Faculty Bibliography

INTRODUCTION/BACKGROUND:Disparities in vaccination rates exist among racial/ethnic minority adults. This study examined factors associated with influenza (flu) and pneumococcal vaccination rates among non-Hispanic black, Hispanic, and Asian American adults aged 50 or older living in New York City or Los Angeles and Orange counties in California. METHODS:We used data collected by the REACH US Risk Factor Survey 2009-2012 in New York City and California. We analyzed data on 14,139 adults aged 50 or older who were categorized as non-Hispanic black (New York City [n = 1,715], California [n = 530]), Hispanic (New York City [n = 2,667], California [n = 1,099]), Chinese American (New York City [n = 1,656]), Korean American (New York City [n = 310]), Filipino American (California [n = 1,515]), or Vietnamese American (California [n = 3,435]). Bivariate analyses examined difference across race/ethnicity and location, and multivariable logistic regression models, adjusting for sociodemographic and health variables, examined flu and pneumococcal vaccination rates. RESULTS:Among adults aged 50 or older, the flu vaccination rate was lower among non-Hispanic black respondents (New York City, 53.3%; California, 40.5%) than among Hispanic (New York City, 61.0%; California, 49.4%), Chinese (New York City, 67.6%), Korean (New York City, 60.5%), Filipino (California, 66.2%), and Vietnamese (California, 68.0%) respondents. Among adults aged 65 or older, pneumococcal vaccination rates were lowest among Chinese and Korean respondents in New York City (51.7% and 49.1%, respectively), compared with non-Hispanic black (New York City, 62.0%, California, 65.6%), Hispanic (New York City, 60.0%; California 62.7%), Filipino (California, 63.4%), and Vietnamese (California, 63.8%) respondents. Older age, having had a checkup in the past year, and diabetes diagnosis were significantly associated with flu and pneumococcal vaccination in both locations. Additional variables were significant for some vaccinations and locations. CONCLUSION/CONCLUSIONS:When compared with Asian American respondents, non-Hispanic black respondents were least likely to receive the flu vaccine in New York City and California. We found no racial/ethnic differences in pneumococcal vaccination rates. Our findings highlight the need for targeted efforts to increase vaccination rates among racial/ethnic minority older adults.

BACKGROUND:Immigrants comprise approximately 13% of the US population and 33% lack health coverage. Asian Americans are the fastest growing immigrant group; many lack a usual source of care. This study examines factors associated with health insurance among Asian American immigrants living in New York City. METHODS:Community needs assessments were conducted among Asian American subgroups in New York City from 2013 to 2015; analysis was completed in 2017 and 2018. Descriptive statistics examined factors associated with health insurance status while stratifying by Asian ethnic subgroup; multivariable logistic regression models further assessed these associations (p < 0.05 significance level). RESULTS:Approximately 19% of the study population (n = 1399) was uninsured. Logistic regression models adjusted for all factors. Among East Asians, insurance status was associated with female sex (OR = 2.8, p = 0.005), excellent/very good health status (OR = 3.5, p = 0.014), and seeing a private doctor when sick or injured (OR = 3.2, p = 0.033). Among South Asians, insurance status was associated with high school/some college and college education (OR = 2.6 and 2.9, respectively, p = 0.039 and p = 0.021), having a routine health check in the past year (OR = 6.4, p < 0.001), no diabetes diagnosis (OR = 2.7, p = 0.030), and a tuberculosis diagnosis (OR = 4.7, p = 0.019). Among Southeast Asians, insurance status was associated with less than high school education (p < 0.05), living in the USA > 20 years (OR = 3.7, p = 0.009), having a routine health check in the past year (OR = 5.6, p = 0.025), and seeing a private doctor when sick or injured (OR = 2.6, p = 0.018). CONCLUSIONS:Health insurance status was associated with differing factors among each subgroup. Findings may inform strategies to address challenges and barriers of healthcare access to immigrants, making healthcare more accessible to this underserved population.

OBJECTIVE:To examine the association between the inflammatory potential of diet and the quality of cognitive function in an older adult Korean population. METHODS:A total of 239 participants (88 men and 151 women) ages ≥65 y were selected from various health centers in Korea. To assess the inflammatory potential of diet, Energy-adjusted Dietary Inflammatory Index (E-DII) scores were computed based on a single 24-h recall. Cognitive function was assessed using the Korean Mini-Mental State Examination. Multiple linear and logistic regression models were fit to estimate the association between E-DII scores and the degree of cognitive function. RESULTS:E-DII scores were significantly inversely associated with Korean Mini-Mental State Examination score in both unadjusted and adjusted models, after controlling for sex, age, body mass index, sleep hours, supplement use, education level, self-reported health conditions, history of dementia, and physical activity (β = -1.33, 95% confidence interval [CI] = -1.95, -0.71, P <0.0001; β = -0.58, 95% CI = -1.11, -0.06, P = 0.03, respectively). Participants in the highest E-DII tertile had increased risk for mild or moderate cognitive impairment compared with those in the lowest E-DII tertile (adjusted odds ratio 6.32, 95% CI 1.18-33.78; P for trend = 0.0031). CONCLUSIONS:Higher E-DII scores were associated with increased risk of cognitive impairment, suggesting that consuming a proinflammatory diet is associated with increased risk for cognitive impairment in the older Korean adults.

There has been increasing recognition of the need to engage patients, families, and other patient stakeholders in research. This article seeks to provide understanding and examples of how to apply core principles of community-based participatory research (CBPR) in developing patient-centered outcomes research (PCOR) that can impact clinical and public health practice. Authors review CBPR principles and demonstrate how to translate them into effective PCOR strategies. Common themes of CBPR principles and PCOR strategies are related to: (a) fostering joint ownership in the identification of health priorities, the development and evaluation of research strategies and their design, and the dissemination of findings; (b) a keen recognition and appreciation for the importance of stakeholder-driven priorities, research, and solutions; (c) building capacity of both stakeholders and researchers to engage in research collaboratively; and (d) recognizing that conducting the research is not the endpoint but continues on with a commitment to dissemination, spread, adoption and sustainability. The authors highlight the specific strategies in which these CBPR principles can be translated for use in engaging patients and families, and including other stakeholders such as care providers, community partner organizations, health systems, and insurers, in the research process to ensure the development of PCOR.

BACKGROUND: Research suggests that fall risk among older adults varies by racial/ethnic groups; however, few studies have examined fall risk among Hispanics and Asian American older adults. METHODS: Using 2011-2012 California Health Interview Survey data, this study examines falling >/=2 times in the past year by racial/ethnic groups (Asian Americans, Hispanics, and Blacks) aged >/=65, adjusting for socio-demographic characteristics, body mass index, co-morbidities, and functional limitations. A secondary analysis examines differences in fall risk by English language proficiency and race/ethnicity among Asian Americans and Hispanics. RESULTS: Asian Americans were significantly less likely to fall compared to non-Hispanic whites, individuals with >/=2 chronic diseases were significantly more likely to fall than individuals with <2 chronic diseases, and many functional limitations were significantly associated with fall risk, when adjusting for all factors. African Americans and Hispanics did not differ significantly from non-Hispanic whites. Analysis adjusting for race/ethnicity and English language proficiency found that limited English proficient Asian Americans were significantly less likely to fall compared to non-Hispanic whites, individuals with >/=2 chronic diseases were significantly more likely to fall than individuals with <2 chronic diseases, and all functional limitations were significantly associated with fall risk, when adjusting for all factors. No differences were found when examining by racial/ethnic and English proficient/limited English proficient groups. CONCLUSION: Further research is needed to explore factors associated with fall risks across racial/ethnic groups. Culturally relevant and targeted interventions are needed to prevent falls and subsequent injuries in the increasingly diverse aging population in the USA.

THE PROBLEM/OBJECTIVE:Policy, systems, and environmental (PSE) approaches have been shown to be effective in increasing rates of healthy behaviors in the overall population, but are not always effective in reaching racial and ethnic minority groups, including Korean Americans (KAs), who may be socially and linguistically isolated from mainstream campaigns and programs. Targeted and tailored PSE strategies are needed to reach these groups. PURPOSE/OBJECTIVE:To describe the process and lessons learned in implementing a targeted and culturally tailored PSE strategy to increase access to healthy foods for KAs. KEY POINTS/CONCLUSIONS:A Korean community-based organization (CBO) used its inherent understanding of cultural context, and social and historical viewpoints of KAs to develop PSE strategies to reach more than 13,000 KAs. CONCLUSIONS:Local CBOs can play a significant role in complementing population-level strategies with more tailored and targeted approaches to reach racial and ethnic minority groups.

Background: Partnership, engagement, and collaboration (PEC) are critical factors in dissemination and implementation (D&I) research. Despite a growing recognition that incorporating PEC strategies in D&I research is likely to increase the relevance, feasibility, impacts, and of evidence-based interventions or practices (EBIs, EBPs), conceptual frameworks and methodologies to guide the development and testing of PEC strategies in D&I research are lacking. To address this methodological gap, a review was conducted to summarize what we know, what we think we know, and what we need to know about PEC to inform D&I research. Methods: A cross-field scoping review, drawing upon a broad range of PEC related literature in health, was conducted. Publications reviewed focused on factors influencing PEC, and processes, mechanisms and strategies for promoting effective PEC. The review was conducted separately for three forms of partnerships that are commonly used in D&I research: (1) consumer-provider or patient-implementer partnership; (2) delivery system or implementation team partnership; and (3) sustainment/support or interagency/community partnership. A total of 39 studies, of which 21 were review articles, were selected for an in-depth review. Results: Across three forms of partnerships, four domains (cognitive, interpersonal/affective, behavioral, and contextual domains) were consistently identified as factors and strategies for promoting PEC. Depending on the stage (preparation or execution) and purpose of the partnership (regulating performance or managing maintenance), certain PEC strategies are more or less relevant. Recent developments of PEC frameworks, such as Partnership Stage of Change and multiple dynamic processes, provide more comprehensive conceptual explanations for PEC mechanisms, which can better guide PEC strategies selection and integration in D&I research. Conclusions: This review contributes to D&I knowledge by identifying critical domain factors, processes, or mechanisms, and key strategies for PEC, and offers a multi-level PEC framework for future research to build the evidence base. However, more research is needed to test PEC mechanisms.

Comprehensive and innovative strategies are needed to address and manage chronic diseases and conditions and to reduce health disparities. EmblemHealth Neighborhood Care (EHNC) sites provide community-based linkages across payers, health providers, and delivery systems and underserved communities using culturally sensitive methods tailored to meet the needs of the community. This article describes this novel initiative and early indicators of its feasibility. Three EHNC sites were established in New York City: Harlem, Cambria Heights, and Chinatown. Each site provides core health and customer services to members and the community. In addition, sites provide tailored services to meet the unique needs of each community. Preliminary data suggest that program and community members are utilizing the sites and returning for follow-up visits. Sites also demonstrate success in cross referral between EHNC teams. The EHNC program is both feasible from the payer's perspective and acceptable to diverse patient populations and settings.