Background/Significance

Raising awareness about and increasing participation in available mental health resources among local Pacific Islander (PI) communities requires a concerted effort to engage the community to do so. The Essence of MANA (MANA) programming strives for this, yet recognizes certain policies or systems, such as how individuals are identified or lack of recognition of groups, are in place that only sometimes allows for easy access to such services.

Objective/Purpose

Over the past three years, under the guidance of a community advocacy coalition, MANA has coached and prepped individuals from different local PI communities to engage and provide feedback to state and local policymakers regarding funding expansion and how funding is applied to mental health services. Additionally, MANA worked alongside other BIPOC-serving mental health programs and participated on a sustainability committee, impacting state and local mental health policies and funding mechanisms.

Methods

Transcripts from interviews with staff and advisory board members and summary notes from staff meetings were collected and reviewed to document the “momentum” to producing policy or systems change.

Results

MANA’s collaborative efforts resulted in 1) securing an additional four years of state funding for mental health services, 2) changing verbiage in a state statute to expand mental health services to more subpopulations within transitional-age- youth groups, and a local statute for funding that allowed organizations to determine how best to address the community.

Discussion/Conclusions

Understanding community needs, MANA learned from others about advocacy and policy change to build up its own communities to do the same.

Background: The Asian Indian (AI) population is the second-largest immigrant group in the United States. While the average age of AIs in the US is approximately 40 years, 20% of AIs are 50 years and older. AIs have multiple comorbidities that are associated with poor aging trajectories, yet they remain under-represented in aging research.

Objective: We aim to understand the perceptions about aging, particularly brain aging, among older AI immigrants in the United States.

Methods: In-depth interviews were conducted with AI immigrants aged 50 years and older (n=12) living in the Dallas-Fort Worth Metroplex. Interviews were guided by a semi-structured interview guide and explored participants’ overall perception of aging in the US. Data were analyzed thematically with a priori and emergent codes.

Results: Most participants were women (n=9). Mean age was 68.9 years (SD=5.3) and mean length of stay in the US was 28.2 years (SD=11.1). Emerging themes around aging include feeling socially isolated and facing challenges with age-related comorbidities. Participants discussed the increasing challenges in navigating healthcare needs and health insurance as they age. Participants’ immigration experience shaped the quality of their social connectedness and their overall perception of aging in the US. Awareness about brain health and dementia was low.

Discussion/Conclusion: Social isolation, loneliness, and lack of awareness about brain health among older AI immigrants in the US are key aspects of aging to target in future work, but data collection is ongoing. These results can be used to guide culturally-responsive interventions related to aging for AI populations.

Background: Native Hawaiian and Pacific Islander (NHPI) populations are diverse, with different languages, histories, and cultural practices that result in specific health patterns. Due to barriers to collection and reporting of data on NHPI communities, their specific needs are not identified by federal funding formulas and grantmaking tools used to target the distribution of resources and inform program development. As a result, these communities are often not prioritized in the distribution of health-related resources and programs, as was highlighted during the COVID-19 pandemic when NHPI communities were underrepresented within areas receiving targeted resources, despite experiencing the highest case and death rates of any racial-ethnic group.

Objective: Develop a new multidimensional health index that can be used to identify NHPI community needs for future resource deployment.

Methods: The UCLA Center for Health Policy Research’s NHPI Data Policy Lab has conducted focus groups with more than 100 NHPI community leaders to identify areas of need and equip communities with the tools they need to make them effective health advocates. Using this input and data from sources such as the American Communities Survey and AskCHIS Neighborhood Edition, we construct a new multidimensional measure, the NHPI Health Equity Index, that better identifies needs within the NHPI population.

Results: Compared to the Healthy Places and Social Vulnerability indices, the NHPI Health Equity Index better predicts life expectancy and NHPI COVID-19 death rates.

Conclusion: The NHPI Health Equity Index can improve health equity by ensuring that resources are targeted at NHPI communities that are often overlooked.

Background:

Studies have investigated excess mortality from COVID-19 between aggregated racial and ethnic groups, but few have examined mortality within ethnic racial or ethnic subgroups, like Asian Americans (AsA) and Native Hawaiians/Pacific Islanders (NHPI).

Objective:

To address this gap, we examined excess mortality among disaggregated AsA and NHPI compared to non-Hispanic Whites (NHW).

Methods:

We analyzed 13,702,743 decedents from the 2015-2020 National Vital Statistics System. We used seasonal autoregressive integrated moving average (sARIMA) models to calculate expected mortality in 2020 (2015-2018 training data, 2019 calibration data) for all-cause mortality, heart disease, cancer, diabetes, cardiovascular accidents, flu/pneumonia, and COVID-19 mortality for the six largest AsA subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, & Vietnamese), NH/PI, and NHW populations. Excess mortality (EM) was calculated as the difference between observed mortality in 2020 and expected mortality from sARIMA.

Results:

In 2020, aggregated AsA had higher all-cause mortality than expected (14,209 deaths, an 18% increase); all subgroups also experienced higher than expected mortality, ranging from Japanese (+10%)—the only subgroup lower than NHW’s +11%—to Filipinos (+22%). Compared to pre-pandemic levels, Chinese individuals had the largest increase in heart disease mortality (+18.4%), and Vietnamese individuals had the largest increases in cancer mortality (+5.9%) and diabetes-related mortality (+52.3%).

Conclusions:

All AsA groups and NHPIs experienced excess mortality in 2020. However, there was vast heterogeneity in increased mortality when disaggregated. Future work should consider how changes in EM alter discussions of disparities in mortality during the pandemic.

Background: Due to limited English proficiency and distinct cultural factors, South Asians (SAs) in the United States face a high burden of diabetes and comorbid hypertension. Community health worker (CHW)-led interventions have shown to improve diabetes and hypertension outcomes in ethnic communities. Methods: This study investigated the experiences of SA participants in a CHW-led diabetes and hypertension intervention based in Atlanta, Georgia. The Reach, Efficacy, Adoption and Implementation (RE-AIM) and Consolidated Framework for Implementation Research (CFIR) models informed the creation of a semi-structured interview guide. Rapid qualitative assessment was used to evaluate participant input on the program's organization and logistics, participation and retention, and telehealth sessions. Results: 21 participants (mean age: 53.4, SD: 10.4; 43% female) participated across three focus groups. The delivery of the intervention in participants’ native language, participants’ concern for ability to manage diabetes and hypertension, and CHW’s motivation skills were key factors for participant recruitment and retention. The need for more personalized counseling on comorbidities of diabetes and hypertension was identified. Telehealth sessions on diabetes and hypertension management helped participants lose weight, reduce A1c levels, adopt healthier eating habits, and increase self-management of diabetes and hypertension. Participants reported that group telehealth sessions established strong bonds, allowing them to learn from each other. Despite identifying lack of technological literacy as a challenge to telehealth sessions, participants shared that an in-person program would be unsuccessful. Conclusions: Findings highlight high levels of satisfaction and feasibility of a telehealth CHW-based intervention for SAs with diabetes and comorbid hypertension.