For the first time, health survey data on disease outcomes and associated risk factors for Cambodian, Chinese, and Vietnamese populations in Chicago are available. These data are important locally to community organizations, researchers, and policy makers in allocating resources, prioritizing health concerns, and improving health. It demonstrates the value of collecting local level data for unique Asian subpopulations who can now participate in the dialogue on health disparities in Chicago. The data also respond to the growing need for baseline information about Asian subgroups in order to participate in national health initiatives and compete for federal funding.
Findings are consistent with the few other studies that confirm heterogeneity within the Asian populations in terms of sociodemographics, health outcomes, and healthcare utilization.3
Data show that the Chinese, Cambodian, and Vietnamese populations surveyed from Chicago were uniquely different from US Asians not only in their sociodemographic characteristics, but also in health outcomes. For example, Chinese and Vietnamese populations in Chicago were older, more likely to be foreign born, and reported poorer English proficiency compared to US Asians. Current smoking estimates for all three groups were comparable to US Asian averages but were half the US average. When compared to specific Asian subgroups from other geographic areas, smoking rates in the Chicago communities were better,11,21,22
positive skin tests for tuberculosis were comparable,23
and cancer-screening utilization was far worse.21,24
Survey data also indicate that the health data for US Asians are inadequate to reveal the health of Asian subgroups in smaller geographic areas. Although some indicators among the three Asian subgroups surveyed were similar to US Asian estimates, there was substantial variation among the populations and US Asian estimates, adding to the growing number of studies advocating for disaggregated data.
Survey findings are consistent with many recent studies dispelling the “model minority” myth. They disprove the perception that Asian Americans uniformly have access to medical care and have better health outcomes than other racial and ethnic groups. In fact, Chicago’s survey data for the Chinese, Cambodian and Vietnamese populations offer data that describe their unique experiences of health services and outcomes, including inadequate cancer screening, a disproportionate burden of tuberculosis, and a high proportion reporting fair/poor self-rated health.
In addition, these survey data offer for the first time a means for the Chinese, Cambodian, and Vietnamese populations in Chicago to track their progress toward reaching HP2010 goals. Recent analyses comparing the ten largest racial and ethnic health disparities in the United States suggest that of the 183 indicators (out of 498) for which data were available, Asians had the best group rate for 44% of these indicators.25
While the averages may suggest Asians are a “model minority,” our local survey data suggest that serious health concerns such as poor cancer-screening utilization may be masked by aggregated data at the national level. Survey data presented here offer baseline data for three Asian subgroups in Chicago to measure progress toward HP2010 targets.
Methodological Strengths and Considerations
There are a few methodological considerations to discuss. First, data were self-reported and could be either over- or under-estimated; however, all comparison data were likewise self-reported, so any bias could be assumed to be consistent. Second, study findings were not collected to be generalizable to all Chinese, Cambodian, or Vietnamese populations in Chicago. However, the surveys were conducted among the highest concentrations of these Asian subpopulations based on the 2000 US Census and were designed with input from community organizations. The findings are representative of the sample for each surveyed area and have captured health measures of relatively understudied populations. Third, most national health surveys are not offered in Asian languages and thus miss non-English speaking respondents and potentially recent immigrants. There is a desperate need to capture differences in language, acculturation, and immigration patterns because these factors influence health outcomes.26
The fact that the Asian surveys described herein were offered and most often administered in non-English further adds strength to our study. US Asian rates in this study were thus used for the lack of better comparison data.
Lastly, RDS has emerged as an important scientific sampling technique and is being used extensively among hidden populations.16,17
The methodologies described here offer an alternative means of conducting population health surveys, particularly for populations with a small sample size. To our knowledge, this is the first time RDS has been used to complete a health survey for Asians subpopulations within an urban setting. We thus briefly describe the biases associated with using RDS compared with conventional household sampling methods. In conventional probability sampling, the assumption is that an individual’s probability of selection is constant and known and additionally that within each strata of selection that the probability of each sample is known. In contrast to conventional probability methods, which attempt to make direct inference from the sample to the population, RDS uses the sample to characterize the social network that is then used to make inferences about the population. It assumes that the social network information gathered from participants is nondifferentially misclassified. For example, that all individuals in the study sample are equally likely to over- or under-estimate the size of their social network. RDS also assumes that a path exists that links all individuals in the population and that no person is completely isolated from other members of the population. Finally, RDS assumes that all participants receive and use one coupon and that when participants recruit others they do so randomly from all persons within their network (conditioned on strata of relationship type). Based on these assumptions, RDS has been shown to provide asymptotically unbiased estimates of the proportion of the population with an outcome of interest.27
Thus, while the sampling methods are different, the disease outcomes and health measures collected from this sampling frame are considered comparable for these analyses.
Health data about the Chinese, Cambodian, and Vietnamese populations demonstrate the need for public health agencies to study the health status of specific racial and ethnic subpopulations. Data offer grant makers and researchers information on where to target their resources and concentrate their efforts. They also give Asian populations in Chicago the opportunity to more effectively describe their health needs, guide their program planning and evaluation, and take action. For instance, survey data have helped local community organizations advocate to funds to address the high rates of diabetes in the Cambodian and Vietnamese populations. These baseline data have directly informed the planning of this pilot project to develop culturally and linguistically competent educational outreach for improved management and control strategies for those diagnosed with diabetes. In addition, the low rates of cancer screening that were documented by this data were also revealed as a major health concern in all three communities. Chicago cancer awareness advocacy groups are thus partnering with the three Asian communities to increase the awareness of screening strategies by creating tailored breast and cervical cancer toolkits that community health workers and health advocates can use as training and development documents.
The goal of this paper is to show the importance of local data for Asian subgroups. While only a subset of the rich data collected are presented here, future research can examine the specific barriers facing each surveyed population and its implications for programming. The study also demonstrates how local data can be collected for populations with small sample sizes, even when they are not concentrated in one area and may be difficult to find. The unique methods described offer an alternative for surveying small subpopulations that are often overlooked in large, diverse urban settings. In addition, the efforts put forth by the community-based organizations and the study partners illustrate that the Chicago community values the health of its unique Asian populations. By understanding their health, Chinese, Cambodian, and Vietnamese communities can engage in the political discussion around health disparities in Chicago, advocate for resources, and make improvements to their health one community at a time.