Winston Tseng

Using appropriate body mass index cut points for overweight and obesity among Asian Americans

OBJECTIVE Asian Americans have low prevalence of overweight/obesity based on standard BMI cut points yet have higher rates of diabetes. We examined the prevalence of overweight/obesity, using lower BMI cut points recommended by the World Health Organization (WHO) for Asians, and diabetes in Asian American subgroups in California. METHOD Secondary analysis of the 2009 adult California Health Interview Survey (n=45,946) of non-Hispanic Whites (NHW), African Americans, Hispanics and Asians (Vietnamese, Chinese, Korean, Filipino, South Asian and Japanese). WHO Asian BMI cut points (overweight=23-27.5kg/m(2); obese≥27.5kg/m(2)) were used for Asian subgroups. Standard BMI cut points (overweight=25-29.9kg/m(2); obese≥30kg/m(2)) were applied for other groups. RESULTS Among Asian subgroups, overweight/obesity was highest among Filipinos (78.6%), which was higher than NHWs (p<0.001) but similar to African Americans and Hispanics. Compared to NHW, diabetes prevalence was higher for Vietnamese, Koreans, Filipinos and South Asians with BMI=23-24.9kg/m(2) and Koreans, Filipinos and Japanese with BMI=27.5-29.9kg/m(2), the ranges WHO recommends as overweight or obese for Asians but not for other groups. CONCLUSIONS Filipinos should be a priority population for overweight/obesity screening. Filipinos, Vietnamese, Korean, South Asians and Japanese have higher diabetes prevalence at lower BMI cut points. WHO Asian BMI cut points may have clinical utility to identify at-risk Asian Americans.

Developing the Community Empowered Research Training Program: Building Research Capacity for Community-Initiated and Community-Driven Research

Health promotion practice research conducted by or in partnership with community-based organizations (CBOs) serving Asian Americans, Native Hawaiians, and Pacific Islanders (AA and NHPI) can address health disparities. Few CBOs have the tools to integrate or initiate research into their programmatic agenda. The New York University (NYU) Center for the Study of Asian American Health (CSAAH) and the Asian & Pacific Islander American Health Forum (APIAHF) created a partnership with the goal to support CBO research infrastructure development by creating the Community Empowered Research Training (CERT) program. Methods: A survey was conducted and discussions held with CBO leaders representing AA and NHPI communities to inform the development of the CERT program. Results: The majority of participants are engaged in service-related research and reported interest in building their research capacity. CBOs may require help reframing how data can be collected and used to better inform programmatic activities and to address health disparities facing AA and NHPI communities. Conclusions: CBOs possess both an interest in and access to local knowledge that can inform health priorities. Findings have been applied to the CERT program to build capacity to support community-initiated/driven research to address health disparities affecting AAs and NHPIs.

Knowledge, attitudes, and practice toward epilepsy (KAPE): A survey of Chinese and Vietnamese adults in the United States

We conducted, in four languages, the first national cross-sectional survey of the knowledge, attitudes, and practice with respect to epilepsy of Chinese- and Vietnamese-American adults. We used a convenience sampling method to recruit 2831 adults in seven states. Eighty-four percent had heard or read of epilepsy and 58% had seen a seizure, whereas only 34% knew someone with epilepsy. Forty-two percent would object to their children marrying a person with epilepsy, and 43% would not knowingly hire someone with epilepsy. We examined bivariate associations for questions of knowledge, attitudes, and practice with age, gender, ethnicity, nativity, language, and education. chi(2) analyses showed differences in knowledge of and attitudes toward epilepsy by age group, gender, ethnicity, and education. Although misconceptions and negative views about epilepsy are held by Chinese and Vietnamese populations living in the United States, our results show noteworthy differences in attitudes and practice in relation to previous studies in Asian countries.

Quality of life in epilepsy (QOLIE): insights about epilepsy and support groups from people with epilepsy (San Francisco Bay Area, USA).

INTRODUCTION This study evaluated quality of life (QOL) in people with epilepsy (PWE) in the San Francisco Bay Area. METHODS This was a qualitative study examining QOL through the use of focus groups and of the QOLIE-31-P survey instrument. Six focus groups were conducted to examine self-reported challenges due to epilepsy. Focus groups were conducted for individuals who did and did not attend support groups. RESULTS Individuals with epilepsy reported substantial difficulties with finances, physical and psychosocial functioning. Also, limited knowledge about services and relatively negative feelings toward self were common among newly diagnosed participants. CONCLUSION Many of the issues surrounding QOL and challenges were shared across groups. Epilepsy-related social services appeared to be useful in helping PWE cope and in increasing PWEs awareness of key enabling services. Although many individuals with epilepsy reported poor QOL and other challenges, epilepsy-related services may be under-utilized due to a lack of awareness.

Older adults' concerns about cognitive health: Commonalities and differences among six United States ethnic groups

ABSTRACT We studied concerns about cognitive health among ethnically diverse groups of older adults. The study was grounded in theories of health behaviour and the representation of health and illness. We conducted 42 focus groups (N=396, ages 50+) in four languages, with African Americans, American Indians, Chinese Americans, Latinos, Whites other than Latinos (hereafter, Whites) and Vietnamese Americans, in nine United States locations. Participants discussed concerns about keeping their memory or ability to think as they age. Audio recordings were transcribed verbatim. Constant comparison methods identified themes. In findings, all ethnic groups expressed concern and fear about memory loss, losing independence, and becoming ‘a burden’. Knowing someone with Alzheimers disease increased concern. American Indians, Chinese Americans, Latinos and Vietnamese Americans expected memory loss. American Indians, Chinese Americans and Vietnamese Americans were concerned about stigma associated with Alzheimers disease. Only African Americans, Chinese and Whites expressed concern about genetic risks. Only African Americans and Whites expressed concern about behaviour changes. Although we asked participants for their thoughts about their ability to think as they age, they focused almost exclusively on memory. This suggests that health education promoting cognitive health should focus on memory, but should also educate the public about the importance of maintaining all aspects of cognitive health.

Responding to the deaf in disasters: establishing the need for systematic training for state-level emergency management agencies and community organizations

BackgroundDeaf and hard-of-hearing (Deaf/HH) individuals have been underserved before and during emergencies. This paper will assess Deaf/HH related emergency preparedness training needs for state emergency management agencies and deaf-serving community-based organizations (CBOs).MethodsFour approaches were used: 1) a literature review; 2) results from 50 key informant (KI) interviews from state and territorial-level emergency management and public health agencies; 3) results from 14 KI interviews with deaf-serving CBOs in the San Francisco Bay Area; and 4) a pilot program evaluation of an emergency responder training serving the Deaf/HH in one urban community.ResultsResults from literature review and state and territorial level KIs indicate that there is a substantive gap in emergency preparedness training on serving Deaf/HH provided by state agencies. In addition, local KI interviews with 14 deaf-serving CBOs found gaps in training within deaf-serving CBOs. These gaps have implications for preparing for and responding to all-hazards emergencies including weather-related or earthquake-related natural disasters, terrorist attacks, and nuclear-chemical disasters.ConclusionEmergency preparedness trainings specific to responding to or promoting preparedness of the Deaf/HH is rare, even for state agency personnel, and frequently lack standardization, evaluation, or institutionalization in emergency management infrastructure. This has significant policy and research implications. Similarly, CBOs are not adequately trained to serve the needs of their constituents.

Experiences and concerns of family caregivers providing support to people with dementia: A cross-cultural perspective

Abstract: We examined experiences and concerns among caregivers of community-dwelling people with dementia from two ethnic groups. We conducted a thematic analysis of responses to the question, ‘What is your life like as a caregiver?’ in nine focus groups (n = 75) with Filipino and non–Hispanic White caregivers. Constant comparison methods identified themes by ethnicity. Experiences and concerns expressed across groups were related to care recipient symptoms commonly associated with dementia, including severe memory loss and behavioral changes. Participants in both ethnic groups described strategies that help them cope, such as receiving help from family and friends, receiving respite support, and participating in support groups. Filipino caregivers more often emphasized positive aspects of caregiving, whereas Whites often expressed that others do not understand the daily experiences of caregiving. Filipinos more commonly described caregivers as a ‘good person’ or ‘saint’ and emphasized that caregiving made them stronger.

Availability and Readability of Emergency Preparedness Materials for Deaf and Hard-of-Hearing and Older Adult Populations: Issues and Assessments

A major public health challenge is to communicate effectively with vulnerable populations about preparing for disasters and other health emergencies. People who are Deaf or Hard of Hearing (Deaf/HH) and older adults are particularly vulnerable during health emergencies and require communications that are accessible and understandable. Although health literacy studies indicate that the readability of health communication materials often exceeds people’s literacy levels, we could find no research about the readability of emergency preparedness materials (EPM) intended for Deaf/HH and older adult populations. The objective of this study was to explore issues related to EPM for Deaf/HH and older adult populations, to assess the availability and readability of materials for these populations, and to recommend improvements. In two California counties, we interviewed staff at 14 community-based organizations (CBOs) serving Deaf/HH clients and 20 CBOs serving older adults selected from a stratified, random sample of 227 CBOs. We collected 40 EPM from 10 CBOs and 2 public health departments and 40 EPM from 14 local and national websites with EPM for the public. We used computerized assessments to test the U.S. grade reading levels of the 16 eligible CBO and health department EPM, and the 18 eligible website materials. Results showed that less than half of CBOs had EPM for their clients. All EPM intended for clients of Deaf/HH-serving CBOs tested above the recommended 4th grade reading level, and 91% of the materials intended for clients of older adult-serving CBOs scored above the recommended 6th grade level. EPM for these populations should be widely available through CBOs and public health departments, adhere to health literacy principles, and be accessible in alternative formats including American Sign Language. Developers should engage the intended users of EPM as co-designers and testers. This study adds to the limited literature about EPM for these populations.

Beliefs and Communication Practices Regarding Cognitive Functioning Among Consumers and Primary Care Providers in the United States, 2009

Introduction Limited research has examined primary care providers’ communication with patients about maintaining cognitive functioning. Our study’s objective was to compare the perceptions of consumers and primary care providers related to beliefs and communication practices about lifestyle behaviors beneficial for overall health and for maintaining cognitive functioning. Methods In 2009, we submitted 10 questions to Porter Novelli’s HealthStyles survey and 6 questions to their DocStyles survey. We compared consumers’ (n = 4,728) and providers’ (n = 1,250) beliefs, practices, and information sources related to maintaining health and cognitive functioning. We made comparisons using nonparametric statistics. Results Approximately 76% of consumers considered their health to be good or very good; 73.4% were concerned or very concerned about the possibility that their memory may worsen with age. Women were significantly more concerned than men, and white consumers were more concerned than black and Hispanic consumers. Consumers reported they believed that intellectual stimulation (86.6%), physical activity (82.6%), and healthful diet (82.5%) prevented or delayed cognitive impairment. Providers reported advising patients to reduce cognitive impairment risk through physical activity (85.9%), intellectual stimulation (80.3%), and social involvement (67.4%). Few consumers (7.8%) reported receiving this information from providers but reported learning about strategies to maintain memory, primarily from television (50.1%), magazines (44.1%), and newspapers (33.7%). Conclusion Providers reported advising patients about how to reduce risks of cognitive impairment. Consumers reported receiving this information from other sources. Findings suggest a need to examine and assess media messages and to better understand patient–provider communication about cognitive functioning.

Evaluating a Culturally and Linguistically Competent Health Coach Intervention for Chinese-American Patients With Diabetes

Abstract Background. Type 2 diabetes is a growing concern among medically underserved Chinese Americans. However, very few interventions have been developed or adapted for Chinese Americans with diabetes. Objective. To use a participatory research approach to evaluate the effectiveness of a culturally tailored, linguistically appropriate model for diabetes care employing health coaches to improve A1C levels among Chinese-American patients in a federally qualified health center setting. Methods. We compared change in A1C between intervention participants (n = 46), who received a health coaching intervention, and control participants (n = 46), who received usual care over a period of ~ 6 months. Results. Intervention participants showed a decrease in mean A1C at follow-up (−0.40%) compared to control subjects (+0.04%), although this difference was not statistically significant. At the 6-month follow-up, a significantly higher percentage of intervention participants (45.7%) had well-controlled A1C levels compared to control subjects (23.9%) (P = 0.048). Conclusions. It is feasible to implement a culturally tailored, linguistically appropriate teamlet model of care for Chinese Americans with type 2 diabetes. Such a model may be helpful in reducing A1C levels. Given trends in A1C improvement during a 6-month pilot, future randomized trials with a larger sample capable of providing adequate statistical power to detect improvements are warranted.