TY - JOUR
T1 - Health Related Social Needs Among Chinese American Primary Care Patients During the COVID-19 Pandemic
T2 - Implications for Cancer Screening and Primary Care
AU - Tsui, Jennifer
AU - Yang, Annie
AU - Anuforo, Bianca
AU - Chou, Jolene
AU - Brogden, Ruth
AU - Xu, Binghong
AU - Cantor, Joel C.
AU - Wang, Su
N1 - Funding Information:
Our HRSN measures were based on the 2016 Centers for Medicare and Medicaid Services (CMS) screening tool for HRSN through CMS Accountable Health Communities (61), which comprised of a ten-item (27, 36, 62–65) HRSN Screening Tool covering the following social needs: housing instability (“What is your living situation today?”), food insecurity (2 questions: “Within the past 12 months, you worried that your food would run out before you got money to buy more;” “Within the past 12 months, the food you bought just didn’t last and you didn’t have money to get more.”), transportation (“In the past 12 months, has lack of reliable transportation kept you from medical appointments, meetings, work or from getting to things needed for daily living?”), utility needs (“In the past 12 months has the electric, gas, oil, or water company threatened to shut off services in your home?”), and interpersonal violence (4 questions: “How often does anyone, including family and friends, physically hurt you?” “How often does anyone, including family and friends, insult or talk down to you?” “How often does anyone, including family and friends, threaten you with harm?” “How often does anyone, including family and friends, scream or curse at you?”) We created composite measures for each domain that had more than one question with yes (at least one reported need within the domain) and no (answer no to all questions in the domain). We also created an HRSN composite measure by aggregating the number of unmet HRSN reported and then categorized overall HRSN as none vs. 1 or more, and none/one vs. 2 or more. We compared frequency distributions of HRSN reported by study participants with frequencies reported from the 2019 New Jersey statewide Health and Well-Being Poll (66). The Health and Well-Being Poll was developed by the Rutgers Center for State Health Policy with funding from the Robert Wood Johnson foundation. Abt Associates, under contract to Rutgers, drew a statewide random digit dialed telephone (landline and cell) sample and conducted interviews in English and Spanish, from January to February 2019 with adults living in New Jersey.
Funding Information:
We thank Bi Zhang, Sophia Huang and Wen-Chi Chen and other clinic staff from the Center for Asian Health (CAH) at Saint Barnabas Medical Center for recruitment and input on study design and the physicians at CAH, Drs. Zhai, Chow, Houng and Wang, for their support of the study. We thank Baichen Xu from the Rutgers Cancer Institute of New Jersey for data management and analysis of preliminary data. Data collection services were generated by the Rutgers Cancer Institute of New Jersey Biomedical Informatics Shared Resource, supported, in part, with funding from NCI-CCSG P30CA072720. Questions on housing instability and transportation come from the national PRAPARE social determinants of health assessment protocol, developed and owned by the National Association of Community Health Centers (NACHC), in partnership with the Association of Asian Pacific Community Health Organization (AAPCHO), the Oregon Primary Care Association (OPCA), and the Institute for Alternative Futures (IAF). For more information, visit www.nachc.org/prapare. This study received support from the Rutgers University Asian Resource Centers for Minority Aging Research Center under NIH/NIA Grant P30-AG0059304. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH. We thank the Rutgers Asian RCMAR Research and Education Core & Rutgers IFH Asian Health Initiative for feedback.
Publisher Copyright:
© Copyright © 2021 Tsui, Yang, Anuforo, Chou, Brogden, Xu, Cantor and Wang.
PY - 2021/5/28
Y1 - 2021/5/28
N2 - Research Objective: Initiatives to address social determinants of health (SDOH) and measure health-related social needs (HRSN) within clinic settings are increasing. However, few have focused on the specific needs of Asian Americans (AA). We examine the prevalence of HRSN during a period spanning the COVID-19 pandemic to inform strategies to improve cancer screening and primary care among AA patients. Methods: We implemented a self-administered HRSN screening tool in English and Chinese, traditional (T) or simplified (S) text, within a hospital-affiliated, outpatient primary care practice predominantly serving AA in New Jersey. HRSN items included food insecurity, transportation barriers, utility needs, interpersonal violence, housing instability, immigration history, and neighborhood perceptions on cohesion and trust. We conducted medical chart reviews for a subset of participants to explore the relationship between HRSN and history of cancer screening. Results: Among 236 participants, most were Asian (74%), non-US born (79%), and privately insured (57%). One-third responded in Chinese (37%). Half reported having ≥1 HRSN. Interpersonal violence was high across all participants. Transportation needs were highest among Chinese-T participants, while food insecurity and housing instability were higher among Chinese-S participants. Lower-income patients had higher odds of having ≥2 HRSN (OR:2.53, 95% CI: 1.12, 5.98). Older age and public insurance/uninsured were significantly associated with low neighborhood perceptions. Conclusions: We observed higher than anticipated reports of HRSN among primary care patients in a suburban, hospital-affiliated practice serving AA. Low neighborhood perceptions, particularly among Chinese-S participants, highlight the importance of addressing broader SDOH among insured, suburban AA patients. These study findings inform the need to augment HRSN identification to adequately address social needs that impact health outcomes and life course experiences for Asian patients. As HRSN measuring efforts continue, and COVID-19's impact on the health of minority communities emerge, it will be critical to develop community-specific referral pathways to connect AA to resources for HRSN and continue to address more upstream social determinants of health for those who are disproportionately impacted.
AB - Research Objective: Initiatives to address social determinants of health (SDOH) and measure health-related social needs (HRSN) within clinic settings are increasing. However, few have focused on the specific needs of Asian Americans (AA). We examine the prevalence of HRSN during a period spanning the COVID-19 pandemic to inform strategies to improve cancer screening and primary care among AA patients. Methods: We implemented a self-administered HRSN screening tool in English and Chinese, traditional (T) or simplified (S) text, within a hospital-affiliated, outpatient primary care practice predominantly serving AA in New Jersey. HRSN items included food insecurity, transportation barriers, utility needs, interpersonal violence, housing instability, immigration history, and neighborhood perceptions on cohesion and trust. We conducted medical chart reviews for a subset of participants to explore the relationship between HRSN and history of cancer screening. Results: Among 236 participants, most were Asian (74%), non-US born (79%), and privately insured (57%). One-third responded in Chinese (37%). Half reported having ≥1 HRSN. Interpersonal violence was high across all participants. Transportation needs were highest among Chinese-T participants, while food insecurity and housing instability were higher among Chinese-S participants. Lower-income patients had higher odds of having ≥2 HRSN (OR:2.53, 95% CI: 1.12, 5.98). Older age and public insurance/uninsured were significantly associated with low neighborhood perceptions. Conclusions: We observed higher than anticipated reports of HRSN among primary care patients in a suburban, hospital-affiliated practice serving AA. Low neighborhood perceptions, particularly among Chinese-S participants, highlight the importance of addressing broader SDOH among insured, suburban AA patients. These study findings inform the need to augment HRSN identification to adequately address social needs that impact health outcomes and life course experiences for Asian patients. As HRSN measuring efforts continue, and COVID-19's impact on the health of minority communities emerge, it will be critical to develop community-specific referral pathways to connect AA to resources for HRSN and continue to address more upstream social determinants of health for those who are disproportionately impacted.
KW - Asian American (AA)
KW - COVID-19
KW - cancer screening
KW - primary care
KW - social determinants
KW - social needs
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U2 - 10.3389/fpubh.2021.674035
DO - 10.3389/fpubh.2021.674035
M3 - Article
C2 - 34123992
AN - SCOPUS:85107573390
SN - 2296-2565
VL - 9
JO - Frontiers in Public Health
JF - Frontiers in Public Health
M1 - 674035
ER -