Asian American, Native Hawaiian, And Pacific Islander Research Articles

Abstract B007: Developing community-primary care-specialty care partnerships to address cancer disparities in Asian Americans, Native Hawaiians, and Pacific Islanders

Abstract Cancer continues to be the leading cause of death in Asian Americans, Native Hawaiians, and Pacific Islanders (AANHPIs), with over one-third of the AANHPI population residing in California and Hawai’i. Due to linguistic, cultural, and sociodemographic differences, cancer prevention, control, and treatment remains a challenge. These compounded factors hinder AANHPIs from seeking care or following through with provider’s recommendations as they experience high level of dissatisfaction in care, risk of misdiagnosis or ineffective treatment plans, resulting in low levels of engagement with the healthcare system. This has called for a need to create partnerships and improve coordination between community, primary care, and specialty care. The Bristol-Myers Squibb Foundation’s Specialty Care for Vulnerable Populations initiative addresses inequities in access to and utilization of specialty care services by medically underserved and vulnerable populations in the US. The goal of this national initiative is to catalyze sustainable improvement and expansion of specialty care and health service delivery by safety net providers for people at high risk of cancer and cardiovascular disease. In response to the cancer disparities and inequities faced by AANHPI populations, the Bristol-Myers Squibb Foundation’s Specialty Care for Vulnerable Populations awarded 4 organizations $750,000 each to support 3 year health service delivery demonstration projects to improve access to quality cancer care, patient engagement, and supportive services to AANHPIs. Objectives for this session will be: • Describe the cancer disparities in Asian Americans, Native Hawaiians, and Pacific Islanders (AANHPIs) • Explain current research and new partnerships to improve cancer outcomes and access for AANHPIs • Disseminate different models of care bolstering community, primary care, and specialty care in AANHPI cancer patients This session will delve into the cancer disparities apparent in AANHPIs and highlight the 4 AANHPI-dedicated projects to create better coordination between community, primary care, and specialty care: 1. University of California Davis Cancer Center/Health & Life Organization 2. University of California San Francisco 3. University of California Irvine Chao Family Comprehensive Cancer Center 4. University of Hawai’i John A. Burns School of Family Medicine These projects include forming new partnerships between a NCI comprehensive cancer center + FQHC-lookalike; testing an in-person and virtual patient navigation portal; utilizing a hub-and-spoke model between primary care, FQHCs, and specialty care; and bolstering telehealth capabilities to train workers in USAPI territories and Hawai’i on cancer topics and services. Citation Format: Priscilla Ko, Patricia Doykos, Moon Chen, Scarlett Lin Gomez, Neal Palafox, Sora Park Tanjasiri. Developing community-primary care-specialty care partnerships to address cancer disparities in Asian Americans, Native Hawaiians, and Pacific Islanders [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr B007.

Egocentric social networks, lifestyle behaviors, and body size in the Asian Community Health Initiative (CHI) cohort.

BackgroundSocial networks have been shown to influence lifestyle behaviors in non-Latinx white (NLW) populations. We examined their influence in Asian American, Native Hawaiian and Pacific Islander (AANHPI) women.MethodsWe included 477 AANHPI women from the Asian Community Health Initiative Study who provided egocentric (degree, density, composition) and epidemiologic (size, types of ties) social network data and data on alcohol intake, physical activity, smoking, diet, and body size. We used logistic regression to evaluate associations of social network measures and dichotomous outcomes, and linear regression for continuous outcomes.ResultsIn multivariable-adjusted analyses, higher degree and/or proportion of friends were significantly related to higher Western diet, higher odds of any alcohol consumption, and lower odds of physical inactivity and body mass index (BMI)≥23 kg/m2. Additionally, a higher proportion of NLW in women’s networks was related to lower Asian diet but also lower waist size. Community participation was related to higher Western diet and lower Asian diet. By contrast, degree and/or proportion of relatives were positively related to BMI, waist size and to a higher odds of BMI≥23 kg/m2 and of ever smoking 100 cigarettes. Being married was related to fewer alcoholic drinks per week and higher Asian diet. A higher density of relationships with frequent contact was also associated with higher Asian diet.ConclusionsAANHPI women with larger proportions of friends and NLWs in their networks had more Western health behaviors and smaller body size. Norms for health behaviors and body size may be influenced by the size, composition, and structure of social networks, relevant to chronic disease prevention.

SYSTEMATIC REVIEW AND GAP ANALYSIS ON ALZHEIMER’S DISEASE IN ASIAN AMERICANS, NATIVE HAWAIIANS, AND PACIFIC ISLANDERS

Background: The Asian American, Native Hawaiian, and Pacific Islander (AANHPI) aging population is rapidly growing and the burden of Alzheimer’s disease and its related dementias (AD/ADRD) will likely mirror this demographic growth. AANHPIs face significant barriers in obtaining timely AD/ADRD diagnosis and services; yet little is known about AD/ADRD in this population. The study objective is to conduct a systematic review on the published literature on AD/ADRD among AANHPIs to identify gaps and priorities to inform future research and action plans. Methods: The systematic review was conducted following the PRISMA Protocol for Systematic Reviews. Co-author (TR), an experienced Medical Librarian, searched PubMed, EMBASE, PsycINFO, Cochrane Central of Clinical Trials, Ageline and Web of Science for peer-reviewed articles describing AD/ADRD among AANHPIs. The search was not limited by language or publication date. Each citation was reviewed by two trained independent reviewers. Conflicts were resolved through consensus. Results: The title/abstract and full texts of 1,447 unique articles were screened for inclusion, yielding 310 articles for analysis. Major research topics included prevalence, risk factors, comorbidities, interventions and outreach, knowledge/perceptions/attitudes, caregiving, and detection tools. A limited number of studies reported on national data, on NHPI communities generally, and on efficacy of interventions targeting AANHPI communities. Conclusion: To our knowledge, this is the first systematic review on AD/ADRD among AANHPI populations. Our review provides a first step in mapping the extant literature on AD/ADRD among this underserved and under-researched population and will serve as a guide for future research, policy and intervention.

Medicaid And Private Insurance Coverage For Low-Income Asian Americans, Native Hawaiians, And Pacific Islanders, 2010-16.

To determine how low-income Asian American, Native Hawaiian, and Pacific Islander (AANHPI) adults gained health insurance coverage-specifically, via Medicaid or private insurance-under the Affordable Care Act, we used a difference-in-differences approach to compare uninsurance rates in 2010-13 and 2015-16. In Medicaid expansion states, adjusted Medicaid coverage gains were 9.67 percentage points larger than in nonexpansion states; however, adjusted private coverage gains in expansion states were 10.19 percentage points lower. These results indicate that, in contrast to the case for other racial/ethnic groups, for AANHPI the Medicaid coverage increases in expansion states were of similar magnitude to the private insurance coverage increases in nonexpansion states. Reasons for this may include differences in willingness to enroll in public versus private coverage, barriers related to language or citizenship status, or other factors. Future studies are needed to understand these patterns and promote health equity for this population.

Trends in Clinical Research Including Asian American, Native Hawaiian, and Pacific Islander Participants Funded by the US National Institutes of Health, 1992 to 2018

Advancing the health equity agenda for Asian American, Native Hawaiian, and Pacific Islander (AA/NHPI) individuals has become an intersecting priority for federal agencies. However, the impact of federal investments and legislation to ensure systematic processes and resources to eliminate health disparities in AA/NHPI populations is unclear. To perform a portfolio review of clinical research funded by the National Institutes of Health (NIH) for AA/NHPI populations and determine the level of NIH investment in serving these populations. Cross-sectional study in which the NIH Research Portfolio Online Reporting Tools Expenditures and Results system was queried for extramural AA/NHPI-focused clinical research projects conducted in the United States from January 1, 1992, to December 31, 2018. Clinical research funded under research project grants, centers, cooperative awards, research career awards, training grants, and fellowships was included, with an advanced text search for AA/NHPI countries and cultures of origin. Project titles and terms were screened for inclusion and project abstracts were reviewed to verify eligibility. Descriptive analyses were completed. Outcomes included NIH funding trends and characteristics of funded projects and organizations. The proportions of AA/NHPI-related funding trends were calculated using 2 denominators, total NIH expenditures and clinical research expenditures. There were 5460 records identified, of which 891 studies were reviewed for eligibility. Of these, 529 clinical research studies focused on AA/NHPI participants composed 0.17% of the total NIH budget over 26 years. Projects studying AA/NHPI individuals in addition to other populations were funded across 17 NIH institutes and centers. The top 5 funders collectively contributed almost 60% of the total funding dollars for AA/NHPI projects and were the National Cancer Institute ($231 584 664), National Institute on Aging ($108 365 124), National Heart, Lung, and Blood Institute ($67 232 910), National Institute on Minority Health and Health Disparities ($62 982 901), and National Institute on Mental Health ($60 072 779). Funding of these projects ($775 536 121) made up 0.17% of the overall NIH expenditures ($451 284 075 000) between 1992 and 2018, and 0.18% ($677 479 468) of the NIH research budget after 2000. Funding for AA/NHPI projects significantly increased over time, but the proportion of the total NIH budget has only increased from 0.12% before 2000 to 0.18% after 2000. Of total funding, 60.8% was awarded to research project grants compared with only 5.1% allocated to research career awards, training grants, and fellowships. Increases in research dollars for AA/NHPI clinical research were not associated with increases in the overall NIH research budget, and underrepresentation of AA/NHPI subgroups still remains. Without overt direction from federal entities and dedicated funds for health disparities research, as well as parallel efforts to increase diversity in the biomedical workforce, investments may continue to languish for AA/NHPI populations.

Issues Affecting Medication Use Among Asian Americans, Native Hawaiians, and Pacific Islanders

Background and Purpose: Asian American, Native Hawaiian, and Pacific Islander (AANHPI) populations may have unique issues (e.g., cultural attitudes and language barriers) that impact their relatively low adherence to medication use. Research on the topic is limited because AANHPI populations are generally not included in research studies. We conducted a qualitative investigation to gain insights into low adherence to medication use among AANHPIs and how to address this health disparity. Methods: In-depth individual interviews were conducted with 14 academic pharmacists and four other health care professionals knowledgeable about AANHPI disparities. Results: The majority of participants were either unsure of appropriate medication use by AANHPIs or felt they were used inappropriately. Over half of the participants were involved in or knew of efforts which focused on appropriate medication use. Participants felt that approaches to improving medication adherence included education and counseling, collaboration between providers, and conducting additional research, a role they felt the Daniel K. Inouye College of Pharmacy could fulfill. Conclusion: The appropriate use of medications for AANHPI populations is perceived as a barrier to parity in health care by pharmacists and other health care professionals. While current efforts exist to address appropriate medication use, additional research focusing on potential solutions identified by our participants is required to further assess their effectiveness in helping to close the health care gap.

Wide variation in cancer rates among Asian Americans, Native Americans, Pacific Islanders

Cancer is the leading cause of death for Asian Americans, Native Hawaiians, and Pacific Islanders (AANHPIs) even though overall cancer mortality and incidence rates in this population are 30% to 40% lower than those for non-Hispanic whites (NHWs), according to a new report from the American Cancer Society (ACS). At the same time, stomach and liver cancer rates in AANHPIs are double those in NHWs, notes the report, which appears in CA: A Cancer Journal for Clinicians and as the special section in Cancer Facts & Figures 2016.1, 2 The report estimates that there will be 57,740 new cancer cases and 16,910 cancer deaths among AANHPIs in 2016. Among AANHPI males, the 3 leading causes of cancer death are lung cancer (27%), liver cancer (14%), and colon/rectum cancer (11%). Among women, they are lung cancer (21%), breast cancer (14%), and colon/rectum cancer (11%). According to the report, the term “Asian” refers to people with origins in the Far East, Southeast Asia, or the Indian subcontinent. Included in that group are Asian Indians, Cambodians, Chinese, Filipinos, Hmong, Japanese, Koreans, Pakistanis, and Vietnamese. Asian Americans represented 6.3% of the total US population in 2014 and are the fastest growing racial/ethnic group in the country. Lindsey Torre, MSPH, of the American Cancer Society surveillance research group and coauthor of the report, notes that cancer control strategies in this population include improved use of vaccination and screening; interventions to increase physical activity and reduce body weight, tobacco use, and alcohol consumption; and research to gain a better understanding of differences in risk factors between subgroups.

Strategies for recruiting representative samples of Asian Americans for a population-based case–control study

BackgroundData are limited on effective methods for recruiting persons, especially from ethnically diverse populations, into population-based studies. The goal of this study was to evaluate the variation among and representativeness...

Cancer statistics for Asian Americans, Native Hawaiians, and Pacific Islanders, 2016: Converging incidence in males and females.

Cancer is the leading cause of death among Asian Americans, Native Hawaiians, and Pacific Islanders (AANHPIs). In this report, the American Cancer Society presents AANHPI cancer incidence data from the National Cancer Institute, the Centers for Disease Control and Prevention, and the North American Association of Central Cancer Registries and mortality data from the National Center for Health Statistics. Among AANHPIs in 2016, there will be an estimated 57,740 new cancer cases and 16,910 cancer deaths. While AANHPIs have 30% to 40% lower incidence and mortality rates than non-Hispanic whites for all cancers combined, risk of stomach and liver cancers is double. The male-to-female incidence rate ratio among AANHPIs declined from 1.43 (95% confidence interval, 1.36-1.49) in 1992 to 1.04 (95% confidence interval, 1.01-1.07) in 2012 because of declining prostate and lung cancer rates in males and increasing breast cancer rates in females. The diversity within the AANHPI population is reflected in the disparate cancer risk by subgroup. For example, the overall incidence rate in Samoan men (526.5 per 100,000) is more than twice that in Asian Indian/Pakistani men (216.8). Variations in cancer rates in AANHPIs are related to differences in behavioral risk factors, use of screening and preventive services, and exposure to cancer-causing infections. Cancer-control strategies include improved use of vaccination and screening; interventions to increase physical activity and reduce excess body weight, tobacco use, and alcohol consumption; and subgroup-level research on burden and risk factors. CA Cancer J Clin 2016;66:182-202. © 2016 American Cancer Society.

Perspectives on Medication-Related and Other Health Disparities Affecting Asian Americans, Native Hawaiians, and Other Pacific Islanders

Background and Purpose: The present body of literature has little information regarding factors behind gaps in health status affecting Asian American, Native Hawaiian and Pacific Islander (AANHPI) communities, and methods to address them. We sought to examine pharmacists’ and other health care professionals’ perceptions of AANHPI health disparities and their ideas for solutions involving pharmacists, pharmacy schools, and the U.S. Food and Drug Administration (FDA). Methods: In-depth individual interviews were conducted with ten academic pharmacists and four other health care professionals knowledgeable about AANHPI disparities, with a focus on medication-related disparities. Results: Commonly identified factors behind disparities included poor communication, low socioeconomic status, cultural inhibitions creating a reluctance to seek care, and limited access to care. Suggested strategies for community pharmacists to reduce disparities included one-on-one care focused on outcomes, translated materials and translation services, and tracking adherence to medications. Participants suggested that colleges of pharmacy could continue community health events, encourage students to be culturally aware, and conduct health disparities research, and that the FDA could provide translated information, research funding, and requirements for greater ethnic diversity in clinical trials. Conclusion: Experts believe that pharmacists have the potential to help close the health care gap for AANHPI populations.

Improving Access to Healthy Foods for Asian Americans, Native Hawaiians, and Pacific Islanders: Lessons Learned from the STRIVE Program.

Asian Americans, Native Hawaiians, and Pacific Islanders (AANHPIs) experience a large burden from certain chronic disease-related risk factors. The STRIVE Program funded four AANHPI community-based organizations (CBOs) to implement culturally adapted community gardens and farmers' markets to increase access to healthy foods. Key CBO informant interviews were conducted to understand processes and lessons learned.

Pathophysiologic Differences Among Asians, Native Hawaiians, and Other Pacific Islanders and Treatment Implications

Differences in pathophysiology may affect the diagnosis, prevention, and treatment of diabetes in Asian Americans, Native Hawaiians, and Pacific Islanders (AANHPIs). Equally important are differences in cultural beliefs, dietary habits, and behavioral patterns among AANHPIs that require culturally effective translation of interventions into the community. These issues were discussed by clinicians and investigators at a conference held in Honolulu, Hawaii, in September 2011 with the theme “Diabetes in Asian Americans, Native Hawaiians, and Pacific Islanders: A Call to Action” by a coalition of health care organizations, clinicians, and scientists with strong interests in the topic and in the health of AANHPI populations (1). The discourse begins with an evaluation of pathophysiologic differences, followed by a discussion of the standard diagnostic criteria and current treatment algorithms as well as dietary recommendations. The focus then shifts to various diabetes prevention studies specific to AANHPIs and their relevance to this growing ethnic minority group in America. This review concludes with two investigations that demonstrate culturally appropriate interventions and a brief description of the role played by the National Diabetes Education Program (NDEP). ### Pathophysiology—type 1 diabetes Diabetes has reached an epidemic level around the world, with most of the increase attributable to type 2 diabetes in developing Asian countries such as India and China (2). Type 1 diabetes is also increasing, although at a much less dramatic rate than type 2 diabetes and is now also increasingly associated with obesity and insulin resistance (3). The highest rates for type 1 diabetes are found in Northern European and Scandinavian countries and among the Caucasian population of the U.S. In contrast, type 1 diabetes is approximately 5 to 10 times lower in prevalence in those of Asian than those of European descent (4). In the U.S., the incidence of type 1 diabetes is lower by two- to fivefold in …

Crossing Intersections: Challenges Facing Asian American, Native Hawaiian, Pacific Islander and Lesbian, Gay, Bisexual, Transgender Youth: Exploring Issues and Recommendations

The experiences and the everyday life stories of lesbian, gay, bisexual, and transgender (LGBT) youth who are also Asian American, Native Hawaiian, and Pacific Islander (AANHPI) are not well-known or documented in the literature about LGBT or AANHPI communities. To help address this lack of information and knowledge, this article highlights some of the issues that these youth face and offers recommendations regarding data collection, cultural competency, and utilization of an intersectional lens of race/ethnicity and sexual orientation to ensure changes will be considered to policies that affect these populations. The policy recommendations focus on issues such as bullying and sexual and reproductive health.

Crossing Intersections: Challenges Facing Asian American, Native Hawaiian, Pacific IslanderandLesbian, Gay, Bisexual, Transgender Youth: Exploring Issues and Recommendations

The experiences and the everyday life stories of lesbian, gay, bisexual and transgender (LGBT) youth who are also Asian American, Native Hawaiian, and Pacific Islander (AANHPI) are not well-know or documented in the literature about LGBT or AANHPI communities. To help address this lack of information and knowledge, this article highlights some of the issues that these youth face and offers recommendations regarding data collection, cultural competency, and utilization of intersectional lens of race/ethnicity and sexual orientation to ensure changes will be considered to policies that affect these populations. The policy recommendations focus on issues such as bullying and sexual and reproductive health.

Culture and Mental Health: Risk, Prevention and Treatment for Asian Americans

Although the number of Asian Americans, Native Hawaiians, and Pacific Islanders (AANHPI) has grown from three million to over sixteen million in the past thirty years (U.S. Census Bureau, 2010), there are still major limitations to our basic understanding about the mental health and service needs of AANHPI groups in the United States. This is unfortunate, as nearly a decade has passed since the Surgeon General's landmark report on culture, race, and mental health (Department of Health and Human Services [DHSS], 2001). The report acknowledged the contributions of many important scholars, but also indicated that the knowledge base remained insufficient and required immediate attention.