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The second leading cause of death in the United States for the Asian and Pacific Islander populations is cardiovascular disease. Centers for Disease Control and Prevention (2017) state that about 22.2% of the Asian and Pacific Islander population die from heart disease. The reduction of mortality rates associated with heart disease can be prevented with the control of modifiable risk factors. Modifiable risk factors that contribute to heart disease include prevention and control of high blood pressure, smoking cessation, and diet control (Hinkle, 2017, p.752).
As the Asian and Pacific Islander populations continue to grow, many are faced with difficulties managing their health, receiving access to health care, and overcoming communication barriers in patient education. With the increase in diversity of the Asian and Pacific Islander population, this paper will discuss the largest Asian and Pacific Islander sub-groups from the Philippines, Vietnam, Hawaii, and Japan. Moreover, the purpose of this paper is to discuss the effectiveness of diet restriction and smoking cessation in relation to the reduction of heart disease within the Asian and Pacific Islander population with hypertension. The importance of reducing this health disparity include advantages of cost reduction in preventable hospitalizations and reduced mortality rates will also be further discussed.
Disease Overview
Pacific Islanders and Asian Americans are one of the fastest growing populations in the United States today. According to the U.S. Census Bureau (2017), the Asian American population increased by 3.0% from 17.3 million to 21.4 million and the Pacific Islander population grew by 2.1% with 1.3 million to 1.5 million from 2015 to 2016 alone. The three leading causes of death for the Asian American and Pacific Islander populations include cancer, heart disease, and stroke as stated by the Centers for Disease Control and Prevention (2017). The four causes of hypertension and risk for cardiovascular disease in Pacific Islander and Asian American populations include smoking and physical inactivity, which leads to obesity and diabetes mellitus. Approximately 55.9% of Pacific Islanders and Asian Americans were diagnosed with hypertension in 2013 per the American Heart Association (2016). As mentioned by Hinkle and Cheever (2017), modifiable risk factors for cardiovascular disease include hypertension, cigarette smoking, diabetes, obesity, and physical inactivity (p. 752).
According to Healthy People 2010 (2019), factors that may contribute to hypertension and risk for cardiovascular disease in Pacific Islander and Asian American populations include economic stability, geographic location, language fluency and literacy, and provider availability secondary to provider linguistic and cultural competency. According to Ramkrishnan and Ahmad (2014), the average median household income among Asian Americans is an estimated $72,000 while Pacific Islanders have an estimated median household income of $55,000 from 2008 to 2012. In addition, Ramkrishnan and Ahmad (2014) indicate about 19% of the Asian American population can speak English well while 4% does not speak English at all. On the other hand, about 9% of the Pacific Islander population speak English well. Many Asian Americans and Pacific Islanders come from first generation families that have migrated from remote geographic locations such as the Philippines, Vietnam, Hawaii nad Japan. Most immigrants bring their cultural beliefs as well as difficulties speaking English. As a result, they have a difficult time understanding patient education in order to improve their health.
Advantages of addressing hypertension and its role in preventing heart disease in the United States include the reduction of preventable hospital visits and reduction of cost burden towards patients, especially in low income populations. Centers of Disease Control and Prevention (2017) states that heart disease alone cost $200 billion each year, including loss of productivity, health care services, and medications. Disadvantages of uncontrolled hypertension and heart disease include increased morbidity and mortality rate, and increased number of preventable hospital visits. Approximately 17.6 million deaths in 2016 occurred from cardiovascular disease per American Heart Association (2019). Therefore, the importance of addressing hypertension and cardiovascular disease can greatly reduce the cost as well as morbidity and mortality rates in America.
CARS Analysis of Yoo Et Al. (2015)
Yoo, Musselma, Lee, and Yee-Melichar (2014) examined the different health care disparities that affect the Asian elderly American populations ages 65 years and older. The peer-reviewed article was published on Winter 2014-2015 from the Journal of the American Society of Aging. The article was written by four authors from the San Francisco State University in California: Grace J. Yoo, M.P.H., Ph.D., Elaine Mussellman, R.N., Ph.D., C.N.E., Yeon-Shim Lee, M.S.W., Ph.D., and Darlene Yee Melichar, Ed.D, C.H.E.S. These authors are professors at the San Francisco State University from different departments, such as the School of Nursing, the School of Social Work, and from the College of Health and Social Sciences. In this article, there is a total of 30 references with most resources within six years. This article is relevant because it explores the diversity of Asian American populations and solutions to reduce health care disparities including heart disease and diabetes. The content did not show bias, remained factual and consistent with the supported research throughout the article.
CARS Analysis of Sentell Et Al. (2015)
Sentell, Ahn, Miyamura, and Juarez (2015) explored the cost burden of preventable hospitalizations from diabetes and cardiovascular disease for Asian Americans, Pacific Islanders, and Whites. The peer- reviewed article was published by the Journal of Health Care for the Poor and Underserved in 2015. Three out of four authors of this article hold a PhD and ScD. The author is an Associate Professor at the Office of Public Health Studies at the University of Hawaii at Manoa with available contact information on the first page. This article contains 40 references with most within six years. This article is relevant because it examines preventable hospitalizations in Asian American and Pacific Islander populations with diabetes and cardiovascular disease. The content remained factual without bias and stated statistics and evidence on the cost of preventable hospitalizations in Asian Americans and Pacific Islanders.
CARS Analysis of Ma Et Al. (2017)
Ma et al. (2017) examined the risk assessment and prevention of hypertension in Filipino Americans. The peer-reviewed article was published on February 2017 by the Journal of Community Health. The author Grace X. Ma, PhD is an Associate Dean for Health Disparities at Temple University, School of Medicine. The five other authors are Academic Researchers and a Board-Certified Doctor specializing in Nephrology, Hypertension, and Kidney Transplantation. The article contains 25 references with most references within a six-year period. This article does not contain any bias and remained consistent and factual throughout. The content was relevant as it contained factors such as lifestyle modifications, hypertension status, acculturation, and health behaviors to improve hypertension and prevent cardiovascular disease in the Filipino, Asian American population.
Nursing Level Interventions
Nurses play a pivotal role in patient education by providing specific patient and family education towards prevention and reduction of disease such as heart disease. Aside from patient education, nurses also conduct assessments to determine patients risk in developing complications. Ma et al. (2017) conducted a risk assessment of hypertension in 200 Filipino Americans in the Pennsylvania and New Jersey area. The risk assessment noted that about 66.5% of participants had hypertension, 86.3% were acculturated, 8.5% were smokers, 76.1% were physical active, and majority of 75% reported adding salt to food. Ma et al. (2017) noted that the it is vital to encourage patients to change their dietary pattern including salt reduction to reduce and manage blood pressure. In the study, individuals reported to be more motivated after being told that they have high blood pressure. Therefore, a nurse level intervention would be an assessment of risk factors associated with heart disease. Risk assessments in high-risk minority communities are essential to increase awareness and education. Although patient education is an important tool in promoting awareness towards enhanced self-care and disease prevention effective communication is still an essential factor in creating change. Therefore, the use of translators and translated patient educational resources are helpful in providing high quality care.
Hinkle and Cheever (2018) state that promoting patient education towards modifiable risk factors and promoting self-care are vital in the prevention of heart disease (p. 753). Patient teaching focuses on dietary modifications from controlling cholesterol intake and following dietary measures such reading nutritional data on product labels. Educating patients about nutritional intake of home-cooked meals versus eating at restaurants or fast food chains minimize uncontrolled diet and weight gain. Additional patient education would also emphasize the importance of increased physical activity and weight reduction to decrease coronary events. Ma et al. (2017), also states that Filipino Americans are the only Asian American subgroup with lower control rates of treated high blood pressure with only 38.4% of treated patients with optimal blood pressure control. Prevention of risk factors associated with heart disease also include the promotion of smoking cessation, management of hypertension, and controlling diabetes. Thus, enforced medication reconciliation teaching including the discussion of benefits and side effects of medications is also included in patient education provided by nurses.
Organizational Interventions
Because patient education is important in increasing awareness and education regarding health conditions, organizational interventions can help build a bridge towards individuals who do not have access to health care or lack health insurance. The Centers for Disease Control and Prevention (2017) state that the percentage of the Asian population without health insurance coverage under the age of 65 is 7.4% and is 12.9% in the Pacific Islander population. Therefore, organizational level interventions to reduce health care cost and improve quality of life will engage the public in health educational programs such as free cultural health fairs, free basic health check-ups, and basic screenings. For example, Lee, Chen, Deng, and Parasurama (2015) conducted a study to analyze 377 Asian Immigrants in Michigan and their benefits during a free health fair. The free health fair included volunteer community health workers and bilingual health care providers and doctors, who were able to engage about basic health care screenings. Such screenings including blood pressure, cholesterol, and glucose checks as well as a BMI assessment. Of the 377 participants at the health care, approximately 42.4% did not have health care coverage. Many participated in the free health fair due to lack of insurance and found the health fair as an opportunity to receive free medical attention.
As a result, providing free health care fairs to the public and offering single-ethnic group fairs, gives non-profit organizations, health care organizations, and community and public services the opportunity to reach out to minority populations such as the Asians and Pacific Islanders. Data can be collected during health fairs which will contribute to studies in understanding sub-ethnic Asian and Pacific Islander groups and can be used to help acquire additional resources. The use of free basic screenings such as BMI, blood glucose, blood pressure, and cholesterol checks are useful tools in increasing awareness and educating about prevention for heart disease. In fact, Yoo, Musselma, Lee, and Yee-Melichar (2014) concluded that effective communication is an important key factor in the management of chronic conditions which include increasing awareness and education in diverse populations.
Policy Interventions
To further reduce risk factors associated with hypertension and heart disease, policy and environmental changes are vital in the promotion of health. Policy level interventions to promote environmental and social impact include increasing access of nutritious foods through local farmers markets and community gardens while promoting an active lifestyle. Kwon et al. (2015), examined how community-based organizations implemented culturally adapted gardens and farmers markets to expand access to healthy foods across underserved communities. Policy interventions included applying nutritional policies such as incorporating traditional foods, herbs, and vegetables into the diet and implementing worksite policies of increased physical activities during breaks.
In comparison, effective policies in the promoting smoking cessation and decreased tobacco use include implementing peer-education programs and public education. Golechha (2016), examined the effectiveness of a peer-led intervention to stop smoking initiation at schools known as ASSIST, A Stop Smoking in Schools Trial. The study showed effectiveness with a reduction of 22% of students and faculty from smoking in a two-year period. Health and social initiatives such as community-based organizations and peer-led programs are resources that health care providers promote to encourage a healthy lifestyle.
As the population of Asian and Pacific Islanders continue to grow in the United States, the prevention and reduction of risk factors associated with hypertension and heart disease is vital in the prevention mortality and morbidity rates. Sentell, Ahn, Miyamura, and Juarez (2015) state that the estimated average cost of preventable hospitalization is about $87.2 million in Hawaiians and $65.4 million in Japanese. Community health clinics play an important role in the management and prevention of hospitalizations. With fewer risk factors and healthier behavioral changes, potential for preventable hospitalizations improve health equity.
Conclusion
In conclusion, the evidence and research examined shows diet restriction interventions such as patient teaching with the use of free community resources, is effective in reducing heart disease compared to smoking cessation. Whereas, more research and data regarding smoking cessation in Asian and Pacific Islander populations is needed to further analyze its effectiveness in preventing heart disease. Interventive measures to reduce risk of heart disease and promote health equity among Asian American and Pacific Islander populations include nurse-led risk assessment for hypertension and nutritional education, organizational interventions of free health fairs with basic screening and health checkups, and policy interventions of community gardens, local farmers markets, and smoking prevention a school setting.
Furthermore, to understand the health disparity of heart disease within the Asian American and Pacific Islander population obtaining data and statistics from sub-ethnic groups would be essential in providing resources and preventing risk factors. With free access to health care screenings from culturally and linguistically competent health care providers and volunteers, individuals without health care insurance or access can be assisted in preventing chronic conditions such as hypertension, diabetes, and heart disease.
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