Filipino Americans and “HighBlood”: Addressing Challenges of Heart Health Rhodora Ursua, MPH Project Director July 23, 2010 FANHS 13th Biennial National Conference
act Project EXPORT P60 CenterCSAAH was founded in 2003 and funded by NIH/NCMHD as a Center ofExcellence dedicated to the research and reduction of health disparitiesaffecting Asian Americans through research, training, and partnership.
Project AsPIRE’s story…Feb 2004 April 2004 Summer 2004 April 2005 CommunityOutreach Forum Sep 2005
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.
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
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
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).
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.
Filipino Population in NYC & NJTotal Filipino Population 10,223New York State: 120,940New Jersey State: 121,197 5,446Total NYS & NJS: 242,137Note: Alone or in CombinationSource: U.S. Census CommunityHealth Survey, 2008 33,225NJ - largest population by countyMorris County - 3,459 7,918Essex County - 8,406Union County - 6,313Middlesex - 13,507 5,246Bergen County - 15,403Hudson County - 30,066
Cardiovascular disease asprominent health concern (n=120)Source: Abesamis-Mendoza et al., (2007), Community Health Needs & Resource Assessment
Financial barriers as most commonlyexperienced health care access barrierSource: Abesamis-Mendoza et al., (2007), Community Health Needs & Resource Assessment
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
The Big Picture Potential funding for 11 years 3 year 5 year 3 year planning implementation dissemination grant grant grantFunding by NIH/NCMHD for healthdisparities intervention research
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)
Participant recruitment 75 community health screenings in NYC & NJ
Engaged community inparticipant 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
In partnership with…17 faith based organizationsNew 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
15 civic, government, and community organizationsNJ Pan-American Concerned Citizens League (PACCAL) Philippine American Veterans Organization (PAVO) City Hall-Jersey City CREATE Charter SchoolNY 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
10 local businessesNJ Phil-Am Trading Co. Kusina Kabalen Blue Ribbon Rowena’s Topnotch Monica Claire Restaurant Philippine National BankNY Johnny Air Cargo Sally’s Restaurant
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
AsPIRE Screening DataSample size: n=1750Gender: 68% female, 32% maleGeography: NYC (n=1011), NJ (n=719)Place of birth: 94% born in PhilippinesInsurance status: 45% uninsuredSelf-perceived health status: Poor (2%) Fair (21%)
Hypertension among 1750 Filipinos 3 out of 51 out of 2 1 out of 2 individuals individualsindividuals had with elevated BP were taking BPelevated BP NOT taking BP medication still medication had elevated BP
Body Mass Index (BMI) Among 1428 Filipinos 2 OUT OF 5 WERE OVERWEIGHT Underweight Normal Overweight ObeseGender TOTAL (> 18.5) (18.5 - 24.9) (25 - 29.9) ( < 30 )Male 6(1.3%) 188 (40.2%) 236 (50.4%) 38(8.1%) 486Female 16 (1.5%) 520(54.2%) 353 (36.8%) 71 (7.4%) 960TOTAL 22(1.5%) 708(49.6%) 589 (41.2%) 109 (7.6%) 1428
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)
Predictors of HypertensionCompared 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
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
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
Gardening: healthy food and sense ofcommunity 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
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
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
CHW Roles: Trainers/Researchers Training new CHWs Data collection
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)
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
Other initiatives addressing Filipinohealth in NYC APA HEALIN’ –food and active living initiative PROJECT CHARGE – policy advocacy on health care reform
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.
For more information: Rhodora Ursua Project Director, Project AspIRE 212-263-3776 email@example.com www.kalusugancoalition.org www.med.nyu.edu/csaah This presentation was made possible by Grant Number R24 MD001786 fromNCMHD and its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NCMHD.
Acknowledgements Special acknowledgement to all the community members who agreed to participate in this study.