Faculty Bibliography

OBJECTIVES/OBJECTIVE:To measure disparities in hepatitis B virus (HBV) infection and immunity among a high-risk patient population at a community health center in New York City. METHODS:and logistic regression analysis. RESULTS:Of 25 565 adults, 13.4% were currently infected, 52.1% were ever infected, 33.4% were immune from vaccination, and 14.5% were susceptible. Significant factors associated with ever infection were age, male sex, being China-born, limited English proficiency, having Medicaid or no insurance, and family history of HBV (P < .01). CONCLUSIONS:Our study demonstrated a high burden of HBV infection among foreign-born Asian Americans seeking care at a community health center. Public Health Implications. It is important to test patients at high risk for HBV infection with all 3 tests to identify those with current infection, risk for reactivation, or need for vaccination, and to assess the effectiveness of public health interventions.

Among an estimated 850,000 to 2.2 million persons with chronic hepatitis B virus (HBV) infection in the United States, 70% are non-U.S.-born (1,2). All patients require linkage to care, and approximately 20%-40% require antiviral treatment (3). Without treatment, one in four persons chronically infected with HBV will die prematurely from liver failure, liver cirrhosis, or hepatocellular carcinoma (4). To mitigate morbidity and mortality, CDC funded a cooperative agreement to develop hepatitis B testing and linkage-to-care programs serving non-U.S.-born persons during October 2014-September 2017. This report describes each program's operational services and partnerships with primary care centers, community-based organizations, and public health departments to recruit non-U.S.-born persons for HBV testing using the hepatitis B surface antigen (HBsAg) and link those whose test results were positive to HBV-directed care (medical visit attendance with monitoring of HBV DNA and liver enzyme tests). Among 10,152 program participants, 757 (7.5%) were HBsAg-positive, indicative of chronic HBV infection; among these, 643 (85%) attended ≥1 medical visit, 587 (78%) received HBV-directed care, and 137 (18%) were prescribed antiviral treatment. Among 273 household contacts of HBsAg-positive persons, 39 (14%) had positive test results for HBsAg. Prevalence of current HBV infection was high in this non-U.S.-born population and among household and sexual contacts of HBV-infected persons. HBV testing and linkage to care can be achieved through partnerships with community organizations, health centers, and public health departments.

OBJECTIVES: As Asian Americans are dis- proportionately affected by the hepatitis B virus (HBV), we explored predictors of HBV screening and vaccination among Chinese and Korean Americans. METHODS: We used cross-sectional data from a com- munity-based sample of Chinese Americans (N = 502) and Korean Americans (N = 487) residing in the metropolitan New York City area during 2008-2009. Logistic regression models were stratified by Asian-American subgroup and sex to predict HBV screening (for the entire sam- ple) and HBV vaccination (among those not HBV positive). RESULTS: Overall, screening rates were high (71.3% among Chinese and 70.1% among Koreans). The majority of respondents were aware of HBV; however, knowledge about HBV transmission was low. In logistic regression, a physician recommendation was consistently associated with HBV screening and vaccination outcomes across all groups; having heard of HBV was significantly associated with screening and vaccination among Chinese males and screening among Korean males and females. Screening and vaccination barriers were reported among all groups, and included lack of knowledge and feeling well/having no health issues. CONCLUSIONS: Targeted efforts in these at-risk communities are necessary to improve HBV knowledge, address misinformation about HBV, and eliminate provider-, patient-, and resource-related barriers to HBV screening and vaccination.

Colorectal cancer is a major cause of cancer-related deaths in Asian Americans, yet Asian Americans have the lowest colorectal cancer screening rates in New York City. The Charles B. Wang Community Health Center implemented a patient navigation program to increase colorectal cancer screening. This report describes the lessons learned from the program.

BACKGROUND: Because health disparities among Asian Americans are understudied, a partnership program between the Charles B Wang Community Health Center and the Center for the Study of Asian American Health was created to increase awareness and interest in Asian American research. PURPOSE: To evaluate the process, outcome, and impact of a health professionals' research training program. METHODS: Mixed research methods were employed to collect data from online surveys administered to mentors and trainees of the program. RESULTS: Although many trainees did not continue to pursue Asian American health disparities research, results indicate that the program has positive impacts on trainees in their preparedness to conduct CBPR, work within the Asian American community, and network with public health professionals and researchers. DISCUSSION: This evaluation adds to the current literature of research training programs but more research on Asian American health disparities is needed. TRANSLATION TO HEALTH EDUCATION PRACTICE: Although the program has helped raise awareness in Asian American health disparities research, more Asian American specific research training programs are needed to stimulate a true generation of researchers.

Background: Community coalitions are increasingly recognized as important strategies for addressing health disparities. By providing the opportunity to pool resources, they provide a means to develop and sustain innovative approaches to affect community health. Objectives: This article describes the challenges and lessons learned in building the Asian American Hepatitis B Program (AAHBP) coalition to conduct a community-based participatory research (CBPR) initiative to address hepatitis B (HBV) among New York City Asian-American communities. Methods: Using the stages of coalition development as a framework, a comprehensive assessment of the process of developing and implementing the AAHBP coalition is presented. Lessons Learned: Findings highlight the importance of developing a sound infrastructure and set of processes to foster a greater sense of ownership, shared vision, and investment in the program. Conclusion: Grassroots community organizing and campus-community partnerships can be successfully leveraged to address and prevent a significant health disparity in an underserved and diverse community

Implementing a full-featured EHR at a community health center is a daunting undertaking. Stakeholder buy-in, contract negotiation, workflow redesign, equipment purchases, preloading charts and trainings are just some of the necessary tasks in managing an implementation. METCHIT, a health center controlled network, used a collaborative approach to implement electronic medical records. This article will cover the experience, benefits and lessons learned by a group of four FQHCs that took a cooperative, mentorship approach to implementation. Since 2005, the four community health centers, Charles B. Wang Community Health Center, Morris Heights Health Center, Settlement Health, and Comprehensive Community Development Corporation, have implemented EHRs at four organizations with multiple sites in diverse neighborhoods in New York City. The collaboration began and grew during this period, aided by a technology grant from HRSA