A Multi-Stage Dyadic Qualitative Analysis to Disentangle How Dietary Behaviors of Asian American Young Adults are Influenced by Family.

The dietary behaviors of Asian American (AA) young adults, who face a growing non-communicable disease burden, are impacted by complex socio-ecological forces. Family plays a crucial role in the lifestyle behaviors of AA young adults; however, little is known on the methods, contributors, and impact of familial dietary influence. This study aims to deconstruct the mechanisms of AA young adult familial dietary influence through a multi-perspective qualitative assessment. A five-phase method of dyadic analysis adapted from past research was employed to extract nuanced insights from dyadic interviews with AA young adults and family members, and ground findings in behavioral theory (the Social Cognitive Theory, SCT). 37 interviews were conducted: 18 young adults, comprising 10 different AA ethnic subgroups, and 19 family members (10 parents, 9 siblings). Participants described dietary influences that were both active (facilitating, shaping, and restricting) and passive (e.g., sharing foods or environment, mirroring food behaviors). Influences connected strongly with multiple SCT constructs (e.g., behavioral capacity, reinforcements for active influences, and expectations, observational learning for passive influences). Familial influence contributed to changes in the total amount, variety, and healthfulness of foods consumed. Intra-family dynamics were crucial; family members often leveraged each other's persuasiveness or food skills to collaboratively influence diet. AA family-based interventions should consider incorporating both passive and active forms of dietary influence within a family unit, involve multiple family members, and allow for individualization to the unique dynamics and dietary behaviors within each family unit.

The Health Implications of Perceived Anti-Muslim Discrimination Among South Asian Muslim Americans.

Introduction: Anti-Muslim discrimination in the U.S. has increased exponentially since 2001, but the impact of anti-Muslim discrimination has yet to be fully examined because of limited data available on this topic and population. The objectives of this study were to (1) examine the association between perceived anti-Muslim discrimination and health risk behaviors, with depressive symptoms as a potential mediator, among South Asian Muslim Americans and (2) examine the association between other forms of perceived discrimination and health risk behaviors, with depressive symptoms as a potential mediator, among South Asian Muslim Americans. Methods: Data were collected using an online survey, which was disseminated on subscriber e-mail lists for organizations that serve South Asian or Muslim communities. Participants were asked about perceived discrimination, depressive symptoms, diet, physical activity, tobacco use, and alcohol consumption. Data were analyzed using structural equation modeling in Mplus 8. Results: Societal anti-Muslim discrimination had a positive association with depressive symptoms (0.19, p<0.05), as did interpersonal anti-Muslim discrimination (0.20, p<0.05) and other forms of discrimination (0.22, p<0.05). None of the discrimination scales were associated with dietary patterns, tobacco use, or alcohol consumption. Conclusions: Study results demonstrated a link between discrimination and depressive symptoms. Further research is needed to examine associations with other adverse health outcomes and potential buffers against discrimination.

Community-Based Organizations as Trusted Messengers in Health.

Trust is a key component in delivering quality and respectful care within health care systems. However, a growing lack of confidence in health care, particularly among specific subgroups of the population in the United States, could further widen health disparities. In this essay, we explore one approach to building trust and reaching diverse communities to promote health: engaging community-based organizations (CBOs) as trusted community messengers. We present case studies of partnerships in health promotion, community education, and outreach that showcase how CBOs' programs build and leverage trust in health care systems through their workforce, services, and engagement with the community.

Stakeholder Perspectives on the Impact of COVID-19 on the Implementation of a Community-Clinic Linkage Model in New York City.

Community-clinical linkage models (CCLM) have the potential to reduce health disparities, especially in underserved communities; however, the COVID-19 pandemic drastically impacted their implementation. This paper explores the impact of the pandemic on the implementation of CCLM intervention led by community health workers (CHWs) to address diabetes disparities among South Asian patients in New York City. Guided by the Consolidated Framework for Implementation Research (CFIR), 22 stakeholders were interviewed: 7 primary care providers, 7 CHWs, 5 community-based organization (CBO) representatives, and 3 research staff. Semi-structured interviews were conducted; interviews were audio-recorded and transcribed. CFIR constructs guided the identification of barriers and adaptations made across several dimensions of the study's implementation context. We also explored stakeholder-identified adaptations used to mitigate the challenges in the intervention delivery using the Model for Adaptation Design and Impact (MADI) framework. (1) Communication and engagement refers to how stakeholders communicated with participants during the intervention period, including difficulties experienced staying connected with intervention activities during the lockdown. The study team and CHWs developed simple, plain-language guides designed to enhance digital literacy. (2) Intervention/research process describes intervention characteristics and challenges stakeholders faced in implementing components of the intervention during the lockdown. CHWs modified the health curriculum materials delivered remotely to support engagement in the intervention and health promotion. (3) community and implementation context pertains to the social and economic consequences of the lockdown and their effect on intervention implementation. CHWs and CBOs enhanced efforts to provide emotional/mental health support and connected community members to resources to address social needs. Study findings articulate a repository of recommendations for the adaptation of community-delivered programs in under-served communities during a time of public health crises.

Integrating Community Health Workers into Community-Based Primary Care Practice Settings to Improve Blood Pressure Control Among South Asian Immigrants in New York City: Results from a Randomized Control Trial.

BACKGROUND: Blood pressure (BP) control is suboptimal in minority communities, including Asian populations. We evaluate the feasibility, adoption, and effectiveness of an integrated CHW-led health coaching and practice-level intervention to improve hypertension control among South Asian patients in New York City, Project IMPACT (Integrating Million Hearts for Provider and Community Transformation). The primary outcome was BP control, and secondary outcomes were systolic BP and diastolic BP at 6-month follow-up. METHODS: A randomized-controlled trial took place within community-based primary care practices that primarily serve South Asian patients in New York City between 2017 and 2019. A total of 303 South Asian patients aged 18-85 with diagnosed hypertension and uncontrolled BP (systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg) within the previous 6 months at 14 clinic sites consented to participate. After completing 1 education session, individuals were randomized into treatment (n=159) or control (n=144) groups. Treatment participants received 4 additional group education sessions and individualized health coaching over a 6-month period. A mixed effect generalized linear model with a logit link function was used to assess intervention effectiveness for controlled hypertension (Yes/No), adjusting for practice level random effect, age, sex, baseline systolic BP, and days between BP measurements. RESULTS: Among the total enrolled population, mean age was 56.8±11.2 years, and 54.1% were women. At 6 months among individuals with follow-up BP data (treatment, n=154; control, n=137), 68.2% of the treatment group and 41.6% of the control group had controlled BP (P<0.001). In final adjusted analysis, treatment group participants had 3.7 [95% CI, 2.1-6.5] times the odds of achieving BP control at follow-up compared with the control group. CONCLUSIONS: A CHW-led health coaching intervention was effective in achieving BP control among South Asian Americans in New York City primary care practices. Findings can guide translation and dissemination of this model across other communities experiencing hypertension disparities. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT03159533.

Evaluating the healthfulness of Asian American young adult dietary behaviors and its association with family structure: Disaggregated results from NHIS 2015.

Background: Asian Americans (AA) young adults face a growing non-communicable disease burden linked with poor dietary behaviors. Family plays a significant role in shaping the diet of AA young adults, although little is known on the specific types of family structures most associated with different dietary behaviors. Aim: This analysis explores the changes in dietary behaviors across different AA young adult family structural characteristics. Methods: Nationwide data of 18-35-year-old self-identified Asians surveyed in the 2015 National Health Interview Survey (NHIS) was analyzed. Family structure was measured through family size, family health, and family members in one's life. The Dietary Screener Questionnaire (DSQ) measured the average intake of 10 food and nutrient groups. Published dietary guidelines were used to calculate the number of dietary recommendations met. Results: 670 AA young adults with dietary data were analyzed (26.1% Asian Indian, 26.1% Chinese, 19.3% Filipino, 28.5% other Asian). Participants had an average family size of 2.3. In weighted analyses, 19% of AA young adults met none of the examined dietary recommendations, and only 14% met 3-4 guidelines. Living with a child was associated meeting more dietary recommendations (adjusted odds ratio [AOR]: 1.22; 95%CI: 1.05, 1.42). The adjusted association between living with an older adult and lower odds of meeting dietary recommendations approached significance (AOR: 0.70; 95%CI: 0.49, 1.00). Conclusions: Findings revealed the important role of children and older adults in influencing the diet of AA young adults. Further mixed-methods research to disentangle mechanisms behind the influence of family structure on diet is warranted.

A Culturally Adapted Breast and Cervical Cancer Screening Intervention Among Muslim Women in New York City: Results from the MARHABA Trial.

We examine the efficacy of MARHABA, a social marketing-informed, lay health worker (LHW) intervention with patient navigation (PN), to increase breast and cervical cancer screening among Muslim women in New York City. Muslim women were eligible if they were overdue for a mammogram and/or a Pap test. All participants attended a 1-h educational seminar with distribution of small media health education materials, after which randomization occurred. Women in the Education + Media + PN arm received planned follow-ups from a LHW. Women in the Education + Media arm received no further contact. A total of 428 women were randomized into the intervention (214 into each arm). Between baseline and 4-month follow-up, mammogram screening increased from 16.0 to 49.0% in the Education + Media + PN arm (p < 0.001), and from 14.7 to 44.6% in the Education + Media arm (p < 0.001). Pap test screening increased from 16.9 to 42.3% in the Education + Media + PN arm (p < 0.001) and from 17.3 to 37.1% in the Education + Media arm (p < 0.001). Cancer screening knowledge increased in both groups. Between group differences were not statistically significant for screening and knowledge outcomes. A longer follow-up period may have resulted in a greater proportion of up-to-date screenings, given that many women had not yet received their scheduled screenings. Findings suggest that the educational session and small media materials were perhaps sufficient to increase breast and cervical cancer screening among Muslim American women. ClinicalTrials.gov NCT03081507.

Factors Influencing Recovery and Well-Being Among Asian Survivors of International Criminal Sex Trafficking in an Urban U.S. City.

Sex trafficking is serious form of gender-based violence that results in profound adverse health outcomes, yet one that is poorly understood. New York City is a major hub for sex trafficking, with a significant but unquantified number of victims originating from East Asian countries and trafficked via illicit massage businesses. Peer-reviewed studies among Asian survivors of international criminal sex trafficking do not exist. The aim of this study is to qualitatively examine the factors at various levels of influence that impact the recovery and reintegration process of Asian criminal sex trafficking survivors in the United States from the perspective of survivors and front-line service providers. The study was guided by community-based participatory research and trauma-informed approaches, leveraging a collaboration with a well-established service provider organization. Ten in-depth interviews were conducted between 2018 and 2019 with three Korean survivors and seven key informants who were anti-trafficking service providers working with East Asian clients. Data were analyzed using a grounded theory approach. Survivors and service providers vocalized factors at multiple levels that either facilitate or impede recovery and well-being. Levels of influence included structural (e.g., poverty/debt bondage, immigration status, limited English proficiency), cultural (e.g., fatalism, collectivism), institutional (e.g., lack of culturally appropriate, trauma-informed care), interpersonal (e.g., exploitation, social support), and individual (e.g., resilience). Stigma was a crosscutting factor that spanned all levels of influence. This study highlights the voices of survivors and front-line service providers to understand the lives of an under-researched population of Asian sex trafficking survivors. Ultimately, the root, structural causes of survivor marginalization need to be addressed, which stem from the intersection of class-, gender-, and race-related inequities. While survivors continue to experience exploitation and marginalization post-trafficking, they also carry an enormous amount of resilience that must be leveraged in their path to recovery from trauma.

Promoting Physical Activity Among Immigrant Asian Americans: Results from Four Community Health Worker Studies.

Racial/ethnic minorities have demonstrated lower rates of physical activity (PA) than non-Hispanic Whites. This study examined outcomes in PA measures after participation in a community health worker (CHW) intervention. We performed a secondary data analysis from four randomized controlled trials utilizing CHWs (n = 842) in New York City (Bangladeshi-diabetes management, Filipino-hypertension management, and Korean and Asian Indian-diabetes prevention). Outcomes included total weekly PA, PA self-efficacy, PA barriers, and PA social interaction. Each measure was examined at baseline and study endpoint. Generalized estimating equation models were fitted to assess the repeated measures over time, while accounting for study group and socio-demographic factors. Moderate PA, recommended PA, and self-efficacy increased significantly among treatment group participants. PA social interaction increased significantly among Filipinos and Asian Indians. In adjusted regression analysis, time x group interaction was significant for all PA outcomes except for PA barriers. Culturally-adapted lifestyle interventions may potentially improve PA-related outcomes in Asian immigrant communities. Trial registration at ClinicalTrials.gov includes: NCT03530579 (RICE Project), NCT02041598 (DREAM Project), and NCT03100812 (AsPIRE).

Family Involvement in Asian American Health Interventions: A Scoping Review and Conceptual Model.

Family members play a crucial role in the health of Asian American communities, and their involvement in health interventions can be pivotal in optimizing impact and implementation. To explore how family members can be effectively involved in Asian American health interventions and develop a conceptual framework of methods of involvement at the stages of intervention development, process, and evaluation, this scoping review documented the role of Asian American family members in interventions (across any health objective). Of the 7175 studies identified through database and manual searches, we included 48 studies in the final analysis. Many studies focused on Chinese (54%) or Vietnamese (21%) populations, were conducted in California (44%), and involved spouses (35%) or parents/children (39%). We observed involvement across 3 stages: (1) intervention development (formative research, review process, material development), (2) intervention process (recruitment, receiving the intervention together, receiving a parallel intervention, enlisting support to achieve goals, voluntary intervention support, agent of family-wide change, and participation gatekeepers), and (3) intervention evaluation (received evaluation together, indirect impact evaluation, and feedback during intervention). Impact of family member involvement was both positive (as sources of encouragement, insight, accountability, comfort, and passion) and negative (sources of hindrance, backlash, stigma, obligation, and negative influence). Suggestions for future research interventions include (1) exploring family involvement in South Asian or young adult interventions, (2) diversifying types of family members involved (eg, extended family), and (3) diversifying methods of involvement (eg, family members as implementation agents).

COVID-19 and Asian Americans: Reinforcing the Role of Community-Based Organizations in Providing Culturally and Linguistically Centered Care.

Introduction: Community-based organizations (CBOs) have provided critical resources during the pandemic, particularly for marginalized communities, and are trusted liaisons who connect socially and linguistically isolated community members, such as the highly diverse Asian American population, to care during public health emergencies. Stereotypes such as the model minority myth have permeated public perception of Asian Americans' health status and health care access needs, fueling widespread belief that Asian Americans do not experience health disparities, and mask the high rates of coronavirus disease 2019 (COVID-19) infection, hospitalization, and mortality among Asian Americans. The unequal burden of COVID-19 on Asian American communities has largely remained absent from the public health and national discourse, with exceptions such as community voices that have directed news media coverage and leading roles of CBOs in offering culturally adapted, in-language programming on COVID-19 infection prevention and control. Methods: CBOs and their staff are well-equipped with the cultural acuity, language capacity, and familiarity with local norms to improve structural gaps affecting health outcomes and support health care delivery. Results: We discuss the roles and responsibilities of CBOs in strengthening the health care workforce and expanding community-clinic linkages and provide two case studies illustrating the efforts of two community organizations serving Asian American and immigrant communities, who have been disproportionally affected by the COVID-19 pandemic. Discussion: CBOs are essential to supporting health service coordination and care delivery for structurally vulnerable populations, and are vital to sustaining the coordinated, multilevel public health response to improving community health. Conclusion: Bolstering the current infrastructure to support CBOs is necessary to facilitating immediate responses to serve community needs.

Evaluation of a Diabetes Prevention Intervention for Korean American immigrants at Risk for Diabetes.

Purpose: Despite the small but growing number of studies documenting the increasing prevalence of diabetes among Korean Americans, no culturally adapted interventions have been developed for Korean Americans at risk for diabetes. We evaluate the efficacy of a culturally tailored lifestyle intervention among Korean American immigrants at risk for diabetes in New York City (NYC). Methods: Korean Americans at risk for diabetes were recruited into a culturally adapted, community health worker (CHW) intervention in NYC. Treatment group participants received 6 group sessions and 10 follow-up phone calls from CHWs over the 6-month period. Control participants received only the first session. Study outcomes included changes in weight, body mass index (BMI), blood pressure, physical activity (PA) and PA behaviors, nutrition behaviors, and diabetes knowledge. Paired t-tests and chi-square tests assessed group differences for each group for each outcome measure. Results: The treatment group reported significant positive changes in recommended weekly PA, PA self-efficacy, PA barriers, nutrition self-efficacy, diabetes knowledge, weight, BMI, and systolic blood pressure compared with control participants. Generalized estimated equations models for repeated measures assessed change across time while adjusting for study arm, time point, and the interaction between study arm and time point. The intervention effect was significant for weekly moderate and vigorous PA, recommended weekly PA, PA self-efficacy, and diabetes knowledge. Conclusions: Results suggest that a culturally adapted lifestyle intervention for Korean American immigrants at risk for diabetes have the potential to improve behaviors associated with cardiovascular disease outcomes and diabetes prevention. Further research among Korean Americans is warranted.

Small Practices, Big (QI) Dreams: Customizing Quality Improvement (QI) Efforts for Under-Resourced Primary Care Practices to Improve Diabetes Disparities.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/s13063-019-3711-y.

The Mutually Reinforcing Cycle Of Poor Data Quality And Racialized Stereotypes That Shapes Asian American Health.

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.

Associations between Spiritual Health Locus of Control, Perceived Discrimination and Breast and Cervical Cancer Screening for Muslim American Women in New York City.

BACKGROUND: We sought to understand the impacts of religion-related factors, namely perceived discrimination and spiritual health locus of control, on breast and cervical cancer screening for Muslim American women. METHODS: A total of 421 Muslim American women were surveyed at baseline of a breast and cervical cancer screening intervention, measuring discrimination through the Perceived Ethnic Discrimination Questionnaire (PED-Q), a 17-item scale measuring perceived interpersonal racial/ethnic discrimination; and spiritual beliefs through the Spiritual Health Locus of Control Scale, a 13-item scale measuring the link between control over one's health with a connection to religious beliefs. Multivariable logistic regression models were used to determine factors associated with an up-to-date mammogram and Pap test. RESULTS: Most women preferred to receive medical care from a healthcare provider of their same gender (75.2%) and same race, ethnicity or religion (62.1%). The middle age group (50-59) and a lower God's Grace Spiritual Health Locus of Control subscale were associated with up-to-date mammogram. Younger age, lower education, higher Exclusion/Rejection subscale, and lower Spiritual Life/Faith Subscale were associated with an up-to-date Pap test. CONCLUSION: The spiritual beliefs of Muslim American women impact their likelihood of obtaining breast and cervical cancer screenings. Therefore, these services need to be better tailored to match these needs, for example, by ensuring that Muslim American women have access to healthcare providers of their same gender, race, ethnicity or religion.

Prevention Research Centers and COVID-19: Models of a Community-Engaged Response to a Public Health Emergency.

For more than 30 years, the network of Centers for Disease Control and Prevention (CDC)-funded Prevention Research Centers (PRCs) has worked with local communities and partners to implement and evaluate public health interventions and policies for the prevention of disease and promotion of health. The COVID-19 pandemic tested the PRC network's ability to rapidly respond to multiple, simultaneous public health crises. On April 28, 2020, to assess the network's engagement with activities undertaken in response to the early phase of the pandemic, PRC network leadership distributed an online survey to the directors of 34 currently or formerly funded PRCs, asking them to report their PRCs' engagement with predetermined activities across 9 topical areas and provide case studies exemplifying that engagement. We received responses from 24 PRCs, all of which reported engagement with at least 1 of the 9 topical areas (mean, 5). The topical areas with which the greatest number of PRCs reported engagement were support of frontline agencies (21 of 24, 88%) and support of activities related to health care (21 of 24, 88%). The mean number of activities with which PRCs reported engagement was 11. The PRCs provided more than 90 case studies exemplifying their work. The results of the survey indicated that the PRCs mobilized their personnel and resources to support the COVID-19 response in less than 6 weeks. We posit that the speed of this response was due, in part, to the broad and diverse expertise of PRC personnel and long-standing partnerships between PRCs and the communities in which they work.

Disparities in colorectal cancer screening among South Asians in New York City: a cross-sectional study.

Despite improvements in colorectal cancer (CRC) screening in New York City (NYC) since the early 2000s, the degree to which disparities persist for specific Asian American subgroups has yet to be fully elucidated. The purpose of this study is to examine disparities in rates of timely colonoscopy screening among five racial/ethnic groups in NYC. We performed a retrospective cross-sectional analysis of combined 2014-2018 NYC Community Health Survey data. Prevalence estimates of timely colonoscopy screening (within the past 10 years) among individuals ≥ 50 years of age were calculated and presented overall (n = 24,288) and by socio-demographic variables. Racial/ethnic categories included White, Black, Hispanic, East Asian, and South Asian. Multivariable models examined socio-demographic and racial/ethnic predictors of timely colonoscopy screening. A trend analysis examined colonoscopy screening by race/ethnicity and year from 2012 to 2018 (n = 33,130). Age-adjusted prevalence of timely colonoscopy screening was lowest among Asian Americans (South Asian 61.1% and East Asian 65.9%) compared to Hispanics (71.3%), Blacks (70.2%), and Whites (68.6%). Adjustment by socio-demographics, including insurance status, further explained disparities for South Asians (adjusted risk ratio [RR] = 0.84, 95% CI = 0.73-0.97) compared to Hispanics; additionally, Whites (adjusted RR=0.88, 95% CI = 0.84-0.92) were less likely to have received a timely colonoscopy compared to Hispanics. Age, health insurance, poverty group, and education were significant predictors in adjusted regression. Results indicate that South Asians have not equally benefited from campaigns to increase colonoscopy screening in NYC. Our findings support the development of targeted, and linguistically and culturally adapted campaigns that facilitate access to health systems and leverage existing community assets and social support systems among South Asian populations.

Implementation of a multi-level community-clinical linkage intervention to improve glycemic control among south Asian patients with uncontrolled diabetes: study protocol of the DREAM initiative.

BACKGROUND: A number of studies have identified patient-, provider-, and community-level barriers to effective diabetes management among South Asian Americans, who have a high prevalence of type 2 diabetes. However, no multi-level, integrated community health worker (CHW) models leveraging health information technology (HIT) have been developed to mitigate disease among this population. This paper describes the protocol for a multi-level, community-clinical linkage intervention to improve glycemic control among South Asians with uncontrolled diabetes. METHODS: The study includes three components: 1) building the capacity of primary care practices (PCPs) to utilize electronic health record (EHR) registries to identify patients with uncontrolled diabetes; 2) delivery of a culturally- and linguistically-adapted CHW intervention to improve diabetes self-management; and 3) HIT-enabled linkage to culturally-relevant community resources. The CHW intervention component includes a randomized controlled trial consisting of group education sessions on diabetes management, physical activity, and diet/nutrition. South Asian individuals with type 2 diabetes are recruited from 20 PCPs throughout NYC and randomized at the individual level within each PCP site. A total of 886 individuals will be randomized into treatment or control groups; EHR data collection occurs at screening, 6-, 12-, and 18-month. We hypothesize that individuals receiving the multi-level diabetes management intervention will be 15% more likely than the control group to achieve ≥0.5% point reduction in hemoglobin A1c (HbA1c) at 6-months. Secondary outcomes include change in weight, body mass index, and LDL cholesterol; the increased use of community and social services; and increased health self-efficacy. Additionally, a cost-effectiveness analysis will focus on implementation and healthcare utilization costs to determine the incremental cost per person achieving an HbA1c change of ≥0.5%. DISCUSSION: Final outcomes will provide evidence regarding the effectiveness of a multi-level, integrated EHR-CHW intervention, implemented in small PCP settings to promote diabetes control among an underserved South Asian population. The study leverages multisectoral partnerships, including the local health department, a healthcare payer, and EHR vendors. Study findings will have important implications for the translation of integrated evidence-based strategies to other minority communities and in under-resourced primary care settings. TRIAL REGISTRATION: This study was registered with clinicaltrials.gov: NCT03333044 on November 6, 2017.

A Community Health Worker-Led Intervention to Improve Blood Pressure Control in an Immigrant Community With Comorbid Diabetes: Data From Two Randomized, Controlled Trials Conducted in 2011-2019.

Evidence-based strategies addressing comorbid hypertension and diabetes are needed among minority communities. We analyzed the outcome of blood pressure (BP) control using pooled data from two community health worker interventions in New York City conducted between 2011 and 2019, focusing on participants with comorbid hypertension and diabetes. The adjusted odds of controlled BP (< 140/90 mmHg) for the treatment group were significant compared with the control group (odds ratio = 1.4; 95% confidence interval = 1.1, 1.8). The interventions demonstrated clinically meaningful reductions in BP among participants with comorbid hypertension and diabetes.