Awareness, Treatment and Control of Hypertension among Filipino Americans

1. Awareness, Treatment and Control of Hypertension among Filipino Americans Mariano Rey, M.D. Principal Investigator July 8-9, 20110 Gaylord National Hotel and Convention Center, Maryland

2. Overview of Project AsPIRE(Asian American Partnership in Research and Empowerment) Background on Project AsPIRE: Development Process Descriptive Study Experimental Study Future Directions

3. CSAAH was founded in 2003 and funded by NIH/NIMHD as a Center of Excellence dedicated to the research and reduction of health disparities affecting Asian Americans through research, training, and partnership. Project EXPORT P60 Center

4. Mission Kalusugan Coalition is a multidisciplinary collaboration dedicated to creating a unified voice to improve the health of the Filipino community in the NY/NJ area through network development, educational activities, research, community action, and advocacy. Lead Community Partner:

5. Project AsPIRE: Overall Goal To improve the health care access and CVD health status in the NYC Filipino American community through interventions by community health workers

6. The Big Picture Potential funding for 11 years 7th year 3 year planning grant 5 year implementation grant 3 year dissemination grant Funding by NIH/NIMHD for health disparities intervention research

7. Community-Based Participatory Research (CBPR) “A collaborative approach to research that equitably involves all partners in the research process and recognizes the unique strengths that each brings”. --W.K. Kellogg Foundation (2001)

8. Descriptive Study

9. What the literature shows: Filipinos and Hypertension Heart disease accounted for 33% of all deaths for Filipino Americans compared to 19% for Vietnamese, 24% for Koreans, 28% for Japanese, and 29% for Chinese. Ryan et al., 2000 The 2004-2006 National Health Interview Survey showed Filipino American adults as having the highest HTN prevalence among Asian Americans at 27%. NHANES

10. What the literature shows: Filipinos and Diabetes Filipinos had a higher incidence of diabetes (34.7% vs. 24.1%) than whites. Ryan et al., 2000 Filipinos (n=294) had higher prevalence of type 2 diabetes and metabolic syndrome compared to White women (n=379) [Filipina women (36.4%), Caucasian women (8.7%)]. Araneta et al., 2002 Diabetes is more common among Filipino (n = 268) than in Whites (n=3164) and other Asian Pacific Islander subgroups (n = 801) [Filipinos (21.2%), Whites (8.1 %), All Asians combined (12.9%)]. Javier et al., 2007; Gomez et al, 2004.

11. Who are we targeting:Filipino Population in NYC & NJ Total Filipino Population New York State: 120,940 New Jersey State: 121,197 Total NYS & NJS: 242,137 Note: Alone or in Combination Source: U.S. Census Community Health Survey, 2008 10,223 5,446 33,225 NJ - largest population by county Morris County - 3,459 Essex County - 8,406 Union County - 6,313 Middlesex - 13,507 Bergen County - 15,403 Hudson County - 30,066 7,918 5,246

12. Experimental Study

13. AsPIRE Screening Data • Sample size: n=1634 • Gender: 68% female, 32% male • Geography: NYC (59%), NJ (41%) • Place of birth: 98% born outside of the U.S. • Insurance status: 50% uninsured • Self-perceived health status: • Poor (2%) • Fair (21%) • Good (49%) • Very good (21%) • Excellent (7%)

14. Hypertension Awareness, Treatment, and Control (AsPIRE Sample)

15. Predictors of HTN Awareness a Adjusted for gender b Categories in parentheses are reference groups

16. Predictors of HTN Treatment a Adjusted for gender b Categories in parentheses are reference groups

17. Predictors of HTN Control a Adjusted for gender b Categories in parentheses are reference groups

19. Type of Medication, Single Antihypertensive Drug Therapy N=317 27.5% 13.5% 27.7% 27.8% 3.9%

20. Future Directions • States and certain localities should develop surveillance capacity that would include direct assessment of “awareness, detection, treatment, and control of obesity, HTN, dyslipidemia, and diabetes.” Angell SY et al., 2008 • Community organizing strategies increase the feasibility of reaching a large community-based population. • Coalition building and engagement of multiple sectors (faith-based and community-based organizations, businesses, and health professional associations), optimize recruitment efforts and provide mechanisms to refer participants to necessary healthcare resources, especially to manage and control their HTN.

21. Future Directions • Findings from CBPR efforts such as this study can  provide valuable information to policy makers and health departments as to how to address the burden of HTN in similar populations. • Community-based screenings provide an effective means of increasing HTN awareness. • Behavioral interventions are also critical to improving HTN control.

22. This presentation was made possible by Grant Number R24 MD001786 from NIMHD and its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIMHD.

23. Acknowledgements Rhodora Ursua, Project Director David Aguilar, Project Coordinator Henry Soliveres, CHW RomericoFoz, CHW Leonie Gamboa, CHW Jay Duller, Research Analyst Chau Trinh-Shevrin, Academic Partner Nadia Islam, Academic Partner Darius Tandon, Academic Partner Ed Fryer, Biostatistician Thomas Miyoshi, Biostatistician Laura Wyatt, Data Manager NoilynAbesamis-Mendoza, KC Chair Ben Ileto, Community Advisor Josephine Rago-Adia, Community Advisor PotriRankaManis, Community Health Nurse Patricia Roy, Research Assistant Mary Grace Centeno, Research Assistant Denise Kim, Research Assistant Cinyuki Chung, Research Assistant Rachel Slutsky, Research Assistant

24. For more information: Rhodora Ursua, MPH Project Director, Project AsPIRE rhodora.ursua@nyumc.org (212) 263-3776 Mariano J. Rey, MD Director, Institute of Community Health and Research mariano.rey@nyumc.org (212) 263-0985