10/10/2017 Research Team Little Evidence-Based Clinical Practice for Asian Am ericans, Native Hawaiians, and Pacific Islanders? D E T E R M I N I N G T H E P R O G R E S S F O R H E A L T H E Q U I T Y Winston Tseng, PhD, Diana Lau, PhD, RN, CNS, Katie Lau, Justine Wong, RN, MSN, Kelsey Chun, Dustin Bainto, and Andrew Choothakan, MPH Objectives Historical Background Model Minority Myth: Report of the Secretary’s Task Force Examine the data gap and what progress has been on Black and Minority Health (Heckler Report 1985) made in clinical research among Asian Americans and Pacific Islanders (AAs and PIs) Out of the Shadows: AAs and PIs constitute some of the fastest growing racial groups in the US and can no longer be ignored or left behind. OMB Directive-15 (1997) and ACA Conduct a systematic literature review using Section 4302 (2010) developed national standards for PubMed focused on the state of clinical research for disaggregation of AAs and PIs. 10 major health conditions of concern among AAs and PIs Shining the Light on AA and PI health: HHS Plan for AANHPI Health (2011) identified major data gaps and provides national guidelines for advancing AA and PI health. 1
10/10/2017 What is PubMed? Methods A free search engine accessing primarily the MEDLINE Systematic review of PubMed records spanning from (est. 1971) and Index Medicus (back to 1951 & earlier) conception (1809) to December 31, 2012. databases of references and abstracts on life sciences and biomedical topics. Article abstractions examined the publication titles, 1809 – first PubMed records abstracts, and full manuscripts as is available on PubMed. 24.6 million Pub records (Feb 2015) Search strategy excluded non-human or non-U.S. ~500,000 new records added per year subjects. National Library of Medicine (NLM) maintains the database as part of the Entrez system. Methods Methods – Health Search Terms Major AA and PI health conditions identified: • Define search criteria and search terms/ timeline 1. Cancer • Identify Medical Subject Headings (MeSH) terms Heart Disease 2. Stroke 3. Diabetes 4. • Identify records through PubMed searches Hypertension 5. • Screened abstracts/ full-text for assessing eligibility 6. Hepatitis B HIV/ AIDS 7. Tuberculosis 8. • Finalized articles to be included in review Infant Mortality 9. 10. Immunization 2
10/10/2017 Methods – Asian Search Terms Methods – Asian Search Terms 2010 Census-defined Asian racial/ ethnic groups: 2010 Census-defined Asian racial/ ethnic groups: Asian Burmese Gujarati Javanese Madras Mongolian Asian American Cambodian Hmong Karnatakan Maharashtran Montagnard Afghan Cantonese Hong Kong Kashmiri Malaysian Myanmar Andaman Islander Chinese Indian Katu Maldivian Mysorean Andhra Pradesh East Indian Indochinese Keralan Manchurian Naga Assamese Eurasian Indonesian Khmer Mandarin Nepalese, Nepali Balochistani Filipino, Filipina Issei Korean Meo Nisei Bangladeshi Formosan Japanese Laotian Miao Okinawan Bengali Goanese Macanese Mien Oriental Bhutanese Gonsei Madhya Pradesh Mnong Orissan Borneo Guamanian Methods – Asian Search Terms Methods – PI Search Terms 2010 Census-defined Asian racial/ ethnic groups: 2010 Census-defined Pacific Islander racial/ ethnic groups: Pakistani Singaporean Uttar Pradesh Pathan Singhalese Veddah American Hawaiian Niuean Pradeshi South Asian Vietnamese Samoan Maorian Norfolk Islander Punjabi South East Asian Yonsei Carolinian Marshallese Northern Rajasthani Sri Lankan Chamorro Mariana Melanesian Ryukyu Islander Sumatran Chuukese Islander Micronesian Sansei Taiwanese Cook Islander Oceanian Nauru Shan Tamil Fikian Pacific Islander New Caledonian Sikkim Thai Guamanian Palau New Zealander Sikkimese Tibetan 3
10/10/2017 Methods – PI Search Terms Results - Trends Totals by Decade for 10 Health Conditions 2010 Census-defined Pacific Islander racial/ ethnic groups: 1800 1556 1600 Papua New Solomon Islander 1400 # of Publications Islander Guinean Tokelauan 1200 1000 Tahitian Papuan Tongan AA 800 574 Tarawa PI 600 Pohnpeian Trukese 474 400 Islander Vanuatu Polynesian 170 146 200 75 27 8 Tasmanian 0 Yapese Saipan 1971-1980 1981-1990 1991-2000 2001-2010 Tinian Year Results – AA Totals Results – PI Totals Health Conditions PI Health Conditions AA Cancer 1,335 Cancer 481 AIDS/ HIV 152 Heart 552 Diabetes 426 Diabetes 128 Hepatitis B 264 Immunization 92 AIDS/ HIV 255 Heart 78 Immunization 241 Hepatitis B 77 Infant Mortality 64 Hypertension 238 Stroke 177 Hypertension 52 Stroke 47 Tuberculosis 125 Infant Mortality 74 Tuberculosis 30 Total Publications 2,8 67 Total Publications 94 8 % (n=2,951,0 70 ) 0 .0 97% %( v) 0 .0 32% 4
10/10/2017 Discussion Overall Recommendations Need to build research/ data capacity and pipeline to The AA and PI PubMed research database has made better monitor and identify AA and PI health disparities substantial progress, particularly since 1990. Yet much work needs to be done to catch up. Public-private partnerships are critical to developing innovative and culturally relevant strategies to collect The health conditions with most publications among data in AA and PI communities AAs include cancer and heart disease. For PIs, cancer and HIV/ AIDS have the most publications. Further disaggregation of data by AA and PI ethnic groups to document these disparities measures is needed and can support the Healthy People 2020 disparities Documenting the evidence-based clinical research initiative and implementation of the data collection goals for the AAs and PIs in support of leading federal from the HHS Plan for AANHPI Health and ACA Section initiatives 4302 Data Recommendations Data Recommendations Regional sampling and oversampling from community clusters 2011: HHS Data Standards for AAs and PIs (Native Hawaiian, Guamanian or with a high concentration of PIs to obtain robust data and keep Chamorro, Samoan, Other Pacific Islander) survey costs down 2011: AB 1088 (Eng) CA guidelines for AAs and PIs (Fijian, Instead of adjusting for race, stratify and report by race groups Guamanian/ Chamorro, Native Hawaiian, Samoan, Tongan) (Dept Industrial Relations, Dept of Fair Employment & Housing) for monitoring population health 2016: AB 1726 (Bonta) new CA guidelines for AAs and PIs (Fijian, Indicate when no PI or AA data can be reported, rather than Guamanian/ Chamorro, Native Hawaiian, Samoan, and Tongan) (Dept of Public aggregating Asian/ Pacific Islander data Health) Support state and local surveys, healthcare providers, and administered health Disaggregate by PI ethnic groups and AA ethnic groups following programs to implement AB 1088 / AB 1726 standards for AAs and PIs federal and state data standards whenever possible Explore Partnerships with local health departments, BARHII, CA DPH and Pool data across years of data to ensure adequate PI or AA CHIS on AA and PI data activities sample for reporting 5
10/10/2017 Data Recommendations Data Recommendations 2011: HHS Data Standards for AAs and PIs (Native Hawaiian, Guamanian or Chamorro, Samoan, Other Pacific Islander) Build a PI data infrastructure (PI liaison, cultural humility training, PI field interviewers) 2011: AB 1088 (Eng) CA guidelines for AAs and PIs (Fijian, Engage communities in the design, planning, implementation, and Guamanian/ Chamorro, Native Hawaiian, Samoan, Tongan) (Dept Industrial dissemination of data on race, ethnicity, and language to ensure Relations, Dept of Fair Employment & Housing) community participation and relevance 2016: AB 1726 (Bonta) new CA guidelines for AAs and PIs (Fijian, Coordinate with faith-based organizations and community leaders Guamanian/ Chamorro, Native Hawaiian, Samoan, and Tongan) (Dept of Public to increase buy-in regarding community outreach efforts Health) Linguistically appropriate survey administration (translating and/ or Support state and local surveys, healthcare providers, and administered health interpreting surveys for individuals with LEP, survey materials are programs to implement AB 1088 / AB 1726 standards for AAs and PIs culturally relevant) Explore Partnerships with local health departments, BARHII, CA DPH and CHIS on AA and PI data activities Thank you! For m ore inform ation: Winston Tseng winston@berkeley.edu Diana Lau lau2.ucsf@gm ail.com 6
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