Addressing Barriers in Health Equity through Innovations in Health Information Technology: A Health Center’s Experiences in Implementing a Chinese Language Patient Portal
Authors: Mei, C, Kim, E, Sherman, L, Sim, S-C, Yeung, K, Poon, C, Wong, M, Egleson, N.
Journal: aapi nexus, 2014, 12. 1 & 2: 97- 120
Summary: Patient portals have the potential to empower patients to be more knowledgeable and proactive about their health. Implementation of patient portals has become increasingly critical at primary care sites that serve undeserved communities, where there is a growing need for linguistically appropriate electronic access. The Charles B. Wang Community Health Center has recently developed a linguistically appropriate patient portal with the goal of providing increased access to its majority Chinese American patient population with low English proficiency and literacy levels. This article will discuss experiences learned from implementing a Chinese Language Patient Portal that addresses socioeconomic barriers and disparities in health care access.
Building a Community Health Center Data Warehouse to Promote Patient-Centered Research in the Asian American, Native Hawaiian, and Pacific Islanders Population
Authors: Li, V, Weir, R, Quach, T, Gillespie, S, McBurnie, M, Oster, A, Laws, R, Alperovitz-Bichell, K, Kaleba, E, and Nelson, C.
Journal: aapi nexus, 2014, 12. 1 & 2: 21- 43
Summary: In 2010, the Health Resources and Services Administration established the Community Health Applied Research Network to build research infrastructure and capacity at community health centers and to promote comparative effectiveness research in these safety-net settings. A data warehouse with standardized data was created to capture, manage, and share patient-level data with all eighteen participating CHC,s including four CHCs primarily serving Asian Americans, Native Hawaiian, and Other Pacific Islanders (AANHOPI). AANHOPI patients face unique health risks, yet these large and diverse populations are historically understudied. The CHARN data warehouse provides important opportunities for understanding the health needs of this heterogeneous population.
Chronic Hepatitis B and Liver Cancer Risks among Asian Immigrants in New York City: Results from a Large, Community-Based Screening, Evaluation, and Treatment Program.
Authors: Pollack, HJ, Kwon SC, Wang SH, Wyatt, LC, Trinh-Shevrin, C.
Journal: Cancer Epidemiol Biomarkers Prev, 2014, 23(11): 2229-39
Summary: Retrospective analyses were conducted on a large, community-based HBV screening and treatment program in New York City—a 4-year program that enrolled 7,272 Asian-born individuals. This article examines the determinants of HBV seroprevalence and compares risk factors for HCC progression across Asian subgroups.
Creating Community Criteria for Research Participation at Community Health Centers
Authors: Oneha, M, DeCambra, H, Leong, L, Song, H, Quach, T, Chang-Weir, R, Ponce, N, Enos, R, Sim, S-C, Kagawa-Singer, M.
Journal: aapi nexus, 2014, 12. 1 & 2: 1-20
Summary: Research conducted to benefit communities is often done without community involvement, threatening its relevance for the groups the studies purport to serve. A great need exists for education of both researchers and community members on how research can be more appropriately conducted in partnership with community members. This paper presents Community Criteria for Research Participation developed by community health centers (CHCs) with input from academic partners to support CHCs’ capacity to conduct research of community significance.
Early Implementation Lessons on the Patient Protection and Affordable Care Act Outreach and Enrollment Efforts in the Asian American and Pacific Islander Communities
Authors: Lee, R, Lee, R, Aguilar, D, Cheng, B, Lee, K, Quach, T.
Journal: aapi nexus, 2014, 12. 1 & 2: 55-72
Summary: Enacted in 2010, the Patient Protection and Affordable Care Act intended to make health insurance coverage more affordable and accessible for millions of Americans. However, achieving this goal requires significant targeted, culturally and linguistically appropriate outreach and education efforts for vulnerable communities, such as low-income, underserved Asian Americans and Pacific Islanders. This article describes multiple innovative strategies and approaches used by two well-established community health centers, Charles B. Wang Community Health Center in New York and Asian Health Services in California, as well as the early-stage impacts of outreach and enrollment assistance for the state exchange marketplaces promoting the ACA.
Evaluation of a Health Professionals’ Training Program to Conduct Research in New York City’s Asian American Community
Authors: Zhang, PSL, Sim, S-C, Pong, P, Islam, N, Trinh-Shevrin, C, Li, S, Tsang, T, Rey, M
Journal: American Journal of Health Education, 2014, 45: 97-104
Summary: This was an evaluation of the Health Disparities Research Training Program, a partnership program between the Charles B. Wang Community Health Center and the Center for the Study of Asian American Health. Mixed research methods were utilized to evaluate process, outcome, and impact of the program on trainees and mentors of the program. Although many trainees did not continue to pursue Asian American health disparities research, the results indicate that the program has positive impacts on trainees in their preparedness to conduct community-based participatory research (CBPR), work within the Asian American community, and network with public health professionals and researchers.
Exploring Different Methods to Obtain Patient Experience Feedback in a Community Health Center for Quality Improvement and Quality Assurance Purposes
Authors: Song, N, Sim, S-C, Borja, G, Pong, P.
Journal: aapi nexus, 2014, 12. 1 & 2: 245-259
Summary: This paper will provide the policy context for the important role of capturing patient experience at federally qualified health centers (FQHCs), especially with the implementation of the patient-centered medical home. We discuss various quantitative and qualitative methods that were utilized to capture patient experience at the Charles B. Wang Community Health Center in New York City. Specifically, we describe our experience in adapting, pilot testing, and refining the Consumer Assessment of Healthcare Providers and Systems to address the unique cultural and linguistic needs of our health center’s patient population. We also explore the benefits and limitations of these methods, and discuss factors that FQHCs should consider when capturing patient feedback.
Federally Qualified Health Center: A Prescription for Health Equality
Authors: Trinh-Shevrin, C, Pollack, HJ, Tsang, T, Park, J, Ramos, MR, Islam, N, Wang, S, Chun, K, Sim, S-C, Kagawa-Singer, M, and Ponce, N.
Journal: aapi nexus, 2014, 12. 1 & 2: xi – xiv
Summary: A message from the editors, this article provides an introduction to the special issue on Asian American, Native Hawaiian, and Pacific Islander Communities and Federally Qualified Health Centers.
Setting Up a Medical Home for Chinese Immigrant Families with Children with Special Health Care Needs: A Step-Wise Approach
Authors: Huang, S, Au, L.
Journal: aapi nexus, 2014, 12. 1 & 2: 161-178
Summary: Children with special health care needs (CSHCN) require health services beyond what generally is required. CSHCN from immigrant families face additional challenges, including cultural, language, racial, and socioeconomic barriers. Federally qualified health centers provide an ideal setting to treat these children, providing comprehensive, family-centered care that fits their linguistic and cultural needs. This article describes the development of a National Committee for Quality Assurance level 3 medical home, addressing cultural perspectives and barriers to quality care for the Chinese immigrant community by highlighting Edward Wagner’s Chronic Care Model, medical home criteria, electronic health records, parent engagement, staff development, and community collaboration.
The Role of the Patient-Centered Medical Home in Addressing Hepatitis B Perinatal Transmission: Charles B. Wang Community Health Center’s Hep B Moms Program
Authors: Weerasinghe, I, Bannister, N, Huang, V, Cohen, C, Caballero, J, Wang, S.
Journal: appi nexus, 2014, 12. 1 & 2: 140-160
Summary: Chronic hepatitis B is a serious liver disease caused by the hepatitis B virus (HBV). Each year, approximately twenty-five thousand infants are born to HBV-infected mothers, and one thousand newborns become infected. To prevent HBV perinatal transmission and facilitate care management, health centers should utilize a patient-centered medical home model that provides coordinated, comprehensive, and culturally appropriate services. One model is the Hep B Moms Program at Charles B. Wang Community Health Center in New York City.
Building Research Infrastructure in Community Health Centers: A Community Health Applied Research Network (CHARN) Report
Authors: Likumabuwa, S, Song, H, Singal, R, Chang Weir, R, Crane, H, Muench, J, Sim, S-C, DeVoe, JE
Journal: Journal of the American Board of Family Medicine, 2013, 26: 579-587
Summary: This article introduces the Community Health Applied Research Network (CHARN), a practice-based research network of community health centers (CHCs). Established by the Health Resources and Services Administration in 2010, CHARN is a network of 4 community research nodes, each with multiple affiliated CHCs and an academic center. The four nodes (18 individual CHCs and 4 academic partners in 9 states) are supported by a data coordinating center. Here we provide case studies detailing how CHARN is building research infrastructure and capacity in CHCs, with a particular focus on how community practice-academic partnerships were facilitated by the CHARN structure. The examples provided by the CHARN nodes include many of the building blocks of research capacity: communication capacity and “matchmaking” between providers and researchers; technology transfer; research methods tailored to community practice settings; and community institutional review board infrastructure to enable community oversight. We draw lessons learned from these case studies that we hope will serve as examples for other networks, with special relevance for community-based networks seeking to build research infrastructure in primary care settings.
Addressing Hepatitis B: Community Health Centers, Partnerships and the Affordable Care Act
Authors: Dan, C, Tai, K, Wang, SH, Caballero, J, Martin, M, Lavilla, S, Agbayani, N
Journal: Journal of the Health Care for the Poor and Underserved, 2012, 23: 507-512
Summary: Hepatitis B virus (HBV) infection is a major preventable health problem in the
U.S. and the most pronounced health disparity disfavoring Asian Americans and Pacific Islanders (AAPIs). Despite constituting only 5% of the U.S. population, AAPIs account for at least 50% of all individuals with chronic HBV infection. Additionally, rates of liver cancer, often caused by chronic HBV are up to 13 times higher in some AAPI subgroups than average. Vaccination, testing, and treatment tools needed to eliminate new HBV infections and prevent liver disease and liver cancer caused by chronic HBV infection exist, but these tools are inadequately implemented. Uncoordinated programs, sparse federal funding, high rates of uninsurance, language barriers, and low levels of awareness among the public and health care providers, are all barriers preventing effective implementation of these tools in AAPI communities. A limited number of programs demonstrating effective public health and primary care collaborative efforts also exist, but support to replicate these programs is needed. Asian Americans and Pacific Islander communities with high rates of hepatitis B infection must mobilize, work with public health and primary care systems, and capitalize on opportunities such as the new Viral Hepatitis Action Plan (Action Plan) and the Patient Protection and Affordable Care Act (ACA) to eliminate HBV and liver cancer.
Disability Beliefs and Help-Seeking Behavior of Depressed Chinese-American Patients in a Primary Care Setting
Authors: Kwong, K, Chung, H, Cheal, K, Chou, JC, Chen, T
Journal: Journal of Social Work in Disability & Rehabilitation, 2012, 11(2): 81-99
Summary: In this study the authors assessed the effects of disability beliefs, conceptualization and labeling of emotional disabilities, and perceived barriers on help-seeking behaviors among depressed Chinese Americans in a primary care setting. Authors found that care utilization appears to be complicated by somatization of emotional problems, variations in causal attribution to depression, barriers to receiving mental health care, and the burden of comorbid physical conditions. Findings highlight the importance of addressing these issues and educating patients about body-mind dialectic common to depression.
Lessons Learned from a Community-Academic Initiative: The Development of a Core Competency-Based Training for Community-Academic Initiative Community Health Workers
Authors: Ruiz, Y, Matos, S, Kapadia, S, Islam, N, Cusack, A, Kwong, S, Trinh-Shevrin, C
Journal: American Journal of Public Health, 2012, 102(2): 2373-2379
Summary: Despite the importance of community health workers (CHWs) in strategies to reduce health disparities and the call to enhance their roles in research, little information exists on how to prepare CHWs involved in community–academic initiatives (CAIs). In this study, the authors piloted a CAI-CHW training program to report quantitative and qualitative evaluation results from the pilot training.
A Comprehensive Screening and Treatment Model for Reducing Disparities in Hepatitis B
Authors: Pollack, H, Wang, S, Wyatt, L, Peng, C-H, Wan, K, Trinh-Shevrin, Chun, K, Tsang, T, Kwon, S
Journal: Health Affairs, 2011, 30(10): 1974-1983
Summary: Chronic hepatitis B affects Asian Americans at a much higher rate than the general US population. Appropriate care can limit morbidity and mortality from hepatitis B. However, access to care for many Asian Americans and other immigrant groups is limited by their lack of knowledge about the disease, as well as cultural, linguistic, and financial challenges. This article describes the results of BfreeNYC, a New York City pilot program that, from 2004 to 2008, provided hepatitis B community education and awareness, free screening and vaccinations, and free or low-cost treatment primarily to immigrants from Asia, but also to residents from other racial and ethnic minority groups. The program was the largest citywide screening program in the United States, reaching nearly 9,000 people, and the only one providing comprehensive care to those who were infected. During the program, new hepatitis B cases reported annually from predominantly Asian neighborhoods in the city increased 34 percent. More than two thousand people were vaccinated, and 1,162 of the 1,632 people who tested positive for hepatitis
B received care from the program’s clinical services. Our analysis found that the program was effective in reaching the target population and providing care. Although follow-up care data will be needed to demonstrate long-term cost-effectiveness, the program may serve as a useful prototype for addressing hepatitis B disparities in communities across the United States.
Caries Experience among Chinese-American Children in Manhattan Chinatown
Authors: Chinn, CH, Cruz, GD, Chan, A
Journal: New York State Dental Journal, 2011: 43-47
Summary: There is little research on the oral health status of Chinese-American children in the U.S. and Asian/Pacific Islanders in general. The purpose of this study was to characterize the dental caries experience of a Chinese-American child population in Manhattan Chinatown, New York City. A five-year chart review of 545 initial dental exams of patients aged 2 to 11 was conducted at a community clinic serving immigrant Chinese-American population. DMFT/dft were compared to National Health and Nutrition Examination Survey (NHANES) and analyzed for associations among birthplace, language and untreated tooth decay at recall. Subject mean dft was higher compared to NHANES data both in aggregate and ethnic/race subgroups. Subjects had lower DMFT compared to the national data. Significant difference was found between U.S. and non-U.S.-born mean dft. Asian Pacific Islander Americans include a fast-growing immigrant pediatric population at high risk for tooth decay.
Childhood Obesity in the Asian American and Pacific Islander Communities: Critical Data Needs and Research Priorities
Authors: Sim, S-C
Journal: AAPI Nexus, 2011, 9(1&2): 184-192
Summary: Preventing childhood obesity among Asian American, Native Hawaiian, and Pacific Islanders (AANHPIs) is a challenge constrained by resource and research gaps. These include the lack of national prevalence data, insufficient funding support, limited knowledge of risk factors associated with childhood obesity, particularly in these populations, and the lack of programmatic evaluations. The finding of this literature review shows that only 0.11 percent of PubMed articles on childhood obesity focused on AANHPIs. Recommendations to advance what is known about AANHPI and childhood obesity include targeting community prevalence studies, community needs assessments, risk factor studies, and program evaluations; training and mentoring junior researchers; and creating a national clearinghouse to compile research literature and evidence-based practices.
Depression Care Management for Chinese Americans in Primary Care: A Feasibility Pilot Study
Authors: Kwong, K, Chung, H, Cheal, K, Chou, JC, Chen T
Journal: Community Mental Health Journal, 2011, DOI 10.1007/s10597-011-9459-9
Summary: This study describes a culturally relevant intervention using a collaborative depression care model to integrate mental health and primary care services for depressed low income Chinese-Americans at a community health center. A total of 6,065 patients were screened for depression. Of the 341 who screened positive, 57 participated and were randomly assigned to receive either enhanced physician care with care management or enhanced physician care only. All enrolled participants were assessed at baseline and 4 monthly follow-up visits for depression, physical and mental health functioning, and perceived stigma toward receiving depression care, to determine the impact, if any, of their mental health treatment. Both groups reported significant reduction of depressive symptoms and improved mental health functioning from baseline to follow-up assessments although there was no significant difference between the two groups. Although the study found no advantage to adding the care management component in the treatment of depression, screening and assertive treatment of immigrant Chinese Americans who tend to underutilize mental health services is important and consistent with the increased adoption of team based care models in patient centered medical homes. High refusal rates for enrollment in the study have implications for future study designs for this group.
Effectiveness of Pre-counseling Genetic Education Workshops at a Large Urban Community Health Center Serving Low-Income Chinese American Women
Authors: Sim, S-C, Zhou, XD, Hom, LD, Chen, C, Sze, R
Journal: Journal of Genetic Counseling, 2011, DOI 10.1007/s10897-011-9397-2
Summary: Chinese American pregnant women and women of childbearing age face economic, cultural and linguistic barriers in accessing mainstream health care services. The Charles B. Wang Community Health Center developed a culturally and linguistically competent genetic education workshop for high-risk Chinese American prenatal patients. Patients referred for genetic counseling for thalassemia, abnormal triple screen results, and/or advanced maternal age were recruited to participate in the workshop. The workshop provided basic “genetic 101” education, focusing on topics that were directly relevant to the patients’ reasons for referral. The effectiveness of the workshop was measured using a quasi-experimental design with pre-post surveys administered to intervention and control group participants. The evaluation also included a genetic counselor assessment and a pilot study of genetic counseling appointment length. Overall, workshop participants showed significant increases in knowledge, positive attitude and self-efficacy regarding genetic services as compared to their control group counterparts. The pilot appointment length study data revealed that the workshop reduced the length of the genetic counseling appointment time by 40%. These positive findings suggest that it would be worthwhile to replicate the genetic education workshop at other health agencies serving Chinese-speaking populations and that further evaluation research should be conducted.
Evaluation of Community-Academic Partnership Functioning: Center for the Elimination of Hepatitis B Health Disparities
Authors: VanDevanter, N, Kwon, S, Sim, S-C, Chun, K, B Free CEED Coalition, Trinh-Shevrin, C.
Journal: Progress in Community Health Partnerships: Research, Education and Action, 2011, 5(3): 223-233
Summary: This article describes the evaluation of B Free CEED, a community–academic partnership created to address hepatitis health disparities in Asian American and Pacific Islander (API) communities. Survey findings showed stability over time, with some consistent differences in community and academic perspectives. Academic members were somewhat more satisfied with the partnership functioning. Key informant interviews provided contextual data key to further defining partnership functioning. Conducting ongoing partnership evaluations is necessary to reassess and align processes and protocols to enhance partnership functioning and strengthen group cohesion.
Hepatitis B Virus in the United States
Authors: Wang, S.H, Perry, P.
Journal: Annals of Internal Medicine, 2011, 155(3): 4
Summary: In a letter to the editor, the authors emphasized the undersampling of persons of Asian and Pacific Islander descent in data from NHANES, leading to significant national underestimates of HBV. The authors underlined the need to identify and provide care to infected persons, in addition to the need to identify susceptible adults who should receive the HBV vaccine.
The Evolution of Community Mental Health Services in Asian American Communities
Authors: Nguyen, D, Shibusawa, T, Chen, MT
Journal: Clinical Social Work Journal, 2011, DOI 10.1007/s10615-011-0356-z
Summary: This paper explores the history of Asian immigration to the United States, and its intersections with the mental health system. As mental health care have evolved since the 1960s from institutions to the community, public mental health services for Asian Americans have become increasingly culturally relevant. Major policy shifts, trends in immigration, and mental health practice will be presented with a focus on the Bridge Program at the Charles B. Wang Community Health Center. Integrative practice and research models that extend evidence-based knowledge to Asian American communities and practice implications are discussed.
The Asian American Hepatitis B Program: Building a Coalition to Address Hepatitis B Health Disparities
Authors: Trinh-Shevrin, C, Pollack, HJ, Tsang, T, Park, J, Ramos, MR, Islam, N, Wang, S, Chun, K, Sim, S-C, Pong, P, Rey, MJ, Kwon, SC
Journal: Progress in Community Health Partnerships: Research, Education, and Action, 2011, 5(3): 261-271
Summary: This article describes the challenges and lessons learned in building the Asian American Hepatitis B Program (AAHBP) coalition to conduct a community-based participatory research (CBPR) initiative to address hepatitis B (HBV) among New York City Asian-American communities. Findings highlight the importance of developing a sound infrastructure and set of processes to foster a greater sense of ownership, shared vision, and investment in the program. Grassroots community organizing and campus–community partnerships can be successfully leveraged to address and prevent a significant health disparity in an underserved and diverse community.
A health center controlled network's experience in ambulatory care EHR
implementation Authors: Egleson N, Kang JH, Collymore D, Esmond W, Gonzalez L, Pong P, Sherman L
Journal: Journal of Healthcare Information Management, 2010, 24(2): 28-33
Summary: Implementing a full-featured Electronic Health Record (EHR) system requires several necessary tasks, including stakeholder buy-in, contract negotiation, workflow redesign, equipment purchases, preloading charts and trainings. METCHIT, a health center controlled network, used a collaborative approach to implement electronic medical records. This article covers the experience, benefits and lessons learned by a group of four Federally Qualified Health Centers (FQHCs) that took a cooperative, mentorship approach to implementation.
Dietary acculturation, obesity, and diabetes among Chinese immigrants in New York City
Authors: Oster, A, Yung, J
Journal: Diabetes Care, 2010, 33(8): e109
Summary: We conducted a cross-sectional study of the association between sociodemographic factors, Western acculturation, BMI, physical activity, and fasting glucose among Chinese immigrants attending free cardiovascular risk screening at a New York City community health center. We obtained randomly selected venous samples from 300 of a total of 622 self-identified Chinese participants, age 18 years or older. Sociodemographic details and time since immigration were obtained. Dietary acculturation was measured using a previously validated scale relying on self-recollected consumption of Western and Chinese foods. Adoption of Western diet may not predispose to obesity or dysglycemia. BMI was the strongest positive risk factor of dysglycemia. Interventions targeting weight maintenance and physical activity, rather than specific dietary practices may be most effective in preventing diabetes among Chinese immigrants.
Utilizing an Electronic Health Record system to Improve Vaccination Coverage in Children
Authors: Au, L, Oster, A, Yeh, GH, Magno, J, Paek, HM
Journal: Applied Clinical Informatics, 2010, 1: 221-231
Summary: Electronic Health Records (EHR) are widely believed to improve quality of care and effectiveness of service delivery. Use of EHR to improve childhood immunization rates has not been fully explored in an ambulatory setting. EHR-based quality improvement interventions were successfully implemented at a community health center. EHR systems have versatility in their ability to track patients in need of vaccines, identify patients who are delayed, facilitate ordering and coding of multiple vaccines and promote interdisciplinary communication among personnel involved in the vaccination process. EHR systems can be used to improve childhood vaccination rates.
Development and Evaluation of a Physician-Led Smoking Cessation Intervention for Low-Income Chinese Americans
Authors: Kwong, K, Ferketich, AK, Wewers, ME, Shek, A, Tsang, T, Tso, A
Journal: Journal of Smoking Cessation, 2009, 4(2): 92-98
Summary: This article describes a culturally and linguistically relevant, physician-led smoking cessation intervention that was delivered to the Chinese American community in New York City. Data were collected from a convenience sample of 115 participants (94% male) at a clinical site of a community health centre. The smoking intervention program included pharmacological treatments and brief cessation counselling, education and support by the physician and the health educator. Process data included the drop-out rate, number of visits completed and use of pharmacotherapy. Outcome data included self-reported and biochemically verified (expired carbon monoxide) smoking status at week 12. In the process evaluation, valuable information about the components of interventions that worked well and challenges participants faced during their quit attempts was gathered from participants, doctors and the health educator. Sixteen participants (13.9%) successfully quit smoking. Chinese male smokers face many daunting challenges that prevent them from regularly attending a smoking cessation program. Despite these challenges, they appeared to benefit from brief interventions, although the cessation rate was modest at best. This information should be incorporated into future design of smoking cessation programs to address required behavioural change in this population.
Factors Associated with Reverse-Migration Separation Among a Cohort of Low-Income Chinese Immigrant Families in New York City
Authors: Kwong, K, Chung, H, Sun, L, Chou, J, Taylor-Shih, A.
Journal: Social Work in Health Care, 2009, 48: 348-359
Summary: This study examined the practice and factors associated with “reverse-migration”—sending American-born children to China to be raised by extended family members, and bringing them back upon reaching school age. Authors also explored reasons leading to and perceived impact of reverse-migration separation.
Improving Organ Donation in Chinese Communities in New York: Perspective from Consortium Partners
Authors: Herbert, PL, Rivera, J, Eng, K, Lee, R, Seto-Yee, S
Book: Understanding Organ Donation, 2009
Prevalence of overweight and obesity in Chinese American children in New York City
Authors: Au L, Kwong K, Chou J, Tso A, Wong M
Journal: Journal of Immigrant and Minority Health, 2009, 11(5): 337-341
Summary: In this study, the prevalence of overweight and obesity in a Chinese American pediatric population (6-19 years) was determined through a chart review of patients from CBWCHC. Overall, 24.6% of the children studied were overweight or obese (defined as BMI > 85th percentile for age and sex). Among US born boys aged 6-12 years, the combined prevalence of overweight and obesity was found to be as high as 40%. Further studies are needed to understand the complex interplay of factors that contribute to obesity in pediatric immigrant groups.
What Makes an Effective Advocacy Organization? A Framework for Determining Advocacy Capacity
Authors: Raynor, J, York, P, Sim, S-C.
Paper: Evaluating advocacy and policy change efforts presents unique challenges—external players and dynamics, complexity, lengthy time frame, and the need to shift strategies. Yet, evaluation is critically important, both for the foundation and the advocacy organization. Recognizing the limitations of most evaluation methods for policy activities, over the last several years, The California Endowment, along with several other foundations and consultants, have sought to develop frameworks and methodologies to be able to meaningfully evaluate policy change efforts. In this paper, authors identified distinctive characteristics that are critical to high-performing advocacy organizations. The authors also outlined a model for evaluating organizational capacity for advocacy organizations and described in detail the capacities that are critical to advocacy and how they interrelate to each other.
Why Should Nonprofits Care? How Evaluation Can Benefit Nonprofits During this Era of Declining Resources
Author: Sim, S-C.
Journal: The Journal for Nonprofit Managers, 2009, 21(6): 1-5
Summary: In this paper, the author explains the benefits of evaluation as measures for program improvement and organizational learning.
Addressing Cardiovascular Health Disparities of Chinese Immigrants in New York City: A Case Study of the Chinese-American Healthy Heart Coalition
Author: Kwong, K, Ho-Asjoe, H, Chung, W, Wong, S.
Book: Toward Equity in Health (pp.237-252), 2007
Summary: The authors expound on cardiovascular health disparities of Chinese immigrants in New York City through various topics including: increased risk due to acculturation and dietary changes, barriers to screening and health education among Chinese Americans.
Design and evaluation of a tobacco-prevention program targeting Chinese American youth in New York City
Author: Ferketich, A, Kwong, K, Shek, A, Lee, M.
Journal: Nicotine & Tobacco Research, 2007, 9(2): 249-256
Summary: In 1994 the Centers for Disease Control and Prevention recognized the importance of incorporating tobacco prevention programs into school curricula with the publication of guidelines for such programs. Included in these guidelines are recommendations to provide instruction about the consequences of tobacco use and to provide tobacco prevention programs to all students, with a particularly intensive curriculum in junior high school. Many school-based programs have been developed and tested; however, most have been delivered in English. This paper presents a culturally appropriate tobacco prevention curriculum developed for Chinese American 7th and 8th graders.
Follow-up Care After a Diagnosis of Helicobacter pylori Infection in an Immigrant Cohort
Authors: Cho, A, Chaudhry, A, Minksy-Primus, L, Tso, A, Perez-Perez, G, Diehl, D, Marcus, S, Gany, F.
Journal: J Clin Gastroenterol, 2006, 40(1): 29-32
Summary: Gastric cancer is the second leading cause of cancer death worldwide, and is especially prevalent in East Asia; immigrants from this part of the world remain at higher risk. Infection with H. pylori is a known risk factor for gastric cancer. There have been no studies of completion of H. pylori treatment in immigrant populations. This study examines the rate at which Helicobacter pylori infection is treated in an immigrant cohort after diagnosis by esophagogastroduodenoscopy (EGD).
Racial and Ethnic Differences in the Relationship Between Depression Severity and Functional Status
Authors: Huang, F, Chung, H, Kroenke, K, Spitzer, R.
Journal: Psychiatric Services, 2006, 57(4): 1-6
Summary: Major depression has a negative impact on functional status and quality of life, but little is known about racial or ethnic differences in the relationship between depression and functional disability. This study compared the association between depression severity and functional status among three different racial or ethnic groups.
Screening for Chronic Hepatitis B Among Asian/Pacific Islander Populations—New York City, 2005
Authors: Pollack, H, Wan, K, Ramos, R, Rey, M, Sherman, A, Tobias, H, Tsang, T, Tso, A, Korenblit, P, Son, S, Poon, E, Bialek, S, Bell, B.
Article: Morbidity and Mortality Weekly Report, 2006, 55(18):505-509
Summary: Chronic hepatitis B virus (HBV) infection is the most common cause of cirrhosis and liver cancer worldwide. In Asian and western Pacific countries where HBV is endemic, estimated prevalence of chronic HBV infection ranges from 2.4% to 16.0%, and liver cancer is a leading cause of mortality. Although population-based prevalence data for Asians/Pacific Islanders (A/PIs) living in the United States are lacking, they are believed to constitute a sizeable percentage of persons with chronic HBV infection in the United States, a country of low endemicity. To assess the prevalence of chronic HBV infection among A/PI populations living in New York City, the study conducted a seroprevalence study among persons who participated in an ongoing hepatitis B screening, evaluation, and treatment program.
Using the PHQ-9 for Depression Screening and Treatment Monitoring for Chinese Americans in Primary Care
Authors: Chen, T, Huang, F, Chang, C, Chung, H.
Journal: Psychiatric Services, 2006, 57(7): 976-981
Summary: Because Chinese Americans are known to underutilize mental health services, routine screening for depression in primary care clinics has been advocated as a means of identifying Chinese-American patients with depression and initiating appropriate treatment. This paper evaluated the utility of the nine-item depression module of the Patient Health Questionnaire (PHQ-9) for depression screening and monitoring treatment outcomes among Chinese Americans at a primary health care setting.
Engaging Asian Americans for Mental Health Research: Challenges and Solutions
Authors: Chen, H, Kramer E, Chen, T, Chung, H.
Journal: Journal of Immigrant Health, 2005, 7(2): 109-116
Summary: Asian American communities have important and unmet mental health needs, but there is comparatively little research data on process and outcomes that can guide evidence-based approaches to mental health care. This paper describes our experience of building research programs in a community-based health care facility, some of the challenges we faced, and barriers that were overcome. We have learned that a) mental health services research can be carried out in a community health center with minimal intrusion on usual patient flow; b) the effort must be shared between the health center and the community; c) barriers to participation in mental health research programs are multifactorial ranging from conceptual, cultural, and attitudinal biases to practical concerns inherent in the ethnic minority population; and d) resistance can be overcome by working with participants' cultural and social needs and using their explanatory belief models when developing and pursuing studies.
Clinical deterioration in pediatric asthmatic patients after September 11, 2001
Authors: Szema, A, Khedkar, M, Maloney, P, Takach, P, Nickels, M, Patel, H, Modugno, F, Tso, A, Lin, D.
Journal: J Allergy Clin Immunol, 2004, 113(3): 420-426
Summary: New York City residents were exposed to a variety of inhaled substances after the collapse of the World Trade Center. Exposure to these substances might lead to an increase
in asthma severity, with residential distance from Ground Zero predictive of the degree of change. In this paper, we sought to assess the effect of the World Trade Center collapse on local pediatric asthmatic patients. We retrospectively reviewed the charts of 205 pediatric patients with established asthma from a clinic in lower Manhattan’s Chinatown. Clinical data were obtained for the year before and the year after September 11, 2001. Measurements
included numbers of visits, asthma medication prescriptions, oral corticosteroid prescriptions, weekly doses of rescue inhaler, and peak expiratory flow rates. Residential zip codes were used to compare the asthma severity of patients living within and beyond a 5-mile radius of Ground Zero.
Smoking cessation interventions among Chinese Americans: The role of families, physicians, and the media
Authors: Ferketich, A, Wewers, M.E, Kwong, K, Louie, E, Moeschberger, M, Tso, A, Chen, M.
Journal: Nicotine & Tobacco Research, 2004, 6(2): 241-248
Summary: This article describes the results from two studies of Chinese Americans. In one study, a convenience sample of patients completed face-to-face interviews to assess smoking patterns in the home, knowledge of tobacco, and ways in which health interventions could be communicated to the community. The other study involved two focus group discussions with the primary purpose of learning how spouses, health care workers, and the media can participate in smoking cessation interventions. A convenience sample of 795 patients at the Charles B. Wang Community Health Center in New York City’s Chinatown was interviewed using face-to-face interviews. The focus group discussions were conducted using 15 volunteers. One discussion was conducted in Mandarin and the other in Cantonese. Although 92.7% of the respondents prefer people not smoke in the home, only 21% ban smoking with few exceptions. The focus group participants indicated that often the smoker is the oldest male and he also is the person who establishes the rules. Nearly half of the respondents receive most of their health-related information from their physician, and the focus group participants stated that physicians are highly regarded in their culture. Finally, the majority of respondents receive health-related information from Chinese language media. These results will assist in the planning of a smoking cessation intervention targeting Chinese Americans. The physician represents a key player
in any intervention, and public health antismoking messages may be communicated effectively through Chinese language media.
The Emotional Distress in a Community After the Terrorist Attack on the World Trade Center
Authors: Chen, H, Chung, H, Chen, T, Fang, L, Chen, J-P.
Journal: Community Mental Health Journal, 2003, 39(2): 157-165
Summary: This paper examined the psychological impact of the September 11th disaster
on the immediate neighborhood of the New York World Trade Center. 555 residents from the local Chinatown community participated in the study. They were surveyed retrospectively on their emotional distress immediately after the tragedy and five months later. Prevalent anxiety was found in general community residents and additional depression in those who lost family members or friends. The mental health condition of the community improved tremendously five months later, with the initial 59% of general residents having 4 or more emotional symptoms dropping to 17%. However, More than half of the community residents had persistently shown one or more symptoms of emotional distress. Those who had lost a family member or friend in the disaster showed significantly higher distress, with 90% of them had four or more major psychiatric symptoms during the first few weeks right after the disaster, and the rate dropped
to 35% five months later. Overall, those in their 40s and 50s seemed to have had relatively higher emotional distress than both younger and older groups.
Author: Chen, J-P.
Journal: West J Med, 2002, 176: 249-253
Summary: Anxiety disorders are a group of mental disturbances characterized by anxiety as a core symptom. In this article, we discuss anxiety disorders common to primary care, specifically
panic disorder, generalized anxiety disorder (GAD), and posttraumatic stress disorder (PTSD).
Chinese Herbal Medicines
Authors: Ergil, K, Kramer, E, Ng, A.
Journal: West J Med, 2002, 176: 275-279
Summary: In this article, authors discuss the history and use of Chinese herbal medicines, the Chinese medicine framework for understanding mental illness, and some concerns surrounding
patients’ use of traditional Chinese medicines.
Cultural factors influence the mental health of Asian Americans
Authors: Kramer, E, Kwong, K, Lee, E, Chung, H.
Journal: West J Med, 2002, 176: 227-231
Summary: Culture influences the Asian health belief system and has an effect on the diagnosis and treatment of mental disorders. However, there is tremendous cultural variability among groups and heterogeneity within groups. These factors will have differing effects, depending on the individual’s degree of acculturation, socioeconomic status, and immigration status. In this paper, the authors discuss new immigrants, who comprise 2.6% of the US population, and those who are more traditionally oriented. The authors chose this focus because it is these patients who experience the greatest barriers to receiving mental health care.
Depression in Asian American children
Authors: Abright, A, Chung, H.
Journal: West J Med, 176: 244-248
Summary: Problems experienced by Asian Americans in accessing health care, especially mental health services, include cultural and linguistic barriers, stigma associated with psychiatric disorders, availability of staff, and lack of adequate insurance coverage. In this article, the authors discuss barriers to mental health services specific to Asian American children and the potential importance of using routine check-ups to identify debilitating depressive symptoms.
Depressive disorders in Asian American adults
Authors: Chen, J-P, Chen, H, Chung, H.
Journal: West J Med, 2002, 176: 239-244
Summary: Few studies of the prevalence of mental disorders in Asian Americans have been conducted. This article discusses the best practices for assessing and evaluating depression in Asian American patients.
Initial behavioral health assessment of Asian Americans. Part 1. Key Principles
Authors: Chung, H, Nguyen, D, Gany, F.
Journal: West J Med, 2002, 176: 233-236.
Summary: In this article, authors provide practical information on how to perform the initial assessment of an Asian American patient suspected to have a behavioral health problem.
Initial behavioral health assessment of Asian Americans. Part 2. Putting principles into practice
Authors: Chung, H, Nguyen, D, Gany, F.
Journal: West J Med, 2002, 176: 236-238
Summary: In this article, authors present a clinical case scenario that illustrates how to put the principles of initial assessment and treatment into practice.
Mental health services research in Asian Americans: What do we know and where are we going?
Authors: Takeuchi, D, Kramer, E.
Journal: West J Med, 2002, 176: 225-226
Summary: This opinion-editorial presents the authors’ view on current research and highlights opportunities for further research on improving clinical care.
Prescribing medication for Asians with mental disorders
Authors: Chen, J-P, Barron, C, Lin, K.M, Chung, H.
Journal: West J Med, 2002, 176: 271-275
Summary: Many recommendations have been made about the drug treatment of medical outpatients with depression. In this article, we do not attempt to repeat this guidance. Instead, we begin with a focus on the education of Asian patients who require medication and the clinical principles that guide medication management. Then, we discuss medication for mood and anxiety disorders using the selective serotonin reuptake inhibitors (SSRIs) and benzodiazepines.
Finally, we address important clinical issues related to the use of antipsychotic medications.
Authors: Ferran, E, Barron, C, Chen, T.
Journal: West J Med, 2002, 176: 263-266
Summary: Psychotic symptoms on initial presentation may be more severe in Asian patients than in other ethnic groups. The reason for this disparity is that the stigma and shame associated with mental illness in Asian cultures delays appropriate and timely care. In addition, patients’ symptoms are often kept within the family until the symptoms become intolerable or unmanageable, or legal involvement occurs. In this article, authors present an overview of treatments for psychosis and discuss care specific for Asian Americans.
Authors: Chen, H, Foo, S-H, Ury, W.
Journal: West J Med, 2002, 176: 267-270
Summary: Although dementia is an organic psychiatric disorder, its diagnosis, presentation, and management are influenced by the sociocultural context in which it occurs and the meaning of the disorder to the patient and his or her caregivers. Culturally specific values, concepts of illness, knowledge of curability of an illness, and views of responsibility all affect presentation and help-seeking behavior related to dementia. In this paper, authors discuss the challenges of recognizing dementia in Asian Americans and provide guidance on how to better screen Asian patients for dementia.
Self-attention as a Mediator of Cultural Influences on Depression
Authors: Chen, H, Guarnaccia, P, Chung, H.
Journal: International Journal of Social Psychiatry, 2003, 49(3): 192-203.
Summary: Despite the widespread recognition of cultural differences in depressive symptoms, it is unclear through what processes culture affects depressive symptoms. This study aims at examining whether self-attention mediates the influence of acculturation on changes in depressive symptoms in an immigrant group.
Suicidal and Death Ideation in Older Primary Care Patients with Depression, Anxiety, and At-Risk Alcohol Use
Authors: Bartels, S, Coakley, E, Oxman, T, Constantino, G, Oslin, D, Chen, H, Zubritsky, C, Cheal, K, Durai, U, Gallo, J, Llorente, M, Sanchez, H.
Journal: Am J Geriatr Psychiatry, 2002, 10(4): 417-427
Summary: The authors identified correlates of active suicidal ideation and passive death ideation in older primary care patients with depression, anxiety, and at-risk alcohol use. Participants included 2,240 older primary care patients (age 65+), who were identified in three mutually exclusive groups on the basis of responses to the Paykel suicide questions: No Ideation, Death Ideation, and Suicidal Ideation. Chi-square, ANOVA, and polytomous logistic regression analyses were used to identify characteristics associated with suicidal ideation.
Asthma Care Management – Chronic Care Model
Authors: Lee, H, Au, L, Tso, A, Sze, Y.
Summary: In February 2000, Chinatown Health Clinic (CHC) was invited to participate in a series of learning sessions organized by The Institute of Health Care Improvement, sponsored by The Bureau of Primary Health Care and The Robert Wood Johnson Foundation. In this study, the authors aimed to develop and adopt new strategies to improve care management in chronic disease like asthma. The new Chronic Care Model emphasizes focus on multi-disciplinary approaches to apply changes in various aspects of CHC’s organization.
Breastfeeding in Chinese Immigrant Women in New York City Chinatown
Authors: Chiu, L and Au, L.
Summary: This study seeks to identify the factors contributing to the observed low breastfeeding rate at the Charles B. Wang Community Health Center.
Community-wide Diabetic Screening in Chinese Community in NYC in 2001
Authors: Law, C, Tso, A, Chen, C.
Summary: The incidence of Diabetes Mellitus (DM) is increasing in the general population. American Diabetic Association has modified its guidelines for screening and for the diagnosis of DM in recent years. In the general population, type 2 diabetes has been associated with obesity. However, there is little information on this importance disease in the Chinese community. In this article, the authors estimate the prevalence of DM; determine the percentage of unknown DM cases; and determine if there is an association between DM and obesity in the Chinese community in New York City.
One Year Follow-Up Survey of Hepatitis B Carrier After Community Screening
Authors: Luk, E, Tso, A, Chen, C.
Summary: In year 2000, 341 of 2937 community members screened were tested positive as hepatitis B carriers. Patients were encouraged to share their results with a physician. Charles B. Wang Community Health Center (CHC), with the support of GlaxoSmithKine, conducted a one-year follow-up through telephone calls to gather information concerning the actions or lack of actions taken by these patients. Patients who were unreachable by phone were subsequently sent a survey and information through the mail. In this study, the authors examined whether sex and insurance status were possible indicators for seeking medical care.
Prostatic Health among Chinese-American men in New York City
Authors: Ng, C, Tso, A, Loo, M.
Summary: Pooling resources from the Charles B. Way Community Health Centers (Chinatown Health Clinic and Flushing Primary Care Center) and physicians from the community, the authors employed an integrative screening program to provide prostate cancer (PCa) screening and education for Chinese-American men over the age of 50 in New York City.
A Multiorganization Collaborative Model to Screen for Hepatitis B and to Raise Awareness of the Disease in the Chinese American Population of New York City (NYC)
Authors: Tso, A, Yeung, L, Chung, H, Law, C.
Journal: Management of Hepatitis B, 2000.
Summary: Chronic hepatitis B is prevalent in the Chinese population. Numerous epidemiologic studies in Asia show hepatitis B surface antigen (HBsAg) carrier rates of 10 to 20%. Patients chronically infected with hepatitis B are at increased risk for developing cirrhosis and hepatocellular carcinoma. Treatment can potentially alter the natural course of this infection. A multiorganization collaborative model was developed to screen for HBsAg and to educate the Chinese Community in NYC.
Asian-American Adolescent Immigrants: The New York City Schools Experience
Authors: Au, L, Tso, A, Chin, K.
Journal: Journal of School Health, 1997, 67(7): 277-279
Summary: This article describes development and implementation of a school-based vaccination program that targeted Asian-American adolescents. The program was implemented by the Chinatown Health Clinic in New York City in two high schools and a junior high school in Lower Manhattan. The article examines strategies effective in vaccinating this varied group of adolescents. Rates of completion for the three-dose Hepatitis B vaccine are compared between schools. Optional serology testing for hepatitis B infection was conducted as part of the school program and rates of infection in this population are presented. The article discusses the importance and effectiveness of school-based programs in providing essential health services to this group of adolescents.
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