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The Impact of Heart Disease on Asian Americans and Pacific Islanders

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					The Impact of Heart Disease
  on Asian Americans and
      Pacific Islanders
        Background Reports
From “Addressing Cardiovascular Health in Asian Americans
        and Pacific Islanders: A Background Report”
               NIH Publication No. 00-3647
 “Asian American and Pacific Islander Workshops Summary
             Report on Cardiovascular Health”
               NIH Publication No. 00-3793

             For more information, contact:
       The National Heart, Lung, and Blood Institute
               Health Information Network
       P.O. Box 30105, Bethesda, MD 20824-0105
                   Tel: (301) 592-8573
                  Fax: (301) 592-8563

                    www.nhlbi.nih.gov
          Ethnic Distribution of the Asian American and
         Pacific Islander Population, United States, 1990
                                          Chinese
                                           22%



                    Pacific Islander                               Filipino
                           5%                                       19%

                      Vietnamese
                          9%




                         Other Asian                               Japanese
                            11%                                      12%


                                       Korean       Asian Indian
                                        11%             11%

Source: U.S. Bureau of Census, 1992.
                 Asian American Population for Selected
                Groups, 1990 (excludes Pacific Islanders)
            Asian Indian                            Korean
                12%                                  12%

                                                                 Vietnamese
                                                                     9%
 Japanese
   12%
                                                                               OTHER 9%:

                                                                       Other   Cambodian 2%
                                                                        9%     Thai 1%
                                                                               Hmong 1%
                                                                   Laotian     Other Asian 4%
                                                                     2%

        Filipino
          20%                                                Chinese
                                                              24%


Source: U.S. Bureau of Census, We the Americans: Asians, 1993.
                        Pacific Islander Population, 1990
                          (Excludes Asian Americans)

                                       Samoan
                                         17%
                                                Guamanian
                                                   14%


                                                      Tongan
                                                        5%

                                                     Fijian
                                                      2%

                   Hawaiian                         Other
                     57%                             5%




Source: U.S. Bureau of Census, 1993.
           Breaking the “Model Minority Myth”
            Asian American and Pacific Islander Poverty Rates, 1990

           70                        63.6
           60
           50                               42.6
 Percent




           40                                      34.7

           30                                         25.7                                  25.8
                                                                                                   23.1
                                                                                         18.2
           20                 17.1                                                                     15.3 14.3
                 13 14.1 14                                  14 13.712.5
                                                                           9.7
           10                                                                    7 6.4

             0
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Source: U.S. Census, 1992
                   Breaking the “Model Minority Myth”
                    Asian American and Pacific Islander Per Capita Income, 1990

                   25,000

                                                  73
                   20,000                     19,3      77
                                                    17,7
                                 43                       76
                   15,000     4,1 38 06
                             1 ,6                     14,8     16
         Dollars




                                13 13,8                     3,6      0
                                                           1      ,97 177                         0 46
                                                                11
                                                                      11,                    11,00 11,4 ,834
                                          342                                32                        10
                   10,000              10,                                9,0                                90
                                                                                                          7,6
                                                                                 97                             44
                                                                              5,5 5,120                      6,1
                    5,000                                                               92
                                                                                     2,6

                       0




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Source: U.S. Census, 1992.
                              Heart Disease as
                           Percentage of All Deaths
                   Vietnamese                                    19.5
                          Korean                                     21.8
                        Chinese                                             27.1
                     Japanese*                                                29.4
                       Samoan*                                                 30.4
                         Filipino*                                                 31.7
                   Guamanian*                                                        33.7
                      Hawaiian*                                                      33.9
                 Asian Indian*                                                        34.6

                                     0                 10       20           30              40
                                                             Percentage
        *Heart disease is the leading cause of death


Source: National Vital Statistics System, CDC, NCHS, 1994.
                                Selected 1995 Age-Adjusted
                                       Death Rates
                               200
                                     181.8                             All Races
                               180
                                                                       AAPI
                               160
                               140
           Rates per 100,000




                               120           109.7    107.9
                               100
                               80
                                                              62.6
                               60
                               40                                       26.7   25.8
                               20
                                 0
                                     Cardiovascular   Coronary Heart       Stroke
                                        Disease          Disease
Source: Anderson, 1998.
                                           Age-Adjusted Heart Disease
                                            Death Rates for Hawaiians
                                     500                                                             Full Hawaiian
                                            443.2                                                    Part Hawaiian
                                     450
                                                                                                     Non-Hawaiian
                                     400                                                 375.9       Hawaii: All Races
            Per 100,000 Population




                                                                    340.8
                                     350

                                     300        273.8
                                     250

                                     200
                                                      190
                                                                                             146.8
                                     150                    142.9       125.8
                                     100                                     89.3 96.5                   79.2
                                                                                                  68.5
                                      50

                                       0

                                                    1970                    1980                 1990

Source: Look MA & Braun KL, 1995.
AAPI CV Health Status: Risk Factors
 High Blood Pressure

• Low levels of awareness and control
• Very little awareness among Cambodian,
  Laotian, and Vietnamese immigrants
• Significantly higher levels among Filipino
  Americans
• Significantly lower blood pressure screening
  rates among AAPIs
 AAPI CV Health Status: Risk Factors

High Blood Cholesterol

• Low blood cholesterol screening rates

• Highest in Japanese men and women vs. other
  AAPI ethnic groups

• Cholesterol levels are lower in Asian countries
  than in Western countries
AAPI CV Health Status: Risk Factors

Cigarette Smoking

• Highest rates among Southeast Asians

• Southeast Asian males start smoking early in
  life

• High tobacco use among Korean men in
  California
AAPI CV Health Status: Risk Factors

Obesity

• Overweight and obesity are prevalent among
  Pacific Islanders
• Native Hawaiians and Samoans are among the
  most obese people in the world
• Molokai Heart Study (Native Hawaiians): 64%
  were obese
 AAPI CV Health Status: Risk Factors
  Obesity (cont.)
• BMI levels for selected Samoan population
   subgroups*
                                  Men (BMI) Women (BMI)
   Western Samoan                       26              28
   Hawaii                               31              33
   California                           35              34
   American Samoa                       30              33

* NOTE: BMI > 30 is obese; BMI of 25-29 is overweight
AAPI CV Health Status: Risk Factors
Physical Inactivity

• AAPIs engage in less physical activity compared
  to the general population

• Korean Americans in California are less likely to
  exercise than the general Californian population
AAPI CV Health Status: Risk Factors
Diabetes

• Highly prevalent among Pacific Islanders
• Higher risk for Native Hawaiians vs. other
  Hawaiian groups
• Guam’s death rate is 5 times higher than U.S.
  mainland
• One of the leading causes of death in
  American Samoa
      Diet-Related Characteristics

• Migration patterns affect diet
• Eating habits change among Korean
  students

• Filipinos: food high in salt increased risk for
  hypertension
  Diet-Related Characteristics (cont.)

• Some groups maintain strong ties to traditional
  diet

• Micronesia: deaths due to CVD and diabetes
  have been attributed to poor diet
    Designing Culturally Appropriate
     Community-Based Programs
Strategies
• Establish trust with the community

• Integrate a health topic within a comfortable setting
• Address the community’s priority issues first
• Recognize cultural factors may affect improved
  health outcomes
    Designing Culturally Appropriate
     Community-Based Programs

Strategies
• Use compelling and accurate data

• Develop a cadre of knowledgeable lay counselors

• Establish alliances and coalitions

• Provide culturally sensitive and linguistically
  appropriate materials
    Designing Culturally Appropriate
     Community-Based Programs

Strategies
• Use cultural themes and symbols

• Determine the role of public policy

• Be prepared to respond to changing needs of the
  population (e.g., use consumer feedback)
                                   The Impact of Heart Disease
                                     on Asian Americans and
                                         Pacific Islanders




These slides were developed by the National Heart, Lung, and Blood Institute (NHLBI) to inform health
professionals, students, and community members about the impact of heart disease on Asian Americans and
Pacific Islanders (AAPIs). Health planners, administrators, students, and public health officials will find these
materials useful as they provide comprehensive information on AAPI sociodemographic profiles, health beliefs
and perceptions, examples of successful community-based programs for AAPIs, and important community
recommendations on how to bring heart health to AAPIs. These slides may also be used as teaching tools. The
information presented here is found in two background reports developed by the NHLBI.




                                                                                                                    1
        Background Reports
From “Addressing Cardiovascular Health in Asian Americans
        and Pacific Islanders: A Background Report”
               NIH Publication No. 00-3647
 “Asian American and Pacific Islander Workshops Summary
             Report on Cardiovascular Health”
               NIH Publication No. 00-3793

              For more information, contact:
       The National Heart, Lung, and Blood Institute
               Health Information Network
       P.O. Box 30105, Bethesda, MD 20824-0105
                   Tel: (301) 592-8573
                  Fax: (301) 592-8563

                    www.nhlbi.nih.gov




                                                            2
                                      Ethnic Distribution of the Asian American and
                                     Pacific Islander Population, United States, 1990
                                                                      Chinese
                                                                       22%



                                                Pacific Islander                               Filipino
                                                      5%                                        19%

                                                  Vietnamese
                                                      9%




                                                     Other Asian                               Japanese
                                                        11%                                      12%


                                                                   Korean       Asian Indian
                                                                    11%             11%

                            Source: U.S. Bureau of Census, 1992.




AAPIs represent diverse communities with unique histories, cultures, languages, traditional beliefs, and values.
AAPIs are the fastest growing minority group in the United States. AAPIs numbered 10.4 million in 1998 or
approximately 3.9 percent of the U.S. population. The Census Bureau projects that AAPIs will reach 34.4 million by
the year 2050, representing 10 percent of all Americans.




                                                                                                                     3
                                             Asian American Population for Selected
                                            Groups, 1990 (excludes Pacific Islanders)
                                        Asian Indian                             Korean
                                            12%                                   12%

                                                                                                Vietnamese
                                                                                                    9%
                             Japanese
                               12%
                                                                                                               OTHER 9%:
                                                                                                               Cambodian 2%
                                                                                                       Other
                                                                                                        9%     Thai 1%
                                                                                                               Hmong 1%
                                                                                                  Laotian      Other Asian 4%
                                                                                                    2%

                                    Filipino
                                      20%                                                    Chinese
                                                                                              24%

                            Source: U.S. Bureau of Census, We the Americans: Asians, 1993.




According to the U.S. Census, the “Asian and Pacific Islander” racial category consists of 50 ethnic subgroups.
Some of the ethnic subgroups included in the category Asian includes: Afghani, Asian Indian, Bangladeshi,
Burmese, Cambodian, Chinese, Filipino, Hmong, Indonesian, Iwo-Jiman, Japanese, Korean, Laotian, Malaysian,
Mien, Nepali, Okinawan, Pakistani, Sikkim, Sri Lankan, Thai, and Vietnamese.




                                                                                                                                4
                                                     Pacific Islander Population, 1990
                                                       (Excludes Asian Americans)

                                                                   Samoan
                                                                     17%
                                                                            Guamanian
                                                                              14%

                                                                                 Tongan
                                                                                   5%

                                                                                 Fijian
                                                                                  2%

                                               Hawaiian                         Other
                                                 57%                             5%




                            Source: U.S. Bureau of Census, 1993.




The Pacific Islander community is diverse and heterogeneous as well. Some of the ethnic subgroups included in the
Pacific Islander category are: Chamorro (Guam), Chuukese, Fijian, Hawaiian, Kosraean, (Federated States of
Micronesia), Mariana Islanders (Commonwealth of Northern Mariana Islands), Melanesian, Palauan (Republic of
Palau), Papese, Pohnpein, Samoan (American and Western Samoa), and Tongan.




                                                                                                                    5
                                         Breaking the “Model Minority Myth”
                                          Asian American and Pacific Islander Poverty Rates, 1990

                                          70                       63.6
                                          60
                                          50                              42.6




                               Percent
                                          40                                     34.7

                                          30                                            25.7                                      25.8
                                                                                                                                         23.1
                                                            17.1                                                           18.2
                                          20                                                                                                15.3 14.3
                                               13 14.1 14                                      14 13.712.5
                                                                                                             9.7
                                          10                                                                       7 6.4

                                           0




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                              Source: U.S. Census, 1992




For years, AAPIs have been portrayed by the mainstream media as the “model minority”: they are self-sufficient,
well-educated, hardworking, and upwardly mobile. While the number of AAPIs living in the U.S. has increased at a
rate of 4.5 percent per year since 1990, they are one of the most poorly understood, invisible, and neglected minority
groups. A closer look at socioeconomic indicators tells a different story.


This slide shows that AAPIs are not immune from poverty. Some communities such as the Hmong, Laotian,
Vietnamese, and Cambodian, Samoan and Tongan experience poverty at a much higher rate than the total U.S.
population.




                                                                                                                                                        6
                                               Breaking the “Model Minority Myth”
                                                Asian American and Pacific Islander Per Capita Income, 1990

                                               25,000
                                                                               3
                                               20,000                       ,37
                                                                          19      ,77
                                                                                     7
                                                                                17
                                                           ,143                     ,87
                                                                                       6
                                               15,000    14 ,638 806              14     ,61
                                                                                            6




                                     Dollars
                                                            13 13,                     13         0
                                                                                               ,97 177                              46
                                                                                             11      ,                       000 1,4 34
                                                                     ,34
                                                                        2                          11                     11, 1 10,8
                                                                   10                                     32
                                               10,000                                                  9,0                              90
                                                                                                                                     7,6
                                                                                                              97                           44
                                                                                                           5,5 5,120                    6,1
                                                5,000                                                                92
                                                                                                                  2,6

                                                   0




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                            Source: U.S. Census, 1992.




This slide that also shows that not all AAPIs are “well-off.” AAPIs tend to display higher income levels compared to
other groups in the U.S. because they tend to have more workers per household. Twenty percent of AAPI families
had three or more workers compared to 13 percent of total U.S. families.




                                                                                                                                                7
                                                          Heart Disease as
                                                       Percentage of All Deaths
                                               Vietnamese                                    19.5
                                                      Korean                                     21.8
                                                    Chinese                                             27.1
                                                 Japanese*                                                29.4
                                                   Samoan*                                                    30.4
                                                    Filipino*                                                  31.7
                                               Guamanian*                                                        33.7
                                                  Hawaiian*                                                      33.9
                                              Asian Indian*                                                          34.6

                                                                 0                10        20           30                 40
                                                                                         Percentage
                                   *Heart disease is the leading cause of death


                            Source: National Vital Statistics System, CDC, NCHS, 1994.




Heart disease and cancer are either the leading or second leading cause of death for each of the AAPI subgroups.
For Asian Indians, Hawaiians, Guamanians, Filipinos, and Japanese heart disease is the leading cause of all deaths.
Stroke is the third leading cause death for Chinese, Japanese, Hawaiians, and Filipinos. Between 1990-1995, stroke
was the leading cause of death for Filipino females in San Francisco.




                                                                                                                                 8
                                                             Selected 1995 Age-Adjusted
                                                                    Death Rates
                                                            200
                                                                  181.8                             All Races
                                                            180
                                                                                                    AAPI
                                                            160




                                        Rates per 100,000
                                                            140
                                                            120           109.7    107.9
                                                            100
                                                             80
                                                                                           62.6
                                                             60
                                                             40                                      26.7   25.8
                                                             20
                                                              0
                                                                  Cardiovascular   Coronary Heart       Stroke
                                                                     Disease          Disease
                             Source: Anderson, 1998.




The age-adjusted cardiovascular disease (CVD) death rate for AAPIs is 109.7 per 100,000 compared to 181.8 for the
total U.S. population.


The age-adjusted death rate due to coronary heart disease (CHD) for AAPIs is 62.6 per 100,000 compared to 107.9
per 100,000 for all races combined.


Death rates due to stroke for AAPIs is 25.8 per 100,000 compared to 26.7 per 100,000 for the general population.




                                                                                                                    9
                                                                        Age-Adjusted Heart Disease
                                                                         Death Rates for Hawaiians
                                                                  500                                                             Full Hawaiian
                                                                         443.2                                                    Part Hawaiian
                                                                  450
                                                                                                                                  Non-Hawaiian
                                                                  400                                                 375.9       Hawaii: All Races




                                         Per 100,000 Population
                                                                                                 340.8
                                                                  350

                                                                  300        273.8
                                                                  250
                                                                                   190
                                                                  200
                                                                                                                          146.8
                                                                  150                    142.9       125.8
                                                                  100                                     89.3 96.5                   79.2
                                                                                                                               68.5
                                                                   50

                                                                    0
                                                                                 1970                    1980                 1990

                             Source: Look MA & Braun KL, 1995.




Native Hawaiians disproportionately suffer from heart disease compared to other ethnic groups in the State of
Hawaii. The death rate for Hawaiians (full and part) for heart disease is 66 percent higher than for the total state
population. Among Full Hawaiians, the mortality rates for heart disease are the highest-271 percent higher than
part-Hawaiians and 382 percent than non-Hawaiians.




                                                                                                                                                      10
                                 AAPI CV Health Status: Risk Factors
                                  High Blood Pressure

                                • Low levels of awareness and control
                                • Very little awareness among Cambodian,
                                  Laotian, and Vietnamese immigrants
                                • Significantly higher levels among Filipino
                                  Americans
                                • Significantly lower blood pressure screening
                                  rates among AAPIs




Compared to most Americans, AAPIs are less likely to be aware of hypertension or to be undergoing treatment
(Chen et al., 1991).


In a study of Cambodian, Laotian, and Vietnamese immigrants, 94 percent had no knowledge of what blood pressure
is and 85 percent did not know how to prevent heart disease (Chen et al., 1991).


As a group, Filipino Americans have higher levels of hypertension compared with other AAPIs, closer to that of
African Americans (NHLBI, 1993; Stavig, Igra, Leonard, 1988).


In 1995, 15.7 percent of Asian Americans in Massachusetts reported to have never checked their blood pressure,
compared to 5.5 percent of the total State population (MA Dept. of Public Health, 1996).




                                                                                                                  11
                                 AAPI CV Health Status: Risk Factors

                                High Blood Cholesterol

                               • Low blood cholesterol screening rates

                               • Highest in Japanese men and women vs. other
                                 AAPI ethnic groups

                               • Cholesterol levels are lower in Asian countries
                                 than in Western countries




The limited number of AAPIs who have their blood cholesterol checked indicates a gap in knowledge and access to
information. More importantly, it indicates a significant number of AAPIs who are unaware of their risk for heart
disease.


In 1993, only 44 percent of AAPIs had their blood cholesterol levels checked within the past 2 years compared to 54
percent of the total population (NCHS, 1993).


There are very few studies on the blood cholesterol levels of AAPIs. One California study found that cholesterol
levels were highest among Japanese men and women compared with other AAPI ethnic groups (Klatsky and
Armstrong, 1991).


Several studies show that cholesterol levels are are lower in Asian countries than in Western countries (Bates et al.,
1989; Kesteloot et al., 1985; Yao et al., 1988).




                                                                                                                         12
                                AAPI CV Health Status: Risk Factors

                                 Cigarette Smoking

                                • Highest rates among Southeast Asians

                                • Southeast Asian males start smoking early in
                                  life

                                • High tobacco use among Korean men in
                                  California




Although rates for smoking in the United States are reported to be lowest among AAPIs (18.2 percent), ethnic-
specific data show that that 92 percent of Laotians, 71 percent of Cambodians, and 65 percent of Vietnamese smoke
(CDC, 1998).


One study found that Southeast Asian males start smoking early in life. Eighty-two percent of Laotian males began
smoking before the age of 20, and 55 percent of those began before the age of 15 (Levin, 1987).


A survey of Koreans in California found that tobacco use among Korean men is higher than the state population: 39
percent vs. 19 percent (Wismer et al., 1994).




                                                                                                                    13
                                AAPI CV Health Status: Risk Factors

                                Obesity

                               • Overweight and obesity are prevalent among
                                 Pacific Islanders
                               • Native Hawaiians and Samoans are among the
                                 most obese people in the world
                               • Molokai Heart Study (Native Hawaiians): 64%
                                 were obese




Overweight and obesity is a major risk factor among Pacific Islanders. For example, Native Hawaiians and
Samoans are among the most obese people in the world (Crews, 1988).


Sixty-four percent of Native Hawaiians who participated in the Molokai Heart study were obese (Aluli, 1991).




                                                                                                               14
                              AAPI CV Health Status: Risk Factors
                               Obesity (cont.)
                             • BMI levels for selected Samoan population
                               subgroups*
                                                               Men (BMI) Women (BMI)
                                Western Samoan                       26              28
                                Hawaii                               31              33
                                California                           35              34
                                American Samoa                       30              33

                             * NOTE: BMI > 30 is obese; BMI of 25-29 is overweight



Samoans age 20 and above, regardless of where they live, show higher levels of obesity as measured by BMI
(Pawson, 1986).




                                                                                                            15
                                AAPI CV Health Status: Risk Factors
                                Physical Inactivity

                               • AAPIs engage in less physical activity compared
                                 to the general population

                               • Korean Americans in California are less likely to
                                 exercise than the general Californian population




Sedentary lifestyle is common among AAPIs, and as a group they engage in less physical activity than the general
population. One study showed that 40 percent of Vietnamese males and 50 percent of Vietnamese females do not
exercise. This compares with 24 percent of men and 28 percent of women in the U.S. population. This study
defined “no exercise” as no leisure time physical activity (CDC, 1992).


Korean Americans are less likely to exercise at least once in the past month than general Californian population (69
percent vs. 79 percent). This study defined “exercise” as moderate physical activity (30 minutes a day, 3 days a
week) (Wismer, 1994).




                                                                                                                       16
                                       AAPI CV Health Status: Risk Factors
                                       Diabetes

                                       • Highly prevalent among Pacific Islanders
                                       • Higher risk for Native Hawaiians vs. other
                                         Hawaiian groups
                                       • Guam’s death rate is 5 times higher than U.S.
                                         mainland
                                       • One of the leading causes of death in
                                         American Samoa




Diabetes is major cardiovascular risk factor among Pacific Islanders. For example, Native Hawaiians are twice as
likely to be diagnosed with diabetes than white residents of Hawaii (Hawaii Diabetes Control Program. Based on Wen M,
unpublished analysis of data from the Behavioral Risk Factor Surveillance System (BRFSS) from 1988 to 1995.).



Guam’s death rate due to diabetes is nearly five times higher than that of the U.S. mainland (Dept. of Public Health and
Social Services, 1997).



Diabetes is one of the top 10 causes of death in American Samoa and is found in 40% of adults over the age of 50
(Diaz, 1997).




                                                                                                                           17
                                      Diet-Related Characteristics

                                • Migration patterns affect diet
                                • Eating habits change among Korean
                                  students

                                • Filipinos: food high in salt increased risk for
                                  hypertension




For AAPI immigrants, adaptation to Western lifestyle is often manifested by increased intake of fatty and high-calorie
food. The classical migration study, Ni-Hon-San Study looked at migration from Japan to Honolulu to San Francisco.
It showed that intake of saturated fat and cholesterol increased with migration and westernization and were
associated with higher CHD mortality rates (Kagan, Harris, Winkelstein, et al., 1974).


Another study found that Korean students showed a decrease in their consumption of rice while showing a marked
increase intakes of fatty cuts of beef, pork, fried poultry, and regular dairy products (Pan et al., 1999).


Among Filipinos, frequent consumption of meat, salted eggs, and sauces high in salt increased their risk for
hypertension (Picache, 1992).




                                                                                                                         18
                                   Diet-Related Characteristics (cont.)


                                • Some groups maintain strong ties to traditional
                                  diet

                                • Micronesia: deaths due to CVD and diabetes
                                  have been attributed to poor diet




However, some AAPIs continue eating traditional diet despite adaptation to a more Western diet. For example,
Southeast Asians tend to maintain strong ties to their traditional diets and native foods in spite of dramatic changes
in their food buying practices (Story and Harris, 1989).


While information on the eating habits of Pacific Islanders is limited, some information reveal eating patterns that
warrant immediate attention from the public health community. For example, in Micronesia deaths due to CVD and
diabetes have been attributed to heavy consumption of fatty food such as canned and other imported meat (corned
beef and turkey tails), shortening, salt from canned fish and vegetables, soy sauce, and instant noodles (Jackson,
1997).




                                                                                                                         19
                   Designing Culturally Appropriate
                    Community-Based Programs
              Strategies
              • Establish trust with the community

              • Integrate a health topic within a comfortable setting
              • Address the community’s priority issues first
              • Recognize cultural factors may affect improved
                health outcomes




Establish trust with the community. Establishing trust with the community is key to successful
implementation of any health promotion program, especially for AAPIs who often seek health advice
from a religious or community leader first (i.e., Hmong clan leaders).


Integrate a health topic within a comfortable and accessible social setting. Persistent barriers
continue to prevent AAPI communities in accessing health services consistently: financial, cultural
(e.g., language, fear, denial of health problems), and logistical (e.g., transportation, childcare).


Address priority issues of concern to the community first (e.g., stress, unemployment, immigration
status) and then introduce cardiovascular disease prevention activities for improved health.


Recognize and understand that there are myriad of cultural factors that may prevent AAPI
communities from securing improved health outcomes (e.g., refugee immigrants might fear authority
figures, certain ethnic groups may have differing cultural beliefs about preventive health services).




                                                                                                        20
                                    Designing Culturally Appropriate
                                     Community-Based Programs

                                Strategies
                                • Use compelling and accurate data

                                • Develop a cadre of knowledgeable lay counselors

                                • Establish alliances and coalitions

                                • Provide culturally sensitive and linguistically
                                  appropriate materials



Here are a few suggested strategies that are aimed at planning, developing and implementing successful
community-based programs for AAPIs.


Use compelling and accurate data to identify where gaps exist. Organizations targeting AAPIs must be able to
access sources of data, interpret them in useful terms, and identify areas where gaps exist. For instance, information
on local demographics may help identify high-risk groups.


Develop a cadre of knowledgeable lay counselors. Community members are most qualified to promote heart health.
They are aware of the needs and strengths of the community.


Establish alliances and coalitions. Collaborations strengthen and sustain health promotion at the community level.
Coalitions work best when there is equal representation of community members.


Provide culturally sensitive and linguistically appropriate materials. Materials should be more than just literal
translations of English brochures to other languages. Messages must take into consideration cultural value systems,
cognitive abilities, and environmental factors surrounding the individual.




                                                                                                                         21
                                     Designing Culturally Appropriate
                                      Community-Based Programs

                                Strategies
                                • Use cultural themes and symbols

                                • Determine the role of public policy

                                • Be prepared to respond to changing needs of the
                                  population (e.g., use consumer feedback)




Use cultural themes and symbols that evoke affinity. Cultural imagery highlights family cohesiveness and harmony
which are dominant values in the AAPI communities. Communicate creatively with picture stories, storytelling, and
folklores.


Determine the role of public policy in eliminating health disparities. Formulating strategies with a policy framework
allows the advocate to identify ways local, state, and federal governments can be held accountable for eliminating
health disparities.


Be prepared to respond to changing needs of the population (e.g., use consumer feedback). Gather feedback from
the community to enhance programmatic elements and meet the dynamic needs of the community.




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Description: The Impact of Heart Disease on Asian Americans and Pacific Islanders