Healthy People 2010 and Asian Americans and Asian Americans and Pacific Islanders: Defining a Baseline of Information Chandak Ghosh, MD, MPH Medical Consultant Health Resources and Services Administration

Addressing Needs of APIs White House White House Initiative on APIs: Initiative on APIs: Executive Order Executive Order June, 1999 June, 1999 Initiative on Race : Initiative on Race : Elimination of Health Disparities u Infant Mortality u Cancer u Immunizations u Diabetes u Cardiovascular Disease u HIV/AIDS

Asia

API Characteristics API Characteristics More than 2 million uninsured More than 2 million uninsured (17% of APIs) (17% of APIs) Poverty rate higher than Poverty rate higher than non-Hispanic Whites (14% vs. 8%) non-Hispanic Whites (14% vs. 8%) Largest percentage of immigrants of any minority group (61%) Largest percentage of immigrants of any minority group (61%) Limited English proficiency (40%) Limited English proficiency (40%)

Diabetes Diabetes u Northern Marianas u Native Hawaiians Infant Mortality Infant Mortality u All Pacific Islanders Cancer Cancer u Chinese (Nasopharyngeal) u Vietnamese (Cervical) Infectious Disease Infectious Disease API Health Burden

HP2010 Goals and White House Initiative Define a Baseline of Current Data Define a Baseline of Current Data HP2010 Data for APIs : HP2010 Data for APIs : u Data Not Collected u Data Statistically Unreliable u API treated as an aggregate Data Limited on APIs: Data Limited on APIs: u Small Numbers and Diversity of APIs u Model Minority u Over-represented Minority u Few Healthy People 2000 Goals

Study Objective To Examine Existing API Health Data More Comprehensively By: u Sub-Population Healthy People 2010 Objectives Healthy People 2010 Objectives Potential API Data Sources: Potential API Data Sources: Grants/Initiatives Grants/Initiatives Government Organizations Foundations Government Organizations Foundations Federal Community Federal Community StateTrade StateTrade LocalProfessional LocalProfessional Research Publications Research Publications

Methods Federal Grants ( ) Federal Grants ( ) u API Sub-Populations u Six Health Areas Computer Retrieval of Information on Specific Projects (C.R.I.S.P.) Computer Retrieval of Information on Specific Projects (C.R.I.S.P.) NIH FDA OASH NIH FDA OASH SAMHSACDC HRSA AHRQ SAMHSACDC HRSA AHRQ Research Publications ( ) Research Publications ( ) u API Sub-Populations u Six Health areas Medline Medline

Federal Grant Results Federal Grant Results

In CRISP: 0.2% of Federal grants relate to API health

Federal Grant Results 5 Grants 3 of 23 HP2010 Goals: Fetal and Infant Deaths Fetal and Infant Deaths API Chinese Filipino API Chinese Filipino Low Birth Weight Low Birth Weight API Chinese Filipino API Chinese Filipino Breastfeeding Breastfeeding Malaysian Malaysian Immunizations 1 Grant 2 of 31 HP2010 Goals: Hepatitis B in Infants and Young Children Hepatitis B in Infants and Young Children Vietnamese Vietnamese Hepatitis B in Adults and High-Risk Groups Hepatitis B in Adults and High-Risk Groups Vietnamese Vietnamese Infant Mortality

Federal Grant Results Diabetes 9 Grants 3 of 17 goals: Prevent Diabetes Prevent Diabetes API API Reduce Diabetes Reduce Diabetes API API Reduce Diabetes Death Rate Reduce Diabetes Death Rate API Cambodian API Cambodian Filipino Filipino Cardiovasc Disease 7 Grants 3 of 16 goals: Coronary Heart Disease Deaths Coronary Heart Disease Deaths API API Stroke Deaths Stroke Deaths API API High Blood Cholesterol High Blood Cholesterol API API

Federal Grant Results HIV/AIDS 9 Grants 5 of 17 goals: New HIV Cases New HIV Cases South AsiansPI South AsiansPI Condom Use Condom Use South AsiansAPI South AsiansAPI Knowledge of Sero- status Knowledge of Sero- status South Asians South Asians Counseling for Substance Abusers Counseling for Substance Abusers API Filipino API Filipino Chinese Vietnamese Chinese Vietnamese Treatment According to Guidelines Treatment According to Guidelines API Chinese API Chinese Japanese Filipino Japanese Filipino

Federal Grant Results Cancer 52 Grants 9 of 15 goals: Cancer Deaths Cancer Deaths API (Aggregate and Disaggregate) API (Aggregate and Disaggregate) Chinese Filipino Japanese Chinese Filipino Japanese N. Hawaiian N. Hawaiian Breast Cancer Deaths Breast Cancer Deaths API Korean Chinese Japanese API Korean Chinese Japanese N. Hawaiian Filipino Vietnamese Indian N. Hawaiian Filipino Vietnamese Indian Cervical Cancer Deaths Cervical Cancer Deaths Korean Cambodian Chinese Filipino Japanese N. Hawaiian Samoan Korean Cambodian Chinese Filipino Japanese N. Hawaiian Samoan Prostate Cancer Deaths Prostate Cancer Deaths API Chinese Japanese Vietnamese Indian API Chinese Japanese Vietnamese Indian Lung Cancer Deaths Lung Cancer Deaths Vietnamese Vietnamese

Federal Grant Results Cancer (Continued) Colorectal Cancer Deaths Colorectal Cancer Deaths API Chinese Vietnamese Indian Mammograms Mammograms API API Counseling about Prevention Counseling about Prevention API Korean Japanese Chinese Filipino N. Hawaiian API Korean Japanese Chinese Filipino N. Hawaiian Cancer Survival Cancer Survival Chinese Filipino Japanese Chinese Filipino Japanese N. Hawaiian N. Hawaiian

In CRISP: 0.2% of Federal grants relate to API health

Research Publication Results

In MEDLINE: 0.01% of articles deal with API health

Research Publication Results Infant Mortality 21 Studies 4 of 23 goals: Fetal and Infant Deaths Fetal and Infant Deaths API Chinese Japanese API Chinese Japanese Low Birth Weight Low Birth Weight API Chinese Filipino Indian Samoan Japanese N. Hawaiian API Chinese Filipino Indian Samoan Japanese N. Hawaiian Prenatal Care Prenatal Care Japanese N. Hawaiian Filipino Japanese N. Hawaiian Filipino Maternal Illness Maternal Illness Cambodian Cambodian Immunizations 23 Studies 4 of 31 goals: Hepatitis B in infants Hepatitis B in infants API SE Asians Chinese Vietnamese API SE Asians Chinese Vietnamese Hepatitis B in adults Hepatitis B in adults API API Vaccines Vaccines API Chinese Laotians API Chinese Laotians Tuberculosis Tuberculosis API Vietnamese Filipino Chinese Korean

Research Publication Results Diabetes 43 Studies 6 of 17 goals: Prevent Diabetes Prevent Diabetes API Japanese API Japanese Reduce Diabetes Reduce Diabetes API API Gestational Diabetes Gestational Diabetes PI Filipino PI Filipino Diagnosis of Diabetes Diagnosis of Diabetes Japanese Chinese Japanese Chinese CV Deaths in Diabetics CV Deaths in Diabetics Japanese Indian Japanese Indian Foot Ulcers Foot Ulcers Japanese Japanese

Research Publication Results Cardiovascular Disease 51 Studies 7 of 16 goals: Coronary Heart Disease Deaths Coronary Heart Disease Deaths API Samoan Japanese Filipino API Samoan Japanese Filipino Chinese N. Hawaiian Indian Chinese N. Hawaiian Indian Stroke Deaths Stroke Deaths API Japanese Chinese API Japanese Chinese Artery-opening Therapy Artery-opening Therapy API API High Blood Cholesterol High Blood Cholesterol API Japanese Chinese Filipino API Japanese Chinese Filipino High Blood High Blood Pressure Pressure Japanese Filipino Japanese Filipino N. Hawaiian N. Hawaiian Mean Total Cholesterol Mean Total Cholesterol Japanese Japanese LDL-Cholesterol Level in CHD LDL-Cholesterol Level in CHD API Filipino API Filipino

Research Publication Results HIV/AIDS 9 Studies 7 of 17 goals: New HIV Cases New HIV Cases API API Condom Use Condom Use API Vietnamese Filipino Cambodian Korean Chinese API Vietnamese Filipino Cambodian Korean Chinese Knowledge of Sero- status Knowledge of Sero- status Chinese Filipino Indian Vietnamese Korean Japanese Chinese Filipino Indian Vietnamese Korean Japanese New AIDS Cases New AIDS Cases API API AIDS Among MSM AIDS Among MSM AA SE Asian Japanese Filipino Chinese PI AA SE Asian Japanese Filipino Chinese PI HIV Testing in TB Patients HIV Testing in TB Patients API API Treatment According to Guidelines Treatment According to Guidelines AA AA

Research Publication Results Cancer 185 Studies 13 of 15 goals: Cancer Deaths Cancer Deaths Chinese Filipino Japanese Chinese Filipino Japanese N. Hawaiian N. Hawaiian Breast Cancer Deaths Breast Cancer Deaths API Pakistani Indian Filipino API Pakistani Indian Filipino Chinese Japanese Samoan Vietnamese Islamic South Asian Chinese Japanese Samoan Vietnamese Islamic South Asian Cervical Cancer Deaths Cervical Cancer Deaths Korean Cambodian Chinese Filipino N. Hawaiian Samoan Vietnamese API Korean Cambodian Chinese Filipino N. Hawaiian Samoan Vietnamese API Prostate Cancer Deaths Prostate Cancer Deaths API Chinese Japanese Vietnamese Indian API Chinese Japanese Vietnamese Indian Lung Cancer Deaths Lung Cancer Deaths Vietnamese Samoan Japanese Chinese API Vietnamese Samoan Japanese Chinese API

Research Publication Results Colorectal Cancer Deaths Colorectal Cancer Deaths API Chinese Japanese API Chinese Japanese N. Hawaiian Korean Samoan N. Hawaiian Korean Samoan Mammograms Mammograms Filipino Korean Vietnamese Chinese Cambodian South Asian Filipino Korean Vietnamese Chinese Cambodian South Asian Colorectal Cancer Screening Colorectal Cancer Screening Chinese N. Hawaiian Japanese API Chinese N. Hawaiian Japanese API Oropharyngeal Cancer Oropharyngeal Cancer Korean Samoan Chinese Korean Samoan Chinese Pap Tests Pap Tests Korean Chinese Vietnamese API Cambodian Korean Chinese Vietnamese API Cambodian Sun Exposure Sun Exposure Japanese Chinese Japanese Chinese Filipino N. Hawaiian Filipino N. Hawaiian Melanoma Cancer Deaths Melanoma Cancer Deaths Samoans Samoans Statewide Cancer Registries Statewide Cancer Registries Vietnamese Vietnamese

In MEDLINE: 0.01% of articles deal with API health

Preliminary Results from Current Marked increase in MEDLINE articles concerning APIS. Marked increase in MEDLINE articles concerning APIS. Very small increase in CRISP grants concerning APIs. Very small increase in CRISP grants concerning APIs. Most research coming out of community-based organizations and academia. Most research coming out of community-based organizations and academia. Most study funding from local and state governments, cbos, academia. Most study funding from local and state governments, cbos, academia. No order or consistency to types of API data No order or consistency to types of API data

Conclusions Current health data remain inadequate for APIs. Current health data remain inadequate for APIs. To reach HP2010 goals, the health community needs baseline data on disaggregated API sub- groups. To reach HP2010 goals, the health community needs baseline data on disaggregated API sub- groups.Recommendations Projects that serve to fill in HP2010 gaps should be funded. Projects that serve to fill in HP2010 gaps should be funded. Investigation of other sources of API data should be started. Investigation of other sources of API data should be started. Evaluation of the quality of the data should be performed. Evaluation of the quality of the data should be performed.

OH WAIT!!!! I ALMOST FORGOT !!!!!!

In CRISP: 0.2% of Federal grants relate to API health. In MEDLINE: 0.01% of articles deal with API health.

CHANDAK GHOSH, MD, MPH Medical Consultant HRSA 26 Federal Plaza, 3337 New York, NY (212)