Faculty Bibliography

BACKGROUND AND OBJECTIVES/OBJECTIVE:Immigrant older adults are a particularly disadvantaged population due to structural factors including immigration and citizenship status, language and literacy barriers, and underrepresentation in health research, that increase the burden of social isolation and loneliness. This scoping review synthesizes the existing literature on social isolation and loneliness among Asian American older adults in the United States. RESEARCH DESIGN AND METHODS/METHODS:This study searched PubMed, CINAHL, and PsycInfo for relevant literature and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Twenty-nine articles were included. RESULTS:We summarize four topics that emerged on social isolation and loneliness: instruments, prevalence, associated factors, and perceptions. Most articles focused on older Chinese and Korean American adults from the Population Study of Chinese Elderly in Chicago Study and Study of Older Korean Americans, and there was a concentration of studies based in the Midwest and Northeast. One intervention was found. DISCUSSION AND IMPLICATIONS/CONCLUSIONS:This review highlighted significant gaps in understanding experiences of social isolation and loneliness among older Asian American adults, emphasizing the need for more inclusive research and culturally responsive interventions to promote healthy aging in this growing population.

Minoritized communities often experience worse health outcomes on the cancer continuum. Mainstream strategies may have limited reach and utility to populations experiencing inequities in real-world settings. Through the combined use of community-based participatory research (CBPR) and social marketing strategies, which highlight community-centered and culturally adapted processes, we provide an approach to inform future intervention research across various health topics that has been successful in engaging minoritized and understudied communities. We present two case studies that used participatory social marketing principles to culturally adapt evidence-based cancer screening programs for two communities in New York City. The first program is a campaign to increase screening and vaccination for hepatitis B among Korean and Chinese American immigrants. The second is a culturally adapted program to increase breast and cervical cancer screening among a multiracial and ethnic population of Muslim women. These case studies illustrate the benefits of integrating social marketing and CBPR approaches as a key strategy when developing public health campaigns to effectively reach and influence health behaviors in partnership with communities that have been socially marginalized and historically underserved.

PURPOSE/OBJECTIVE:Faith-based organizations (FBOs) have been recognized as a critical partner to reach underserved, marginalized populations in the U.S. for disease prevention and health promotion. FBOs have been successfully engaged to lower risk for leading causes of death, including cancer, but despite the proliferation of FBO cancer intervention research, a comprehensive review is lacking. METHODS:We conducted a PRISMA Scoping Review to ascertain the impact of FBO cancer interventions. Seven bibliographical databases were used to search for articles evaluating cancer interventions reporting quantitative outcomes in which places of worship in the U.S. served as the research location. Study characteristics and results data were extracted by two independent extractors. RESULTS:Thirty-six studies were included. All FBOs were Christian churches with healthy populations. Breast (25%), prostate (22%), and colorectal (17%) were the primary cancers targeted and cancer screening was the primary outcome of 75% of studies. Sixty-nine percent (k = 25) reported significant results in cancer-related outcomes from baseline to post-intervention follow-up, with 100% of studies in Korean American communities (k = 7) reporting significant results. CONCLUSION/CONCLUSIONS:FBO interventions can successfully increase preventative screening across numerous cancer types in diverse communities, particularly in Korean Americans. Additional FBO cancer interventions that aim to reduce inequities in other cancers (e.g., lung) that disproportionately affect Korean Americans and have not been targeted are warranted. Expanding current investigations of FBO collaborations with other faiths (besides Christian) to include cancer prevention and control would further realize FBOs' untapped potential.

BACKGROUND:Linkage to medical services is key to early detection, diagnosis, and care for dementia. Yet, racial and ethnic minoritized older adults and their caregivers are particularly vulnerable to inequity in dementia care due to limited dementia literacy. Mobilizing community resources such as community health workers (CHWs) can benefit older patients and their caregivers who are challenged by linguistic barriers and low health literacy. METHODS:Preparing for healthy aging through dementia Literacy education And Navigation (PLAN), is a CHW-led intervention program designed to promote linkage to medical services for dementia and caregiver outcomes in a multi-site clinical trial in the Greater Washington and New York metropolitan areas. This protocol describes the rationale, design, and methods of the PLAN trial. CONCLUSION/CONCLUSIONS:We recruited 288 dyads of eligible Korean American older adults with undiagnosed dementia and their caregivers, totaling 576 participants. Data collection is ongoing. Findings from this trial will contribute to knowledge around identifying community-dwelling older adults with probable dementia with limited health resources as well as navigating appropriate medical evaluation and support. CLINICALTRIALS/RESULTS:gov identifier: NCT03909347.

BACKGROUND:Asian New York City (NYC) residents have the lowest cancer screening uptake across race and ethnicity. Few studies have examined screening differences across Asian ethnic subgroups in NYC. METHODS:Cross-sectional survey data were analyzed using multivariable logistic and multinomial regression analyses. Differences among Chinese, Korean, and South Asian adults in breast, cervical, and colorectal cancer (CRC) screening uptake; breast and CRC screening knowledge; and cancer fatalism were examined. Associations between breast and CRC screening knowledge and their uptake were also assessed along with associations between cancer fatalism and breast, cervical, and CRC screening uptake. RESULTS:Korean women reported 0.52 (95%CI: 0.31, 0.89) times lower odds of Pap test uptake compared to Chinese women; South Asian adults had 0.43 (95%CI: 0.24, 0.79) times lower odds of CRC screening uptake compared to Chinese adults. Korean adults reported 1.80 (95%CI: 1.26, 2.58) times higher odds of knowing the correct age to begin having mammograms compared to Chinese adults; and South Asian adults had 0.67 (95%CI: 0.47, 0.96) times lower odds of knowing the correct age to begin CRC screening compared to Chinese adults. Korean adults had 0.37 (95%CI: 0.27, 0.53) times lower odds of reporting cancer fatalism compared to Chinese adults. CONCLUSIONS:Low cancer screening uptake among Asian American adults, low screening knowledge, and high cancer fatalism were found. Cancer screening uptake, knowledge, and fatalism varied by ethnic subgroup. IMPACT/CONCLUSIONS:Findings indicate the need for ethnic-specific cultural and linguistic tailoring for future cancer screening interventions.

PURPOSE/OBJECTIVE:To report osteoporosis screening utilization rates among Asian American (AsA) populations in the USA. METHODS:We retrospectively assessed the use of dual-energy X-ray absorptiometry (DXA) screening using the Medicare 5% Research Identifiable Files. Using Current Procedural Terminology (CPT) codes indicative of a DXA scan, we identified patients recommended for DXA screening according to the ACR-SPR-SSR Practice Parameters (females ≥ 65 years, males ≥ 70 years). Sociodemographic factors and their association with screening were evaluated using chi-square tests. RESULTS:There were 80,439 eligible AsA beneficiaries, and 12,102 (15.1%) received osteoporosis screening. DXA rate for women was approximately four times greater than the rate for men (19.8% vs. 5.0%; p < 0.001). AsA beneficiaries in zip codes with higher mean household income (MHI) were more likely to have DXA than those in lower MHI areas (17.6% vs. 14.3%, p < 0.001). AsA beneficiaries aged < 80 were more likely to receive DXA (15.5%) than those aged ≥ 80 (14.1%, p < 0.001). There were 2,979,801 eligible non-AsA beneficiaries, and 496,957 (16.7%) received osteoporosis screening during the study period. Non-Hispanic white beneficiaries had the highest overall screening rate (17.5%), followed by North American Native (13.0%), Black (11.8%), and Hispanic (11.1%) beneficiaries. Comparing AsA to non-AsA populations, there were significantly lower DXA rates among AsA beneficiaries when controlling for years of Medicare eligibility, patient age, sex, location, and mean income (p < 0.001). CONCLUSION/CONCLUSIONS:We found lower than expected DXA screening rates for AsA patients. A better understanding of the barriers and facilitators to AsA osteoporosis screening is needed to improve patient care.

BACKGROUND:Asian Americans have the lowest colorectal cancer screening uptake of any racial and ethnic group in the United States. Asian Indians are among the most under-screened Asian American subgroups, but there is limited data for this population. We sought to characterize predictors of colonoscopy use among Asian Indians in New York City. METHODS:Using 2003 to 2016 data from the New York City Community Health Survey, we identified all Asian Indian participants aged 50 years or older. We examined the association between sociodemographic and medical factors and up-to-date colonoscopy use (defined as colonoscopy within the last 10 y) using logistic regression over 4 time periods: 2003 to 2008, 2009 to 2012, 2013 to 2014, 2015 to 2016. RESULTS:On multivariable analysis, language, age, income, recent exercise, body mass index, and influenza vaccination were associated with colonoscopy uptake in 1 time period. Compared with participants who preferred English, those who preferred an Indian language were less likely to have been up-to-date in 2013 to 2014 (odds ratio 0.12, 95% CI 0.02-0.66). Individuals older than 65 years were more likely than those aged 50 to 64 years to have received a colonoscopy in 2009 to 2012 (odds ratio 3.91, 95% CI 1.49-10.24), although the risk estimates were also consistently positive in the other 3 time periods. CONCLUSIONS:Among Asian Indians living in New York City, several demographic, socioeconomic, and health-related characteristics predict colonoscopy use. These findings highlight the importance of examining determinants of colonoscopy uptake in this understudied population to inform future public health interventions.

INTRODUCTION/BACKGROUND:Chinese Americans are one of the fastest growing racial and ethnic groups and represent the largest subgroup of the Asian American population in the US and in New York City (NYC) where they number 573,528 in 2021. Despite their numbers, current pain perceptions, expectations, and attitudes of Chinese Americans remains poorly understood, especially as related to postoperative pain. OBJECTIVE:A better understanding of pain experience among Chinese American patients is needed to inform strategies on improving pain management satisfaction. METHODS:A total of 27 Chinese American postoperative patients from a NYC health system were recruited for face-to-face surveys and interviews with a trained bilingual and bicultural Community Health Worker. Questions from the Survey on Disparities in Quality of Healthcare and Kleinman's Explanatory Model of Illness were integrated into the survey and topic guide. Topics of discussion included satisfaction with healthcare and pain management during hospital stay and health beliefs and practices. RESULTS:More than half of participants experienced language challenges that made it difficult to communicate with healthcare staff. In general, high levels of satisfaction with pain management were reported; however, participants reported feeling less comfortable asking healthcare teams questions. Common themes across interviews included: (1) pain was an expected outcome of the procedure and was thus perceived as tolerable; (2) the wish to not be a burden to others; (3) concerns about side effects of pain medications; and (4) a cultural and language mismatch between healthcare teams and patients on words being used to elicit pain and discomfort. CONCLUSION/CONCLUSIONS:Our project findings can inform pain management strategies and tools to serve the Chinese American patient population.