Health Promotion: The Burden of Disease in Asian American Populations; An analysis of Cancer Prevention and Treatment Programs for Asian Americans

1. Health Promotion:
Asian Americans
Kevin Tao, Calvin Brasor, and Rhianna Mendez

2. Demographics of Asian
Americans

3. Who are Asian Americans?
● Asian Americans (AAs) are a diverse ethnic
group originating from nearly 50 different
countries
● There are over 800 languages and dialects
spoken among Asian American groups.
● Wide range of socioeconomic characteristics,
religious practices, and cultural practices.
● One of the fastest growing populations in the
U.S. - 43% increase between 2000 & 2010.

4. Highest State Populations
● California - 4,155,685
● New York - 1,169,200
● Hawaii - 703,232
● Texas - 644,193
● New Jersey - 524,356

5. Health Disparities Facing
Asian Americans

6. Health Disparities
1. The two leading causes of death for Asian Americans in
the U.S. are cancer and cardiovascular disease
2. Asian American women have the lowest screening rates,
and are usually diagnosed with cancer at a later stage
than other minority groups
3. Asian Americans account for over half of deaths caused
by hepatitis B
4. High prevalence of mental health problems
5. Asian Americans have a higher prevalence of
tuberculosis than all other racial and ethnic groups
6. Asian American youth in grades 7 through 12 have the
highest increase in smoking rates of any racial and
ethnic group.

7. Cancer
● AAs are the only racial/ethnic group in the U.S. who
experiences cancer as the leading cause of death
● Asian subgroups:
○ Chinese: highest mortality rates for lung &
bronchial cancer
○ Filipinos: highest incidence & mortality rates for
prostate & thyroid cancer
○ Japanese: highest incidence & mortality rates for
colorectal & uterine cancer
○ Koreans: highest incidence & mortality rates for
stomach cancer
○ Vietnamese: highest incidence & mortality rates for

8. Contributing Factors for
Disparities

9. Barriers to Care
● Low socioeconomic status
○ Two million Asian Americans do not have insurance
in the U.S.
● Language
○ limited english proficiency may discourage or
prevent them from accessing health care services
available to them
● Perception of Health
○ Asian Americans may not perceive the value or
identify the purpose or necessity in obtaining care
because of traditional approaches to health care.

10. Model Minority
● Myth: AAs are healthy, wealthy, and wise.
○ AAs are a small and exceptionally healthy because of
socio-economic security and high education
○ "The Asian Pacific Islander minority in aggregate is
healthier than all racial ethnic groups in the US
including whites" - Department of Health & Human Services
● Reality:
○ AAs are the fastest growing population in the US
○ They suffer from several health disparities including
cancer and cardiovascular disease.
● Effect:

11. Generalizations About Asian
American Cultural Norms

12. World Views
● Naturalistic: harmony with environment
● Time is an unlimited continuum
○ birth and death are not absolute of ends
● Fatalistic

13. Explanatory Model of Illness
Holistic
● Chinese: balance of hot & cold
○ use of herbs, massage, thermal treatments,
acupuncture
○ qi
● Filipino:
○ Mystical - wandering souls
○ Personalistic - social or supernatural punishment
○ Naturalistic - natural events and stress
● Differing local beliefs
○ i.e. Hmong and the curses/wrath of gods

14. ● Most Asian cultures are collectivist
○ People view themselves as a member of a group
● What is best for the group
○ Dependence & Needs
● Societal orientation: family
Collectivist Society

15. Religion & Spirituality
● Buddhism
○ one with nature
● Confucianism
○ Focus: world & family (instead of god & afterlife)
● Taoism
○ "yin" and "yang"
■ i.e. balance of hot and cold
● Islam
● Judaism
● Hinduism
● Christianity
● Jainism
● Sikhism
● Zoroastranism
● Sanamahism

16. Traditional Belief
● Beliefs:
○ Fatalism
○ Karma
○ Harmony with nature
○ Cooperation
○ Spiritualism
**Herbalist doctors are the standard for cancer

17. Health Habits/Preferences
● Social Orientation: Family
● Family Makeup: Extended
● Primary Relationship: Parent-child
● Family Values: Well defined
● Relationship Emphasis: Interpersonal & Harmony
● Gender Roles: Male Dominant
● Control: Authoritative
● Emotional Expression: Suppressive

18. Protective Factors
● "There is little information provided about
the Protective factors among the Asian
American groups." (Harrison, 2005)
● Strong mentalities in:
○ Conformity
○ Immersion-emersion

19. Health Literacy
● 2000 census:
○ 4 million AA had Limited English
Proficiency
○ 73% of AA do not speak English in their
homes
■ national average = 18%

20. Discrimination
● Strained history with United States
○ Chinese Communism
○ Vietnam War
○ Korean War
○ World War II- Japanese Americans
● Workplace discrimination
○ can be written off as being intelligent and not having
problems (model minority)
● Cultural discrimination (language, practices)

21. Colorectal Cancer

22. Colorectal Cancer (CRC)
● 2nd
most diagnosed cancer among AA
● Cancer that begins in the colon or rectum
○ begins as a polyp
■ slow to develop
○ screenable & preventative
● Japanese are the subculture with the largest
problem of Colorectal Cancer

23. Rates
Source: Data Evaluation and Publication Committee of the North
American Association of Central Cancer Registries (1999)

24. Colorectal Cancer Prevention
● Colonoscopy
● Lifestyle
○ Avoid excess red meat, alcohol, and tobacco
○ Maintain good BMI & body composition with
exercise
○ Sufficient Calcium & Vitamin D
● Know family history

25. Health Promotion Program #1

26. Asian American Health
Initiative
● Formed in January 2005 to increase
awareness about cancers by:
○ Providing culturally competent cancer
education
○ Screening services
● First health program in Montgomery County
to specifically target the Asian American
community

27. Outreach and Education
● Health Fairs and Health Education Seminars
provide:
○ Educational materials in many different asian
languages
○ Bilingual Asian Health promoters
○ Information targeted to specific Asian American
Subgroups

28. Media Campaign
● Many Asian Americans use
ethnic media sources
● Asian American Health
Initiative regular launches
health awareness
campaigns in Chinese,
Cambodian, Vietnamese,
and Korean

29. Screening Services
● Free screening for colorectal cancer are
provided for eligible Asian Americans
residing in Montgomery County
● Those who are eligible have the opportunity
to seek care from a provider who speak their
native language.

30. Effectiveness
● Breaks down language barriers
● Provides tailored care for individuals
● Plentiful network of providers for clients to
use

31. Improvements
● Enhance research efforts
○ A lack of health data on Asian Americans contributes
to certain health disparities
● Rethink referrals
● Provider training

32. Health Promotion Program #2

33. The Asian American Network for Cancer
Awareness, Research and Training
● Founded in 1999 and launched in 2000
● Designated: The National Cancer Institute as The
National Center for Reducing Asian American Cancer
Health Disparities
● Mission Statement:
○ "to reduce cancer health disparities by conduc
community-based participatory education, tra
and research by, for, and with Asian Americans."

34. Outreach
● Locations:
○ Sacramento, San Francisco, Los Angeles, Seattle, and Honolulu.
● Members:
○ Chinese Community Health Resource Center
○ Hmong Women's Heritage Association
○ University of Hawaii Office of Student Equity, Excellence and
Diversity
○ UC Davis Cancer Center
○ UC Los Angeles: UC San Francisco
○ University of Washington

35. Education
● Focus:
○ Cambodian, Chinese, Filipino, Hmong, Korean, and
Vietnamese ancestry
● Education is tailored to each culture
○ "ethnically-specific, linguistically diverse, culturally
appropriate, and cognitively empowering"
● Community relationships and trust are
established before testing begins
○ The idea of blood biospecimen collection is
introduced very slowly and in a delicate manner
○ Subjects must understand that testing benefits both
the subjects and the researchers

36. Media Campaign
● Presentations & publications on studies and
research have been provided to AA
communities.
● Holds public events which are advertised
through their website and regular
flyer/calendar postings
● Holds Several Conferences and Symposiums

37. Effectiveness
● 1,051 outreach activities
● produced 166 peer-reviewed publications
● secured $64.2 million in total grants

38. Improvements
● Expansion to other regions of the U.S.
● Expansion to other Asian-American
subpopulations

39. Health Promotion Program #3

40. Effective Colorectal Cancer Education for Asian
Americans: A Michigan Program
Health Asian American Project
● In 2005- 2006 HAAP began to include
community based CRC education
● Goal:
○ Improve knowledge & attitude towards screening
○ increase screening rates
● Coordinated with community organizations

41. Outreach
● Subgroups
○ Asian Indian, Chinese, Filipino, Hmong, Japanese,
Korean, Vietnamese
● Recruitment
○ Association of Chinese Americans & Korean Cultural
Center of Michigan
● Used community gathering places
○ Churches, temples, community centers, & group
picnics.

42. Education
● Fairs that promote health education
○ Presentation on early detection with on sight
translation
● Educational brochures from the American
Cancer Society are distributed in different
asian languages
● Stressed importance of screening when no
symptoms are presents
○ especially for older populations

43. Media Campaign
● Newspaper advertisements
● Flyers in grocery stores
● Coverage in asian language media
● Used sub-group's preferred language

44. Effectiveness
● Effective
● Evidence-based education evaluation
○ showed a "significant increased knowledge and
attitudes about the importance of screening"
● Program follow up
○ 78% screening participation within the last 12
months
○ compared to 37% participation prior to study

45. Improvements
● For public policy purposes:
○ program would need to include more AA without
health insurance
● Could improve accuracy by tracking
screening rates through means other than
self reports

46. Suggestions for the Future

47. Steps to Take in Improving
Quality and Access
● Need to absolve model minority
○ acknowledge AA population growth rate
○ understand that AA suffer from significant health
disparities (i.e. cancer)
● More research is needed, overall.
○ especially on AA without health insurance to justify
larger changes in public policy
○ essential to creating national visibility of health
disparities
● Find middle-ground between cultures
○ Inclusion of Holistic Medicine in Western practice
○ Methods to remove language barriers

48. References
● Ritter, Lois & Hoffman, Nancy, (2010). Multicultural Health. ISBN-978-0-
7637-5742-7
● Kline, Michael and Huff, Robert, (2007). Health Promotion in
Multicultural Populations: A Handbook for Practitioners and Students.
● Wu, T., Kao, J.Y., Hsieh, H., Tang, Y.Y., Chen, J., Lee, J., & Oakley, D.
Effective Colorectal Cancer Education for Asian Americans: A Michigan
Program. J Canc Educ (2010) 25:146–152 DOI 10.1007/s13187-009-0009-
x
● Asian American Health Initiative (n.d.). Retrieved from http://aahiinfo.
org/
● Chen, M., Chow, E., & Nguyen, T. The Asian American Network for Cancer
Awareness, Research and Training. (n.d.). Retrieved from http://www.
aancart.org/