Month: September 2023

Categories
General Healthcare Disparities Mental Health Public Health

Let Me Be Brief: Addressing Health Disparities Among the AAPI Community

A series of briefs by Texas Medical Students

By: Jasmine Liu-Zarzuela, Emily Liu, and Justin McCormack

Asian Americans are the fastest-growing ethnic group in the United States, with Texas ranked 3rd in overall population and 2nd in an increase in population over the past 20 years.1 While this group is often referred to and perceived as a monolith, the label of Asian American and Pacific Islander (AAPI) encompasses over 50 ethnic groups speaking over 100 languages.2 With such a variety of ethnicities and language barriers within one group there also comes a variety of unique healthcare problems this population faces. AAPI individuals have been shown to face health disparities in cancer screening and mental healthcare, amongst many others, despite the population being relatively understudied compared to others.3 Thus, it is paramount for healthcare providers to be aware of AAPI health disparities to ensure access to adequate resources and outreach for proper screening, preventative care, necessary follow-ups, as well as proper research and study of this population to ensure disparities can be prevented. 

The AAPI community is composed of distinct ethnic subgroups which differ significantly by socioeconomic status, educational attainment, cultural background, amongst other major social determinants of health. For example, Asian Americans are the most economically divided racial group,4 and access to healthcare can depend on factors such as insurance coverage and interpreter access, which vary wildly based on subgroup.5 Thus, disaggregation of demographic data is paramount in order to identify within-group disparities in health outcomes and representation in medicine. The disaggregation of AAPI data will also aid in helping determine necessary initiatives to decrease disease burden in subgroups within the AAPI community. 

According to the National Alliance of Mental Health, AAPIs have the lowest rate of seeking mental help of any minority group, with just under a quarter of AAPI adults with mental illness receiving treatment.7 Several barriers contribute to difficulties seeking care, ranging from language barriers, stigma, the model minority myth, and alternative treatments, amongst others.8 The COVID-19 pandemic has increased xenophobia against Chinese Americans and the AAPI community as a whole, and these experiences have been associated with an increased level of depressive and anxiety symptoms.9  

In the US, incidence and death rates for liver cancer are second-highest in Asians compared to other ethnic groups (after Hispanic), reaching as high as twice the rates of other racial or ethnic groups.10 Liver cancers have been attributed to Hepatitis B (HBV) and C virus (HCV), which are often silent infections.11 Compared to other demographics, Asian Americans have the highest rates of HBV infection and are least aware of their HCV status.11,12 However, AAPIs with Hepatitis infection do not engage in established risk factors for HCV in other populations, and hence are often under-diagnosed.13

TMA Policy

Currently, TMA policy 260.126 supports the Texas Department of State Health Services efforts in addressing racial/ethnic healthcare disparities and the funding needed to lessen such disparities. However, there are no current TMA policies that acknowledge disparities in healthcare specifically among the AAPI population. TMA does support AMA policy H-350.954, which advocates for the restoration of web pages on AAPI initiatives that address disaggregation of health outcomes concerning AAPI data.

Recently, the medical student section (MSS) of the TMA have submitted several resolutions to address the health disparities within the AAPI population. One of the proposed policies calls for the TMA to support the disaggregation of demographic data regarding AAPIs to reveal the within-group disparities that exist in health outcomes and representation in medicine. A second proposed policy calls for the TMA to support legislation for the funding and promotion of HBV screening, treatment, and education among the Asian American and Pacific Islander population. Lastly, a third proposed policy urges the TMA to support raising awareness and educating providers about the discrepancies in mental health among AAPI populations. 

Advocacy Goals/MSS Perspectives

Advocacy goals on increasing HBV screening and education among the AAPI community would improve health outcomes, education, and treatment for HBV and HCV screening, while decreasing the prevalence of liver cancer among one of the most commonly impacted racial and ethnic groups in Texas and the United States. Similarly, advocacy goals on increasing mental health screening and education among this population would improve health outcomes and quality of life. By bringing awareness and policy to decreasing the prevalence of liver cancer, HBV, HCV, and mental illness among the AAPI community, the TMA-MSS has an intricate and influential role in building a stronger screening program and culturally specific interventions to improve the livelihoods and health outcomes in the AAPI community.

Current Bills

Stop Mental Health Stigma in Our Communities Act (H.R. 3573) (7) is a current bill that instructs the SAMHSA to provide outreach and education strategies for the Asian American, Native Hawaiian, and Pacific Islander (AAPI) community.14

Call to Action

It is imperative that medical professionals and students acknowledge the health disparities that exist within the AAPI community and further spread awareness and policy to ultimately improve the health outcomes of this community. 

References

  1. Asian Americans are the fastest-growing racial or ethnic group in the U.S. (2021, April 9). Pew Research Center. https://www.pewresearch.org/fact-tank/2021/04/09/asian-americans-are-the-fastest-growing-racial-or-ethnic-group-in-the-u-s/
  2. Asian American and pacific islander. (n.d.). Nami.Org. Retrieved April 8, 2022, from https://www.nami.org/Your-Journey/Identity-and-Cultural-Dimensions/Asian-American-and-Pacific-Islander
  3. The center for Asian health engages communities in research to reduce Asian American health disparities. (n.d.). Nih.Gov. Retrieved April 8, 2022, from https://www.nimhd.nih.gov/news-events/features/training-workforce-dev/center-asian-health.html
  4. Kochhar, R. (2018, July 12). Income inequality in the U.s. is rising most rapidly among Asians. Pew Research Center’s Social & Demographic Trends Project. https://www.pewresearch.org/social-trends/2018/07/12/income-inequality-in-the-u-s-is-rising-most-rapidly-among-asians/
  5. Lee, S., Martinez, G., Ma, G. X., Hsu, C. E., Robinson, E. S., Bawa, J., & Juon, H.-S. (2010). Barriers to health care access in 13 Asian American communities. American Journal of Health Behavior, 34(1), 21–30. https://doi.org/10.5993/ajhb.34.1.3
  6. Misra S, Le PD, Goldmann E, Yang LH. Psychological impact of anti-Asian stigma due to the COVID-19 pandemic: A call for research, practice, and policy responses. Psychol Trauma. 2020;12(5):461-464. doi:10.1037/tra0000821
  7. Duh-Leong C, Yin HS, Yi SS, et al. Material hardship and stress from COVID-19 in immigrant Chinese American families with infants. J Immigr Minor Health. Published online 2021:1. doi:10.1007/s10903-021-01267-8
  8. Why Asian Americans don’t seek help for mental illness. Mcleanhospital.org. Accessed December 20, 2021. https://www.mcleanhospital.org/essential/why-asian-americans-dont-seek-help-mental-illness
  9. Cheah CSL, Wang C, Ren H, Zong X, Cho HS, Xue X. COVID-19 racism and mental health in Chinese American families. Pediatrics. 2020;146(5):e2020021816. doi:10.1542/peds.2020-021816
  10. Products – data briefs – number 314 – July 2018. (2019, June 7). Cdc.Gov. https://www.cdc.gov/nchs/products/databriefs/db314.htm
  11. Ho, E. Y., Ha, N. B., Ahmed, A., Ayoub, W., Daugherty, T., Garcia, G., Cooper, A., Keeffe, E. B., & Nguyen, M. H. (2012). Prospective study of risk factors for hepatitis C virus acquisition by Caucasian, Hispanic, and Asian American patients: Ethnic differences in risk factors for HCV. Journal of Viral Hepatitis, 19(2), e105-11. https://doi.org/10.1111/j.1365-2893.2011.01513.x
  12. Kim, H.-S., Yang, J. D., El-Serag, H. B., & Kanwal, F. (2019). Awareness of chronic viral hepatitis in the United States: An update from the National Health and Nutrition Examination Survey. Journal of Viral Hepatitis, 26(5), 596–602. https://doi.org/10.1111/jvh.13060
  13. Products – data briefs – number 361 – march 2020. (2020, June 26). Cdc.Gov. https://www.cdc.gov/nchs/products/databriefs/db361.htm
  14. https://www.congress.gov/bill/117th-congress/house-bill/3573/text#:~:text=Introduced%20in%20House%20(05%2F28%2F2021)&text=To%20amend%20the%20Public%20Health,Hawaiian%2C%20and%20Pacific%20Islander%20 population. 
Categories
General Healthcare Disparities Public Health

Let Me Be Brief: LGBTQ+ Healthcare Under Attack Across Texas

A series of briefs by Texas Medical Students

By Amanda Block, Parminder Deo, and Zoe Davis

The onslaught of anti-LGBTQ+ legislative proposals continues to rise among Texas lawmakers amid already skyrocketing negative rhetoric and violence towards the LGBTQ+ community1. Some legislation calls for book bans in school libraries, questions the legality of gender-affirming care for transgender youths, and paints drag shows as grooming children for sex.

The United States Department of Health and Human Services defines gender-affirming care as a supportive form of health care which can include medical, surgical, mental health, and/or non-medical services for transgender and nonbinary people2. This early gender affirming care is essential to overall health for transgender or nonbinary children, allowing them to focus on social transitions which can increase their confidence while navigating the healthcare system. 

LGBTQ+ people are more visible in their communities than ever before. A Public Religion Research Institute (PPRI) survey found that 70% of Americans report that they have a close friend or family member who is gay or lesbian, while the number of Americans who say they personally know someone who is transgender has nearly doubled, from 11% to 21%3. Texas is home to approximately 7 million youth under 18, and holds the second largest LGBTQ youth population in the U.S., according to an analysis by Williams Institute at the UCLA School of Law and Gallup Daily4.

LGBTQ+ Demographics in Texas:

% of Adults (18+) who are LGBTQ+Total LGBTQ+Population (13+)% of Workforcethat is LGBTQ+Total LGBTQWorkers% of LGBTQ+ Adults (25+) Raising Children
4.1%1,053,0005%647,00029%

As of February 2023, the American Civil Liberties Union (ACLU) has identified 23 anti-LGBTQ bills in Texas– 10 of which directly target access to healthcare5. Many of the healthcare bills seek to limit or ban gender-affirming care for transgender youth by declaring gender-affirming care as “child abuse” and target medical providers with threats losing licensure and pressing criminal charges, and removing state funds for gender-affirming care. Other bills attempt to limit classroom instruction on sexuality and gender identity. Introduction of legislation like this affects the emotional and physical well-being of this historically marginalized patient population. 

Key Bills this Session:

  • Senate Bill 1029, filed by Texas Republican Bob Hall, would ban public funding for gender modifications and treatments, which includes castration, vasectomy, and hysterectomy regardless of age6. It would also bar some health plans from providing “gender modification procedure” and increase legal liability for medical professionals who offer the care.
  • Senate Bill 1082, filed by Texas Republican Bob Hall, relating to the definition and use of the terms “male” and “female” for purposes of certain government documents7. This would restrict all government-produced communications that request or provide information on someone’s sex to only use “male” and “female.”

The proposed Texas legislations are a direct insult to the mental-well being of LGBTQ+ people and their quality of life. Transgender and gender nonbinary adolescents are already at increased risk for mental health issues, substance use, and suicide. The Trevor Project, a suicide hotline for LGBTQ youth, reported that LGBTQ youth of color reported higher rates of attempting suicide than their white peers in 2022, and that for 86% of respondents in Texas, recent politics further negatively impacted theirwell-beings8.

A safe and affirming healthcare environment is critical in fostering better outcomes for transgender, nonbinary, and other gender diverse children and adolescents. Medical and psychosocial gender affirming healthcare practices have demonstrated lower rates of adverse mental health outcomes, increased self-esteem, and improvement in overall quality of life for transgender and gender diverse youth9.

As future healthcare professionals, it is our duty to ensure equitable healthcare for all individuals, regardless of gender identity. Furthermore, it is our duty to take actions of non-maleficence, avoiding doing any harm to individuals. If bills that restrict the healthcare for these individuals are put into place, this population will not have the same opportunity to advance their mental health and physical health as their non-transgender counterparts. Their mental health will undoubtedly undergo negative impacts as a consequenceThese pieces of legislation decry appreciation for LGBTQ community members and the autonomy and dignity these individuals deserve and are inappropriate for any policy, especially those pertaining to the healthcare legislature . 

TMA Policy

The LGBTQ Health Section of the TMA is charged with addressing important issues of interest to LGBTQ medical students, residents and fellows, and physicians. The goal is to advance the association’s leadership role in providing physicians and patients with evidence-based, scientific information on care for lesbian, gay, bisexual, transexual, and queer/questioning individuals. TMA specifically wants to protect the patient-physician relationship. Below are policy examples.

60.008 Rejection of Discrimination: The Texas Medical Association does not discriminate, and opposes discrimination, based on race, religion, disability, ethnic origin, national origin, age, sexual orientation, sex, or gender identity. TMA supports physician efforts to encourage that the nondiscrimination policies in their practices, medical schools, hospitals, and clinics be broadened to include “race, religion, disability, ethnic origin, national origin, age, sexual orientation, sex, or gender identity” in relation to patients, health care workers, and employees. (CSPH Rep. 1-A-18)

60.010 Opposing Legislation that Mandates Physician Discrimination: The Texas Medical Association (1) supports the removal of “opposite sex” as a requirement for affirmative defense to prosecution within the Texas Penal Code, and (2) opposes legislation or regulation that mandates physicians and other health professionals discriminate against or limit access to health care for a specific patient population (Res. 111-A-19).

265.028 Improving LGBTQ Health Care Access: The Texas Medical Association recognizes that lesbian, gay, bisexual, transgender, queer, or questioning (LGBTQ) individuals have unique health care needs and suffer significant barriers in access to care that result in health care disparities. TMA will provide educational opportunities for physicians on LGBTQ health issues to increase physician awareness of the importance of building trust so LGBTQ patients feel comfortable voluntarily providing information on their sexual orientation and gender identity, thus improving their quality of care. TMA also will continue to study how best to reduce barriers to care and increase access to physicians and public health services to improve the health of the LGBTQ population. (CSPH Rep. 8-A-18)

For LGBTQ mental health support, call the Trevor Project’s 24/7 toll-free support line at 866-488-7386. You can also reach a trained crisis counselor through the Suicide and Crisis Lifeline by calling or texting 98810.

Sources

  1. Legislative Bill Tracker 2023: Equality Texas. equalitytexas.org. https://www.equalitytexas.org/legislature/legislative-bill-tracker-2023/. Published March 13, 2023. Accessed March 31, 2023. 
  2. Lesbian, gay, bisexual, and Transgender Health. Centers for Disease Control and Prevention. https://www.cdc.gov/lgbthealth/index.htm. Published November 3, 2022. Accessed March 31, 2023. 
  3. How social contact with LGBT people impacts attitudes on policy. PRRI. https://www.prri.org/spotlight/lgbt-pride-month-social-contact-gay-lesbian-transgender-individuals/. Published October 13, 2021. Accessed March 31, 2023. 
  4. The Williams Institute. https://williamsinstitute.law.ucla.edu/visualization/lgbt-stats/?topic=LGBT&area=48#density. Accessed March 31, 2023. 
  5. Mapping attacks on LGBTQ rights in U.S. state legislatures. American Civil Liberties Union. https://www.aclu.org/legislative-attacks-on-lgbtq-rights. Published March 28, 2023. Accessed March 31, 2023. 
  6. Texas SB1029: 2023-2024: 88th legislature. LegiScan. https://legiscan.com/TX/bill/SB1029/2023. Accessed March 31, 2023. 
  7. Texas SB1082: 2023-2024: 88th legislature. LegiScan. https://legiscan.com/TX/sponsors/SB1082/2023. Accessed March 31, 2023. 
  8. 2022 National Survey on LGBTQ Youth Mental Health by State. The Trevor Project. https://www.thetrevorproject.org/wp-content/uploads/2022/12/The-Trevor-Project-2022-National-Survey-on-LGBTQ-Youth-Mental-Health-by-State-Texas.pdf. Accessed March 31, 2023.
  9. Tordoff DM;Wanta JW;Collin A;Stepney C;Inwards-Breland DJ;Ahrens K; Mental health outcomes in transgender and nonbinary youths receiving gender-affirming care. JAMA network open. https://pubmed.ncbi.nlm.nih.gov/35212746/. Accessed March 31, 2023. 
  10. For young LGBTQ LIVES. The Trevor Project. https://www.thetrevorproject.org/. Published February 27, 2023. Accessed March 31, 2023.