Chiehwen Ed Hsu

Model minority at risk: expressed needs of mental health by Asian American young adults.

The objective of this study is to obtain and discuss in-depth information on mental health problems, including the status, barriers, and potential solutions in 1.5 and 2nd generation Asian American young adults. As a part of the Health Needs Assessment project, the researchers conducted two focus groups with 17 young adults (mainly 1.5 or 2nd generation) from eight Asian American communities (Asian Indian, Cambodian, Chinese, Indonesian, Korean, Taiwanese, Thai, and Vietnamese) in Montgomery County, Maryland. We developed a moderator’s guide with open-ended questions and used it to collect qualitative data. Using a software, we organized and identified emergent themes by major categories. Participants reported a several common sources of stress that affect the mental health of Asian American young adults including: pressure to meet parental expectations of high academic achievement and live up to the “model minority” stereotype; difficulty of balancing two different cultures and communicating with parents; family obligations based on the strong family values; and discrimination or isolation due to racial or cultural background. Young Asian Americans tend not to seek professional help for their mental health problems; instead they use personal support networks—close friends, significant others, and religious community. Participants suggested that Asian cultural norms that do not consider mental problems important, and associated stigma of seeking professional care might undermine their mental health help seeking behavior. Our findings support a need for delivering culturally appropriate programs to raise awareness of mental health and cultural training for health providers to deliver culturally appropriate care.

Detecting spatiotemporal clusters of accidental poisoning mortality among Texas counties, U.S., 1980 – 2001

BackgroundAccidental poisoning is one of the leading causes of injury in the United States, second only to motor vehicle accidents. According to the Centers for Disease Control and Prevention, the rates of accidental poisoning mortality have been increasing in the past fourteen years nationally. In Texas, mortality rates from accidental poisoning have mirrored national trends, increasing linearly from 1981 to 2001. The purpose of this study was to determine if there are spatiotemporal clusters of accidental poisoning mortality among Texas counties, and if so, whether there are variations in clustering and risk according to gender and race/ethnicity. The Spatial Scan Statistic in combination with GIS software was used to identify potential clusters between 1980 and 2001 among Texas counties, and Poisson regression was used to evaluate risk differences.ResultsSeveral significant (p < 0.05) accidental poisoning mortality clusters were identified in different regions of Texas. The geographic and temporal persistence of clusters was found to vary by racial group, gender, and race/gender combinations, and most of the clusters persisted into the present decade. Poisson regression revealed significant differences in risk according to race and gender. The Black population was found to be at greatest risk of accidental poisoning mortality relative to other race/ethnic groups (Relative Risk (RR) = 1.25, 95% Confidence Interval (CI) = 1.24 – 1.27), and the male population was found to be at elevated risk (RR = 2.47, 95% CI = 2.45 – 2.50) when the female population was used as a reference.ConclusionThe findings of the present study provide evidence for the existence of accidental poisoning mortality clusters in Texas, demonstrate the persistence of these clusters into the present decade, and show the spatiotemporal variations in risk and clustering of accidental poisoning deaths by gender and race/ethnicity. By quantifying disparities in accidental poisoning mortality by place, time and person, this study demonstrates the utility of the spatial scan statistic combined with GIS and regression methods in identifying priority areas for public health planning and resource allocation.

Evaluating the disparity of female breast cancer mortality among racial groups - a spatiotemporal analysis

BackgroundThe literature suggests that the distribution of female breast cancer mortality demonstrates spatial concentration. There remains a lack of studies on how the mortality burden may impact racial groups across space and over time. The present study evaluated the geographic variations in breast cancer mortality in Texas females according to three predominant racial groups (non-Hispanic White, Black, and Hispanic females) over a twelve-year period. It sought to clarify whether the spatiotemporal trend might place an uneven burden on particular racial groups, and whether the excess trend has persisted into the current decade.MethodsThe Spatial Scan Statistic was employed to examine the geographic excess of breast cancer mortality by race in Texas counties between 1990 and 2001. The statistic was conducted with a scan window of a maximum of 90% of the study period and a spatial cluster size of 50% of the population at risk. The next scan was conducted with a purely spatial option to verify whether the excess mortality persisted further. Spatial queries were performed to locate the regions of excess mortality affecting multiple racial groups.ResultsThe first scan identified 4 regions with breast cancer mortality excess in both non-Hispanic White and Hispanic female populations. The most likely excess mortality with a relative risk of 1.12 (p = 0.001) occurred between 1990 and 1996 for non-Hispanic Whites, including 42 Texas counties along Gulf Coast and Central Texas. For Hispanics, West Texas with a relative risk of 1.18 was the most probable region of excess mortality (p = 0.001). Results of the second scan were identical to the first. This suggested that the excess mortality might not persist to the present decade. Spatial queries found that 3 counties in Southeast and 9 counties in Central Texas had excess mortality involving multiple racial groups.ConclusionSpatiotemporal variations in breast cancer mortality affected racial groups at varying levels. There was neither evidence of hot-spot clusters nor persistent spatiotemporal trends of excess mortality into the present decade. Non-Hispanic Whites in the Gulf Coast and Hispanics in West Texas carried the highest burden of mortality, as evidenced by spatial concentration and temporal persistence.

Barriers to health care access in 13 Asian American communities

OBJECTIVE To obtain and discuss in-depth information on health care use in Asian Americans (AAs). METHODS Nineteen focus groups were conducted in 174 adults from 13 AA communities in Montgomery County, Maryland. MAX QDA software was used to analyze qualitative data. RESULTS Financial, physical, communication, and cultural attitudes were 4 major barriers to accessing health care. Underrepresented communities reported unique additional barriers, such as lack of screening opportunities and interpretation services due to lack of resources in the communities. CONCLUSIONS Future studies, public health policy, and funding resources should consider including underrepresented AA subgroups and reflect their needs.

Factors Influencing Women’s Quality of Life in the Later Half of Life

Background Among older women in East Asia, and Taiwan in particular, there is little research on quality of life and the health care they receive to address the symptoms of menopause. This study evaluated factors which influence quality of life among post middle-age women in Taiwan. Methods This cross-sectional study recruited 1250 women between 43 and 77 years of age during the year 2002. The factors investigated were demographics, menstruation status, menopausal symptoms, osteoporosis status, and use of hormone replacement therapy (HRT). SF-36 was used to assess the health-related quality of life of these women. Correlation, multiple regression and path analysis were used to test for direct and indirect relationships among the variables. Results There are statistical significances between menopause symptoms and quality of life across different age groups. Path analysis shows a direct positive effect of HRT and a direct negative effect of climacteric symptoms on both physical and mental components of quality of life. Age, marital status, education and osteoporosis also have direct and indirect effects, some positive and others negative, on the components of quality of life. Conclusions When developing programs to enhance health in post middle-age women, consideration should be given to symptom relief as well as quality of life.

The association between government expenditure and economic growth: granger causality test of us data, 1947-2002

Wagner’s Law and Keynesian’s theory are two widely accepted yet contrasting propositions. This paper employs Granger causality test on US federal government data, from 1947 to 2002. We used aggregate data as well as disaggregate data with the sub-categories of five federal expenditures, including: national defense, human resources expenditure, physical resources expenditure, net interest payment, and other expenditure. The results of our study suggest that total federal government expenditure is more consistent with Keynesian’s theory while there are diversified causal relationships among five sub-category of federal expenditure. The policy recommendation generated from this paper is that the US federal government should invest more public resources in human resources expenditure assuming that economic growth is the utmost important item on the government agenda.

Self-Assessed Emergency Readiness and Training Needs of Nurses in Rural Texas

OBJECTIVE Nurses, particularly public health nurses, play a key role in emergency preparedness and response in rural areas. To prepare rural jurisdictions for unforeseen disastrous events it is imperative to assess the public health emergency readiness and training needs of nurses. The objective of this study was to assess the self-reported terrorism preparedness and training needs of a nurse workforce. DESIGN AND SAMPLE Cross-sectional prevalence of practicing nurses in regions of North Texas. 3,508 rural nurses practicing in North Texas participated in the study. MEASUREMENTS Data were collected through a mailed survey; analyses included multinominal logistic regression and descriptive statistics. RESULTS A total of 941 (27%) nurses completed the survey. The majority of respondents reported limited bioterrorism-related training. Fewer than 10% were confident in their ability to diagnose or treat bioterrorism-related conditions. Although only 30% expressed a willingness to collaborate with state and local authorities during a bioterrorism event, more than 69% indicated interest in future training opportunities. Preferred training modalities included small group workshops with instructor-led training, and Internet-based training. CONCLUSIONS Licensing agencies, professional organizations, and community constituencies may need to play a stronger role in improving the bioterrorism-related emergency preparedness of rural nurses.

Effects of cardiorespiratory fitness on serum ferritin concentration and incidence of type 2 diabetes: Evidence from the Aerobics Center Longitudinal Study (ACLS)

BACKGROUND Cardiorespiratory fitness (CRF) and physical activity (PA) are inversely related to the occurrence of type 2 diabetes (T2D). Both play an important role in reducing serum ferritin (SF) concentration. Increased SF concentration is considered a contributing factor for developing T2D. METHODS The present cohort study investigated 5,512 adult participants enrolled in the Aerobics Center Longitudinal Study (ACLS) between 1995 and 2001. The subjects completed a comprehensive medical examination and a SF evaluation, and had been followed up until either diabetes onset, death, or the cut-off date of November 2007. Three CRF levels were categorized. SF quartile levels were defined by gender and menopausal status. The incidence of T2D was calculated for 10,000 person-years, and hazard ratios (HR) were computed to predict the incidence of T2D based on SF quartiles and CRF levels. RESULTS SF concentration was significantly higher in males than in females (148.5 +/- 104.7 ng/ml vs. 52.2 +/- 45.9 ng/ml) and was inversely associated with CRF levels. In the high CRF group, 32.7% of participants had a low SF concentration whereas only 16.8% of participants had a high SF concentration level. After adjusting for potential confounders, male participants in the highest SF quartile level had a 1.7 times (HR: 1.67, 95% CI: 1.05, 2.66; p-trend = 0.027) increased risk for developing T2D compared with those in the lowest SF quartile group. CONCLUSION Lower SF concentration was associated with lower risk of developing T2D in those regularly participating in CRF. The findings from this study suggest that SF concentration could be used as a diabetic predictor. Based on these results clinicians and public health professionals should promote regular physical activity or fitness to reduce the incidence of T2D.

Assessing the Needs and Guiding the Future: Findings from the Health Needs Assessment in 13 Asian American Communities of Maryland in the United States

There is lack of in depth data on health needs of diverse Asian American communities. We conducted 19 focus groups in 13 Asian American communities in Maryland in 2007. We developed a moderator’s guide to collect qualitative data on health needs from 174 participants, and used MAX QDA to analyze data and code emergent themes. Cardiovascular disease related conditions, diabetes, and mental health were the top three health concerns. Weight concerns, cancer, arthritis, smoking, osteoporosis, and hepatitis B followed next. Many participants were not receiving preventive health service such as cancer screening due to a lack of access to health care or lack of awareness of preventive care. Additionally, under-represented communities lacked adequate health resources and advocacy, potentially due to a relatively shorter history of immigration and a small population. The results render support for awareness education on importance of preventive care and mental health.

Surveillance of the colorectal cancer disparities among demographic subgroups: a spatial analysis.

Objective: The literature suggests that colorectal cancer mortality in Texas is distributed inhomogeneously among specific demographic subgroups and in certain geographic regions over an extended period. To understand the extent of the demographic and geographic disparities, the present study examined colorectal cancer mortality in 15 demographic groups in Texas counties between 1990 and 2001. Methods: The Spatial Scan Statistic was used to assess the standardized mortality ratio, duration and age-adjusted rates of excess mortality, and their respective p-values for testing the null hypothesis of homogeneity of geographic and temporal distribution. Results: The study confirmed the excess mortality in some Texas counties found in the literature, identified 13 additional excess mortality regions, and found 4 health regions with persistent excess mortality involving several population subgroups. Conclusion: Health disparities of colorectal cancer mortality continue to exist in Texas demographic subpopulations. Health education and intervention programs should be directed to the at-risk subpopulations in the identified regions.