Borders and Blood Pressure: Understanding the Role of Acculturation in a Hypertension Diagnosis Among Hispanic Americans: 2014 California Health Interview Survey

Background: In the U.S. Hispanic population overall, heart disease is the leading cause of death. The prevalence of hypertension among Mexican American immigrants is lower than the general population, yet it is on the rise. Health risks among Hispanics vary depending on their length of stay in the US (as proxy measure of acculturation). The purpose of this study was to examine the association between acculturation and the individual\u27s likelihood of being diagnosed with hypertension among Hispanic Americans. Methods: We used data from the 2014 California Health Interview Survey (CHIS) and performed univariate analysis to examine racial differences in prevalence of hypertension. We also performed a multivariate logistic regression to identify if acculturation was significantly related to hypertension diagnoses, after controlling for sociodemographic characteristics (e.g., age, gender, level of education, marital status), access to care, and health status (e.g., self-reported health status, BMI), among Mexican Americans and all Hispanics, respectively. Results: Of 3,793 Hispanic American participating in the survey, 81.8% were Mexican Americans and 18.2% were other Hispanics. The prevalence of hypertension among Hispanic was 24.0% (95% CI: 21.5%. 26.7%) which was lower than that of African Americans (39.2%, 95% CI 33.7%, 44.9%) and White (30.2%, 95% CI: 28.5%, 31.9%). In multivariate analyses, acculturation was associated with hypertension among Mexican Americans, but not all Hispanics. For both Mexican Americans and Hispanics, age, health status and BMI were associated with having hypertension: Older people, those with poor health status, and overweight and obese people were more likely than their comparison groups to have hypertension. Those without health insurance were less likely to have hypertension. Conclusion: The results show a positive association between length of time in the United States for longer periods of time, and a diagnosis of hypertension. These results, along with others conducted around Hispanic American immigration, acculturation and chronic disease prevalence, help medical providers, to understand the effects of acculturation on specific health care needs among immigrants, and offer suggestions to patients which are culturally sensitive and relevant. Poster presented at AHPA conference in Atlanta Georgia.https://jdc.jefferson.edu/jcphposters/1014/thumbnail.jp

The Mediating Role of Pain Catastrophizing on the Association Between Depression and Pain Severity and Interference Among Elderly Asian Immigrants with Chronic Pain

Purpose: The association between depression and chronic pain is well established. However, few studies have examined the pathways from depression to chronic pain. The present cross-cultural study aimed to test the mediating effects of pain catastrophizing on associations between depression and chronic pain (eg, pain severity, pain intensity) among Korean American elderly. Patients and Methods: A total of 132 elderly Korean Americans with chronic pain were recruited from elderly daycare centers and Korean ethnic churches in the community. For mediation analyses, structural equation modeling with full information maximum likelihood estimation method was used. The bias-corrected bootstrap confidence interval (CI) method for inferential tests of the indirect effects was also conducted in mediation analysis. Results: The results indicated that the proportion of comorbid depression and chronic pain was 45.7%. Elderly Korean Americans with depression scored higher in pain severity, pain interference, and pain catastrophizing than those without depression. Pain catastrophizing was found to have a significant mediating effect on the relationship between depression and pain severity (indirect effect = 0.147, Bootstrap 95% CI = [0.079, 0.226]), controlling for demographic covariates, comorbidities and pain area. Pain catastrophizing also mediated the relationship between depression and pain interference (indirect effect =0.164, Bootstrap 95% CI = [0.097, 0.244]), controlling for the covariates. Conclusion: These findings add to the literature by providing evidence that pain catastrophizing plays a role in high levels of pain severity and pain interference comorbid chronic pain and depression in Asian elderly immigrants. Appropriate culturally tailored programs to redirect pain catastrophizing cognitive process should be developed and provided for elderly Asian Americans to reduce chronic pain disparity

Reducing liver cancer disparities: a community-based hepatitis-B prevention program for Asian-American communities

OBJECTIVES: Several Asian-American groups are at a higher risk of dying of liver diseases attributable to hepatitis-B infection. This culturally diverse community should be well informed of and protected against liver diseases. The present study assesses the knowledge of hepatitis B before and after a hepatitis-B educational program and determines the infection status of an Asian community. METHODS: Nine Asian communities of Montgomery County, MD, enrolled in the hepatitis-B prevention program between 2005 and 2006. They attended culturally tailored lectures on prevention, completed self-administered pre- and posttests, and received blood screening for the disease. RESULTS: More than 800 Asian Americans participated in the study. Knowledge of prevention was improved after educational delivery. The average infection rate was 4.5%, with Cambodian, Thai, Vietnamese, Chinese and Korean groups having higher infection rates. The age group of 36-45 had the highest percentage of carriers (9.1%). CONCLUSION: Many Asian groups, particularly those of a southeast Asian decent, were subject to a higher probability of hepatitis-B infection. At an increased risk are first-generation Asian immigrants, groups with low immunization rates and those aged 36-45. The findings provide potential directions for focusing preventive interventions on at-risk Asian communities to reduce liver cancer disparities

Asian-White disparities in short sleep duration by industry of employment and occupation in the US: a cross-sectional study

Background: Although short sleep is associated with an increased risk of morbidity as well as mortality and has been shown to vary by industry of employment and occupation, little is known about the relationship between work and sleep among Asian Americans. Methods: Using a nationally representative sample of US adults (n = 125,610) in the National Health Interview Survey from 2004–2011, we estimated prevalence ratios for self-reported short sleep duration (<7 hours) in Asians compared to Whites by industry of employment and occupation using adjusted Poisson regression models with robust variance. Results: Asians were more likely to report short sleep duration than Whites (33 vs. 28%, p < 0.001), and the Asian-White disparity was widest in finance/information and healthcare industries. Compared to Whites after adjustments, short sleep was also more prevalent among Asians employed in Public administration (PR = 1.35 [95% CI: 1.17,1.56]), Education (PR = 1.29 [95% CI: 1.08,1.53]), and Professional/Management (PR = 1.18 [95% CI: 1.03,1.36]). Short sleep, however, was lower among Asians in Accommodation/Food (PR = 0.81 [95% CI: 0.66, 0.99]) with no difference in Retail. In professional and support-service occupations, short sleep was higher among Asians, but was not different among laborers. Conclusions: U.S. Asian-White disparities in short sleep varied by industries, suggesting a need to consider both race and occupational characteristics to identify high-risk individuals

Assessment of Hepatitis B Virus Screening Behaviors among Asian-Americans through the Lens of Social Cognitive Theory

Asian-Americans suffer from significant liver cancer disparity caused by chronic hepatitis B virus (HBV) infection. Understanding psychosocial predictors of HBV screening is critical to designing effective interventions. Chinese-, Korean-, and Vietnamese-Americans in the Baltimore-Washington metropolitan region (N=877) were recruited from community-based organizations. Applying the Social Cognitive Theory (SCT), three main theoretical constructs (knowledge, outcome expectancy, and self-efficacy) were tested. Descriptive analyses using Chi-square and ANOVA and multivariate logistic regression models were conducted. About 47% of participants reported ever having screening for HBV. Vietnamese-Americans had the lowest HBV screening rate (39%), followed by Korean-Americans (46%) and Chinese-Americans (55%). Multiple logistic regression analyses showed significant effects of HBV-related knowledge on screening in all three groups, whereas self-efficacy had significant effects in the Chinese and Korean subgroups, but not Vietnamese. HBV outcome expectancy had no effect on the screening outcome in any of the groups. Additionally, consistent in all three groups, those who had lived in the United States longer were less likely to have screening. HBV screening rates in Asian Americans remain low; targeted interventions need to consider the differences across ethnic subgroups and address the psychosocial risk factors

Prevalence of health-related quality of life (HRQOL) in Asian Americans

Objectives To report the prevalence of Health Related Quality of Life (HRQOL) in foreign-born Asian Americans (AA) and to compare this with the general AA from 2010 BRFSS data. To examine the influential factors associated with HRQOL-4 including English proficiency, perceived racial discrimination, smoking, alcohol use, and sociodemographics. Background Quality of life (QOL) represents individuals’ subjective perception of multidimensional aspects of life including physical, psychological, social and spiritual aspects. HRQOL represents the physical and mental health domain of QOL. Centers for Disease Control and Prevention (CDC) has been measuring HRQOL to capture people’s overall perceptions about their health; HRQOL has become an important component of health surveillance (U.S. DHHS, 2000). While acculturation and racial discrimination have been negatively associated to the number of chronic health conditions and well-being of AA, their influence on HRQOL has not been studied. Public surveillance study has typically considered Asian Americans as a single group and little is known about how HRQOL and health-related risk factors vary among foreign-born Asian Americans including Chinese-, Korean-, and Vietnamese- Americans. Poster presented at APHA in Chicago Illinois.https://jdc.jefferson.edu/medoncposters/1000/thumbnail.jp

Effect of a liver cancer education program on hepatitis B screening among Asian Americans in the Baltimore-Washington metropolitan area, 2009-2010

IntroductionAsian Americans have the highest incidence of hepatocellular carcinoma (HCC), the major form of primary liver cancer, of all ethnic groups in the United States. Chronic hepatitis B virus (HBV) infection is the most common cause of HCC, and as many as 1 in 10 foreign-born Asian Americans are chronically infected with HBV. We tested the effectiveness of a culturally tailored liver cancer education program for increasing screening for HBV among Chinese, Korean, and Vietnamese Americans residing in the Baltimore–Washington metropolitan area, from November 2009 through June 2010. MethodsWe used a cluster randomized controlled trial to recruit volunteer participants from community-based organizations (CBOs) in the Baltimore–Washington metropolitan area. We selected 877 participants by using a pretest survey. People were eligible to participate if they had not attended a hepatitis B–related education program in the past 5 years. The intervention group (n = 441) received a 30-minute educational program, and the control group (n = 436) received an educational brochure. After attending the educational program, the intervention group completed a post-education survey. Six months later, participants in both groups were followed up by telephone. Receipt of HBV screening was the outcome measure. ResultsApproximately 79% (n = 688) of participants completed the 6-month follow-up telephone survey. Among those who had not had HBV screening at baseline (n = 446), the adjusted odds of self-reported receipt of HBV screening at the 6-month follow-up to the educational program were significantly higher for the intervention group than for the control group (odds ratio = 5.13; 95% confidence interval, 3.14–8.39; P \u3c .001). Chinese Americans and Vietnamese Americans had significantly higher odds of having HBV screening in the 6-month period than Korean Americans. ConclusionCulturally tailored education programs that increase liver cancer awareness can be effective in increasing HBV screening among underserved Asian American populations