Vaccination

37 million adult routine vaccine doses were missed as a result of the COVID-19 pandemic. Currently, 1 in 4 adults are missing one of more of their four critical vaccines for flu, pneumococcal, shingles, and Td or Tdap. While these statistics are daunting, they don’t encapsulate the disparities in vaccine coverage that exist when stratifying by race, ethnicity, and county of birth. 

Vaccination coverage among US-born adults was significantly higher than that of foreign-born adults. COVID-19 vaccination has been relatively high among the broader Asian American population, but certain Asian immigrant groups have low vaccination rates related to lack of knowledge, limited access, language barriers, religious and cultural beliefs, and vaccine hesitancy. In addition to those factors that impact vaccination in the Asian population, the Black and African immigrant populations have higher rates of medical mistrust due to historic and current experiences with racism and discrimination, eliciting vaccine hesitancy.

The Asian Health Coalition created a mixed-methods program designed to understand the different vaccine-related hesitancies that exist among Asian, Black, African, and Middle Eastern refugee, immigrant, and migrant (RIM) communities and from the findings create individualized educational curriculum to increase vaccine confidence and uptake. Curriculum focuses on all vaccines such as COVID-19, influenza, childhood immunization, maternal immunization, and other relevant routine adult vaccines. It also is created to be culturally and linguistically appropriate for the RIM communities it is completed within. 

Language Access

Asian Americans are the fastest growing racial/ ethnic group in the United States, constituting 7.2% of the total population in the United States. In 2020, there were approximately 24 million AAs in the US, and that number is projected to grow to nearly 46 million by 2060. The major growth in the AA population is accompanied by growth in foreign-born Asians with language barriers or limited English proficiency (I.e., inability to speak, read, or write English “very well”). 

The reported rate of limited English proficient Asian Americans in the US is 34%, but as high as 47% for Southeast Asian and 45% for Chinese/ Mongolian populations. Asian Americans with limited English proficiency are more likely to have low socioeconomic status, poor health access, and are more likely to suffer from chronic disease.

The Asian Health Coalition created a mixed-methods program designed to understand the needs and barriers that exist among limited English proficient Asian Americans, as well as the current language access services available at neighboring clinic locations. This program is designed to address language access needs for both the Asian American community and the clinics that serve this community. 

Diabetes

Diabetes is often influenced by genetic and social determinants (e.g., lack of insurance, cost of medications, language barriers), and Asian Americans have been found to have higher diabetes prevalence rates of diabetes than Whites and comparable rates to Hispanic and African Americans. In fact, diabetes remains the fifth leading cause of death in Asian Americans. It was discovered through the Chicago Asian Community Surveys research initiative that the prevalence of type 2 diabetes in Chicago’s Asian communities is strikingly high, notably 10% in the Chinese community, 9% in the Cambodian community, and 15% in the Vietnamese community. These rates are much higher than the national rate of diabetes of 7%. Asian immigrant and refugee communities face significant barriers to accessing health programs and services, often related to cultural and linguistic differences, health insurance status, and attitudes towards the Western health care system. Specific to diabetes control, members from the three communities expressed a lack of diabetes health awareness, knowledge, and literacy to effectively manage this chronic condition. The Asian Health Coalition, along with community partners, has used both quantitative data and supplemental qualitative data from the Chicago Asian Community Survey to guide the development of diabetes self-management programs for the targeted Asian communities.

Hepatitis B

Hepatitis B is a serious global health problem that affects Asians and Africans disproportionately. Of the two billion people infected with the hepatitis B virus worldwide, more than 350 million have chronic infections (CHB). In the U.S., the number of CHB infections is approximately 1.2 million, although recent studies estimate this number to be as high as 2 million, and Asians and Pacific Islanders account for more than 50% of people living with CHB, while African immigrants account for up to 30% of those with CHB, irrespective of the fact that they constitute less than 6% of the total U.S. population. Less than 50% of individuals with CHB have been tested for HBV, and among persons who are aware of their HBV infection, only one-third report that they are receiving medical care for CHB. Chronically infected persons are at high risk for cirrhosis, liver cancer, and liver failure, which all can be fatal. Chronic hepatitis B infection is present in 5% to 15% of Asians living in the Chicago area (rates vary by ethnic group), far higher than the 1%-2% prevalence of chronic hepatitis B infection in the general U.S. population.  

Fortunately, hepatitis B is preventable with safe and effective vaccines for children and adults. Early detection through screening is key for preventing the onset of serious liver disease in those who are chronically infected with the hepatitis B virus. Though people with HBV may not feel sick, left untreated, about 1 in 4 will eventually die from HBV-related health problems, including cirrhosis or liver cancer. The virus is spread by contact with an infected person’s blood or certain body fluids, and the most common way that HBV is spread is from mother to baby during childbirth. Pregnant women, and women planning to become pregnant, should get tested for Hepatitis B to find out if they are HBV positive. Other individuals who may be at high risk for HBV include those who use injection drugs, men who have sex with men, and individuals born in or whose parents were born in Asian or African countries. 

In the U.S., the number of CHB infections is approximately 1.2 million (CDC, 2012), although recent studies estimate this number to be as high as 2 million, and Asians and Pacific Islanders account for more than 50% of people living with CHB, while African immigrants account for up to 30% of those with CHB, irrespective of the fact that they constitute less than 6% of the total U.S. population. Less than 50% of individuals with CHB have been tested for HBV; among persons who are aware of their HBV infection, only one-third report that they are receiving medical care for CHB.

Emerging from such need is the Chicago-based Hepatitis Education and Prevention & Immunization Program (HEPP) initiated by the Asian Health Coalition in 1997 to:

• Improve hepatitis B immunization rates among Asian American children from birth to 18 years

• Raise public awareness of hepatitis risk factors

• Reduce the incidence of liver disease and cancer through early recognition of chronic infection

• Provide health professionals with up-to-date guidelines for diagnosis and treatment.

In 2000, the program’s mission expanded to include prevention of childhood communicable diseases through education and vaccine promotion. The program is community-based, providing education to Asian and African immigrants and refugees in their native languages by lay health educators who are trained and supervised by the Asian Health Coalition.

HIV/AIDS

Until recently HIV surveillance among Asian immigrants was inconsistent or completely uncollected, and for many years, the disease received little attention in this ethnic community. However, in 2007, the Centers for Disease Control and Prevention reported that Asians were the only racial/ethnic group in the U.S. to experience statistically significant increases in HIV/AIDS diagnosis rates. A particular concern, which may be a contributing factor is the low rates of HIV/AIDS testing among Asian Americans.

Asian Americans are generally ignored in current HIV/AIDS prevention efforts because the overall numbers of HIV/AIDS infections are low. Furthermore, few studies distinguish between Asian Americans and the “Other” racial category, leading to a lack of statistical data about the prevalence in the community. Because of the marginalization of Asian Americans in the HIV/AIDS debate, little funding has gone to HIV/AIDS prevention programs that focus on the Asian American community.

A multitude of reports urge the development of culturally sensitive HIV prevention programs for communities of color; however, there has only been one controlled study to date examining the efficacy of an HIV prevention program for an AAPI population in the U.S. The need to develop and test culturally specific programs for these populations is urgent.

The Asian Health Coalition developed culturally tailored HIV awareness campaigns for the Asian American communities in the Chicago metropolitan area through its Fight Ignorance Campaign working with front-line anchor staff at community-based organizations. In addition, we received HIV capacity building assistance from our national partners Asia Pacific Islander Wellness Center and Asian & Pacific Islander American Health Forum for our Banyan Tree Project from 2003 to 2009. The Banyan Tree Project is a nationally funded campaign to end the silence and shame surrounding HIV/AIDS in Asian communities and produces an annual social marketing campaign, the National Asian & Pacific Islander HIV/AIDS Awareness Day, and capacity building assistance programs targeting community-based organizations serving Asians.

We were the Midwest regional partner for the Banyan Tree project and provided capacity building assistance to community partners to improve their HIV programs’ ability to achieve their mission and goals more effectively. The activities covered during our six-year participation in the project involved
providing HIV prevention community development and technical assistance services for Midwest community organizations through training events, individual technical consultations, referrals, and resource development and dissemination. Additionally, we strengthened the adaptation, diffusion, implementation, and evaluation of effective HIV prevention interventions serving high-risk and people living with HIV in Midwest Asian American communities.

Obesity

Obesity is an often overlooked problem in AAPI communities, and according to the Asian American Network for Cancer Awareness, Research and Training, AAPIs have the fastest growing rate of overweight children. Research has also found that AAPI youth consume fewer fruits/vegetables, and have the lowest rates of physical activity but highest consumption of fast foods. Moreover, national studies indicate the prevalence of obesity among Chinese American children ranges from 21.5% to 33.8%.

Locally, according to to the Illinois Youth Survey, only 12% of eight graders, 24% of the tenth graders, and 17% of the twelfth graders have met the recommended amount of physical activity in Chinatown. Additionally, only about 20 to 30% of the students consumed the recommended daily values of fruits and vegetables.

The prevailing “model minority myth” perpetuates the belief that Asian Americans do not suffer from obesity. However, according to the U.S. Department of Public Health, 43% of Asian teens consume fast food on a daily basis compared to 35% of white teens. Also, only one in three Asian children consumes the recommended daily portion of fruits and vegetables compared to one in two Caucasian children. Furthermore, the World Health Organization indicates that Asians are at a higher risk of weight-related health problems at a lower body fat count than Caucasians. For example, a 12-year-old Caucasian child who weighs 150 pounds and an Asian child who weighs 125 pounds face the same incidence of type 2 diabetes, hypertension, and heart disease. In fact, the rate of childhood diabetes among Asian Americans is very high; the rate of diagnosed diabetes in Asian Americans (all ages) is 7.5% compared to 6.6% of Caucasians.

Cardiovascular Disease

Cardiovascular disease (CVD) or heart disease was the leading cause of death for Asian American and Pacific Islander (AAPI) men and women in 1980 and continues to remain the top disease killer for AAPIs in 2010. The lack of progress in a generation’s time poses an important public health challenge, especially in the Chicago metropolitan area where there are approximately 558,000 people of Asian descent, making this area the 5th largest concentration of AAPIs in the nation and largest in the Midwest region. Heart disease among AAPIs is highly correlated with adult diabetes mellitus, a co-morbidity that increases the health burden for Asian immigrant populations who are already highly vulnerable to negative health outcomes. 2008 National Health Interview Survey data suggests that the prevalence of diabetes mellitus is higher among Asian Americans (4.3-8.2%) than Caucasians (3.8-6%). For some ethnic groups (e.g., South Asians) diabetes prevalence was as high as 14%. Research shows that despite the “model minority myth” that surrounds Asians, many tend to engage in poor health behaviors. Only 17.8% of Asian Americans met 2008 Federal Physical Activity Guidelines, plus several Asian groups tend to have higher rates of smoking. For example, a survey conducted in Chicago’s Chinatown area revealed that over 30% of Chinese men living in this area smoke. Studies have shown that immigrant AAPIs also underutilize health services. Working in collaboration with community-based organizations, the Asian Health Coalition aims to address these and other risk factors in order to reduce CVD and diabetes incidence in Chicago’s AAPI population.