Bayanihan – Promoting Organ Donation in Filipinos Living in Hawaii
Very few ethnic minorities, especially Filipinos, volunteer to become organ donors, even though ethnic minorities are often overrepresented on lists of people waiting for a transplant. However, there are ethnic, cultural, religious, and personal barriers to becoming a designated organ donor. The factors that promote and/or inhibit organ donation in ethnic minorities, especially Filipinos, are not fully understood. The Bayanihan Project is designed to assess awareness and attitudes toward organ donation in Filipinos living in Hawaii. Six focus groups were conducted with participants ranging from adolescents (high school seniors) to adults who represented various key groups in the Filipino community (i.e. church members, nurses, physicians, organ recipients, and organ donor families). The participants’ (N=56) mean age was 43 and 75% were female.

A qualitative theme analysis was used to identify seven key topics or themes, and to determine how often each theme was mentioned by each focus group. The themes and how often they were mentioned (i.e. percentages) were: religion (10%), family (25%), knowledge /misinformation (38%), medical knowledge/issues (6%), personal experience with organ donation/ recipient (8%), attitude/emotions (10%), and culture/ethnicity (3%). Thus, across all the groups, the most prevalent themes were knowledge and family. There were differences in the number of times a particular theme was mentioned within any one focus group. For example, the most prevalent theme for the church group was family, not religion; but, almost every theme was mentioned in all of the six focus groups. Understanding a specific ethnic group’s knowledge, attitudes, and cultural beliefs regarding organ donation is important to the development of community-based educational campaigns to encourage organ donation in ethnic minority populations.

Factors Influencing Physical Activity in New Mothers in Hawaii
Adult women with young children are much less likely to be regularly active compared to women without children. New mothers are also at increased risk for postpartum weight gain. The factors that promote and/or inhibit physical activity (PA) in new mothers, especially differences across ethnic groups, are not fully understood. To identify PA issues in these women, five focus groups were conducted with mothers of infants less than 12 months of age. Women were recruited largely through Baby Hui, an organization that places mothers in small support groups consisting of 6-12 mothers with similarly aged infants. The participants’ (N=43) mean age was 31.5 ± 6, and the mean age of their infants were 6 months ± 3. Ethnicity was 35% white, 39% Asian/ Filipino, and 20% Hawaiian / Pacific Islander (Albright, et. al., 2004).

Women reported their level of PA before the pregnancy and after the birth of their child, yielding 4 groups: 1) 18% were sedentary before and after birth, 2) 14% exercised both before and after birth, 3) 16% increased PA after birth, and 4) 51% decreased or stopped PA after birth. Most exercisers reduced intensity/frequency postpartum. Barriers to PA included: personal (too tired, lack of sleep, no “personal” time), financial (money for PA now spent on diapers), parenting (breast feeding, babysitting, other children), cultural norms (Asian cultural belief that baby should not leave home during the first 3 months), and social support (husband not supportive of PA). New mothers are at high risk for inactivity and PA relapse.

Activity Counseling Trial (ACT):
ACT was a multi-center randomized clinical trial (N=374), to increase physical activity and fitness in healthy, sedenarty adults under the care of a primary care physician [King, et.al., 1998; Albright, et. al., 2000]. The intervention compared 3 study groups that were designed to be hierarchical. The minimal intervention group, the “Advice only”, consisted of physician advice to increase PA and standard patient education materials. The “Assistance” intervention group added interactive mail and behavioral counseling at physician visits. The “Counseling” intervention group further added regular telephone counseling and behavior change classes. Sixty-seven percent of participants were less than 55 years old (mean age 51 ±10 years), 33% were minorities, and 84% had one or more other CVD risk factors.

ACT participants had increases in physical activity and fitness at the end of 2 years; however, the relative impact of the 3 intervention groups differed for women versus men. For women, cardiorespiratory fitness (VO2max) was significantly higher in the Assistance and Counseling groups than the Advice group at 24 months (mean differences 80.6 and 73.9 mL_min-1, adjusted p=0.021 and 0.046, respectively), with no difference between Counseling and Assistance groups and no significant differences in physical activity. For men, there were no significant between-group differences in fitness or physical activity, although over the 2 years they had increases in energy expenditure that represented a 5-7 mile a week increase in brisk walking. At 24 months, significantly more women in the staff counseling group and men in the staff/ mail assisted group exercised at levels that met national recommendations for moderate-to-vigorous intensity exercise. Physician advice + brief follow-up were effective in increasing physical activity [Simons-Morton, et. al, 2001].

Increasing Motivation for Physical ACTivity or IMPACT Project:
The IMPACT Project was a randomized clinical trial testing the effectiveness of a behavioral intervention designed to encourage ethnic minority women to adopt and maintain regular physical activity. The intervention used constructs from the Transtheoretical Model (i.e. stages of change) and Social Cognitive Theory. Many of the women were participants in the federally funded Welfare-to-Work program and were taking job-training classes [Collins, et. al, 2004]. The study’s intervention occurred in two phases; the first phase included a 2-month class-based intervention, tailored to low-income women. The second, 10-month long, phase was a randomized investigation of two types of home-based PA interventions: telephone plus mail support versus mail-only support. Women in the telephone + mail group received regular phone calls from a bilingual health educator to discuss barriers and set goals for physical activity. They also received a monthly newsletter with tips on community resources for doing PA. Women in the mail-only group received just the newsletter.

Most (73%) of the IMPACT participants were Latina, and their mean age was 32 ± 10 years. A majority of the women were bilingual (70%), over half had not completed high school, and 60% had an annual income < $20,000. The mean BMI was 30 ± 6.6; thus, a large percentage of the sample was obese. After the class, from 10-weeks to 12-months, 56% of women in the telephone group had additional advancements in stage, compared to 36% in the mail group (p< .05). Only 13% of women in the telephone group did not progress in stage over this time, compared to 36% in the mail group. Women in the telephone group had significantly greater increases in energy expenditure via the PAR compared to women in the mail group (p < .05) [Albright, et. al, 2002]. Thus, low-income women receiving telephone counseling following classes significantly increased the energy expenditure, compared to women followed with only mail support.

Promoting Repeat Mammography
This bilingual project investigated whether mailed messages based on Shared Decision Making (SDM) constructs could change perceptions about breast cancer risk and increase intentions to be rescreened in older, low income Latinas who were off-schedule for their annual mammogram [Albright and Sears, 2001]. SDM messages highlighted the benefits of repeat mammography and were tailored to their cultural values and screening barriers. Fifty women were randomized to receive the SDM messages or a standard reminder card. Their mean age was 58 ± 6, mean years living in U.S. was 23 ± 19 years, with a mean of 6.6 ± 3.5 years of formal education. Over 80% spoke mostly Spanish at home and were born in Mexico or Latin America. On average they had their last mammogram 24 ± 5.5 months ago. Intention to be rescreened in the future was over 90%. An analysis of covariance for change in perceived future Breast Cancer risk for women “their own age” revealed significant group differences (p < .02), after controlling for age and baseline knowledge. The SDM group’s perception of future risk increased, while the reminder group’s perception decreased.

Future Research Interests:
Dr. Albright’s future research will continue to focus on behaviors related to cancer prevention and early detection including breast cancer rescreening, increasing physical activity, modifying dietary intake of fat, fruits & vegetables, and preventing weight gain in young, overweight adults (Albright, 2003).