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In the state of Hawaii, it has been shown that certain ethnic minority groups, such as Filipinos and Pacific Islanders, suffer disproportionally high rates of cardiovascular disease, evidence that local health-care systems and governing bodies fail to equally extend the human right to health to all. This study aims to examine whether these ethnic health disparities in cardiovascular disease persist even within an already globally disadvantaged group, the houseless population of Hawaii.

A retrospective chart review of records from Hawaii Houseless Outreach and Medical Education Project clinic sites from 2016 to 2020 was performed to gather patient demographics and reported histories of type II diabetes, obesity, hyperlipidemia, hypertension and other cardiovascular disease diagnoses. Reported disease prevalence rates were compared between larger ethnic categories as well as ethnic subgroups.

Unexpectedly, the data revealed lower reported prevalence rates of most cardiometabolic diseases among the houseless compared to the general population. However, multiple ethnic health disparities were identified, including higher rates of diabetes and obesity among Native Hawaiians and other Pacific Islanders and higher rates of hypertension among Filipinos and Asians overall. The findings suggest that even within a generally disadvantaged houseless population, disparities in health outcomes persist between ethnic groups and that ethnocultural considerations are just as important in caring for this vulnerable population.

To the best of the authors’ knowledge, this is the first comprehensive study focusing on ethnic health disparities in cardiovascular disease and the structural processes that contribute to them, among a houseless population in the ethnically diverse state of Hawaii.

The mid-1990s marked a paradigm shift in the way physical activity is promoted, and walking is now considered the most suitable type of physical activity for widespread promotion. Accurate measurement underpins public health practice, hence the aims of this chapter are to: (1) provide a typology for the measurement of walking; (2) review methods to assess walking; (3) present challenges in defining walking measures; (4) identify issues in selecting instruments for the evaluation of walking and (5) discuss current efforts to overcome measurement challenges and methodological limitations. The taxonomy of walking indicates that secondary purpose walking is a more complex set of behaviours than primary purpose walks. It has many purposes and no specific domain or intensity, may lack regularity, and therefore poses greater measurement challenges. Objective measurement methods, such as accelerometers, pedometers, smartphones and other electronic devices, have shown good approximation for walking energy expenditure, but are indirect methods of walking assessment. Global Positioning System technology, the ‘Smartmat’ and radio-frequency identification tags are potential objective methods that can distinguish walkers, but also require complex analysis, are costly, and still need their measurement properties corroborated. Subjective direct methods, such as questionnaires, diaries and direct observation, provide the richest information on walking, especially short-term diaries, such as trip records and time use records, and are particularly useful for assessing secondary purpose walking. A unifying measure for health research, surveillance and health promotion would strongly advance the understanding of the impact of walking on health.

This chapter reviews the empirical evidence for Psychological First Aid (PFA) in the context and experience of the Southeast Asian (SEA) region. First, this chapter provides the definition and background of PFA and its core principles, to explain the basis for doing PFA as part of an integrated approach to disaster mental health. Second, the existing literature on the effectiveness of PFA is reviewed. Third, this chapter examines the application and adaptation of PFA in SEA. Implications and recommendations are provided at the end of the chapter.