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.

Many communities are oftentimes labeled as "hard to reach communities" by health researchers. Instead, what may be a more appropriate framing is that conventional research approaches are a mismatch for recruiting and retaining these understudied communities. This paper describes an inclusive research process with particular attention to engaging multilingual communities in the U.S. that we have developed while implementing a community-level nutrition program. The program, Harvest Share, is an equity-centered, systems-based strategy to improve diet for neighborhood residents in Brooklyn, NY. Our research approach involves three components: participatory mapping, cultural adaptation/transcreation and language justice, and two cross-cutting areas: researcher positionality and research team diversity. The application of these methods in research resulted in our research program being highly accepted by partner organizations and participants. Applying inclusive research practices in addition to centering the community/es of interest will aid in the implementation of solutions that are feasible and culturally and linguistically responsive, ensuring successful recruitment and retention; and in the long run, sustainable, community-engaged solutions that have high acceptability and promote community well-being.

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.

BACKGROUND:Colorectal cancer screening uptake in the United States overall has increased, but racial/ethnic disparities persist and data on colonoscopy uptake by racial/ethnic subgroups are lacking. We sought to better characterize these trends and to identify predictors of colonoscopy uptake, particularly among Asian and Hispanic subgroups. STUDY/METHODS:We used data from the New York City Community Health Survey to generate estimates of up-to-date colonoscopy use in Asian and Hispanic subgroups across 6 time periods spanning 2003-2016. For each subgroup, we calculated the percent change in colonoscopy uptake over the study period and the difference in uptake compared to non-Hispanic Whites in 2015-2016. We also used multivariable logistic regression to identify predictors of colonoscopy uptake. RESULTS:All racial and ethnic subgroups with reliable estimates saw a net increase in colonoscopy uptake between 2003 and 2016. In 2015-2016, compared with non-Hispanic Whites, Puerto Ricans, Dominicans, and Central/South Americans had higher colonoscopy uptake, whereas Chinese, Asian Indians, and Mexicans had lower uptake. On multivariable analysis, age, marital status, insurance status, primary care provider, receipt of flu vaccine, frequency of exercise, and smoking status were the most consistent predictors of colonoscopy uptake (≥4 time periods). CONCLUSIONS:We found significant variation in colonoscopy uptake among Asian and Hispanic subgroups. We also identified numerous demographic, socioeconomic, and health-related predictors of colonoscopy uptake. These findings highlight the importance of examining health disparities through the lens of disaggregated racial/ethnic subgroups and have the potential to inform future public health interventions.