Engaging Hmong adults in genomic and pharmacogenomic research: Toward reducing health disparities in genomic knowledge using a community-based participatory research approach.

Advancing precision medicine relies in part on examining populations that may exhibit unique genetic variants that impact clinical outcomes. Failure to include diverse populations in genomic-based research represents a health disparity. We implemented a community-based participatory research (CBPR) process with the Hmong community in Minnesota, who were refugees from Laos, in order to assess the feasibility of conducting genomic and pharmacogenomic-based research for genetic variants that are relevant to the Hmong community. Our Hmong Genomics Board, consisting of Hmong and non-Hmong professionals, used CBPR principles and built on previous formative research to create and implement culturally and linguistically appropriate informed consent processes for Hmong people at six community venues. The Board chose genetic variants for diabetes risk and warfarin response as relevant to the community. The Institutional Review Board approved aggregate but not individual return of results. Two hundred thirty-seven Hmong participants with mean (range) age of 30.2 (18-81) years and diverse levels of education (22% without and 75% with high-school education) provided saliva for genetic (DNA) analyses. Eighty-five percent of participants agreed to store DNA for future analyses, 82% agreed to share DNA with other researchers, and 78% agreed to be contacted for future studies. Twenty-five elders refused to participate because they wanted individual results. Aggregate results were shared with all participants. This CBPR approach proved highly successful to obtain informed consent and recruit a sample from the Hmong community for a genomic and pharmacogenomic study. Investment in the CBPR process may prove successful to address the gap of genomic information in under-represented communities.

Leaves imitate trees: Minnesota Hmong concepts of heredity and applications to genomics research.

Historically, Hmong refugees in the USA were distrustful of Western medicine, medicines, and medical research due to concerns about harm and experimentation. Current Hmong concerns about genomics research are not well known. Our research aims were to identify cultural and ethical issues about conducting genomic studies in the Hmong community. Using a community-based participatory action process, the West Side Hmong Genomics Research Board conducted a qualitative exploratory research study that included semistructured interviews with five Hmong key informants and five focus groups with 42 Hmong adults near Saint Paul, Minnesota. We used a thematic analysis approach to qualitatively analyze the data. Identified concepts of heredity included characteristics that are passed between the generations: physical features; character traits; some behaviors; some diseases; and probably not response to medicines, although individual variations to medicines are known. Most participants were willing to join genomic research projects to help themselves and community. Others refused to participate: they did not want to know future disease risk; did not want doctors to know their genes; did not trust doctors with their blood; and did not know if they would benefit from results. Ethically, many participants were in favor of confidentiality, but wanted to know their personal results; many were willing to agree to genetic storage of anonymous samples; all agreed with individual consent, not family or community consent; and none were concerned about social stigma from genetic testing about chronic diseases and medications. The Hmong Genomics Board will build upon these concepts to create, conduct, and evaluate culturally-appropriate genomic and pharmacogenomic research projects relevant to community interests.

High prevalence of gouty arthritis among the Hmong population in Minnesota.

OBJECTIVE: The prevalence of gout is on the rise worldwide, especially among newly industrialized populations. We evaluated the prevalence of gout in the recently established Hmong of Minneapolis/St. Paul (MSP) compared with that in non-Hmong populations. METHODS: The prevalence of self-reported gout in the Hmong population was estimated from 2 cross-sectional community surveys and compared with national data extrapolated from the Third National Health and Nutrition Examination Survey. The prevalence of physician-diagnosed gout in Hmong and non-Hmong MSP residents was separately estimated from the diagnosis codes of 11 MSP primary care clinics. RESULTS: The prevalence of self-reported gout among MSP Hmong was 2-fold higher than in the general US population (6.5% versus 2.9%; P < 0.001). Although women of both groups reported gout at a rate of 1.9%, Hmong men were significantly more likely than their non-Hmong counterparts to report gout (11.5% versus 4.1%; P < 0.001). Similar results were observed when investigating physician-diagnosed gout in MSP (2.8% Hmong versus 1.5% non-Hmong; P < 0.001). No difference was observed between the women of the 2 groups (0.8% versus 0.7%; P = 0.833), whereas Hmong men were more than twice as likely to be diagnosed with gout compared with their non-Hmong counterparts (6.1% versus 2.5%; P < 0.001). Among Hmong men, advancing age was associated with a considerably higher likelihood of being diagnosed with gout. CONCLUSION: A significant association is observed between Hmong ethnicity and gout, both self-reported and physician diagnosed. This unique population may provide an opportunity to further our understanding of the pathophysiology of gout.

Cardiovascular disease risks in Hmong refugees from Wat Tham Krabok, Thailand.

No epidemiological studies on cardiovascular disease (CVD) were conducted on Hmong refugees arriving to the U.S. from 1970s to 1990s. This study measured prevalence of CVD and CVD risk factors in Hmong refugees newly arriving from Wat Tham Krabok, Thailand 2004-2006. Cross-sectional study of 1,462 Hmong refugees who received refugee screening exams at seven primary care clinics in St. Paul MN, June 2004-March 2006. In younger age group (N = 988, 0-20 years old), overweight equaled 13.7%, hypertension = 8.2%, pre-hypertension = 9.6% and in a subset, hyperglycemia equaled 20.7% and hyperlipidemia = 13.5%. In older age group (N = 448, >20 years old), overweight equaled 33.4%, obese = 14.8%, hypertension = 16.5%, and pre-hypertension = 36.2%. In a subset, diabetes mellitus = 2.8%, hyperglycemia = 31.7%, hyperlipidemia = 25.8%, renal insufficiency = 9%, and hyperuricemia = 11.7%. Hmong refugees had significant CVD risk factors on arrival. Healthcare providers and public health officers must identify CVD in addition to infectious diseases when refugees arrive in the U.S. and must address long-term care in order to forestall the development of CVD.

Orphan boy the farmer: evaluating folktales to teach safety to Hmong farmers.

Many Hmong refugees continue their cultural tradition of farming in the United States. The purpose of this project was to evaluate culturally based storytelling as a method to convey farming safety information to Hmong families. Hmong have an oral tradition; spoken stories are used to teach about heritage, as well as personal and social values, and end with a lesson or moral that can apply to their lives. Stories from "Orphan Boy the Farmer" illustrate hazards, behaviors, consequences, and control strategies related to farm work typical of Hmong farming in Minnesota and Wisconsin. The message of the 3 stories is that the successful farmer works safely and keeps his children safe from injury. Three stories were read, in Hmong, at 6 events in Minnesota and Wisconsin. Data were collected from 118 participants using focus group discussions. Transcripts were translated and analyzed to identify ideas and reactions to the stories expressed by participants. Findings indicate that storytelling was an appealing delivery method for most of the participants of this study. Participants were able to recount story content pertaining to farming safety and relate messages to their experiences dealing with hazards; unanticipated findings uncovered barriers to adopting safe practices. Several aspects of the storytelling performance influence its effectiveness. Development of folktale content and implementation of storytelling performances are described.