In my experience as a health equity researcher, it has become evident that the terms health disparities and Asian American do not go hand-in-hand in popular thought. I am routinely met with ...skepticism when describing low-income Asian American communities or the poor health status, health care use, or health outcomes for these communities. My work, however, is guided by data. Specifically, Asian Americans* Have the highest poverty rate of all racial/ethnic minority groups in New York City,1* Constitute 15% of the New York City population yet were awarded 1.4% of New York City-based agency contracts to social services providers in the past 13 years,2 and* Are the most understudied racial/ethnic group in the peer-reviewed literature (6% of US population; 0.01% of MEDLINE articles).3Furthermore, research including Asian American participants is critically underfunded by the National Institutes of Health (less than 0.17% of the total National Institutes of Health budget).4 To put it bluntly, Asian Americans are simply not a part of the collective consciousness of public health researchers and practitioners either as a community of color oras a population that experiences health disparities.
The COVID-19 pandemic has exposed the many broken fragments of US health care and social service systems, reinforcing extant health and socioeconomic inequities faced by structurally marginalized ...immigrant communities. Throughout the pandemic, even during the most critical period of rising cases in different epicenters, immigrants continued to work in high-risk-exposure environments while simultaneously having less access to health care and economic relief and facing discrimination. We describe systemic factors that have adversely affected low-income immigrants, including limiting their work opportunities to essential jobs, living in substandard housing conditions that do not allow for social distancing or space to safely isolate from others in the household, and policies that discourage access to public resources that are available to them or that make resources completely inaccessible. We demonstrate that the current public health infrastructure has not improved health care access or linkages to necessary services, treatments, or culturally competent health care providers, and we provide suggestions for how the Public Health 3.0 framework could advance this. We recommend the following strategies to improve the Public Health 3.0 public health infrastructure and mitigate widening disparities: (1) address the social determinants of health, (2) broaden engagement with stakeholders across multiple sectors, and (3) develop appropriate tools and technologies. (
2021;111(S3):S224-S231. https://doi.org/10.2105/AJPH.2021.306433).
Cancer cells simultaneously harbor global losses and gains in DNA methylation. We demonstrate that inducing cellular oxidative stress by hydrogen peroxide treatment recruits DNA methyltransferase 1 ...(DNMT1) to damaged chromatin. DNMT1 becomes part of a complex(es) containing DNMT3B and members of the polycomb repressive complex 4. Hydrogen peroxide treatment causes relocalization of these proteins from non-GC-rich to GC-rich areas. Key components are similarly enriched at gene promoters in an in vivo colitis model. Although high-expression genes enriched for members of the complex have histone mark and nascent transcription changes, CpG island-containing low-expression genes gain promoter DNA methylation. Thus, oxidative damage induces formation and relocalization of a silencing complex that may explain cancer-specific aberrant DNA methylation and transcriptional silencing.
► DNMT1 becomes more tightly bound to chromatin after oxidative damage ► Oxidative damage induces formation of a complex containing DNMT1, DNMT3B and PRC4 ► DNMT-PRC4 enrichment at CpG islands may explain aberrant gene silencing in cancer ► Promoters enriched for these proteins have histone mark and DNA methylation changes
Though food insecurity has long been recognised to impact health, population-specific determinants of food insecurity have recently been studied systematically as an important public health concern. ...Indeed, while immigrant populations face particular challenges to equitable access to the food system, many of these concerns have not been systematically described. To this end, we critically review recent work that demonstrates the importance of transportation and language access as independent determinants of access to food for immigrant populations. Furthermore, we highlight proposals to mitigate barriers to access, including both academic and community-driven approaches to create overlapping institutional commitments for inclusive policymaking that meets the specific needs of diverse populations.
The US Preventive Services Task Force recently released a recommendation on screening for prediabetes and type 2 diabetes among adults, but no recommendation has been issued for youths to date. A ...recent study estimated that among youths aged 12 to 19 years, approximately 1 in 5 had prediabetes, with large variations across sociodemographic characteristics. Here, Liu et al assessed trends in prediabetes among US youths from 1999 through 2018.
About 4.6 million older adults (aged 60 years and older) in the United States are foreign born, and Asian Americans are projected to become the largest immigrant group in the United States by 2055.1 ...Older Asian immigrants have to navigate new sociocultural contexts, including relationships with health care providers, dietary recommendations and adjustments, and care-seeking norms.2 They may also experience structural challenges, such as discrimination in the health care system because of race, ancestry, and language.3 These adults often require assistance from unpaid family caregivers (e.g., adult children)-with whom they are also likely to reside-to navigate these sociocultural complexities and barriers in the health care system.4 Yet, our understanding of the experiences and challenges of family caregivers of older Asian immigrants remains limited despite their unique circumstances as children of immigrants who are simultaneously balancing and navigating multiple cultural identities of their own while often being viewed as perpetual foreigners or outsiders to US culture. Immigration history and experiences likely also influence the use of formal services. Minority family caregivers are less likely than White caregivers to use formal support services (e.g., mental health treatment), suggesting that they may face additional burdens and barriers in the process of supporting their older relative in the health care system.6 Identifying ways to better support family caregivers as they care for their immigrant older relatives is critical for promoting inclusion in the health care system. This requires concerted research on Asian American caregivers and their experiences and challenges in their role supporting older relatives with household, daily functioning, and health care activities as well as navigating sociocultural aspects of care.7 It also requires recognition and consideration of the diversity of experiences and challenges faced by Asian American families, including heterogenous Asian ethnic subgroups with distinct cultures, languages, needs, and preferences.
Broad recognition now exists that price, availability, and other structural factors are meaningful barriers to fruit and vegetable consumption, particularly among low-income adults. Beginning in ...2005, the New York City Department of Health and Mental Hygiene used the social-ecological model to develop a multifaceted effort to increase fruit and vegetable access citywide, with emphasis in low-income neighborhoods. Overall, the percentage of New York City adults who reported consuming no fruits and vegetables in the previous day decreased slightly over a 10-year period (2002: 14.3% 95% confidence interval = 13.4%, 15.2%; 2012: 12.5% 95% confidence interval = 11.4%, 13.6%; P for trend < .001). Our approach hypothesizes that complementary initiatives, implemented simultaneously, will create a citywide food environment that fuels changes in social norms and cultural preferences, increases consumer demand, and supports sustainable access to affordable produce.
Are recommended dietary patterns equitable? Wang, Vivian Hsing-Chun; Foster, Victoria; Yi, Stella S
Public health nutrition,
02/2022, Letnik:
25, Številka:
2
Journal Article
Recenzirano
Odprti dostop
Dietary recommendations (DR) in the USA may be inadequate at improving diets in racial/ethnic minority communities and may require redesign of the systems driving their development over the long ...term. Meanwhile, cultural adaptation of evidence-based DR may be an important strategy for mitigating nutrition disparities, but less is known about the adaptability of these recommendations to meet the needs of diverse groups. We examined the content and origin of major DRs - aspects that provide context on their potential universality across populations and evaluated their potential for cultural adaptation.
Case studies of Dietary Approaches to Stop Hypertension (DASH), the Mediterranean diet (MD), the EAT-Lancet diet (EAT) and the NOVA classification system.
United States.
Racial/ethnic minority populations.
Current DR differ in their origin/evolution but are similar in their reductionist emphasis on physical health. DASH has been successfully adapted for some cultures but may be challenged by the need for intensive resources; MD may be more beneficial if applied as part of a broader set of food procurement/preparation practices than as just diet alone; EAT-Lancet adaptation may not honor existing country-specific practices that are already beneficial to human and environmental health (e.g. traditional/plant-based diets); evidence for cultural adaptation is limited with NOVA, but classification of levels of food processing has potential for widespread application.
For DR to equitably support diverse populations, they must move beyond a Eurocentric or 'general population' framing, be more inclusive of cultural differences and honour social practices to improve diet and reduce disparities.
COVID-19 mitigation strategies have had an untold effect on food retail stores and restaurants. Early evidence from New York City (NYC) indicated that these strategies, among decreased travel from ...China and increased fears of viral transmission and xenophobia, were leading to mass closures of businesses in Manhattan's Chinatown. The constantly evolving COVID -19 crisis has caused research design and methodology to fundamentally shift, requiring adaptable strategies to address emerging and existing public health problems such as food security that may result from closures of food outlets.
We describe innovative approaches used to evaluate changes to the food retail environment amidst the constraints of the pandemic in an urban center heavily burdened by COVID-19. Included are challenges faced, lessons learned and future opportunities.
First, we identified six diverse neighborhoods in NYC: two lower-resourced, two higher-resourced, and two Chinese ethnic enclaves. We then developed a census of food outlets in these six neighborhoods using state and local licensing databases. To ascertain the status (open vs. closed) of outlets pre-pandemic, we employed a manual web-scraping technique. We used a similar method to determine the status of outlets during the pandemic. Two independent online sources were required to confirm the status of outlets. If two sources could not confirm the status, we conducted phone call checks and/or in-person visits.
The final baseline database included 2585 food outlets across six neighborhoods. Ascertaining the status of food outlets was more difficult in lower-resourced neighborhoods and Chinese ethnic enclaves compared to higher-resourced areas. Higher-resourced neighborhoods required fewer phone call and in-person checks for both restaurants and food retailers than other neighborhoods.
Our multi-step data collection approach maximized safety and efficiency while minimizing cost and resources. Challenges in remote data collection varied by neighborhood and may reflect the different resources or social capital of the communities; understanding neighborhood-specific constraints prior to data collection may streamline the process.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The Asian American health narrative reflects a long history of structural racism in the US and the complex interplay of racialized history, immigrant patterns, and policies regarding Asians in the ...US. Yet owing to systematic issues in data collection including missing or misclassified data for Asian Americans and practices that lead to indiscriminate grouping of unlike individuals (for example, Chinese, Vietnamese, and Bangladeshi) together in data systems and pervasive stereotypes of Asian Americans, the drivers and experiences of health disparities experienced by these diverse groups remain unclear. The perpetual exclusion and misrepresentation of Asian American experiences in health research is exacerbated by three racialized stereotypes-the model minority, healthy immigrant effect, and perpetual foreigner-that fuel scientific and societal perceptions that Asian Americans do not experience health disparities. This codifies racist biases against the Asian American population in a mutually reinforcing cycle. In this article we describe the poor-quality data infrastructure and biases on the part of researchers and public health professionals, and we highlight examples from the health disparities literature. We provide recommendations on how to implement systems-level change and educational reform to infuse racial equity in future policy and practice for Asian American communities.
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