Asian Health Coalition

Introduction:The 2022 Russian invasion of Ukraine exacts a heavy death toll throughout Ukraine. Morbidity and mortality of warfighters and vulnerable civilian communities are inversely proportional to quality access to a viable medical evacuation chain. The military inspector is one option to fill the gap in prehospital medicine to reduce morbidity and mortality by providing damage control resuscitation/surgery (DCR/DCS).Method:Qualitative and quantitative methodologies are applied. Qualitatively describing the medical evacuation of Shane, providing death estimates of the point of injury to receipt of DCR/DCS. Provide interoperable care across the military-civilian and humanitarian sectors. Describe the standardized and consistent evacuation chains across the entire battlefront from the point of injury to the Role 1/Role 2 echelons of care.Results:The medical evacuation chain for this current iteration of Russian violence is currently inadequate, not standardized, not well integrated at the military-civilian interface. Preventable morbidity and mortality from conventional Russian weapon systems have increased.Conclusion:Armed Forces of Ukraine to engage with NATO and EU colleagues to acquire the methodology and practical applications to reduce preventable morbidity and mortality. Standardized approaches to the concept of damage control resuscitation and damage control surgery to the paradigm of tactical combat casualty care can help reduce morbidity and mortality. The Ukraine crisis and Russian war is killing people in Ukraine, prehospital medicine must address and focus on reducing preventable causes of morbidity and mortality.

Some definitions of homelessness include doubling up—living with others because of economic hardship or housing loss. Doubling up can have negative consequences that should be addressed, but the U.S. Department of Housing and Urban Development’s methods for enumerating homelessness exclude these arrangements, and Department of Education counts of doubling up include only school children. We provide a new method for measuring doubled-up homelessness in the total population using American Community Survey public use microdata. Using this method, we find that 3.7 million people in the U.S. population were doubled up in 2019 and show significant differences in doubling up by geography, race and ethnicity, marital status, educational attainment, school enrollment, and employment status, and compare these findings with research on sheltered and unsheltered homelessness. Notably, rates of Hispanic/Latinx doubled-up homelessness were high, in contrast to their rates of literal homelessness, and some rural areas with low rates of sheltered and unsheltered homelessness had high rates of doubling up. To aid in future research and policy, supplemental materials provide open-source tools for replicating the measure. Findings suggest that policies addressing homelessness and housing insecurity consider those experiencing doubled-up homelessness and that the current measure can assist in those efforts.

In 2024, Russia will change over to the 11th version of the International Classification of Diseases (ICD-11) where the diagnosis transsexualism will be replaced by gender incongruence. At present, clinical practice guidelines rooted in evidence-based medicine are being developed. This means that validated instruments of experimental psychological diagnostics should be used. In the present review, we identify ten instruments used in international practice. After discussing their strengths and weaknesses we can recommend four instruments for diagnosing gender dysphoria and gender incongruence: Transgender Congruence Scale, Trans Collaborations Clinical Check-In (TC3), Gender Congruence and Life Satisfaction Scale, and Utrecht Gender Dysphoria Scale Gender Spectrum (UDGS-GS). Six instruments are recommended for prescribing psychotherapy aimed to help the patients accept their gender identity and build resilience: Transgender Congruence Scale, Gender Identity Reflection and Rumination Scale, Gender Preoccupation and Stability Questionnaire, Trans Collaborations Clinical Check-In (TC3), Gender Congruence and Life Satisfaction Scale, and Transgender Identity Survey. At the same time, we do not recommend two widely used instruments Utrecht Gender Dysphoria Scale (classical version) and Gender Identity/Gender Dysphoria Questionnaire for Adolescents and Adults due to their inapplicability to gender non-binary individuals and those in the process of gender transition. In the article we also discuss issues related to differential diagnostics in the context of ICD-11, as well as peculiarities of using diagnostic scales with gender non-binary individuals, intersex people and detransitioners.

Medicaid beneficiaries in most states must go through a redetermination process every 6-12months to demonstrate continued eligibility. This study sought to examine Medicaid redetermination experiences among beneficiaries with Limited English Proficiency (LEP). A sequential mixed methods study was conducted involving quantitative phone surveys and semi-structured, in-person interviews with Arabic, Chinese, Korean, and Vietnamese speaking beneficiaries in Illinois. Survey respondents experienced notable barriers during the redetermination process. Quantitative data showed LEP respondents to have 5.3 times the odds of losing their Medicaid benefits as compared to English proficient respondents. Qualitative interviews illustrated the impact of Medicaid loss on individuals and families, as well as strategies for successfully navigating redetermination. Findings suggest that language barriers hinder Medicaid redetermination and play a role in cancellation of benefits. Recommendations for better language supports during the Medicaid redetermination process are discussed.

Personal audio systems (PAS) use is a major risk factor for noise-induced hearing loss (NIHL). PAS include a content device and earbuds or headphones for listening to personal audio without disturbing others. PAS are inherently unsafe because their design exposes users to high sound pressure levels. PAS users are at about 4-times greater risk of developing NIHL than non-users, with hearing loss reported in users as young as 9. The greatest risk is for personal listening > 1 hour daily > 50% volume for > 5 years. Nearly 50% of PAS users aged 12-35 listen at volume settings > 50%, putting 1.1 billion young people worldwide at risk of auditory damage. PAS users have a higher risk of tinnitus and hidden hearing loss than non-users. Children and teenagers are at higher risk than adults from noise exposure during auditory system developmental periods. Hearing loss has a greater impact on young people than older adults because good hearing is vital for communication, socialization, education, and future vocational success. A harmonized global manufacturing standard is needed, specifying PAS sound output limits based on the non-occupational 70 dBA daily average noise exposure limit. Without regulated PAS sound limits, preventable NIHL and tinnitus will continue to increase.

Abstract Background Community health workers (CHWs) are lay people from within the communities where they work, who share common characteristics with their members, such as ethnicity, culture, and language. They are frontline health workers who often serve socially and linguistically isolated populations. As trusted members of their communities, they provide critical links between community and systems of care. CHWs can empower community members with enhanced health knowledge, help navigating health systems, and access to care. This study examined the central role of CHWs in disseminating colorectal cancer screening guidelines in seven Asian immigrant communities (Cambodian, Chinese, Filipino, Korean, Lao, South Asian, and Vietnamese) in Chicago. Method The parent project was designed to use a community-centered dissemination model to promote the adoption of colorectal cancer (CRC) screening guidelines in seven Asian communities. In this study, we used social marketing campaign and CHWs as part of the intervention to disseminate CRC screening guidelines. Although social marketing campaigns can create public awareness, they rarely shape attitudes and bring behavior change. To take community members from awareness to commitment and then action, we used CHWs as influencers. All ten CHWs recruited in this study were bicultural and bilingual health professionals. In addition, all CHWs had at least a bachelor's degree, had worked in the community for more than a year and well understood the social norms of the community. All CHWs were required to attend a 6-hour training course on CRC screening, motivational interviewing techniques, and the application of Stage of Change Theory. A CHW guidebook, which listed rationales and components of the intervention, was given to the CHWs. The roles and responsibilities of the CHW (outreaching, educating, navigating and collecting data) were also clearly stated in the guidebook. All CHEs were committed 20 hours/week for the project during the 12-week intervention period. Both quantitative and qualitative data were collected during and after the CHW intervention through weekly activity logs, site visits notes, and focus groups with implementation CHWs at the end of the project. Results Our ten CHWs placed 320 posters (in English or native language) to promote CRC screening in different venues, such as restaurants, churches, temples, and grocery stores, that were frequented by local community members. They also sent out 4,665 CRC postcards to clients on their mail lists. Besides one-on-one counselling session, CHW also conducted 32 CRC information sessions (> 5 people). Across the seven communities, over 2,400 community residents were reached through one-on-one education or small group information sessions over the 12-week intervention period. Most of the CHWs used familiar places to do their outreach, such as in-house programs (e.g. senior services or immigrant programs) or other places that they have implemented programs before. They also used other opportunities, such when they were shopping at the community store or in a bible study, as well as family and friend gatherings, to disseminate CRC screening guidelines. Although not all people they encountered wanted to be screened, they felt that they at least got them thinking about CRC and had impact on them. For personal experience, most CHWs stated that the project increased their knowledge of CRC and they also felt valued. Discussion Participation of CHWs in this demonstration project was invaluable. Each CHW brought critical knowledge of their community, its language, values, norms, and health beliefs. CHWs are uniquely positioned to deliver culturally ad linguistically tailored intervention and can serve as a source of peer support and social influence. Citation Format: Karen Kim, Michael Quinn, Edwin Chandrasekar, Helen Lam. The role of community health workers in disseminating colorectal cancer guidelines in Asian Americans. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr A30.

Abstract Background A community and academic partnership is a powerful vehicle to translate lessons learned in research to a wider audience and bring about changes that can improve community health and eventually eliminate health disparities. Community-based participatory research (CBPR) is an approach to research that focuses on the development of a community-academic partnership. In CBPR, researchers work collaboratively with communities as true partners and use CBPR principles, such as co-learning and mutual benefit, to address identified public health concerns. Evaluating these partnerships and understanding the conditions and processes within CBPR that lead to achieving project goals, such as successful research implementation and outcomes, is important to move the science of CBPR forward. The purpose of this study was to evaluate a cross community and academic partnership that involved seven Asian communities (Cambodian, Chinese, Filipino, Korean, Laotian, South Asians and Vietnamese) that were different in culture, immigration history, and language. Method The parent project was designed to use a community-centered dissemination model to promote the adoption of colorectal cancer screening guidelines in Asian Americans (AA). The academic investigator has already established a good rapport with all partners prior to the project and has done projects with some of them in the past. Since community capacity building and sustainability are key values and outcomes of CBPR, an initial assessment of each partner's capacity and readiness was conducted during the first three months. Based on the findings, the research team conducted several training sessions throughout the 3-year project period to build capacity. In-person quarterly meetings were conduct to discuss project progress, solicit inputs for survey tools, disseminate findings and share lessons learned. The meeting sites were rotated among partners. A website was established to communicate project activities, findings and allow members to post comments. All partner leaderships were asked to participate in an one-on-one, in-depth interview at the end of the project to describe their experience of the partnership and the CBPR process. All interviews were tape-recorded and transcribed. All transcripts were coded and reviewed by three research members until consensus arrived on all themes. Results Overall project satisfaction rates were high, ranging from 8 to 10 out of a 10 scale (0=not at all satisfy and 10 = extremely satisfy). All partner leaderships reported that the project aligned with their priorities and values, although there were differences across organizations, from “including more specific education around specific diseases” to “getting some data for our work”. All leadership reported getting benefits from participating in the project. They also placed high value on the co-learning experience, from the academia and from other organizations. They also felt strongly about the collaboration, among partners and academia, and the attention they got as “mutually, equitably and well distributed”. Some organizations in their early development stage felt empowered by learning from more established organizations. Some saw the project as an opportunity to explore some other issues in their communities. All partners wanted to maintain the task force and to brainstorm issues that were relevant to Asian communities, even after the funding was ended. Conclusion A diverse and cross community partnership may sound complicated; however, with careful planning from the academic research team and mutual respect from all partners, it can enrich the CBPR process and generate greater outcomes. Citation Format: Karen Kim, Michael Quinn, Edwin Chandrasekar, Reena Patel, Helen Lam. Evaluating a diverse and cross community and academic partnership to promote colorectal cancer screening guidelines. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr A31.

The health insurance coverage established by the Patient Protection and Affordable Care Act has created an opportunity to reduce racial/ethnic disparities in healthcare. It is expected that of the 24 million individuals projected to join, nearly one-half will be non-white and one-fourth will speak a language other than English at home. Asian Americans are one of the fastest growing racial/ethnic groups in the USA. The majority are foreign born and experience limited English proficiency. The role of navigators has been shown to increase enrollment rates of public insurance programs. They are trusted for their shared traditions and sense of community. By conducting culturally-targeted outreach, Cambodian, Chinese, Vietnamese, Korean, and Laotian community-based organizations were able to reach individuals for whom the percentage of uninsured is disproportionately high. They enrolled eligible Asians immigrants in coverage despite language barriers and limited health knowledge. Through a collaborative network, a community-level intervention was implemented that was associated with increases in first year marketplace enrollment and greater likelihood of obtaining a primary care physician. Preventable illnesses, lost productivity, and inadequate healthcare are major hardships in immigrant communities that bear similar burdens to society. Bringing primary care to the underserved helps to contain these costs.

Vietnamese American women represent one of the ethnic subgroups at great risk for cervical cancer in the United States. The underutilization of cervical cancer screening and the vulnerability of Vietnamese American women to cervical cancer may be compounded by their health beliefs. The objective of this study was to explore the associations between factors of the Health Belief Model (HBM) and cervical cancer screening among Vietnamese American women. Vietnamese American women (n=1,450) were enrolled into the randomized controlled trial (RCT) study who were recruited from 30 Vietnamese community-based organizations located in Pennsylvania and New Jersey. Participants completed baseline assessments of demographic and acculturation variables, health care access factors, and constructs of the HBM, as well as health behaviors in either English or Vietnamese. The rate of those who had ever undergone cervical cancer screening was 53% (769/1450) among the participants. After adjusting for sociodemographic variables, the significant associated factors from HBM included: believing themselves at risk and more likely than average women to get cervical cancer; believing that cervical cancer changes life; believing a Pap test is important for staying healthy, not understanding what is done during a Pap test, being scared to know having cervical cancer; taking a Pap test is embarrassing; not being available by doctors at convenient times; having too much time for a test; believing no need for a Pap test when feeling well; and being confident in getting a test. Understanding how health beliefs may be associated with cervical cancer screening among underserved Vietnamese American women is essential for identifying the subgroup of women who are most at risk for cervical cancer and would benefit from intervention programs to increase screening rates.