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Report Title:	CMRI's Asian American and Pacific Islander Medicare Mammography Brochure Focus Group Report
*Abstract:*	The AAPI mammography brochures were created in response to concerns that while Asian American women were facing increasing cancer risk, there are many myths and language and cultural barriers that result in relatively fewer AAPI women from having an annual mammogram. This may be even truer among elder women over the age of 65, despite the fact that Medicare covers an annual mammogram. The focus groups conducted for the CMRI brochures were an opportunity to learn more about AAPI women’s preference in regard to mammography and learn more about the key messages that would serve as an effective “call to action” in obtaining their necessary health care. All stages of the focus groups brochure development represented a collaborative effort between the three agencies that were contracted to conduct the focus groups and assist in the development of the key messages and brochures. While the groups varied a bit in some of their preferences, the following themes emerged overall: The elder women responded to the words and images about family and community. Women wanted to have the message reflect their concerns about their families and communities. Furthermore, many groups commented that they wanted multigenerational photographs, and wanted photos of men, to either show that the issue affects families, not just individuals, and that men were at risk for breast cancer too. The elder women said the images and colors in the brochures should be bright, colorful and friendly. While a few focus group participants said the brochure should be frightening, most wanted bright colors. They liked the brochures with flowers. They also said they preferred photographs of people, with drawings illustrating how a mammogram is performed. Different colors represent different meanings. Unlike Western culture, there is no universally acceptable color to Asian cultures. While red means health, happiness and prosperity in some cultures, it represents death in other cultures. Other colors such as purple can also represent death. These issues should always be discussed and verified with a number of community representatives. The elder women wanted information on local referral networks. Nearly all the groups wanted information or a phone number where they could get information on a local provider or network to get a mammogram. The elder women wanted AAPI statistics. The elder women liked the idea of having more specific statistics on AAPI elder women's risk for breast cancer. The community partners that conducted English speaking focus groups, and the community partners whose languages were not addressed continually offered their interest in the project, and in seeing similar materials being developed and offered to the their communities in the future.
	Details...
Agency:	Centers for Medicare & Medicaid Services
Date of Report:	6/7/2000

2

Report Title:	Cardiovascular Risk in the Vietnamese Community
*Abstract:*	Asian Americans and Pacific Islanders (AAPIs) are the fastest growing racial/ethnic group in the United States. They have varying socioeconomic characteristics, levels of acculturation, immigration history, and health profiles. The AAPI population is extremely diverse; its members have ancestral ties to approximately 50 Asian and Pacific Islander nations. Heart disease is the leading cause of death among these groups, but its impact on each group varies. The National Heart, Lung, and Blood Institute (NHLBI) worked in partnership with the Asian & Pacific Islander American Health Forum (Health Forum) to conduct an assessement of the cardiovascular health status of four AAPIs groups nationwide. The Vietnamese community is the second of four Asian American communities studied. Other populations included in this assessment are Filipinos in Daly City and San Francisco, California; Native Hawaiians in Moloka'i, Hawaii; and Cambodians in Lowell, Massachusetts. This report focus on the Vietnamese community in Houston, Texas. Three formative research methods were used to study this community: 1) focus groups with staff and volunteers from a local community service agency; 2) key informant interviews with community leaders; and 3) indepth interviews with community residents conducted by trained bilingual facilitators. This report provides insight into the Vietnamese community's perceptions and knowledge of heart disease, and motivations to making lifestyle changes. Results of this study indicate that while Vietnamese in the United States are concerned about their overall cardiovascular health, they have little to no knowledge about heard disease or its risk factors. Many are new immigrants and do not seek proper health care services because of language barriers, confusion over the American health care system, financial difficulties, and time constraints. Intervention programs need to incorporate the values and traditions of the Vietnamese culture, be community-based, and start with the basics of taking care of one's heart health and mental health, including making good food choices and managing stress.
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Agency:	NIH:National Heart, Lung, and Blood Institute
Date of Report:	3/1/2003

3

Report Title:	Cardiovascular Risk in the Cambodian Community
*Abstract:*	Asian Americans and Pacific Islanders (AAPIs) are the fastest growing racial/ethnic group in the United States. They have varying socioeconomic characteristics, levels of acculturation, immigration history, and health profiles. The AAPI population is extremely diverse; its members have ancestral ties to approximately 50 Asian and Pacific Islander nations. Heart disease is the leading cause of death among these groups, but its impact on each group varies. Although few studies exist on the cardiovascular health of Cambodians in the United States, several studies suggest that they are at high risk for cardiovascular disease (CVD) based on their lifestyle behaviors. The National Heart, Lung, and Blood Institute (NHLBI) worked in partnership with the Asian & Pacific Islander American Health Forum (Health Forum) to conduct an assessement of the cardiovascular health status of AAPIs. The Cambodian community is the third of four AAPI populations studied. The other populations studied are Filipinos, Vietnamese, and Native Hawaiians. This report focus on the Cambodian population. Three formative research methods were used to study the Cambodian communities: 1) focus groups with staff and volunteers from a local community service agency, 2) key informant interviews with community leaders, and 3) indepth interviews with community residents conducted by trained bilingual (English and Khmer) facilitators. This report provides insights into the Cambodian community, its perceptions and knowledge of heart disease, and motivations to making healthy lifestyle changes. Results from this study indicate that Cambodians in the United States are at high risk for developing CVD. Stress from acculturation and financial problems, as well as mental health problems are primary issues that plague this refuree population. Nevertheless, the need for healthy eating habits, regular checkups with a health care professional, physical activity, smoking cessation, and other heart healthy practices are important concerns identified by the community. Health education interventions for Cambodians should focus on primary prevention of heart disease risk factors and behavior modifications.
	Details...
Agency:	NIH:National Heart, Lung, and Blood Institute
Date of Report:	4/1/2003

4

Report Title:	Cardiovascular Risk in the Filipino Community
*Abstract:*	The National Hearth, Lung, and Blood Institute (NHLBI) worked in partnership with the Asian & Pacific Islander American Health Forum to conduct an assessment of the cardiovascular health status of AAPIs nationwide. The first AAPI populations studied were the Filipino communities in Daly City and San Francisco, California. Those particular communities were chosen for their strong family and community support. Other populations studied include Vietnamese, Cambodians, and Native Hawaiians. This report focuses on the Filipino population. Three formative research methods were used to study Filipino communities: 1) focus groups with staff and volunteers from a local community service agency, 2) key informant interviews with community leaders, and 3) indepth interviews with community residents conducted by trained bilingual (English and Tagalog) facilitators. This report provides insights from the Filipino community, its perceptions and knowledge of heart disease, and motivations to making lifestyle changes. Results of this study indicate that Filipinos in the United States are concerned abou their overall health. There is highly consistent and convergent evidence that this population is at high risk of developing cardiovascular disease. Filipinos, particularly new immigrants, are susceptible to stress from work and family issues. Some of their coping strategies include unhealthy eating and smoking. Outreach and education interventions for this population must address dietary habits, blood pressure and blood cholesterol control, tobacco use, physical activity, stress, and socioeconomic concerns.
	Details...
Agency:	NIH:National Heart, Lung, and Blood Institute
Date of Report:	3/1/2003

5

Report Title:	Cardiovascular Health Small Group Discussion in Baltimore City Public Housing, Consumer Assessment for Community-Based Outreach and Education
*Abstract:*	Background Nationwide, as well as within the city of Baltimore, a number of agencies are now partnering with housing authorities to address the multiplicity of health risks that may characterize the residents of public housing communities. National data reveal that approximately one-quarter of all public housing residents live in low-income areas, and more than 40 percent of housing authority residents live in majority African American neighborhoods. The average income for the 50,000 residents in Baltimore City public housing is $7,000 per year. Currently, the National Heart, Lung, and Blood Institute (NHLBI) is collaborating with the Housing Authority of Baltimore City (HABC) in an effort to decrease cardiovascular disease (CVD)-related illness and death in these exceptionally impoverished public housing communities. Purpose Before designing and implementing a public housing public health program, consumer assessments are necessary to create effective heart health programs by promoting knowledge, attitudes, and behaviors among public housing residents. NHLBI and HABC conducted a consumer assessment in July and August 2002 to assess the current levels of cardiovascular health (CVH) awareness, knowledge, and behaviors among public housing residents in Baltimore City. This consumer assessment project was an outcome of the formation and planning activities of the Baltimore City cardiovascular Health Partnership (BCCHP), a collaborative partnership to address CVH in Baltimore City. The partnership is comprised of a core group of health and housing institutions in Baltimore City including: (1) HABC; (2) Morgan State University Public Health Program; (3) Baltimore Field Office of the U.S. Department of Housing and Urban Development; and (4) the Baltimore City Department of Recreation and Parks. Methods NHLBI and HABC used a small group discussion assessment approach. Each session consisted of nine or fewer participants, a lead facilitator, resident cofacilitators, graduate student notetakers, an NHLBI observer, and occasionally additional resident and resident leader observers. The topic areas of inquiry were: What are the current levels of CVH knowledge among public housing residents? To what degree are the current levels of knowledge reflected in the health practices and behaviors of public housing residents? Are CVH knowledge levels, practices, and behaviors affected by public housing as a community and social context for CVH? What types of educational products and behavioral skills and techniques can be used to effect CVH-related behavioral changes amongst public housing residents? In order to gain insights regarding the areas listed above from public housing demographic subgroups, males and females ages 15 older were recruited and assigned to age and gender-specific sessions. Findings Overview Public housing residents had a preexisting knowledge and awareness of heart healthy lifestyles and CVD risk factors. The comments made during the small group discussions suggest that programs targeting heart healthy lifestyles for the public housing community population must address the various stages of readiness to adopt heart healthy behavior. These stages are diverse and are a function of an individual’s readiness and needs, as opposed to the demographic population segment to which one belongs. However, some common themes do exist that are functions of the age and gender groups that mitigate the ability to practice and maintain heart health-promoting lifestyles once a person has made this decision. One cardiovascular risk behavior, cigarette smoking, is pervasive among the demographic groups probed (excluding teen females)and accordingly smoking cessation is a critical element of any community outreach strategy that would be developed. Stress, from environmental and personal stimuli, is also cited by participants as a major barrier to improving health, including young adults ages 15–18. In fact, many participants cite stress as a primary risk factor for heart disease and a barrier to heart disease prevention. Diet and Physical Activity Heart healthy dietary behaviors are not as consistent across age and gender groups nor within a homogenous group (e.g., females ages 19–34). Many discussants expressed readiness to adopt and maintain heart healthy diets, as shown by some participants’ requests for nutrition education classes. However, there were as many discussants with an opposing practice or attitude regarding heart healthy diets who were resistant to change or to consistently adopting heart healthy dietary recommendations. Participants’ current physical activity behaviors and behavior change readiness was dependent upon demographic group(s). Although the majority of participants, irrespective of age and gender status, cited walking as their main means of exercise, males ages 15–34 cited sports, exercise programs, and the requirements of their occupation as additional sources of physical activity. Females ages 19 and older cited child care and housework. Based on these findings, there are some content emphasis areas, such as smoking and stress in particular. With regard to other heart health topics, including managing CVD clinical risk factors and dietary and physical activity behaviors, heart health educational products should meet the individual’s needs and be specific to his or her readiness level. Heart Health Education Products Participants recommended that products should be presented “straight” and “to-thepoint” with hard facts to substantiate claims and recommendations. Print products should clearly and plainly identify the health topic or behavior, as this was the first point of interest among participants in selecting sample materials. The second point of interest is the artistry. A majority of participants preferred photos of people compared to line art, artist illustrations, or cartoons. Participants ages 15–18 however, preferred mixed medium graphics, including cartoons, photos of youth, 3-D art, and real-life anatomical representations of the body and heart. These participants also preferred products that were specifically geared to the youth audience. Participants in adult sessions (ages 19 and above) preferred intergenerational representation in materials. The majority of all participants identified that effective daily reminders were in a format that can be placed on refrigerators, walls, mirrors, and locations in the home that can be hung at eye level. They recommended a daily heart health reminder and messages in calendar format, allowing one to chart progress daily. Participants were also interested in products that demonstrate what they should do to be heart healthy. They preferred products with comprehensive content such as a single booklet versus a series. However, because participants are interested in products that meet their health needs, print products should allow for easy navigation of sections/topics. Themes that motivate participants included the importance of family and children, the loss of a loved one due to heart disease, and for some, their own personal desire to improve their health and life. Females ages 19 and above mentioned their belief in God, prayer, and gospel music as sources of inspiration to get through hard days. Because some participants demonstrated a low literacy level, products should meet the various literacy and education levels in public housing.
	Details...
Agency:	NIH:National Heart, Lung, and Blood Institute
Date of Report:	12/1/2003

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