BackgroundService learning is endorsed by the Liaison Committee on Medical Education (LCME) as an integral part of U.S. medical school curricula for future physicians. Service learning has been shown to help physicians in training rediscover the altruistic reasons for pursuing medicine and has the potential to enhance students’ perspectives of humanism in medicine. The Kalaupapa service learning project is a unique collaboration between disadvantaged post-baccalaureate students with an underserved rural community. This study was conducted to determine whether the Kalaupapa service learning curricula enhanced student perspectives of humanism in medicine at an early stage of their medical training.MethodProgram participants between 2008 and 2014 (n = 41) completed written reflections following the conclusion of the service learning project. Four prompts guided student responses. Reflections were thematically analyzed. Once all essays were read, team members compared their findings to condense or expand themes and assess levels of agreement.ResultsEmerging themes of resilience and unity were prominent throughout the student reflections. Students expressed respect and empathy for the patients’ struggles and strengths, as well as those of their peers. The experience also reinforced students’ commitment to service, particularly to populations in rural and underserved communities. Students also gained a deeper understanding of the patient experience and also of themselves as future physicians.ConclusionTo identify and address underserved and rural patients’ health care needs, training programs must prepare an altruistic health care workforce that embraces the humanistic element of medicine. The Kalaupapa service learning project is a potential curricular model that can be used to enhance students’ awareness and perspectives of humanism in medicine.

This study compared self-reported risk factors for suicide among American high school students in the last decade. Data from the 1999-2009 Youth Risk Behavior Surveys was analyzed by 8 self-reported ethnicity groups across 6 suicide-related items: depression, suicide ideation, suicide planning, suicide attempts, and suicide attempts requiring medical attention). Native Hawaiian/Pacific Islander adolescents had the higher prevalence of risk factors for suicide. Multiracial adolescents were also at high risk for suicide-related behaviors, with a risk comparable to American Indian/Alaska Native adolescents. Overall, Native Hawaiian/Pacific Islander, multiracial, and American Indian/Alaska Native adolescents reported a significantly higher risk for suicide-related behaviors compared to their Asian, Black, Hispanic, and White peers. The ethnic disparities in risk factors for suicide dictate a need to understand the vulnerability of the Pacific Islander, American Indian, and growing multiracial adolescent populations, in an effort to develop and implement suicide prevention strategies.

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Multivariate dynamic relationships among suicide attempts, anxiety and/or depressive symptoms, hope, and help-seeking were examined across time in Native Hawaiian and non-Hawaiian adolescents, using data from a 5-year longitudinal cohort study (N = 7,317). The rate of suicide attempts decreased over time, but this reduction was significantly less among Native Hawaiian youth than their non-Hawaiian peers. There were also significant differences between groups in hope and help-seeking, with Native Hawaiian youth increasing help-seeking and decreasing hope to a greater degree. Youth-centered, cultural approaches to suicide prevention are essential in enhancing well-being in indigenous communities.

Suicide rates have reached their highest documented levels in the United States with the greatest increases among indigenous youth, including Native Hawaiians. Culturally informed, effective prevention and treatment services are needed now more than ever for Native communities to heal and flourish. Multicomponent prevention and service strategies rooted in indigenous values and approaches show the most promise. Native Hawaiian communities are united around a common goal of suicide prevention, intervention and postvention, linking cultural meanings to improve understanding and guide local efforts. This paper highlights important cultural values to consider when developing and implementing suicide prevention, intervention and postvention. Strategies build upon the strengths of Native Hawaiian youth and their respective communities. Native Hawaiian sayings anchor each level and serve to organize a set of culturally informed and culturally embedded programs and approaches along the continuum of prevention, intervention and postvention. Application of indigenization to suicide prevention enhances connections to people and place, inspiring hope among Native Hawaiian youth, their families and their communities. (PsycINFO Database Record

The objective of this study was to determine the longitudinal predictors of past-6-month suicide attempts for a diverse adolescent sample of Native Hawaiians, Pacific peoples, and Asian Americans. The study used longitudinal data from the Hawaiian High Schools Health Survey (N = 2,083, 9th to 11th graders, 1992-1993 and 1993-1994 school years). A stepwise multiple logistic regression was conducted. The final model consisted of three statistically significant predictors: (1) Time 1 suicide attempt, odds ratio = 30.6; (2) state anxiety, odds ratio = 4.9; and (3) parent expectations, odds ratio = 1.9. Past suicide attempt was by far the strongest predictor of future suicide attempts. Implications are discussed, including the need for screening of prior suicide attempts and focused interventions after suicide attempts.

This study assesses the relative fit of risk/protective and social ecological models of youth violence among predominantly Asian and Pacific Islander students. Data from a 2007 survey of two multi-ethnic high schools in Hawai'i were used. The survey assessed interpersonal youth violence, suicidality and risk and protective factors. Two models of youth violence (risk/protective and social ecological) were tested using structural equation modeling. We found good fits for the risk/protective model (χ(2) = 369.42, df = 77, P < .0001; CFI = .580; RMSEA = .066) and the ecological model (χ(2) = 1763.65, df = 292, P < .0001; CFI = .636; RMSEA = .076). The risk/protective model showed the importance of coping skills. However, the ecological model allowed examination of the interconnectivity among factors. Peer exposure to violence had no direct influence on individuals and peer influence was fully mediated by school climate. Furthermore, family factors directly contributed to peer exposure, community, and individual risk/protection. These findings have significant implications for intervention and prevention efforts and for the promotion of positive, competent, and healthy youth development. While few family and school-based programs have been developed and evaluated for adolescents, they have the greatest potential for success.

Youth violence remains a serious public health issue nationally and internationally. The social ecological model has been recommended as a framework to design youth violence prevention initiatives, requiring interventions at the micro-, meso-, exo-, and macro-levels. However, documentation of interventions at the macro-level, particularly those that address policy issues, is limited. This study examines a recommendation in the literature that formalized collaborations play a vital role in stimulating macro-level policy change. The purpose of this systematic literature review is to examine existing youth violence prevention collaborations and evaluate their policy-related outcomes. The search found 23 unique collaborations focused on youth violence prevention. These were organized into three groups based on the “catalyst” for action for the collaboration—internal (momentum began with-in the community), external (sparked by an external agency), or policy (mandated by law). Findings suggest that internally catalyzed collaborations were most successful at changing laws to address youth violence, while both internally and externally catalyzed collaborations successfully attained policy change at the organizational level. A conceptual model is proposed, describing a potential pathway for achieving macro-level change via collaboration. Recommendations for future research and practice are suggested, including expansion of this study to capture additional collaborations, investigation of macro-level changes with a primary prevention focus, and improvement of evaluation, dissemination, and translation of macro-level initiatives.