1. Promising Models and Practices with Southeast Asian American Communities
Zha Blong Xiong
University of Minnesota
Yorn Yan
United Cambodian Association of Minnesota

2. Overview of Presentation
Context of Southeast Asian (SEA) Americans in Minnesota.
The Citizen Health Care Model to build collaboration between the University and Southeast Asian communities.
The Statewide Tobacco Education and Education Project (STEEP) Model.
Some evaluation data testing the model.
Lessons learned.

3. SEA Resettlement in the United States, 1975-1994
40,000
35,000
30,000
25,000
20,000
15,000
10,000
5,000
1975-
1976
1977-
1978
1979-
1980
1981-
1982
1983-
1984
1985-
1986
1987-
1988
1989-
1990
1991-
1992
1993-
1994

4. U.S. Southeast Asian Population
Asian Indians
Filipino
Hmong = %; Asian Indian = %; Chinese = 23.36%; Vietnamese = 10.81%; Korean = 9.94%; Filipino = 17.84%;
Laotian = 1.33%; Cambodian = %; Others = 13.53%

5. Minnesota Southeast Asian Population
Cambodian = 8,140; Hmong = 55,915; Lao = 10,070; and Vietnamese = 22,923 (Total MN Asian Pop = 214,234)

6. Hmong
Vietnamese
One county (Ramsey) near Minneapolis, MN, had concentrations of the Asian-alone-or-in-combination population between 10.0 percent and 24.9 percent of the total population. Counties with concentrations of 5.0 percent to 9.9 percent of the Asian alone-or-in-combination population were near all of the metropolitan statistical areas (Minneapolis-St. Paul, Bloomington (MN) mentioned above.

8. Most Southeast Asians in Minnesota concentrated in urban and poor areas
53% of Minnesota’s Hmong population lives in Ramsey County and 45% within the City of St. Paul.
The Hmong comprise 57% of all Asians in Ramsey County nd 65% of Asians in St. Paul ( American Community Survey 5-Year Estimates).

9. Percentage of Household Income below the Poverty Line in St
Percentage of Household Income below the Poverty Line in St. Paul, Ramsey and Hennepin Counties, MN by Race
Caucasian
African American
Hispanic
American Indian
Asian-non Hmong
Hmong
St. Paul
3.4
19.2
12.8
17.8
25.8
33.9
Ramsey County
2.6
18.7
12.3
14.1
12.6
31.9
Hennepin County
1.7
19.5
12.7
20.2
6.3
33.7

10. Linguistically Isolated
A recent study found that 81% of first generation respondents reported using a language other than English
as their primary language, while 20% of second generation respondents also reported this (Robynn el al., 2010).
Source: Census 2000 Data for Minnesota Population.

11. Smoking rates
Smoking rates in the general population are declining since 2004 (stalled at 20%)
Smoking rates in the SEA communities are still high.
Some studies show that the prevalence rates for SEAs ages 18 and over ranged from 34% to 70% (Bautista, Ednacot, & Wong, 2005; Chen, 2001; McPhee et al., 1995).
A 2009 study of 2,856 Hmong youth and adults in Wisconsin found that 15% of the youth ages reported daily use and 32% ever use.
The American Legacy Foundation (2001) reported that the number of Asian American teens who smoke increased from 4.4% in middle school to 33.1% by 12th grade.
Blue Cross and Blue Shield of Minnesota’s (2009) SEA study found that men are more likely to smoke (30%) than women (7%).

12. Engaging the Southeast Asian Communities to Address the Tobacco Use Problem
Community Engagement: Buy-in & Planning
Capacity Building
Culturally Tailored, Multi-Approached Education
Embedding and Systems Change

13. Engaging the Southeast Asian Communities to Address the Tobacco Use Problem
STEEP
Collaborative Executive Team (CET)
Lao Family Community of Minnesota
Lao Advancement Organization of America
United Cambodian Association of Minnesota, Inc.
Association
for the Advancement of Hmong Women in Minnesota
Department of Family Social Science, University of Minnesota
Association for Nonsmokers-Minnesota

14. Community Engagement Buy-in & Planning Model
Citizen Health Care Model’s Principles:
The greatest untapped resource for strengthening families and communities is the knowledge, wisdom, and lived experience of community members/citizens.
Citizens must be included in the engagement process as producers and contributors, and not a clients or consumers of services.
Researchers must come to the collaboration as citizen professionals to identify challenges, sources and nature of the problem, mobilize resources, and generate plans of action together.
Source: Doherty & Carroll, 2002; Doherty & Mendenhall, 2006.

15. Community Engagement Buy-in & Planning Process
The Engagement Process for the Statewide Tobacco
Education and Engagement Project (STEEP) took 2
Years (supported by ClearWay Minnesota: ):
Action plans & program development: Retreat.
Data collection: Focus groups.
Data collection: Stakeholder interviews.
Community leadership groups.
The researcher and representatives of the four organizations met to establish roles and expectations, to review goals of the research project, and to draft and finalize the job descriptions for the community facilitators and the research assistant
Identified stakeholders for the community leadership groups.
Capacity building for the collaborative & staff.
Shared decision making and partnership building.

16. The STEEP Project
Mr. Yorn Yan

17. Dandelion
Systems Change

18. Capacity Building Model: LAAMPP Approach: Train-the-trainers
Community Engagement: Buy-in & Planning
Capacity Building
Culturally Tailored, Multi-Approached Education
Embedding and Systems Change
Model: LAAMPP
Leadership and Advocacy Institute to Advance
Minnesota’s Priority Populations project (Lew, Honma,
Portugal, & Baezconde-Garbanati, 2008).
Build community and cross-cultural capacity for tobacco control
Developing a pool of Coaches
Approach: Train-the-trainers
(Corelli et al., 2007; Orfaly et. el., 2005).
Capacity building of the collaboration
Staff/Tobacco Educators
Volunteers: Community fellows
Allies: Community leaders
Community members
This approach is based on the work of ClearWay Minnesota’s LAAMPP (Leadership and Advocacy Institute to Advance Minnesota’s Parity for Priority Populations) project (Lew, Honma, Portugal, & Baezconde-Garbanati, 2008) and the train-the-trainers model (Corelli et al., 2007; Orfaly, Frances, Campbell, Whittemore, Joly, & Koh, 2005).

19. Culturally Tailored, Multi-Approached Education
Community Engagement: Buy-in & Planning
Capacity Building
Culturally Tailored, Multi-Approached Education
Embedding and Systems Change
Setting: Places of congregation (“if we build it, people will come” is not working )
Community events
Temples
Multi-housing units
Community-based organizations
Materials: Posters, objects, tools, etc. (see samples)
Pedagogies: Story telling, demonstrations,
and role playing.
Evaluation: Pre- and post-tests; retrospective

20. Chemical Poster What it is:
A poster depicting the chemicals present in cigarettes.
Why it is used:
It is used to alert observers to the dangerous
chemicals found in cigarettes.
Its message:
The chemicals pictured in this poster are chemicals
that many observers will recognize. This poster
encourages smokers to ask themselves,
“If these chemicals are used in each cigarette,
why am I still smoking?
Retailer: Nimco Inc.,
, Fax:
Its message: The chemicals pictured in this poster are chemicals that many observers will recognize. This poster encourages smokers to ask themselves, “If these chemicals are used in each cigarette, why am I still smoking?

21. Tar Jar What it is: This jar shows the amount of tar a smoker
consumes in one year from smoking a pack
(20 cigarettes) a day.
Why it is used:
It provides a visual picture of the tar that turns
the lungs black.
Its message:
This educational tool teaches the effects of tobacco
use on health.
Retailer: Nimco Inc.,
, Fax:

22. Community Engagement: Getting Communities & Institutions to Commit to Change
Community Engagement: Buy-in & Planning
Capacity Building
Culturally Tailored, Multi-Approached Education
Embedding and Systems Change
Embedding practices and policies
Healthy living messages and practices become part of each agency’s programs.
Co-presentations and team-focused programs.
Systems change practices and policies
Develop appropriate language for policies
Adopt policies
Implement and enforce adopted policies
Educate and inform existing state and local policies

23. Commit to Embedding and Systems Change
Community Engagement: Buy-in & Planning
Capacity Building
Culturally Tailored, Multi-Approached Education
Embedding and Systems Change
Action taken:
Date Initiated
Date Completed
Comments
Initial contact w/ member who knows someone in the entity.
Talk with representative(s) of the entity about potential policy.
Conversation with and/or present to group about potential policy.
Have a conversation with the decision maker or the executive group.
Present idea and language of policy and what the entity wants to cover.
Help draft policy idea and language to the entity.
Revise policy statement.
Policy adopted. 

24. NUMBER OF POLICIES PASSED
TYPE OF POLICY
SYSTEMS
TOBACCO
COMMUNITY BASED ORG.
TEMPLE
GROUP
MULTI- UNIT HOUSING
OTHERS
Hmong Soccer Tournament (1)
Tobacco X
No Tobacco Funding (5)
Strengthening Comprehensive Policy (5)
World Refugee Day (1)
Multi-unit Housing (1)
Cambodian Temple (1)
Lao Temple (1)
20% healthy options (5)
Healthy Eating
20% healthy options (1)
20% healthy options (1)
Bike racks (5)
Active Living

25. Lessons Learned Collaboration Staff
Shared vision about the community well-being.
Trust and respect one another as professional citizens.
Commitment from the top of the organizations (i.e., executive directors).
Shared leadership and sacrifice at the collaborative level (chair committees, rally, petition, cost to pay grant writer, etc.).
The role of the University in the collaboration is key to our program success (i.e., model development, grant writing, and evaluation).
The ongoing contributions of the TAs, consultants, and funders to guide, support, and strengthen the collaboration.
Staff
Capacity building is critical (i.e., demonstrate credibility, buy-in, and trust in the community, esp. with young, second-generation staff).
Mentoring and coaching staff play an important role in our successes.
Organizational flexibility (in office vs. in the field).

26. Lessons Learned Evaluation
Evaluation is a challenge when working with low literacy population.
The need to balance between delivering the program vs. collecting data
An hour training with pre- and post-tests
The challenge of using survey to collect data (i.e., response options; right and wrong answers).
Reliable vs. practical measures.

27. Lessons Learned Volunteers Program Challenge of retaining volunteers.
Challenge of getting volunteers to commit to advanced training (tier three – two week training and a mentored project).
Program
Build relationship with people is key to engagement, education, and systems change.
If we move too quickly into systems change, the buy-in is not there in the community to pass policies.
People need to personalize the problem before they can commit to change.

28. Please don’t hesitate to contact us if you want to…
Learn more about the Citizen Health Care Model to engage other immigrant and/or low SES communities;
Learn more about our STEEP’s Dandelion and Systems Change Model;
Have access to our evaluation data; or
Know more about our lessons learned and other success stories.

29. CDC’s Program Evaluation Framework Framework for Program Evaluation in Public Health. MMWR 1999;48(No. RR-11)
JH: this graphic summarizes the main points of the Steps in Program Evaluation and has the CDC stamp on it. It also references the AEA Evaluation Standards updated document which we can include in their electronic “packet.”

30. American Evaluation Association Evaluation Standards
Utility: credible, negotiated, timely
Feasibility: practical, context, efficient
Propriety: formal agreements, conflict of interest, transparency, inclusive
Accuracy: valid, reliable, justified
Accountability: documentation; internal & external metaevaluation
Yarbrough, D. B., Shulha, L. M., Hopson, R. K., and Caruthers, F. A. The program evaluation standards: A guide for evaluators and evaluation users (3rd ed.). Thousand Oaks, CA: Sage;
JH: This is a very brief summary of the AEA Evaluation Standards document and I don’t think we need to read every word. This is the skeleton of a 3-page document, which is on your thumb drives. The standards have been under revision for the past couple of years in committee and we are showing you this just to make the point that AEA evaluators continuously try to professionalize their evaluation practice, and hold practitioners to high standards of excellence. [One of the HELI participants asked about “standards.”]

31. Evaluation Address four evaluative questions:
How much have we been reaching out to the SEA communities?
How much do the people in the community know about STEEP?
How much have we made a difference in the SEA communities?
How much have we made a difference to the people we educated?

32. How much have we been penetrating the SEA communities?
Conducted 65 events, delivered educational tools to 40,000 people in three target SEA locations: Twin Cities, Rochester, & St. Cloud.
Recruited and trained over 120 volunteers; 20 of them delivered the education in their respective community.
Networked/partnered with over 72 agencies and/or groups working on a variety of projects/activities in Minnesota.
Recruited and trained 120 volunteers. Of the 120 trained volunteers, 20 had delivered the education using STEEP’s educational tools into their respective community.
Networked and partnered with 72 agencies working on a variety of projects and activities in Minnesota.
Engaged in several policy-related activities:

33. How much do the people in the community know about STEEP?
Nearly 97% of all survey respondents reported
having seen STEEP at community events in the
past year.
More than 50% of the survey respondents
indicated hearing people talking “quite
often” about STEEP’s work in their communities
within the past year ( ).

34. How much have we made a difference in the SEA communities?

35. How much have we made a difference to the people we educated
How much have we made a difference to the people we educated? (Knowledge)
Do you think smoking contributes to mouth cancers, poor vision, skin damage, ear ached. Now, think back to before you knew STEEP, would you say your answer to these questions (REPEAT) be (1) “the same now compared to before you knew STEEP,” ( 2) “a little different now compared to before you knew STEEP, or (3) “much different now compared to before you knew STEEP.”

36. Graph 11. Rules about not smoking inside the home
How much have we made a difference to the people we educated? (Smoking norms inside the home)
Graph 11. Rules about not smoking inside the home
. Changing smoking norms inside the home

37. How much have we made a difference to the people we educated
How much have we made a difference to the people we educated? (see smoking now vs. a year ago in the community)
In your observation, do you see smoking in the following places NOW compared to A YEAR AGO in your community? Please answer Yes or No to each place

38. How much have we made a difference to the people we educated
How much have we made a difference to the people we educated? (see smoking now vs. a year ago in the community)

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