April 2013 News

Monthly Newsletter


1) The NHANES data on Asian Americans and obesity
(www.cdc.gov/nchs/data/databriefs/db131.htm) has generated quite a bit of discussion.  Here is our take on that data and debate as written by Dr. Kanaya.
The NHANES 2011-2012 survey data were just released and for the first time Asians have been oversampled.  The Asian category includes all persons having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent, including Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam (unfortunately, all aggregated into one very heterogeneous group).  The unweighted sample size of Asians (single race only) in this NHANES sample is 1,215 individuals (13% of the total study population). The first analysis released by the CDC from this NHANES data was a descriptive analysis of the prevalence of obesity among adults.  Overall rates of obesity (BMI ≥30 kg/m2) were 35% in the study.  When the authors examined obesity rates by ethnic group, unfortunately they used the standard BMI cut-point, not the WHO-Asian BMI recommendations (23 for overweight, and 27.5 kg/m2 for obesity).  While the obesity prevalence was high for non-Hispanic Whites (33%), non-Hispanic Blacks (48%), Hispanics (42%), this “obesity” rate was not surprisingly very low in Asians (11%).  They further concluded that the estimated Asian adult population with “obesity” was 1.2 million in the U.S.  So while it’s great that the U.S. governmental agencies have begun to oversample Asians for these national surveys, there are many misconceptions that have yet to be understood…and more opportunity for ARCH members to do to disseminate our collective work.

2) Thanks to AAPCHO, we have included a link to its fact sheet that provides a set of research criteria to help Community Health Centers (CHCs) and community organizations evaluate their participation in research studies on our website under “Research Resources." The direct link to the fact sheet is www.aapcho.org/resources_db/community-criteria-for-research-participation/ 

3) ARCH members Arnab Mukherjea, Susan L. Ivey, and Alka Kanaya recently published a paper entitled "Asian Indian views on diet and health in the United States: importance of understanding cultural and social factors to address disparities." Fam Community Health. 2013 Oct-Dec;36(4):311-23. www.ncbi.nlm.nih.gov/pubmed/23986072. This study with 38 Asian Indian immigrants from 4 focus groups  found influences on diet and health of beliefs from respondents' native India, preservation of cultural practices within the US social structure, conflicts with subsequent generations, and reinterpretation of health-related knowledge through a lens, hybridizing both "native" and "host" contexts.

4) Abstract Highlights
While researchers and the press have been discussing the rates of obesity among Asian Americans in the most recent NHANES study, several papers make it clear that diabetes is already a major scourge among Asians and Asian Americans. A major epidemiological study out of China (www.ncbi.nlm.nih.gov/pubmed/24002281) published in JAMA with about 100,000 participants estimated that diabetes prevalence in China was 11% and pre-diabetes, 50%. In other words, China has about 119 million diabetic patients and 490 million pre-diabetic patients! 

A study out of Hawaii (www.ncbi.nlm.nih.gov/pubmed/23886042) with 1,515 diabetic patients age 65 and older found that  Native Hawaiian, Filipino, and Japanese men and Filipino women aged 65 years or older have a higher risk than whites for diabetes-related potentially preventable hospitalizations. 

One of those diabetes-related complications is coronary artery disease. A small study out of New York (www.ncbi.nlm.nih.gov/pubmed/23914413) showed that South Asians who were referred for coronary angiography with stable angina and acute coronary syndromes were younger, had significantly higher rates of 3-vessel disease, and higher rates of diabetes, hypertension, obesity and dyslipidemia compared to non-Hispanic whites.

One other interesting paper is a follow-up of Vietnamese Americans who received hepatitis B screening from community events (www.ncbi.nlm.nih.gov/pubmed/23564428) and found that 13.8% had chronic hepatitis B. Among those who had chronic hepatitis B, 13.3% met criteria for antiviral therapy, but none had been initiated on treatment. This is a reminder for us all that hepatitis B screening is only the first step toward eliminating hepatitis B and liver cancer disparities among Asian Americans.

Xu Y, Wang L, He J, et al. Prevalence and control of diabetes in Chinese adults.
JAMA. 2013 Sep 4;310(9):948-59. http://www.ncbi.nlm.nih.gov/pubmed/24002281

Sentell TL, Ahn HJ, Juarez DT,  et al. Comparison of potentially preventable hospitalizations related to diabetes among Native Hawaiian, Chinese, Filipino, and Japanese elderly compared with whites, Hawai'i, December 2006-December 2010. Prev Chronic Dis. 2013 Jul 25;10:E123. http://www.ncbi.nlm.nih.gov/pubmed/23886042

Ha NBTrinh HNNguyen TT, et al. Prevalence, risk factors, and disease knowledge of chronic hepatitis B infection in Vietnamese Americans in California. J Cancer Educ. 2013 Jun;28(2):319-24. http://www.ncbi.nlm.nih.gov/pubmed/23564428


-Tung Nguyen

latest resources

Cancer Surveillance Research in Asian Americans presntation
by Scarlett Lin Gomez, MPH, PhD, from CPIC

ARCH is proud to announce newly funded projects led by ARCH investigators:

A Patient-Centered Intervention to Increase Screening of Hepatitis B and C among Asian Americans
Funding Agency:
Patient-Centered Outcomes Research Institute (PCORI)
Funding Dates: 8/1/2013 - 7/31/2016
Principal Investigator: Tung Nguyen (ARCH Co-Investigators: Mandana Khalili, Urmimala Sarkar, Janice Tsoh)
Abstract: The goal of this study is to develop a mobile application in English, Chinese, and Vietnamese with a video doctor delivering messages promoting screening for viral hepatitis and to test the application’s efficacy in a randomized controlled trial.

A Family-Based Approach To Reduce Smoking in Vietnamese Men
Funding Agency:
 Tobacco Related Disease Research Program
Funding Dates:
 8/01/2013 – 7/31/2016
Principal Investigator: Janice Tsoh (ARCH Co-Investigators: Nancy Burke, Stephen J. McPhee, Tung Nguyen, Bang Nguyen)
Abstract: The goal of the proposed research project is to conduct a randomized controlled trial to evaluate the efficacy of the newly developed family-based intervention using lay health worker outreach to promote smoking cessation among Vietnamese American men.

Other Resources

Lung Cancer Study

An international group of scientists has identified three genetic regions that predispose Asian women who have never smoked to lung cancer. The finding provides further evidence that risk of lung cancer among never-smokers, especially Asian women, may be associated with certain unique inherited genetic characteristics that distinguishes it from lung cancer in smokers.

Lung cancer in never-smokers is the seventh leading cause of cancer deaths worldwide, and the majority of lung cancers diagnosed historically among women in Eastern Asia have been in women who never smoked. The specific genetic variations found in this study had not been associated with lung cancer risk in other populations.


Asian Americans, Mental Health, and Tobacco Use from the 2009–2011 National Survey on Drug Use and Health

Based on the 2009-2011 National Survey on Drug Use and Health, the CDC reports that 14.9% of Asian American men and 16.6% of Asian American women report having any mental illness. Asian Americans with mental illness have a current smoking prevalence twice as high as those without (20.6% vs. 10.4%). Asian American women with any mental illness have 3 times the smoking prevalence of those without (16.0% vs. 5.5%).

Mental illness was assessed for the preceding year using a series of 14 questions that made up two scales measuring psychological distress (Kessler-6) and disability (World Health Organization Disability Assessment Schedule). It should be noted that the NSDUH is conducted at the respondent’s household but only in English or Spanish, potentially missing 1/3 of Asian Americans who have limited English proficiency.

Details can be found at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm62e0205a1.htm?s_cid=mm62e0205a1_e

Asian Vaccination coverage from the CDC: MMWR Vol. 62 / Early Release

With the caveat that this is data from the National Health Interview Survey, which is not administered in an Asian language and therefore misses about 1/3 of Asian Americans, this report contains very interesting information about vaccination rates.

A few highlights:

- Only 12% of high-risk Asian Americans age 19-64 received the pneumococcal vaccination compared to 20% of non-Hispanic whites. Only 40% of Asian Americans age 65+ had it compared to 66% among non-Hispanic whites.
- Only 12% of Asian Americans age 19-64 received a combined tetanus and pertussis shot in the last 6 years.
- Only 41% of Asian Americans age 19-49 had hepatitis B vaccination.
- Only 14% of Asian Americans age 60+ had a shingles vaccination.
- Only 22% of Asian American women age 19-24 had human papillomavirus (HPV) vaccine compared to 33% of non-Hispanic whites.

The report is available on line at http://www.cdc.gov/mmwr/pdf/wk/mm62e0129.pdf

The Institute for Asian American Studies at University of Massachusetts-Boston has published a report, "Information on Small Populations with Significant Health Disparities: A Report on Data Collected on the Health of Asian Americans in Massachusetts."

The report can be downloaded at

Learn more about the Institute

News cont.

Burman BE, Mukhtar NA, Toy BC, Nguyen TT, Chen AH, Yu A, Berman P, Hammer H, Chan D, McCulloch CE, Khalili M. Hepatitis B Management in Vulnerable Populations: Gaps in Disease Monitoring and Opportunities for Improved Care. Dig Dis Sci. Sep 20 2013. http://www.ncbi.nlm.nih.gov/pubmed/24052195

BACKGROUND: Hepatitis B (HBV) is prevalent in certain US populations and regular HBV disease monitoring is critical to reducing associated morbidity and mortality. Adherence to established HBV monitoring guidelines among primary care providers is unknown.

AIMS: The purpose of this study was to evaluate HBV disease monitoring patterns and factors associated with adherence to HBV management guidelines in the primary care setting.

METHODS: Primary providers within the San Francisco safety net healthcare system were surveyed for HBV management practices, knowledge, attitudes, and barriers to HBV care. Medical records from 1,727 HBV-infected patients were also reviewed retrospectively.

RESULTS: Of 148 (45 %) responding providers, 79 % reported ALT and 44 % reported HBV viral load testing every 6-12 months. Most providers were knowledgeable about HBV but 43 % were unfamiliar with HBV management guidelines. Patient characteristics included: mean age 51 years, 54 % male and 67 % Asian. Within the past year, 75 % had ALT, 24 % viral load, 21 % HBeAg tested, and 40 % of at-risk patients had abdominal imaging for HCC. Provider familiarity with guidelines (OR 1.02, 95 % CI 1.00-1.03), Asian patient race (OR 4.18, 95 % CI 2.40-7.27), and patient age were associated with recommended HBV monitoring. Provider HBV knowledge and attitudes were positively associated, while provider age and perceived barriers were negatively associated with HCC surveillance.

CONCLUSIONS: Comprehensive HBV disease monitoring including HCC screening with imaging were suboptimal. While familiarity with AASLD guidelines and patient factors were associated with HBV monitoring, only provider and practice factors were associated with HCC surveillance. These findings highlight the importance of targeted provider education to improve HBV care.

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Walsh JMKim SESawaya GKaplan CPWong STGregorich SEPérez-Stable EJ. Colorectal cancer screening: what do women from diverse ethnic groups want?
J Gen Intern Med. 2013 Feb;28(2):239-46. doi: 10.1007/s11606-012-2210-6. Epub 2012 Sep 12. http://www.ncbi.nlm.nih.gov/pubmed/22968796

BACKGROUND: Little is known about factors associated with willingness to undergo colorectal cancer (CRC) screening for personal or public health benefit among women from diverse race/ethnic groups.

OBJECTIVE: To evaluate factors associated with willingness to undergo CRC screening for personal and public health benefit among women from diverse race/ethnic groups.

METHODS: We interviewed women aged 50 to 80 from four racial/ethnic groups from primary care clinics in 2003-2005. We asked about demographics, CRC screening knowledge and history, perceived risk of colon cancer, and about the outcomes of intention to be screened for personal benefit and for public health benefit.

RESULTS: Of the 492 women who completed the interview, 32 % were White, 16 % were African American, 21 % were Latina and 32 % were Asian. Up-to-date screening was reported by 77 % of women, with similar numbers obtaining fecal occult blood test (FOBT) within 2 years or colonoscopy within 10 years. The majority of women were "likely or very likely" to get FOBT or colonoscopy after learning the benefits and risks. Multivariate models showed that compared to Whites, fewer Asians would undergo colonoscopy (OR = 0.28; 95 % CI: 0.12, 0.63), while more Latinas would undergo colonoscopy (OR = 6.14; 95 % CI: 1.77, 21.34) and obtain regular CRC screening (OR = 4.47; 95 % CI: 1.66, 12.04). The majority would obtain CRC screening even if they would not personally benefit; those who perceived themselves to be at higher than average cancer risk were more likely to participate in CRC screening for public health benefit (OR = 2.32; 95 % CI: 1.32, 4.09).

CONCLUSIONS: The majority of women are willing to undergo screening for personal benefit. Asians were less likely, and Latinas more likely, to accept colonoscopy. Most are also willing to undergo screening for public health benefit. Self-perceived risk of CRC was the most consistent predictor of willingness and intention to be screened for either personal or public health benefit.

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Rafful CGarcía-Rodríguez OWang SSecades-Villa RMartínez-Ortega JMBlanco C. Predictors of quit attempts and successful quit attempts in a nationally representative sample of smokers. Addict Behav. 2013 Apr;38(4):1920-3. doi: 10.1016/j.addbeh.2012.12.019. Epub 2013 Jan 4. http://www.ncbi.nlm.nih.gov/pubmed/23380497

Abstract. Although most current smokers report that they would like to quit, most quit attempts fail suggesting that predictors of quitting attempts may differ from those of successful attempts. We examined sociodemographic and clinical predictors of quit attempts and successful quit attempts in a nationally representative sample of US adults. Data was collected in 2001-2002 (Wave 1) and 2004-2005 (Wave 2). Almost 40% of individuals who had not previously attempted to quit, tried to quit over the next three years; only 4.6% of those who tried had succeeded at the time of the evaluation. Hispanics, Asians, individuals with high income, and those with college education were less likely to attempt to quit, whereas those with daily nicotine use, younger age at first use and most symptoms of dependence were more likely to do so. Having an educational level below high school and older age at first nicotine use were predictors of successful quitting. Despite relatively high rates of quit attempts, rates of success are extremely low, indicating a gap between the public health need of decreasing tobacco use, and existing means to achieve it. Although there is a need to encourage people to quit tobacco, there may be an equally large need to develop more effective interventions that increase the rate of successful quit attempts.

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Robinson-Cohen C, Hoofnagle AN, Ix JH, Sachs MC, Tracy RP, Siscovick DS, Kestenbaum BR, de Boer IH. Racial differences in the association of serum 25-hydroxyvitamin D concentration with coronary heart disease events. JAMA. 2013 Jul 10;310(2):179-88. doi: 10.1001/jama.2013.7228.

IMPORTANCE: Low circulating concentrations of 25-hydroxyvitamin D (25[OH]D) have been consistently associated with an increased risk of coronary heart disease (CHD) in white populations. This association has not been rigorously evaluated in other races or ethnicities, in which the distributions of 25(OH)D concentration and possibly other aspects of 25(OH)D metabolism differ.

OBJECTIVE: To examine the association of serum 25(OH)D concentration with risk of CHD in a multiethnic population.

DESIGN, SETTING, AND PARTICIPANTS: We studied 6436 participants in the Multi-Ethnic Study of Atherosclerosis (MESA), recruited from July 2000 through September 2002, who were free of known cardiovascular disease at baseline. We measured baseline serum 25(OH)D concentrations using a mass spectrometry assay calibrated to established standards. We tested associations of 25(OH)D with adjudicated CHD events assessed through May 2012.
MAIN OUTCOME AND MEASURES: Primary outcome measure was time to first adjudicated CHD event, defined as myocardial infarction, angina, cardiac arrest, or CHD death.

RESULTS:  During a median follow-up of 8.5 years, 361 participants had an incident CHD event (7.38 events per 1000 person-years). Associations of 25(OH)D with CHD differed by race/ethnicity (P for interaction < .05). After adjustment, lower 25(OH)D concentration was associated with a greater risk of incident CHD among participants who were white (n = 167 events; hazard ratio [HR], 1.26 [95% CI, 1.06-1.49] for each 10-ng/mL decrement in 25(OH)D) or Chinese (HR, 1.67 [95% CI, 1.07-2.61]; n = 27). In contrast, 25(OH)D was not associated with risk of CHD in participants who were black (HR, 0.93 [95% CI, 0.73-1.20]; n = 94) or Hispanic (HR, 1.01 [95% CI, 0.77-1.33]; n = 73).

CONCLUSIONS AND RELEVANCE:  Lower serum 25(OH)D concentration was associated with an increased risk of incident CHD events among participants who were white or Chinese but not black or Hispanic. Results evaluating 25(OH)D in ethnically homogeneous populations may not be broadly generalizable to other racial or ethnic groups.

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2012 Dec News