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Zhu Y, Park S, Kolady R, Zha W, Ma Y, Dias A, McGuire K, Hardi A, Lin S, Ismail Z, Adkins‐Jackson PB, Trani J, Babulal GM. A systematic review/meta-analysis of prevalence and incidence rates illustrates systemic underrepresentation of individuals racialized as Asian and/or Asian-American in ADRD research. Alzheimers Dement 2024; 20:4315-4330. [PMID: 38708587 PMCID: PMC11180860 DOI: 10.1002/alz.13820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 03/04/2024] [Accepted: 03/11/2024] [Indexed: 05/07/2024]
Abstract
We investigate Alzheimer's disease and related dementia (ADRD) prevalence, incidence rate, and risk factors in individuals racialized as Asian and/or Asian-American and assess sample representation. Prevalence, incidence rate, risk factors, and heterogeneity of samples were assessed. Random-effects meta-analysis was conducted, generating pooled estimates. Of 920 records across 14 databases, 45 studies were included. Individuals racialized as Asian and/or Asian-American were mainly from Eastern and Southern Asia, had higher education, and constituted a smaller sample relative to non-Hispanic white cohorts. The average prevalence was 10.9%, ranging from 0.4% to 46%. The average incidence rate was 20.03 (12.01-33.8) per 1000 person-years with a range of 75.19-13.59 (12.89-14.33). Risk factors included physiological, genetic, psychological, behavioral, and social factors. This review underscores the systemic underrepresentation of individuals racialized as Asian and/or Asian-American in ADRD research and the need for inclusive approaches accounting for culture, language, and immigration status. HIGHLIGHTS: There is considerable heterogeneity in the prevalence of ADRD among studies of Asian-Americans. There is limited data on group-specific risk factors for ADRD among Asian-Americans. The average prevalence of (ADRD) among Asian-Americans was found to be 7.4%, with a wide range from 0.5% to 46%.
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Affiliation(s)
- Yiqi Zhu
- School of Social WorkAdelphi UniversityGarden CityNew YorkUSA
| | - Soobin Park
- Brown SchoolWashington University in St. LouisSt. LouisMissouriUSA
| | | | - Wenqing Zha
- Department of NeurologyWashington University School of MedicineSt. LouisMissouriUSA
| | - Ying Ma
- University of Houston56B M.D. Anderson Library HoustonTexasUSA
| | - Amanda Dias
- School of Social WorkAdelphi UniversityGarden CityNew YorkUSA
| | | | - Angela Hardi
- Bernard Becker Medical LibraryWashington University School of MedicineSt. LouisMissouriUSA
| | - Sunny Lin
- Division of General Medical SciencesDepartment of MedicineWashington University School of MedicineSt. LouisMissouriUSA
| | - Zahinoor Ismail
- Departments of PsychiatryClinical Neurosciences, and Community Health SciencesHotchkiss Brain InstituteUniversity of CalgaryCalgaryAlbertaCanada
- Department of Clinical and Biomedical SciencesFaculty of Health and Life SciencesUniversity of ExeterDevonUK
| | - Paris B. Adkins‐Jackson
- Departments of Epidemiology and Sociomedical SciencesMailman School of Public HealthColumbia UniversityNew YorkNew YorkUSA
| | - Jean‐Francois Trani
- Brown SchoolWashington University in St. LouisSt. LouisMissouriUSA
- Institute of Public HealthWashington UniversitySt. LouisMissouriUSA
- Centre for Social Development in AfricaFaculty of HumanitiesUniversity of JohannesburgCnr Kingsway & University RoadsJohannesburgSouth Africa
- National Conservatory of Arts and CraftsParisFrance
| | - Ganesh M. Babulal
- Department of NeurologyWashington University School of MedicineSt. LouisMissouriUSA
- Institute of Public HealthWashington UniversitySt. LouisMissouriUSA
- National Conservatory of Arts and CraftsParisFrance
- Department of Clinical Research and LeadershipThe George Washington University School of Medicine and Health SciencesWashingtonDistrict of ColumbiaUSA
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Young K, Xiong T, Lee R, Banerjee AT, Leslie M, Ko WY, Guo JYJ, Pham Q. Honoring the Care Experiences of Chinese Canadian Survivors of Prostate Cancer to Cultivate Cultural Safety and Relationality in Digital Health: Exploratory-Descriptive Qualitative Study. J Med Internet Res 2023; 25:e49349. [PMID: 38153784 PMCID: PMC10784982 DOI: 10.2196/49349] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/31/2023] [Accepted: 11/28/2023] [Indexed: 12/29/2023] Open
Abstract
BACKGROUND Prostate cancer (PCa) is the most commonly diagnosed nonskin cancer for Canadian men and has one of the highest 5-year survival rates, straining systems to provide care. Virtual care can be one way to relieve this strain, but survivors' care needs and technology use are influenced by intersecting social and cultural structures. Cultural adaptation has been posited as an effective method to tailor existing interventions to better serve racialized communities, including Chinese men. However, cultural adaptations may inadvertently draw attention away from addressing structural inequities. OBJECTIVE This study used qualitative methods to (1) explore the perceptions and experiences of Chinese Canadian PCa survivors with follow-up and virtual care, and (2) identify implications for the cultural adaptation of a PCa follow-up care app, the Ned (no evidence of disease) Clinic. METHODS An axiology of relational accountability and a relational paradigm underpinned our phenomenologically informed exploratory-descriptive qualitative study design. A community-based participatory approach was used, informed by cultural safety and user-centered design principles, to invite Chinese Canadian PCa survivors and their caregivers to share their stories. Data were inductively analyzed to explore their unmet needs, common experiences, and levels of digital literacy. RESULTS Unmet needs and technology preferences were similar to broader trends within the wider community of PCa survivors. However, participants indicated that they felt uncomfortable, unable to, or ignored when expressing their needs. Responses spoke to a sense of isolation and reflected a reliance on culturally informed coping mechanisms, such as "eating bitterness," and familial assistance to overcome systemic barriers and gaps in care. Moreover, virtual care was viewed as "better than nothing;" it did not change a perceived lack of focus on improving quality of life or care continuity in survivorship care. Systemic changes were identified as likely to be more effective in improving care delivery and well-being rather than the cultural adaptation of Ned for Chinese Canadians. Participants' desires for care reflected accessibility issues that were not culturally specific to Chinese Canadians. CONCLUSIONS Chinese Canadian survivors are seeking to strengthen their connections in a health care system that provides privacy and accessibility, protects relationality, and promotes transparency, accountability, and responsibility. Designing "trickle-up" adaptations that address structural inequities and emphasize accessibility, relationality, and privacy may be more effective and efficient at improving care than creating cultural adaptations of interventions.
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Affiliation(s)
- Karen Young
- Centre for Digital Therapeutics, Techna Institute, University Health Network, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Ting Xiong
- Centre for Digital Therapeutics, Techna Institute, University Health Network, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Rachel Lee
- Centre for Digital Therapeutics, Techna Institute, University Health Network, Toronto, ON, Canada
| | - Ananya Tina Banerjee
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Myles Leslie
- School of Public Policy, University of Calgary, Calgary, AB, Canada
| | - Wellam Yu Ko
- Men's Health Research Program, University of British Columbia, Vancouver, BC, Canada
| | - Julia Yu Jia Guo
- Centre for Digital Therapeutics, Techna Institute, University Health Network, Toronto, ON, Canada
| | - Quynh Pham
- Centre for Digital Therapeutics, Techna Institute, University Health Network, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
- Telfer School of Management, University of Ottawa, Ottawa, ON, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
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García-Barata AR, Ventura I, Ribas-Pérez D, Flores-Fraile J, Castaño-Séiquer A. Oral Health Status in a Group of Roma Children in Seville, Spain. Healthcare (Basel) 2023; 11:healthcare11071016. [PMID: 37046943 PMCID: PMC10093784 DOI: 10.3390/healthcare11071016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 03/18/2023] [Accepted: 03/31/2023] [Indexed: 04/05/2023] Open
Abstract
The Spanish gypsy community is widely integrated among the rest of the Spanish population due to a coexistence that dates back centuries. Despite this integration, they are at risk of marginalization, the child population clearly being a vulnerable group. In terms of social and health inequalities, ethnic minorities in general, and the gipsy minority in particular, in many cases do not achieve equity with the rest of the population. Regarding health in general and, more specifically, oral health, this fact can be perceived, although it has not been evidenced by any epidemiological study of oral health in the Andalusia region. Objective: Identify the oral health status through an epidemiological survey of the population of gipsy children in the city of Seville. Methods: The WHO (World Health Organization) criteria for oral health surveys were used in the study with children aged 6 to 13 years carried out in two Seville schools located in neighborhoods with a high percentage of gypsy population (Polígono Norte and Sur of the city of Seville). Results: The final sample consisted of 108 children in whom the DMF (decay-missing-filled index) for primary dentition was 5.0 + −3.1 for the 6–9 year-old age group and the DMFT (Decayed, Missing, and Filled Teeth) for the 10–13 year-old group was 4.5 + −3.3. The frequency of brushing was low, with a significant percentage of children not brushing their teeth (42.3%). The striking feature is that 26.9% of children had never visited the dentist despite their basic dental care being covered by the regional government. Conclusions: The children studied present high levels of caries compared to the rest of the Spanish population, as well as very low levels of oral hygiene. Given the lack of success of existing oral health programmes among this population, a different intervention is needed, taking into account the idiosyncrasies of the gipsy community.
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Affiliation(s)
- Ana Raquel García-Barata
- Department of Paediatric Dentistry, Egas Moniz School of Healht & Science, 2829-511 Almada, Portugal
| | - Irene Ventura
- Department of Paediatric Dentistry, Egas Moniz School of Healht & Science, 2829-511 Almada, Portugal
| | - David Ribas-Pérez
- Department of Stomatology, Universidad de Sevilla, 41004 Sevilla, Spain
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Ravaghi H, Guisset AL, Elfeky S, Nasir N, Khani S, Ahmadnezhad E, Abdi Z. A scoping review of community health needs and assets assessment: concepts, rationale, tools and uses. BMC Health Serv Res 2023; 23:44. [PMID: 36650529 PMCID: PMC9847055 DOI: 10.1186/s12913-022-08983-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 12/19/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Community health needs and assets assessment is a means of identifying and describing community health needs and resources, serving as a mechanism to gain the necessary information to make informed choices about community health. The current review of the literature was performed in order to shed more light on concepts, rationale, tools and uses of community health needs and assets assessment. METHODS We conducted a scoping review of the literature published in English using PubMed, Embase, Scopus, Web of Science, PDQ evidence, NIH database, Cochrane library, CDC library, Trip, and Global Health Library databases until March 2021. RESULTS A total of 169 articles including both empirical papers and theoretical and conceptual work were ultimately retained for analysis. Relevant concepts were examined guided by a conceptual framework. The empirical papers were dominantly conducted in the United States. Qualitative, quantitative and mixed-method approaches were used to collect data on community health needs and assets, with an increasing trend of using mixed-method approaches. Almost half of the included empirical studies used participatory approaches to incorporate community inputs into the process. CONCLUSION Our findings highlight the need for having holistic approaches to assess community's health needs focusing on physical, mental and social wellbeing, along with considering the broader systems factors and structural challenges to individual and population health. Furthermore, the findings emphasize assessing community health assets as an integral component of the process, beginning foremost with community capabilities and knowledge. There has been a trend toward using mixed-methods approaches to conduct the assessment in recent years that led to the inclusion of the voices of all community members, particularly vulnerable and disadvantaged groups. A notable gap in the existing literature is the lack of long-term or longitudinal-assessment of the community health needs assessment impacts.
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Affiliation(s)
- Hamid Ravaghi
- grid.483405.e0000 0001 1942 4602Department of Universal Health Coverage/Health Systems (UHS), World Health Organization, Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Ann-Lise Guisset
- grid.3575.40000000121633745Department of Integrated Health Services (IHS), World Health Organization, Headquarters, Geneva, Switzerland
| | - Samar Elfeky
- grid.483405.e0000 0001 1942 4602Department of Healthier Populations (DHP), World Health Organization, Regional Office of Eastern Mediterranean Region, Cairo, Egypt
| | - Naima Nasir
- grid.4991.50000 0004 1936 8948Center for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | - Elham Ahmadnezhad
- grid.411705.60000 0001 0166 0922 National Institute of Health Research (NIHR), Tehran University of Medical Sciences, Tehran (TUMS), Tehran, Iran
| | - Zhaleh Abdi
- National Institute of Health Research (NIHR), Tehran University of Medical Sciences, Tehran (TUMS), Tehran, Iran.
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Young JL, Mak J, Stanley T, Bass M, Cho MK, Tabor HK. Genetic counseling and testing for Asian Americans: a systematic review. Genet Med 2021; 23:1424-1437. [PMID: 33972720 DOI: 10.1038/s41436-021-01169-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 03/25/2021] [Accepted: 03/26/2021] [Indexed: 12/30/2022] Open
Abstract
PURPOSE Asian Americans have been understudied in the literature on genetic and genomic services. The current study systematically identified, evaluated, and summarized findings from relevant qualitative and quantitative studies on genetic health care for Asian Americans. METHODS A search of five databases (1990 to 2018) returned 8,522 unique records. After removing duplicates, abstract/title screening, and full text review, 47 studies met inclusion criteria. Data from quantitative studies were converted into "qualitized data" and pooled together with thematic data from qualitative studies to produce a set of integrated findings. RESULTS Synthesis of results revealed that (1) Asian Americans are under-referred but have high uptake for genetic services, (2) linguistic/communication challenges were common and Asian Americans expected more directive genetic counseling, and (3) Asian Americans' family members were involved in testing decisions, but communication of results and risk information to family members was lower than other racial groups. CONCLUSION This study identified multiple barriers to genetic counseling, testing, and care for Asian Americans, as well as gaps in the research literature. By focusing on these barriers and filling these gaps, clinical genetic approaches can be tailored to meet the needs of diverse patient groups, particularly those of Asian descent.
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Affiliation(s)
- Jennifer L Young
- Stanford Center for Biomedical Ethics, Stanford University, CA, USA.
| | - Julie Mak
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, CA, USA
| | - Talia Stanley
- Stanford Center for Biomedical Ethics, Stanford University, CA, USA
| | - Michelle Bass
- Countway Library of Medicine, Harvard Medical School, MA, USA
| | - Mildred K Cho
- Department of Pediatrics, Stanford University, CA, USA
- Department of Medicine, Stanford University, CA, USA
| | - Holly K Tabor
- Department of Medicine, Stanford University, CA, USA
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Swierad E, Huang TTK, Ballard E, Flórez K, Li S. Developing a Socioculturally Nuanced Systems Model of Childhood Obesity in Manhattan's Chinese American Community via Group Model Building. J Obes 2020; 2020:4819143. [PMID: 33628493 PMCID: PMC7895604 DOI: 10.1155/2020/4819143] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 05/27/2020] [Indexed: 01/01/2023] Open
Abstract
The purpose of this study was to develop a qualitative and socioculturally tailored systems model of childhood obesity in the Chinese American community in Manhattan's Chinatown. We utilized group model building (GMB) methodology as a form of participatory systems modeling. The study was conducted in Manhattan's Chinatown community. We recruited 16 Chinese American adults from the community. GMB workshops engendered a causal loop diagram (CLD), the visualization of a complex systems model illustrating the structures, feedbacks, and interdependencies among socioculturally specific pathways underlying childhood obesity, in Manhattan's Chinatown community. The analysis of CLD revealed that participants considered the following factors to influence childhood obesity: (1) traditional social norms affecting body image, how children are raised, parental pressure to study, and trust in health of traditional foods; (2) grandparents' responsibility for children; (3) limited time availability of parents at home; and (4) a significant amount of children's time spent indoors. GMB represents a novel method to understand the complexity of childhood obesity in culturally specific populations and contexts. The study identified sociocultural subsystems that may underlie the development and perpetuation of childhood obesity among Chinese American children. Insights from the study can be useful in the design of future empirical studies and interventions.
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Affiliation(s)
- Ewelina Swierad
- Columbia University Irving Medical Center, New York, NY, USA
- Center for Systems and Community Design, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - Terry T.-K. Huang
- Center for Systems and Community Design, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - Ellis Ballard
- Social System Design Lab, Brown School at Washington University in St. Louis, St. Louis, WA, USA
| | - Karen Flórez
- Center for Systems and Community Design, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - Sheng Li
- Center for Systems and Community Design, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
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Nguyen KH, Trivedi AN. Asian American Access to Care in the Affordable Care Act Era: Findings from a Population-Based Survey in California. J Gen Intern Med 2019; 34:2660-2668. [PMID: 31512183 PMCID: PMC6848322 DOI: 10.1007/s11606-019-05328-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 05/14/2019] [Accepted: 08/16/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Though Asian Americans made gains in coverage following the Affordable Care Act (ACA), substantial variations in access to care remain across different ethnic subgroups. Several states are considering adoption of policies to collect health data for Asian Americans that is disaggregated by ethnic subgroup, which may identify disparities in access to care. OBJECTIVE We examined coverage and access to care between non-Hispanic White and Asian American adults following the ACA in California. We first compared outcomes in non-Hispanic White adults with all Asian Americans in our sample, and then evaluated whether we detect disparities when data is disaggregated into five of the most populous ethnic subgroups (Chinese, Korean, Filipino, Vietnamese, and Japanese). DESIGN Cross-sectional California Health Interview Survey data were collected between January 2014 and December 2016. PARTICIPANTS Our sample included 19,201 non-Hispanic White and 3077 Asian American non-elderly adults age 18 to 64 living in California. MAIN MEASURES Our outcomes were (1) being uninsured, (2) having a usual source of care, (3) delaying necessary medical care, and (4) delaying necessary prescription medications. Using multivariable logistic regression models, we examined our outcomes, adjusting for predisposing, enabling, need, and acculturation factors. KEY RESULTS Compared with non-Hispanic Whites, some subgroups of Asian Americans reported significantly worse access to care: disaggregated, adjusted analyses revealed that Koreans were significantly less likely to report a usual source of care (adjusted odds ratio [AOR] = 0.31, p < 0.01) relative to non-Hispanic Whites. Chinese (AOR = 0.42, p < 0.01) and Vietnamese (AOR = 0.34, p < 0.01) adults were significantly less likely to delay necessary care. CONCLUSIONS Disaggregated analyses identified differences in access to care for Asian American subgroups following the ACA. State policies to collect disaggregated health data for Asian Americans may reveal heterogeneity in experiences of care and inform specific policies to reduce disparities in access to care.
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Affiliation(s)
- Kevin H Nguyen
- Brown University School of Public Health, Providence, RI, USA.
| | - Amal N Trivedi
- Brown University School of Public Health, Providence, RI, USA.,Providence Veterans Affairs Medical Center, Providence, RI, USA
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Examining the gastric cancer survival gap between Asians and whites in the United States. Gastric Cancer 2017; 20:573-582. [PMID: 27866287 DOI: 10.1007/s10120-016-0667-4] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 11/08/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Globally, Asian countries bear a disproportionate gastric cancer burden. Asian Americans, the fastest growing minority population in the US, have higher gastric cancer survival than non-Hispanic whites (NHWs) despite higher incidence. Benefitting from uniform cancer registry standards within the US, we examine for the first time the heterogeneity in the Asian American population, which may elucidate the causes of these disparities. METHODS SEER gastric cancer data from 2000 to 2012 were used to calculate 5-year survival estimates for NHWs and the six largest Asian ethnicities. Multivariate analyses were performed to identify critical prognostic factors and survival disparities between Asian groups and NHWs. RESULTS We analyzed 33,313 NHW and 8473 Asian gastric cancer cases. All Asian groups had significantly higher 5-year survival than NHWs, at 29.8%. Among Asians, Koreans and Vietnamese had the highest and lowest survival, at 45.4% and 35.7%, respectively. The Korean survival advantage was largely attributable to relatively high proportions of localized stage and low proportions of cardia tumors. After adjusting for major prognostic factors, the survival disadvantage of NHWs, while attenuated, remained significant in comparison to all Asian groups (HR: 1.33, 95% CI: 1.24-1.43; reference: Korean). The survival disparities within the Asian groups vanished with adjustment. CONCLUSIONS This study characterizes distinctive gastric cancer survival patterns among the six major Asian groups and NHWs in the US. The favorable survival for Koreans is largely attributable to specific clinical factors, particularly stage at diagnosis. The causes of the survival disadvantage for NHWs remain elusive.
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Simon MA, Tom LS, Dong X. Knowledge and Beliefs About Biospecimen Research Among Chinese Older Women in Chicago's Chinatown. J Gerontol A Biol Sci Med Sci 2017; 72:S41-S49. [PMID: 28575264 PMCID: PMC5861856 DOI: 10.1093/gerona/glw333] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 01/07/2017] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Enhancing the participation of Chinese older women in biobanking efforts is important for precision medicine efforts, as underrepresented groups risk benefiting less than others from medical advancements in individualized therapies. Focusing on a sample of Chinese older women in Chicago's Chinatown, this qualitative study seeks to describe attitudes toward, and barriers and facilitators of, participation in biospecimen research. METHOD We conducted six focus groups among Chinese-speaking adult women age 45 and above. Focus groups were transcribed, coded, and analyzed for emergent themes. RESULTS Forty-seven women participated in focus groups, the majority (66.0%) were age 66 and over and half (50.1%) had less than a high school education. Participants expressed predominantly positive attitudes toward biospecimen research, but also identified multifaceted barriers to participation that included cultural beliefs of the body, perceived physical and privacy risks, as well as perceptions related to aging. Use of minimally invasive biospecimen collection and education to promote awareness of biospecimen research were suggested facilitators to increasing biospecimen research participation. CONCLUSIONS Culturally and linguistically isolated populations like Chinese older women are at risk of exclusion from advancements in precision medicine. Our findings provide cultural insights for tailoring interventions for Chinese older women to increase knowledge, change attitudes, and increase intention and participation in biospecimen research. We also highlight the need for individual, family, and community level interventions to promote healthy aging among Chinese older women.
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Affiliation(s)
- Melissa A Simon
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois
- Robert H Lurie Comprehensive Cancer Center, Chicago, Illinois
| | - Laura S Tom
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - XinQi Dong
- Rush University Medical Center, Chicago, Illinois
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Tung EL, Baig AA, Huang ES, Laiteerapong N, Chua KP. Racial and Ethnic Disparities in Diabetes Screening Between Asian Americans and Other Adults: BRFSS 2012-2014. J Gen Intern Med 2017; 32:423-429. [PMID: 27848187 PMCID: PMC5377880 DOI: 10.1007/s11606-016-3913-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 10/12/2016] [Accepted: 10/20/2016] [Indexed: 01/02/2023]
Abstract
BACKGROUND Although Asian Americans are at high risk for type 2 diabetes, it is not known whether they are appropriately screened for this disease. OBJECTIVE To assess racial and ethnic disparities in diabetes screening between Asian Americans and other adults. DESIGN Analysis of pooled cross-sectional data from 45 U.S. states and territories using the 2012-2014 Behavioral Risk Factor Surveillance System. We calculated the weighted proportions of adults in each racial and ethnic group who received recommended diabetes screening. To assess for racial and ethnic disparities, we used multivariable logistic regression to model receipt of recommended diabetes screening as a function of race and ethnicity, adjusting for demographics, healthcare access, survey year, and state. PARTICIPANTS A total of 526,000 adults who were eligible to receive diabetes screening according to American Diabetes Association guidelines from 2012 to 2014 (age ≥ 45 years or age < 45 years with a body mass index [BMI] ≥ 25 kg/m2). MAIN MEASURES Self-reported receipt of diabetes screening (defined as a test for high blood sugar or diabetes within the past 3 years) and self-reported race/ethnicity (non-Hispanic white, non-Hispanic Asian, non-Hispanic Pacific Islander, non-Hispanic American Indian or Alaskan Native, non-Hispanic black, Hispanic or Latino, and non-Hispanic multiracial or other). KEY RESULTS Asian Americans were the least likely racial and ethnic group to receive recommended diabetes screening. Overall, Asian Americans had 34% lower adjusted odds of receiving recommended diabetes screening compared to non-Hispanic whites (95 % CI: 0.60, 0.73). In subgroup analyses by age and weight status, disparities were widest among obese Asian Americans ≥ 45 years (AOR = 0.56; 95 % CI: 0.39, 0.81). Disparities persisted among Asian Americans who completed other types of preventive cancer screening. CONCLUSIONS Despite their high risk of diabetes, Asian Americans were the least likely racial and ethnic group to receive recommended diabetes screening.
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Affiliation(s)
- Elizabeth L Tung
- Section of General Internal Medicine, Department of Medicine, University of Chicago, 5841 South Maryland Avenue, MC 2007, Chicago, IL, 60637, USA.
| | - Arshiya A Baig
- Section of General Internal Medicine, Department of Medicine, University of Chicago, 5841 South Maryland Avenue, MC 2007, Chicago, IL, 60637, USA
| | - Elbert S Huang
- Section of General Internal Medicine, Department of Medicine, University of Chicago, 5841 South Maryland Avenue, MC 2007, Chicago, IL, 60637, USA
| | - Neda Laiteerapong
- Section of General Internal Medicine, Department of Medicine, University of Chicago, 5841 South Maryland Avenue, MC 2007, Chicago, IL, 60637, USA
| | - Kao-Ping Chua
- Section of General Academic Pediatrics, Department of Pediatrics, University of Chicago, 5841 South Maryland Avenue, MC 2007, Chicago, IL, 60637, USA.,Department of Public Health Sciences, University of Chicago, 5841 South Maryland Avenue, MC 2007, Chicago, IL, 60637, USA
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11
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Acciai F, Noah AJ, Firebaugh G. Pinpointing the sources of the Asian mortality advantage in the USA. J Epidemiol Community Health 2015; 69:1006-11. [PMID: 26034046 PMCID: PMC4567918 DOI: 10.1136/jech-2015-205623] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 05/12/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND Asian-Americans outlive whites by an average of nearly 8 years. By determining the sources of the Asian mortality advantage, we can pinpoint where there is the greatest potential for raising the life expectancy of whites and other groups in the USA. METHODS Our analyses include all Asian and white deaths in the USA between 2006 and 2010, from the Center for Disease Control. Using the International Classification of Diseases (V.10), we code causes of deaths into 19 categories, based on the most common causes as well as causes particularly relevant to racial differences. We then create life tables and apply a newly-developed demographic method to determine whether Asians have longer life expectancy because they are less likely than whites to die of causes of death that strike at younger ages, or because they tend to outlive whites regardless of cause of death. RESULTS Nearly 90% of the Asian-white life expectancy gap is attributable to the fact that Asians tend to outlive whites regardless of the cause of death. The causes that contribute the most to the gap are heart disease (24%) and cancers (18%). Men contribute somewhat more to the gap than women do (55% vs 45%), primarily because Asian-white differences in mortality are greater among men than among women with respect to suicide, traffic accidents and accidental poisoning. CONCLUSIONS For almost all causes of death, Asian victims tend to be older than white victims. The greatest potential for raising the life expectancy of whites to that of Asians, then, resides in efforts that effectively increase whites' average age at death for the most common causes of death.
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Affiliation(s)
- Francesco Acciai
- Department of Sociology, Pennsylvania State University, University Park, PA, USA
- Population Research Institute, Pennsylvania State University, University Park, PA, USA
| | - Aggie J. Noah
- Department of Sociology, Pennsylvania State University, University Park, PA, USA
- Population Research Institute, Pennsylvania State University, University Park, PA, USA
| | - Glenn Firebaugh
- Department of Sociology, Pennsylvania State University, University Park, PA, USA
- Population Research Institute, Pennsylvania State University, University Park, PA, USA
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12
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Nguyen TH, Nguyen TN, Fischer T, Ha W, Tran TV. Type 2 diabetes among Asian Americans: Prevalence and prevention. World J Diabetes 2015; 6:543-547. [PMID: 25987951 PMCID: PMC4434074 DOI: 10.4239/wjd.v6.i4.543] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 01/31/2015] [Accepted: 02/12/2015] [Indexed: 02/05/2023] Open
Abstract
Type 2 diabetes mellitus (T2DM) is a growing problem among Asian Americans. Based on the Centers for Disease Control, the age-adjusted prevalence of T2DM for Asian Americans is 9%, placing them at “moderate risk”. However differential patterns of disease burden emerge when examining disaggregated data across Asian American ethnic groups; with Filipino, Pacific Islander, Japanese, and South Asian groups consistently described as having the highest prevalence of T2DM. Disentangling and strengthening prevalence data is vital for on-going prevention efforts. The strongest evidence currently available to guide the prevention of T2DM in the United States comes from a large multicenter randomized clinical control trial called the Diabetes Prevention Program, which targets individual lifestyle behavior changes. It has been translated and adopted for some Asian American groups, and shows promise. However stronger study designs and attention to several key methodological considerations will improve the science. Increased attention has also been directed toward population level downstream prevention efforts. Building an infrastructure that includes both individual and population approaches is needed to prevent T2DM among Asian American populations, and is essential for reducing health disparities.
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Affiliation(s)
- Tam H Nguyen
- William F. Connell School of Nursing, Boston College, Chestnut Hill, MA 02467, United States
| | - Thuc-Nhi Nguyen
- Graduate School of Social Work, Boston College, Chestnut Hill, MA 02467, United States
| | - Taylor Fischer
- William F. Connell School of Nursing, Boston College, Chestnut Hill, MA 02467, United States
| | - Won Ha
- Graduate School of Social Work Library, Boston College, Chestnut Hill, MA 02467, United States
| | - Thanh V Tran
- Graduate School of Social Work, Boston College, Chestnut Hill, MA 02467, United States
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13
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Trinh-Shevrin C, Kwon SC, Park R, Nadkarni SK, Islam NS. Moving the dial to advance population health equity in New York City Asian American populations. Am J Public Health 2015; 105 Suppl 3:e16-25. [PMID: 25905858 DOI: 10.2105/ajph.2015.302626] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The shift toward a health equity framework for eliminating the health disparities burden of racial/ethnic minority populations has moved away from a disease-focused model to a social determinants framework that aims to achieve the highest attainment of health for all. The New York University Center for the Study of Asian American Health (CSAAH) has identified core themes and strategies for advancing population health equity for Asian American populations in New York City that are rooted in the following: social determinants of health; multisectoral, community-engaged approaches; leveraging community assets; improved disaggregated data collection and access to care; and building sustainability through community leadership and infrastructure-building activities. We describe the strategies CSAAH employed to move the dial on population health equity.
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Affiliation(s)
- Chau Trinh-Shevrin
- All of the authors are with the Center for the Study of Asian American Health, Department of Population Health, NYU School of Medicine, New York, NY
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14
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Nguyen AB, Chawla N, Noone AM, Srinivasan S. Disaggregated data and beyond: future queries in cancer control research. Cancer Epidemiol Biomarkers Prev 2014; 23:2266-72. [PMID: 25368401 PMCID: PMC4220244 DOI: 10.1158/1055-9965.epi-14-0387] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The goal of health equity requires the collection and reporting of disaggregated data in underrepresented populations such as Asian American (AA) and Native Hawaiian and Other Pacific Islander (NHOPI) communities. A recent Department of Health and Human Services report outlines the necessity for disaggregated data, which would offer communities, providers, and planners better tools to address health problems. In a recent collaboration, the National Cancer Institute (NCI) and several registries published a series of articles tracking cancer incidence data on AA and NHOPI communities using data from the NCI's Surveillance, Epidemiology, and End Results (SEER) program. The findings indicate a need for concentrated focus and planning for the next stages of cancer prevention and control for AA and NHOPI subpopulations. In this article, we provide (i) the context for the perpetuation of the model minority myth as well as historical and sociocultural factors that have shaped health and disease for AA and NHOPI subgroups; (ii) potential strategies for research and public health policy for AA and NHOPI groups using subpopulation-based approaches while addressing challenges and limitations; and (iii) a portfolio analysis of currently funded projects within the NCI/DCCPS to identify gaps and areas of potential research.
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Affiliation(s)
- Anh Bao Nguyen
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland.
| | - Neetu Chawla
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
| | - Anne-Michelle Noone
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
| | - Shobha Srinivasan
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
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