Evaluation of a Health Professionals' Training Program to Conduct Research in New York City's Asian American Community.

BACKGROUND: Because health disparities among Asian Americans are understudied, a partnership program between the Charles B Wang Community Health Center and the Center for the Study of Asian American Health was created to increase awareness and interest in Asian American research. PURPOSE: To evaluate the process, outcome, and impact of a health professionals' research training program. METHODS: Mixed research methods were employed to collect data from online surveys administered to mentors and trainees of the program. RESULTS: Although many trainees did not continue to pursue Asian American health disparities research, results indicate that the program has positive impacts on trainees in their preparedness to conduct CBPR, work within the Asian American community, and network with public health professionals and researchers. DISCUSSION: This evaluation adds to the current literature of research training programs but more research on Asian American health disparities is needed. TRANSLATION TO HEALTH EDUCATION PRACTICE: Although the program has helped raise awareness in Asian American health disparities research, more Asian American specific research training programs are needed to stimulate a true generation of researchers.

A community health worker intervention to improve management of hypertension among Filipino Americans in New York and New Jersey: a pilot study.

OBJECTIVE: The purpose of the pilot study was to assess the feasibility and efficacy of a 4-month community health worker (CHW) intervention to improve hypertension management among Filipino immigrants in New York and New Jersey. DESIGN: Single-arm CHW pilot intervention using a pre-post design delivered by 5 CHWs. SETTING: New York City, NY and Jersey City, NJ. PARTICIPANTS: Of 88 Filipino individuals recruited for the study, 39 received the full pilot intervention, 18 received a partial intervention, and 31 dropped out; 13 Filipino participants, 10 CHW Trainers, and 3 Filipino CHWs were interviewed for qualitative analysis. INTERVENTION: Individuals participated in 4 workshops related to hypertension management and cardiovascular disease (CVD) risk factors and received monthly in-person visits, and twice monthly phone calls individually from a CHW. MAIN OUTCOME MEASURES: Primary outcomes included blood pressure (BP) reduction and control, appointment keeping, and medication adherence; secondary outcomes included weight, body mass index (BMI), self-efficacy related to diet, exercise, and medication taking, CVD knowledge, and nutrition (salt/ sodium and cholesterol/fat). RESULTS: A mixed method analysis was used to assess the intervention, utilizing quantitative and qualitative methods. By the end of the intervention, significant changes were exhibited for systolic and diastolic BP, weight, and BMI (P<.01). Significant changes were not seen for medication adherence and appointment keeping, however, CVD knowledge and self-efficacy related to diet and weight management all improved significantly (P<.01). Qualitative findings provided additional information on the acceptability, feasibility, and efficacy of the intervention. CONCLUSIONS: This pilot CHW intervention showed evidence of feasibility, as well as efficacy, in improving hypertension management and reducing CVD factors in Filipino Americans.

Protocol for the DREAM Project (Diabetes Research, Education, and Action for Minorities): a randomized trial of a community health worker intervention to improve diabetic management and control among Bangladeshi adults in NYC.

BACKGROUND: New York City (NYC) is currently home to the largest Bangladeshi population in the United States (US) at approximately 62,000 individuals. The high prevalence of Type 2 diabetes mellitus (T2DM) among Bangladeshis has been well documented in Bangladesh, as well as in Canada and the United Kingdom (UK). However, little is known about the diabetes prevalence and management practices of US Bangladeshis. This paper describes the protocol for a Community Health Worker (CHW) intervention to improve diabetic management and control among Bangladeshis with diabetes in NYC. METHODS/DESIGN: For a two-arm, randomized controlled trial (RCT), investigators will recruit a sample of 256 participants, all of whom are 1) of Bangladeshi descent, 2) residing in NYC, 3) diagnosed with T2DM and a recent Hemoglobin A1c (HbA1c) of ≥ 6.5, and 4) between the ages of 21-85. The treatment group receives a six-month CHW-led intervention consisting of five monthly group educational sessions, two one-on-one visits, and follow-up phone calls as needed from a CHW. The control group receives an introductory educational session only. Primary and secondary outcomes include clinical and behavioral measures, such as HbA1c and weight change, access to and utilization of care (i.e. appointment keeping and use of specialty care), and knowledge and practice of physical activity and healthful eating. Additionally, information regarding CHW characteristics, the processes and mechanisms for influencing healthful behavior change, and fidelity of the intervention are collected. Outcomes are measured at Baseline, 3-Months, 6-Months for both groups, and at 12-Months for the treatment group. DISCUSSION: To our knowledge, this study represents the first attempt to document the efficacy of T2DM management strategies in the NYC Bangladeshi population. Thus, future qualitative and quantitative findings of the submitted protocol will fill an important gap in the health disparities literature. TRIAL REGISTRATION: NCT02041598.

Awareness, treatment and control of hypertension among Filipino immigrants.

BACKGROUND: Filipino Americans have high rates of hypertension, yet little research has examined hypertension awareness, treatment, and control in this group. OBJECTIVE: In a community-based sample of hypertensive Filipino American immigrants, we identify 1) rates of hypertension awareness, treatment, and control; and 2) factors associated with awareness, treatment, and control. DESIGN: Cross-sectional analysis of survey data from health screenings collected from 2006 to 2010. PARTICIPANTS: A total of 566 hypertensive Filipino immigrants in New York City, New York and Jersey City, New Jersey. MAIN MEASURES: Hypertension awareness, treatment, and control. Participants were included in analysis if they were hypertensive, based on: a past physician diagnosis, antihypertensive medication use, and/or high blood pressure (BP) screening measurements. Demographic variables included sex, age, time in the United States, location of residence, and English spoken language fluency. Health-related variables included self-reported health, insurance status, diabetes diagnosis, high cholesterol diagnosis, clinical measures (body mass index [BMI], glucose, and cholesterol), exercise frequency, smoking status, cardiac event history, family history of cardiac event, and family history of hypertension. RESULTS: Among the hypertensive individuals, awareness, treatment, and control rates were suboptimal; 72.1 % were aware of their status, 56.5 % were on medication, and only 21.7 % had controlled BP. Factors related to awareness included older age, worse self-reported health, family history of hypertension, and a diagnosis of high cholesterol or diabetes; factors related to treatment included older age, longer time lived in the United States, and being a non-smoker; having health insurance was found to be the main predictor of hypertension control. Many individuals had other cardiovascular disease (CVD) risk factors; 60.4 % had a BMI ≥25, 12.0 % had at-risk glucose measurements and 12.8 % had cholesterol ≥ 240. CONCLUSIONS: Hypertensive Filipinos exhibit poor hypertension management, warranting increased efforts to improve awareness, treatment and control. Culturally tailored public health strategies must be prioritized to reduce CVD risk factors among at-risk minority populations.

Using the Delphi and snow card techniques to build consensus among diverse community and academic stakeholders.

BACKGROUND: The New York University- New York City Health and Hospitals Corporation (NYU-HHC) Clinical and Translational Science Institute (CTSI) used a community-based participatory research (CBPR) and consensus-building approach among its community advisory board (CAB) and steering committee (SC) members to formulate research priorities to foster shared research collaborations. METHODS: The Delphi technique is a methodology used to generate consensus from diverse perspectives and organizational agendas through a multi-method, iterative approach to collecting data. A series of on-line surveys was conducted with CAB members to identify health and research priorities from the community perspective. Subsequently, CAB and SC members were brought together and the snow card approach was utilized to narrow to two priority areas for shared research collaborations. RESULTS: Cardiovascular disease (CVD)/obesity and mental health were identified as health disparity areas for shared research collaborations within a social determinants framework. In response, two workgroups were formed with leadership provided by three co-chairs representing the three constituents of the NYU-HHC CTSI: NYU faculty, HHC providers, and community leaders CONCLUSIONS: The Delphi approach fostered ownership and engagement with community partners because it was an iterative process that required stakeholders' input into decision making. The snow card technique allowed for organizing of a large number of discrete ideas. Results have helped to inform the overall CTSI research agenda by defining action steps, and setting an organizing framework to tackle two health disparity areas. The process helped ensure that NYUHHC CTSI research and community engagement strategies are congruent with community priorities.

Evaluation of a community health worker pilot intervention to improve diabetes management in Bangladeshi immigrants with type 2 diabetes in New York City.

PURPOSE: The purpose of this study is to explore the impact and feasibility of a pilot Community Health Worker (CHW) intervention to improve diabetes management among Bangladeshi-American individuals with type 2 diabetes living in New York City. METHODS: Participants were recruited at clinic- and community-based venues. The intervention consisted of 6 monthly, CHW-facilitated group sessions on topics related to management of diabetes. Surveys were collected at baseline and follow-up time points. Study outcomes included clinical, behavioral, and satisfaction measures for participants, as well as qualitative measures from CHWs. RESULTS: Improvements were seen in diabetes knowledge, exercise and diet to control diabetes, frequency of checking feet, medication compliance, and self-efficacy of health and physical activity from baseline to 12 months. Additionally, there were decreases in A1C, weight, and body mass index. Program evaluation revealed a high acceptability of the intervention, and qualitative findings indicated that CHWs helped overcome barriers and facilitated program outcomes through communal concordance, trust, and leadership. CONCLUSIONS: The intervention demonstrated high acceptability and suggested efficacy in improving diabetes management outcomes among Bangladeshi immigrants in an urban setting. The US Bangladeshi population will continue to increase, and given the high rates of diabetes, as well as linguistic and economic barriers faced by this community, effective and culturally tailored health interventions are needed to overcome barriers and provide support for diabetes management.

Smoking among Asian Americans: acculturation and gender in the context of tobacco control policies in New York City.

New York City (NYC) has experienced significant decline in smoking prevalence since its antismoking campaign; however, the rates among NYC's Asian communities have persisted since 2002. Using combined data from the REACH US Risk Factor Survey (2009-2011), this article examined ethnic- and gender-specific smoking behaviors and the effects of acculturation and location of residence on cigarette smoking behavior among Chinese, Korean, Asian Indians, and other Asian Americans. Results indicated that current smoking prevalence was higher for men than women among all four groups. Korean men and women had the highest current smoking rates whereas Indians had the lowest among the four subgroups. Asian American women reporting speaking only English at home had higher current smoking prevalence, but this was not observed for men. Living in Sunset Park, an emerging Asian ethnic enclave, was associated with higher odds of smoking than living in other locations in NYC. In conclusion, smoking prevalence varied across gender and ethnic subgroups among Asian Americans in NYC. A "one-size-fits-all" type of intervention strategy for "pan-Asians" could not be effective. Community-based culturally appropriate and gender-specific interventions for smoking cessation might be an option for Asian Americans residing in linguistically isolated ethnic enclaves.

Predictors of hypertension among Filipino immigrants in the Northeast US.

Hypertension remains disproportionately high among Filipinos compared to other racial and ethnic minority populations, and little research on cardiovascular disease risk factors has been conducted among Filipino immigrants in the Northeastern part of the United States. To determine hypertension prevalence and risk factors among Filipino Americans in the New York City area, blood pressure and other clinical measurements were taken from a sample of Filipino Americans during 119 community health screenings conducted between 2006 and 2010. Additional socio-demographic and health-related characteristics were also collected via a cross-sectional survey. A total of 1,028 Filipino immigrants completed the survey and had clinical readings collected. Bivariate analyses and logistic regression were performed in order to predict and assess risk factors for hypertension among our sample. Fifty-three percent of individuals were hypertensive, and half of hypertensive individuals were uninsured. Logistic regression indicated that older age, male gender, living in the United States for over 5 years, a BMI greater than 23.0 kg/m(2), an elevated glucose reading, a family history of hypertension, and fair or poor self-reported health status were predictors of hypertension. There is a great need to develop more effective community-based interventions in the Filipino community to address cardiovascular health disparities.

Role of federal policy in building research infrastructure among emerging minorities: the Asian American experience.

PROBLEM: Considerable progress in Asian American health research has occurred over the last two decades. However, greater and sustained federal support is needed for reducing health disparities in Asian American communities. PURPOSE OF THE ARTICLE: This paper reviews federal policies that support infrastructure to conduct minority health research and highlights one model for strengthening research capacity and infrastructure in Asian American communities. KEY POINTS: Research center infrastructures can play a significant role in addressing pipeline/workforce challenges, fostering campus-community research collaborations, engaging communities in health, disseminating evidence-based strategies and health information, and policy development. CONCLUSION: Research centers provide the capacity needed for academic institutions and communities to work together synergistically in achieving the goal to reduce health disparities in the Asian American community. Policies that support the development of concentrated and targeted research for Asian Americans must continue so that these centers will reach their full potential.

Understanding barriers to and facilitators of diabetes control and prevention in the New York City Bangladeshi community: a mixed-methods approach.

We have reported results from the formative stage of a community health worker intervention designed to improve diabetes management among Bangladeshi patients in New York City. Trained community health workers conducted focus groups (n = 47) and surveys (n = 169) with Bangladeshi individuals recruited from community locations. Results indicated that participants faced numerous barriers to care, had high rates of limited English proficiency, and had low levels of knowledge about diabetes. Most participants expressed interest in participating in a community health worker intervention.

The Asian American hepatitis B program: building a coalition to address hepatitis B health disparities.

BACKGROUND: Community coalitions are increasingly recognized as important strategies for addressing health disparities. By providing the opportunity to pool resources, they provide a means to develop and sustain innovative approaches to affect community health. OBJECTIVES: This article describes the challenges and lessons learned in building the Asian American Hepatitis B Program (AAHBP) coalition to conduct a community-based participatory research (CBPR) initiative to address hepatitis B (HBV) among New York City Asian-American communities. METHODS: Using the stages of coalition development as a framework, a comprehensive assessment of the process of developing and implementing the AAHBP coalition is presented. LESSONS LEARNED: Findings highlight the importance of developing a sound infrastructure and set of processes to foster a greater sense of ownership, shared vision, and investment in the program. CONCLUSION: Grassroots community organizing and campus-community partnerships can be successfully leveraged to address and prevent a significant health disparity in an underserved and diverse community.

Moderate doses of hGH (0.64 mg/d) improve lipids but not cardiovascular function in GH-deficient adults with normal baseline cardiac function.

CONTEXT: Data regarding effects of lower-dose GH on cardiopulmonary function in GH-deficient (GHD) adults are limited. OBJECTIVES: The objective was to assess effects of lower-dose GH on exercise capacity and echocardiographic parameters in GHD adults. DESIGN: The study was a 6-month double-blind, placebo-controlled randomized trial. SETTING: The study was conducted at the General Clinical Research Center. PARTICIPANTS: Thirty hypopituitary adults with GHD were studied. INTERVENTION: Subjects were randomized to recombinant human GH or placebo for 6 months, followed by open-label recombinant human GH for 12 months. MAIN OUTCOME MEASURES: Primary endpoints were exercise duration, maximal oxygen consumption, and left ventricular ejection fraction. Secondary endpoints were echocardiographic indices of systolic and diastolic function, left ventricular mass, lipids, and body composition. RESULTS: In the 6-month double-blind phase, mean GH dose was 0.64 mg/d. Mean IGF-I sd score increased from -4.5 to -1.0. Exercise duration, maximal oxygen consumption, left ventricular ejection fraction, and other echocardiographic parameters were normal at baseline and did not change. GH decreased total and low-density lipoprotein cholesterol by 7.5% (P = 0.016) and 14.7% (P = 0.002) (P = 0.04 vs. placebo). Mean lean body mass increased by 2.2 kg (P = 0.004), fat mass decreased by 1.7 kg (P = 0.21), and percent body fat decreased by 2.5% (P = 0.018), although between-group changes were not significant. CONCLUSIONS: Human GH did not improve exercise performance or echocardiographic parameters or decrease fat mass but significantly decreased total and low-density lipoprotein cholesterol, increased IGF-I, and increased lean body mass. These results indicate that responses to human GH are variable and should be assessed at baseline and during treatment.

Using community-based participatory research as a guiding framework for health disparities research centers.

There has been growing interest in conducting community-based health research using a participatory approach that involves the active collaboration of academic and community partners to address community-level health concerns. Project EXPORT (Excellence in Partnerships, Outreach, Research, and Training) is a National Center for Minority Health and Health Disparities (NCMHD) initiative focused on understanding and eliminating health disparities for racial and ethnic minorities and medically underserved populations in the United States. The New York University (NYU) Center for the Study of Asian American Health (CSAAH) is 1 of 76 Project EXPORT sites. This paper describes how CSAAH developed partnerships with varied Asian American community stakeholders as a first step in establishing itself as a Project EXPORT center that uses community-based participatory research (CBPR) as its orienting framework. Three guiding principles were followed to develop community-academic partnerships: (1) creating and sustaining multiple partnerships; (2) promoting equity in partnerships; and (3) commitment to action and research. We discuss strategies and action steps taken to put each principle into practice, as well as the successes and challenges we faced in doing so. Developing community-academic partnerships has been essential in our ability to conduct health disparities research in Asian American communities. Approaches and lessons learned from our experience can be applied to other communities conducing health disparities research.

A new functional status outcome measure of dyspnea and anxiety for adults with lung disease: the dyspnea management questionnaire.

PURPOSE: To develop and psychometrically test the Dyspnea Management Questionnaire (DMQ), a new multidimensional measure of dyspnea in adults with chronic obstructive lung disease. PARTICIPANTS: Eighty-five participants were recruited with diagnoses of chronic obstructive pulmonary disease (COPD, n = 73) and asthma (n = 12). The total sample was predominately female (65%) and married (34%), with 64.9% white and a mean age of 75 years (SD = 9.6, n = 76), diagnosed with pulmonary disease 4.8 years ago (SD = 4.4), 32% requiring the use of supplemental oxygen. Participants were also African American (29.9%), Asian (2.6%), and Hispanic (2.6%); n = 77. METHODS: An initial item pool of 74 items was drawn for the DMQ aided by qualitative interview data, literature review, and pilot testing with 3 adults with COPD. Several analyses were used to reduce the item pool. An interdisciplinary panel of 12 experts evaluated the content validity of the DMQ items. To evaluate test-retest reliability, respondents with stable COPD (n = 26) completed the questionnaire twice within a mean interval of 18 days (SD = 7.17). The DMQ was compared with the Medical Outcomes Study 12-Item Short-Form (SF-12) Health Survey, the Seattle Obstructive Lung Disease Questionnaire, and the Hospital Anxiety and Depression Scale. RESULTS: The resulting DMQ is a 30-item scale that measures 5 conceptually derived dimensions: dyspnea intensity, dyspnea-related anxiety, fearful activity avoidance, self-efficacy for activity, and satisfaction with strategy use. It has a 7-point Likert-type scale and third Flesch-Kincaid reading grade level. A panel of 12 experts supported the content validity of the DMQ. It showed high internal consistency (alpha = .87 to .96) and test-retest reliability over 2.5 weeks (intraclass correlation coefficient = 0.71 to 0.95). Dyspnea intensity, dyspnea-related anxiety, and fearful activity avoidance subscales of DMQ-30 and composite score were moderately to highly correlated with 3 Seattle Obstructive Lung Disease Questionnaire dimensions (r = 0.44-0.83), Medical Outcomes Study 12-Item Short-Form scales (r = 0.41-0.57), and Hospital Anxiety and Depression Scale-Anxiety (r = -0.59 to -0.65). Two of DMQ's subscales, self-efficacy for activity and satisfaction with strategy use, correlated mildly with Seattle Obstructive Lung Disease Questionnaire (r = 0.28 and 0.27, respectively). Some very low correlations for DMQ-30's satisfaction with strategy use compared with the Medical Outcomes Study 12-Item Short-Form provided preliminary support for its divergent construct validity. The DMQ-30 discriminated adults with COPD requiring supplemental oxygen from those not requiring it. CONCLUSIONS: The DMQ addresses the need for a more comprehensive, multidimensional assessment of dyspnea, especially for anxious patients with COPD, in order to better guide the appropriate application of dyspnea management interventions and measure pulmonary rehabilitation outcomes. The DMQ can help add insights into the benefit of adjunctive therapies such as psychoeducation, controlled breathing strategies, and cognitive-behavioral approaches in pulmonary rehabilitation for anxious patients with COPD.

Effects of horticultural therapy on mood and heart rate in patients participating in an inpatient cardiopulmonary rehabilitation program.

PURPOSE: To assess the effects of horticultural therapy (HT) on mood state and heart rate (HR) in patients participating in an inpatient cardiac rehabilitation program. METHODS: Cardiac rehabilitation inpatients (n = 107) participated in the study. The HT group consisted of 59 subjects (34 males, 25 females). The control group, which participated in patient education classes (PECs), consisted of 48 subjects (31 males, 17 females). Both HT sessions and PEC are components of the inpatient rehabilitation program. Each group was evaluated before and after a class in their respective modality. Evaluation consisted of the completion of a Profile of Mood States (POMS) inventory, and an HR obtained by pulse oximetry. RESULTS: Changes in the POMS total mood disturbance (TMD) score and HR between preintervention and postintervention were compared between groups. There was no presession difference in either TMD score (16 +/- 3.6 and 19.0 +/- 3.2, PEC and HT, respectively) or HR (73.5 +/- 2.5 and 79 +/- 1.8, PEC and HT, respectively). Immediately following the intervention, the HT TMD was significantly reduced (post-TMD = 1.6 +/- 3.2, P < .001), while PEC TMD was not significantly changed (TMD = 17.0 +/- 28.5). After intervention, HR fell in HT by 4 +/- 9.6 bpm (P < .001) but was unchanged in PEC. CONCLUSION: These findings indicate that HT improves mood state, suggesting that it may be a useful tool in reducing stress. Therefore, to the extent that stress contributes to coronary heart disease, these findings support the role of HT as an effective component of cardiac rehabilitation.

The effectiveness of different combinations of pulmonary rehabilitation program components: a randomized controlled trial.

STUDY OBJECTIVES: To study the short-term and long-term effects of combining activity training or lectures to exercise training on quality of life, functional status, and exercise tolerance. DESIGN: Randomized clinical trial. SETTING: Outpatient pulmonary rehabilitation center. PARTICIPANTS: Forty-three outpatients with COPD. INTERVENTIONS: Patients were randomized to one of three treatment groups: exercise training alone, exercise training plus activity training, and exercise training plus a lecture series. The mean treatment period was 10 weeks. MEASUREMENT: The Chronic Respiratory Disease Questionnaire, the modified version of the Pulmonary Functional Status and Dyspnea Questionnaire, and the COPD Self-Efficacy Scale were administered at baseline, and 6, 12, 18, and 24 weeks from the beginning of the rehabilitation program. The 6-min walk test was used to measure exercise tolerance. RESULTS: Benefits of activity training combined with exercise included less dyspnea (p < or = 0.04) and fatigue (p < or = 0.01), and increased activity involvement (p < or = 0.02) and total functional status (p < or = 0.02) in the short term compared to comparison treatment groups for comparatively older participants. Compared to the lecture series adjunct, the activity training adjunct resulted in significantly higher gains in total quality of life (p = 0.04) maintained at 24 weeks. Significantly worse emotional function and functional status resulted from the lecture series adjunct in the oldest participants (p < or = 0.03). Treatment groups did not differ significantly on exercise tolerance or self-efficacy. CONCLUSIONS: Evidence for additional benefits of activity-specific training combined with exercise was found. A behavioral method emphasizing structured controlled breathing and supervised physical activity was statistically significantly more effective than didactic instruction in facilitating additional gains and meeting participants' learning needs.

Medical humanities at New York University School of Medicine: an array of rich programs in diverse settings.

The New York University School of Medicine has a rich tradition of cultivating programs in medical humanities and professionalism. They are drawn from the departments, centers, students, and faculty in the School of Medicine, have linkages throughout the university, and are interwoven into the fabric and culture of the institution. Some are centrally based in the School of Medicine's deans' office, and others are located in individual departments and receive support from the dean's office. This article describes representative programs for medical students and faculty. Curricular initiatives, the fundamental components of medical students' learning, include a course entitled "The Physician, Patient, and Society," a clerkship essay in the Medicine Clerkship, an opportunity for reflection during the medicine clerkship, and a medical humanities elective. In 2002, the Professionalism Initiative was launched to enhance and reflect the values of the medical profession. Its curriculum consists of a series of events that coordinate, particularly, with existing elements of the first-year curriculum (e.g., orientation week, a session during anatomy, a self-assessment workshop, and a peer-assessment workshop). The Master Scholars Program is a group of five, theme-based master societies consisting of faculty and students who share common interests around the society's themes. Programs developed for the societies include colloquia, faculty-led seminars, a mandatory student-mentoring program, and visiting scholars. Finally, the authors describe three high-quality literary publications created at New York University School of Medicine. Each of the initiatives undergoes regular critical examination and reflection that drive future planning.