID. Many of those with long-COVID also have pulmonary problems like persistent cough and labored breathing. Researchers are investigating the change in the body’s function that causes disease, and how social and psychological situations could contribute to long-term outcomes, particularly for Native Hawaiians and other Pacific Islanders and Filipinos. Gehan Devendra and Juwon Park are the principal investigators.

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With updated COVID-19 boosters being recommended to provide increased protection against the circulating omicron variant, a new paper by University of Hawaiʻi at ²ÑÄå²Ô´Ç²¹ and Waiʻanae Coast Comprehensive Health Center (WCCHC) researchers is shedding light on who is getting booster shots in Hawaiʻi, and how trust and consumption of different information sources affect that decision.

The paper, “,” was published August 31, in Vaccines.

Results of the study show individuals vaccinated within two months of eligibility tended to have more years of schooling, with greater trust in and consumption of official sources of COVID-19 information, in comparison to those who waited three to six months, or those who remained unvaccinated at six months post-eligibility. Most or 70% of those individuals who were vaccinated within two months of eligibility took the booster shot, compared to only 30.5% of those who waited three to six months, with the latter group gaining trust and consumption of official information after four months.

“This study shows that social factors, including education and individual-level degree of trust in sources of COVID-19 information, played a large part in whether someone decided to get a booster shot,” said Ruben Juarez, an economics professor in ¶«¾«Ó°Òµ ²ÑÄå²Ô´Ç²¹â€™s and HMSA Endowed Professor of Health Economics at . “COVID-19 booster hesitancy remains an issue in our community, and understanding what contributes to this has significant implications to ongoing public health responses as we enter a new phase in the pandemic.”

Researchers collaborate to survey adults

Working in collaboration with the , ¶«¾«Ó°Òµ researchers surveyed almost 1,600 Hawaiʻi adults enrolled in the group’s COVID-19 testing program. Study participants completed standardized surveys from January to February 2021 on demographics, vaccination status and trust in sources of COVID-19 information during the delta wave. Of those, about 800 individuals or 50.3% completed a follow-up survey from January to February 2022 during the omicron wave.

“Results from our study reinforces the need to nurture trust and promote health literacy in our community, which our model predicts will improve vaccine uptake, including boosters. This is especially important given new COVID-19 vaccines recently announced by the FDA that target the Omicron variant that is currently circulating in our population,” said Alika Maunakea, (JABSOM) associate professor.

Added May Okihiro, JABSOM associate professor and pediatrician at WCCHC, “This data provides critical information for the Department of Health and our community of health centers to act on the development of effective strategies that include vaccination to help us emerge out of this pandemic.”

In addition to Juarez, Maunakea and Okihiro, other co-authors include:

• Zheng Kang, graduate research assistant, Department of Economics and ¶«¾«Ó°ÒµERO, College of Social Sciences;
• Krit Phankitnirundorn, computational biologist, JABSOM, Department of Anatomy, Biochemistry and Physiology;
• Blane K. Garcia, community facilitator, WCCHC.

University of Hawaiʻi at ²ÑÄå²Ô´Ç²¹ researchers are analyzing wastewater collected in Honolulu for the COVID-19 virus and its properties to gain a greater understanding of the virusÊ»s community spread. The technique that may be utilized in the future to measure the presence of other types of viruses.

The project, led by ¶«¾«Ó°Òµ ²ÑÄå²Ô´Ç²¹ and Professor Tao Yan, began in mid-2020, just several months into the pandemic. The team partnered with the City and County of Honolulu to collect wastewater samples. Thirteen samples taken from the Sand Island Wastewater Treatment Plant between June and December 2020 were analyzed in a laboratory at ¶«¾«Ó°Òµ ²ÑÄå²Ô´Ç²¹.

The researchers discovered that the D614G mutation was the most prevalent mutation in those samples. According to Yan, the D614G mutation has now been found in 15 COVID-19 variants of concern, including Alpha, Beta, Delta, Epsilon, Eta, Gamma, Iota, Kappa, Lambda, Mu, Omicron BA.1, Omicron BA.2, Omicron BA.3, Theta and Zeta. Detecting the mutation is one of the indications that the virus continues to evolve.

Yan’s team is also currently analyzing previously collected wastewater samples from locations within ¶«¾«Ó°Òµ ²ÑÄå²Ô´Ç²¹ student housing and the ²ÑÄå²Ô´Ç²¹ Valley watershed/sewershed. They are hoping to determine if the SARS-CoV-2 viral mutations collected in ²ÑÄå²Ô´Ç²¹ are different from those collected from the Sand Island samples and how different mutations emerged from the beginning of the pandemic.

“This virus will continue to mutate, and some more ominous variants may emerge as a result,” Yan said. “Wastewater surveillance has the potential to provide comprehensive and even early detection of mutations. What we have done is to use past samples and data to develop and calibrate the tools, and the next step will be to use them for forecasting.”

Yan’s research team includes postdoctoral researchers Doris Di and Bo Li, and graduate research assistant Min Ki Jeon.

Related ¶«¾«Ó°Òµ News stories:

• COVID-19 in Honolulu wastewater reflects levels of infection, April 19, 2021
• ¶«¾«Ó°Òµ ²ÑÄå²Ô´Ç²¹ COVID-19 wastewater surveillance project receives NSF funding, April 27, 2020

A national study looking at the impacts that mandated vaccine policies had on universities and colleges and their surrounding communities found that those policies reduced the overall death rate of the U.S. in fall 2021 by about 5%, roughly 7,300 lives.

Almost 700 colleges and universities across the country established COVID-19 vaccine mandates to return to campus. Researchers took data from the first 13 weeks of the fall 2021 semester. They found that colleges that had vaccine mandates reduced new COVID-19 cases by 339 per 100,000 residents in the surrounding communities, and new deaths by 5.4 per 100,000 residents.

The study by the National Bureau of Economic Research was conducted by researchers at Miami of Ohio University and Michigan State University.

“This study shows the importance these vaccines can have beyond our campuses, which in a place like Hawaiʻi is especially sensitive to our close-knit communities,” said Lee Buenconsejo-Lum, associate dean for academic affairs at University of Hawaiʻi at ²ÑÄå²Ô´Ç²¹â€™s . “It is important to note that while much of our lives are returning to normal, we are still in a pandemic and we need to consider the best ways to protect ourselves and those around us.”

The study did not point to whether or not such policies should be mandated, but the authors said it is important that the impacts of such decisions be part of the available facts.

Pfizer and Moderna have both announced plans to release updated vaccines this fall in hopes of keeping up with the new variants of COVID-19.

Hawaiʻi healthcare workers surveyed in 2020 were primarily concerned about contracting COVID-19 at work and transmitting it to their families, according to a recently published University of Hawaiʻi at ²ÑÄå²Ô´Ç²¹ . The survey was conducted between July and October 2020 by Anna D. Davide and Amelia R. Arechy, who earned their bachelor’s of arts degrees in public health in December 2020 and May 2021, respectively.

“As essential workers on the front lines of a pandemic, healthcare workers are unable to shelter-in-place, and to treat patients, often cannot obey physical distancing guidelines, making them highly exposed and vulnerable to infection,” said Davide.

According to , 93% of health care workers were experiencing stress in 2020, and 76% of healthcare workers with children reported that they were worried about exposing their families to COVID-19.

Davide added, “Despite this, we did not know about the impact of COVID-19 on the physical and emotional health of Hawaiʻi healthcare workers, or how healthcare workers in Hawaiʻi may have experienced the COVID-19 pandemic differently than those in less isolated geographic regions—this study worked to change that.”

The study also highlighted several findings of how the pandemic has affected the local healthcare community:

• Solo practitioners in outpatient clinics reported increased financial challenges and greater difficulty obtaining personal protective equipment than those employed by hospitals or group practices.
• Nearly all participants noted an increased use of telehealth options for healthcare access.
• Inequities in access to telehealth services among kÅ«puna (elders) and underserved populations, including those with poor internet connectivity and low technological literacy.
• Participants expressed worry that the new “forgiving” workplace attitudes that emerged from the pandemic would be diminished after the spread of COVID-19 subsides.
• Additional mental health support and resources from employers are needed.

Study methods

Data for the study was collected through qualitative interviews and demographic surveys. Davide and Arechy recruited two cohorts for the interview portion, which consisted of 15 participants in Cohort 1 (July–August) and 16 participants in Cohort 2 (September–October), all between the ages of 18–60+ years old. Seven themes were identified among the participants utilizing thematic analysis: 1) Emotional effects 2) Physical effects, 3) Workplace effects, 4) Telehealth and patient care, 5) Private practice challenges, 6) Mental health resources and 7) Regional attitude.

The demographic surveys were self-reported and included 28 physicians and three registered nurses. Participants were asked about their degree of worry about the COVID-19 pandemic, their overall wellbeing at the beginning of the pandemic, and their degree of worry at the time of the survey.

“I thought the most interesting finding was the increase in telehealth use among physicians and the perceived impact it would have in the future. It appears that the COVID-19 pandemic may have helped create a shift in medicine in Hawaiʻi by encouraging hospitals and clinics to provide virtual care and increase accessibility for patients,” said Arechy.

“I was proud of Ms. Arechy and Ms. Davide’s decision to use their undergraduate capstone project to contribute to our understanding of the pandemic’s impact on the health care community. Their work is an outstanding example of our students’ passion for public health,” said Opal V. Buchthal, assistant professor of public health.

Overall, available personal protective equipment, good communication and leadership from employers, and new information regarding best practices against COVID-19 contributed to health care workers’ sense of safety. The study’s findings help bring a better understanding on the effect of the pandemic on health care workers. Further research into the effects of COVID-19, specifically on nurses in Hawaiʻi, is recommended by the researchers.

Davide and Arechy’s co-authors on the paper also included Buchthal, and Professor Joseph Keaweʻaimoku Kaholokula and Assistant Professor Andrea H. Hermosura from the at the John A. Burns School of Medicine.