Population characteristics and health care needs of Asian Pacific Americans

Asian Pacific Americans are one of the smallest but fastest growing minority groups in the United States. Between 1970 and 1980, this population increased 142 percent, from 1.5 million to 3.7 million. This dramatic growth is due largely to a change in U.S. immigration policies in the mid-1960s and the continuous influx of refugees from Southeast Asia since 1975. Despite such sharp increase, Asian Pacific Americans remain one of the most poorly understood minorities, and their health care needs have received relatively little attention. Health policy makers, planners, and service providers need to have a better understanding of the population characteristics of Asian Pacific Americans in order to address their needs properly. Asian Pacific Americans are largely recent immigrants and refugees. They are extremely heterogeneous and bipolar in socioeconomic status and health indices. Because of their small numbers until the last two decades, many health workers have had little exposure to this minority, their culture, and health problems. Health workers need to be sensitive to the ethnocultural barriers that confront recent arrivals; be aware of the genetic disorders, infectious diseases, and mental health problems common in this population; and realize that anatomical and physiological differences may require attention in certain surgical procedures and medical management. Neglecting the health care needs of Asian Pacific Americans is not simply a violation of the principle of equality for all, but also an imprudent act that increases the mortalities and morbidities and health care costs of the nation.     

Mental Health Service Use Types Among Asian Americans with a Psychiatric Disorder: Considerations of Culture and Need

Despite levels of need that are comparable with other groups, relatively few Asian Americans receive mental health care. While studies have described the tendency for Asian Americans to delay care until mental health symptoms are severe, relatively little research has examined how the severity of symptoms impact mental health service use. This study uses publicly available data from the National Latino and Asian American Study (NLAAS) and focuses solely on Asian American respondents with a psychiatric disorder (n?=?230). Unexpectedly, few Asian Americans with a psychiatric disorder received care in a medical setting. The perception of mental health needs increased the likelihood of using mental health specialist care. Social and systemic barriers together hinder mental health service use. Implications for addressing Asian American mental health service use within a changing health care environment are discussed.     

Pacific Americans and the National Health Care Act: Where we fit

PURPOSE OF THE PAPER. The purposes of this report were to identify Pacific American health care priorities, recommend how these needs can be addressed in national health care reform legislation, and inform national leaders of the cultural and social context withing which these needs must be met. SUMMARY OF METHODS UTILIZED. In concert with a team of researchers, the authors compiled and analyzed extant literature on the health care of Pacific Americans; discussions were held with health care professionals, state and territorial health care leaders, and agencies and organizations with substantial experience and expertise in health care promotion and development; a two-day health symposium was conducted by Pacific American health care community leaders to review the initial findings, conclusions, and recommendations of the draft report; and follow up meetings were heald with actual communitiy health care providers to validate the data and recommendations of the report. PRINCIPAL FINDINGS. Pacific Americans have collective historical and political relationship not only with the federal government and the continental United States, but also to each other's island state or territory. Thus, common needs and unique interrelationships serve to highlight the importance of the differences between western-oriented and Pacific American health care providers. There is a profound lack of health resources in many Pacific American communities, and even when health resources are potentially available, poor access to health care compounds the need. Pacific Americans are a mobile people with large numbers residing in California, Oregon, Washington, Nevada, Texas, Utah, and the New York-Virginia corridor. Their health needs continue even when they do not reside in their home bases. CONCLUSIONS. Pacific Americans know best how to bridge the cultural gap that continues to exist between them and western-oriented health care providers; improvements in their health care is best accomplished by Pacific Americans themselves. Pacific American health care did not start from an "Even playing field"; hence, the mismatch in resources and needs is so pronounced that it argues not only for continued but also greatly expanded federal support for enabling services, research development, and professional education and development. The federal government must collect and develop better demographic and health access information specifically and separately for Pacific Americans. Baseline data for Pacific American populations, regardless of their residence, must be available and analyzable in terms of community and/or geographic areas. Only then can effective programs be established, managed, evaluated, and improved. KEY WORDS. American Samoans; Chamorrors; Hawaiians; Pacific Americans; Pacific Islanders&semi.     

The organization and financing of health services for persons with disabilities

Americans with disabilities are rarely considered a distinct group of health care users in the same way as are older Americans, children, racial and ethnic minorities, and others who are perceived to have different needs and access issues. Indeed, to some extent individuals with disabilities overlap with all these groups. But they also have distinct needs with material implications for the organization, delivery, and financing of health care services. Despite the disproportionate health care needs and expenditures of many--though not all--individuals with disabilities, the mainstream health services research community has largely neglected them. This article outlines the most pressing health service research issues in addressing the health care needs of individuals with disabilities.     

Depathologizing Asian American Perspectives of Health and Healing

PURPOSE: The purpose of this literature review is to analyze how culture, both western and Asian, affect the characterization of Asian Americans in mental health. FINDINGS: Asian Americans are pathologized by the current Western health care system in two primary areas: somatization and dependency. The diagnosis of somatization contributes to the stereotyping of Asian Americans as hypochondriacal and alexythymic; the dependency characterization fosters the belief that Asian Americans are physcoloically immature and unsophisicated. Due to these perceptions, mental health services do not adequately serve the needs of Asian Americans. CONCLUSIONS: A cultural perspective of indigenous Asian values and specific diagnositic terminology explains these differences in Asian American practices of health and healing.     

Health care strategies for Asian American patients.

The health status of Asian Americans is at risk because the existing health care delivery system is unable to provide ethnic-sensitive health care services. This condition is attributed to the changing policies and practices of the health care system of the past decades. Thus it is argued that health care providers must become more knowledgeable about the specific health needs of Asian Americans.     

Needs in health: important questions for nursing work

The construction of new paradigms and practices in health and nursing, directed to an effective exercise of social rights is an actual challenge. The present study is a contribution to solve this challenge. Looking at nursing knowledge, authors reflect on a way of interpreting the needs in health. Based on a discussion about human needs and their relationship with the health work, they analyse them following the direction of Wanda de Aguiar Horta's theory. They emphasize the importance of human autonomy/selfvaluing and the interpretation of needs based on the consideration of people who receive and give health care and of the social context.     

Happy with health care?

The American Association of Health Plans (the main HMO trade association), in making the case against patients' rights legislation, points to polling data that show Americans are basically satisfied with managed care plans. Although large majorities, including those with HMOs, do say they are "satisfied" with their health care plans, HMO members are less satisfied than members of other types of plans. And if we look beyond personal-satisfaction ratings, we find plenty of evidence for public concern about HMOs in particular and the health care system in general. Americans are supportive of HMO regulation, and despite their willingness to say they are "satisfied" with their health care plans, they harbor a lot of worries about the future--treatment that could be denied them, costs that could ruin them, and loss of coverage. The public sees the need for major change not just in HMOs but in the health care system as a whole. As HMO lobbyists scramble for new arguments against legislation, they will likely persist in misrepresenting and misusing polling data to make their case.     

Factors associated with health care access and outcome

This study aims to (1) assess ethnic differences in health care access and health outcome between Asian Americans and whites and between Asian American subgroups, (2) examine effects of cultural factors, and (3) investigate moderating effects of health risk behaviors between cultural characteristics and health care access and outcome. Data were derived from the 2007 California Health Interview Survey. Asian Americans (n = 4,462) and whites (n = 4,470) were included. There were significant ethnic differences in health care access and health perception between Asian Americans and Whites and across Asian American subgroups. Health risk behaviors moderated relationships between cultural factors and health care access and outcome. Findings reveal that ethnicity affects an individual's health care access and health perception, and their health behaviors are an important factor that may improve or worsen outcomes. This study may increase our knowledge base of research and interventions to enhance ethnic minority populations' health care accessibility and perceptions.     

Factors Associated With Health Care Access and Outcome

This study aims to (1) assess ethnic differences in health care access and health outcome between Asian Americans and Whites and between Asian American subgroups, (2) examine effects of cultural factors, and (3) investigate moderating effects of health risk behaviors between cultural characteristics and health care access and outcome. Data were derived from the 2007 California Health Interview Survey. Asian Americans (n = 4,462) and Whites (n = 4,470) were included. There were significant ethnic differences in health care access and health perception between Asian Americans and Whites and across Asian American subgroups. Health risk behaviors moderated relationships between cultural factors and health care access and outcome. Findings reveal that ethnicity affects an individual's health care access and health perception, and their health behaviors are an important factor that may improve or worsen outcomes. This study may increase our knowledge base of research and interventions to enhance ethnic minority populations' health care accessibility and perceptions.     

Asian and Pacific Islander Americans: An Overview of Demographic Characteristics and Health Care Issues

PURPOSE: To review the demographic characteristics of Asian and Pacific Islander Americans (APIAs) and their health care needs. METHODS: The author reviewed the 1990 Census data, later Current Population Surveys, monographs, books, and the medical literature on APIAs based on MEDLINE and other sources. FINDINGS: APIAs are the fastest growing minority in the U.S. They are mostly foreign­born, highly diversified, heterogeneous, bipolar in socioeconomic status, and concentrated in the West and metropolitan areas. APIAs have many health care needs: lack of health data, ethnocultural barriers, and high frequency of hepatitis B and tuberculosis and certain genetic disorders such as thalassemia and lactase deficiency. It is also questionable whether some U.S. norms and standards based on non­APIA subjects are appropriate for APIAs. CONCLUSIONS: APIAs are a fast growing minority whose many unmet health care needs have been overshadowed by the myth of a model minority. The health care system should address these needs and assure equal access to health services for all minorities. KEY WORDS: Asian Americans, Culture, Ethnicity, Health Services Accessibility, Health Education, Health Policy, Hepatitis B, Minority Groups, Thalassemia, Tuberculosis     

Americans compare managed care, Medicare, and fee-for-service

Are all health plans created equal? A recent survey of 1,000 adults queried Americans about their experiences with managed care, the Medicare program, and traditional fee-for-service medicine. Most Americans said they generally are content with their arrangements, but Medicare patients reported the highest level of satisfaction. Managed care consumers said they are generally pleased with their care, but they reported some problems with their specialist care. Overall most Americans are not looking for a completely new health care system.     

Reaching out to those in need: the case for community health science.

The present health care delivery model in the United States does not work; it perpetuates unequal access to care, favors treatment over prevention, and contributes to persistent health disparities and lack of insurance. The vast majority of those who suffer from preventable diseases and health disparities, and who are at greatest risk of not having insurance, are minorities (Native Americans, Hispanics, and African Americans) and those of lower socioeconomic status. Because the nation's poor are most affected by built-in inequities in the health care system and because they have little political power, policy makers have been able to ignore their responsibility to this group. Family medicine leaders have an opportunity to integrate community health science into their academic departments and throughout the specialty in a way that might improve health care for the underserved. The specialty could adapt existing structures to better educate and involve students, residents, and faculty in community health. Family medicine can also involve community practices and respond to community needs through practice based research networks and community based participatory research models. It may also be possible to coordinate the community activities of family medicine organizations to be more responsive to the health crisis of those in need. More emphasis on community health science is consistent with family medicine's roots in social reform, and its historical and philosophical commitment to the principle of uninhibited access to medical care for the underserved.     

Conducting Health Research in Korean American Churches: Perspectives from Church Leaders

Korean Americans experience many challenges to obtaining adequate health care coverage and access to needed services. Because a large proportion of Korean Americans attend churches on a regular basis, churches may be a promising venue where health programs can be delivered. In order to gain an in-depth understanding of Korean American churches with respect to conducting future health intervention research, we conducted exploratory interviews and focus groups with 58 leaders from 23 Korean American churches and three community organizations. From these interviews and focus groups, we found that Korean churches and church leaders seek to meet a variety of social and health needs of their congregation and their surrounding community. Several leaders have stated that assisting with social and medical needs of their members is an important component of their current ministry. They described profound health needs of their congregations and have suggested various ways in which the university can partner with the local churches to help address these needs through research. Additionally, they described various resources churches can provide to researchers such as: their personal assistance, church volunteer base, church facility, and church network and contacts. Our findings suggest that Korean churches have a high potential to serve an important role in the health of Korean Americans. On the basis of the promising results of the present study, we are planning to conduct a cross sectional survey of Korean church leaders and members in Los Angeles County to substantiate our findings in a larger representative sample.     

Methodological issues in the collection, analysis, and reporting of granular data in Asian American populations: historical challenges and potential solutions

There are close to 15 million Asian Americans living in the United States, and they represent the fastest growing populations in the country. By the year 2050, there will be an estimated 33.4 million Asian Americans living in the country. However, their health needs remain poorly understood and there is a critical lack of data disaggregated by Asian American ethnic subgroups, primary language, and geography. This paper examines methodological issues, challenges, and potential solutions to addressing the collection, analysis, and reporting of disaggregated (or, granular) data on Asian Americans. The article explores emerging efforts to increase granular data through the use of innovative study design and analysis techniques. Concerted efforts to implement these techniques will be critical to the future development of sound research, health programs, and policy efforts targeting this and other minority populations.     

Social work and health restructuring in Canada and Finland

The health care systems in Canada and Finland are currently in the process of restructuring. Responsibility for care has increasingly shifted to ill persons themselves and to their families and friends. Reduced hospital stays, service privatization and user fees have been implemented to some degree in both countries. These changes are reverberating throughout Finnish and Canadian societies, affecting not only users of health care but also the labour force in health workplaces. Health social workers, at the front line with clients, have experienced new issues which have impacted on their practice with ill persons and their families. In an environment of health care restructuring, they have needed to draw upon their repertoires of knowledge, skills and community networks in order to respond. At the same time, social workers noted that there is a leaner package of health and social service benefits to support patients and families. Social workers have tried to adapt and find new opportunities to practice social work in the changed environment. This small study, initially conducted as a pilot for a larger study, compared the experiences of social workers in Canada and Finland and the perceived impacts of health restructuring on their clients. The findings, seen within the context of changing societal and institutional environments, can help us to better understand some of the impacts of health restructuring on social work and social workers in hospitals and local health centres. Indirectly and directly, these changes also affect clients in the health care system, those whose needs remain uppermost in the delivery of social work services.     

The social network of children with special healthcare needs in the (in)visibility of nursing care

This study aimed to identify the (in)visibility of nursing care and discuss ways of (dis)articulating this care with family care in the social network of children with special healthcare needs. A qualitative research was performed with health professionals at a pediatric hospital, four units of the Family Medical Program (FMP), and children's relatives living in Niterói (RJ). The field work was put in practice after IRB approval (HESFA/EEAN), consisting of five semi-structured interviews and two group dynamics. Critical Discourse Analysis indicated that nursing care is visible in the child's social network through the nurse's educational and care activities and home visits by the nurisng aide of the FMP. Due to errors in the national health system's referral and counter-referral, mothers articulate the network and not the health service; thus, the reorganization of the system in the State would foster social networks that are less wearing for their families.     

Social connections, immigration-related factors, and self-rated physical and mental health among Asian Americans

Focusing on Asian Americans, this study examines how self-rated physical and mental health depends on the layered social connections (including 4 types: family cohesion, relative support, friend support, and neighborhood cohesion), socioeconomic status, and immigration-related factors (including nativity, length of residence in the U.S., and proficiency of the English language). It draws on the 2002–2003 National Latino and Asian American Study, a nationally representative household survey of Latino and Asian Americans. Findings of this study include: (1) there are significant differences in self-rated physical health among Asian Americans of different national origin, but their self-rated physical health differences diminish after indicators of socioeconomic status and immigration-related factors are considered; (2) four types of social connections are all related to the self-rated physical and mental health of Asian Americans, but the patterns of the associations as well as the mechanisms linking the associations vary; and (3) family cohesion has independent and direct effects on both self-rated physical and mental health over and above controls and mediators, whereas the effects of other social connection measures are partially mediated by socioeconomic status and immigration-related factors. In sum, this study indicates the significant effects of social connections, socioeconomic status, and immigration-related factors on the self-rated physical and mental health of Asian Americans.     

HIV services for a new generation.

Expanded treatment capabilities, supportive services, and education are available to control the AIDS epidemic as it spreads among new, harder-to-reach populations. Unfortunately, disparities in health status among these groups often prevent them from getting preventive care and treatment. To build awareness among today's at-risk population, health care marketers must address the needs of their target audience. With a well-planned and sensitive approach, they can work with practitioners to bring these services to the people who need them most.     

Perceptions,Attitudes, and Experience Regarding mHealth Among Homeless Persons in New York City Shelters

Mobile health may be an effective means of providing access and education to the millions of homeless Americans. We conducted semi-structured interviews with 50 homeless people from different shelters in New York City to evaluate their perceptions, attitudes, and experiences regarding mobile health. Participants’ average age was 51.66 (SD = 11.34) years; duration of homelessness was 2.0 (SD = 3.10) years. The majority had a mobile phone with the ability to receive and send text messages. Most participants attempted to maintain the same phone number over time. The homeless were welcoming and supportive of text messaging regarding health care issues, including appointment reminders, health education, or management of diseases considering their barriers and mobility, and believed it would help them access necessary health care. Overwhelmingly they preferred text reminders that were short, positively framed, and directive in nature compared to lengthy or motivational texts. The majority believed that free cell phone plans would improve their engagement with, help them navigate, and ultimately improve their access to care. These positive attitudes and experience could be effectively used to improve health care for the homeless. Policies to improve access to mobile health and adapted text messaging strategies regarding the health care needs of this mobile population should be considered.