Keynote Speaker

Asian Americans & Pacific Islanders Health
The Whole Is Greater Than the Sum of the Parts
Tung Nguyen, MD
Chair, President’s Advisory Commission on AAPI
APPEAL Pathways of Change Conference:
Advancing Equity on Tobacco, Obesity, and Cancer Control
September 24, 2014
Yes, We Care!
Community
 Access
 Research
 Engagement

Yes, We Care!

Community
Access
 Research
 Engagement

Demographics
 AAPIs are the fastest growing
racial group in the country
 Between 2000 and 2010, the AAPI
community grew by 46%
 AAPI community will more than
double to 35.8 million by 2060
 AAPIs trace their heritage to more
than 30 different countries and
ethnic groups and speak over
100 languages and dialects
Immigration and Languages
 66% born outside the U.S.
 50% of foreign-born Asians came after 1990
 ~1.3 million AAPIs are “undocumented”
 10% of undocumented Americans is AAPI
 37% speak another language other than English at
home and speak English less than “very well”
 23% of Asian Indians
 48% of Chinese
 22% of Filipino
 27% of Japanese
 49% of Koreans
 55% of Vietnamese
Median Income
Source: U.S. Census Bureau, 2008-2010 American Community Survey.
7
WHIAAPI Policy Focus
 Disaggregated data
 Language access
 Immigration reform
 Minimum wage
 Gender equality in pay
 Workforce diversity
 Impact of regional issues
Challenges and Opportunities
 We need more disaggregated data
 We need more local data
 Is there a downside to disaggregation?
 What does it mean to media, policy makers, and
other decision makers to see small numbers?
Yes, We Care!
 Community

Access
Research
 Engagement

The Affordable Care Act (ACA)
 In March 2010, President Obama signed into law the
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Affordable Care Act.
No other single government action in the last 40 years
has more impact on AAPI health than the ACA.
Increased financial access to care.
Implementation of electronic health records.
Increased funding for community health centers.
Increased collection of disaggregated data.
ACCESSIBLE
 10.3 million previously uninsured
Americans are now insured.
 7.9% of the newly insured are Asian
Americans.
 2 million AAPIs may obtain health
insurance through the ACA.
AFFORDABLE
Source: CMS Consumers Benefit from 80/20 Rule in 2013, July 24, 2014; CMS Medicare Part D Savings Summary,
June 2014; Annual Medicare Boards of Trustees Report, July 2014
#GetCovered
HealthCare.gov or 1-800-3182596
2014 NAVIGATOR GRANT AWARDS
INCLUDING AAPI COMMUNITIES
 University of Arkansas (Arkansas)-Hmong
 Ascension Health (Kansas)
 Arab Community Center for Economic & Social Services
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(Michigan)-Bangladeshi
American Indian Health & Family Services of SE Michigan, Inc.
(Michigan)
Midwest Asian Health Association (MAHA)* (IL, OH, and
Michigan)
Ohio Association of Foodbanks (Ohio)
Oklahoma Community Health Centers, Inc. (Oklahoma)
Penn Asian Senior Services (Pennsylvania)
Light and Salt Association (Texas)
Utah Health Policy Project (Utah)
Partners for Community Development, Inc. (Wisconsin)
WHIAAPI Policy Focus
 ACA Enrollment
 Quality of care for the enrolled
 Roadmap to Care
 CLAS standards
 Investment in Federally Qualified Health
Centers
Challenges and Opportunities
 Can we increase the number of states that accept
Medicaid expansion?
 Do we have the workforce needed to deliver
quality healthcare to AAPIs?
 What will happen with Electronic Health Records
and Patient Portals?
Yes, We Care!
 Community
 Access

Research

Engagement
Leading Causes of Death for Asian
Americans
 Cancer (27.7%)
 Heart Disease (22.5%)
 Stroke (7.5%)
 Unintentional Injuries (4.2%)
 Diabetes (3.6%)
 Influenza and pneumonia (3.0%)
 Chronic lung diseases (2.9%)
National Vital Statistics Report, 12/20/13
HHS Plan for AAPI Health
 Prevent, treat and control Hepatitis B Viral (HBV)
infections in AANHPI communities
 Improve data collection in AANHPI communities
 Adds 7 Asian and 4 Native Hawaiian and Pacific Islander
subgroups to health data collection standards.
 Align the healthcare workforce with needs of the
AANHPI communities
 Improve health conditions and access to health care
services for Native Hawaiians and Pacific Islanders
Addressing Tobacco, Obesity,
and Cancer
Yes, We Care!
 Community
 Access
 Research

Engagement
History
 President Barack Obama
signed Executive Order
13515 reestablishing the
White House Initiative on
Asian Americans and Pacific
Islanders on October 14,
2009.
 Chair: Secretary Arne
Duncan, U.S. Department
of Education
Mission
The White House Initiative on
Asian Americans and Pacific Islanders works
to improve the quality of life and
opportunities for Asian Americans and
Pacific Islanders by facilitating increased
access to and participation in federal
programs where they remain underserved.
WHIAAPI Staff
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Education
Immigration
Health
Civil Rights
Community Engagement
Data Disaggregation
Language Access
Capacity Building
Workforce Diversity
President’s Advisory Commission on
Asian Americans and Pacific Islanders
Community Engagement
From 2009-2013, the Initiative and Commission have:
•Hosted over 200 events including national summits,
roundtables, open dialogue sessions, and workshops,
•Located in 25 states, the District of Columbia and Pacific
Islands, and in 50 cities, and
•Reached more than 27,000 people.
Linking the AAPI Community to Federal
Agencies
Public feedback
Interagency Working Group
Regional Interagency Working Group
VIII
E3! (Educate, Engage, Empower)
Ambassadors
Thank You and Stay Engaged!
WhiteHouseAAPI
@WhiteHouseAAPI
WhiteHouseAAPI
Dr. Tung Nguyen
@ARCHDrNguyen
www.whitehouse.gov/aapi
www.ed.gov/aapi
Recent Research on Cancer, Tobacco, and Obesity
among Asian Americans
Tung Nguyen, MD
Director, Asian American Research Center on Health (ARCH)
Professor of Medicine, University of California, San Francisco
APPEAL Pathways of Change Conference:
Advancing Equity on Tobacco, Obesity, and Cancer Control
September 24, 2014
Leading Causes of Death for Asian
Americans
 Cancer (27.7%)
 Heart Disease (22.5%)
 Stroke (7.5%)
 Unintentional Injuries (4.2%)
 Diabetes (3.6%)
 Influenza and pneumonia (3.0%)
 Chronic lung diseases (2.9%)
National Vital Statistics Report, 12/20/13
Asian Americans and Cancer
 Cancer is the leading cause of death.
 Leading cancers are preventable but are rising in
incidence.
 Usually rare cancers are common.
 Rates of cancer prevention activities are low.
Trend in Incidence of 5 Most
Common Cancers, Men: 1990-2008
Gomez et al JNCI 2013; 105(15):1096-110.
Asian Indian/Pakistani
Chinese
Filipino
Japanese
Trend in Incidence of 5 Most
Common Cancers, Men: 1990-2008
Cambodian
Korean
Laotian
Vietnamese
Trend in Incidence of 5 Most
Common Cancers, Women: 1990-2008
Asian Indian/
Pakistani
Chinese
Filipino
Japanese
Trend in Incidence of 5 Most Common
Cancers, Women: 1990-2008
Cambodian
Korean
Laotian
Vietnamese
Liver Cancer Incidence, Men
1998-2002
Miller, Cancer Causes & Control, 2008
Common Liver Cancer Risk Factors
• Hepatitis B
• Among some Asian American groups, the rate of
chronic hepatitis B is ~10-15%.
• More than 1/3 of Asian Americans have never had a
hepatitis B test.
• Hepatitis C
• Few studies on AAPIs and hepatitis C, but
prevalence may be high
• Fatty liver (non-alcoholic steatohepatitis)
• Alcohol
• Smoking
Cancer Screening (CHIS 2009)
• No mammogram within 2 years
• 13.0% of non-Latino whites
• 17.9% of Asians
• 35.3% of Koreans and 30.8% of South Asians
• Not adherent to colon cancer screening
• 28.6% of non-Latino whites
• 35.3% of Asians
• 41% of Koreans and South Asians
50%
Current Smoking Prevalence by English
Proficiency and selected Asian American Male
Subgroups in California (Source: 2011-12 CHIS)
40%
30%
20%
10%
0%
Chinese
Korean
Vietnamese
All Asian Males
LEP
Proficient
Smoking Prevalence By Selected
Special Populations in the U.S.
Sources: 2011 National Survey on Drug Use and Health; 2012 National Health Interview Survey; CDC MMWR, 2012; CHIS 2011-12
Needed help for self-reported mental
health problems but did not seek or
receive treatment (CHIS 2007)
100.0
80.0
60.0
%
40.0
20.0
0.0
Male
Female
Chinese
Japanese
Korean
Filipino
Vietnamese
71.0
62.9
93.7
23.7
64.1
30.1
55.4
39.0
89.7
39.3
All Asians
Combined
63.6
42.9
Obesity and Diabetes
• Risk for Asians to develop obesity-related diseases
such as diabetes occur at lower Body Mass Index
(BMI) than that seen in whites.
•
World Health Organization (WHO) recommends cut-off
BMI of 23 for overweight and 27.5 for obesity for Asian
Americans compared with 25 and 27 for non-Hispanic
whites.
• Although prevalence of obesity may be lower than
non-Hispanic whites for some Asian American
groups, rates of hypertension and diabetes are the
same or higher!
Prevalence of Obesity Using Asian BMI
Cut Points (2009 CHIS)
90
80
*
70
Percentage
60
‡
^
50
‡
†‡
40
†‡
30
20
10
0
NHW
n=30,456
African
American
n=1,833
Hispanic
n=8,097
Vietnamese
n=1,325
Chinese
n=952
Obesity
Korean
n=878
Overweight
Filipino
n=418
South
Asian
n=383
Japanese
n=350
Prevalence of Diabetes by BMI (2009 CHIS)
What We Know Work: AANCART Community
Interventions for Cancer Screening
• Access to Care
• Media interventions
• Lay health worker outreach
• Telephone counseling
Smoking Cessation Interventions for Asian
Americans
• 8 RCTS as of August 2014. 4 out of 8 showed
efficacy on smoking cessation at 6 months and
beyond:
• Media intervention targeting Vietnamese
(McPhee, 1995)
• Individual counseling plus NRT for Chinese and
Koreans (Kim, 2012; Wu, 2009)
• Telephone quitline for Chinese, Vietnamese and
Koreans (Zhu, 2012).
• We need more RCTs, but we also know enough to
intervene now!
Ongoing Community-Based RCTs with Lay
Health Worker Outreach
• Healthy Behaviors among Vietnamese Nail Salon
Workers (NIEHS R01, T. Quach PI)
• Colorectal Cancer Screening:
• Vietnamese in Santa Clara County (NCI R01, B.
Nguyen PI)
• Chinese in San Francisco (NCI R01, T. Nguyen
PI)
• Filipino in Hawaii, Hmong in Sacramento,
Koreans in Los Angeles (NCI U54 [AANCART],
Chen, T. Nguyen, Chow PI)
The Healthy Family Project:
Quit Smoking for a Healthy Family
A Social Network Based Family-Focused
Intervention for Chinese and Vietnamese Smokers
Ongoing RCT: A Family-Based Approach To Reduce
Smoking in Vietnamese Men (TRDRP 22RT-0089, PI: Tsoh)
18 Lay Health Workers (Each LHW recruits 6 dyads)
108 Smoker-Family Dyads (108 Smoker and 108 Family participants
complete Baseline Assessment)
Randomization by LHW, stratified by LHW Agencies
INTERVENTION: 9 LHW & 54 Dyads
Topics: Quit Smoking for a Healthy Family
-2 group sessions
-2 individual calls
CONTROL: 9 LHW & their 54 Dyads
Topics: Healthy Eating & Physical Activity
-2 group sessions
-2 individual calls
-
All 108 Smoker & 108 Family participants complete Follow-up Assessments
at Months 3, & 6
Primary outcomes: smoking abstinence, quit attempts, & use of evidence-based smoking cessation
resources
Healthy Weight Chart for Asian Adults
Healthy BMI 18.5-22.9; Overweight BMI 23.0-27.4, Obese BMI >27.5
Weight (lbs)
Height
(ft / in)
Underweight
Healthy Weight
Overweight
(less than)
4' 6"
4' 7"
4' 8"
4' 9"
4' 10"
4' 11"
5' 0"
5' 1"
5' 2"
5' 3"
5' 4"
<
<
<
<
<
<
<
<
<
<
<
76.7
79.6
82.5
85.5
88.5
91.6
94.7
97.9
101.1
104.4
107.8
5' 5"
< 111.2
5' 6"
5' 7"
5' 8"
5' 9"
5' 10"
5' 11"
6' 0"
<
<
<
<
<
<
<
114.6
118.1
121.7
125.3
128.9
132.6
136.4
Obese
(more than)
76.7
79.6
82.5
85.5
88.5
91.6
94.7
97.9
101.1
104.4
107.8
-
95.3
98.9
102.5
106.2
109.9
113.8
117.7
121.6
125.7
129.7
133.9
95.4
99.0
102.6
106.3
110.0
113.9
117.8
121.7
125.8
129.8
134.0
-
114.0
118.3
122.7
127.1
131.6
136.2
140.8
145.5
150.4
155.2
160.2
>
>
>
>
>
>
>
>
>
>
>
111.2 114.6 118.1 121.7 125.3 128.9 132.6 136.4 -
138.1
138.2 142.5 146.9 151.3 155.7 160.3 164.9 169.6 -
165.3
> 165.3
170.4
175.6
180.9
186.2
191.7
197.2
202.8
>
>
>
>
>
>
>
142.4
146.8
151.2
155.6
160.2
164.8
169.5
114.0
118.3
122.7
127.1
131.6
136.2
140.8
145.5
150.4
155.2
160.2
170.4
175.6
180.9
186.2
191.7
197.2
202.8
Challenges and Opportunities
 When do we have enough data to move on to
addressing our problems?
 Do we have to tailor our interventions to each
specific group?
 Are there cross-cutting interventions?
 What structural changes can we make to address
obesity, diabetes, and cardiovascular diseases?
 What will happen with “Big” Data?
 What will happen with Precision/Personalized
Medicine?
www.asianarch.org
[email protected]
Foreign Born by Selected
Asian Groups: 2008-2010
Source: U.S. Census Bureau, 2008-2010 American Community Survey.
Percent with a Bachelor’s Degree or Higher
by Selected Asian Alone Groups and Sex:
2008-2010
(Population 25 years and older.)
60
Source: U.S. Census Bureau, 2008-2010 American Community Survey.
Education and Income, NHPI
Poverty Rate in the Past 12 Months by
Selected Asian Groups: 2008-2010
(Percent. Poverty status was determined for all individuals except for
unrelated individuals under 15 years old.)
Source: U.S. Census Bureau, 2008-2010 American Community Survey.
62
California Medical Board Survey, 2008
•Very few physicians of Samoan, Cambodian, and Hmong/Laotian
ethnicity
•Large proportions of AAPI physicians are international medical graduates
•Minority physicians are much more likely than white physicians to
practice in medically underserved and poor communities.
Grumbach et al. Physician Diversity in California, 2008
Prevalence of Heart Disease
among Adults
 Non-Latino whites 6.7%
 All Asian Americans 5.3%
 Asian Indian 5.1%
 Chinese 4.8%
 Filipino 7.4%
 Japanese 4.9%
 Koreans 3.4%
 Vietnamese 5.6%
CHIS 2003 & 2005
Percent of Foreign Born Who are Not a Citizen by Selected
Asian Groups: 2008-2010
Source: U.S. Census Bureau, 2008-2010 American Community Survey.
66
Prevalence of Diabetes among
Adults, California 2007
Prevalence of Hypertension
among Adults
 Non-Latino whites 23%
 All Asian Americans 23%
 Asian Indian 21%
 Chinese 19%
 Filipino 31%
 Japanese 22%
 Koreans 16%
 Vietnamese 23%
CHIS 2003 & 2005

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