Asian American Ethnic Subgroups Research Articles

Asian American sub-ethnic disparities and trends in epithelial ovarian cancer diagnosis, treatment and survival

ABSTRACT Objectives Studies on ovarian cancer (OC) diagnosis, treatment and survival across disaggregated Asian sub-ethnic groups are sparse. Few studies have also conducted trend analyses of these outcomes within and across Asian groups. Methods Using logistic, Cox, and Joinpoint regression analyses of the 2000–2018 Surveillance, Epidemiology, and End Results (SEER) data, we examined disparities and trends in OC advanced stage diagnosis, receipt of treatments and the 5-year cause-specific survival across seven Asian sub-ethnic groups. Results There were 6491 OC patients across seven Asian sub-ethnic groups (mean [SD] age, 57.29 [13.90] years). There were 1583(24.39%) Filipino, 1183(18.23%) Chinese, and 761(11.72%) Asian Indian or Pakistani (AIP) patients. The majority (52.49%) were diagnosed with OC with at an advanced stage. AIP were more likely to have advanced stage diagnosis than other subgroups (ORs, 95%CIs: 0.77, 0.62−0.96 [Filipino]; 0.76, 0.60−0.95 [Chinese]; 0.71, 0.54−0.94 [Japanese]; 0.74, 0.56−0.98 [Vietnamese] and 0.66, 0.53−0.83 [Other Asians]). The Filipinos were least likely to receive surgery but most likely to undergo chemotherapy. Japanese patients had the worst 5-year OC cause-specific survival (50.29%, 95%CI: 46.20%−54.74%). Based on the aggregated analyses, there was a significantly decreased trend in advanced-stage diagnosis and an increased trend in receipt of chemotherapy. Trends in OC outcomes for several subethnicities differed from those observed in aggregated analyses. Conclusion In this cohort study of 6491 patients, OC diagnosis, treatment, survival, and trends differed across Asian American ethnic subgroups. Such differences must be considered in future research and interventions to ensure all Asian American subethnicities equally benefit from the advancements in OC care and control.

Disparities in Access to Primary Care Appointments Among Asian American Subgroups, and the Impact of Concordance.

While Asian Americans experience disparate access to health services, little is known about the extent to which providers discriminate against Asian American patients. Further, research on Asian American health disparities tends to group Asian American ethnicities together, overlooking potential within-group differences. We deployed a field experiment to assess whether Asian American ethnic sub-groups experience discrimination in appointment scheduling. We further explored the impact of racial concordance between Asian patients and physicians. Overall, we did not detect significant differences in appointment offer rates between White and Asian American patients. However, we found that Asian Americans experienced longer wait times driven primarily by the treatment of patients of Chinese and Korean descent. Physician offices, surprisingly, offered concordant Asian patients appointments at significantly lower rates. The disparities Asian Americans experience relative to White Americans through longer waits for primary care appointments are not consistent across sub-groups. Increased attention to the unique experiences of people of Asian descent in accessing health services is warranted.

Online Grocery Shopping Behaviors and Attitudes Among Asian Americans.

How online grocery shopping behaviors differ among Asian American (AA) ethnic subgroups and acculturation level is unknown. From June 9-15, 2020, we administered an online survey to a nationally-derived nonprobability sample of 2,895 AA adults, including 1,737 East, 570 South, and 587 Southeast Asian adults, assessing online grocery shopping (yes/no, frequency, reasons). We used logistic regression to compare responses by subgroup and acculturation score, controlling for sociodemographics. Thirty-percent of participants reported shopping online for groceries in a typical month, with a higher percentage among South (45%) versus East Asian adults (23%). Participants with low (vs. high) acculturation scores were more likely to report a lack of special foods (OR = 0.7; 95% CI: 0.5-0.98) and poor food quality (OR = 0.6; 95% CI: 0.4-0.7) as preventing them from shopping online. Online grocery shopping has the capacity to address inequities in health, potentially via culturally-tailored programs designed for less-acculturated AA adults.

Mind The Gap: Differences in Alcohol Use Screening And Discussions Among Adults Comparing Asian American And Other Racial And Ethnic Subgroups in the United States, 2015-2019.

Asian Americans are the fastest growing racial and ethnic subgroup in the USA but are underrepresented in the alcohol literature, partially due to misconceptions and racial stereotypes. We estimated any alcohol screening/discussions with providers among Asian Americans and other racial and ethnic subgroups and tested associations with alcohol treatment. Weighted prevalences of any alcohol screening or discussions with providers included US adults reporting past-year alcohol use and > =1 healthcare visit in the 2015-2019 National Survey on Drug Use and Health (n = 123,002). Multinomial logistic regressions estimated adjusted associations between alcohol use screening/discussions (ref: no screening/discussion) comparing Asian Americans to other racial and ethnic adult subgroups. Among adults with alcohol use disorder (AUD), we estimated adjusted odds of alcohol treatment and perceived treatment need by screening/discussions and racial and ethnic subgroup. Among Asian American adults who reported past-year alcohol use and a healthcare visit, 24.7% reported any screening only and 51.4% discussed alcohol with providers. All racial and ethnic subgroups were more likely than Asian Americans to report alcohol screening/discussions (e.g. white adults, screening adjusted relative risk ratio [aRRR] = 1.48, 95% CI: 1.28-1.72; discussions aRRR = 1.92, 95% CI: 1.74-2.10). AUD treatment use and perceived need were about two times higher among people reporting alcohol discussions. Asian Americans were less likely to report discussing alcohol with providers than all other racial and ethnic subgroups. Alcohol discussions were associated with treatment use and perceived need. Efforts to increase equitable alcohol screening and discussions with clinicians are needed.

Vaccination patterns, disparities, and policy among Asian-Americans and Asians living in the USA

BackgroundAlthough Asian-American individuals have higher rates of some vaccine-preventable diseases such as hepatitis B, vaccination rates among them are low compared with those of non-Hispanic White individuals. Most vaccine research looks at Asian-American people as a single category despite large within-group heterogeneity in health-seeking behaviours. Little is known about vaccination coverage among disaggregated Asian-American ethnic subgroups, although such information could inform policies focused on increasing vaccine uptake. Therefore, we aimed to assess vaccination coverage for several vaccines among disaggregated Asian-American subgroups. MethodsWe examined National Health Interview Survey (NHIS) data from 2015–18 to analyse the vaccination status of Chinese, Asian Indian, Filipino, other Asian, and non-Hispanic White adults (n=253 626) for seven vaccines recommended by the US Centers for Disease Control and Prevention: human papillomavirus (HPV), hepatitis B (HBV), influenza, tetanus, tetanus-diphtheria-pertussis (Tdap), shingles, and the pneumococcal vaccine. We used NHIS data from 2006–18 (n=880 210) to analyse changes in vaccination rates for each ethnic group over time. We used logistic regression to estimate differences in vaccination rates while controlling for demographic, socioeconomic and health-related variables. FindingsAmong the seven vaccines, HPV and shingles vaccines had the lowest uptake, whereas Tdap had the highest uptake among all groups. Compared with the non-Hispanic White group, Asian Indians were almost half as likely to receive the HPV vaccine (odds ratio 0·61, 95% CI 0·41–0·92), whereas Filipinos (1·51, 1·02–2·25) and other Asians (1·42, 1·02–1·97) were more likely to receive it. The Filipino (1·50, 1·21–1·88) and other Asian groups (1·42, 1·19–1·71) were more likely to receive the HBV vaccine than the non-Hispanic White group. For the influenza vaccine, the Asian Indian (1·28, 1·05–1·56), Filipino (1·44, 1·17–1·79) and other Asian (1·38, 1·16–1·65) groups were more likely to receive the vaccine than the non-Hispanic White group. For the pneumococcal vaccine, the Chinese (0·57, 0·34–0·94) and other Asian (0·66, 0·47–0·92) groups were less likely to receive the vaccine than the non-Hispanic White group. InterpretationAmong US adults, we found significant disparities in vaccine uptake among different Asian and Asian-American ethnic groups. US policy makers trying to improve vaccine uptake among Asian and Asian-American people could learn from successful international immunisation programmes to develop culturally appropriate interventions to improve vaccine uptake in Asian and Asian-American individuals. FundingNone.

Abstract PO-198: Disparities in nasopharyngeal cancer incidence among Asian American ethnic subgroups

Abstract Background: Although nasopharyngeal cancer is a relatively rare malignancy in the United States (U.S.), its racial disparities are striking. Incidence has been shown to be over four times higher in Asian Americans than the general U.S. population and over seven times higher when compared to Whites. However, Asian Americans constitute a heterogeneous racial group, and it is becoming increasingly evident that considering each Asian ethnicity separately is crucial when it comes to cancer research so ethnic-specific differences are not missed. These differences can inform disease etiology and improve prevention efforts, but there is limited literature that considers the diversity of the Asian American population when it comes to nasopharyngeal cancer. Methods: Using population-based cancer registry data in the Surveillance, Epidemiology, and End Results Program from 1990 to 2014, we calculated age-adjusted incidence rates of nasopharyngeal cancer for nine Asian American ethnic subgroups: Chinese, Japanese, Filipino, Korean, Asian Indian/Pakistani, Vietnamese, Laotian, Cambodian, and Native Hawaiian/Pacific Islander. We compared these rates to the rate for non-Hispanic whites using incidence rate ratios (IRRs) and 95% confidence intervals (CIs). Sex and tumor histology were considered in the analyses as well. Results: Approximately 9,700 nasopharyngeal cancer cases were included. Incidence of nasopharyngeal cancer in all Asian American ethnic subgroups with the exception of Japanese and Asian Indian/Pakistani were statistically significantly higher than non-Hispanic whites; most notably, incidence in Laotians was over 14 times higher (IRR=14.71, 95% CI 11.87-18.02) and incidence in Chinese was over 10 times higher (IRR=10.73, 95% CI 10.19-11.29). When tumor histology was considered, the disparities were most pronounced for the differentiated and undifferentiated non-keratinizing tumors. Relative to non-Hispanic whites, incidence of the differentiated non-keratinizing histology was over 30 times higher in Laotians (IRR=30.19, 95% CI 17.97-47.45), and incidence of the undifferentiated non-keratinizing histology was close to 25 times higher in both Chinese and Laotians (IRR=24.82, 95% CI 21.97-28.02 and IRR=24.95, 95% CI 15.24-38.91, respectively). Conclusions: The higher incidence of nasopharyngeal cancer previously observed in Asian Americans is largely attributable to specific ethnic subgroups. Such disparities are overlooked when Asian Americans are studied in the aggregate. Future research should explore the environmental, behavioral, and genetic factors that may contribute to the significantly higher incidence of nasopharyngeal cancer observed in Chinese and Laotians. Citation Format: Alice W. Lee, Angela Sou, Lihua Liu. Disparities in nasopharyngeal cancer incidence among Asian American ethnic subgroups [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-198.

Exploring the Subjective Caregiving Experience Among Chinese, Korean, and Southeast Asian Communities

Although the Asian American community is one of the fastest growing racial groups in the US, members of this group continue to be underserved and understudied, especially when it comes to the needs of family caregivers. Therefore, through a national initiative to understand the lived experiences of diverse family and friend caregivers, survey data was collected from a variety of Asian American ethnic subgroups including Chinese (n=148), Korean (n=131), and Southeast Asian (i.e., Vietnamese, Hmong, Cambodian, Laotian; n=161). Surveys were distributed in-person and online, and also offered in the translated native languages of the abovementioned groups. Caregivers had to be 18 years and older and providing care to a person aged 55 and older who needed assistance because of ongoing health problems or disabilities. For the overall sample of Asian American caregivers (n=440), participants were on average 51.68 years of age (SD=15.98), identified as female (n=336), were not born in the US (n=348), lived with the care receiver (n=247), and reported less than $10,000 in income per year (n=199). As guided by the Stress Process Model and through a series of ANOVA tests, when compared on all major outcomes, Southeast Asian caregivers significantly reported: 1) more difficulty with care related tasks (e.g., financial/legal decisions), 2) a stronger cultural commitment to caregiving, 3) higher work strain, and 4) more depressive symptomology. Discussion will focus on opportunities for professionals to meet the needs of Asian American caregivers through the use of available trainings and programs aimed to support diverse caregivers.

Asian American ethnic subgroup disparities in time to surgical treatment for breast cancer in the California Cancer Registry.

101 Background: Health risks and outcomes among Asian American patients are not adequately understood when Asians are treated as a homogenous ethnic group. This work is the first to explore trends in time to surgical treatment for breast cancer amongst Asian American ethnic subgroups. Methods: We used data from the population-based California Cancer Registry to identify a cohort of females diagnosed with invasive breast cancer between 2012-2017 in California. Time to surgical treatment was defined as the time elapsed between definitive diagnosis of breast cancer and receipt of surgery. Covariates included individual patient sociodemographic, health history, and tumor characteristics. Multivariable logistic regression was used to determine the odds of receiving surgery within 30 and 90 days of breast cancer diagnosis and multivariable Cox proportional hazards regression was used to analyze the likelihood of shorter time to surgery. A Bonferroni corrected alpha level was used to account for multiple racial/ethnic group comparisons. Results: Of 106,441 breast cancer patients, 57% were non-Hispanic white (NHW), 21% were Hispanic, 14% were Asian (4% Filipino; 3% Chinese; 1% each of Asian Indian or Pakistani (AIP), Vietnamese, Japanese, and Korean; 3% other Asian), and 6% were non-Hispanic black (NHB). Compared to NHWs, Hispanics (OR = 0.86, 99.5% CI = 0.82-0.92) and NHBs (OR = 0.82, 99.5% CI = 0.76-0.90) were less likely to receive surgery within 30 days of breast cancer diagnosis, while Chinese (OR = 1.30, 99.5% CI = 1.17-1.45) and AIPs (OR = 1.24, 99.5% CI = 1.04-1.48) were more likely to receive surgery within 30 days. These trends persisted for Hispanic (OR = 0.87, 99.5% CI = 0.79-0.96), NHB (OR = 0.73, 99.5% CI = 0.63-0.85), and Chinese patients (OR = 1.33, 99.5% CI = 1.04-1.71) when analyzing the likelihood of receiving surgery within 90 days of diagnosis. Compared to NHWs, Hispanics (OR = 0.94, 99.5% CI = 0.92-0.97), NHBs (OR = 0.88, 99.5% CI = 0.85-0.91), and Vietnamese (OR = 0.90, 99.5% CI = 0.83-0.98) were less likely to experience shorter time to surgical treatment, while Chinese (OR = 1.15, 99.5% CI = 1.09-1.21) and AIPs (OR = 1.09, 99.5% CI = 1.01-1.18) were more likely to have shorter time to surgery. Conclusions: In this population-based study of the California Cancer Registry, trends in time to surgical treatment for breast cancer were not consistent for patients belonging to different Asian ethnic subgroups. While Chinese and AIP patients tended to receive surgery sooner than NHW patients, Vietnamese patients face a disparity in receiving timely surgical treatment relative to NHW patients. Further research is needed to fully understand and appropriately target disparities in breast cancer treatment for patients of different Asian American ethnic subgroups.

Who Votes among Asian American Ethnic Subgroups?

The authors address the gap in what is known about voting among Asian American ethnic subgroups using National Asian American Survey 2016 Post-Election Survey data to investigate the propensity to vote in the 2016 presidential election across two samples: registered Asian Americans and registered naturalized Asian Americans. The authors use logistic regressions to examine voting behavior across 10 Asian ethnic subgroups for the first time. Across both samples of Asian Americans and naturalized Asian Americans, Chinese Americans demonstrate a lower propensity to vote than most other Asian ethnic subgroups, while Asian Indian and Bangladeshi Americans demonstrate a higher propensity to vote. Among all Asian Americans, being female, being older, and having more education all pattern higher rates of reported voting in the 2016 presidential election, while for naturalized Asians, time in the United States and higher levels of education are associated with a higher likelihood of voting in the 2016 presidential election.

Aggregation of Asian-American subgroups masks meaningful differences in health and health risks among Asian ethnicities: an electronic health record based cohort study

BackgroundFew large cohort studies have examined the prevalence of diabetes mellitus (DM), hypertension (HTN), coronary artery disease (CAD), obesity, and smoking among middle-aged and older adults in the major Asian-American ethnic groups and Native Hawaiian/Pacific Islanders (PIs). The aim of this study was to evaluate how prevalence of these conditions and risk factors differs across Asian-American and PI ethnic groups and compares with an aggregated All Asian-American racial group.MethodsThis study used a cohort of 1.4 million adults aged 45 to 84 who were Kaiser Permanente Northern California health plan members during 2016. The cohort included approximately 274,910 Asian-Americans (Chinese, Filipino, Japanese, Korean, Southeast Asian, South Asian, other), 8450 PIs, 795,080 non-Hispanic whites, 107,200 blacks, and 210,050 Latinos. We used electronic health record data to produce age-standardized prevalence estimates of DM, HTN, CAD, obesity (using standard and Asian thresholds), and smoking for men and women in all racial/ethnic subgroups and compared these subgroups to an aggregated All Asian-American racial group and to whites, blacks, and Latinos.ResultsWe found large differences in health burden across Asian-American ethnic subgroups. For both sexes, there were 16 and > 22 percentage point differences between the lowest and highest prevalence of DM and HTN, respectively. Obesity prevalence among Asian subgroups (based on an Asian BMI ≥ 27.5 kg/m2 threshold) ranged from 14 to 39% among women and 21 to 45% among men. Prevalence of smoking ranged from 1 to 4% among women and 5 to 14% among men. Across all conditions and risk factors, prevalence estimates for Asian-American and PI ethnic groups significantly differed from those for the All Asian-American group. In general, Filipinos and PIs had greater health burden than All Asians, with prevalence estimates approaching those of blacks.ConclusionsIn a population of middle-aged and older adult Northern California health plan members, we found substantive differences in prevalence of chronic cardiovascular conditions, obesity, and smoking across Asian-American ethnic groups and between Asian-American ethnic groups and an aggregated All Asian racial group. Our study confirms that reporting statistics for an aggregated Asian-American racial group masks meaningful differences in Asian-American ethnic group health.

Posttraumatic stress symptoms, shame, and substance use among Asian Americans

BackgroundTo examine the association between posttraumatic stress symptoms (PTSS) and substance use among Asian Americans and the influence of a culturally-relevant moderator, shame. MethodsFrom 2016 to 2017, 199 participants from Amazon Mechanical Turk and a university subject pool completed an online survey. Chi-square and Kruskal-Wallis tests explored demographic and clinical differences among three Asian American ethnic subgroups (East Asians, South Asians, and Southeast Asians). Generalized linear models assessed the association between PTSS and substance use (alcohol, tobacco, and other drugs) and the moderation of this relationship by shame. ResultsEthnic subgroups significantly differed on all three substance use variables. The severity in PTSS was significantly associated with hazardous drug use (IRR = 1.03, (1.01, 1.05), p = .003). The association between PTSS and days of tobacco use and binge drinking was significantly moderated by shame. Low levels of shame increased the effect of PTSS on binge drinking (IRR = 1.05, (1.00, 1.10), p = .035) and tobacco use (IRR = 1.15, (1.11, 1.19), p < .001). High levels of shame had no effect of PTSS on binge drinking (IRR = 1.01, (0.99, 1.03), p = .54) and a reduced effect on tobacco use (IRR = 1.07, (1.05, 1.09), p < .001). ConclusionsAmong Asian Americans, the association of PTSS and substance use depends on shame. Lower levels of shame are a risk factor, increasing the effect of PTSS on substance use. Culturally-modified addiction treatments should assess for shame among Asian Americans and attend to ethnic sub-group diversity in substance use.

Colorectal cancer screening prevalence and predictors among Asian American subgroups using Medical Expenditure Panel Survey National Data.

Asian American (AA) ethnic subgroups are diverse in socio-economic status, years in the United States, English proficiency, and cultures with different health seeking behaviors and health care access. Fifty-two percent of AAs age ≥50 years had colorectal cancer screening (CRCS) in 2013, compared with 61% of non-Hispanic whites. We hypothesized that CRCS prevalence among AA ethnicities is heterogeneous and that the reasons related to CRCS among AA subgroups are associated with demographic characteristics, acculturation, health care access, and health attitudes. Medical Expenditure Panel Survey data for 2009-2014 compared CRCS status among whites (n = 28,834), Asian Indians (n = 466), Chinese (n = 652), and Filipinos (n = 788). Multivariate logistic regression examined ethnic differences and correlates of CRCS accounting for complex sampling design. Whites had the highest prevalence of screening (62.3%), followed by Filipinos (55.0%), Chinese (50.9%), and Asian Indians (48.6%). Older age, having health insurance, and having a usual care provider predicted CRCS across all ethnicities. Different demographic, health care access, and health attitude predictors within each ethnic group were related to CRCS. This study contributes to the literature on influences of differential CRCS prevalence among AA subgroups. CRCS promotion should be tailored according to attitudes and structural barriers affecting screening behavior of specific ethnic subgroups to truly serve the health needs of the diverse AA population. Cancer 2018;124:1543-51. © 2018 American Cancer Society.

Unraveling the Determinants to Colorectal Cancer Screening Among Asian Americans: a Systematic Literature Review.

Colorectal cancer (CRC) is one of the top three cancers experienced among Asian American (AA) men and women. One effective way to decrease incidence and mortality from CRC is the adherence of regular CRC screening; however, AA continue to receive the lowest screening rates compared to other racial/ethnic groups. When disaggregating this heterogeneous population, further disparities exist between subgroups. Examination of facilitators and barriers to cancer screening among AA subgroups is fairly recent and the synthesis of this information is limited. As such, a systematic review was conducted examining the facilitators and the barriers among Chinese, Filipino, Korean, and Japanese Americans using a systematic literature review method. The Health Belief Model served as the primary theoretical framework for this study and used to organize and synthesize the facilitators and barriers to CRC screening. In total, 22 articles yielded 29 examinations of each of the AA subgroups. Different facilitators and barriers to screening uptake for each subgroup were revealed; however, consistent across all the subgroups was physician recommendation as a facilitator and participants' unawareness of screening tests and those stating having no problems/symptoms of CRC as a barrier across screening modalities. Tailored approach in outreach and intervention efforts are suggested when achieving to improve CRC screening in AA ethnic subgroups.

Factors associated with having a usual source of care in an ethnically diverse sample of Asian American adults.

Despite significant population increases, how Asian Americans ethnic subgroups vary in having a usual source of care (USC) is poorly understood. To examine how having a USC varies among Asian American ethnic subgroups (Chinese, Filipinos, Japanese, Koreans, Vietnamese, and South Asians), and the potential factors influencing variation in having a USC. Data were from 2005 and 2009 California Health Interview Survey. Logistic regressions and pair-wise comparisons were used to compare odds of having a USC among Asian ethnic adults (18-64 y) and to examine ethnicity-specific associations with immigration-related factors (English proficiency, length of residence, and living in an ethnically concordant neighborhood) and key enabling (employment, income, insurance), predisposing (education), and need (health status) factors. Models also adjusted for other sociodemographic factors. Significant differences in the magnitude of the variation and factors influencing having a USC were found across Asian subgroups. Korean and Japanese adults had 52%-69% lower adjusted odds of having a USC compared with Chinese. Among all Asian subgroups, uninsured adults had 85%-94% lower adjusted odds of having a USC. Patterns of associations with USC and key factors varied by specific Asian subgroup. Patterns of associations for USC varied by Asian subgroup, although uninsurance persisted significantly across all subgroups. Persistent variation and heterogenous associations suggest that targeted, ethnicity-specific policies and outreach are needed to improve having a USC for Asian American ethnic adults.

Factors Associated with Colorectal Cancer Screening Among Cambodians, Vietnamese, Koreans and Chinese Living in the United States

The purpose of this community-based participatory study was to identify factors associated with colorectal cancer (CRC) screening compliance and non-compliance among Cambodians, Vietnamese, Koreans and Chinese men and women 50 years and older living in the United States. A cross-sectional design was used in the study. The completed sample included 815 Asian Americans which included Cambodians (N=215), Vietnamese (N=195), Koreans (N=94) and Chinese (N=311). A 95-item questionnaire was developed and pilot tested for content validity and reliability. An in-person data collection approach was utilized and participants were given choice in responding in English or their native language. Of the 815 participants, 79.1% (N=645) reported never-screened, 7.9% (N=64), non-compliance, and 13.0% (N=106) compliance. Education was significantly associated with never-screened for CRC for Vietnamese and Chinese; employment status for Cambodians and Koreans; lack of health insurance for Cambodians, Korean and Chinese; English fluency and years lived in the U.S. for Vietnamese, Koreans, and Chinese. Less acculturated Asian Americans were more likely to be never screened, but differentially across ethnic subgroups. Barriers to screening included lack of knowledge, language, transportation, and time. Increased culturally-targeted public awareness and education programs are needed to improve CRC screening and compliance among high risk Asian American ethnic subgroups.

Methodological issues in the collection, analysis, and reporting of granular data in Asian American populations: historical challenges and potential solutions.

There are close to 15 million Asian Americans living in the United States, and they represent the fastest growing populations in the country. By the year 2050, there will be an estimated 33.4 million Asian Americans living in the country. However, their health needs remain poorly understood and there is a critical lack of data disaggregated by Asian American ethnic subgroups, primary language, and geography. This paper examines methodological issues, challenges, and potential solutions to addressing the collection, analysis, and reporting of disaggregated (or, granular) data on Asian Americans. The article explores emerging efforts to increase granular data through the use of innovative study design and analysis techniques. Concerted efforts to implement these techniques will be critical to the future development of sound research, health programs, and policy efforts targeting this and other minority populations.

Breaking Down the Silence

Sexual assault is a widespread problem with high prevalence among college women. Disclosure of such experiences is important because it can help mitigate stress, anxiety, and depression related to sexual assault. This article provides data on sexual assault prevalence of Asian American college women and their subsequent help-seeking patterns. Using a community-based participatory research approach, crosssectional data were obtained through a Web-based quantitative survey (N=809). Descriptive statistics and chi-square tests conducted revealed that 35% of undergraduate female students experienced some form of sexual assault in their lifetime, and that more than half of women (54%) reported that their most recent incident occurred during college. The three largest Asian American ethnic sub-groups represented in the study, Chinese, South Asian, and Filipina, reported higher sexual assault prevalence during college than other ethnic groups. Women were more likely to disclose to informal sources, such as friends, family, and partners, than to formal sources. Asian Americans disclosed less often than Whites, 50% vs. 59%, respectively. The article explores existing resources to encourage disclosure and help-seeking behavior on campus, and provides suggestions for creating a more responsive campus environment.

Leading Causes of Death for Older Asian Americans

Asian Americans are the fastest growing population in US, but data describing their disease burden are limited. For most US health statistics, Asian Americans are grouped into a single race category. We use a unique data file to identify causes of death for persons aged 65 or older in six Asian American ethnic subgroups (Chinese, Indians, Japanese, Koreans, Filipinos, and Vietnamese). Causes of death classified by the International Classification of Diseases, Tenth Revision (ICD–10) are ranked according to the number of deaths assigned to each cause. There are a total of 76,866 death records included in this study. The 10 leading causes of death account for 85% of all deaths for Asian Americans and the top 3 causes (heart disease, cancer, and stroke) account for 68%. The rankings and relative cause-specific mortalities varied significantly across the six Asian ethnic groups. Indians had the highest relative burden of heart disease (41.6% of all deaths), followed by Filipinos (35.6%), then the other four Asian ethnic groups (~30%). Cancer, the second leading cause of death, accounted for about 26% of all deaths for Chinese, Japanese, Koreans and Vietnamese, 21% for Filipinos and 18% for Indians. Influenza and pneumonia, chronic lower respiratory disease, diabetes, accidents (unintentional injuries), and kidney disease also ranked among the top 10 causes, but the specific ranks vary across ethnic populations. Differences in the ranking are also evident by age and sex. Because of significant heterogeneity among Asian American ethnic groups, it is more informative to calculate ethnicity-specific rankings of causes of death.

Cancer death rates for older Asian-Americans: classification by race versus ethnicity

For most US health statistics, Asian-Americans are grouped into a single race category. We use a unique data file to determine site-specific cancer death rates for persons aged 65 and older in six Asian-American ethnic subgroups (Chinese, Indian, Japanese, Korean, Filipino, and Vietnamese) and determine for which cancer sites the aggregate Asian-American race category is a misleading summary of subgroup cancer risk. We previously determined all-cause death rates for Asian-American subgroups using Social Security files, in collaboration with a colleague at the Social Security Administration. By linking these records to death certificates, we determine cause-specific death rates for 21 cancer sites. We test whether there is significant heterogeneity among subgroups, using Poisson regression. For about half of cancer sites, all Asian subgroups have lower rates than Whites. For three sites most subgroups have higher rates than Whites (stomach, liver, and cervix), but there is significant heterogeneity. For other cancer sites, there is an inconsistent pattern, with some subgroups having rates lower than Whites and some having rates similar to Whites. Asian Indians are most often the Asian subgroup with a divergent rate. The aggregate Asian-American rate masks significant subgroup heterogeneity for many, but not all, cancer sites.

Tobacco use and dependence in Asian Americans: A review of the literature

This article reports on an integrative review of literature on Asian American tobacco use and dependence, identifies gaps in the literature, and proposes studies needed in the future. Articles were retrieved from electronic health-related databases indexed for permutations of the keywords Asian Americans, smoking, tobacco use, tobacco dependence, and nicotine dependence. A manual search also was done to identify additional literature. A total of 216 articles were identified; the review includes 39 articles reporting gender- and ethnic-specific information on subgroups of Asian Americans in the following areas: Smoking prevalence, correlates of smoking, and tobacco dependence treatment. In addition, 13 articles on tobacco and nicotine metabolism were reviewed. Empirical studies have concentrated on Chinese, Korean, and Vietnamese American men. Smoking prevalence is higher among Asian American men with low acculturation than among their counterparts, but the reverse pattern is observed among Asian American women. Asian Americans tend to smoke fewer cigarettes per day than White Americans, and this difference may be explained by differences between the two groups in nicotine metabolism. More research is needed on this diverse population, especially Asian American women of all ethnic subgroups and Asian Indian, Filipino, Pakistani, and Thai American men. A need also exists for the development of specialized tobacco dependence treatments to address the cultural issues of specific Asian American ethnic subgroups, to enhance access to treatment, and to determine how treatment recommendations should reflect differences in acculturation level and tobacco and nicotine metabolism.