Faculty Bibliography

The Asian American health narrative reflects a long history of structural racism in the US and the complex interplay of racialized history, immigrant patterns, and policies regarding Asians in the US. Yet owing to systematic issues in data collection including missing or misclassified data for Asian Americans and practices that lead to indiscriminate grouping of unlike individuals (for example, Chinese, Vietnamese, and Bangladeshi) together in data systems and pervasive stereotypes of Asian Americans, the drivers and experiences of health disparities experienced by these diverse groups remain unclear. The perpetual exclusion and misrepresentation of Asian American experiences in health research is exacerbated by three racialized stereotypes-the model minority, healthy immigrant effect, and perpetual foreigner-that fuel scientific and societal perceptions that Asian Americans do not experience health disparities. This codifies racist biases against the Asian American population in a mutually reinforcing cycle. In this article we describe the poor-quality data infrastructure and biases on the part of researchers and public health professionals, and we highlight examples from the health disparities literature. We provide recommendations on how to implement systems-level change and educational reform to infuse racial equity in future policy and practice for Asian American communities.

A systematic assessment of the effect of COVID-19 on the food retail environment-an important determinant of health-has not been conducted. Our objective was to assess the impact of COVID-19 on closures of restaurants, food retail stores, and fresh produce vendors in New York City (NYC). We conducted a cross-sectional study following the peak of COVID-19 in six neighborhoods in NYC. Two Chinese ethnic neighborhoods and four higher/lower resourced comparison neighborhoods were selected a priori based on 14 sociodemographic indicators. The primary outcome was indefinite/temporary closures or absence of food businesses. Of 2720 food businesses identified, produce vendors and restaurants were more likely to close than food retail stores. A higher proportion of food businesses closed in Chinese ethnic neighborhoods vs. comparison neighborhoods. COVID-19 impacted food businesses in six NYC neighborhoods examined in this period, with the greatest effect observed for Chinese ethnic neighborhoods.

Material hardship and stress, associated with poor infant outcomes, increased during the Coronavirus Disease 2019 pandemic. Chinese American families were vulnerable to racism-driven disparities. Little is known about maternal perceptions of pandemic impacts on their infants, family, and community. Purposive sampling of low-income Chinese American mothers (n = 25) with infants (1-15 months). Semi-structured qualitative interviews conducted in Mandarin, Cantonese, or English were audio-recorded, transcribed, and translated. Transcripts coded using applied thematic analysis in an iterative process of textual analysis until thematic saturation. Three themes emerged: (1) Heightened family hardship included financial strain, disruption of transnational childcare, experiences of racism; (2) Altered infant routines/developmental consequences included using protective equipment on infants, concerns about infant socio-emotional development; (3) Coping strategies included stockpiling essentials, adapting family diets. Strategies to mitigate disparities include expanding social needs screening, correcting misinformation, strengthening support networks, and including low-income Chinese Americans in these efforts.

INTRODUCTION/BACKGROUND:Little is known on the independent effects of generational status and acculturation on the consumption of specific foods among disaggregated Asian American (AA) populations. This study explores the associations of generational status and acculturation with dietary behaviors of a nationwide non-probability sample of 3018 AAs (57.6% East Asian American (EAA), 18.9% South Asian American (SAA), 19.4% Southeast Asian American (SEAA)). METHODS:Recruited participants completed an online dietary survey designed and adapted for AAs to assess a range of diet and food purchasing behaviors. Generational status was assessed through participant and parental country of birth (1st-Gen, 2nd-Gen, 3rd-Gen); the Marin Short Acculturation Scale was adapted to measure acculturation. Linear regression models assessed the association of generational status and acculturation with consumption of 11 food/nutrient groups, adjusted for socio-economic variables. RESULTS:Compared to estimated US averages, participants reported lower fruit, dairy, and seafood intake yet lower red and processed meat, and higher whole grain, calcium, and fiber intake. Compared to EAA, SAA reported higher dairy (1.72 vs. 1.46 cups/day) and calcium (1029 vs. 954 mg/day) intakes, while SEAA reported lower vegetable intake (1.66 vs. 1.78 cups/day). In adjusted analyses, processed meat intake was higher among 2nd-Gen and 3rd-Gen vs.1st-Gen (+0.029 times/day; +0.061 times/day) participants. Higher acculturation was associated with lower vegetable, fiber, and seafood intake (-0.005 cups/day; -0.02 g/day; -0.002 times/day). CONCLUSION/CONCLUSIONS:Greater attention to the role of generational status and acculturation in AA dietary behaviors is needed, and findings call for further research to understand the mechanisms behind the dietary influence of different socialization and acculturative processes.

Introduction/UNASSIGNED:Community-based organizations (CBOs) have provided critical resources during the pandemic, particularly for marginalized communities, and are trusted liaisons who connect socially and linguistically isolated community members, such as the highly diverse Asian American population, to care during public health emergencies. Stereotypes such as the model minority myth have permeated public perception of Asian Americans' health status and health care access needs, fueling widespread belief that Asian Americans do not experience health disparities, and mask the high rates of coronavirus disease 2019 (COVID-19) infection, hospitalization, and mortality among Asian Americans. The unequal burden of COVID-19 on Asian American communities has largely remained absent from the public health and national discourse, with exceptions such as community voices that have directed news media coverage and leading roles of CBOs in offering culturally adapted, in-language programming on COVID-19 infection prevention and control. Methods/UNASSIGNED:CBOs and their staff are well-equipped with the cultural acuity, language capacity, and familiarity with local norms to improve structural gaps affecting health outcomes and support health care delivery. Results/UNASSIGNED:We discuss the roles and responsibilities of CBOs in strengthening the health care workforce and expanding community-clinic linkages and provide two case studies illustrating the efforts of two community organizations serving Asian American and immigrant communities, who have been disproportionally affected by the COVID-19 pandemic. Discussion/UNASSIGNED:CBOs are essential to supporting health service coordination and care delivery for structurally vulnerable populations, and are vital to sustaining the coordinated, multilevel public health response to improving community health. Conclusion/UNASSIGNED:Bolstering the current infrastructure to support CBOs is necessary to facilitating immediate responses to serve community needs.

Background: Asian Americans have experienced increased mental health challenges since the onset of the COVID-19 pandemic. Substantial research documents the salubrious effects of social support on mental and overall health among Asian Americans. However, the role of social support in mental health and health behaviors like vaccine willingness for Asian American older adults during the pandemic remains underexplored despite the importance of social support for health and quality of life in this population.
Objective(s): This study examines the relationship between social support, mental health, and COVID-19 vaccine willingness among Asian American older adults during the pandemic.
Method(s): The Asian American, Native Hawaiian, and Pacific Islander COVID-19 Needs Assessment Survey was a national survey administered between January 18 - April 9, 2021 (n=3,736). Adults aged 50 years and older who self-identified as Asian American were included. Logistic regressions were conducted to analyze associations among depression symptoms, anxiety symptoms, COVID-19 vaccine willingness, and social support types (receiving or providing emotional and instrumental support).
Result(s): The sample (n=654) was 59% East Asian, 22% Southeast Asian, 10% South Asian, and 9% Multiethnic/Other. About 12.5% screened positive for depression symptoms, 16.7% for anxiety symptoms, 20.6% for depression or anxiety symptoms, and 75.2% were willing to get the COVID-19 vaccine. Compared to adults not receiving emotional support, adults who received emotional support were less likely to have depression [0.42 (0.25, 0.70)] and anxiety [0.56 (0.35, 0.90)], and they were more likely to get the COVID-19 vaccine [1.63 (1.00, 2.64)]. Adults who provided emotional support to others were also less likely to have depression [0.54 (0.31, 0.95)].
Conclusion(s): Receiving emotional support was not only associated with better mental health outcomes but also COVID-19 vaccine willingness. This may have implications for developing supportive programming for this population that not only includes instrumental or practical support, but also emotional support

Purpose/UNASSIGNED:Despite the small but growing number of studies documenting the increasing prevalence of diabetes among Korean Americans, no culturally adapted interventions have been developed for Korean Americans at risk for diabetes. We evaluate the efficacy of a culturally tailored lifestyle intervention among Korean American immigrants at risk for diabetes in New York City (NYC). Methods/UNASSIGNED:-tests and chi-square tests assessed group differences for each group for each outcome measure. Results/UNASSIGNED:The treatment group reported significant positive changes in recommended weekly PA, PA self-efficacy, PA barriers, nutrition self-efficacy, diabetes knowledge, weight, BMI, and systolic blood pressure compared with control participants. Generalized estimated equations models for repeated measures assessed change across time while adjusting for study arm, time point, and the interaction between study arm and time point. The intervention effect was significant for weekly moderate and vigorous PA, recommended weekly PA, PA self-efficacy, and diabetes knowledge. Conclusions/UNASSIGNED:Results suggest that a culturally adapted lifestyle intervention for Korean American immigrants at risk for diabetes have the potential to improve behaviors associated with cardiovascular disease outcomes and diabetes prevention. Further research among Korean Americans is warranted.

OBJECTIVES/UNASSIGNED:Data on the health burden of COVID-19 among Asian American people of various ethnic subgroups remain limited. We examined COVID-19 outcomes of people of various Asian ethnic subgroups and other racial and ethnic groups in an urban safety net hospital system. METHODS/UNASSIGNED:We conducted a retrospective analysis of 85 328 adults aged ≥18 tested for COVID-19 at New York City's public hospital system from March 1 through May 31, 2020. We examined COVID-19 positivity, hospitalization, and mortality, as well as demographic characteristics and comorbidities known to worsen COVID-19 outcomes. We conducted adjusted multivariable regression analyses examining racial and ethnic disparities in mortality. RESULTS/UNASSIGNED:Of 9971 Asian patients (11.7% of patients overall), 48.2% were South Asian, 22.2% were Chinese, and 29.6% were in other Asian ethnic groups. South Asian patients had the highest rates of COVID-19 positivity (30.8%) and hospitalization (51.6%) among Asian patients, second overall only to Hispanic (32.1% and 45.8%, respectively) and non-Hispanic Black (27.5% and 57.5%, respectively) patients. Chinese patients had a mortality rate of 35.7%, highest of all racial and ethnic groups. After adjusting for demographic characteristics and comorbidities, only Chinese patients had significantly higher odds of mortality than non-Hispanic White patients (odds ratio = 1.44; 95% CI, 1.04-2.01). CONCLUSIONS/UNASSIGNED:Asian American people, particularly those of South Asian and Chinese descent, bear a substantial and disproportionate health burden of COVID-19. These findings underscore the need for improved data collection and reporting and public health efforts to mitigate disparities in COVID-19 morbidity and mortality among these groups.

The COVID-19 pandemic has disrupted the social, economic, and health care systems in the United States and shined a spotlight on the burden of disease associated with social determinants of health (SDOH). Addressing SDOH, while a challenge, provides important opportunities to mitigate cardiovascular disease incidence, morbidity, and mortality. We present a conceptual framework to examine the differential effects of the COVID-19 pandemic on SDOH across demographically diverse populations, focusing on the short- and long-term development of cardiovascular disease, as well as future research opportunities for cardiovascular disease prevention. The COVID-19 pandemic exerted negative shifts in SDOH and cardiovascular risk factors (ie, smoking, body mass index, physical activity, dietary behavior, cholesterol, blood pressure, and blood sugar). For example, evidence suggests that unemployment and food insecurity have increased, whereas health care access and income have decreased; changes to SDOH have resulted in increases in loneliness and processed food consumption, as well as decreases in physical activity and hypertension management. We found that policy measures enacted to mitigate economic, social, and health issues inadequately protected populations. Low-income and racial and ethnic minority communities, historically underserved populations, were not only disproportionately adversely affected by the pandemic but also less likely to receive assistance, likely attributable in part to the deep structural inequities pervasive in our society. Effective and culturally appropriate interventions are needed to mitigate the negative health impacts of historical systems, policies, and programs that created and maintain structural racism, especially for immigrants, racial and ethnic minorities, and populations experiencing social disadvantage.

There is a lack of quantitative research examining how the pandemic has affected individuals at different income levels. The Asian American population has the highest level of income inequality and serves as an excellent case study for examining differences in experience between income groups. A non-probability sample of 3084 Asian American adults living in the US was surveyed in June 2020, examining health-related behaviors and outcomes. Descriptive analyses and chi-squared statistics were conducted to identify differences in income groups (low, medium, high) among Asian Americans across regional subgroups (East, South, Southeast, Multiethnic) and disaggregated ethnicities (Chinese, Asian Indian, Japanese, and Filipino). In bivariable analyses, a significantly (p < 0.05) greater percentage of high-income individuals during the pandemic reported having enough money to buy the food they needed, a away to get to the store for food, and reported stores where they get food had everything they needed. High-income Chinese, Japanese, and Filipino individual also noted that, since the COVID-19 crisis, they are now working partially or fully from home. In the total sample, multivariable adjusted logistic regressions revealed medium- and low-income individuals to have low odds of working partially or fully from home (AOR:0.55, 95%CI:0.42-0.72), higher odds of not having enough money to buy the food they needed (AOR:3.54, 95%CI:1.43-11.81), and higher odds of eating less (AOR:1.58, 95%CI:1.14-2.22). These results highlight the importance of considering income distribution when characterizing disparities in health behaviors within racial/ethnic minority groups and underscore the need to bolster the infrastructure supporting low-income Asian Americans.