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Sharma AE, Khosla K, Potharaju K, Mukherjea A, Sarkar U. COVID-19-Associated Misinformation Across the South Asian Diaspora: Qualitative Study of WhatsApp Messages. JMIR Infodemiology 2023; 3:e38607. [PMID: 37113380 PMCID: PMC10013129 DOI: 10.2196/38607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 11/18/2022] [Accepted: 11/30/2022] [Indexed: 04/29/2023]
Abstract
Background South Asians, inclusive of individuals originating in India, Pakistan, Maldives, Bangladesh, Sri Lanka, Bhutan, and Nepal, comprise the largest diaspora in the world, with large South Asian communities residing in the Caribbean, Africa, Europe, and elsewhere. There is evidence that South Asian communities have disproportionately experienced COVID-19 infections and mortality. WhatsApp, a free messaging app, is widely used in transnational communication within the South Asian diaspora. Limited studies exist on COVID-19-related misinformation specific to the South Asian community on WhatsApp. Understanding communication on WhatsApp may improve public health messaging to address COVID-19 disparities among South Asian communities worldwide. Objective We developed the COVID-19-Associated misinfoRmation On Messaging apps (CAROM) study to identify messages containing misinformation about COVID-19 shared via WhatsApp. Methods We collected messages forwarded globally through WhatsApp from self-identified South Asian community members between March 23 and June 3, 2021. We excluded messages that were in languages other than English, did not contain misinformation, or were not relevant to COVID-19. We deidentified each message and coded them for one or more content categories, media types (eg, video, image, text, web link, or a combination of these elements), and tone (eg, fearful, well intentioned, or pleading). We then performed a qualitative content analysis to arrive at key themes of COVID-19 misinformation. Results We received 108 messages; 55 messages met the inclusion criteria for the final analytic sample; 32 (58%) contained text, 15 (27%) contained images, and 13 (24%) contained video. Content analysis revealed the following themes: "community transmission" relating to misinformation on how COVID-19 spreads in the community; "prevention" and "treatment," including Ayurvedic and traditional remedies for how to prevent or treat COVID-19 infection; and messaging attempting to sell "products or services" to prevent or cure COVID-19. Messages varied in audience from the general public to South Asians specifically; the latter included messages alluding to South Asian pride and solidarity. Scientific jargon and references to major organizations and leaders in health care were included to provide credibility. Messages with a pleading tone encouraged users to forward them to friends or family. Conclusions Misinformation in the South Asian community on WhatsApp spreads erroneous ideas regarding disease transmission, prevention, and treatment. Content evoking solidarity, "trustworthy" sources, and encouragement to forward messages may increase the spread of misinformation. Public health outlets and social media companies must actively combat misinformation to address health disparities among the South Asian diaspora during the COVID-19 pandemic and in future public health emergencies.
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Affiliation(s)
- Anjana E Sharma
- Department of Family and Community Medicine University of California San Francisco San Francisco, CA United States
- Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital University of California San Francisco San Francisco, CA United States
| | - Kiran Khosla
- School of Public Health Boston University Boston, MA United States
| | | | - Arnab Mukherjea
- Department of Public Health California State University East Bay Hayward, CA United States
| | - Urmimala Sarkar
- Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital University of California San Francisco San Francisco, CA United States
- Division of General Internal Medicine at Zuckerberg San Francisco General Hospital University of California San Francisco San Francisco, CA United States
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Mukherjea A, Shariff-Marco S, Yang J, Tseng W, Palaniappan L, Li J, Ivey SL, Somsouk M, Gomez SL. Determinants of Colorectal Cancer Screening among South Asian Americans. J Asian Health 2022; 10:1-12. [PMID: 35909807 PMCID: PMC9335393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Colorectal cancer screening rates among South Asian Americans are among the lowest of US population groups. Few population-based studies have examined determinants of screening in this population. The purpose of this study was to identify factors associated with colorectal cancer screening among South Asian Americans. METHODS Data from the 2001-2009 California Health Interview Survey and multivariable logistic regression were used to examine determinants of being non-adherent with colorectal cancer screening recommendations. Independent variables include sociodemographic and healthcare access measures. RESULTS Overall, 49% of 459 South Asian Americans were non-adherent to screening recommendations. Characteristics associated with non-adherence were the absence of flu shot, absence of doctor visits, sole use of non-English language at home and ≤40% life spent in the United States. In the multivariable model, screening non-adherence was associated with ≤40% life in the United States (odds ratio [95% confidence interval] 3.0 [1.4-6.5]), use of non-English at home (2.8 [1.0-7.8]) and no flu shot (2.5 [1.3-4.8]). Obese (BMI > 27.5 kg/m2) versus normal-weight patients were less likely to be non-adherent (0.4 [0.2-0.9]). CONCLUSIONS Length of time in the United States and language spoken at home rather than English proficiency were associated with non-adherence to colorectal cancer screening, reflecting the importance of acculturation and retention of cultural values. Health conditions and behaviors reflecting more proactive healthcare utilization may reinforce the importance of provider recommendations and perceived efficacy of health prevention. Qualitative research would inform cultural tailoring necessary to improve colorectal cancer screening rates among the rapidly growing South Asian American population.
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Affiliation(s)
- Arnab Mukherjea
- Department of Public Health, California State University, East Bay, Hayward, CA
- Health Research for Action, School of Public Health, University of California, Berkeley, CA
| | - Salma Shariff-Marco
- Department of Epidemiology & Biostatistics, University of California, San Francisco, CA
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA
| | - Juan Yang
- Department of Epidemiology & Biostatistics, University of California, San Francisco, CA
| | - Winston Tseng
- Health Research for Action, School of Public Health, University of California, Berkeley, CA
| | | | - Jun Li
- Division of Cancer Prevention & Control, National Center for Chronic Disease Prevention & Health Promotion, Centers for Disease Control & Prevention, Atlanta, GA
| | - Susan L. Ivey
- Health Research for Action, School of Public Health, University of California, Berkeley, CA
| | - Ma Somsouk
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA
- Division of Gastroenterology, Department of Medicine, University of California, San Francisco, CA
| | - Scarlett Lin Gomez
- Department of Epidemiology & Biostatistics, University of California, San Francisco, CA
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA
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Choi J, Park VT, Vuong Q, Cheng J, Mukherjea A, Tsoh JY. Dementia family caregiving experience among Asian American older adults. Alzheimers Dement 2021. [DOI: 10.1002/alz.055055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- JiWon Choi
- University of California, San Francisco San Francisco CA USA
| | - Van Ta Park
- University of California, San Francisco San Francisco CA USA
| | - Quyen Vuong
- International Children Assistance Network Milpitas CA USA
| | - Joyce Cheng
- Chinese Community Health Resource Center San Francisco CA USA
| | | | - Janice Y Tsoh
- University of California, San Francisco San Francisco CA USA
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Guan A, Mukherjea A. Appropriate Use of the Asian American Demographic Category in Health Disparities Research. Am J Public Health 2021; 111:e15-e16. [PMID: 33950726 PMCID: PMC8101574 DOI: 10.2105/ajph.2021.306266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Alice Guan
- Alice Guan is a PhD student with the Department of Epidemiology & Biostatistics, University of California, San Francisco. Arnab Mukherjea is an Associate Professor and Incoming Chair of the Department of Public Health, California State University, East Bay
| | - Arnab Mukherjea
- Alice Guan is a PhD student with the Department of Epidemiology & Biostatistics, University of California, San Francisco. Arnab Mukherjea is an Associate Professor and Incoming Chair of the Department of Public Health, California State University, East Bay
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Rao M, Bar L, Yu Y, Srinivasan M, Mukherjea A, Li J, Chung S, Venkatraman S, Dan S, Palaniappan L. Disaggregating Asian American Cigarette and Alternative Tobacco Product Use: Results from the National Health Interview Survey (NHIS) 2006-2018. J Racial Ethn Health Disparities 2021; 9:856-864. [PMID: 33909281 PMCID: PMC8080866 DOI: 10.1007/s40615-021-01024-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 02/23/2021] [Accepted: 03/14/2021] [Indexed: 11/30/2022]
Abstract
Introduction Asian Americans suffer high rates of smoking and tobacco-related deaths, varying by ethnic group. Trends of cigarette and alternative tobacco product use among Asian Americans, specifically considering ethnic group, sex, and nativity, are infrequently reported. Methods Using National Health Interview Survey (NHIS) data from 2006–2018 and the 2016–2018 alternative tobacco supplement (e-cigarettes, cigars, smokeless tobacco, pipes), we explored cigarette and alternative tobacco product use by Asian ethnic group (Asian Indian (n = 4373), Chinese (n = 4736), Filipino (n = 4912)) in comparison to non-Hispanic Whites (NHWs (n = 275,025)), adjusting for socioeconomic and demographic factors. Results Among 289,046 adults, 12% of Filipinos were current smokers, twice the prevalence in Asian Indians and Chinese (p < 0.001). The male–female gender difference was fivefold for Chinese (10.3% vs. 2.2%; p < 0.001), eightfold for Asian Indians (8.7% vs. 1.1%; p < 0.001), and twofold for Filipinos (16.8% vs. 9.0%). Moreover, 16.3% of US-born and 10.3% of foreign-born Filipinos were current smokers. Odds of ever using e-cigarettes, cigars, smokeless tobacco, and pipes in comparison to NHWs were lowest for Chinese (ORs 0.6, 0.5, 0.2, and 0.5). Discussion Filipinos had the highest current smoking rates of Asian ethnic groups. Though more Asian men were current smokers, the high rate of current smoking among Filipinas is concerning. More US-born Filipinos were current smokers than foreign-born, despite rates typically decreasing for US-born Asians. Investigating cultural factors contributing to less frequent use of tobacco products, such as alternative tobacco products among Chinese, may aid campaigns in curbing tobacco usage. Supplementary Information The online version contains supplementary material available at 10.1007/s40615-021-01024-5.
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Affiliation(s)
- Manaeha Rao
- Stanford Center for Asian Health Research and Education, Stanford University School of Medicine, Stanford, CA, USA.,Department of Neuroscience, University of Chicago, Hyde Park, IL, USA
| | - Lilly Bar
- Stanford Center for Asian Health Research and Education, Stanford University School of Medicine, Stanford, CA, USA. .,Departments of Biology and Chemistry, Pomona College, Claremont, CA, USA.
| | - Yunnan Yu
- Stanford Center for Asian Health Research and Education, Stanford University School of Medicine, Stanford, CA, USA.,School of Computing and Information, University of Pittsburgh, Pittsburgh, PA, USA
| | - Malathi Srinivasan
- Stanford Center for Asian Health Research and Education, Stanford University School of Medicine, Stanford, CA, USA.,Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Arnab Mukherjea
- Department of Health Sciences, California State University, East Bay, Hayward, CA, USA
| | - Jiang Li
- Center for Health Systems Research, Palo Alto Medical Foundation Research Institute, Sutter Health, Palo Alto, CA, USA
| | - Sukyung Chung
- Stanford Center for Asian Health Research and Education, Stanford University School of Medicine, Stanford, CA, USA.,Quantitative Sciences Unit, Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Siddharth Venkatraman
- Stanford Center for Asian Health Research and Education, Stanford University School of Medicine, Stanford, CA, USA.,Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Shozen Dan
- Stanford Center for Asian Health Research and Education, Stanford University School of Medicine, Stanford, CA, USA.,Department of Environmental and Information Science, Keio University, Tokyo, Japan
| | - Latha Palaniappan
- Stanford Center for Asian Health Research and Education, Stanford University School of Medicine, Stanford, CA, USA.,Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
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Mukherjea A, Ansari ZK, Senthil Kumar S, Katyal T, Sahota DS, Handa R, Ivey SL. Preliminary Evaluation of Educational Outreach to Promote Colorectal Cancer Screening Among South Asians in the San Francisco Bay Area. J Immigr Minor Health 2020; 22:873-877. [PMID: 31898079 DOI: 10.1007/s10903-019-00965-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Culturally-tailored interventions increase rates of colorectal cancer (CRC) screening in diverse populations. South Asian Americans have very low rates of CRC screening. Targeted interventions may improve community awareness and likelihood of undergoing screening. We identified and recruited multiple South Asian-serving community and religious centers to conduct South Asian physician-led presentations about CRC screening. A post-presentation survey tool was used to evaluate CRC screening history, intent to screen, and acceptance of a tailored brochure. In a convenience sample of 103 surveys, many participants had not undergone screening in the past (48%), and intent to screen after the presentation was high in those previously not screened (87%). Those who took a culturally-tailored brochure said they would share materials with family and friends (95% and 39% respectively). Our results support earlier findings of success in culturally-tailored interventions and indicate acceptance of culturally-tailored CRC screening outreach in community sites.
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Affiliation(s)
- Arnab Mukherjea
- Department of Health Sciences, California State University, East Bay, Hayward, CA, USA. .,Health Research for Action, School of Public Health, University of California, Berkeley, Berkeley, CA, USA.
| | - Zahra K Ansari
- Health Research for Action, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Sailakshmi Senthil Kumar
- Health Research for Action, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Toshali Katyal
- Health Research for Action, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Dilpreet S Sahota
- Health Research for Action, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Raja Handa
- Health Research for Action, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Susan L Ivey
- Health Research for Action, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
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Needham BL, Mukherjee B, Bagchi P, Kim C, Mukherjea A, Kandula NR, Kanaya AM. Acculturation Strategies and Symptoms of Depression: The Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study. J Immigr Minor Health 2019; 20:792-798. [PMID: 28748299 DOI: 10.1007/s10903-017-0635-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Using latent class analysis, we previously identified three acculturation strategies employed by South Asian immigrants in the US. Members of the Separation class showed a preference for South Asian culture over US culture, while members of the Assimilation class showed a preference for US culture, and those in the Integration class showed a similar preference for South Asian and US cultures. The purpose of this study was to examine associations between these acculturation strategies and symptoms of depression, a common yet underdiagnosed and undertreated mental disorder. We used data from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study (n = 856). Data were collected between October 2010 and March 2013 in the San Francisco Bay Area and Chicago. Depressive symptoms were assessed using the CES-D Scale. Applying a simple new method to account for uncertainty in class assignment when modeling latent classes as an exposure, we found that respondents in the Separation class had more depressive symptoms than those in the Integration class, but only after taking into account self-reported social support (b = 0.11; p = 0.05). There were no differences in depressive symptoms among those in the Assimilation class vs. those in the Integration class (b = -0.06; p = 0.41). Social support may protect against elevated symptoms of depression in South Asian immigrants with lower levels of integration into US culture.
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Affiliation(s)
- Belinda L Needham
- Department of Epidemiology and Center for Social Epidemiology and Population Health, University of Michigan, 1415 Washington Heights, 2649A SPH Tower, Ann Arbor, MI, 48109-2029, USA.
| | - Bhramar Mukherjee
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Pramita Bagchi
- Department of Statistics, University of Michigan, Ann Arbor, MI, USA
| | - Catherine Kim
- Departments of Medicine and Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Arnab Mukherjea
- Department of Health Science, California State University, East Bay, Hayward, CA, USA
| | | | - Alka M Kanaya
- Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
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Khosla N, Washington KT, Mukherjea A, Aslakson R. Health-Care Providers' Perspectives on Decision-Making Among Seriously Ill Patients of South Asian Origin in the United States. J Palliat Care 2019; 34:181-188. [PMID: 30808268 DOI: 10.1177/0825859719829480] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Persons of South Asian origin (SAs) are the fastest growing minority group in the United States. Culturally competent care for patients and families of SA origin necessitates an understanding of the cultural factors that affect decision-making for palliative and end-of-life care. OBJECTIVE To better understand health-care providers' perspectives on decision-making among seriously ill persons of SA origin. METHOD Data were collected in a US Midwestern city, predominantly in 2 hospital-based health-care systems along with a few interviews of private practitioners. Researchers conducted a thematic analysis of data. Transcripts were coded individually, coding disagreements resolved through discussion and themes arrived upon by consensus. RESULTS Health-care providers reported that numerous factors interact to influence decision-making among SAs. Patient-based factors include education, time spent in the United States, expectations of physician-directed care, and spiritual beliefs. Family-based factors include a norm of family-based decision-making and a complex distribution of decision-making responsibilities among family members. Provider-based factors include challenges reconciling SA and American approaches to decision-making. Community-based factors include negative attitudes and a lack of education regarding palliative care and the potential role of community support in health-care decision-making. CONCLUSIONS A rich cultural context influences health-care decision-making among seriously ill SAs. An understanding of this context will enhance providers' cultural competence and likely improve services to this growing population.
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Affiliation(s)
- Nidhi Khosla
- 1 Department of Health Sciences, California State University, East Bay, Hayward, CA, USA
| | - Karla T Washington
- 2 Department of Family and Community Medicine, University of Missouri, Columbia, MO, USA
| | - Arnab Mukherjea
- 1 Department of Health Sciences, California State University, East Bay, Hayward, CA, USA
| | - Rebecca Aslakson
- 3 Departments of Medicine & Anesthesiology, Perioperative & Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
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Ivey SL, Mukherjea A, Patel A, Kapoor N, Rau S, Kazi E, Bhatia J, Somsouk M, Tseng W. Colorectal Cancer Screening Among South Asians: Focus Group Findings on Attitudes, Knowledge, Barriers and Facilitators. J Health Care Poor Underserved 2018; 29:1416-1437. [PMID: 30449755 DOI: 10.1353/hpu.2018.0104] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Colorectal cancer (CRC) screening rates are low among South Asians. Understanding barriers and facilitators about CRC screening among South Asians may inform effective messaging and interventions. METHODS We conducted eight focus groups (FGs) among South Asians to gather contextual information about CRC causes, screening barriers and facilitators, and cultural factors affecting screening. FINDINGS An overarching sentiment across Asian Indian and Bangladeshi FGs was that cancer is considered a death sentence. However, many participants were unaware that CRC was a problem in their communities, and considered CRC screening as a low priority. Women often thought of CRC as mostly affecting men. Physician influence on screening decisions was most frequently discussed among Bangladeshis, as were sentiments of shame and modesty that may prevent screening. CONCLUSION Findings highlight that physicians should provide culturally-appropriate CRC information for South Asian patients, and the importance of access to CRC screening for South Asians.
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Mukherjea A, Modayil MV, Tong EK. Moving toward a true depiction of tobacco behavior among Asian Indians in California: Prevalence and factors associated with cultural smokeless tobacco product use. Cancer 2018; 124 Suppl 7:1607-1613. [PMID: 29578599 PMCID: PMC5876718 DOI: 10.1002/cncr.31102] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 10/10/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Asian Indians (AIs) in the United States exhibit disproportionate burdens of oral cancer and cardiovascular disease, which are potentially linked to smokeless tobacco. However, little is known about the use of cultural smokeless tobacco (CST) products in this population. METHODS California Asian Indian Tobacco Use Survey data from 2004 (n = 1618) were used to investigate CST prevalence among California's AIs. CST products included paan, paan masala, and gutka. A multivariable logistic regression was conducted to examine factors (socioeconomic status, acculturation measures, and religious affiliation) associated with current CST use versus never use. RESULTS The current CST prevalence was 13.0% (14.0% for men and 11.8% for women). In contrast, the prevalence of current cigarette use was 5.5% (8.7% for men and 1.9% for women), and the prevalence was lower for cultural smoked tobacco (0.1% for bidis and 0.5% for hookahs). Factors associated with CST use included the following: being male, being 50 years old or older, being an immigrant, speaking an AI language at home, having a higher level of education (adjusted odds ratio [AOR] for high school/some college, 2.6; 95% confidence interval [CI], 1.1-6.5; AOR for college degree or higher, 4.0; 95% CI, 1.7-9.5), having a higher income (AOR for $75,000-$100,000, 2.5; 95% CI, 1.3-4.7; AOR for ≥$100,000, 2.6; 95% CI, 1.4-5.0), identifying as non-Sikh (AOR for Hinduism, 10.0; 95% CI, 6.0-16.5; AOR for other faiths, 10.2; 95% CI, 5.9-17.7), and disagreeing that spiritual beliefs are the foundation of life (AOR, 2.1; 95% CI, 1.2-3.5). CONCLUSIONS The current CST prevalence is relatively high among California's AIs in comparison with the prevalence of smoking, with narrower differences between sexes. The association with a higher socioeconomic status is contrary to typical cigarette smoking patterns. Acculturation and religious affiliation are important factors associated with current use. Health care providers and policymakers should consider such determinants for targeted interventions. Cancer 2018;124:1607-13. © 2018 American Cancer Society.
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Affiliation(s)
- Arnab Mukherjea
- Health Sciences Program; College of Science; California State University, East Bay (Hayward, CA, USA)
| | - Mary V. Modayil
- Primary Health Care; Alberta Health Services (Edmonton, Alberta, Canada)
| | - Elisa K. Tong
- Division of General Internal Medicine; University of California, Davis (Sacramento, CA, USA)
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Mukherjea A, Ivey SL, Shariff-Marco S, Kapoor N, Allen L. Overcoming Challenges in Recruitment of South Asians for Health Disparities Research in the USA. J Racial Ethn Health Disparities 2018; 5:195-208. [PMID: 28364371 PMCID: PMC5640461 DOI: 10.1007/s40615-017-0357-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 02/25/2017] [Accepted: 03/01/2017] [Indexed: 02/03/2023]
Abstract
South Asians-individuals with origins in the countries of Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, Sri Lanka, and other regions of the subcontinent-are an understudied and at-risk racial/ethnic minority population for disproportionate burden of preventable diseases in the USA. Notwithstanding lack of research disaggregating Asian American subgroups, a key factor in this paucity of data is the lack of participation and engagement of community members in studies which examine distribution and determinants of adverse health outcomes. The purpose of this case study series is to elucidate distinct barriers in recruitment of South Asians in health disparities research within four diverse study designs. These illustrations are followed by a discussion of effective strategies and promising practices to increase and enhance the participation of community members in health-related studies in order to ultimately understand and address disparities among this rapidly growing cultural group in the US systematic collection of data which not only is representative of this understudied population but also elucidates contextual influences on community health and well-being and is pivotal to the reduction and elimination of preventable disparities among South Asians in the USA.
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Affiliation(s)
- Arnab Mukherjea
- Health Sciences Program, California State University, East Bay, 25800 Carlos Bee Boulevard, Student and Faculty Support Building 502, Hayward, CA, 94542, USA.
- Health Research for Action, School of Public Health, University of California, Berkeley, Berkeley 2140 Shattuck Ave., 10th Floor, Berkeley, CA, 94704, USA.
- Asian American Research Center on Health, 3333 California St., Suite 335, San Francisco, CA, 94118, USA.
| | - Susan L Ivey
- Health Research for Action, School of Public Health, University of California, Berkeley, Berkeley 2140 Shattuck Ave., 10th Floor, Berkeley, CA, 94704, USA
- Asian American Research Center on Health, 3333 California St., Suite 335, San Francisco, CA, 94118, USA
| | - Salma Shariff-Marco
- Cancer Prevention Institute of California, 2201 Walnut Ave., Suite 300, Fremont, CA, 94538, USA
- Stanford University Cancer Institute, 265 Campus Drive, Suite G2103, Stanford, CA, 94305, USA
| | - Nilesh Kapoor
- Health Research for Action, School of Public Health, University of California, Berkeley, Berkeley 2140 Shattuck Ave., 10th Floor, Berkeley, CA, 94704, USA
| | - Laura Allen
- Cancer Prevention Institute of California, 2201 Walnut Ave., Suite 300, Fremont, CA, 94538, USA
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Needham BL, Mukherjee B, Bagchi P, Kim C, Mukherjea A, Kandula NR, Kanaya AM. Acculturation Strategies Among South Asian Immigrants: The Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study. J Immigr Minor Health 2018; 19:373-380. [PMID: 26928020 DOI: 10.1007/s10903-016-0372-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In the past, epidemiologic research on acculturation and health has been criticized for its conceptual ambiguity and simplistic measurement approaches. This study applied a widely-used theoretical framework from cross-cultural psychology to identify acculturation strategies among South Asian immigrants in the US and to examine sociodemographic correlates of acculturation strategies. Data were from the Mediators of Atherosclerosis in South Asians Living in America study. We used latent class analysis to identify groups of individuals that were similar based on cultural attitudes and behaviors. We used latent class regression analysis to examine sociodemographic correlates of acculturation strategies. We found that South Asian immigrants employed three acculturation strategies, including separation (characterized by a relatively high degree of preference for South Asian culture over US culture), assimilation (characterized by a relatively high degree of preference for US culture over South Asian culture), and integration (characterized by a similar level of preference for South Asian and US cultures). Respondents with no religious affiliation, those with higher levels of income, those who lived a greater percentage of their lives in the US, and those who spoke English well or very well were less likely to use the separation strategy than the assimilation or integration strategies. Using epidemiologic cohort data, this study illustrated a conceptual and methodological approach that addresses limitations of previous research on acculturation and health. More work is needed to understand how the acculturation strategies identified in this study affect the health of South Asian immigrants in the US.
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Affiliation(s)
- Belinda L Needham
- Department of Epidemiology and Center for Social Epidemiology and Population Health, University of Michigan, 1415 Washington Heights, 2649A SPH Tower, Ann Arbor, MI, 48109-2029, USA.
| | - Bhramar Mukherjee
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Pramita Bagchi
- Department of Statistics, University of Michigan, Ann Arbor, MI, USA
| | - Catherine Kim
- Departments of Medicine and Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Arnab Mukherjea
- Department of Health Science, California State University, East Bay, Hayward, CA, USA
| | | | - Alka M Kanaya
- Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
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Bentley TG, Cohen JT, Elkin EB, Huynh J, Mukherjea A, Neville TH, Mei M, Copher R, Knoth R, Popescu I, Lee J, Zambrano JM, Broder MS. Measuring the Value of New Drugs: Validity and Reliability of 4 Value Assessment Frameworks in the Oncology Setting. J Manag Care Spec Pharm 2017; 23:S34-S48. [PMID: 28535104 PMCID: PMC10585824 DOI: 10.18553/jmcp.2017.23.6-a.s34] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Several organizations have developed frameworks to systematically assess the value of new drugs. OBJECTIVE To evaluate the convergent validity and interrater reliability of 4 value frameworks to understand the extent to which these tools can facilitate value-based treatment decisions in oncology. METHODS Eight panelists used the American Society of Clinical Oncology (ASCO), European Society for Medical Oncology (ESMO), Institute for Clinical and Economic Review (ICER), and National Comprehensive Cancer Network (NCCN) frameworks to conduct value assessments of 15 drugs for advanced lung and breast cancers and castration-refractory prostate cancer. Panelists received instructions and published clinical data required to complete the assessments, assigning each drug a numeric or letter score. Kendall's Coefficient of Concordance for Ranks (Kendall's W) was used to measure convergent validity by cancer type among the 4 frameworks. Intraclass correlation coefficients (ICCs) were used to measure interrater reliability for each framework across cancers. Panelists were surveyed on their experiences. RESULTS Kendall's W across all 4 frameworks for breast, lung, and prostate cancer drugs was 0.560 (P= 0.010), 0.562 (P = 0.010), and 0.920 (P < 0.001), respectively. Pairwise, Kendall's W for breast cancer drugs was highest for ESMO-ICER and ICER-NCCN (W = 0.950, P = 0.019 for both pairs) and lowest for ASCO-NCCN (W = 0.300, P = 0.748). For lung cancer drugs, W was highest pairwise for ESMO-ICER (W = 0.974, P = 0.007) and lowest for ASCO-NCCN (W = 0.218, P = 0.839); for prostate cancer drugs, pairwise W was highest for ICER-NCCN (W = 1.000, P < 0.001) and lowest for ESMO-ICER and ESMO-NCCN (W = 0.900, P = 0.052 for both pairs). When ranking drugs on distinct framework subdomains, Kendall's W among breast cancer drugs was highest for certainty (ICER, NCCN: W = 0.908, P = 0.046) and lowest for clinical benefit (ASCO, ESMO, NCCN: W = 0.345, P = 0.436). Among lung cancer drugs, W was highest for toxicity (ASCO, ESMO, NCCN: W = 0. 944, P < 0.001) and lowest for certainty (ICER, NCCN: W = 0.230, P = 0.827); and among prostate cancer drugs, it was highest for quality of life (ASCO, ESMO: W = 0.986, P = 0.003) and lowest for toxicity (ASCO, ESMO, NCCN: W = 0.200, P = 0.711). ICC (95% CI) for ASCO, ESMO, ICER, and NCCN were 0.800 (0.660-0.913), 0.818 (0.686-0.921), 0.652 (0.466-0.834), and 0.153 (0.045-0.371), respectively. When scores were rescaled to 0-100, NCCN provided the narrowest band of scores. When asked about their experiences using the ASCO, ESMO, ICER, and NCCN frameworks, panelists generally agreed that the frameworks were logically organized and reasonably easy to use, with NCCN rated somewhat easier. CONCLUSIONS Convergent validity among the ASCO, ESMO, ICER, and NCCN frameworks was fair to excellent, increasing with clinical benefit subdomain concordance and simplicity of drug trial data. Interrater reliability, highest for ASCO and ESMO, improved with clarity of instructions and specificity of score definitions. Continued use, analyses, and refinements of these frameworks will bring us closer to the ultimate goal of using value-based treatment decisions to improve patient care and outcomes. DISCLOSURES This work was funded by Eisai Inc. Copher and Knoth are employees of Eisai Inc. Bentley, Lee, Zambrano, and Broder are employees of Partnership for Health Analytic Research, a health services research company paid by Eisai Inc. to conduct this research. For this study, Cohen, Huynh, and Neville report fees from Partnership for Health Analytic Research. Outside of this study, Cohen receives grants and direct consulting fees from various companies that manufacture and market pharmaceuticals. Mei reports a grant from Eisai Inc. during this study. The other authors have no disclosures to report. Study concept and design were contributed by Bentley and Broder, with assistance from Elkin and Cohen. Bentley took the lead in data collection, along with Elkin, Huynh, Mukherjea, Neville, Mei, Popescu, Lee, and Zambrano. Data interpretation was performed by Bentley and Broder, along with Elkin, Cohen, Copher, and Knoth. The manuscript was written primarily by Bentley, along with Elkin and Broder, and revised by Bentley, Broder, Elkin, Cohen, Copher, and Knoth. Select components of this work's methods were presented at ISPOR 19th Annual European Congress held in Vienna, Austria, October 29-November 2, 2016, and Society for Medical Decision Making 38th Annual North American Meeting held in Vancouver, Canada, October 23-26, 2016.
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Affiliation(s)
| | | | - Elena B. Elkin
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Julie Huynh
- Hematology Oncology of San Fernando Valley, Encino, California
| | - Arnab Mukherjea
- Health Sciences Program, California State University, East Bay, Hayward, California
| | - Thanh H. Neville
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - Matthew Mei
- City of Hope National Medical Center, Duarte, California
| | | | | | - Ioana Popescu
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - Jackie Lee
- Partnership for Health Analytic Research, Beverly Hills, California
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Bentley TGK, Cohen JT, Elkin EB, Huynh J, Mukherjea A, Neville TH, Mei MG, Copher R, Knoth RL, Popescu I, Lee J, Zambrano J, Broder M. Validity and reliability of four value frameworks for cancer drugs. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.6603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6603 Background: Little is known about the validity and reliability of value assessment frameworks. Methods: Eight panelists used the ASCO, ESMO, ICER, and NCCN frameworks to conduct value assessments of 15 drugs for advanced lung and breast cancers and castration refractory prostate cancer. Panelists received instructions and published clinical data to complete the assessments, assigning each drug a numeric or letter score. We used Kendall’s W coefficient to measure convergent validity by cancer type among frameworks and intraclass correlation coefficients (ICC) to measure framework inter-rater reliability across cancers. Panelists were surveyed on their experiences. Results: Kendall’s W for breast, lung, and prostate cancer drugs were 0.560 ( p= 0.010), 0.562 ( p= 0.010), and 0.920 ( p< 0.001), respectively. Pairwise and subdomain W are shown in the table. ICC (95% CI) for ASCO, ESMO, ICER, and NCCN were 0.800 (0.660-0.913), 0.818 (0.686-0.921), 0.652 (0.466-0.834), and 0.153 (0.045-0.371), respectively. Panelists generally agreed the frameworks were logically organized and easy to use. Conclusions: Convergent validity among the frameworks was fair to excellent, increasing with clinical benefit subdomain concordance and simplicity of drug trial data. Inter-rater reliability, highest for ASCO and ESMO, improved with clarity of instructions and specificity of score definitions. Continued use, analyses, and refinements of the frameworks will bring us closer to using value-based treatment decisions to improve patient care and outcomes. [Table: see text]
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Affiliation(s)
- Tanya GK Bentley
- Partnership for Health Analytic Research, LLC, Beverly Hills, CA
| | | | | | - Julie Huynh
- Harbor University of California Los Angeles Medical Center, Redondo Beach, CA
| | - Arnab Mukherjea
- Health Sciences Program, California State University, Hayward, CA
| | - Thanh H. Neville
- David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA
| | | | | | | | - Ioana Popescu
- David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA
| | - Jackie Lee
- Partnership for Health Analytic Research, LLC, Beverly Hills, CA
| | - Jenelle Zambrano
- Partnership for Health Analytic Research, LLC, Beverly Hills, CA
| | - Michael Broder
- Partnership for Health Analytic Research, LLC, Beverly Hills, CA
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Bentley TGK, Cohen JT, Elkin EB, Huynh J, Mukherjea A, Neville TH, Mei M, Copher R, Knoth R, Popescu I, Lee J, Zambrano JM, Broder MS. Validity and Reliability of Value Assessment Frameworks for New Cancer Drugs. Value Health 2017; 20:200-205. [PMID: 28237195 DOI: 10.1016/j.jval.2016.12.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Revised: 12/13/2016] [Accepted: 12/14/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Several organizations have developed frameworks to systematically assess the value of new drugs. These organizations include the American Society of Clinical Oncology (ASCO), the European Society for Medical Oncology (ESMO), the Institute for Clinical and Economic Review (ICER), and the National Comprehensive Cancer Network (NCCN). OBJECTIVES To understand the extent to which these four tools can facilitate value-based treatment decisions in oncology. METHODS In this pilot study, eight panelists conducted value assessments of five advanced lung cancer drugs using the ASCO, ESMO, and ICER frameworks. The panelists received instructions and published clinical data required to complete the assessments. Published NCCN framework scores were abstracted. The Kendall's W coefficient was used to measure convergent validity among the four frameworks. Intraclass correlation coefficients were used to measure inter-rater reliability among the ASCO, ESMO, and ICER frameworks. Sensitivity analyses were conducted. RESULTS Drugs were ranked similarly by the four frameworks, with Kendall's W of 0.703 (P = 0.006) across all the four frameworks. Pairwise, Kendall's W was the highest for ESMO-ICER (W = 0.974; P = 0.007) and ASCO-NCCN (W = 0.944; P = 0.022) and the lowest for ICER-NCCN (W = 0.647; P = 0.315) and ESMO-NCCN (W = 0.611; P = 0.360). Intraclass correlation coefficients (confidence interval [CI]) for the ASCO, ESMO, and ICER frameworks were 0.786 (95% CI 0.517-0.970), 0.804 (95% CI 0.545-0.973), and 0.281 (95% CI 0.055-0.799), respectively. When scores were rescaled to 0 to 100, the ICER framework provided the narrowest band of scores. CONCLUSIONS The ASCO, ESMO, ICER, and NCCN frameworks demonstrated convergent validity, despite differences in conceptual approaches used. The ASCO inter-rater reliability was high, although potentially at the cost of user burden. The ICER inter-rater reliability was poor, possibly because of its failure to distinguish differential value among the sample of drugs tested. Refinements of all frameworks should continue on the basis of further testing and stakeholder feedback.
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Affiliation(s)
- Tanya G K Bentley
- Partnership for Health Analytic Research, LLC, Beverly Hills, CA, USA.
| | | | - Elena B Elkin
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Julie Huynh
- Hematology Oncology of San Fernando Valley, Encino, CA, USA
| | - Arnab Mukherjea
- Health Sciences Program, California State University, East Bay, Hayward, CA, USA
| | - Thanh H Neville
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Matthew Mei
- City of Hope National Medical Center, Duarte, CA, USA
| | | | | | - Ioana Popescu
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jackie Lee
- Partnership for Health Analytic Research, LLC, Beverly Hills, CA, USA
| | | | - Michael S Broder
- Partnership for Health Analytic Research, LLC, Beverly Hills, CA, USA
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Hrywna M, Jane Lewis M, Mukherjea A, Banerjee SC, Steinberg MB, Delnevo CD. Awareness and Use of South Asian Tobacco Products Among South Asians in New Jersey. J Community Health 2016; 41:1122-1129. [PMID: 27256410 PMCID: PMC5083141 DOI: 10.1007/s10900-016-0208-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
South Asians are the third largest Asian group in the US and among the fastest growing racial groups in New Jersey. Tobacco consumption among South Asians is characterized by several smoked and smokeless tobacco products indigenous to the Indian subcontinent. However, there is a paucity of research on tobacco use behaviors among South Asians in the US. The goal of this study was to examine the awareness and use of South Asian tobacco products such as bidis, gutkha, paan, paan masala, and zarda as well as other potentially carcinogenic products such as supari, their context of use, and their cultural significance among South Asians living in the US. Eight focus groups were conducted with South Asian adults living in Central New Jersey. Overall, participants were aware of a wide variety of foreign and American tobacco products with older South Asians identifying a greater variety of indigenous products compared to younger South Asians. Hookah was consistently recognized as popular among the younger generation while products such as paan or paan masala were more commonly identified with elders. Use of tobacco-related products such as paan and supari were described as common at social gatherings or after meals. In addition, light or social users of South Asian tobacco products, including products not consistently defined as tobacco, may not report tobacco use on a survey. Better understanding of the use of these products among South Asians and how some may classify tobacco usage can inform future research and public health interventions in these communities.
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Affiliation(s)
- Mary Hrywna
- School of Public Health Rutgers, The State University of New Jersey, 335 George Street, Suite 2100, New Brunswick, NJ, 08901, USA.
| | - M Jane Lewis
- School of Public Health Rutgers, The State University of New Jersey, 335 George Street, Suite 2100, New Brunswick, NJ, 08901, USA
| | - Arnab Mukherjea
- Health Sciences Program, California State University, East Bay, 25800 Carlos Bee Boulevard, Hayward, CA, 94542, USA
| | - Smita C Banerjee
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, 7th Floor, New York, NY, 10022, USA
| | - Michael B Steinberg
- Division of General Internal Medicine, Robert Wood Johnson Medical School Rutgers, The State University of New Jersey, Clinical Academic Building (CAB), 125 Paterson Street, Suite 2304, New Brunswick, NJ, 08901, USA
| | - Cristine D Delnevo
- School of Public Health Rutgers, The State University of New Jersey, 335 George Street, Suite 2100, New Brunswick, NJ, 08901, USA
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Mukherjea A. Random walks on semigroups. ADV APPL PROBAB 2016. [DOI: 10.2307/1426070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Bentley TG, Cohen JT, Elkin EB, Huynh J, Mukherjea A, Neville T, Popescu I, Zambrano J, Chang E, Broder MS. Reliability and consistency of three value frameworks for oncology therapeutics. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e18250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Joshua T Cohen
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
| | | | | | | | | | - Ioana Popescu
- David Geffen School of Medicine at UCLA, Los Angeles, CA
| | | | - Eunice Chang
- Partnership for Health Analytic Research, LLC, Beverly Hills, CA
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Abstract
Two products indigenous to the Indian subcontinent and popular among South Asians globally - paan and paan masala - are inconsistently categorised as tobacco by researchers, clinicians, program planners and policymakers. This article calls for a universally standard classification of these smokeless carcinogenic products as tobacco products and thus, subject to the same public health and clinical protections applied to other forms of tobacco. This recommendation is guided by scientific evidence strongly indicating the common presence of tobacco in paan and paan masala. Inclusion of these two products in population-level surveillance, clinical screening, as well as public health program planning and policy interventions may have considerable impact on preventing and reducing tobacco-related disparities among South Asians around the world.
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Affiliation(s)
- Arnab Mukherjea
- Division of General Internal Medicine, Department of Medicine, University of California, Davis, Sacramento, CA, USA Department of Health Sciences, California State University, East Bay, Hayward, CA, USA
| | - Mary V Modayil
- Institute for Population Health Improvement, University of California, Davis, Sacramento, CA, USA
| | - Elisa K Tong
- Division of General Internal Medicine, Department of Medicine, University of California, Davis, Sacramento, CA, USA
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Jih J, Mukherjea A, Vittinghoff E, Nguyen TT, Tsoh JY, Fukuoka Y, Bender MS, Tseng W, Kanaya AM. Using appropriate body mass index cut points for overweight and obesity among Asian Americans. Prev Med 2014; 65:1-6. [PMID: 24736092 PMCID: PMC4217157 DOI: 10.1016/j.ypmed.2014.04.010] [Citation(s) in RCA: 152] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 04/03/2014] [Accepted: 04/04/2014] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Asian Americans have low prevalence of overweight/obesity based on standard BMI cut points yet have higher rates of diabetes. We examined the prevalence of overweight/obesity, using lower BMI cut points recommended by the World Health Organization (WHO) for Asians, and diabetes in Asian American subgroups in California. METHOD Secondary analysis of the 2009 adult California Health Interview Survey (n=45,946) of non-Hispanic Whites (NHW), African Americans, Hispanics and Asians (Vietnamese, Chinese, Korean, Filipino, South Asian and Japanese). WHO Asian BMI cut points (overweight=23-27.5kg/m(2); obese≥27.5kg/m(2)) were used for Asian subgroups. Standard BMI cut points (overweight=25-29.9kg/m(2); obese≥30kg/m(2)) were applied for other groups. RESULTS Among Asian subgroups, overweight/obesity was highest among Filipinos (78.6%), which was higher than NHWs (p<0.001) but similar to African Americans and Hispanics. Compared to NHW, diabetes prevalence was higher for Vietnamese, Koreans, Filipinos and South Asians with BMI=23-24.9kg/m(2) and Koreans, Filipinos and Japanese with BMI=27.5-29.9kg/m(2), the ranges WHO recommends as overweight or obese for Asians but not for other groups. CONCLUSIONS Filipinos should be a priority population for overweight/obesity screening. Filipinos, Vietnamese, Korean, South Asians and Japanese have higher diabetes prevalence at lower BMI cut points. WHO Asian BMI cut points may have clinical utility to identify at-risk Asian Americans.
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Affiliation(s)
- Jane Jih
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA; Asian American Research Center on Health, San Francisco, CA, USA.
| | - Arnab Mukherjea
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA; Asian American Research Center on Health, San Francisco, CA, USA; Department of Health Sciences, College of Science, California State University, East Bay, Hayward, CA, USA
| | - Eric Vittinghoff
- Division of Biostatistics, Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Tung T Nguyen
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA; Asian American Research Center on Health, San Francisco, CA, USA
| | - Janice Y Tsoh
- Asian American Research Center on Health, San Francisco, CA, USA; Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
| | - Yoshimi Fukuoka
- Asian American Research Center on Health, San Francisco, CA, USA; Institute for Health & Aging/Department of Social and Behavioral Sciences, School of Nursing, University of California San Francisco, CA, USA
| | - Melinda S Bender
- Asian American Research Center on Health, San Francisco, CA, USA; Department of Family Health Care Nursing, University of California San Francisco, San Francisco, CA, USA
| | - Winston Tseng
- Asian American Research Center on Health, San Francisco, CA, USA; School of Public Health, University of California Berkeley, Berkeley, CA, USA
| | - Alka M Kanaya
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA; Asian American Research Center on Health, San Francisco, CA, USA
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Abstract
OBJECTIVES To provide a national depiction of Asian American (AA) and Native Hawaiian/Pacific Islander (NHPI) tobacco use and highlight considerations for targeted interventions. METHODS We analyzed data from the 2009-2010 National Adult Tobacco Survey for subgroup differences in prevalence and consumption of various tobacco products. RESULTS Use varies considerably by ethnic subgroups for cigarette smoking (including menthol) and other forms of tobacco. Despite being lighter, less frequent, and seemingly less dependent smokers, AANHPIs had similar quit ratios as non-AANHPIs. CONCLUSIONS AA and NHPI disparities in tobacco use may be due to underutilization of cessation resources, including those for non-cigarette tobacco products, and lack of availability of culturally-appropriate resources. Community-based and regulatory approaches should be employed to reduce use of all tobacco products, especially among high prevalence subgroups.
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Affiliation(s)
- Arnab Mukherjea
- Center for Tobacco Control Research & Education / Division of General Internal Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA.
| | - Olivia A Wackowski
- Department of Health Education and Behavioral Science, Rutgers School of Public Health, New Brunswick, NJ, USA
| | - Youn Ok Lee
- RTI International, Research Triangle Park, NC, USA
| | - Cristine D Delnevo
- Department of Health Education and Behavioral Science, Rutgers School of Public Health, New Brunswick, NJ, USA
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Mukherjea A, Underwood KC, Stewart AL, Ivey SL, Kanaya AM. Asian Indian views on diet and health in the United States: importance of understanding cultural and social factors to address disparities. Fam Community Health 2013; 36:311-23. [PMID: 23986072 PMCID: PMC3987985 DOI: 10.1097/fch.0b013e31829d2549] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
This study describes Asian Indian immigrant perspectives surrounding dietary beliefs and practices to identify intervention targets for diabetes and heart disease prevention. Participants were asked about conceptualizations of relationships between culture, food, and health during 4 focus groups (n = 38). Findings reveal influences of beliefs from respondents' native India, preservation of cultural practices within the US social structure, conflicts with subsequent generations, and reinterpretation of health-related knowledge through a lens, hybridizing both "native" and "host" contexts. Galvanization of ethnically valued beliefs incorporating family and community structures is needed for multipronged approaches to reduce disproportionate burdens of disease among this understudied minority community.
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Affiliation(s)
- Arnab Mukherjea
- Division of General Internal Medicine, University of California, San Francisco, USA
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Abstract
Over the past two decades, the United States has attracted large South Asian populations, who have imported tobacco products previously unique to the native subcontinent. South Asian cigarette use prevalence is consistently lower than other U.S. Asian subgroups; however, most surveys fail to capture smokeless products accurately. In part because of the pervasive use of popular smokeless cultural products resulting in greater population attributable risk of oral malignancies, many countries outside the United States have developed surveillance systems to capture these products and implemented effective population-level or community-based intervention strategies. This minority population in the United States continues to be “at risk” of suffering from a disproportionate burden of diseases, which are plausibly linked to the use of these products. The primary focus of this article is to provide an exhaustive literature review of tobacco use patterns and existing tobacco control strategies among South Asians in the United States. Framed within the social ecological model, the article suggests that there needs to be more detailed assessment of cultural tobacco products, a concurrent increase in cultural competencies of health care providers and provision of cessation resources outside the clinical setting. At the policy level, future efforts should adequately regulate these products and oversight must include such products in efforts to reduce rates of use. Concurrently, community-based efforts are needed to change social norms related to perceived health benefit and lack of stigma. This will help ensure that appropriately framed messages around use rates and burden of disease are addressed through culturally valued institutions and leaders.
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Affiliation(s)
| | - Mary V. Modayil
- California Tobacco Control Program, California Department of Public Health, Sacramento, CA, USA
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Mukherjea A, Modayil M. Exclusion of US studies examining social contexts of South Asian tobacco use hampers comprehensive intervention strategies. Public Health 2013; 127:99-100. [DOI: 10.1016/j.puhe.2012.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2012] [Indexed: 10/27/2022]
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Affiliation(s)
- Youn Ok Lee
- Postdoctoral Scholar, Center for Tobacco Control Research and Education, University of California, San Francisco, 530 Parnassus Avenue, Suite 366, San Francisco, CA 94143-1390, USA.
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Affiliation(s)
- Arnab Mukherjea
- Center for Tobacco Control Research and Education, Department of Medicine, University of California, San Francisco, CA 94143-1390, USA.
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Mukherjea A, Morgan PA, Snowden LR, Ling PM, Ivey SL. Social and cultural influences on tobacco-related health disparities among South Asians in the USA. Tob Control 2011; 21:422-8. [PMID: 21708814 DOI: 10.1136/tc.2010.042309] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To explore and understand key cultural contexts of tobacco use among South Asian communities in the USA. DESIGN Focus groups, with homogeneous compositions of gender, generational status and length of time in the USA, were conducted in two distinct South Asian ethnic enclaves. Focus group findings were triangulated with observational data regarding the availability of culturally specific tobacco from commercial ethnic outlets and cultural events. SUBJECTS Respondents included 88 men and women of South Asian descent, aged 18-65 years, immigrant and native born, representing diversity of religion, socioeconomic status and region of origin, with the use of at least one culturally specific tobacco product in previous 24 months. RESULTS A large number of culturally specific products were commonly used by community members. Knowledge of product-specific health risks was lacking or inaccurate. Many culturally specific tobacco products were considered to have beneficial properties. South Asian tobacco items were used to preserve cultural traditions and express ethnic identity in a new dominant culture. The social and cultural values ascribed to use helped distinguish community members from mainstream society and from other minority populations. CONCLUSIONS Many cultural factors govern tobacco use among diverse global populations. Especially for migrants with a common regional origin, the role of ethnic identity may strongly influence culturally specific tobacco patterns. Qualitative inquiry helps elucidate such culturally framed behaviour in culturally diverse populations. These cultural contexts should be integrated into research and practice. Understanding multidimensional factors influencing non-traditional tobacco use is essential to ensure that comprehensive tobacco control strategies address tobacco-related disparities.
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Affiliation(s)
- Arnab Mukherjea
- School of Public Health, University of California, Berkeley, California, USA.
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Bi L, Mukherjea A. Identification of parameters and the distribution of the minimum of the tri-variate normal. Stat Probab Lett 2010. [DOI: 10.1016/j.spl.2010.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Palaniappan L, Mukherjea A, Holland A, Ivey SL. Leading causes of mortality of Asian Indians in California. Ethn Dis 2010; 20:53-57. [PMID: 20178183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
OBJECTIVE Asian Indians had one of the highest population growth rates in California between 1990 and 2000. However, few studies have examined common causes of death in this ethnic group in California. We examined leading causes of mortality in Asian Indians in California and analyzed differences across age and sex. DESIGN/SETTING Linear interpolation of 1990 and 2000 US Census data were used to calculate population sizes. California mortality data were examined to determine total number of Asian Indian deaths, and analyzed to determine causes of death across age (25-44, 45-64, > or = 65) and sex subgroups. MAIN OUTCOME MEASURES International Classification of Diseases, 9th and 10th revision codes were used to aggregate causes of mortality into disease categories of cardiovascular diseases, cancers, diabetes, traumas/accidents/suicides, infections, and other conditions. RESULTS Cardiovascular diseases were the leading cause of death for both sexes. Cancers were the second leading cause of death for both sexes. Diabetes and traumas/accidents/suicides were the next most common cause of mortality for females and males respectively. However, differences were found between age groupings across the sexes. CONCLUSION This analysis confirms leading causes of death found in other densely-populated Asian Indian regions. It also sheds light on emerging conditions in this population in California. Although contributors to causes of mortality are discussed, more research is needed to understand the unique biological and socio-cultural determinants of disease in Asian Indians. Translation of this research into intervention strategies will reduce the burden of these diseases in this rapidly-growing population in California and the United States.
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Affiliation(s)
- Latha Palaniappan
- Palo Alto Medical Foundation Research Institute, 795 El Camino Real/Ames Building, Palo Alto, CA 94301, USA.
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Davis J, Mukherjea A. Identification of parameters by the distribution of the minimum: The tri-variate normal case with negative correlations. J MULTIVARIATE ANAL 2007. [DOI: 10.1016/j.jmva.2006.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Cureg E, Mukherjea A. Weak Convergence in Circulant Matrices. J THEOR PROBAB 2005. [DOI: 10.1007/s10959-005-7542-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Mukherjea A, Nakassis A. J THEOR PROBAB 2002; 15:903-918. [DOI: 10.1023/a:1020636603528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Mukherjea A, Nakassis A, Ratti JS. J THEOR PROBAB 1999; 12:1109-1112. [DOI: 10.1023/a:1021605522829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Dhar S, Mukherjea A. J THEOR PROBAB 1997; 10:375-393. [DOI: 10.1023/a:1022612516862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Mukherjea A, Ratti JS. J THEOR PROBAB 1997; 10:499-506. [DOI: 10.1023/a:1022672802749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Plachky D, Strasser H, Lindstrøm T, Pfeifer D, Hida T, Mukherjea A. Book-reviews. METRIKA 1996. [DOI: 10.1007/bf02614071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Gong J, Mukherjea A. Solution of a problem on the identification of parameters by the distribution of the maximum random variable: a multivariate normal case. J THEOR PROBAB 1991. [DOI: 10.1007/bf01259555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Mukherjea A, Nakassis A, Miyashita J. The problem of identification of parameters by the distribution of the maximum random variable. J MULTIVARIATE ANAL 1986. [DOI: 10.1016/0047-259x(86)90068-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Mukherjea A, Nakassis A, Isaacson D. DETERMINATION OF THE BASIS OF A CONVERGENT NON-HOMOGENEOUS MARKOV CHAIN. Statistics & Risk Modeling 1984. [DOI: 10.1524/strm.1984.2.34.363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Mukherjea A, Sun TC. Convergence of products of independent random variables with values in a discrete semigroup. Probab Theory Relat Fields 1979. [DOI: 10.1007/bf00533262] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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