Objective
Asian Americans have low prevalence of overweight/obesity based on standard BMI cut points yet have higher rates of diabetes. We examined the prevalence of overweight/obesity, using lower BMI cut points recommended by the World Health Organization (WHO) for Asians, and diabetes in Asian American subgroups in California.
Method
Secondary analysis of the 2009 adult California Health Interview Survey (n = 45,946) of non-Hispanic Whites (NHW), African Americans, Hispanics and Asians (Vietnamese, Chinese, Korean, Filipino, South Asian and Japanese). WHO Asian BMI cut points (overweight = 23–27.5 kg/m2; obese ≥ 27.5 kg/m2) were used for Asian subgroups. Standard BMI cut points (overweight = 25–29.9 kg/m2; obese ≥ 30 kg/m2) were applied for other groups.
Results
Among Asian subgroups, overweight/obesity was highest among Filipinos (78.6%), which was higher than NHWs (p < 0.001) but similar to African Americans and Hispanics. Compared to NHW, diabetes prevalence was higher for Vietnamese, Koreans, Filipinos and South Asians with BMI = 23–24.9 kg/m2 and Koreans, Filipinos and Japanese with BMI = 27.5–29.9 kg/m2, the ranges WHO recommends as overweight or obese for Asians but not for other groups.
Conclusions
Filipinos should be a priority population for overweight/obesity screening. Filipinos, Vietnamese, Korean, South Asians and Japanese have higher diabetes prevalence at lower BMI cut points. WHO Asian BMI cut points may have clinical utility to identify at-risk Asian Americans.
Objective
Increased out-of-pocket health care expenditures may exert budget pressure on low-income households that leads to food insecurity. The objective of this study was to examine whether older adults with higher chronic disease burden are at increased risk of food insecurity.
Design
Secondary analysis of the 2013 Health and Retirement Study (HRS) Health Care and Nutrition Survey (HCNS) linked to the 2012 nationally representative HRS.
Setting
United States.
Subjects
Respondents of the 2013 HRS HCNS with household incomes <300% of the federal poverty line (n=3552). Chronic disease burden was categorized by number of concurrent chronic conditions (0–1; 2–4; 5+ conditions), with multiple chronic conditions (MCC) defined as ≥ 2 conditions.
Results
The prevalence of food insecurity was 27.8%. Compared to those with 0–1 conditions, respondents with MCC were significantly more likely to report food insecurity, with the adjusted odds ratio for those with 2 to 4 conditions being 2.12 (95%CI 1.45, 3.09) and for those with 5 or more conditions being 3.64 (95%CI 2.47, 5.37).
Conclusions
A heavy chronic disease burden likely exerts substantial pressure on the household budgets of older adults, creating an increased risk for food insecurity. Given the high prevalence of food insecurity among older adults, screening those with MCC for food insecurity in the clinical setting may be warranted in order to refer to community food resources.
Introduction
Chinese Americans have low colorectal cancer (CRC) screening rates. Evidence-based interventions to increase CRC screening in this population are lacking. This study aims to compare the efficacy of two interventions in increasing CRC screening among Chinese Americans.
Design
Cluster randomized comparative trial.
Setting/participants
From 2010 to 2014, a community–academic team conducted this study in San Francisco, CA with Chinese Americans aged 50–75 years who spoke English, Cantonese, or Mandarin.
Intervention
Lay health worker (LHW) intervention plus in-language brochure (LHW+Print) versus brochure (Print). LHWs in the LHW+Print arm were trained to teach participants about CRC in two small group sessions and two telephone calls.
Main outcome measures
Change in self-reports of ever having had CRC screening and being up to date for CRC screening from baseline to 6-months post-intervention. Statistical analysis was performed from 2014 to 2015.
Results
This study recruited 58 LHWs, who in turn recruited 725 participants. The average age of the participants was 62.2 years, with 81.1% women and 99.4% foreign born. Knowledge increase was significant (p<0.002) for nine measures in the LHW+Print group and six in the Print group. Both groups had increases in having ever been screened for CRC (LHW+Print, 73.9% to 88.3%, p<0.0001; Print, 72.3% to 79.5%, p=0.0003) and being up to date for CRC screening (LHW+Print, 60.0% to 78.1%, p<0.0001; Print, 58.1% to 64.1%, p=0.0003). In multivariable analyses, the intervention OR for LHW+Print versus Print was 1.94 (95% CI=1.34, 2.79) for ever screening and 2.02 (95% CI=1.40, 2.90) for being up to date.
Conclusions
Both in-language print materials and LHW outreach plus print materials increased CRC screening among Chinese Americans. The combination of LHW+Print was more effective than Print alone. These findings can guide clinicians and policymakers in choosing appropriate interventions to increase CRC screening among Chinese American immigrants.
Trial registration
ClinicalTrials.gov registry number NCT00947206.
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