National health data often are reported for Asians in the aggregate and do not monitor the health of specific Asian subpopulations (e.g., Cambodians and Vietnamese) in the United States (1,2). In addition, surveys conducted in English exclude Cambodians and Vietnamese with limited English proficiency. This report summarizes and compares health data from 1) a survey of one Cambodian and three Vietnamese communities conducted during 2001–2002 for the Racial and Ethnic Approaches to Community Health (REACH) 2010 project and 2) a survey of Asians in the aggregate and the general U.S. population conducted by the 2002 Behavioral Risk Factor Surveillance System (BRFSS). The questions were identical on both surveys. The results of this analysis indicated that Cambodians and Vietnamese had lower levels of education and household income and substantially different health-risk profiles than both the aggregate Asian population and the general U.S. population. Public health agencies should examine the health status of racial/ethnic subpopulations and prioritize interventions that address disparities.
In 1999, CDC launched the REACH 2010 project to support efforts by minority community coalitions to eliminate health disparities (3). As part of surveillance and evaluation, CDC contracted with the National Organization for Research at the University of Chicago to conduct annual REACH 2010 Risk Factor Surveys in project communities. During June 2001–August 2002, a baseline survey was conducted in 21 minority communities in 14 states. The detailed survey methodology has been published (4).
For this report, data from Vietnamese communities in Los Angeles, Orange, and Santa Clara counties, California, were combined; Cambodian data were from Lowell, Massachusetts, where 57% of the Asian population is Cambodian. Vietnamese respondents were interviewed by telephone; Cambodians were interviewed in person on the advice of local REACH project staff. In Lowell, 199 (19%) of the interviews were conducted in English, and 827 (81%) were conducted in Khmer, In the three Vietnamese communities, 747 (28%) of the interviews were conducted in English, 1,876 (71%) in Vietnamese, and 1% in Chinese. Response rate was 93% in the Cambodian community and 72% in the combined Vietnamese communities.
All data were self reported. Respondents were considered to have fulfilled physical activity recommendations if they participated in moderate physical activity for ≥30 minutes per day, 5 days per week, or participated in vigorous physical activity for ≥20 minutes per day, 3 days per week. Data were weighted to represent the communities surveyed, and SUDAAN was used to account for the complex survey and sample design. Prevalence estimates were standardized to the sex and age distribution of the population in the 2000 U.S. Census.
The REACH 2010 survey sampled 1,026 Cambodians and 2,658 Vietnamese. The 2002 BRFSS survey sampled 5,183 Asians from a total adult sample of 246,025 from 50 states and the District of Columbia (Table 1). Although Asians in the aggregate had higher education and income than the general U.S. population, Cambodians and Vietnamese had substantially lower education and income. The surveyed Cambodians and Vietnamese were at least three times more likely to report not visiting a doctor because of the cost than were all Asians or all U.S. residents.
Among men, greater proportions of Cambodians (50.4%) and Vietnamese (30.4%) smoked than aggregate Asians (14.7%) and the general U.S. population (24.9%). Among women, prevalence of self-reported smoking was higher among Cambodians (56 [10.9%]) than both Vietnamese (15 [0.9%]) and aggregate Asians (274 [7.3%]) but lower than the prevalence in the general U.S. population (29,992 [20.4%]). Cambodians (153 [16.4%]) and Vietnamese (294 [11.1%)) were less likely to report eating five or more fruits and vegetables a day, and Vietnamese (365 [14.3%]) were less likely to meet physical activity recommendations, compared with aggregate Asians (977 [28.1%]) and the general U.S. population (32,450 [33.3%]).
Fewer than half of surveyed Cambodians (477 [47.7%]) reported ever having their blood cholesterol checked, Cambodians with diabetes were the least likely (40 [41.9%]) to have had a hemoglobin A1c test in the preceding year. Cambodian and Vietnamese women had lower rates of Papanicolaou tests (64.2% and 65.5%, respectively) than women in the aggregate Asian and general U.S. populations (74.5% and 85.8%, respectively), Approximately 18.8% of Cambodians and 40.0% of Vietnamese aged ≥65 years reported ever having pneumococcal vaccine, compared with 63.4% of aggregate Asians and 61.8% of the general U.S. population.
Persons interviewed in English had different characteristics than those interviewed in Khmer or Vietnamese (Table 2). For example, Cambodians interviewed in their native language were on average older (39.6 years versus 36.4 years), more likely to have less than a high school education (64.2% versus 39.4%), annual household income of <$25,000 (60.1% versus 51.3%), and to report cost as a barrier to obtaining health care (15.2% versus 11.6%). Vietnamese interviewed in English had a higher fruit and vegetable intake (19.9% versus 7.6%) and reported more leisure-time physical activity (22.5% versus 10.5%). Among men in the Cambodian community, prevalence of smoking was higher among those interviewed in English (63.9% versus 40.9%); however, among women, the opposite pattern was observed (6.1% versus 12.1%).