CARE Research Programs

Asians are the fastest growing racial/ethnic group in the United States, representing 25% of all foreign-born people in the United States. They are projected to reach nearly 34 million by 2050.  Similar to other communities of color, there exist tremendous disparities in health outcomes and indicators among the Asian community in America. Stanford CARE is committed to increasing research and knowledge in Asian and Asian-American communities to drive better health.

ABCs for Global Health: COVID-19 in the Philippines

ABC’s for Global Health is a non-profit organization by Dr. Gabiola that is dedicated to finding practical solutions to health problems of disadvantaged and underserved communities. The organization aims to provide access to continuous quality healthcare through medical mobile clinic outreach, promotion of community health education, and implementation of technology such as telehealth with a focus in the Philippines and the Filipino community. As part of the initiative to educate the community and increase awareness and access to healthcare, ABC’s for Global Health will create white papers such as topics on hypertension, create emergency medical material, write papers on medical mobile clinics and telemedicine in the Philippines, focus on telemedicine devices and commercialization, and advocate for implementation of a medical mobile clinic in Silicon Valley.

Links:

●            ABC’s for Global Health - http://www.abcsforglobalhealth.org/

Project Legacy

Social determinants of health have an ever-increasing body of evidence for their impact on our health. Social data, however, is notoriously difficult to capture in the traditional medical record. The aim of Project LEGACY is to create a database that combines the social data found in obituaries with traditional medical data sources like electronic health records and insurance data. Creation of this database can provide a more personalized and holistic view of a person’s lived experience and sets the stage for future analyses.

Project DAsH – Data on Asian

The goal of DAsH is to bring together diverse datasets to understand complex health issues and find solutions for Precision Health for Asians. We will acquire rich and diverse national and international data with opportunities for potential linkage, recruitment, and long-term follow-up for transdisciplinary research across many health outcomes.

Project COAVE – COVID Asian Vaccine Efficacy Study

The goal of COAVE is to study the effectiveness of COVID vaccines for Asian-Americans and subgroups for equitable, personalized precision medicine for Asian-Americans. We will acquire and analyze COVID vaccine data by Asian Americans and subgroups to understand potential disparities, with the goal of better health outcomes in diverse groups.

Nourish Project

The goal of the Nourish Project is to provide educational resources focused on nutrition for pre-diabetic and type-II diabetic Asians. Each Asian cuisine is unique and consists of its own staples. We will create culturally sensitive guidelines for eating at home and eating out.

 

Japanese Cuisine

This resource provides dietary suggestions for managing type-II diabetes and pre-diabetes conditions while enjoying traditional Japanese dishes. 


Indian Cuisine

These resources provide dietary suggestions for managing type-II diabetes and pre-diabetes conditions while enjoying traditional Indian dishes. 


Filipino Cuisine

This resource provides dietary suggestions for managing type-II diabetes and pre-diabetes conditions while enjoying traditional Filipino dishes. 


Taiwanese Cuisine

This resource provides dietary suggestions for managing type-II diabetes and pre-diabetes conditions while enjoying traditional Taiwanese dishes.


Vietnamese Cuisine

These resources provide dietary suggestions for weight loss and for the management of type-II diabetes and pre-diabetes conditions while enjoying traditional Vietnamese dishes. 


Korean Cuisine

This resource provides dietary suggestions for managing type-II diabetes and pre-diabetes conditions while enjoying traditional Korean dishes.


Chinese Cuisine

This resource provides dietary suggestions for managing type-II diabetes and pre-diabetes conditions while enjoying traditional Chinese dishes.


Body Mass Index (BMI) is a measure of fat levels in an individual’s body. For the general population this calculation is a good estimate. However, this calculation can be inaccurate for pregnant women and athletes.

While a BMI less than 26 kg/m2 is generally considered normal, for Asian populations the cutoff is 23 kg/m2. This is because Asians have a higher number of diabetes diagnoses at lower BMI levels. 

STRONG-D

The STRONG D clinical trials tested whether strength training, aerobic training, or a combination of the two may help control blood sugar in people with normal weight type 2 diabetes1. In addition to changes in blood sugar, there may also be changes in bone composition after training. The aim of this project is to quantify differences in bone mineral density between each of the training treatments used. This is especially important as normal weight type 2 diabetes impacts ethnic minorities and Asian Americans at higher rates1-4. More detailed information about bone health during these treatment programs can give a broader view of strengths and weaknesses of each training program.

STRONG-D Clinical Trial - https://pubmed-ncbi-nlm-nih-gov.laneproxy.stanford.edu/30625372/

Type 2 Diabetic Patients and Excersize: How Much of What Kind? - https://medicine.stanford.edu/news/current-news/standard-news/IMPACT-study-diabetes-and-exercise.html

References:

1.      STRONG-D Clinical Trial - https://pubmed-ncbi-nlm-nih-gov.laneproxy.stanford.edu/30625372/

2.      Diabetes in Normal-Weight Individuals: High Susceptibility in Nonwhite Populations - https://care.diabetesjournals.org/content/42/12/2164

3.      Ethnic difference in the prevalence of diabetes in the underweight and normal weight individuals: The CARRS and NHANES studies - https://www-sciencedirect-com.stanford.idm.oclc.org/science/article/pii/S0168822718311896

4.      Type 2 diabetes: Identifying high risk Asian American subgroups in a clinical population - https://www-sciencedirect-com.laneproxy.stanford.edu/science/article/pii/S0168822711002543?via%3Dihub

Text Message Intervention Program

One of the leading causes of death in the Philippines is cardiovascular disease, with stroke as the second cause of morality. In addition, there is an increasing prevalence of hypertension among both Filipino and Filipino-Americans. Hypertension is the primary risk factor for CVD. Despite pharmacological advancements, management of hypertension is still an issue existing in many patients. The aim of this study is to utilize mobile technology of Short Messaging Service (SMS) as a lifestyle intervention for improving hypertension management and blood pressure outcomes in low and middle income countries (LMIC). SMS intervention serves as a low-cost and efficient tool that has shown in previous studies increases treatment adherence, symptom monitoring, and follow-up appointments. This study will allow for evaluation of clinical effectiveness of SMS in influencing lifestyle behavior and controlling blood pressure in hypertensive patients.

Links:

●            Global burden of blood-pressure-related disease, 2001

https://pubmed.ncbi.nlm.nih.gov/18456100/

●            Differences in prevalence, awareness, treatment and control of hypertension between developing and developed countries -

https://pubmed.ncbi.nlm.nih.gov/19402221/

●            Fundamentals for Future Mobile-Health (mHealth): A Systematic Review of Mobile Phone and Web-Based Text Messaging in Mental Health

https://pubmed.ncbi.nlm.nih.gov/27287668/

●            Short Message Service (SMS) Applications for Disease Prevention in Developing Countries

https://www.jmir.org/2012/1/e3/

●            Perceived social support and preventive health behavioral outcomes among older women

https://pubmed.ncbi.nlm.nih.gov/22836374/

Medical Mobile Clinic Project

Chronic disease is preventable and can be managed with proper treatment and improved lifestyle behaviors. However, due to inaccessibility to chronic disease treatment in the Philippines population, many families experience health complications on top of financial burdens. Creation of a mobile medical clinic in underserved communities in the Philippines has been used to address the gaps in care of these chronic diseases, increasing accessibility to treatment, promoting continuous care, and promoting patient education. The aim of this study is to analyze whether medication adherence and follow-up appointments lead to improved blood pressure and/or blood glucose levels for patients with chronic disease in the Philippines. This study is led by Haley Weiner, a PA student at Stanford, in collaboration with Dr. Julieta Gabiola.

Links:

●            ABC’s for Global Health - http://www.abcsforglobalhealth.org/

Arogya World

70 million people living with diabetes in India and diabetes kills 1 million Indians each year.  Arogya World is a health nonprofit in India focused on preventing non-communicable diseases, specifically diabetes, along with heart disease, cancer, and chronic lung disease. Arogya has identified behavior change to be the most challenging obstacle in improving overall health in India. A large aspect of the nonprofit is their school-based programs that aim to educate students on healthy diet and lifestyle choices. The school-based programs consist of a two-year intervention where students learn about chronic diseases such as diabetes, and a healthy lifestyle through diet and physical exercise. The main goal of this study include:

1.     measuring the effectiveness of Arogya’s World intervention by analyzing data recorded from each partner over the last four years

2.     identifying potential barriers, the non-profit may face and brainstorm potential areas of improvement.

3.     A call to action – To help support Arogya World and other health non-profits working to tackle issues of non-communicable diseases it is necessary to increase awareness on how developing countries are effective by this global health burden.

Links: https://arogyaworld.org/programs/healthy-schools/

Country Specific Data Brief

To better understand disease risks and outcomes in various Asian countries, we have compiled a list of country-specific data briefs. 

Cambodian  and Cambodian American

As a relatively new population that began immigrating to the U.S. largely in the 1980s, Cambodian-Americans make up about 0.09% of the United States population and 1.3% of the AAPI population. Although the Cambodian-American population may be small, they face a unique set of health outcomes and risk factors which define their healthcare needs. As such, the disaggregation of Asian health data to provide comprehensive information regarding Cambodian-American health is important to our ability to provide adequate care to this subgroup of the Asian American community. This brief presents differences in health data between Cambodians and Cambodian-Americans and identifies shortcomings in current literature to encourage the disaggregation of Asian-American health data and further research into the health of Cambodian-Americans.


Indian and Asian-Indian Immigrant Health Statistics

This brief provides information on Indian and Asian Indian immigrant health outcomes, including cardiovascular disease, cancer, chronic obstructive pulmonary disease (COPD), and cerebrovascular diseases. Differences in mortality rates for Indians, Asian Indian immigrants, and Non-Hispanic Whites are presented. Data on health risk factors such as diabetes, poor diet, lack of exercise, and smoking are also discussed. 


Filippine and Filipine-Americans

This brief includes the latest information on cardiovascular disease and cancer among Filipinos and Filipino-Americans, incuding data on health risk factors such as hypertension, diabetes, alcohol consumption, smoking, and diet.


Vietnamese and Vietnamese-American

This brief provides information on Vietnamese and Vietnamese-American health outcomes, including cardiovascular disease, stroke, and diabetes. Health challenges such as smoking, impaired patient-physician communication, and healthcare access are also discussed.


Chinese and Chinese-American

This brief provides information on Chinese and Chinese-American health outcomes, includingsStroke, ischemic heart disease, and chronic obstructive pulmonary disorder (COPD). Smoking, poor diet, low health literacy and alcohol consumption all contribute to health outcomes in these populations.


Characterizing Bone Mineral Density in People with Normal Weight Type 2 Diabetes

Normal weight type 2 diabetes impacts Asian Americans, particularly those of South Asians, Filipino, and Chinese origins, at higher rates1-3. Previous studies have focused on the characteristics of obese type 2 diabetes. The aim of this project is to describe the different characteristics of bone between persons with and without normal weight type 2 diabetes. Measures will include a comparison of bone mineral density using DXA and CT scans. Completion of this analysis will help fill a gap in baseline understanding of normal weight type 2 diabetes and better describe the characteristics for at risk populations.

STRONG-D Clinical Trial - https://pubmed-ncbi-nlm-nih-gov.laneproxy.stanford.edu/30625372/

Type 2 Diabetic Patients and Exercise: How Much of What Kind? - https://medicine.stanford.edu/news/current-news/standard-news/IMPACT-study-diabetes-and-exercise.html

References:

1.      Diabetes in Normal-Weight Individuals: High Susceptibility in Nonwhite Populations - https://care.diabetesjournals.org/content/42/12/2164

2.      Ethnic difference in the prevalence of diabetes in the underweight and normal weight individuals: The CARRS and NHANES studies - https://www-sciencedirect-com.stanford.idm.oclc.org/science/article/pii/S0168822718311896

3.      Type 2 diabetes: Identifying high risk Asian American subgroups in a clinical population - https://www-sciencedirect-com.laneproxy.stanford.edu/science/article/pii/S0168822711002543?via%3Dihub