Filipino Americans and “High Blood”:

Addressing Challenges of Heart Health

Rhodora Ursua, MPHProject Director

July 23, 2010FANHS 13th Biennial National Conference

CSAAH was founded in 2003 and funded by NIH/NCMHD as a Center of Excellence dedicated to the research and reduction of health disparities affecting Asian Americans through research, training, and partnership.

Project EXPORT P60 Center

act

Project AsPIRE’s story…

Community Forum

Outreach

Feb 2004 April 2004 Summer 2004 April 2005

Sep 2005

MissionKalusugan 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 & NJ

5,246

5,446

33,225

7,918

10,223

NJ - largest population by county

Morris County - 3,459Essex County - 8,406Union County - 6,313Middlesex - 13,507Bergen County - 15,403Hudson County - 30,066

Total Filipino Population

New York State: 120,940New Jersey State: 121,197

Total NYS & NJS: 242,137

Note: Alone or in Combination Source: U.S. Census Community Health Survey, 2008

Cardiovascular disease as prominent health concern

Source: Abesamis-Mendoza et al., (2007), Community Health Needs & Resource Assessment

(n=120)

Financial barriers as most commonly experienced health care access barrier

Source: 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

3 year planning grant

5 year implementation grant

3 year dissemination grant

Potential funding for 11 years

Funding by NIH/NCMHD for health disparities 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 in participant 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 organizations

New Jersey•Day by Day Christian Ministries•Christian Living Fellowship •St. Joseph’s Church•St. Aedan’s Church•St. Mary’s Church•Sisters of Our Lady of the Poor•Our Lady of Victories •COMFI

New York St. Lucy’s St. Sebastian’s St. Bartholomew’s Elmhurst Baptist Church Most Precious Blood Church Our Lady of Pompeii Hillside Church of Christ Corpus Christi Church

15 civic, government, and community organizations

NJ 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 businesses

NJ Phil-Am Trading Co. Kusina Kabalen Blue Ribbon Rowena’s Topnotch Monica Claire Restaurant Philippine National Bank

NY Johnny Air Cargo Sally’s Restaurant

31 health providers

1. APICHA2. Bellevue Occupational Health3. Cabrini Medical Center4. Charles B. Wang Community Health Center5. Child Center of New York6. Elmhurst Hospital-Cardiology Department7. Horizon Medical Center 8. Philippine Nurses Association-NY9. Philippine Medical Association in America10. Queens Hospital11. Philippine Physical Therapists12. Metropolitan Family Health Network (Garfield)13. NYU Medical School14. NYU Dental School15. United Home Care16. UPMASA

17. Dr. Erie Agustin18. Dr. Apiado19. Dr. Expedito Castillo20. Dr. Mark Causin21. Merryl Foz, RN22. Myrna Deleon, RN23. Dr. Arnil Neri24. Dr. Oca25. Dr. Zenaida Santos26. Dr. Marissa Santos27. Violeta Totanes, RN28. Cora Velasco, RN29. Nino Velasco, RN30. Rodelia Villanueva, RN31. Kim Quilban, RN

AsPIRE Screening Data

Sample size: n=1750

Gender: 68% female, 32% male

Geography: NYC (n=1011), NJ (n=719)

Place of birth: 94% born in Philippines

Insurance status: 45% uninsured

Self-perceived health status:

Poor (2%)

Fair (21%)

Good (47%)

Very good (20%)

Excellent (6%)

Missing data (4%)

Hypertension among 1750 Filipinos

1 out of 2 individuals had elevated BP

1 out of 2 individuals with elevated BP were NOT taking BP medication

3 out of 5 individuals taking BP medication still had elevated BP

Body Mass Index (BMI)

Gender Underweight (> 18.5)

Normal (18.5 - 24.9)

Overweight (25 - 29.9)

Obese ( < 30 ) TOTAL

Male 6(1.3%) 188 (40.2%) 236 (50.4%) 38(8.1%) 486

Female 16 (1.5%) 520(54.2%) 353 (36.8%) 71 (7.4%) 960

TOTAL 22(1.5%) 708(49.6%) 589 (41.2%) 109 (7.6%) 1428

Among 1428 Filipinos 2 OUT OF 5 WERE OVERWEIGHT

Smoking and Exercise among Hypertensive Sample

Stroke Congestive Heart Failure

Heart Attack

669 (38.2%) 317 (18%) 522 (30%)

Family history of cardiac event

Self reported family* event

*Family includes: father, mother, siblings, and grandparents. (n=1750)

Predictors of Hypertension

Compared 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

Capturing stories…photovoice

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 createsa 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

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

Gardening: healthy food and sense of community

 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

Dancing to exercise…

Community Health Worker Intervention

CHW Training Curriculum (115 hours)CHW Role, Advocacy History of CHWs CHW leadership skills & advocacy Immigrant access to health services in NYCTeaching and Communication Popular education Communication skills Health literacy & simple language Conflict resolutionClinical Skills Trainings Phlebotomy Adult and infant CPR Pharmacology of antihypertensive &

diabetes medicationDisease-specific Trainings Basics of CVD and Diabetes HIV/AIDS Breast cancer awarenessHealth promotion trainings Physical activity Nutrition Chronic disease self-management

Research Trainings Community-based

participatory research Research methods (i.e. FGs,

survey administration) Ethical issues in research;

HIPAA Database & Data analysis

software (access, Atlas ti, SPSS)

Partnership evaluation NHLBI Healthy Heart, Healthy

Family Curriculum Intervention Implementation

& EvaluationOther: Computer literacy

CHW Roles: Community Organizers

Faith-based organizations/ Health professional associations

Businesses Workers

CHW Reaching Out…Chess Tournament

ApartmentsChurch Services

CHW Roles: Bridges to health

Health education

Link to health providers

Monitor blood pressure

Filipino Heart Health Curriculum (NHLBI)

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/ResearchersData collectionTraining new CHWs

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 Filipino health 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

rhodora.ursua@nyumc.org

www.kalusugancoalition.org

www.med.nyu.edu/csaah

This presentation was made possible by Grant Number R24 MD001786 from NCMHD 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.