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- 1. Filipino Americans and “High Blood”: Addressing Challenges of Heart Health Rhodora Ursua, MPH Project Director July 23, 2010 FANHS 13th Biennial National Conference
- 2. act Project EXPORT P60 Center CSAAH was founded in 2003 and funded by NIH/NCMHD as a Center of Excellence dedicated to the research and reduction of health disparities affecting Asian Americans through research, training, and partnership.
- 3. Project AsPIRE’s story… Feb 2004 April 2004 Summer 2004 April 2005 Community Outreach Forum Sep 2005
- 4. Mission Kalusugan Coalition is a multidisciplinary collaboration dedicated to creating a unified voice to improve the health of the Filipino community in the NY/NJ area through network development, educational activities, research, community action, and advocacy.
- 5. What the literature shows: Filipinos and Hypertension Heart disease accounted for 33% of all deaths for Filipino Americans compared to 19% for Vietnamese, 24% for Koreans, 28% for Japanese, and 29% for Chinese. Ryan et al., 2000 The rate of hypertension was highest among Filipino men and women compared to other Asian Americans Klatsky et al., 1991 Filipinos ranked among the lowest in adherence to antihypertensive medication when compared to other groups. Taira et al., 2007
- 6. What the literature shows: Filipinos and Diabetes Diabetes is more common among Filipino than in Whites and other Asian Pacific Islander subgroups [Filipinos (21.2%), Whites (8.1 %), All Asians combined (12.9%)]. Javier et al., 2007; Gomez et al, 2004. Filipinos had a higher incidence of diabetes (34.7% vs. 24.1%) than whites. Ryan et al., 2000 Filipinas had higher prevalence of type 2 diabetes and metabolic syndrome compared to White women [Filipina women (36.4%), Caucasian women (8.7%)]. Araneta et al., 2002
- 7. What the literature shows: Filipinos and Obesity Filipino adults (14%) were more than twice as likely to be obese as Asian Indian (6%), Vietnamese (5%), or Chinese adults (4%). CDC, National Health Interview Surveys, 2004-2006. Filipino men (42%) and Filipino women (26%) had higher median BMI readings (all with a BMI ≥ 24) when compared to other Asian ethnic subgroups. Lauderdale and Rathouz, 2000 (Hawaii). A comparison study among Asian and Pacific Islander adults in Hawaii found Filipinos to be the least active (31.8%, 18.6%). Mampilly et al., 2005. Dramatic rise in overweight and obesity in adult Filipino women: 28% of Filipina non-pregnant women (n=1,943) were overweight (25<BMI<30). Adair et al., 2004 (Cebu, Philippines, 1983-1999).
- 8. What the literature shows: Filipinos and Smoking The California Health Information survey showed that 1 out of 4 Filipino-American adults smoke, ranking third among other Asian subgroups. Maxwell et al., 2005. In a sample of 318 Filipino American men,70% reported having ever smoked at least 100 cigarette in their entire life. Maxwell et al., 2007.
- 9. Filipino Population in NYC & NJ Total Filipino Population 10,223 New York State: 120,940 New Jersey State: 121,197 5,446 Total NYS & NJS: 242,137 Note: Alone or in Combination Source: U.S. Census Community Health Survey, 2008 33,225 NJ - largest population by county Morris County - 3,459 7,918 Essex County - 8,406 Union County - 6,313 Middlesex - 13,507 5,246 Bergen County - 15,403 Hudson County - 30,066
- 10. Cardiovascular disease as prominent health concern (n=120) Source: Abesamis-Mendoza et al., (2007), Community Health Needs & Resource Assessment
- 11. Financial barriers as most commonly experienced health care access barrier Source: Abesamis-Mendoza et al., (2007), Community Health Needs & Resource Assessment
- 12. Project AsPIRE: Overall Goal To improve the health care access and status for Hypertension and CVD in the NYC/NJ Filipino American community through interventions by community health workers
- 13. The Big Picture Potential funding for 11 years 3 year 5 year 3 year planning implementation dissemination grant grant grant Funding by NIH/NCMHD for health disparities intervention research
- 14. Community-Based Participatory Research (CBPR) “A collaborative approach to research that equitably involves all partners in the research process and recognizes the unique strengths that each brings”. --W.K. Kellogg Foundation (2001)
- 15. Participant recruitment 75 community health screenings in NYC & NJ
- 16. Engaged community in participant recruitment Involved churches, businesses, CBOs with Filipino base Trained members within these groups about the study & how to collect data Administered survey in Tagalog when necessary Recruited Filipino health professionals to conduct screening Utilized health education materials in Tagalog
- 17. In partnership with… 17 faith based organizations New Jersey New York •Day by Day Christian Ministries St. Lucy’s •Christian Living Fellowship St. Sebastian’s •St. Joseph’s Church St. Bartholomew’s •St. Aedan’s Church Elmhurst Baptist Church •St. Mary’s Church Most Precious Blood Church •Sisters of Our Lady of the Poor Our Lady of Pompeii •Our Lady of Victories Hillside Church of Christ •COMFI Corpus Christi Church
- 18. 15 civic, government, and community organizations NJ Pan-American Concerned Citizens League (PACCAL) Philippine American Veterans Organization (PAVO) City Hall-Jersey City CREATE Charter School NY Anak Bayan NY/NJ Damayan Migrant Workers’ Association Filipino American Human Services, Inc. (FAHSI) Philippine Consulate Philippine Forum Philippine Jaycees Renaissance Charter School NYC Department of Health Ugnayan ng Mga Anak ng Bayan
- 19. 10 local businesses NJ Phil-Am Trading Co. Kusina Kabalen Blue Ribbon Rowena’s Topnotch Monica Claire Restaurant Philippine National Bank NY Johnny Air Cargo Sally’s Restaurant
- 20. 31 health providers 17. Dr. Erie Agustin 1. APICHA 18. Dr. Apiado 2. Bellevue Occupational Health 19. Dr. Expedito Castillo 3. Cabrini Medical Center 20. Dr. Mark Causin 4. Charles B. Wang Community Health Center 21. Merryl Foz, RN 5. Child Center of New York 22. Myrna Deleon, RN 6. Elmhurst Hospital-Cardiology Department 23. Dr. Arnil Neri 7. Horizon Medical Center 24. Dr. Oca 8. Philippine Nurses Association-NY 25. Dr. Zenaida Santos 9. Philippine Medical Association in America 26. Dr. Marissa Santos 10. Queens Hospital 27. Violeta Totanes, RN 11. Philippine Physical Therapists 28. Cora Velasco, RN 12. Metropolitan Family Health Network (Garfield) 29. Nino Velasco, RN 13. NYU Medical School 30. Rodelia Villanueva, RN 14. NYU Dental School 31. Kim Quilban, RN 15. United Home Care 16. UPMASA
- 21. AsPIRE Screening Data Sample size: n=1750 Gender: 68% female, 32% male Geography: NYC (n=1011), NJ (n=719) Place of birth: 94% born in Philippines Insurance status: 45% uninsured Self-perceived health status: Poor (2%) Fair (21%)
- 22. Hypertension among 1750 Filipinos 3 out of 5 1 out of 2 1 out of 2 individuals individuals individuals had with elevated BP were taking BP elevated BP NOT taking BP medication still medication had elevated BP
- 23. Body Mass Index (BMI) Among 1428 Filipinos 2 OUT OF 5 WERE OVERWEIGHT Underweight Normal Overweight Obese Gender TOTAL (> 18.5) (18.5 - 24.9) (25 - 29.9) ( < 30 ) Male 6(1.3%) 188 (40.2%) 236 (50.4%) 38(8.1%) 486 Female 16 (1.5%) 520(54.2%) 353 (36.8%) 71 (7.4%) 960 TOTAL 22(1.5%) 708(49.6%) 589 (41.2%) 109 (7.6%) 1428
- 24. Smoking and Exercise among Hypertensive Sample
- 25. Family history of cardiac event Self reported family* event Stroke Congestive Heart Attack Heart Failure 669 (38.2%) 317 (18%) 522 (30%) *Family includes: father, mother, siblings, and grandparents. (n=1750)
- 26. Predictors of Hypertension Compared to their counterparts, Filipinos in this study were •2 times more likely to be hypertensive if they were: •Male •Unemployed •Overweight •Rated their health as fair or poor •Living in U.S. more than 15 years •4 times more likely to be hypertensive if they were obese •5 times more likely to be hypertensive if they were older than 52 years
- 28. Filipino restaurants: food availabilty “This is a picture of a busy block in Woodside, Queens that has at least 5 Filipino restaurants next to each other. Many Filipinos go to this one area. Since all the restaurants are on one block, this creates a problem because Filipinos eat a lot.” -Filipino youth
- 29. Filipino diet: high salt + large portions “This is what I ate. It’s really salty and really good. It’s one of my favorite dishes. It’s so unhealthy. I didn’t finish the plate because it was a big serving. This shows that we need to be aware of our comfort foods. It’s common to eat this everyday for breakfast. It’s very filling.” – Filipino youth
- 30. Gardening: healthy food and sense of community Garden in the backyard- Healthy Food and Balance Diet “My husband and I are excited when spring starts. We have seeds of different kinds of vegetables to plant in our backyard. It is our joy to see and watch when it starts to have leaves, flowers and the fruit etc. We watch the plants every morning. Besides that it is an exercise for us. We enjoy it. We harvest a lot. We share some to our friends, neighbors, church member and senior citizen friends, like ampalaya -bitter squash, tomatoes, okra, eggplant, peppers, snake squash (upo), cucumber etc. Thank God for the blessings that will promote good health, strength and sound mind.” -Greg and Andrea Fadul
- 31. Dancing to exercise… Line Dancing I selected this picture because it is a kind of exercise that I love doing. It entertains others, young and elderly alike. It does good to one’s health and well-being since it keeps one moving and feeling happy doing it with the music. Once you take part in this activity, you’re forced to memorize the sequence of the dance for better performance and grace. The act of memorizing is good exercise for the brain, because delaying being Alzheimer. -Filipino senior
- 32. Community Health Worker Intervention
- 33. CHW Training Curriculum (115 hours) CHW Role, Advocacy Research Trainings History of CHWs Community-based CHW leadership skills & advocacy participatory research Immigrant access to health services in NYC Research methods (i.e. FGs, Teaching and Communication Popular education survey administration) Communication skills Ethical issues in research; Health literacy & simple language HIPAA Conflict resolution Database & Data analysis Clinical Skills Trainings software (access, Atlas ti, Phlebotomy SPSS) Adult and infant CPR Partnership evaluation Pharmacology of antihypertensive & diabetes medication NHLBI Healthy Heart, Healthy Disease-specific Trainings Family Curriculum Basics of CVD and Diabetes Intervention Implementation HIV/AIDS & Evaluation Breast cancer awareness Health promotion trainings Other: Computer literacy Physical activity Nutrition Chronic disease self-management
- 34. CHW Roles: Community Organizers Faith-based organizations/ Health professional associations Businesses Workers
- 35. CHW Reaching Out… Chess Tournament Church Services Apartments
- 36. CHW Roles: Bridges to health Link to health providers Monitor blood pressure Health education
- 37. Filipino Heart Health Curriculum (NHLBI)
- 38. CHW Roles: Social Support “We have strong connections to the community so we are able to influence people on how to be healthy. Oftentimes when I do home visits, the participants tell me how thankful they are. They never thought there would be someone that would go out of their way to visit them and show concern for their health and take their blood pressure.” –AsPIRE CHW
- 39. CHW Roles: Trainers/Researchers Training new CHWs Data collection
- 40. CHW Roles: Advocates •Individual level (i.e. advocate for patient’s needs at physician visits) •Systems level (i.e. advocate for streamlined referral systems with hospital administrators; public hearings to inform legislators of challenges community faces and recommended solutions)
- 41. Lessons learned: CHWs as an investment in health equity CHWs are valuable in bridging gaps CHWs facilitate trust building in the community to engage in research projects CHWs serve as voice for undocumented/underserved immigrants through advocacy efforts CHWs build capacity of researchers/interns/coalition members to appropriately conduct CBPR project in community Leadership and capacity buildingbuilds sustainability
- 42. Other initiatives addressing Filipino health in NYC APA HEALIN’ –food and active living initiative PROJECT CHARGE – policy advocacy on health care reform
- 43. Sharing our story… Abesamis-Mendoza et.al. “Filipino Community Health Needs and Resource Assessment: An Exploratory Study of Filipinos in the New York Metropolitan Area.” (2005) Ursua, R, Abesamis-Mendoza N, Kwong K, Ho-Asjoe, H, Chung, W, Wong, S.S. “Addressing Cardiovascular Health Disparities in Filipino and Chinese Immigrant Communities in New York Metropolitan Area.” Praeger Handbook of Asian American Health: Taking Notice and Taking Action.(2009) Aguilar, D, Abesamis-Mendoza, N, Ursua, R, Divino L.A., Cadag, C., Gavin N. “Lessons Learned and Challenges in Building a Filipino Health Coalition.” Health Promotion Practice. 2010 May;11(3):428-36. Epub 2008 Dec 19.
- 44. For more information: Rhodora Ursua Project Director, Project AspIRE 212-263-3776 rhodora.ursua@nyumc.org www.kalusugancoalition.org www.med.nyu.edu/csaah This presentation was made possible by Grant Number R24 MD001786 from NCMHD and its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NCMHD.
- 45. Acknowledgements Special acknowledgement to all the community members who agreed to participate in this study.
Hinweis der Redaktion
- IN 2003 : NYU School of Medicine was awarded a grant from the NIH/NCMHD to establish a Project EXPORT Center: EXPORT stands for Excellence in Partnerships, Outreach, Research, and Training) – only one of its kind in the nation to address Asian American health disparities Importance of a center like this: Today, Asian Americans constitute 5 percent of the total U.S. population and are the fastest growing racial/ethnic group in the United States (U.S. Census Bureau, 2004). They represent a diverse community comprising over 30 countries of origin and representing various cultures, traditional beliefs, religions, years in the U.S., degrees of acculturation, levels of English proficiency, and socioeconomic status. It is projected that by the year 2050 there will be 33.4 million residents whose only race is Asian, which translates to a 213 percent increase, compared to a 49 percent increase in the U.S. population as a whole over the same period (U.S. Census Bureau, 2004). Yet, despite rapid increases in the population during the last three decades, Asian Americans remain one of the most poorly understood and neglected racial/ethnic minority groups (Lin-Fu, 1993; Ghosh, 2003).
- Notes for ‘Project Development Process’ Slide: Filipino Americans are the second largest Asian American ethnic group in the country. Yet they remain one of the most underserved and under-researched communities. OUTREACH : Kara & Noilyn In February 2004, the NYU Center for the Study of Asian American Health (CSAAH) started a health outreach initiative to identify and address the health concerns in the Filipino American community in the New York Metropolitan Area. CSAAH reached out to the Filipino American Human Services, Inc. (FAHSI), a local CBO, about collaborative opportunities to address Filipino American health. Shortly thereafter, an ad-hoc group comprising of representatives from CSAAH, FAHSI, as well as Dr. Benjamin Ileto, a well-respected Filipino community leader, began to meet on a regular basis to plan a community health forum. COMMUNITY FORUM: The organizers invited representatives from Filipino-serving organizations, associations, health professionals, and public interest lawyers to participate in a panel discussion in April 2004. The community health forum was a historic event that brought together, for the first time, over 100 health professionals and community members to begin the dialogue about what they perceived to be the most pressing concerns of the Filipino American community in NYC and New Jersey. Participants were also asked to suggest strategies to address these issues. This led to the initiation of a community health needs assessment and the development of a Filipino Community Advisory Committee which eventually evolved into the Kalusugan Coalition. KALUSUGAN COALITION & CHNA: Since then, individuals representing various sectors of the Filipino community (Filipino artists, students, youth, immigrant advocates, community organizers, health professionals, and academic researchers) have met monthly to reflect on the community’s needs and share experiences about the health and quality of life for Filipinos in the New York/New Jersey area. We also analyzed the findings. We clearly demonstrated that there was minimal research on this community in this area, and thru the CHNA – cardiovascular disease was identified as a priority health concern by over 2/3rds of the participants, and community members identified the different barriers that impede them from accessing the healthcare system. NIH/NCMHD The needs assessment and the strong partnership with this entity- KC –placed our Center in a good position to apply for federal funding by the NIH which was calling for proposals on health disparities intervention research that is jointly conducted by communities and researchers. Hence Project AsPIRE was born.
- Explain narra tree – valued for its healing properties and strength. A national symbol of the philippines Narra is a tree valued for its healing properties, strength and beauty. Found in the Pacific and Asia, narra trees are used to treat ailments like tuberculosis and arthritis. Trees signify life, knowledge, growth, prosperity, stability, and reciprocity.
- NOTES: BULLET 1: Ryan article: “ Coronary heart disease in Filipino and Filipino-American patients: prevalence of risk factors and outcomes of treatment” Results: - Filipino-Americans have a higher prevalence of hypertension and diabetes (34.7% vs. 24.1%, p<0.001) Filipino-American ethnicity is an independent predictor of higher mortality after catherization laboratory intervention and increased need for late reintervention. BULLET 2: Klatsky article: “ Cardiovascular Risk Factors among Asian Americans Living in Northern California” (from American Journal of Public Health) Odds Ratio (Male OR = 0.9, Female OR = 0.6; M Other Asian OR = 3.4, F Other Asian = 1.5) This study examined data among 13,031 persons self-classified as 5951 Chinese, 4211 Filipinos, 1703 Japanese, and 1166 other Asians. Covariates in regression analyses were age, smoking, alcohol, education, and marital status. There are significant differences in risk factors among Asian Americans. Filipino women over the age of 50 had a higher rate of hypertension (65%) than both African American women (63%) and than the general U.S. population of women (47%) - over the age of 50. BULLET 3: Taira article: “ Antihypertensive Adherence and Drug Class among Asian Pacific Americans” Examined factors including drug class, associated with antihypertensive adherence for 28,395 adults in Hawaii. Population included Japanese (n = 13,836), Filipino (n = 3,812), Chinese (n = 2,280), Korean (n = 450), part-Hawaiian (n = 3,746), and white (n = 3,920) patients. Additional Results : Patient factors associated with lower adherence included younger age, higher morbidity and history of heart disease. Patient factors were also significantly related to adherence, including gender and seeing a sub-specialist. Seeing a physician of the same ethnicity.
- BULLET 1: Javier article a. “Filipino Child Health in the United States: Do Health and Health Care Disparities Exist?” Compared with white women, Filipino women have a higher prevalence of diabetes and metabolic syndrome despite the fact that 90% of Filipino women were not defined as obese Study suggests that the high prevalence of diabetes in Filipinos may be missed by health care providers because they are not obese by Western standards (Javier et al., 2007) BULLET 3: “Araneta article” “ Type 2 diabetes and metabolic syndrome in Filipina-American women: A high-risk nonobese population” Cross-sectional study Study population: Community-dwelling women aged 50-69 years Mostly from San Diego county, California Filipino women with diabetes have a greater waist girth In general: Several studies have found a relationship between diabetes and hypertension in Filipino Americans: According to the National Vital Statistics Reports (17), in 2002 Filipino mothers (data not available by place of birth) had the highest rate of gestational diabetes among all measured subgroups at 59.8 per 1,000. Another study using national data reported that Philippine-born Filipino mothers are significantly more likely to have diabetes during pregnancy than U.S.-born Filipino mothers
- NOTES Intro: Overweight in adults is a strong determinant of variance in CVD risk factor prevalence. The rise in the prevalence of overweight and obesity (body mass index ≥25 kg m−2) is, in part, a negative consequence of the increasing economic developments of many lower- and middle-income countries in the Asia–Pacific region. BULLET 1: METHODS : Data on Native Hawaiian/Part Native Hawaiian (N=585), Filipino (N=548), Japanese (N=871), and White (N=1728) adults were obtained from the Hawaii 2001 Behavioral Risk Factor Surveillance System (BRFSS), which contained more detailed questions on ethnicity than are collected by most states. Six physical activity categories were compared: inactive, insufficient (some activity but less than recommended activity), moderate activity (> or = 30 minutes of moderate activity > or = 5 days a week), vigorous activity (> or = 20 minutes of vigorous activity > or = 3 days a week), recommended activity (meeting either moderate or vigorous activity requirements), and a recently suggested target of > or = 60 minutes of moderate activity 7 days a week or > or = 20 minutes of vigorous activity > or = 4 days a week. BULLET 2: Lauderdale and Rathouz article “ Coronary heart disease in Filipino and Filipino-American patients: prevalence of risk factors and outcomes of treatment. International journal of obesity and related metabolic disorders” This study had a sample size of 7263 Asian Americans Family income is strongly inversely related to BMI for women For US-born Asian American women, there is a strong inverse association between BMI and income The inverse association between income and BMI, however, is very weak and of marginal statistical significance for foreign-born Asian American women, just 0.06 kg/m^2 per $10,000 income BULLET 3: Mampilly article “ Prevalence of physical activity levels by ethnicity among adults in Hawaii, BRFSS 2001 “ Japanese ranked in second when it comes to being physical active (32.1%, 20.4%) Whites were more active than any of the three subgroups (47.2%, 35.4%) BULLET 4: Adair article “ Lipid profiles in adolescent Filipinos: relation to birth weight and maternal energy status during pregnancy” Sample size: n = 3327, Filipino women, Cebu, Philippines followed from 1983-1999 Weight gain was positively associated with urban residence, improved socioeconomic status, fewer pregnancies and months of lactation, and more away-from home work hours.
- NOTES Introduction to Filipinos and Smoking According to Klatsky, there is a correlation between the rate of smoking and hypertension in Filipinos (Klatsky et al., 1996). Smoking was determined to be more common in Filipino-American men (Gomez et al, 2004) compared with Whites and other Asian male subgroups. BULLET 1: Maxwell article: “ Smoking prevalence and correlates among Chinese- and Filipino-American adults: findings from the 2001 California health interview survey ” The 2001 California Health Interview Survey (CHIS) indicate that for Asian women, acculturation to the U.S. is linked with increased smoking prevalence rates Yet smoking rates were higher among foreign-born vs. U.S.-born Asian males. BULLET 2: Maxwell article: “ Understanding tobacco use among Filipino American men” Based on a Smoking Beliefs Scale (Cronbach’s alpha = .84), smokers were more likely than nonsmokers to agree that smoking can alleviate stress, depression, boredom, and that smoking is part of social interactions, being a man, maturity. ………………………………………………… -il0i08pino women than foreign-born Filipino women, but higher in foreign born Filipino men than in American born Filipino men. Gomez and colleagues (2002) demonstrated that smoking rates began as early as age 18 years among Filipinos.
- To further understand the makeup of the Filipino community, community leaders also provided feedback about which neighborhoods had large concentrations of Filipinos. Their insight was supported by an examination of U.S. Census 2008 data showing the highest geographic concentrations of Filipinos in the Elmhurst, Woodside, Jackson Heights, Astoria, and Jamaica areas of Queens County, NY and the West Side area of Jersey City, New Jersey. In particular, community partners also identified ethnic enclaves where especially underserved low-income Filipinos resided. GIS technology was used to develop asset maps depicting these concentrations and the resources available for Filipinos. These helped the team create appropriate outreach strategies to reach a sample that was representative of the general Filipino population.
- One part our social assessment was the administration of a Filipino Community Health Needs and Resource Assessment, which included the following methods: (a) surveys with Filipino American adults (n = 135) to assess health priorities and barriers, (b) focus groups with cross-sections of the community (e.g., adolescents, senior citizens) (n = 52 focus group participants) and (c) open-ended interviews with key informant community leaders (n = 5) (Abesamis-Mendoza et al., 2007). This Assessment found that 71% of Filipino adults either had a CVD health concern or had a family member with a CVD health concern. Respondents also suggested a holistic approach that integrates health education, advocacy, collaboration across sectors, and capacity building of social service and health providers to work with the Filipino community.
- CBPR is not a method per se but an orientation to research that may employ any of a number of qualitative and quantitative methodologies.
- 3) culturally appropriate outreach and recruitment strategies; and Involve churches, businesses, cbo’s with Filipino base Train members within these groups about the study – so they in turn could recruit their members to be screened, to administer the screening tool in tagalong therefore non-threatening since they know them Tagalog-speaking survey administrators Recruit Filipino health professionals to conduct screening Health education materials in Tagalog
- So this is what CBPR is all about –it means a academic and community partners working together in a study at all phases from planning, implement, and analyze
- All variables significant at p<0.05 were placed into a logistic regression model, adjusting for other factors (Table 3). Individuals older than 52 were 5.2 times more likely to be hypertensive compared to individuals age 52 and younger (p<0.001). Males were 1.8 times more likely to be hypertensive than females (p<0.01) and unemployed individuals were 1.9 times more likely to be hypertensive (p<0.05). When adjusting for other factors and using the Asian WHO guidelines, overweight individuals were 1.8 times more likely to be hypertensive (p<0.05), and obese individuals were 4.2 times more likely to be hypertensive (p<0.001). Self-reported health status was also found to be significant, individuals who rated their health as fair or poor were 1.9 times more likely to be hypertensive compared to those who rated their health as excellent or very good, and individuals who rated their health as good were 1.7 times more likely to be hypertensive compared to those who rated their health as excellent or very good (p<0.05). Finally, individuals who had lived in the U.S. for more than 15 years were 2.1 times more likely to be hypertensive compared to individuals who had lived in the U.S. for 5 years or less (p<0.01), and individuals who had lived in the U.S between 5-15 years were 1.7 times more likely to be hypertensive compared to individuals who had lived in the U.S for 5 years or less (p<0.05).
- This is the 2 nd picture - tapsilog is a traditional dish made of 2 fried eggs, fatty beef, and served with garlic fried rice. Trish says “This is what I ate …” Both of these pictures prompted a discussion about traditional Filipino dishes and comfort foods. The fact that everyone started salivating and saying how hungry they were each time we looked at this photo speaks to the cultural recognition and craving of these types of food. Even though they knew it wasn’t the healthiest thing to eat, they naturally wanted to have it. It certainly made everyone hungry! Rhodora also raised the issue of portion control. The foods served in these restaurants are cheap and served on large platters – there aren’t different sizes of plates and customers can’t control how much is piled on. Part of Project AsPIRE’s outreach involves reaching restaurant owners. It’s tricky when they may feel threatened if they think that all we want to do is blame them for all their unhealthy food, but the intention is to get them to offer healthy menu options without having to change the entire menu
- Project AsPIRE CHW received 115 hours of training
- Outreach Community organizing (e.g. Health fairs/relationship building w/ various sectors) Participant Recruitment (e.g. Coordination of health fairs) Health education Home visiting Informal counseling Monitoring blood pressure/diabetes; assuring adherence to medication taking and appointment keeping with PCPs and specialists Developing health education materials Social support Linking and negotiating participants’ access to a primary care physician (PCP) Translation/ interpretation Data collection/foster community engagement in research Advocacy (for appropriate translation of materials; for discounted services; for improved health access for immigrant communities) Trainers of future CHWs
- Outreach Community organizing (e.g. Health fairs/relationship building w/ various sectors) Participant Recruitment (e.g. Coordination of health fairs) Health education Home visiting Informal counseling Monitoring blood pressure/diabetes; assuring adherence to medication taking and appointment keeping with PCPs and specialists Developing health education materials Social support Linking and negotiating participants’ access to a primary care physician (PCP) Translation/ interpretation Data collection/foster community engagement in research Advocacy (for appropriate translation of materials; for discounted services; for improved health access for immigrant communities) Trainers of future CHWs
- Please emphasize in this slide the importance capacity building in the community. Our CHW model has already been replicated in the community. In 2008, the main community partner in Project AsPIRE which is Kalusugan Coalition hired 3 CHWs from Jersey City and Queens area. In this aspect, we are achieving one of the main focus of CBPR and its shows how the model we created are sustainable in the long run.
- CHWs are advocates at both an individual and systems level. For example, Henry and Rico advocate for their patient’s needs during a physician’s visit, but also speak on behalf of their clients’ needs to hospital administrators in order to develop streamlined referral systems for participants to more easily access health providers. In addition, AsPIRE’s CHWs conduct advocacy at a government policy level through testimonies, often times as the sole representative of the Filipino community, at public hearings with state government officials.
- CHWs are valuable in bridging gaps for underserved/new immigrant communities who lack health access i.e. demystifying HC system Facilitate trust building in the community to engage in research project (b/c they’re trusted by community; know/understand community cultural norms/values/beliefs; speak the language, etc.) CHWs as voice for rights of undocumented/underserved immigrants through advocacy efforts (i.e. negotiating for affordable rates; advocating for comprehensive coverage, etc.) CHWs build capacity of researchers/interns/coalition members how to appropriately conduct CBPR project in community (includes outreach/retention) Leadership and capacity building builds sustainability ( the use of community organizing as a tool to increase participation and commitment of community members to collectively get involved in decision-making related to theirs and their community’s health, helps to ensure the sustainability of their initiatives )