Faculty Bibliography

Colorectal cancer (CRC) screening uptake in the Veterans Health Administration (VA) has been reported to be higher than the US general population, but CRC remains a prevalent cancer within the VA system. To examine CRC predictors and the extent to which the conventional definition of up-to-date screening applies to the population, we conducted a case-control study using VA data from 2012 to 2018. We classified patients into 5 categories: up-to-date or not up-to-date average-risk patients aged 50 to 75 (Categories 1 and 2), up-to-date or not up-to-date average-risk patients aged <50 or >75 (Categories 3 and 4), and high-risk patients (Category 5). Each CRC case was matched by age, sex, and facility with 4 controls. We performed multivariable conditional logistic regression, adjusting for race and ethnicity, diabetes, obesity, and alcohol use. Among 3714 CRC cases identified, Category 4 (odds ratio [OR] 1.40, 95% CI 1.11-1.78) and Category 5 (OR 6.23, 95% CI 5.06-7.66) patients had a higher risk of CRC compared to Category 1 patients. Compared with White patients, Black patients had a higher risk (OR 1.54, 95% CI 1.37-1.73). Diabetes (OR 1.65, 95% CI 1.51-1.81) and alcohol use disorder (OR 1.53, 95% CI 1.35-1.73) were also associated with CRC. Most CRC cases occurred in individuals aged 50 to 75, but 12.5% occurred in persons who were outside of this age range or had high-risk personal or family history. The conventional measure of CRC screening, focused on average-risk individuals aged 50 to 75, does not reflect screening status in an important minority of CRC patients.

BackgroundCommunity health workers (CHW) can perform unique functions to facilitate the implementation of evidence-based interventions for infection-related cancer prevention and control, and alleviate minoritized and immigration-related disparities.PurposeWe describe the implementation evaluation of three CHW-delivered infection-related cancer programs focused on Asian American (AA) communities in New York City: 1) a H. pylori treatment adherence program for Chinese and Korean Americans; 2) a HPV screening program for Muslim Americans; and 3) a hepatitis B screening, linkage to care, and treatment program for AA and other priority communities.MethodsWe conducted semi-structured key informant interviews with multi-level stakeholders from the programs.ResultsLessons learned include the importance of: 1) sustaining engagement and buy-in from implementation partners; 2) prioritizing recipient- and deliverer-centeredness; 3) fostering program flexibility to accommodate multiple implementation settings and to meet dynamic community resources and priorities; and 4) understanding interoperability between the CHW-delivered intervention and the inner setting for effective program implementation.ConclusionsThese findings can inform other efforts to implement CHW-delivered community-clinical cancer programs for AA and other underserved communities to advance health equity.

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.

PURPOSE/OBJECTIVE:Faith-based organizations (FBOs) have been recognized as a critical partner to reach underserved, marginalized populations in the U.S. for disease prevention and health promotion. FBOs have been successfully engaged to lower risk for leading causes of death, including cancer, but despite the proliferation of FBO cancer intervention research, a comprehensive review is lacking. METHODS:We conducted a PRISMA Scoping Review to ascertain the impact of FBO cancer interventions. Seven bibliographical databases were used to search for articles evaluating cancer interventions reporting quantitative outcomes in which places of worship in the U.S. served as the research location. Study characteristics and results data were extracted by two independent extractors. RESULTS:Thirty-six studies were included. All FBOs were Christian churches with healthy populations. Breast (25%), prostate (22%), and colorectal (17%) were the primary cancers targeted and cancer screening was the primary outcome of 75% of studies. Sixty-nine percent (k = 25) reported significant results in cancer-related outcomes from baseline to post-intervention follow-up, with 100% of studies in Korean American communities (k = 7) reporting significant results. CONCLUSION/CONCLUSIONS:FBO interventions can successfully increase preventative screening across numerous cancer types in diverse communities, particularly in Korean Americans. Additional FBO cancer interventions that aim to reduce inequities in other cancers (e.g., lung) that disproportionately affect Korean Americans and have not been targeted are warranted. Expanding current investigations of FBO collaborations with other faiths (besides Christian) to include cancer prevention and control would further realize FBOs' untapped potential.

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.