Faculty Bibliography

Hypertension affects a third of U.S. adults and is especially high among Asian American groups. The Racial and Ethnic Approaches to Community Health for Asian AmeRicans (REACH FAR) project delivers culturally adapted, evidence-based hypertension-related programs to Bangladeshi, Filipino, Korean, and Asian Indian communities in New York and New Jersey through 26 sites: ethnic grocery stores, restaurants, and Muslim, Christian, and Sikh faith-based organizations. Knowledge of the implementation mechanisms of culturally adapted programs is limited and is critical to inform the design and execution of such programs by and in community sites. We applied four categories of the Consolidated Framework for Implementation Research-intervention and individuals' characteristics, inner and outer setting-to analyze factors influencing implementation outcomes, that is, site leaders' perceptions about adopting, adapting, and sustaining REACH FAR. We conducted semistructured interviews with 15 leaders, coded them for implementation outcomes, and recoded them to identify contextual factors. Our findings show that REACH FAR resonated in sites where leaders perceived unhealthy diet and lifestyles in their communities (intervention characteristics), sites had historically engaged in health programs as a public-service mission (inner setting), and leaders identified with this mission (individuals' characteristics). Site leaders strived to adapt programs to respond to community preferences (outer setting) without compromising core objectives (inner setting). Leaders noted that program sustainability could be impeded by staff and volunteer turnover (inner setting) but enhanced by reinforcing programs through community networks (outer setting). The findings suggest that to facilitate implementation of culturally adapted health behavior programs through community sites, interventions should reinforce sites' organizational commitments and social ties.

In the United States (US), chronic disease risk factors are highly prevalent among Asian immigrant communities, who also exhibit low health screening rates. Perceived neighborhood social cohesion (NSC) has been associated with preventive healthcare use in the general US population, although it remains unexplored among Asian Americans (AAs). The aim of this study is to evaluate the association between NSC and preventive screening for hypertension, high cholesterol, diabetes, and depression among East, South and Southeast Asian American (EAA, SAA, SEAA) communities in New York City (NYC) using cross-sectional, locally collected data from 2013 to 2016. NSC was assessed using a 4-question scale to create an additive score between 4 and 16 and was analyzed both as a continuous and categorial variable (High, Medium, and Low tertiles). Recent screening was defined as a check-up within the last year for each of the included health conditions. A one-unit increase in NSC score was associated with increased odds of recent screening for high cholesterol in EAAs (AOR = 1.09, 95%CI:1.00-1.20); for high cholesterol, diabetes, and depression in SAAs (AOR = 1.08, 95%CI:1.00-1.20; AOR = 1.07, 95%CI:1.00-1.15; AOR = 1.15, 95%CI:1.06-1.25); and with high cholesterol among SEAAs (AOR = 1.12, 95%CI:1.00-1.25). Overall, NSC was an important facilitator for preventive screening behaviors for specific conditions in different groups, though was consistently associated with screening for high cholesterol in our sample. Enhancing NSC through family and community-based programming may be one strategy to encourage screening for preventive behaviors, though more research is needed to elucidate a precise mechanism.

INTRODUCTION/BACKGROUND:Added sugars and high glycemic index (GI) foods might play a role in cardiometabolic pathogenesis. Our study aimed to describe the top sources of added sugars and types of high GI foods in diets of children by race/ethnicity. METHODS:We examined data for 3,112 children, aged 6 to 11 years from the National Health and Nutrition Examination Survey (NHANES), 2011 to 2016. Mean intake was estimated and linear regression models tested for differences by race/ethnicity. Population proportions for food sources were created and ranked, accounting for survey weighting when appropriate. RESULTS:Asian American and Mexican American children had the lowest reported added sugar intake. Cereals were observed to contribute highly to added sugar intake. Soft drinks did not contribute as much added sugar intake for Asian American children as it did for children of other races/ethnicities. Asian American children consumed significantly more high GI foods than other groups. Types of high GI foods differed meaningfully across racial/ethnic groups (ie, Mexican American: burritos/tacos; other Hispanic, White, and Black: pizza; Asian American: rice). Rice accounted for 37% of total high GI foods consumed by Asian American children. CONCLUSIONS:Sources of added sugars and types of high GI foods in children's diets vary across racial/ethnic groups. Targeting foods identified as top sources of added sugars for all race/ethnicities and focusing on substitution of whole grains may reduce obesity, diabetes, and related cardiometabolic risk more equitably.

With growing numbers of aging Asian Americans, Native Hawaiians, and Pacific Islanders (AANHPIs), the availability of culturally and linguistically appropriate screening tools for Alzheimer's disease and its related dementias (ADRD) is needed. The aim of this scoping review is to summarize the tools that have been adapted for and validated among the AANHPI population. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol for systematic reviews, six databases were searched for peer-reviewed articles describing ADRD among AANHPIs. Among 1,477 articles screened for inclusion, 15 articles were included in the final analysis. Results showed a paucity of studies that psychometrically validate tools among this population. Furthermore, studies that culturally adapted and/or translated existing tools mostly targeted East Asian American populations. Our review provides a first step in mapping the extant literature on ADRD screening tools for this underresearched population and will serve as a guide for future research, policy, and intervention.

BACKGROUND:It is important to monitor the scope of clinical research of all types, to involve participants of all ages and subgroups in studies that are appropriate to their condition, and to ensure equal access and broad validity of the findings. OBJECTIVE:We conducted a review of clinical research performed at New York University with the following objectives: (1) to determine the utility of institutional administrative data to characterize clinical research activity; (2) to assess the inclusion of special populations; and (3) to determine if the type, initiation, and completion of the study differed by age. METHODS:Data for all studies that were institutional review board-approved between January 1, 2014, and November 2, 2016, were obtained from the research navigator system, which was launched in November 2013. One module provided details about the study protocol, and another module provided the characteristics of individual participants. Research studies were classified as observational or interventional. Descriptive statistics were used to assess the characteristics of clinical studies across the lifespan, by type, and over time. RESULTS:A total of 22%-24% of studies included children (minimum age <18 years) and 4%-5% focused exclusively on pediatrics. Similarly, 64%-72% of studies included older patients (maximum age >65 years) but only 5%-12% focused exclusively on geriatrics. Approximately 85% of the studies included both male and female participants. Of the remaining studies, those open only to girls or women were approximately 3 times as common as those confined to boys or men. A total of 56%-58% of projects focused on nonvulnerable patients. Among the special populations studied, children (12%-15%) were the most common. Noninterventional trial types included research on human data sets (24%), observational research (22%), survey research (16%), and biospecimen research (8%). The percentage of projects designed to test an intervention in a vulnerable population increased from 17% in 2014 to 21% in 2015. CONCLUSIONS:Pediatric participants were the special population that was most often studied based on the number of registered projects that included children and adolescents. However, they were much less likely to be successfully enrolled in research studies compared with adults older than 65 years. Only 20% of the studies were interventional, and 20%-35% of participants in this category were from vulnerable populations. More studies are exclusively devoted to women's health issues compared with men's health issues.

Korean American immigrants (KAIs) face diverse sociocultural stressors in the acculturation process. While stress is known to cause short sleep, little is known about how acculturative stress affects sleep differently for KAI men and women. The purpose of this cross-sectional study was to examine gender differences in the association between diverse domains of acculturative stress and sleep duration among KAIs. Middle-aged KAIs were recruited in community settings and online. KAIs completed validated measures of acculturative stress (homesickness, social isolation, employment barriers, discrimination, civic disengagement, and family problems) and sleep duration. Multiple linear regression analysis was performed and stratified by gender. 343 KAIs participated (mean age = 41 ± 10 years, 47% female, 11% short sleepers [< 6 h]). After adjustment for covariates, higher homesickness (β = - 23.19, p < 0.05) and lower civic disengagement (β = 17.75, p < 0.05) were associated with shorter sleep duration in women, while higher isolation was associated with shorter sleep duration in men (β = - 13.73, p < 0.05). Discussion: Results suggest gender-specific associations between acculturative stress and sleep duration. Future research should take into account gender differences in the experience and effects of acculturative stress when developing interventions to improve sleep health in KAIs.

Background: Chinese Americans make up the largest subgroup of the Asian American population in the US and are the largest Asian subset in New York City, where the population of Chinese Americans is 547,886; 72% are foreign-born, 34% lack a high school diploma, 61% have limited English proficiency (LEP), and 21% are living in poverty. Cancer is the leading cause of date among Chinese New Yorkers who suffer a disproportionately high burden for specific cancers, including nasopharyngeal, liver, and stomach cancer. Despite this cancer burden, Chinese Americans are at high risk for poorly controlled and managed pain in clinic and hospital settings and underrepresented in pain related research. The goal of the CAPE project is to understand the concepts of pain and pain experience and identify potential facilitators and barriers to pain treatment and satisfaction among limited-Englishproficient Chinese American inpatients treated at a New York City-based hospital.
Method(s): Kleinman's Patient's Explanatory Model of Illness and principles of social marketing served as guiding frameworks. In addition, a scoping review was conducted of electronic databases including PubMed, Google Scholar, and the gray literature on the pain management literature for Chinese American patients to further inform the interview topic guide and survey instrument. Key search terms included combinations of "Asian American,""Chinese," "Chinese American," "cancer," "pain," "pain management," and "pain experience." Chinese Americanpatients who requested services in Chinese language (e.g., Cantonese, Mandarin) will participate in a one-timequalitative interview and survey data collection. A sample of 25 participants will be recruited or until data saturationis achieved. All data collection will be conducted in the patients' preferred language. Analysis of the qualitative datawill utilize the techniques of narrative analysis and constant comparison analytic approach.
Result(s): The scoping review identified significant gaps in the extant literature. Findings highlighted the lack ofintervention or clinical trial studies to address pain and cancer-related pain management for Chinese Americanpatients despite data confirming high rates of dissatisfaction with pain management in clinic and hospital settings.Qualitative data will be assessed to identify themes related to factors to inform the development of strategies andprograms on optimal and cultural relevant pain management.
Conclusion(s): To improve quality of cancer care for Chinese American patients, study findings will inform thecultural adaption of hospital-based pain management programs and services and practice recommendations tofacilitate culturally relevant pain treatment for this vulnerable patient population

Background: Gastric cancer is the third most common cause of cancer death worldwide. In the US, gastric cancer incidence for Chinese Americans is nearly twice that for non-Hispanic whites. Cancer is the leading cause of death among Chinese New Yorkers who experience higher mortality for gastric cancer than other New Yorkers overall. The bacterium Helicobacter pylori (H. pylori) is the strongest risk factor for gastric cancer, and eradication of H. pylori through triple antibiotic therapy is the most effective prevention strategy for gastric cancer. Despite the elevated burden, there are no culturally and linguistically tailored evidence-based intervention strategies to address H. pylori medication adherence and gastric cancer prevention for Chinese Americans in NYC, a largely foreign-born (72%), limited English proficient (61%), and low-income (21% living in poverty) population.
Objective(s): The study objective was to develop and pilot a community health worker (CHW)-delivered linguistically and culturally adapted gastric cancer prevention intervention to improve H. pylori treatment adherence and address modifiable cancer prevention risk factors, including improved nutrition for low-income, LEP, Chinese American immigrants.
Method(s): We used a mixed methods and community-engaged research approach to develop and pilot the intervention curriculum and materials. Methods included: 1) a comprehensive scoping review of the peer-reviewed and grey literature on gastric cancer prevention programs and strategies targeting Chinese Americans; 2) 15 key informant interviews with gatekeepers and stakeholders serving the New York Chinese immigrant community to assess the knowledge and perception of H. pylori infection and gastric cancer among Chinese New Yorkers; and 3) pilot implementation of the collaboratively developed intervention with H. pylori-infected LEP Chinese immigrant participants (n=7).
Result(s): Study process findings and pilot results will be presented. Preliminary results indicate high patient- and community-level need and acceptability for the intervention. Baseline and 1-month post-treatment outcomes and survey data, qualitative data analysis of the CHW session notes, and key informant interviews will be presented.
Conclusion(s): Findings suggest that a CHW-delivered culturally adapted gastric cancer prevention intervention can result in meaningful health information and treatment adherence for at-risk, low-income Chinese immigrant communities. Study findings are being applied to inform a randomized controlled trial being implemented in safety net hospital settings

Colorectal cancer (CRC) screening has increased substantially in New York City in recent years. However, screening uptake measured by telephone surveys may not fully capture rates among underserved populations. We measured screening completion within one year of a primary care visit among previously unscreened patients in a large urban safety-net hospital and identified sociodemographic and health-related predictors of screening. We identified 21,256 patients aged 50-75 who were seen by primary care providers (PCPs) in 2014, of whom 14,425 (67.9%) were not up-to-date with screening. Since PCPs facilitate the majority of screening, we compared patients who received screening within one year of an initial PCP visit to those who remained unscreened using multivariable logistic regression. Among patients not up-to-date with screening at study outset, 11.5% (1,658 patients) completed screening within one year of a PCP visit. Asian race, more PCP visits, and higher area-level income were associated with higher screening completion. Factors associated with remaining unscreened included morbid obesity, ever smoking, Elixhauser comorbidity index of 0, and having Medicaid/Medicare insurance. Age, sex, language, and travel time to the hospital were not associated with screening status. Overall, 39.9% of patients were up-to-date with screening by 2015. In an underserved urban population, CRC screening disparities remain, and overall screening uptake was low. Since more PCP visits were associated with modestly higher screening completion at one year, additional community-level education and outreach may be crucial to increase CRC screening in underserved populations.

Background: With the rapidly aging US population, Alzheimer's disease and related dementias (AD/ADRD) are increasingly important issues for research (Alzheimer's Association, 2019). Asian Americans, Native Hawaiians and Pacific Islanders (AANHPIs) are becoming a larger portion of seniors, as the fasted growing minority in the US (National Asian Pacific Center on Aging, 2018; US Census Bureau, 2018). The NYU Center for the Study of Asian American Health (CSAAH), conducted a scoping review showing there is little AD/ADRD research disaggregated by AANHPI subgroups. This study aims to learn about challenges, facilitators, socio-cultural norms, and strategies in conducting research on AD/ADRD and designing interventions for AANHPIs.
Method(s): We conducted eight semi-structured key informant qualitative interviews with local/national community leaders from CSAAH's Community Partner Network and National Advisory Committee using a modified snowball sampling approach. Leaders represented Korean, Filipino, South Asian, and Native Hawaiian communities and many worked directly in senior services. Interviews were coded using Dedoose and analyzed using inductive content theme analysis. Two coders developed a codebook and theme list through discussion and consensus.
Result(s): Community priorities included: a cultural expectation to age at home; a need for AD/ADRD education and services; cultural competency of healthcare systems; and engaging family/social support systems. Stigma was variable within and between communities, stemming from a lack of information and openness. Financial costs and limited resources were challenges. AD/ADRD information sources and availability of in-language materials varied, and a need for research in specific subgroups was noted.
Conclusion(s): Several challenges including lack of in-language information, financial barriers and lack of resources, and facilitators including family and social support, were identified. Next steps include applying findings to inform a strategic plan for healthy aging and AD/ADRD research for AANHPIs, including advocating for subgroup-specific research particularly in NHPIs and South Asians