Faculty Bibliography

Little is known about the dietary patterns of Chinese Americans. Understanding their dietary patterns can provide insights for addressing cardiovascular disease (CVD) risk among Chinese American immigrants. The objective of this study was to identify dietary patterns among Chinese American immigrants living in New York City (NYC) and to describe associations with demographic and CVD risk factors. A validated Food Frequency Questionnaire assessed usual dietary intake in Chinese American immigrants living in NYC as part of the Chinese American Cardiovascular Health Assessment (CHA CHA) in 2010-2011 (n = 1973, age range 21-89 years). Principal components analysis with varimax rotation retaining three factors with eigenvalues > 1.5 identified dietary patterns. Multivariable linear regression models tested associations between CVD risk factors and dietary pattern scores. In multivariable analyses, each unit of increase in the Sweets factor was associated with 0.76 ± 0.33 (mean ± SD) mg/dL higher HDL cholesterol and a 6.2 ± 2.7% increase in HOMA-IR. In contrast, each unit increase in the Fried Noodles factor was associated with a 0.27 ± 0.11 inch greater waist circumference, - 0.89 ± 0.40 mg/dL lower HDL cholesterol, and also a 6.9 ± 2.6% increase in HOMA-IR. Each unit increase in the Vegetables factor was associated with a - 1.40 ± 0.43 mmHg and - 0.95 ± 0.27 mm Hg decrease in systolic and diastolic blood pressure, respectively. Dietary patterns are significantly associated with CVD risk factors among Chinese American immigrants in NYC. Future work will inform how dietary patterns relate to level of acculturation in order to guide the development of dietary interventions to reduce CVD risk.

Minority populations, including Asian Americans, face disparities in hypertension compared with non-Hispanic whites. This underscores the need for culturally adapted programs in settings that reach Asian American communities, such as faith-based organizations. We worked collaboratively with community partners to culturally adapt and implement an evidence-based community blood pressure monitoring program for Asian Americans (Asian Indians, Koreans, Filipinos, and Bangladeshis) in metropolitan New York during 2015 and 2016. The program included regularly scheduled volunteer-led screening and counseling events with congregants at faith-based organizations. Among participants with complete 6-month data (n = 348), health-related self-efficacy significantly improved after 6 months, and systolic and diastolic blood pressure was significantly reduced in some subgroups; reductions were highest in participants who self-reported a previous diagnosis of hypertension. Among Asian Americans, faith-based programs may be a replicable, low-cost, sustainable way to increase health-related self-efficacy and decrease blood pressure, specifically among individuals with self-reported hypertension.

Chinese American immigrants are at increased risk for Helicobacter pylori infection and stomach cancer. Despite their increased risk, very few prevention strategies exist which target this vulnerable population. The purpose of this article is to present the stakeholder engaged development, review, assessment, refinement, and finalization of a H. pylori treatment adherence and stomach cancer prevention curriculum specifically designed to engage vulnerable, limited English proficient Chinese Americans in New York City.

Despite the high prevalence of smokeless tobacco (SLT) use in South Asia, little is known about the use of cultural smokeless tobacco among South Asians in the United States (US). This study examines the prevalence and correlates of SLT products among South Asians living in New York City (NYC). A total of 602 South Asians living in NYC completed a community health needs and resource assessment and answered questions about the use of SLT. Multivariable logistic regression models were run to examine predictors of SLT use (ever and current use). A total of 28.2% South Asian individuals reported ever use of SLT (35.9% among men and 21.5% among women) and a total of 12.9% reported current use of SLT (16.5% among men and 9.7% among women). Logistic regression models were stratified by sex. Among men, factors associated with ever or current use included: Bangladeshi and Himalayan ethnic subgroup, speaking English very well, attending a religious service a few times a year (ever use only), and current or former cigarette smoking. Among women, factors associated with ever use included: Bangladeshi ethnic subgroup, self-reporting condition of mouth and teeth as fair/poor, and at risk for depression. No factors were significant among women for current use. Overall, prevalence of current and ever use of SLT is high, and important differences exist by sex. Future studies are needed to better understand SLT use patterns in South Asian communities in the US and to inform culturally relevant interventions aiming to decrease overall tobacco use.

Objectives/UNASSIGNED:To assess prevalence of dietary cultural norms (consumption of brown rice, raw vegetables, low sodium diet) and the association of acculturation level with these norms in a Chinese American sample in New York City (NYC). Methods/UNASSIGNED: = 239). Multivariable models predicted the effect of acculturation on three dimensions of Chinese cultural dietary norms: non-consumption of raw vegetables, brown rice, and low sodium diet, adjusted for age and sex. Acculturation dimensions were defined as both identification with ethnic society (Chinese culture) immersion (ESI) and with dominant society (American culture) immersion (DSI); maximum possible scores = 4. STATA was used for all analyses. Results/UNASSIGNED:The majority of the sample identified strongly with Chinese culture (73% above mean ESI = 3.2) and less with American culture (55% below mean DSI = 3.0). Overall, participation in dietary norms was low across the three dimensions; 21% reported not consuming raw vegetables; 37% not consuming brown rice; and 41% not consuming low sodium diets. Participants with higher acculturation to American society (DSI > 3.0) had lower participation in raw vegetable and brown rice dietary norms; 7% for raw vegetables, and 22% for brown rice. Those more acculturated to American culture were more likely to report consumption of brown rice (aOR = 3.57, 95% CI 0.01-12.50). Having a college education or higher was associated with reduced likelihood of participating in raw vegetable norms (aOR = 0.21, 95% CI 0.08-0.51) and brown rice norms (aOR = 0.46, 95% CI 0.22-0.98). No associations were found between ESI and participating in any dietary norms using univariate or multivariate models. Conclusions/UNASSIGNED:Immersion into American society and education may be more influential on norms than traditional beliefs while acculturation to American society appears to dissuade participation in traditional Chinese dietary norms - specifically, consumption of brown rice. Interestingly, education appears to be a stronger predictor of participation in cultural dietary norms than American or Chinese acculturation in this sample. Funding Sources/UNASSIGNED:NIMHD/NIH.

BACKGROUND & AIMS/OBJECTIVE:Disparities in colorectal cancer (CRC) screening uptake by race/ethnicity, socioeconomic status, and geography are well documented. We sought to further characterize the relationship between sociodemographic factors and up-to-date colonoscopy use in a diverse urban center using the 2014 New York City Community Health Survey (NYCCHS). METHODS:We examined overall colonoscopy uptake by race/ethnicity-with a particular interest in Asian and Hispanic subgroups-and used weighting to represent the entire 2014 NYC adult population. We also evaluated the association between 10 sociodemographic variables (age, sex, race/ethnicity, birthplace, home language, time living in the US, education, employment, income, and borough of residence) and colonoscopy use using univariable and multivariable logistic regression models. RESULTS:Up-to-date colonoscopy uptake was 69% overall with reported differences by racial/ethnic group, ranging from 44%-45% for Mexicans and Asian Indians to 75% for Dominicans. In the multivariable regression model, colonoscopy use was associated with age greater than 65 years, Chinese language spoken at home, and not being in the labor force. Lower colonoscopy use was associated with living in the US for less than 5 years, Asian Indian language spoken at home, lower income, and residing outside of Manhattan. CONCLUSIONS:Among New Yorkers older than age 50, up-to-date colonoscopy use varied significantly by race/ethnicity, especially in Asian and Hispanic subgroups. Recent immigrants, low-income groups, and those living outside of Manhattan were significantly less likely to receive CRC screening. Targeted interventions to promote CRC screening in these underserved groups may improve overall screening uptake.

Introduction/UNASSIGNED:Sikh Asian Indians are an underserved, minority group demonstrating high rates of diabetes. Community health workers (CHWs) are effective in addressing health disparities by reaching socially and linguistically isolated populations. There are no culturally-adapted programs for diabetes prevention among Sikh Asian Indians, thus, this study tests the efficacy of a culturally-tailored CHW intervention to improve diabetes prevention-related outcomes among Sikh Asian Indians at-risk for diabetes. Methods/UNASSIGNED:A quasi-experimental two-arm intervention among Sikh Asian Indian adults at-risk for diabetes and living in New York City (n=160) was conducted in 2013-2014. The treatment group received six monthly CHW group education sessions and ten follow-up phone calls; the control group received the first session. Main outcomes included weight, body mass index (BMI), blood pressure (BP), physical activity (PA), diet, and health self-efficacy. Results/UNASSIGNED:Positive and significant changes in weight, BMI, and diabetes prevention-related indicators were seen among both study groups. However, only treatment group participants showed significant changes over time for weight, BMI, PA self-efficacy, and health-related self-efficacy. Significant between-group differences were seen in adjusted analyses for weight, BMI, systolic BP, total weekly PA, PA self-efficacy, PA social interaction, portion control, barriers to healthy eating, and health self-efficacy. At 6-months, treatment participants were more likely to lose ≥5% and ≥7% of their weight compared to control participants (p=0.071, and p=0.015, respectively). Conclusions/UNASSIGNED:Findings demonstrate that a culturally-adapted CHW diabetes prevention program in the Sikh community is efficacious, adding to the growing literature on CHWs' capacity to address health inequity among underserved populations.

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.