United States

Introduction: Although the high rates of mental health issues and the unmet healthcare needs among Asian Americans have been recognized in literature, there is a lack of empirical research on the mental health issues of Filipino Americans (FAs). Using data from a mixed method study that integrated a quantitative survey with qualitative interviews, this study explored factors that influence mental health needs and access to care in FAs living in Eastern Virginia.

Methods: A Community Health Resources and Needs Assessment (CHRNA) survey was implemented online using REDCap and distributed to Asian and Pacific Islanders in Eastern Virginia in April-July 2022. Participants (N=1,462) were recruited through in-person events and social media channels using three sampling criteria: 1) persons of Asian and Pacific Islander descent, 2) ages 18-85 years, and 3) residents of Hampton Roads and the Eastern Shore. Data from a subsample of 281 respondents who self-reported as Filipino were analyzed using descriptive statistics and multivariable logistic regression. Key informants (N=25, including 15 females and 10 males) were recruited through snowball sampling and referrals from Filipino community stakeholders. Semi-structured interviews (30-60 minutes) were conducted virtually via Zoom in English by trained researchers. Semantic analysis was guided by the grounded theory and the socio-ecological model.

Results: While 7.2% of FAs received diagnoses of depression or other mental health problems from healthcare providers, 27.4% frequently experienced the following: 1) had little interest or pleasure in doing things, 2) felt down, depressed, or hopeless; 3) feeling nervous, anxious or on edge; 4) being unable to stop or control worrying. Higher odds of having mental health issues were found in females, older participants, participants who experienced language barriers, and participants with less economic resources. Religious belief (e.g., Catholicism) and family support served as significant buffers for FAs to cope with stress. Stigma embedded within Filipino culture has been a key mental health barrier in FAs. While the Philippine Cultural Center (PCC) has served as a primary source of community support (particularly for the elderly population), the PCC could be further utilized as a community-based mental health resource, involving licensed mental health practitioners for culturally sensitive interventions in a community setting.

Conclusion: Findings demonstrate that FA mental health is influenced by a complex interplay of macro and micro-level socio-ecological factors. Culturally competent community-based interventions are urgently needed to normalize mental health, to increase awareness and access to care, and to reduce mental health issues and disparities.

AMA Research Challenge 2022

Factors Related to the Mental Health of Filipino Americans in Eastern Virginia - Findings from a Mixed Methods Study Conducted in 2022

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Charles Lopresto, DO

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Though originally designed in the 1960s to provide emergency medical care, emergency medical service (EMS) systems have experienced non-emergency utilization by small groups of frequent EMS users. Frequent EMS use as a public health issue reflects healthcare waste, misused EMS resources, and underserved populations. In turn, municipalities such as San Francisco have developed community paramedicine (CP) programs to improve access to healthcare and social services in non-emergency settings. Prior evaluation has found that EMS-6 — one such CP program operated by the San Francisco Fire Department (SFFD) — is safe and effective at reducing frequent EMS use amongst the most frequent EMS users. That said, frequent EMS users are heterogeneous groups with diverse needs, such as housing assistance, primary care, urgent care, and detoxification. The goal of this in-progress study is to describe the characteristics of frequent EMS users in San Francisco over recent years. By characterizing those frequent EMS users who have not experienced decreases in frequent EMS use, the results may be used to inform adjustments to the CP services provided by EMS-6.

Frequent EMS Users in San Francisco: A Cross-Sectional Study

Healthy East Harlem (HEH): Improving Health Outcomes By Prescribing Fruits and Vegetables

Identifying Top Health Priorities Among Afghan Refugees

Context: 
This study assesses the needs of Afghan refugees receiving services at the Center for Refugee Services (CRS) in San Antonio. Services include assisting refugees with doctors’ appointments, applying for health insurance, and providing translation services. Research has shown that refugees face many health challenges like an increased predominance of chronic disease from the stress of resettlement. 

Objective: 
To identify the health priorities of Afghan refugees who visit the CRS using a needs assessment survey. 

Design: 
Each survey was administered in person with the help of an interpreter, as needed. The survey assesses basic demographics and the respondent’s top health concerns through a combination of open-ended and “check all that apply” questions. 

Setting: 
CRS, San Antonio 

Participants: 
Self-identified Afghan refugees (n=33) aged 18 years and older who reside in San Antonio, Texas, and receive services at the CRS. 

Main and Secondary Outcomes: 
By determining which health concerns are most prevalent among the Afghan refugees, the CRS can target their aid to address the specific needs. 

Results: 
Preliminary results reveal most participants, 84.8%, are male (n=27) with an average age of 30.2. All participants speak Pashto with 75.8% (n=25) being their primary language, 87.9% (n=29) are married and live in households with an average size of 5 people, 45.5% (n=15) completed high school, 30.3% (n=10) are working full time, and 72.7% (n=24) have moved to the US within the past 12 months. 54.5% (n=18) of respondents reported they seek healthcare at the San Antonio Refugee clinic, 48.5% (n=16) seek care at a Doctor’s Office, and 42.4% (n=14) go to a hospital emergency department. The participants’ top three health concerns were teeth problems (n=28), no insurance (n=19), and language (n=12). 

Conclusions: 
This research in progress will help provide care and reduce the negative health consequences that refugees face. 


Identifying Top Health Concerns Among Afghan Refugees

Concern about sex education is primarily focused on prevention of unplanned pregnancy and STI’s. A broader perspective on the relationship of sex education with gender roles and stigma related to sexual behavior has been recognized, although data on these relationships is limited. We sought to address this gap by measuring prevalence of receipt of sex education, focus of sex education, perceived stigma related to sexual behavior, and its distribution amongst gender in undergraduate university students.

Impact of Sex Education on Stigma Surrounding Sexual Behavior in Undergraduate Students

Impact of socio-demographics, personal experiences, and barriers to care on COVID-19 vaccination hesitancy in Massachusetts

Background: Vaccine hesitancy among minority communities stems from medical misinformation, decreased health literacy, and fear of vaccines. We predict that medical students providing vaccine education through a student-run free clinic (SRFC) would improve immunization rates by increasing access to and understanding of vaccines in underserved populations. 

Methods: Our vaccine program addresses low immunization rates in underserved West Dallas communities by providing individualized education sessions and handouts about vaccines translated to a 5th-grade reading level. First, a validated pre-survey adapted from the World Health Organization is given to gauge a patient’s knowledge and attitudes towards vaccines. Vaccine education derived from the Centers for Disease Control and Prevention (CDC) website is offered, and vaccines are administered if the patient consents. Finally, a post-survey identical to the pre-survey is given. Medical students must complete CDC modules, orientation, and vaccine administration training at a simulation center before volunteering. 

Results: The patients were 67% female and averaged 48 years old. Most patients primarily spoke Spanish. Approximately 43% of the patients educated at the clinic received a vaccination. Most individuals (49.0%) surveyed obtained their vaccine information from the news or media. The second and third most common sources of information were from family or friends (36.7%) and healthcare providers (24.5%). Comparison of pre- and post-surveys revealed a significant difference in patients’ knowledge regarding the mechanism of vaccines (64.3% vs. 90.5%), trust in healthcare workers (90.5% vs. 97.6%), and belief that they received adequate vaccine information from a healthcare provider (73.8% vs. 90.5%) after education sessions. Of note, 32% of eligible patients received a Tdap vaccine through this program, which is not only higher than the national average for all adults (30%) but especially higher than those of national Hispanic populations (23%). 

Conclusion: Our vaccine program demonstrates that medical students can promote vaccine knowledge and increase immunization rates, especially for Tdap. Implementing our vaccine program has allowed patients to address their misconceptions and ultimately overcome barriers like fear, cost, and accessibility. This study thus highlights the importance of a vaccine element in SRFCs and may serve as a model for those hoping to implement similar programs in their own SRFCs.

Implementation and Operation of a Student-Run Vaccine Educational Program

Background: Colorectal cancer (CRC) is the most common cause of cancer-related deaths in Hispanics in the U.S. Hispanics are screened for CRC at a much lower rate. Implementing mailed fecal immunochemical tests (FITs) is a cost-effective intervention to increase CRC screening rates in vulnerable populations. We aim to describe the effect of using introductory calls coupled with mailed in-home FIT kits on CRC screening completion in two federally qualified health centers (FQHCs) in a US-Mexico border county.

Methods: This was a prospective pragmatic two-arm intervention study with participants randomized to receive a FIT kit by mail or a FIT kit mailed with an introductory call. The primary outcome was the percentage of patients who returned the FIT kit.

Results: Participants who returned the FIT were primarily unemployed (51.1%), had less than a high school education(51.8%), had lived in the U.S. for at least 20 years (71.2%), and had poor self-reported health(48.9%). In addition, we observed a statistically significant absolue rate increase (6.1%, P = 0.003) in CRC screening return rates when a mailed FIT kit was preceded by an introductory compared to no initial call.

Conclusion: This study demonstrates that adding an introductory phone call significantly improves the screening completion rate in a mailed-out CRC screening intervention in a US-Mexico border population.



Implementing systems change to improve colorectal cancer screening among clinics providing care for underserved Hispanic populations

Background
Disparities in oncological outcomes persist despite it being a prevalent research locus. Therefore, the aim of this study is to investigate whether the use of varied databases can identify previously underreported pitfalls driving this disparity.
Methods
The most recent Census Data for the entire nation and South Carolina (2020) was acquired from census.gov. The National Cancer Database (NCDB) was queried for all cancer sites by race. Prisma Health System was selected as a representation of localstateNCI usage by race. The latest 5-year trends in new cancer diagnoses per the Surveillance, Epidemiology, and End Results (SEER) program database was obtained by querying South Carolina’s cancer profile by all sites and race via https://statecancerprofiles.cancer.gov/. The same timeframe and parameters were selected for query within the South Carolina Department of Health’s cancer database utilizing the South Carolina Community Assessment Network (SCAN) tool. 
Results
Query of the NCDB revealed that nationally, white Americans make up 76.53% of the patient data and black Americans make up 11.25%. Within the national census database, 76.53% of Americans identify as white, while 13.4% of Americans identify as black. At Prisma Health System, 83.76% of the oncologic patients were white, while 12.95% were black. In the state census, 68.6% of residents identify as white, while 27.0% identify as black.SEER database query for South Carolina shows 451.7 (CI 448.8-454.5) incidence of cancer (per 100,000) in white residents and 441.1 (CI 436.1-446.2) in black residents.SCAN query reveals an incidence of cancer in white residents of 689.1 (CI 684.28-692.12)and an incidence of 500.4 (CI 495.15-505.65) in black residents.
Conclusion
When observing the distribution of racial diversity in the U.S., it is apparent that population data within the NCDB is not a representative sample. Monolithic use of the NCDB and SEER program database for disparity research, especially in more rural states, may contribute to a public health “blind spot.” State-maintained databases may be able to target that missing data. South Carolina’s SCAN is one such effort. Query of this database within the same parameters yields significantly different incidence rates across races. This implies that some groups lack access to NCI’s.


In the “NCI” of time: How Lack of a Representative Cancer Database May Drive Cancer Care Inequity

Long-Term Medication-Assisted Treatment for Opioid Use Disorder is Associated with a Reduction in History of Non-Fatal Overdoses

Objectives. To identify the role Medicaid coverage might play in mitigating financial stresses during the COVID-19 pandemic.

Methods. We used data from the U.S. Census Bureau’s PULSE survey collected from April 2020 - March 2021 in 12 Southern states (expansion: AR, KY, LA, VA, WV; non-expansion: AL, FL, GA, MS, NC, SC, TN). We conducted logistic regression analyses to estimate food sufficiency and receipt of free food in the prior week and confidence in ability to pay next rent/mortgage. Regression analyses were adjusted with respondent sociodemographic information, 7-day COVID-19 case count averages, and a stringency index to account for COVID-19 related interventions. We computed the marginal probability of each outcome based on whether the respondent lived in an expansion state. 

Results. Respondents living a non-expansion state were less likely to report food sufficiency (92.0%) and less likely to report receiving free food in the prior 7 days (6.2%) compared to their counterparts in a Medicaid expansion state (92.3% and 6.6%, respectively). Similarly, respondents in non-expansion states reported less confidence in paying their next month’s rent or mortgage on time (82.4% vs. 84.3%). 

Conclusions. Our analysis suggests that Medicaid expansion may confer additional financial security during the COVID-19 pandemic. On a population level, these differences translate to 25,553 fewer food-insufficient households and 161,835 fewer households worried about their next rent or mortgage payment. Although Medicaid expansion may serve as a proxy for a more generous social safety net, previous research on Medicaid expansion has demonstrated that it provides considerable financial security.

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Frequent EMS Users in San Francisco: A Cross-Sectional Study

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