The Center for Asian Health Engages Communities in Research to Reduce Asian American Health Disparities
On February 23, 2016, NIMHD and the NIH Asian and Pacific Islander American Organization (APAO) co-sponsored a lecture, Health Disparity Research in Diverse Asian American Populations: Present and Future, by Dr. Grace Ma, Associate Dean for Health Disparities, Founding Director, Center for Asian Health (CAH), Laura H. Carnell Professor of Public Health, and Professor in Clinical Sciences at the Lewis Katz School of Medicine at Temple University.
In her presentation, Ma, an NIMHD grantee, discussed the driving force for Asian health disparity research, health disparities confronting Asian Americans, discoveries from research conducted at CAH, and research opportunities for reducing health disparities among Asian Americans and other underrepresented populations.
Asian Americans are comprised of very diverse ethnic groups and face substantial challenges, according to Ma. For example, more than 70 percent of Asian Americans are foreign-born, and thus many have limited English proficiency. Other challenges include differing cultural beliefs and behaviors and unfamiliarity with the Western health system. In addition, Asian Americans have the most difficulty understanding instructions in a doctor’s office, are the least satisfied with cancer care coordination, and experience unique health disparities from other ethnic populations.
“There is more recognition of these issues that is documented in the literature, even though this population is very much understudied,” said Ma.
Asian Americans face health disparities in cancer, chronic diseases, such as heart disease, hypertension, and diabetes, mental health, and among the elderly. It is the only U.S. population suffering cancer as the leading cause of death. In particular, Asian Americans have the highest incidence and mortality rates of liver and stomach cancers--the most preventable cancers--largely due to high prevalence of related infections such as hepatitis B. In addition, Asian Americans have the lowest cancer screening rates and are typically diagnosed at a later stage compared to other racial and ethnic groups.
There is very limited data on cardiovascular disease in Asian Americans, and few studies of cardiovascular disease have examined Asian American subgroups separately, Ma explained.
“This is important information for guiding targeted interventions,” she said. “Not all groups have similar rates of incidence and prevalence of cardiovascular disease. It’s very important to tailor future prevention and intervention.”
Ma added that more than half of Asian Americans with diabetes don’t know they have the disease, and they are more likely to develop type-2 diabetes compared to whites despite having lower body weight and body mass index (BMI). Unique risk factors for diabetes among Asian Americans include insulin resistance, differential body fat distribution, genetics and emerging risks, such as metabolic syndrome, acculturation and a traditional diet high in sodium and carbohydrates, and physical inactivity.
She shared compelling statistics to dispel the myth that mental illness is rare in the Asian American community. Suicide is one of the leading causes of death for Asian Americans--those aged 20-24 have the highest suicide rate and Asian Americans have the highest suicide rate among females of all racial and ethnic groups aged 65-84. There is an association between depression and diagnoses of diseases and management. Asian Americans often consider expression of mental illness a personal weakness and are more likely than whites to express emotional distress through physical symptoms.
“Cancer patients, especially those with infection-related diseases, may experience shame and stigma that could affect their job and others may look down on them,” said Ma. “We have so few linguistically competent practitioners, and cultural barriers prevent many from seeking help. Through education and awareness we can convey that this is about an infectious disease, not a sexually-transmitted disease. Culturally-tailored messages are important.”
Mental health issues, especially related to depression, is just one area of understudied disparities among elderly Asian Americans, according to Ma. Others include limited access to culturally/linguistically appropriate health care, Alzheimer’s disease and burden of family members as caregivers, self-management of chronic conditions, and lack of medication adherence.
CAH’s mission is to reduce health disparities and improve health equity among Asian Americans and under-represented ethnic populations through intervention research, training, community engagement through cancer and health programs, partnership building (with churches, community organizations, etc.), dissemination, and clinical support/patient navigation for culturally and linguistically appropriate comprehensive health services. Ma shared highlights from community needs assessment studies as well as NIH-, PCORI-, and CDC-funded studies in cervical cancer, smoking cessation, hepatitis B and liver cancer, cardiovascular disease, and translational health (clinical trial education and bio-banking research).
Founded in 2000, CAH has a long tradition of excellence that promotes and supports community-based participatory research (CBPR) and patient-centered outcomes research (PCOR). The expanded mission of CAH is to foster collaborative transdisciplinary research that comprehensively integrates social, behavioral, environmental, and biological factors within a multilevel framework in addressing the determinants of health and health disparities.
Ma described an NIMHD-funded grant that uses CBPR for the dissemination of an evidence-based hepatitis B screening and vaccination intervention in Korean churches. CAH is also pilot testing multi-language mHealth technology applications such as interactive text messaging and web-based interventions in hepatitis B screening and management, and hypertension through sodium reduction for African American, Latinos, and Asian Americans.
“We should continue to emphasize prevention and early detection,” said Ma about hepatitis B. “It would really help to reduce disparities.”
Lastly, she outlined research opportunities for reducing health disparities in Asian Americans and underrepresented populations that include:
- Emphasize prevention, early detection, and treatment adherence research in reducing cancer, chronic diseases, mental health, and other health disparity conditions (understudied)
- Improve access and quality of care
- Use of innovative approaches in health disparity research (e.g., mHealth)
- Use of CBPR in various settings
- Randomized controlled trials (RCTs) for testing effective and culturally appropriate interventions to reduce cancer and health disparities in diverse Asian Pacific Islanders (APIs) and underrepresented populations
- Dissemination and implementation of evidence-based interventions
- Promote team science with transdisciplinary expertise and approaches (behavior, clinical, and basic science) to address social determinants of health disparities
- Engage communities to increase the participation of diverse underrepresented APIs and other ethnic populations in clinical trials, biomedical research, and tissue donation to advance precision medicine
- Comorbidity issues (e.g., healthy lifestyle and cancer, hypertension, diabetes, mental illness)
- Increase mentored research training for the next generation of diverse and underrepresented population scientists in health disparity research to advance health equality