Racial Bias Beliefs Related to COVID-19 Among Asian Americans, Native Hawaiians, and Pacific Islanders: Findings From the COVID-19 Effects on the Mental and Physical Health of Asian Americans and Pacific Islanders Survey Study (COMPASS)

Background: During the COVID-19 pandemic, there have been increased reports of racial biases against Asian American and Native Hawaiian and Pacific Islander individuals. However, the extent to which different Asian American and Native Hawaiian and Pacific Islander groups perceive and experience (firsthand or as a witness to such experiences) how COVID-19 has negatively affected people of their race has not received much attention. Objective: This study used data from the COVID-19 Effects on the Mental and Physical Health of Asian Americans and Pacific Islanders Survey Study (COMPASS), a nationwide, multilingual survey, to empirically examine COVID-19-related racial bias beliefs among Asian American and Native Hawaiian and Pacific Islander individuals and the factors associated with these beliefs. Methods: COMPASS participants were Asian American and Native Hawaiian and Pacific Islander adults who were able to speak English, Chinese (Cantonese or Mandarin), Korean, Samoan, or Vietnamese and who resided in the United States during the time of the survey (October 2020 to May 2021). Participants completed the survey on the web, via phone, or in person. The Coronavirus Racial Bias Scale (CRBS) was used to assess COVID-19-related racial bias beliefs toward Asian American and Native Hawaiian and Pacific Islander individuals. Participants were asked to rate the degree to which they agreed with 9 statements on a 5-point Likert scale (ie, 1=strongly disagree to 5=strongly agree). Multivariable linear regression was used to examine the associations between demographic, health, and COVID-19-related characteristics and perceived racial bias. Results: A total of 5068 participants completed the survey (mean age 45.4, SD 16.4 years; range 18-97 years). Overall, 73.97% (3749/5068) agreed or strongly agreed with ≥1 COVID-19-related racial bias belief in the past 6 months (during the COVID-19 pandemic). Across the 9 racial bias beliefs, participants scored an average of 2.59 (SD 0.96, range 1-5). Adjusted analyses revealed that compared with Asian Indians, those who were ethnic Chinese, Filipino, Hmong, Japanese, Korean, Vietnamese, and other or multicultural had significantly higher mean CRBS scores, whereas no significant differences were found among Native Hawaiian and Pacific Islander individuals. Nonheterosexual participants had statistically significant and higher mean CRBS scores than heterosexual participants. Compared with participants aged ≥60 years, those who were younger (aged \u3c30, 30-39, 40-49, and 50-59 years) had significantly higher mean CRBS scores. US-born participants had significantly higher mean CRBS scores than foreign-born participants, whereas those with limited English proficiency (relative to those reporting no limitation) had lower mean CRBS scores. Conclusions: Many COMPASS participants reported racial bias beliefs because of the COVID-19 pandemic. Relevant sociodemographic contexts and pre-existing and COVID-19-specific factors across individual, community, and society levels were associated with the perceived racial bias of being Asian during the pandemic. The findings underscore the importance of addressing the burden of racial bias on Asian American and Native Hawaiian and Pacific Islander communities among other COVID-19-related sequelae

Social Support and Technology Use and Their Association With Mental and Physical Health During the COVID-19 Pandemic Among Asian Americans: The COMPASS Cross-sectional Study

BACKGROUND: The global COVID-19 pandemic disproportionately affected Asian Americans and Pacific Islanders (AAPIs) and revealed significant health disparities with reports of increased discrimination and xenophobia. Among AAPIs, the pandemic exacerbated their social, linguistic, and geographic isolation. Social support may be especially important for AAPIs given the salience of collectivism as a cultural value. Another mechanism for support among AAPIs was technology use, as it is generally widespread among this population. However, older adults may not perceive the same benefits. OBJECTIVE: We examined social support and technology use and their relationships with mental and physical health outcomes through the COVID-19 pandemic among AAPIs. METHODS: Data were drawn from the COVID-19 Effects on the Mental and Physical Health of AAPI Survey Study (COMPASS) for the time period of October 2020 to February 2021. COMPASS was a cross-sectional, multilingual, national survey conducted online, by phone, and in person with AAPI adults who were ≥18 years of age, in collaboration with academic and community partners in the United States. Data were analyzed using multivariable linear regression using the outcome variables of mental and physical health with various predictors such as social support and technology use. We tested for interactions specific to age and ethnicity. RESULTS: Among 4631 AAPIs (mean age 45.9, SD 16.3 years; 2992/4631, 63.1% female), we found that (1) increased social support was associated with better physical health, (2) total social support was positively associated with better mental health, (3) higher technology use was associated with poorer mental health and inversely associated with poorer physical health, (4) the association of technology use with mental health was weaker among those with low social support (vs those with high social support), (5) adults younger than 60 years old (vs ≥60 years old) were more negatively affected with social support and mental health, and (6) Korean Americans appeared to be a high-risk group for poor physical health with increased technology use. CONCLUSIONS: Our paper identified mental and physical health needs along with supportive therapies observed among AAPIs during the pandemic. Future research on how social support can be leveraged, especially among AAPIs younger than 60 years old, and how various types of technology are being utilized are important to guide the recovery efforts to address both mental and physical disparities across communities as a result of the COVID-19 pandemic

Sleep, Cognitive Health, and Health Services Use in Older Adults

BACKGROUND: Sleep disturbances are common in older adults. Age is a risk factor for dementia, and average health care spending increases with age. There is growing evidence linking sleep disturbances, such as insomnia, to poor later-life health outcomes, including dementia and greater healthcare utilization. However, few longitudinal studies have been conducted in representative samples of older adults, and little is known about the role of depressive and anxiety symptoms in the insomnia-dementia association. Moreover, few studies have investigated insomnia as a predictor of claims-based health services use. Fortunately, the promotion of sleep health is garnering more attention. Preliminary studies suggest that cognitive training interventions may not only improve cognition, but may also improve sleep, but more studies are needed to further investigate this possible non-pharmacologic alternative to improve sleep among older adults. METHODS: Study 1 used data from the National Health and Aging Trends Study (NHATS) to examine the cross-sectional and prospective associations between insomnia symptoms and probable/possible dementia in a nationally representative sample of Medicare beneficiaries. Using NHATS linked-Medicare claims data, Study 2 investigated the prospective associations of insomnia symptoms with use of several health services, including emergency department (ED) visits, hospitalizations, 30-day readmissions, and home health care. Study 3 evaluated the long-term impact of a memory-training program on subjective sleep quality and daytime sleepiness in community-dwelling older adults, using data from the ACTIVE Memory Works (AMW) study. RESULTS: Among Medicare beneficiaries in NHATS, relative to endorsement of 0 insomnia symptoms, endorsement of 1 or 2 (out of 2) insomnia symptoms was cross-sectionally associated with a higher prevalence of probable and possible dementia (prevalence ratio [PR] = 1.22, p<.05, PR = 1.25, p<.05, respectively) after adjustment for demographic, body mass index (BMI), and medical comorbidities. In similarly adjusted prospective analyses, reports of 2 insomnia symptoms, versus 0 insomnia symptoms, was associated with a greater hazard of incident probable and possible dementia (hazard ratio [HR] = 1.37, p<.001) across an average of 4.2 years of follow-up. However, the associations of insomnia symptoms with either prevalent or incident probable/possible dementia turned non-significant after further adjustment for depressive or anxiety symptoms. Among NHATS participants, reports of 2 insomnia symptoms (versus 0 insomnia symptoms) were associated with a higher odds of ED visits (Odds Ratio (OR)=1.60, p<0.001), hospitalizations (OR=1.29, p<0.05), and 30-day readmissions (OR=1.88, p<0.05) as well as a greater number of ED visits and hospitalizations (Incidence Rate Ratio (IRR)=1.52, p<0.001; IRR=1.21, p<0.05, respectively) after adjusting for demographics, depressive and anxiety symptoms, medical comorbidities, and BMI. In the ACTIVE Memory Works (AMW) study, there was no statistically significant training effect on either sleep quality or daytime sleepiness between training responders and non-responders. However, there was a significant worsening of sleep quality only among training non-responders (2=4.10, p<0.05) in post-hoc analyses. CONCLUSIONS: Findings from this dissertation suggest that insomnia may be an important modifiable risk factor and therapeutic target to prevent or delay dementia and reduce health services use. Further investigations are needed regarding the effectiveness of preventive interventions such as cognitive training that may have dual-protective impact for cognitive and sleep health in older adults

Sleep, Cognitive Health, and Health Services Use in Older Adults

BACKGROUND: Sleep disturbances are common in older adults. Age is a risk factor for dementia, and average health care spending increases with age. There is growing evidence linking sleep disturbances, such as insomnia, to poor later-life health outcomes, including dementia and greater healthcare utilization. However, few longitudinal studies have been conducted in representative samples of older adults, and little is known about the role of depressive and anxiety symptoms in the insomnia-dementia association. Moreover, few studies have investigated insomnia as a predictor of claims-based health services use. Fortunately, the promotion of sleep health is garnering more attention. Preliminary studies suggest that cognitive training interventions may not only improve cognition, but may also improve sleep, but more studies are needed to further investigate this possible non-pharmacologic alternative to improve sleep among older adults. METHODS: Study 1 used data from the National Health and Aging Trends Study (NHATS) to examine the cross-sectional and prospective associations between insomnia symptoms and probable/possible dementia in a nationally representative sample of Medicare beneficiaries. Using NHATS linked-Medicare claims data, Study 2 investigated the prospective associations of insomnia symptoms with use of several health services, including emergency department (ED) visits, hospitalizations, 30-day readmissions, and home health care. Study 3 evaluated the long-term impact of a memory-training program on subjective sleep quality and daytime sleepiness in community-dwelling older adults, using data from the ACTIVE Memory Works (AMW) study. RESULTS: Among Medicare beneficiaries in NHATS, relative to endorsement of 0 insomnia symptoms, endorsement of 1 or 2 (out of 2) insomnia symptoms was cross-sectionally associated with a higher prevalence of probable and possible dementia (prevalence ratio [PR] = 1.22, p<.05, PR = 1.25, p<.05, respectively) after adjustment for demographic, body mass index (BMI), and medical comorbidities. In similarly adjusted prospective analyses, reports of 2 insomnia symptoms, versus 0 insomnia symptoms, was associated with a greater hazard of incident probable and possible dementia (hazard ratio [HR] = 1.37, p<.001) across an average of 4.2 years of follow-up. However, the associations of insomnia symptoms with either prevalent or incident probable/possible dementia turned non-significant after further adjustment for depressive or anxiety symptoms. Among NHATS participants, reports of 2 insomnia symptoms (versus 0 insomnia symptoms) were associated with a higher odds of ED visits (Odds Ratio (OR)=1.60, p<0.001), hospitalizations (OR=1.29, p<0.05), and 30-day readmissions (OR=1.88, p<0.05) as well as a greater number of ED visits and hospitalizations (Incidence Rate Ratio (IRR)=1.52, p<0.001; IRR=1.21, p<0.05, respectively) after adjusting for demographics, depressive and anxiety symptoms, medical comorbidities, and BMI. In the ACTIVE Memory Works (AMW) study, there was no statistically significant training effect on either sleep quality or daytime sleepiness between training responders and non-responders. However, there was a significant worsening of sleep quality only among training non-responders (2=4.10, p<0.05) in post-hoc analyses. CONCLUSIONS: Findings from this dissertation suggest that insomnia may be an important modifiable risk factor and therapeutic target to prevent or delay dementia and reduce health services use. Further investigations are needed regarding the effectiveness of preventive interventions such as cognitive training that may have dual-protective impact for cognitive and sleep health in older adults

Differences in COVID-19 Vaccine Concerns Among Asian Americans and Pacific Islanders: The COMPASS Survey.

BackgroundUnderstanding concerns for receiving COVID-19 vaccines is key to ensuring appropriately tailored health communications to increase vaccine uptake. However, limited data exists about vaccine concerns among Asian Americans and Pacific Islanders (AAPI).MethodsData from the COVID-19 Effects on the Mental and Physical Health of AAPI Survey Study (COMPASS), a cross-sectional, national survey for AAPI adults in the U.S. were used (N=1,646). Descriptive statistics were used to assess sample characteristics including proportions of AAPI with various COVID-19 vaccine concerns, categorized as none, side-effects only, unsafe only, and multiple reasons, and differences in vaccine concerns by socio-demographics. Ordinary multivariable logistic regression analyses were conducted to evaluate associations between a characteristic and having any vaccine concerns.ResultsOverall, 76% of the respondents reported having at ≥1 concerns about the vaccine. The most common concern was side effects (65%). Vietnamese Americans reported less concerns (vs. Chinese Americans). Those who were 30-39 and 40-49 years old (vs. &lt;30), females (vs. males), and experienced mild negative impacts from COVID-19 on family income/employment (vs. no change) reported more concerns about the vaccine. Those who had less vaccine concerns were those who reported higher (vs. low) health status, ≥60 years old (vs. &lt;30), and separated/divorced/widowed (vs. single).DiscussionAAPI is a diverse population and this study revealed differences in vaccine concerns across AAPI groups. Findings revealed potential targets for patient education needs. Effective strategies to address various vaccine concerns across subgroups of AAPI will be crucial to ensure equity in vaccination uptake

Differences in COVID-19 Vaccine Concerns Among Asian Americans and Pacific Islanders: The COMPASS Survey.

BackgroundUnderstanding concerns for receiving COVID-19 vaccines is key to ensuring appropriately tailored health communications to increase vaccine uptake. However, limited data exists about vaccine concerns among Asian Americans and Pacific Islanders (AAPI).MethodsData from the COVID-19 Effects on the Mental and Physical Health of AAPI Survey Study (COMPASS), a cross-sectional, national survey for AAPI adults in the U.S. were used (N=1,646). Descriptive statistics were used to assess sample characteristics including proportions of AAPI with various COVID-19 vaccine concerns, categorized as none, side-effects only, unsafe only, and multiple reasons, and differences in vaccine concerns by socio-demographics. Ordinary multivariable logistic regression analyses were conducted to evaluate associations between a characteristic and having any vaccine concerns.ResultsOverall, 76% of the respondents reported having at ≥1 concerns about the vaccine. The most common concern was side effects (65%). Vietnamese Americans reported less concerns (vs. Chinese Americans). Those who were 30-39 and 40-49 years old (vs. &lt;30), females (vs. males), and experienced mild negative impacts from COVID-19 on family income/employment (vs. no change) reported more concerns about the vaccine. Those who had less vaccine concerns were those who reported higher (vs. low) health status, ≥60 years old (vs. &lt;30), and separated/divorced/widowed (vs. single).DiscussionAAPI is a diverse population and this study revealed differences in vaccine concerns across AAPI groups. Findings revealed potential targets for patient education needs. Effective strategies to address various vaccine concerns across subgroups of AAPI will be crucial to ensure equity in vaccination uptake

Vaccine willingness: Findings from the COVID-19 effects on the mental and physical health of Asian Americans &amp; Pacific Islanders survey study (COMPASS).

Willingness to get the COVID-19 vaccine is crucial to reduce the current strain on healthcare systems and increase herd immunity, but only 71% of the U.S. public said they would get the vaccine. It remains unclear whether Asian Americans and Pacific Islanders (AAPI), a population with existing inequalities in COVID-19 infection and mortality, are willing to get the vaccine, and the factors associated with vaccine willingness. Given this imperative, we used data from a national, cross-sectional, community-based survey called COVID-19 Effects on the Mental and Physical Health of AAPI Survey Study (COMPASS), an ongoing survey study that is available in English and Asian languages (i.e., Simplified or Traditional Chinese, Korean, Vietnamese) to examine vaccine willingness among AAPI. A total of 1,646 U.S. adult AAPI participants completed the survey. Self-reported vaccine willingness showed the proportion who were "unsure" or "probably/definitely no" to getting the COVID-19 vaccine was 25.4%. The odds for vaccine willingness were significantly lower for were Native Hawaiians and Pacific Islanders (vs. Asian Americans), Korean Americans (vs. Chinese and Vietnamese Americans), women (vs. men), heterosexuals (vs. non-heterosexuals), those aged 30-39 and 50-59 (vs. aged&nbsp;&lt;&nbsp;30), and those who reported having any vaccine concerns (vs. no concerns). AAPIs' willingness to get COVID-19 vaccine varied by groups, which underscores the need for disaggregated AAPI data. A multi-pronged approach in culturally appropriate and tailored health communication and education with AAPI is critical to achieve the goal of health equity for AAPI as it pertains to COVID-19 mortality and morbidity

Vaccine willingness: Findings from the COVID-19 effects on the mental and physical health of Asian Americans &amp; Pacific Islanders survey study (COMPASS).

Willingness to get the COVID-19 vaccine is crucial to reduce the current strain on healthcare systems and increase herd immunity, but only 71% of the U.S. public said they would get the vaccine. It remains unclear whether Asian Americans and Pacific Islanders (AAPI), a population with existing inequalities in COVID-19 infection and mortality, are willing to get the vaccine, and the factors associated with vaccine willingness. Given this imperative, we used data from a national, cross-sectional, community-based survey called COVID-19 Effects on the Mental and Physical Health of AAPI Survey Study (COMPASS), an ongoing survey study that is available in English and Asian languages (i.e., Simplified or Traditional Chinese, Korean, Vietnamese) to examine vaccine willingness among AAPI. A total of 1,646 U.S. adult AAPI participants completed the survey. Self-reported vaccine willingness showed the proportion who were "unsure" or "probably/definitely no" to getting the COVID-19 vaccine was 25.4%. The odds for vaccine willingness were significantly lower for were Native Hawaiians and Pacific Islanders (vs. Asian Americans), Korean Americans (vs. Chinese and Vietnamese Americans), women (vs. men), heterosexuals (vs. non-heterosexuals), those aged 30-39 and 50-59 (vs. aged&nbsp;&lt;&nbsp;30), and those who reported having any vaccine concerns (vs. no concerns). AAPIs' willingness to get COVID-19 vaccine varied by groups, which underscores the need for disaggregated AAPI data. A multi-pronged approach in culturally appropriate and tailored health communication and education with AAPI is critical to achieve the goal of health equity for AAPI as it pertains to COVID-19 mortality and morbidity

Discrimination Experiences during COVID-19 among a National, Multi-Lingual, Community-Based Sample of Asian Americans and Pacific Islanders: COMPASS Findings

Reports of escalated discrimination among Asian Americans and Pacific Islanders (AAPIs) due to COVID-19 are alarming, making this a public health priority. However, there are limited empirical studies on the scope and impact of COVID-19-related discrimination among AAPIs. Using the COVID-19 Effects on the Mental and Physical Health of AAPI Survey Study (COMPASS) data (N = 4971; survey period: October 2020&ndash;February 2021), which is a U.S.-wide multi-lingual survey, we examined the prevalence of, and factors associated with discrimination experiences attributable to being an AAPI during the COVID-19 pandemic. Overall, 60.7% reported experiencing discrimination; the group prevalence ranged from 80.0% (Hmong) to 40.5% (Native Hawaiians and Pacific Islanders). Multivariable logistic regression models revealed that COVID-19-related factors were associated with many discrimination experiences: having a shelter-in-place order of &ge;1 month, living in areas with perceived similar/higher COVID-19 severity, and negative impact in family income/employment due to COVID-19. Additionally, being Asian American (versus Native Hawaiians and Pacific Islanders), females, non-heterosexuals, younger, more severe effect on family income, living in the non-West, and poorer health were significantly correlated with discrimination experiences. Findings may assist in formulating anti-AAPI-discrimination policies and programs at the local, state, and federal levels. Culturally appropriate programs and policies to combat this are urgently needed

Discrimination Experiences during COVID-19 among a National, Multi-Lingual, Community-Based Sample of Asian Americans and Pacific Islanders: COMPASS Findings.

Reports of escalated discrimination among Asian Americans and Pacific Islanders (AAPIs) due to COVID-19 are alarming, making this a public health priority. However, there are limited empirical studies on the scope and impact of COVID-19-related discrimination among AAPIs. Using the COVID-19 Effects on the Mental and Physical Health of AAPI Survey Study (COMPASS) data (N = 4971; survey period: October 2020-February 2021), which is a U.S.-wide multi-lingual survey, we examined the prevalence of, and factors associated with discrimination experiences attributable to being an AAPI during the COVID-19 pandemic. Overall, 60.7% reported experiencing discrimination; the group prevalence ranged from 80.0% (Hmong) to 40.5% (Native Hawaiians and Pacific Islanders). Multivariable logistic regression models revealed that COVID-19-related factors were associated with many discrimination experiences: having a shelter-in-place order of ≥1 month, living in areas with perceived similar/higher COVID-19 severity, and negative impact in family income/employment due to COVID-19. Additionally, being Asian American (versus Native Hawaiians and Pacific Islanders), females, non-heterosexuals, younger, more severe effect on family income, living in the non-West, and poorer health were significantly correlated with discrimination experiences. Findings may assist in formulating anti-AAPI-discrimination policies and programs at the local, state, and federal levels. Culturally appropriate programs and policies to combat this are urgently needed