Pacific Islander Report 2011

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Pacific Islander Report 2011

  1. 1. Utah Pacific Islanders 2011
  2. 2. Utah Pacific Islanders 2011 Summary & Recommendations In 2011, the Utah Department of Health interviewed 605 adult Utah Pacific Islanders (PIs) to learn about the health needs of this growing population. This was the first statewide health survey conducted in three languages: Samoan, Tongan, and English, and may have been the first study of its kind addressing mainland Pacific Islanders in the United States. Utah PIs were involved in all stages of implementation: suggesting questions, reviewing the questionnaire, pilot-testing, translation, survey promotion, and interviewing respondents. Maternal & Infant Health• 86.6% of PI mothers • 21.9% of PIs were fertile, • Compliance with the guidelines and 78.2% of PI fathers sexually active, and not planning was low with 48.7% of infants agreed that the father’s a pregnancy, but not doing born to women without early involvement in the family anything to prevent pregnancy. prenatal care1, 53.4% of new helped the mothers. mothers not breastfeeding • Few PIs disagreed with guidelines 2-6 months postpartum2, and• Social support for about early prenatal care (2.6%), 36.5% with an interpregnancy breastfeeding was weak. breastfeeding until age one interval less than 18 months.1 39.9% of PIs reported (21.9%), and waiting 18 months Statewide rates were 28.1%1, discomfort when women after giving birth before becoming 32.5%2, and 27.5%1, breastfeed in public places. pregnant again (23.6%). respectively. Those interviewed in Tongan had a particularly high rate of discomfort (65.1%). Disease & Risk Behavior• At 13.7%, the PI adult • 25.2% of PIs reported high • Using a scale customized diabetes rate is nearly blood pressure. When adjusted for PIs, 50.9% were obese.6 double the statewide rate for age, PIs were more likely to This rate is more than double (6.9%).3,4 report high blood pressure than the statewide obesity rate Utahns statewide (23.1%).4,5 (23.1%).3,4• PIs interviewed in Tongan were particularly likely to • At 10.3%, the PI smoking rate • Although only 15.1% of PIs have diabetes, with a rate was similar to the statewide were at healthy or underweight of 44.0%. rate.3,4 PIs under 35 were more BMIs according to the likely to smoke (14.7%). customized PI scale, 33.1% of• Arthritis and asthma rates PIs perceived their weight as were similar to those healthy or underweight. statewide.3,4,5Page 2
  3. 3. Utah Pacific Islanders 2011 Summary & Recommendations “This Healthcare Services research is a crucial insight into the health care needs of our people. It will be invaluable• 16.3% of PIs reported that • 81.3% of PIs reported that in addressing someone in their household had they could usually or always current Pacific been unable to receive needed understand their healthcare Islander health medical care, tests, or treatments providers. Foreign language during the past year, usually due speakers and less educated PIs issues and driving to financial barriers. were less likely to understand further research. their providers. Gathering data• 66.2% of PIs reported that from a diverse they had received a Hepatitis B • Only 46.6% of PIs over age 50 demographic as vaccination. had been screened for colon cancer and 37.7% of PI women multilingual and• 96.9% of PI parents reported that over 40 had been screened multicultural as their children had received all for breast cancer. Statewide Pacific Islanders is an their recommended vaccinations. screening rates are 68.0% and ambitious endeavor, 67.0%, respectively.3,4 and I commend• 22.8% of PIs had experienced racism during the past year and • When asked about preferences for the investigators 5.7% had experienced racism in a home visiting programs, 74.2% on welcoming the health care setting. of PIs said it was not important to involvement and them that home visiting program feedback of Pacific • 21.0% of Tongan and 40.3% of staff be PI. More PIs preferred Islander community Samoan speakers reported that child development than other someone in their doctor’s office educational backgrounds for leaders, consultants, spoke their language. visiting staff. and data collectors throughout the development of Social Determinants of Health this study. I look forward to innovative interventions and further collaborative efforts stemming from the information we have been able to• PIs with low incomes were more • 30.7% of PIs did not have any learn about our Pacific likely to worry about buying adverse childhood experiences nutritious meals and less likely to and 10.7% of PIs experienced Islander communities.” get needed medical care. five or more adverse childhood experiences.7 -Jacob Fitisemanu,• PIs interviewed in Tongan and Healthcare Access for Samoan were more likely to be • Males were more likely to report Minorities Advisory obese than those interviewed adverse childhood experiences Board in English. Those interviewed in compared to females. PIs with no Tongan were also more likely to adverse childhood experiences have diabetes. were less likely to ever smoke.7 Page 3
  4. 4. Utah Pacific Islanders 2011 RecommendationsHealth Promotion Priorities • Screen for mental health • Encourage health plans• Health promotion for PIs issues in the primary care and other organizations to should emphasize obesity, setting and provide referrals offer financial and practical diabetes, pregnancy as appropriate. incentives (e.g., baby health, social support for products, nutritious recipe • Explain screening and health breastfeeding, and preventive books, etc.) to reward care processes and inform care. members for disease about benefits of early management, screening, and• Educate about obesity, screening. health education activities. including risks, food label Partnership Opportunities reading, and making • Fund programs that offer • Collaborate with church peer support for prenatal quick, easy, healthy meals leaders who have significant care and breastfeeding, such inexpensively. Pacific Islander representation as home visiting, Centering• Share benefits of healthy in their congregations. Involve Pregnancy, and WIC. pregnancy spacing with both clergy and other PI opinion men and women. leaders in health promotion. • Provide community organizations with resources• Teach Tongan and Samoan- • Encourage PIs to join to support intervention, speakers how to find community-based organization such as breast pump room multilingual providers or boards and write grants to supplies and DVD players arrange for interpretation support the PI community. to play “For Me, For Us” through their health plans. and other health promotion • Involve elder women in• Share the results and promoting breastfeeding. videos. implications of the PI Study Future Research • Learn from older PI women with the community. and traditional healers about • Study factors contributing Intervention Strategies culturally appropriate care to low rates of prenatal• Use culturally appropriate for PI pregnant women and care, screenings, and other verbal and visual methods educate them about healthy preventive care among PIs. for health promotion, not just pregnancy guidelines. • Explore the differences written materials. • Promote PI-specific best between PI men and • Link people to resources practices for health promotion women in adverse childhood to promote healthy living, from experts in other experiences.7 preventive care and low cost/ countries such as Tonga, • Qualitatively investigate free health screenings. Samoa, and New Zealand. barriers to healthy pregnancy • Include PI actors in existing Policy & Systems Change spacing and research new media campaigns addressing • Support policies that lower strategies to promote healthy obesity, birth outcomes, and the cost of healthy food and pregnancy spacing. preventive care; explore increase the cost of unhealthy • In future studies about funding options for new food. PIs, include a demographic campaigns. question asking respondents • Encourage provision of • Use a PI-specific obesity scale physical and mental health if they identify themselves as for assessing Body Mass Index care in the same location. Tongan, Samoan, Hawaiian among PIs; avoid promoting or other PI. Caucasian weight ideals to PIs. Recommendations by the Utah Department of Health, Office of Health Disparities Reduction Advisory Boards: • Birth Outcomes in Minorities Advisory Board • Obesity in Minorities Advisory Board • Healthcare Access for Minorities Advisory Board (Advisory Board member rosters are listed in Acknowledgments.)Page 4
  5. 5. ContentsSummary & Recommendations Utah Pacific Islanders 2011, Summary—2 Recommendations—4 Contents—5Maternal & Infant Health Pregnancy & Infant Health Attitudes—6 Social Support for Mothers & Children—7 Family Planning—8Disease & Risk Behavior Disease Prevalence—9 Obesity—10 Tobacco—11Healthcare Services Health Screenings & Immunization—12 Barriers to Receiving Needed Care—13 Experiences with Racism—14 Linguistically Appropriate Healthcare—15 Home Visiting Program Preferences—16Social Determinants of Health Hours Worked—17 Income & Education—18 Adverse Childhood Experiences—19 Demographics of Survey Population—20Background and Methodology Methods— 21 Comparison to Utah BRFSS—22 References & Notes—23 Acknowledgments—25Throughout this report, following each rate estimate, the 95%confidence interval is listed in parentheses. The confidence interval is the range in which we can be 95% confident that the actual prevalence falls. Page Summary & Recommendations 5
  6. 6. Pregnancy & Infant Health Attitudes Health Guideline % Who Disagree A healthy pregnant woman should visit a doctor 2.6% (1.5-4.5) during her first three months of pregnancy. Mothers should not stop breastfeeding their babies 21.9% (18.1-26.2) until at least the baby’s first birthday. After a woman has a baby, she should wait at least 18 23.6% (19.8-28.0) months before getting pregnant again. Most Utah Pacific Islanders to get early prenatal care agreed with the pregnancy was particularly strong, with and infant health guidelines almost all respondents (97.4% presented in the survey. [95.5-98.5]) agreeing that a Agreement with the guideline healthy pregnant woman should visit a doctor during her first three months of pregnancy. In spite of apparent agreement with these guidelines, compliance was low. Pacific Islanders were less likely to have early prenatal care,1 continue to breastfeed their infants 2-6 months postpartum,2 or space pregnancies at least 18 months apart than other Utahns.1 Their infant mortality rate was higher than that of any other Utah racial/ethnic group.8 Pacific Islander Utahns All Utahns Disparity Infant Mortality per 1,000 Live Births 8.9 (5.8-13.0)8 4.8 (4.5-5.1)8  Infants Born to Women Without Early 48.8% (46.1-51.5)1 Prenatal Care 27.7% (27.4-27.9)1  Not Breastfeeding 2-6 53.4% (41.3-65.5)2 Months Postpartum 32.5% (31.4-33.6)2  Interpregnancy Interval ≤18 Months 36.5% (32.6-40.4)1 27.5% (27.1-27.9)1 Page Interpregnancy Interval ≤6 Months 11.1% (9.0-13.3)1 4.3% (4.1-4.4)1 6 Maternal & Infant Health
  7. 7. Social Support for Mothers & ChildrenFather involvement is a strengthof the Utah Pacific Islander community. Fathers wereasked if their own involvementhad made things easier forthe mothers of their children. Percent of parents reporting thatMothers were asked if the father involvement has made thingsinvolvement of their children’s easier for the motherfathers had made things easier Mothers Fathersfor themselves. A majorityof both mothers (86.6% 86.6[80.0-91.3]) and fathers A Lot Easier 78.2(78.2% [69.3-85.1]) agreedthat the fathers’ involvement 9.5had made things a lot easier for A Little Easier 19.4mothers.However, social support for Not Easier 3.9breastfeeding in public was 2.4less prevalent, with about twoof five respondents (39.9% 0 20 40 60 80 100 Percent[35.4-44.5]) reporting thatthey are uncomfortable whenmothers breastfeed theirbabies near them in a public Percent reporting that they areplace such as a shopping uncomfortable when motherscenter or bus station. Those breastfeed near them in public places,interviewed in Tongan were the by interview languageleast likely to be comfortablewith breastfeeding in public Tongan 65.1places, with 65.1% (52.8-75.8)reporting discomfort. Therewere no significant differences Samoan 26.0in comfort with publicbreastfeeding by gender, with42.8% (36.2-49.7) of men and English 37.737.0% of women (31.2-43.2)reporting discomfort, nor were Total 39.9there significant differences by age. 0 20 40 60 80 Percent Page Maternal & Infant Health 7
  8. 8. Family Planning Family planning helps couples until the previous child is at space pregnancies far enough least 18 months old before apart to optimize health becoming pregnant again.9 outcomes for mothers and babies. Current national Utah Pacific Islanders were guidelines recommend waiting asked about their family planning practices and 21.9% reported that they were not Are you doing anything to keep planning a pregnancy but not yourself/your partner from becoming doing anything to prevent pregnant? pregnancy. People who were Trying to Prevent not sexually active, infertile or Pregnancy sterilized, already pregnant, or 21.9 Infertile/Too homosexual were not included old/Sterilized in this group. Not Sexually Active 0.3 44.1 2.9 People within this group of Want a Pregnancy fertile, sexually active people 9.2 Already Pregnant not planning a pregnancy were asked why they were 10.4 Same Sex Partner not trying to prevent a 11.2 pregnancy. Unfortunately, Others Who Are Not most of these responses were Trying to Prevent Pregnancy not captured by the survey tool, falling under “some other reason.” After some other reason, the most common Reasons for Not Trying to Prevent response was “I don’t know/Not Pregnancy Among Fertile Couples Not sure.” Disliking birth control, Planning Pregnancy indifference about pregnancy, Not Sure cost of contraception, lapse 17.1 in use of contraception, and Dont Want/Dislike Birth Control, Side recently postpartum were Effects also mentioned. None of the Dont Care if 10.0 Become Pregnant respondents mentioned religious Cost reasons or breastfeeding as 5.7 barriers to contraception. 60.0 Lapse in Use of 4.3 Method 1.4 Recently Postpartum 1.4 Some Other ReasonPage8 Maternal & Infant Health
  9. 9. Disease PrevalenceThe adult diabetes rate of Arthritis and asthma ratesUtah Pacific Islanders (13.7% among Pacific Islanders [11.2-16.6]) was approximately were similar to the statewidetwice as high as the statewide rates.3,4,5rate (6.5% [6.0-7.1])3,4. Pacific Islanders interviewed in Tonganwere particularly likely to havediabetes, with a rate of 44.0%(32.4-56.3).Of Pacific Islander women with diabetes, 32.0% (20.6-46.1)were diagnosed with gestationaldiabetes during pregnancybefore they developed chronicdiabetes.When adjusted for age, Pacific Islanders were more likelyto have high blood pressurethan Utahns statewide.4,5High blood pressure can leadto heart attack or stroke. Of Adult Diabetes Statewide3 and AmongPacific Islanders with high blood Utah Pacific Islanders by Genderpressure, 78.5% (70.4-84.9)were trying to control their Female 14.9blood pressure by changingtheir eating habits and 74.1%(66.3-80.7) were cutting down Male 12.5on salt.Obesity is a risk factor for PI Total 13.7diabetes and high bloodpressure. The high obesity rate Utah 6.5among Utah Pacific Islanders, and particularly among thoseinterviewed in Tongan and 0 5 10 15 20 PercentSamoan, is likely correlated with the high diabetes rate. Pacific Islander All Utahns Utahns (from Utah BRFSS) DisparityArthritis 17.3% (14.4-20.7) 21.4% (20.4-22.4)4,5Asthma 8.3% (6.1-11.3) 9.1% (8.2-10.1)3,4Diabetes 13.7% (11.2-16.6) 6.5 (6.0-7.1)3,4  PageHigh Blood Pressure 25.2% (21.6-29.0) 23.1% (22.0-24.2)4,5  Disease & Risk Behavior 9
  10. 10. Obesity Obesity is usually defined as than half that (21.9-24.3) in a body mass index (BMI) over 2010.3,4 30. At 63.6% (58.9-68.0), a majority of Utah Pacific However, some studies suggest Islanders were obese. The that Pacific Islanders have a obesity rate statewide was less body type that can be healthy with a larger BMI than can be Body Size by Self Perception, Pacific tolerated by people of European Island (PI) Specific BMI Scale & descent.10 Researchers in New Traditional BMI Scale Zealand have developed a BMI scale specifically for people of Self-Described Weight PI-Specific BMI Scale Usual BMI Scale Pacific Island descent.6 Using this scale, about half of Utah 21.3 Pacific Islander adults (50.9% Obese (Very Overweight) 50.9 [46.2-55.6]) are still identified 63.6 as obese. Overweight (A 45.6 Little 34.0 Many overweight Pacific Overweight) 24.9 Islanders were not aware that 33.1 they were overweight. Although Healthy/ Underweight 15.1 only 15.1% (11.8-19.0) 11.5 of PIs were at healthy or 0.0 20.0 40.0 60.0 80.0 underweight BMIs according to Percent the customized scale, 33.1% of PIs perceived their weight as healthy or underweight. BMI >30 Statewide3 and Among Utah Pacific Islanders by Interview Among Utah Pacific Islanders, Language those interviewed in English (62.3% [57.3-67.1]) had lower obesity rates than those Utah 24.8 interviewed in Tongan (73.2% [60.6-82.9]) and Samoan (80.1% [53.1-93.5]). However, Tongan 73.2 those interviewed in English were more likely to perceive Samoan 80.1 themselves as overweight compared with Samoan and Tongan speakers. English 62.3 Limiting sugary drinks helps 0 20 40 60 80 100 control obesity, but 16.4% Percent (13.1-20.3) reported that they drink soda pop and 23.7%Page (20.0-28.0) report drinking fruit juice with added sugar daily.10 Disease & Risk Behavior
  11. 11. TobaccoThe Utah Pacific Islander cigarette smoking rate wassimilar to the statewide rate,with 10.3% (7.5-13.6) ofrespondents reporting thatthey are current smokers.Statewide, 9.1% (8.3-10.0) of Utahns smoke.3,4Utah Pacific Islanders under 35 years of age were more likely to Beliefs About Secondhand Smokesmoke (14.7% [9.8-21.0]) thanthose who were older. 3.5Only 1.7% (0.7-3.7) of 8.8respondents reported usingchewing tobacco.A large majority of respondents,87.7% (84.1-90.6) believedthat breathing secondhand Not Harmfulsmoke is very harmful to one’s Somewhathealth and 3.7% (2.2-6.2) 87.7 Very Harmfulreported that they are exposedto secondhand smoke at home.Pacific Islanders with less education or who reported moreadverse childhood experiences7 Smoking Rate by Agewere more likely to smoke thanother Pacific Islanders. total 10.2 55+ 2.4 35-54 7.6 18-34 14.7 0 5 10 15 20 Percent Page Disease & Risk Behavior 11
  12. 12. Health Screenings & Immunization About two-thirds of Utah Almost all parents surveyed Pacific Islander adults surveyed reported that their children (66.2% [61.4-70.7]) reported had received all of their that they had received a recommended vaccinations: complete, three-dose, Hepatitis 96.9% (94.4-98.3). However, B vaccination. Respondents the survey tool did not verify with incomes over $75,000 that parents knew all of the (78.2% [66.4-86.6]) and vaccinations their children were college graduates (80.9% supposed to have received. [72.8-87.0]) were more likely to report Hepatitis B The study asked parents with vaccination. Nationally, 23.4% children who had not been (20.5-26.5) of U.S. adults vaccinated for the barriers reported that they had been preventing vaccination, but vaccinated for Hepatitis B.11 there were too few respondents However, 64.1% (62.8-65.4) who did not vaccinate to analyze of U.S. infants and 79.8% these responses. (74.2-85.4) of Utah infants Women ages 40 and older currently receive this vaccine.12 should receive a mammogram to screen for breast cancer at least once every two years.13 People over age 50 should be screened for colon cancer.14 Pacific Islanders were less likely to receive these cancer screenings than Utahns statewide.3,4 Utah Pacific Islanders who had not been diagnosed with diabetes were asked if they had been screened for diabetes in the past three years and 48.4% (43.4-53.5) of these respondents reported that they had been screened. Pacific Islander All Utahns Utahns (from 2010 BRFSS) Disparity Breast Cancer Screening (Women Ages 40+) 37.7% (30.3-45.7) 67.0% (65.1-68.8)3,4  Colon Cancer Screening (Ages 50+) 46.6% (39.5-53.9) 68.0% (66.4-69.5) 3,4 Page12 Healthcare Services
  13. 13. Barriers to Receiving Needed CareUtah Pacific Islanders were asked if anyone in theirhousehold was unable to obtainneeded medical care, tests, ortreatments during the past 12months and 16.3% (13.0-20.2)reported this problem. Percent Unable to Attain NeededMost respondents who were Medical Care by Incomeunable to attain neededmedical care for members oftheir households gave financial 75,000 + 4.2reasons, including lack ofinsurance, not being able 50-74,999 15.5to afford the care, and theinsurance company not coveringthe cost of care. 25-49,999 13.2Fewer respondents gavelogistic reasons, including lack <25,000 27.8of child care or time. None of the respondents attributed 0 5 10 15 20 25 30their inability to get care to Percenttransportation problems,language barriers, inability toget time off work, racism, or not Main Barrier to Receiving Medical Careknowing where to get care. Among Pacific Islanders Unable toPeople with low incomes were Access Care in Past Yearmore likely to report that they No Insurancecould not attain needed medical 14.6care, with 27.8% (20.6-36.3) Too Expensiveof people with incomes under 2.4 Not Covered by$25,000 reporting this problem, 40.2 Insurance 9.8 Logistic Problemscompared to 4.2% (1.2-13.6)of people with incomes over Some Other Reason$75,000. 32.9 82.9% with Financial Barriers Page Healthcare Services 13
  14. 14. Experiences with Racism The Utah Pacific Islanders if they had experienced racism surveyed were asked if they or discrimination in a healthcare had experienced racism or setting; 32.0% of these people discrimination during the past (22.7-42.9) reported that they year; 22.8% (18.7-35.1) had this experience. reported that they had this experience. There were no significant differences in experience with racism by gender or income. However, respondents over age 65 (8.1% [3.5-17.4]) and respondents who preferred to speak Tongan (6.4% [2.4-16.0]) were significantly less likely to report that they had experienced racism. Pacific Islanders who had both experienced racism and who visited a healthcare provider within the past year were asked Experiences with Racism in the Past Year 22.8% with Racism Experiences 17.0% Experienced 5.7% Racism, But Not in a Healthcare Setting Experienced Racism in a Healthcare 77.2% Setting No Racism Experiences in Past YearPage14 Healthcare Services
  15. 15. Linguistically Appropriate HealthcareA minority of people interviewedin Tongan (21.0% [10.9-36.6])or Samoan (40.3% [18.8-66.4]) reported that someone at theirdoctor’s office spoke their preferred language. Those Reported Frequency with whichpeople surveyed in foreign Healthcare Providers Explained Thingslanguages were also less likely in a Way That was Understood, byto report always or usually Interview Languageunderstanding their health careproviders. Usually/Always Never/SometimesWhile only 4.5% (3.1-6.5) of 53.6 Tonganall respondents reported that 46.4they never understood theirhealthcare providers, 22.3% 48.6 Samoan(12.2-37.2) of respondents 51.4with less than a high schooleducation reported this 85.6problem. Overall, 81.3% of English 14.4Pacific Islanders reported that they could usually or always 0 20 40 60 80 100understand their healthcare Percentproviders.There were no significant differences in foreign language Foreign Language Speakers Reportingservices or understandable care that Someone at the Doctor’s Officeby the respondent’s income or Spoke their Languagedisease status. Tongan 21.0 Samoan 40.3 0 10 20 30 40 50 Percent Page Healthcare Services 15
  16. 16. Home Visiting Program Preferences Home visiting programs Utah Pacific Islanders were provide helpful information asked about their preferences and resources to support a for the racial and educational healthy pregnancy and child background of home visitors. development through the Nearly three-fourths (74.2% child’s first two years of life. [69.9-78.1]) said that it was not important to them that a home visitor be of Pacific Islander Is it important to you that a home race. Nearly half of respondents visitor be a Pacific Islander? (46.6% [41.8-51.4]) preferred that home visitors have child development training. No 74.2 People over 65 years of age were less likely to have a preference about the type of training of a home visitor, but more likely to prefer that Yes 25.8 a home visitor be a Pacific Islander. Of Utah Pacific Islanders over 65, 56.2% (43.7-68.0) felt that it was 0 20 40 60 80 important that a home visitor Percent be a Pacific Islander. The responses of older respondents about educational background Would you prefer a home visitor who were fairly evenly divided, with was trained in child development, 24.4% (14.2-38.6) preferring nursing, or social work? nursing, 19.7% (10.9-32.9) preferring child development and 16.6% (8.4-30.3) preferring No preference 14.7 social work. However, the largest percentage of Pacific Social Work 16.8 Islanders over 65, 39.4% (26.8-53.4), had no preference about educational background. Nursing 21.9 Child Development 46.6 0 10 20 30 40 50 PercentPage16 Healthcare Services
  17. 17. Hours WorkedOf all Utah Pacific Islanders, 24.3% (20.6-28.4) reportedthat they did not work and22.8% (18.0-29.0) reportedthat they worked more thanfull-time (>40 hours/week).Utah Pacific Islander men (87.1% [91.1-81.8]) were morelikely than women (64.6%[70.3-58.4]) to be in theworkforce.People who worked more hourswere likely to make moremoney than those who workedfewer hours. Of those makingmore than $75,000/year, 41.0%(27.5-63.8) worked more thanfull-time but 8.4% (4.2-17.5)of people with incomes under$25,000/year also workedmore than full-time. Of peoplewith incomes over $75,000/year, 12.3% (5.9-23.8) did notwork, while 34.1% (26.7-42.3)of people with incomes under$25,000/year did not work. Hours Worked by Gender Women MenThere were no statisticallysignificant differences in hours 61+ 0.8 6.2worked by disease or risk 12.2behavior rates. 41-60 26.6 43.3 21-40 42.4 8.2 1-20 12.0 35.4 0 12.9 0 10 20 30 40 50 Percent Page Social Determinants of Health 17
  18. 18. Income & Education People with low incomes were Low income was also associated more likely to report frequent with inability to attain needed worry about having enough medical care. money to buy nutritious meals for their families. There were Pacific Islanders with incomes no statistically significant over $75,000 had a lower rate differences in food security by of diabetes (3.9% [1.4-9.9]) disease or risk behavior rates. than all Pacific Islanders (13.7% [11.2-16.6]). Frequency of Reported Worry About Having Enough Money to Buy Pacific Islanders with more Nutritious Meals, by Income education were more likely to have higher incomes than those Income <$25,000 Income >$75,000 with less education. However, 13.3 people of all income levels were Never 41.5 in every educational category. 12.0 Rarely 25.8 Pacific Islanders with more 32.5 education were less likely to Sometimes 26.1 smoke than those with less 20.3 education. Usually 1.8 21.8 Always 4.9 0 10 20 30 40 50 Percent Proportion at Various Income Levels by Educational Attainment <25,000 $25-$49,999 $50-$74,999 $75,000+ College Graduate 18.3% 29.0% 22.9% 29.8% Some College 26.3% 36.5% 20.5% 16.7% High School/GED 37.7% 38.1% 14.3% 9.9% No High School Diploma 59.0% 20.5% 7.7% 12.8% 0% 20% 40% 60% 80% 100%Page18 Social Determinants of Health
  19. 19. Adverse Childhood ExperiencesAdverse childhood experiences significantly more likely to (ACEs) include verbal, physical, report verbal abuse, physicalor sexual abuse, as well as abuse, and child neglectfamily dysfunction (e.g., an compared to females.incarcerated, mentally ill, orsubstance-abusing family Respondents with an ACE scoremember; domestic violence; or ≥ 5 had a significantly higher absence of a parent because prevalence of current smokingof divorce or separation).15 than those with an ACE scoreACEs have been linked to of 0 and a significantly higher adverse health outcomes such prevalence of former smokingas violence, obesity, diabetes, than those with an ACE score ofcardiopulmonary disease, and 0 and 1-4. Those with an ACEother negative physical and score of 0 were significantly mental health behaviors later inlife.16 ACE Score by Smoking StatusOf surveyed adults, 30.7%reported they did not have any ≥ 5 ACEs 1-4 ACEs 0 ACEsadverse childhood experiences 44.0(0 ACEs), 58.6% reported they Never Smoked 76.8experienced one to four adverse 88.0childhood experiences (1-4 33.4 Former Smoker 13.2ACEs), and 10.7% reported 7.3they experienced five or more 22.9adverse childhood experiences Current Smoker 9.9 4.7*(≥ 5 ACEs). Among the nine adverse childhood experience 0.0 20.0 40.0 60.0 80.0 100.0 Percentquestions that were asked, *Insufficient number of cases to meet the UDOH standard for the most prevalent was verbal data reliability, interpret with caution.abuse at 40.7%. Males wereAdverse Childhood Experience Total Female Male Verbal abuse 40.7 (36.1-45.4) 34.1 (28.0-40.2) 47.7 (40.9-54.5) Physical abuse 36.5 (32.0-41.0) 30.1 (24.3-35.9) 43.1 (36.4-49.9) Witness domestic violence 31.3 (26.9-35.7) 25.8 (20.1-31.5) 37.2 (30.5-43.9) Household member in prison 21.0 (16.9-25.0) 16.2 (11.2-21.2) 25.9 (19.5-32.3) Household alcohol abuse 16.0 (12.5-19.5) 12.3 (8.0-16.6) 19.9 (14.4-25.4) Neglected as a child 15.4 (12.1-18.8) 9.6 (5.9-13.4) 21.5 (16.0-30.0) Parents separated / divorced 13.4 (10.1-16.6) 11.6 (7.3-15.9) 15.2 (10.2-20.2) Mentally ill household member 12.9 (9.6-16.1) 14.7 (9.9-19.4) 11.0 (6.6-15.4) Sexual abuse 8.9 (6.1-11.6) 9.9 (5.9-14.0) 7.8 (4.1-11.5)ACE Category Score Total Female Male 0 30.7 (26.5-34.9) 35.6 (29.6-41.6) 25.2 (19.4-31.0) 1-4 ≥5 58.6 10.7 (54.0-63.3) (7.6-13.8) 56.1 8.3 (49.7-62.4) (4.4-12.2) 61.5 13.2 (54.8-68.3) (8.3-18.2) Page Social Determinants of Health 19
  20. 20. Demographics of Survey Population Most survey respondents Tongan and Samoan were more preferred the English language, likely to be obese than those followed by Tongan and interviewed in English and those Samoan. People interviewed in interviewed in Tongan were more likely to have diabetes. Preferred Language The Pacific Islanders surveyed had lower incomes and less education on average than 17.9% the statewide Utah numbers reported by the by the U.S. Census Bureau American 6.1% English Community Survey (ACS), Samoan Tongan 2007-2009.17,18 However, the ACS estimates were also higher for these measures for Utah 76.0% Pacific Islanders. The ACS estimated that only 17.2% of Utah Pacific Islanders had incomes under $25,000 and 34.4% had incomes over Utah $75,000.17 Statewide Among survey Utah Pacific Population respondents, Islanders (from (participating 2007-2009 34.1% had in survey) ACS)17,18 incomes under Gender $25,000 and Male 48.5% 50.0% only 15.5% had Female 51.5% 50.0% incomes over $75,000. The Age ACS estimated 18-34 33.8% 41.1% 35-49 33.4% 26.0% that 65.2% 50-64 20.9% 19.9% of Utah Pacific 65 + 11.9% 12.9% Islanders had attended college, Educational Attainment while only < High School 8.0% 9.6% 47.0% of survey High School/GED 45.0% 25.2% respondents Some College 28.3% 36.4% College Graduate 18.7% 28.8% had attended college.18 Income < 25,000 34.1% 17.2% 25-49,999 34.6% 26.1%Page 50-74,999 75,000 + 15.8% 15.5% 22.2% 34.4%20 Background and Methodology
  21. 21. MethodsThe Utah Department of Health interviewers, and promoting theinterviewed 605 Utah adult Pacific survey. This community involvementIslanders by telephone for this study. raised interest in the study, improvedThese people were selected through its cultural appropriateness, and saveda sample based on surnames. The the Utah Department of Health money,Utah Department of Heath Vital since many of these efforts wereRecords Department queried its birth completed voluntarily.certificate database to draw surnames of men and women who had a Most of the questions used in the child within the past five years and survey were based on the Behavioralwho identified their race as Pacific Risk Factor Surveillance System Islander. The investigators removed (BRFSS) developed by the Centers for Anglo and Hispanic names from the Disease Control and Prevention. Whenlist. no appropriate BRFSS question existed to meet the research questions posed The primary sponsor and coordinator by collaborators, new questions were of the survey was the Office of Health designed by the investigators.Disparities Reduction at the UtahDepartment of Health, which used A total of 25 bilingual (English/funding appropriated by the Utah Samoan, English/Tongan) Pacific Legislature, as well as funding from Islanders reviewed and suggesteda grant from the U.S. Department of revisions to the questionnaire. Among Health and Human Services, Office the reviewers were communityof Minority Health. Additionally, leaders, public health professionals,nine other programs at the Utah healthcare providers, and theDepartment of Health contributed University of Utah Pacific Islander financially and to the content of the Medical Student Association. The questionnaire, including the Home survey was piloted by calling phoneVisiting Program, Data Resources, numbers of Utah Pacific Islanders Diabetes Prevention and Control, provided by local Pacific Islander Tobacco Prevention and Control, organizations. Once the EnglishHeart Disease and Stroke Prevention, version was completed, the survey wasCancer Control and Prevention, translated into Samoan and Tongan. Asthma Prevention and Control, Bilingual professionals were charged toArthritis Prevention and Control, ensure the linguistic and cultural ap-and Immunization. Other Utah propriateness of the content.Department of Health employees,Office of Health Disparities Reduction This was the first project the Utah Advisory Boards, the University of Department of Health Survey Center Utah Pacific Islander Medical Student had completed in any languageAssociation, and two Pacific Islander other than English or Spanish. The community-based organizations, Utah Department of Health hiredThe Queen Center and the National and trained three Tongan-speakingTongan American Society, also interviewers and two Samoan-contributed to the content of the speaking interviewers to completesurvey. The UDOH Survey Center the survey in addition to the English-implemented the survey. speaking interviewers already on staff.Utah Pacific Islander community members were involved in designingthe questionnaire, pilot-testing the instrument, translating theinstrument, recruiting Pacific Islander Page Background and Methodology 21
  22. 22. Comparison to Utah BRFSS The state of Utah had the largest other people of the same ethnicity.21 proportion of Pacific Islanders of Such an analysis of Pacific Islander all states besides Hawaii in 2009.19 surnames has not been completed. However, only 1.1% of the Utah population identified as Pacific The survey undersampled young Islander or part Pacific Islander.19 people, possibly because the study did Because of the small numbers not include households that exclusively of Pacific Islanders, statewide use cell phones.18 Younger people surveillance surveys, such as the are more likely to use cell phones Behavioral Risk Factor Surveillance exclusively than older people.22 The Survey (BRFSS), rarely reached Utah BRFSS does sample cell phones. a large enough sample of Pacific Islanders to obtain reliable estimates The survey found differences in health without aggregating several years status and behaviors between people of data, making the estimates less interviewed in English, Samoan current or useful for examining and Tongan, with foreign language trends. speakers having higher rates of diabetes and obesity than English Analyses of Utah vital records speakers. The obesity and diabetes indicated that Utah Pacific Islanders rates for Pacific Islanders were higher had unique health problems that in the Pacific Islander Survey than merited further investigation through the rates for Pacific Islanders from a behavioral survey, such as high the BRFSS.3,4 This finding suggests infant mortality and diabetes death that surveys such as the Utah BRFSS rates.20 However, only 61 Pacific that exclude Samoan and Tongan Islanders were reached by the Utah speakers may inaccurately estimate BRFSS in 2010. Moreover, the Utah health status in the Pacific Islander BRFSS was offered in the English population. and Spanish languages only while 13.9% of Utah Pacific Islanders spoke languages other than English at home, usually Pacific Island languages.18 Surveying census tracts with a high proportion of Pacific Islanders was an inefficient option because all Utah census tracts had a Pacific Islander penetration of less than 20%.19 The Pacific Islander survey generated estimates of health status among Utah Pacific Islanders with smaller confidence intervals than those derived from the Utah BRFSS. The project was also less expensive than the Utah BRFSS. However, it is unknown if the survey results are comparable to the BRFSS because the methodology differs. Studies have found that Korean-Americans, Vietnamese-Americans, and Jewish- Americans with specific surnames Page do not differ demographically from22 Background and Methodology
  23. 23. References & Notes 10. See http://apjcn.nhri.org.tw/ server/apjcn/volume18/vol18.3/1. Utah Vital Records, Birth Certificate finished/13_1503_404-411.Database, 2009-2010. Number of pdf and https://researchspace.infants born to pregnant women auckland.ac.nz/bitstream/receiving prenatal care in the first handle/2292/4675/15608799.trimester as a percentage of the total pdf?sequence=1number of live births. 11. http://www.cdc.gov/vaccines/2. Utah Pregnancy Risk Assessment stats-surv/nis/downloads/nis-adult-Monitoring System, 2004-2008. summer-2007.pdf3. Statewide rate is from Utah 12. Estimated Vaccination CoverageBehavioral Risk Factor Surveillance for Hepatitis B Vaccine AmongSystem, 2010. Children from Birth to 3 Days of Age by State and Local Area. National 4. The values given are crude rates Immunization Survey, Q1/2010-that represent the number of people Q4/2010.affected in the respective population.Age-adjusted rates were used to 13. http://ww5.komen.org/compare populations with different BreastCancer/GeneralRecommenda-age distributions. Please note that the tions.htmlsampling methods used to conductthe 2011 Utah Pacific Islander Survey 14. http://www.cancer.org/Healthy/differ from the statewide BRFSS. This FindCancerEarly/CancerScreening-may affect comparability of results. Guidelines/american-cancer-society-Age-adjustment was to the U.S. 2000 guidelines-for-the-early-detection-of-Standard Population using these age cancercategories: 18-34, 35-49, and 50+. See Table A. 15. Adverse Childhood Experiences Reported by Adults – Five States, 5. Statewide rate is from Utah 2009. MMWR 59(49); 1609-1613Behavioral Risk Factor Surveillance System, 2009. 16. Vincent J. Felitti, MD. The Relationship of Adverse Childhood6. According to the New Zealand Experiences to Adult Health: Turning Pacific Islander scale, overweight Gold into Lead, Kaiser Permanenteis a BMI higher than 26, instead of Medical Care Program.25, and obese is a BMI higher than32, instead of 30. See http://www. 17. American Community Survey. everybody.co.nz/tool-06fb03f0-0ebf- 2007-2009 American Community4c02-8551-c1db35f6fb7b.aspx Survey 3-Year Estimates. Washington, D.C.: U.S. Census Bureau, 2009. 7. See Page 19 for a complete Pacific Islander estimates are Native explanation of the term, “adverse Hawaiian and Other Pacific Islander childhood experiences.” alone.8. Utah Vital Records, Birth-Death 18. American Community Survey. Linked Infant Mortality (birth cohort), 2007-2009 American Community2006-2009. Survey 3-Year Estimates. Washington, D.C.: U.S. Census Bureau, 2009. 9. http://health.utah.gov/precon/ Pacific Islander estimates are Native plan/pregnancy-spacing/ Hawaiian and Other Pacific Islander alone or in combination with one or more other races. Page Background and Methodology 23
  24. 24. References and Notes 19. American Community Survey. 2005-2009 American Community Survey 5-Year Estimates. Washington, D.C.: U.S. Census Bureau, 2009. 20. Center for Multicultural Health. Health Status by Race and Ethnicity 2010. Salt Lake City: Utah Department of Health, 2010. 21. HS Himmelfarb, RM Loar, SH Mott. “Sampling by Ethnic Surnames: the Case of American Jews.” Public Opinion Quarterly 47 (1983): 247-260; Sasao, Toshiaki. “Using Surname-Based Telephone Survey Methodology in Asian-American Communities: Practical Issues and Caveats.” Journal of Community Psychology 22 (1994): 283-295; SH Shin, EY Yu. “Use of surnames in ethnic research: the case of Kims in the Korean-American population.” Demography 21 (1984): 347-60.; Taylor V, Nguyen, T, Hoai Do H, et al. “Lessons Learned from the Application of a Vietnamese Surname List for Survey Research.” Journal of Immigrant and Minority Health 13.2 (2011): 345-351. 22. Gardyn, R. “Make a Connection.” American Demographics 23.12 (2011): 17. Table A: Age-Adjusted Rates PI Survey Age-Adjusted BRFSS Statewide Rate Age-Adjusted Rate Arthritis 21.0 (17.9-24.5) 23.2 (22.3-24.1) Asthma 8.5 (6.4-11.2) 9.0 (8.2-9.9) Diabetes 18.4 (15.6-21.6) 6.9 (6.4-7.5) Gestational Diabetes 32.3 (20.6-46.8) Not available High Blood Pressure 31.0 (27.6-34.7) 24.6 (23.6-25.6) Obese 64.4 (60.2-68.4) 24.0 (22.9-25.1) Cigarette Smoking 8.5 (6.4-11.2) 8.9 (8.2-9.6) Diabetes Screening 53.1 (48.4-57.6) Not available. Colon Cancer Screening 47.1 (39.9-54.2) 68.0 (66.4-69.5)Page Breast Cancer Screening 36.1 (29.1-43.7) 41.1 (39.8-42.5)24 Background and Methodology
  25. 25. Acknowledgments UDOH Office of Health Disparities Reduction Birth Outcomes in Minorities Advisory BoardPrincipal Investigator Joyce Ah You, Queen CenterApril Young Bennett, MPA, Jeff Bird, March of DimesUtah Department of Health (UDOH) Eric Christensen, UDOH Neonatal Follow-upOffice of Health Disparities Reduction Liz Cross, UDOH Home Visiting ProgramPrincipal Statistical Analysis Deborah Ellis, UDOH Reproductive Health ProgramMichael Friedrichs, MS, UDOH Bureau Siosaia Hakofa, Central Utah Clinicof Health Promotion Janet Landon, Planned Parenthood of Utah Steve McDonald, March of DimesAdditional Statistical Analyses Cara Munson, UDOH Women, Infants and Children ProgramLaurie Baksh, MPH, UDOH Maternal Betty Sawyer, Project Successand Infant Health Program Namealoha Sells, University of Utah Pacific Islander Medical Anna Fondario, MPH, UDOH Violence Student Associationand Injury Prevention ProgramRich Lakin, MSPH, MPA, UDOH UDOH Office of Health Disparities ReductionImmunization Program Healthcare Access for Minorities Advisory BoardStudy Coordinators Erica Dahl, Intermountain HealthcareApril Young Bennett, MPA, UDOH Jacob Fitisemanu, Queen CenterOffice of Health Disparities Reduction Rich Foster, UDOH Emergency PreparednessDulce Diez, MPH, UDOH Office of Sarah Klingenstein, People’s Health ClinicHealth Disparities Reduction Catherine Marti, UDOH Survey Center Kurt Micka, Utah Partners for HealthStudy Design Team Dexter Pearce, Community Health CentersApril Young Bennett, MPA, UDOH Olga Rubiano, Alliance Community ServicesOffice of Health Disparities Reduction Darrin Sluga, Salt Lake Valley Health DepartmentDulce Díez, MPH, UDOH Office of Michael Styles, Utah Department of Human Services, Health Disparities Reduction Division of Aging Services Ming Wang, Utah Department of Human Services, Christine Espinel, UDOH Office of Substance Abuse ProgramHealth Disparities Reduction Nan Worel, People’s Health ClinicDavid Foley, MPH, UDOH Immunization Jennifer Wrathall, UDOH Survey CenterProgram Elizabeth Craig, Select Health Michelle Martin, UDOH Oral Health ProgramMichael Friedrichs, MS, UDOH Bureau of Health PromotionRobyn Lipkowitz, UDOH Office of Home UDOH Office of Health Disparities ReductionVisiting Obesity in Minorities Advisory BoardBrenda Ralls, PhD, UDOH Diabetes Taynia Brunt, Huntsman Cancer InstitutePrevention and Control Program Heather Aiono, University of Utah, Community Engagement Core, Clinical and Translational ScienceLynn Startup, MPA, UDOH Survey Lynda Blades, UDOH Physical Activity, Nutrition and Obesity Center ProgramUDOH Office of Health Disparities Angela Castaño, Alliance Community ServicesReduction Advisory Boards Joaquin Fenollar, University of Utah, Department of Health Promotion and EducationUniversity of Utah Pacific Islander Valerie Flattes, University of Utah, Hartford Center ofMedical Student Association Geriatric Nursing ExcellenceTranslation & Advertising Doriena Lee, Calvary Baptist ChurchThe National Tongan American Society Justeena Masina, Salt Lake Community College Angelica Nash, Centro HispanoThe Queen Center Heidi Smith, HealthInsightSurvey Implementation Fahina Tavake-Pasi, National Tongan American SocietyUDOH Survey Center Photography UDOH Programs that contributed financially to this PageWilliams Visual project are cited in the Methods section. Background and Methodology 25

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