Health Promotion: Asian Americans

Kevin Tao, Calvin Brasor, and Rhianna Mendez

Demographics of Asian Americans

Who are Asian Americans?

● Asian Americans (AAs) are a diverse ethnic group originating from nearly 50 different countries

● There are over 800 languages and dialects spoken among Asian American groups.

● Wide range of socioeconomic characteristics, religious practices, and cultural practices.

● One of the fastest growing populations in the U.S. - 43% increase between 2000 & 2010.

Highest State Populations

● California - 4,155,685

● New York - 1,169,200

● Hawaii - 703,232

● Texas - 644,193

● New Jersey - 524,356

Health Disparities Facing Asian Americans

Health Disparities

1. The two leading causes of death for Asian Americans in the U.S. are cancer and cardiovascular disease

2. Asian American women have the lowest screening rates, and are usually diagnosed with cancer at a later stage than other minority groups

3. Asian Americans account for over half of deaths caused by hepatitis B

4. High prevalence of mental health problems5. Asian Americans have a higher prevalence of

tuberculosis than all other racial and ethnic groups6. Asian American youth in grades 7 through 12 have the

highest increase in smoking rates of any racial and ethnic group.

Cancer

● AAs are the only racial/ethnic group in the U.S. who experiences cancer as the leading cause of death

● Asian subgroups:○ Chinese: highest mortality rates for lung &

bronchial cancer○ Filipinos: highest incidence & mortality rates for

prostate & thyroid cancer○ Japanese: highest incidence & mortality rates for

colorectal & uterine cancer○ Koreans: highest incidence & mortality rates for

stomach cancer○ Vietnamese: highest incidence & mortality rates for

liver cancer

Contributing Factors for Disparities

Barriers to Care

● Low socioeconomic status○ Two million Asian Americans do not have insurance

in the U.S.● Language

○ limited english proficiency may discourage or prevent them from accessing health care services available to them

● Perception of Health○ Asian Americans may not perceive the value or

identify the purpose or necessity in obtaining care because of traditional approaches to health care.

Model Minority

● Myth: AAs are healthy, wealthy, and wise.○ AAs are a small and exceptionally healthy because of

socio-economic security and high education○ "The Asian Pacific Islander minority in aggregate is

healthier than all racial ethnic groups in the US including whites" - Department of Health & Human Services

● Reality:○ AAs are the fastest growing population in the US○ They suffer from several health disparities including

cancer and cardiovascular disease.● Effect:

○ Health disparities among AAs remain invisible.

Generalizations About Asian American Cultural Norms

World Views

● Naturalistic: harmony with environment

● Time is an unlimited continuum

○ birth and death are not absolute of ends

● Fatalistic

Explanatory Model of Illness

Holistic

● Chinese: balance of hot & cold○ use of herbs, massage, thermal treatments,

acupuncture○ qi

● Filipino:○ Mystical - wandering souls○ Personalistic - social or supernatural punishment○ Naturalistic - natural events and stress

● Differing local beliefs○ i.e. Hmong and the curses/wrath of gods

● Most Asian cultures are collectivist○ People view themselves as a member of a group

● What is best for the group○ Dependence & Needs

● Societal orientation: family

Collectivist Society

Religion & Spirituality● Buddhism

○ one with nature● Confucianism

○ Focus: world & family (instead of god & afterlife)● Taoism

○ "yin" and "yang" ■ i.e. balance of hot and cold

● Islam● Judaism● Hinduism● Christianity● Jainism● Sikhism● Zoroastranism● Sanamahism

Traditional Belief

● Beliefs:○ Fatalism○ Karma○ Harmony with nature○ Cooperation○ Spiritualism

**Herbalist doctors are the standard for cancer

Health Habits/Preferences

● Social Orientation: Family

● Family Makeup: Extended

● Primary Relationship: Parent-child

● Family Values: Well defined

● Relationship Emphasis: Interpersonal & Harmony

● Gender Roles: Male Dominant

● Control: Authoritative

● Emotional Expression: Suppressive

Protective Factors

● "There is little information provided about the Protective factors among the Asian American groups." (Harrison, 2005)

● Strong mentalities in:○ Conformity○ Immersion-emersion

Health Literacy

● 2000 census:○ 4 million AA had Limited English

Proficiency○ 73% of AA do not speak English in their

homes■ national average = 18%

Discrimination

● Strained history with United States ○ Chinese Communism○ Vietnam War○ Korean War○ World War II- Japanese Americans

● Workplace discrimination ○ can be written off as being intelligent and not having

problems (model minority)

● Cultural discrimination (language, practices)

Colorectal Cancer

Colorectal Cancer (CRC)

● 2nd most diagnosed cancer among AA

● Cancer that begins in the colon or rectum

○ begins as a polyp

■ slow to develop

○ screenable & preventative

● Japanese are the subculture with the largest

problem of Colorectal Cancer

Rates

Source: Data Evaluation and Publication Committee of the North American Association of Central Cancer Registries (1999)

Colorectal Cancer Prevention

● Colonoscopy

● Lifestyle

○ Avoid excess red meat, alcohol, and tobacco

○ Maintain good BMI & body composition with

exercise

○ Sufficient Calcium & Vitamin D

● Know family history

Health Promotion Program #1

Asian American Health Initiative● Formed in January 2005 to increase

awareness about cancers by:○ Providing culturally competent cancer

education○ Screening services

● First health program in Montgomery County to specifically target the Asian American community

Outreach and Education

● Health Fairs and Health Education Seminars provide:○ Educational materials in many different asian

languages○ Bilingual Asian Health promoters○ Information targeted to specific Asian American

Subgroups

Media Campaign

● Many Asian Americans use ethnic media sources

● Asian American Health Initiative regular launches health awareness campaigns in Chinese, Cambodian, Vietnamese, and Korean

Screening Services

● Free screening for colorectal cancer are provided for eligible Asian Americans residing in Montgomery County

● Those who are eligible have the opportunity to seek care from a provider who speak their native language.

Effectiveness

● Breaks down language barriers

● Provides tailored care for individuals

● Plentiful network of providers for clients to use

Improvements

● Enhance research efforts○ A lack of health data on Asian Americans contributes

to certain health disparities

● Rethink referrals

● Provider training

Health Promotion Program #2

The Asian American Network for Cancer Awareness, Research and Training

● Founded in 1999 and launched in 2000

● Designated: The National Cancer Institute as The National Center for Reducing Asian American Cancer Health Disparities

● Mission Statement:○ "to reduce cancer health disparities by conducting

community-based participatory education, training, and research by, for, and with Asian Americans."

Outreach

● Locations:○ Sacramento, San Francisco, Los Angeles, Seattle, and Honolulu.

● Members:○ Chinese Community Health Resource Center

○ Hmong Women's Heritage Association

○ University of Hawaii Office of Student Equity, Excellence and Diversity

○ UC Davis Cancer Center

○ UC Los Angeles: UC San Francisco

○ University of Washington

Education

● Focus:○ Cambodian, Chinese, Filipino, Hmong, Korean, and

Vietnamese ancestry● Education is tailored to each culture

○ "ethnically-specific, linguistically diverse, culturally appropriate, and cognitively empowering"

● Community relationships and trust are established before testing begins○ The idea of blood biospecimen collection is

introduced very slowly and in a delicate manner○ Subjects must understand that testing benefits both

the subjects and the researchers

Media Campaign

● Presentations & publications on studies and research have been provided to AA communities.

● Holds public events which are advertised through their website and regular flyer/calendar postings

● Holds Several Conferences and Symposiums

Effectiveness

● 1,051 outreach activities

● produced 166 peer-reviewed publications

● secured $64.2 million in total grants

Improvements

● Expansion to other regions of the U.S.

● Expansion to other Asian-American

subpopulations

Health Promotion Program #3

Effective Colorectal Cancer Education for Asian Americans: A Michigan Program

Health Asian American Project● In 2005- 2006 HAAP began to include

community based CRC education

● Goal:○ Improve knowledge & attitude towards screening○ increase screening rates

● Coordinated with community organizations

Outreach

● Subgroups○ Asian Indian, Chinese, Filipino, Hmong, Japanese,

Korean, Vietnamese● Recruitment

○ Association of Chinese Americans & Korean Cultural Center of Michigan

● Used community gathering places○ Churches, temples, community centers, & group

picnics.

Education

● Fairs that promote health education○ Presentation on early detection with on sight

translation

● Educational brochures from the American Cancer Society are distributed in different asian languages

● Stressed importance of screening when no symptoms are presents○ especially for older populations

Media Campaign

● Newspaper advertisements

● Flyers in grocery stores

● Coverage in asian language media

● Used sub-group's preferred language

Effectiveness

● Effective

● Evidence-based education evaluation○ showed a "significant increased knowledge and

attitudes about the importance of screening"

● Program follow up○ 78% screening participation within the last 12

months○ compared to 37% participation prior to study

Improvements

● For public policy purposes: ○ program would need to include more AA without

health insurance

● Could improve accuracy by tracking screening rates through means other than self reports

Suggestions for the Future

Steps to Take in Improving Quality and Access● Need to absolve model minority

○ acknowledge AA population growth rate○ understand that AA suffer from significant health

disparities (i.e. cancer)● More research is needed, overall.

○ especially on AA without health insurance to justify larger changes in public policy

○ essential to creating national visibility of health disparities

● Find middle-ground between cultures○ Inclusion of Holistic Medicine in Western practice○ Methods to remove language barriers

References● Ritter, Lois & Hoffman, Nancy, (2010). Multicultural Health. ISBN-978-0-

7637-5742-7● Kline, Michael and Huff, Robert, (2007). Health Promotion in

Multicultural Populations: A Handbook for Practitioners and Students. ● Wu, T., Kao, J.Y., Hsieh, H., Tang, Y.Y., Chen, J., Lee, J., & Oakley, D.

Effective Colorectal Cancer Education for Asian Americans: A Michigan Program. J Canc Educ (2010) 25:146–152 DOI 10.1007/s13187-009-0009-x

● Asian American Health Initiative (n.d.). Retrieved from http://aahiinfo.org/

● Chen, M., Chow, E., & Nguyen, T. The Asian American Network for Cancer Awareness, Research and Training. (n.d.). Retrieved from http://www.aancart.org/