Addressing Diabetes Prevention among Hmong adults Moon S. Chen, Jr., Ph.D., M.P.H. Susan L. Stewart, Ph.D. Edward A. Chow, M.D. Julie H.T. Dang, M.P.H Kendra Thao, B.S. Asian American, Native Hawaiian, Pacific Islander Diabetes Coalition Meeting May 2, 2014
Meeting Objectives: Further the knowledge of diabetes type 2 in Asian Americans, Native Hawaiian and Pacific Islander Populations Translate this knowledge and existing data into policies for effective treatment and management Presentation Objectives: Who are the Hmong? What do we know about diabetes types 2 among Hmong Adults? What can we do to use what we know to address diabetes prevention among Hmong adults?
WHO ARE THE HMONG?
Hmong Women s Heritage Association Greater Sacramento Area
Who are the Hmong? Background: American ally from the Vietnam War Population Fastest growing population in Sacramento County from 1990-2000; 195.3% Census 2010: 260,073 identified as Hmong origins -26,996 in Sacramento Metro
Who are the Hmong? (cont.) Income: High rate of low-income and poverty in Hmong community Low income: 59% Meet federal poverty guidelines: 31% Language: 46% of Hmong community in Sacramento Metro Area are limited English proficiency Education: 14% of Hmong Americans have at least a bachelor s degree Per capita income for Hmong Americans in CA is $9,800
Diabetes Management and the Hmong Community Community Health Navigators (CHNs) Program -Pilot program launched in 2010 with support from The California Endowment - Initial Objective: Assist Hmong community members diagnosed with diabetes, hypertension, and cancer to navigate healthcare systems and access resources. - CHNs initial roles 1. Service coordinators 2. Assist clients with accessing resources within community
Diabetes Management 1. ABC Plan - A1C, Blood Pressure, Cholesterol 2. Whole health assessment (strength based approach) - Let s start with what you have 3. Increase client self-advocacy skill(s) - Medication pocket card - Educate clients about their rights as patients - Develop peer leaders among clients
What did we learn? 1. Many factors impact client s ability to manage their diabetes Language Culture Medical adherence Socioeconomic status access to resources Systemic barriers (Ex. Mental health provider vs. primary care provider) 2. Whole health approach Social services + primary care services + behavioral health Social services + primary care + behavioral health + spiritual/soul Social Services Primary Care HWHA (client) Behavioral Health Pharmacy
What do we know about Type 2 diabetes among Hmong Adults
Rates of diabetes, Hmong versus National Average 40% 40% 30% 20% Estimated to be between 16%-40% 10% 8% 0% National Hmong Her and Mundt, 2005
Endocrine, Nutritional, Metabolic, and Immunity (ENMID) mortality rates in California (1988-2002): Hmong vs. Non-Hispanic Whites (NHW) Yang et al., 2010
Approach Utilize list of Hmong households Determine eligibility In person interview to: 1. Collect baseline data Random Assignment Intervention: Hepatitis B With CBO #1 LHW Control: Diet & Exercise With CBO #2 LHW Follow- up interview: self- reported testing Verification of testing by checking medical records
Socio-demographics of Hmong P01 Participants Socio-Demographics Characteristics Total % (n=260) Education No Formal Education/DK 63.85% BMI (Asian Cut Point) 23-27.5 43.08% >27.5 35.77% Overweight and Obese 80.77% Country of Birth Laos 73.08% Thailand 21.54% Language of Survey Hmong 91.02% English Fluency So-So/Poorly/Not at all/dk 84.23% Health Insurance Yes 90.77%
Asian American Health Disparities Studies Thousand Asian American Study (TAAS)
Comparison of Diabetes Risk of Asian Americans Populations from Thousand Asian American Study Sacramento County, CA 2012-2013 Hmong Chinese Korean Vietnamese Sample Size 223 242 283 233 Mean Age 50 53 59 52 Percent Lifetime in the U.S. % Diabetes (A1C) 44.1% 76.2% 60.8% 69.9% Increased Risk 33.5% 44.6% 38.2% 41.7% Yes 14.5% 11.3% 12.5% 6.6% Mean Weight 145.0 138.0 138.0 130.0 Mean Waist Cicumference 36.5 33.8 32.5 33.4 Mean Height 60.7 64.4 63.7 62.4 Mean BMI 28.0 23.5 23.9 23.4
What can we do to use what we know to address diabetes prevention among Hmong adults?
Better characterize the Hmong diabetes burden Lay Health Worker Home Visits Group Sessions Diagnostic Testing
Partner with Hmong Women s Heritage Association in CBPR approach
Examples of nutrition flip chart and the HBV flip chart
Educate health professionals
Lifestyle Approach
Longest journey begins with a single step. Slides created by Julie by: HT Julie Dang, MPH, CHES