Lessons Learned from the Lessons Learned from the Lessons Learned from the Lessons Learned from the Asian American Health Asian American Health Asian American Health Asian American Health Needs Assessment Needs Assessment Needs Assessment Needs Assessment ((((AsANAAsANAAsANAAsANA) Project) Project) Project) Project

Beverly J. Gor, EdD, RD, LD, CDE, Center for Research on Minority HealthCenter for Research on Minority HealthCenter for Research on Minority HealthCenter for Research on Minority Health

Department of Health Disparities ResearchDepartment of Health Disparities ResearchDepartment of Health Disparities ResearchDepartment of Health Disparities Research

““““Houston: We have a problem..Houston: We have a problem..Houston: We have a problem..Houston: We have a problem..””””

U.S. states with a large Asian populationU.S. states with a large Asian populationU.S. states with a large Asian populationU.S. states with a large Asian population

36.1

10.2

5.5 4.9 4.6 4.13.1 2.6 2.5 2.3

0

5

10

15

20

25

30

35

40

CA NY TX HI NJ IL WA FL VA MA

Source: U.S. Census Bureau, Census 2000 Summary File 1, Table P1, Table P3 and Table P9

Population density map

Sources: U.S. Department of Justice, 2000 Census

Asian population in the City of Houston

Chinese & Vietnamese Differences

Languages: Mandarin, Cantonese, English

More second, third generations

Longer time in the US

Immigration issues

Established “Chinatowns” provide social support

Relatively more assimilated

Languages: Vietnamese, English, French

Predominantly first generation

Refugee status, were re-settled

Less linguistically appropriate support services

Hx of political strife

Why is the Why is the Why is the Why is the AsANAAsANAAsANAAsANA study important?study important?study important?study important?Inconsistent and inadequate collection of Asian Inconsistent and inadequate collection of Asian Inconsistent and inadequate collection of Asian Inconsistent and inadequate collection of Asian health datahealth datahealth datahealth dataAsian American health concerns are poorly Asian American health concerns are poorly Asian American health concerns are poorly Asian American health concerns are poorly understood and often overlookedunderstood and often overlookedunderstood and often overlookedunderstood and often overlookedGroupings for “whites” or “others” include Asians Groupings for “whites” or “others” include Asians Groupings for “whites” or “others” include Asians Groupings for “whites” or “others” include Asians and other ethnic groupsand other ethnic groupsand other ethnic groupsand other ethnic groupsAggregation of Asian data masks true health Aggregation of Asian data masks true health Aggregation of Asian data masks true health Aggregation of Asian data masks true health problems within Asian subgroupsproblems within Asian subgroupsproblems within Asian subgroupsproblems within Asian subgroups

Source: Shinagawa, SM, The impact of nativity, culture and cancer on US Asian immigrants. Oncologists Magazine, Third Quarter, 2004.

Asian American Health Needs AssessmentAsian American Health Needs AssessmentAsian American Health Needs AssessmentAsian American Health Needs Assessment

� To collect scientifically sound data on the health practices andhealth beliefs of Asian Americans in Houston and the surrounding area

� To establish baseline data that can set the stage for future studies and research projects with Asian populations

� To compare data with that of other minority groups and the general population

� To provide the data to the targeted communities so they can apply for community development funding

Objectives:

To collect scientifically sound data on the health practices and health beliefs of Asian Americans in Houston and the surrounding areaTo establish baseline data that can set the stage for future studies and research projects with Asian populationsTo compare data with that of other minority groups and the general populationTo provide the data to the targeted communities so they can apply for community development funding

Survey Survey

InstrumentInstrument

ReviewReview

TranslationTranslation

PilotPilot

Analysis &Analysis &

ReportsReports

Contract w/Contract w/

TelesurveyTelesurvey

CompanyCompany

DataData

CollectionCollection

Lit.

Review

AsANAAsANAAsANAAsANA TimelineTimelineTimelineTimeline

Study Plan

Determined geographical boundary for population of interest:� Brazoria, Fort Bend, Galveston, and Harris counties.

� Calculated the required # of completed surveys per county to reflect proportion of Chinese/Vietnamese

Randomly selected participants from the population using an Asian surname telephone listing.

Collected 814 completed surveys (405 Chinese and 409 Vietnamese.)

Population density map

Survey Instrument DevelopmentSurvey Instrument DevelopmentSurvey Instrument DevelopmentSurvey Instrument DevelopmentTexas Community Health Survey (CHS)Texas Community Health Survey (CHS)Texas Community Health Survey (CHS)Texas Community Health Survey (CHS)Questions on pain from R. Questions on pain from R. Questions on pain from R. Questions on pain from R. PortnoyPortnoyPortnoyPortnoyTranslated to Vietnamese and ChineseTranslated to Vietnamese and ChineseTranslated to Vietnamese and ChineseTranslated to Vietnamese and ChineseReviewed by Asian Community Health Review PanelReviewed by Asian Community Health Review PanelReviewed by Asian Community Health Review PanelReviewed by Asian Community Health Review PanelModified for cultural sensitivity and appropriatenessModified for cultural sensitivity and appropriatenessModified for cultural sensitivity and appropriatenessModified for cultural sensitivity and appropriatenessRevised logistic flowRevised logistic flowRevised logistic flowRevised logistic flowBackBackBackBack----translated to ensure validity and comparabilitytranslated to ensure validity and comparabilitytranslated to ensure validity and comparabilitytranslated to ensure validity and comparability

Asian Community Health PanelAsian Community Health PanelAsian Community Health PanelAsian Community Health Panel

Diverse gender, ethnic and professional representationRelevancy testing

AsANA Survey Instrument

From the Texas CHS:

DemographicsMental health Health practicesPhysical examsCancer screeningsImmunization

DiseasesHeart diseaseDiabetesCancer

BehaviorsSmokingAlcohol useNutrition Physical activity

100+ questions100+ questions100+ questions100+ questions

Added questions:

Cancer knowledgeAcculturationEnvironmental exposureAlternative therapyPainOral HealthColorectal cancer screeningMen’s healthHepatitis B immunization

Pilot Interviews

Ten face-to-face interviews

Modifications made based on feedback

Pilot Survey

Interviewers: 2 Vietnamese bilingual

2 Chinese bilingual

Conducted interview in:

� Two Chinese dialects:

� Mandarin

� Cantonese

� Vietnamese

� English

Subject selection methodology

Asian residents of Brazoria, Fort Bend, Galveston, and Harris counties

Random household selection from an Asian telephone list based on Chinese and Vietnamese surnames

Interviewee selected via KISH method

18+ years old

Verbal informed consent

Data collection

4097 numbers called in nine weeks

1085 respondents

814 completed interviews:

� 405 Chinese (25.7% refusal rate)

� 409 Vietnamese (23.8% refusal rate)

Calls averaged 25-40 minutes

AsANA Data

Age Distribution of Chinese in AsANAsample versus Census 2000

4.2

5.26.2

9.710.1

16.7

22

25.626.324.9

21.5

13.2

9.7

4.7

0

5

10

15

20

25

30

%

18-24 25-34 35-44 45-54 55-64 65-74 75+

Age groups Census 2000 AsANA

Age Distribution of Vietnamese in AsANAsample versus Census 2000

2.3

4.65.2

15.8

10

18.7

18

24.3

22.322.3

28.6

10.4

13.6

3.9

0

5

10

15

20

25

30

%

18-24 25-34 35-44 45-54 55-64 65-74 75+

Age groups Census 2000 AsANA

Sample weighting procedure

Separately for Chinese and Vietnamese

Used Census 2000 information for 4 counties

Weighted by age and gender

Weighted by number of individuals in the household

Gender Distribution

100409 (100)100405 (100)Total

49.4212 (51.8)52.2251 (62.0)Female

50.6197 (48.2)47.8154 (38.0)Male

Weighted %

Unweighted

N (%)

Weighted %

Unweighted

N (%)

VietnameseChinese

Age Distribution

2.3

4.25.2

6.2

1010.1

18

2222.3

26.3

28.6

21.5

13.6

9.7

0

5

10

15

20

25

30

%

18-24 25-34 35-44 45-54 55-64 65-74 75+

Age groups Chinese Vietnamese

Residency status

0.11

95.294.1

4.64.9

0

10

20

30

40

50

60

70

80

90

100

%

US Born Immigrant Unknown

Chinese Vietnamese

Education Level

0.30

25.9

62.7

22.6

14.8

25.8

14.915.6

3.8

8.8

310.7

0

10

20

30

40

50

60

70

%

Never atte

nded

Grades 1-8

Grades 9-11

Grade 12 or GED

College 1-3

College 4+ years

Refused

Chinese

Vietnamese

Household income

0.2

3.8

13.3

2.8

11.7

35.3

19.6

13.214.115.1

87.3

10.2

6.38.1

5.78.1

5.36.6

5.2

0

5

10

15

20

25

30

35

40

%

Less than 10K

10-15K

15-20K

20-25K

25-35K

35-50K

50-75K

75+K

Don't Know

Refused

Income categories

Chinese

Vietnamese

Do you have any form of health insurance?

19.9

15.9

51.5

27.8

15.2

30

26.7

0

10

20

30

40

50

60

% uninsured

Chinese

Vietnamese

TX White

TX Black

TX Hispanic

TX BRFSS

US BRFSS

Lessons Learned

Sampling: Who to include? Which AAPI group(s)? Which geographic areas?

Methodology: telephone vs face to face

Instrument: pre-existing vs developing one, pilot testing, translating

Outreach: preparing and engaging the community, which media work best in each population

Lessons Learned

Implementation: Training interviewers, dialectical and regional differences, quality control

Interpretation of Findings: lack of health insurance, missing data, questions we forgot to include, gender and ethnic differences

Dissemination: to community, to academia, to funders

AsANACommunity Reporthttp://www.mdanderson.org/departments/crmh

ManuscriptsChilton, J.A., Gor, B.J., Hajek, R.A., Jones, L.A. Cervical cancer among Vietnamese women: Efforts to define the problem among Houston’s population, Gynecologic Oncology, 99 (2005) S203-206.

Gor, BJ, Shelton, AJ, Esparza, A, Yi, JK, Hoang, TV, Liang, JC, Jones, LA. Development of a health risk factors questionnaire for Chinese and Vietnamese residents of the Houston, Texas area. J Immigrant Minority Health, 2008 Aug;10 (4):373-7.

Gor, BJ, Hoang, TV, Yi, JK, Esparza, A, Hernandez, M, Jones, LA. Cancer Screening Practices among Chinese and Vietnamese in the Greater Houston area. Californian Journal of Health Promotion 2007, Vol 5, Special Issue (Hlth Disparities & Soc Justice), 105-112.

Gor, BJ, Chilton JA, Camingue, PT, Hajek, RA. Young Asian Americans’ knowledge and perceptions of cervical cancer and the human papillomavirus. J Immigrant Minority Health (in progress)

Abstracts presented at national and local meetings, including American Public Health Association, Texas Public Health Association, Intercultural Cancer Council, AANCART, Cancer Health Disparities Summit, American Association for Cancer Research

ResultsData was used by Asian community based organizations to successfully apply for funding for health projects

“Spin off” studies on cervical cancer, Asian youth & tobacco use, hepatitis B

Other Houston Asian communities want this data for their population

Increased interest in AA health and cancer issues

Where do we go from here?

Further analysis and dissemination of AsANA data, additional manuscripts

Needs assessment, such as resource mapping and community discussions

Expanding this to other Asian populations, such as the South Asian and Filipino communities

Future studies on other health topics

Periodic re-surveying of the population

AcknowledgementsFunding for this project was provided by

The National Center on

Minority Health and Health

Disparities (NCMHD)

Purdue Pharma

Asian American Network for

Cancer, Awareness, Research

and Training