1. Wisconsin Department of Health Services January 2014 P-00522S Healthiest Wisconsin 2020 Baseline and Health Disparities Report Asian Population

2. ASIAN POPULATION Chapter Outline Background Overview of Healthiest Wisconsin 2020 Baseline and Health Disparities Report Key points Data Demographic and socioeconomic data Access to health services; health risks and outcomes References Links to additional reports and resources Contacts 2 Chapter outline

3. ASIAN POPULATION Report Overview This chapter is part of a larger report created by the Wisconsin Department of Health Services to track progress on the objectives of Healthiest Wisconsin 2020 (HW2020) and identify health disparities in the state. The full report is available at: http://www.dhs.wisconsin.gov/publications/P0/p00522.pdf http://www.dhs.wisconsin.gov/publications/P0/p00522.pdf The report is designed to address the Health Focus Areas in HW2020. Where direct measures exist, data are presented; where direct measures are not available, related information may be included. Information about populations experiencing health disparities is provided in the Health Focus Area chapters and is summarized in separate chapters devoted to specific populations. Technical notes are available at: http://www.dhs.wisconsin.gov/publications/P0/p00522y.pdf http://www.dhs.wisconsin.gov/publications/P0/p00522y.pdf Report overview 3

4. ASIAN POPULATION Report Format Full Report Format: PDF Intended use: reference document Chapters Format: Annotated PowerPoint slide set Intended uses: presentations to –Decision-makers –Service providers –Community leaders –The public Sample annotated slide Report overview 4

5. ASIAN POPULATION Report Outline Executive Summary Section 1: Introduction Section 2: Demographic overview Section 3: Health focus areas Section 4: Infrastructure focus areas Section 5: Data summaries by population Section 6: Technical notes Report overview 5

6. ASIAN POPULATION Report Outline: Detail Section 3: Health focus areas Alcohol and other drug use Chronic disease prevention and management Communicable diseases Environmental and occupational health Healthy growth and development Injury and violence Mental health Nutrition and healthy foods Oral health Physical activity Reproductive and sexual health Tobacco use and exposure Section 4: Infrastructure focus areas Access to health services Report overview 6

7. ASIAN POPULATION Report Outline: Detail Section 5: Data summaries by population  Racial/ethnic minority populations o American Indians o Asians o Blacks o Hispanics  People of lower socioeconomic status  People with disabilities  Lesbian, gay, bisexual, and transgender populations  Geography Report overview 7

8. ASIAN POPULATION Data notes Please refer to the Technical Notes chapter for a more detailed description of limitations and methods: http://www.dhs.wisconsin.gov/publications/P0/p00522y.pdf http://www.dhs.wisconsin.gov/publications/P0/p00522y.pdf The 95% confidence intervals are denoted by error bars. Where confidence intervals do not overlap, as shown in the example on the right, differences are statistically significant. Larger confidence intervals may indicate less reliable estimates that should be interpreted with caution. Population estimates that are considered unreliable are excluded. Misclassification of racial/ethnic groups may affect the accuracy of rates. Unless otherwise indicated, the Hispanic population may include people of various races; Whites, Blacks, Asians, and American Indians are non- Hispanic. Report overview 8

9. ASIAN POPULATION Factors that influence health Social determinants of health Source: University of Wisconsin Population Health Institute. County Health Rankings 2013, http://www.countyhealthrankings.org/our-approach Report overview 9

10. ASIAN POPULATION Historical trauma Historical trauma is the cumulative exposure to traumatic events that not only affect the individual exposed, but continue to affect subsequent generations. Descendants of those who experienced the traumatic stressor may still exhibit symptoms. Populations affected by historical trauma include American Indians, African Americans/Blacks, Hispanics/Latinos, Asians, immigrants and refugees, war veterans, and families experiencing intergenerational poverty. Current manifestations may include: Mistrust of health care, legal, and educational systems; Higher rates of risk behaviors such as alcohol and drug abuse, suicide, homicide, and domestic violence; and Higher rates of chronic diseases. Report overview Sources: SAMHSA, Fact Sheet: Historical Trauma http://gainscenter.samhsa.gov/cms-assets/documents/93078-842830.historical-trauma.pdf, Texas Department of Health Services, Trauma Informed Care Training, http://www.dfps.state.tx.us/Training/Trauma_Informed_Care/page35.asp 10

11. ASIAN POPULATION Key Points: Asian Population The Asian population in Wisconsin is young, widely distributed geographically, diverse in ethnicity, and increasing in size. A majority of Asians in Wisconsin are foreign-born. Asians in Wisconsin, particularly Laotians/Hmong, are more likely to live in poverty compared to Whites. Asians have a higher prevalence of certain communicable diseases compared to other racial/ethnic groups because many Asians are foreign-born, having come from areas where these diseases are endemic. Key points 11

12. ASIAN POPULATION Asians are less likely to receive first-trimester prenatal care. Asians have a higher rate of obesity among children ages 2-4 in WIC but a lower rate of overweight or obesity among adults. A higher proportion of stroke deaths among Asians occur before the age of 75. Asian youth have higher rates of depression and planning for suicide compared to White students. Better data on Asians are needed to address small sample sizes and the diversity of the population. Aggregate data may mask significant disparities among subpopulations. Key Points: Asian Population Key points 12

13. ASIAN POPULATION Data Quality Issues: Asian Population Major limitations of data for Asians include: Small sample sizes: A majority of Wisconsin BRFS measures cannot be shown for Asians due to small sample sizes. Diversity of the Asian population in terms of ethnicities, nationalities, religions, and foreign- versus U.S.-born status. Aggregate data for all Asians may mask significant disparities among sub-populations. Data Issues 13

14. ASIAN POPULATION Demographic data 14

15. ASIAN POPULATION Demographic Characteristics Wisconsin’s Asian population is increasing in size, young, and diverse in terms of country of origin. More than half are foreign-born. Wisconsin's Asian population, 2010: 128,052; 2.3% of state total Change in the Asian population, 2000 to 2010: 42% increase Median age, 2010: Asian, 26 years (Whites, 41.5 years) The median age is the age at which half the population is older and half is younger. Percent of Asians who were foreign-born, 2010: 58% Sources: http://www.dhs.wisconsin.gov/health/MinorityHealth/Report.htm and U.S. Census Bureau. Demographic and socioeconomic data 15

16. ASIAN POPULATION Source: American Community Survey, 2010. Southeast Asia, 45% East Asia, 27% South Asia, 28% Country of origin of foreign-born Asians, Wisconsin, 2010 Demographic and socioeconomic data 16

17. ASIAN POPULATION Asian population by county, Wisconsin, 2010 Source: U.S. Census, 2010. Racial/ethnic minority populations 17

18. ASIAN POPULATION Level of urbanization of Wisconsin residents, by race/ethnicity, 2007-2011 Geography Source: American Community Survey, 2007-2011.. 18

19. ASIAN POPULATION Socioeconomic data Wisconsin’s Asian population has higher education rates than Whites. However, Wisconsin’s Asian population has a higher poverty rate than Whites, with the Laotian/Hmong population having a higher poverty rate than other Asian groups. Median household income in Wisconsin, 2008-2010: Asians, $53,600 (Whites, $53,000). Living in poverty, 2008-2010: Laotian/Hmong, 25%; Other Asians 17% (Whites, 9%). Bachelor’s degree or more education (age 25 and older), 2007-2010: Asians, 46% (Whites, 27%) Married-couple households as a percent of family households, 2008-2010: Asians: 79% (other racial/ethnic groups range from Blacks, 33% to Whites, 82%) Source: http://www.dhs.wisconsin.gov/health/MinorityHealth/Report.htm and U.S. Census Bureau, American Community Health Survey Demographic and socioeconomic data 19

20. ASIAN POPULATION Access to health services; health risks and outcomes 20

21. ASIAN POPULATION Age-adjusted rates of use of and barriers to health care among Wisconsin adults, by race/ethnicity, 2008-2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset. Note: Estimates that are unreliable (based on Relative Standard Error or small sample size) are not shown; this means an estimate may not be presented for every population group. Access to health care 21

22. ASIAN POPULATION Percentage of births to mothers who received prenatal care during the first trimester, by race/ethnicity, Wisconsin, 2010 Source: Wisconsin Interactive Statistics on Health (WISH), Wisconsin resident birth certificates. Access to health care 22

23. ASIAN POPULATION Obesity among children (ages 2-4 years) enrolled in the Supplemental Nutrition Program for Women, Infants, and Children (WIC), by race/ethnicity, Wisconsin, 2001 and 2010 Source: Centers for Disease Control and Prevention (CDC) Pediatric Nutrition Surveillance Survey, 2010. Note: Based on >= 95 th growth chart percentiles for Body Mass Index for age. WIC is the Supplemental Nutrition Program for Women, Infants, and Children. Nutrition 23

24. ASIAN POPULATION Age-adjusted rates of overweight and obesity among Wisconsin adults, by race/ethnicity, 2008-2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset. Note: Estimates that are unreliable (based on Relative Standard Error or small sample size) are not shown; this means an estimate may not be presented for every population group. Nutrition 24

25. ASIAN POPULATION Percentage of third-grade students with untreated decay and dental sealants, by race/ethnicity, Wisconsin, 2007-2008 school year Source: Wisconsin Department of Health Services, Make Your Smile Count Survey. Oral health 25

26. ASIAN POPULATION Depression among Wisconsin high school students, by race/ethnicity, 2007-2011 Source: Wisconsin Department of Public Instruction, Youth Risk Behavior Survey (YRBS). Mental health 26

27. ASIAN POPULATION Suicide risk during past 12 months among Wisconsin high school students, by race/ethnicity, 2007-2011 Source: Wisconsin Department of Public Instruction, Youth Risk Behavior Survey (YRBS). Note: Estimates that are unreliable (based on Relative Standard Error or small sample size) are not shown; this means an estimate may not be presented for every population group. Mental health 27

28. ASIAN POPULATION Cancer incidence and mortality (all sites) by race/ethnicity, age- adjusted rate per 100,000, Wisconsin, 2010 Sources: Wisconsin Cancer Reporting System, Office of Health Informatics, Division of Public Health, Department of Health Services; and National Center for Health Statistics, Wisconsin mortality file 1995-2102, Vital Statistics Cooperative Program, 2013. Note: Racial groups include both Hispanics and non-Hispanics; Hispanics include all races. Chronic diseases 28

29. ASIAN POPULATION Stage of disease at diagnosis, all cancers, White and Hmong populations, Wisconsin, 1995-2010 Source: Wisconsin Cancer Reporting System, Office of Health Informatics, Division of Public Health, Department of Health Services, 2013. Note: Percentages exclude cases for which stage was unknown or that were not staged. Chronic diseases 29

30. ASIAN POPULATION Percentage of stroke deaths under age 75, by race/ethnicity and sex, Wisconsin, 2006-2010 Source: Wisconsin Interactive Statistics on Health (WISH), Wisconsin resident death certificates. Chronic diseases 30

31. ASIAN POPULATION Chronic hepatitis B cases by race/ethnicity, Wisconsin, 2010-2012 Source: Wisconsin Electronic Disease Surveillance System (WEDSS), 2010-2012. Note: Includes chronic hepatitis B virus cases, confirmed or probable. Communicable diseases 31

32. ASIAN POPULATION Tuberculosis cases by race/ethnicity and foreign-born status, Wisconsin, 2006-2012 Source: Wisconsin Electronic Disease Surveillance System (WEDSS), 2010-2012. Communicable diseases 32

33. ASIAN POPULATION References 1.2010 Census Briefs: The Asian Population. http://www.census.gov/prod/cen2010/briefs/c2010br-11.pdf http://www.census.gov/prod/cen2010/briefs/c2010br-11.pdf 2.2010 Census Briefs: The Native Hawaiian and Other Pacific Islander Population. http://www.census.gov/prod/cen2010/briefs/c2010br-12.pdf http://www.census.gov/prod/cen2010/briefs/c2010br-12.pdf 3.University of Wisconsin Population Health Institute. County Health Rankings, 2013. http://www.countyhealthrankings.org/our-approach http://www.countyhealthrankings.org/our-approach 4.Center for Urban Population Health. Milwaukee Health Report, 2011. http://www.cuph.org/mhr/2011-milwaukee-health-report.pdf http://www.cuph.org/mhr/2011-milwaukee-health-report.pdf 5.LaVeist TA, Gaskin DA, Richard P (2009). The Economic Burden of Health Inequalities in the United States. Joint Center for Political and Economic Studies. http://www.jointcenter.org/sites/default/files/upload/research/files/The%20Economic% 20Burden%20of%20Health%20Inequalities%20in%20the%20United%20States.pdf http://www.jointcenter.org/sites/default/files/upload/research/files/The%20Economic% 20Burden%20of%20Health%20Inequalities%20in%20the%20United%20States.pdf 6.Thomas JC, Sage M, Dillenberg J, Guillory VJ (2002). A Code of Ethics for Public Health. Am Journal of Public Health. 92(7):1057–1059. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447186/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447186/ 7.Wisconsin Department of Health Services (DHS). Healthiest Wisconsin 2020. http://www.dhs.wisconsin.gov/publications/P0/P00187.pdf http://www.dhs.wisconsin.gov/publications/P0/P00187.pdf 8.Greenberg RS (1983). The impact of prenatal care in different social groups. American Journal of Obstetrics and Gynecology. 145(7):797-801. 9.CDC. Obesity Prevalence Among Low-Income, Preschool-Aged Children - United States, 1998-2008. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5828a1.htmhttp://www.cdc.gov/mmwr/preview/mmwrhtml/mm5828a1.htm References 33

34. ASIAN POPULATION 10.CDC. Youth Risk Behavior Surveillance System. http://apps.nccd.cdc.gov/youthonline/App/Default.aspx http://apps.nccd.cdc.gov/youthonline/App/Default.aspx 11.Office of Adolescent Health. Mental Health. http://www.hhs.gov/ash/oah/adolescent- health-topics/mental-health/home.htmlhttp://www.hhs.gov/ash/oah/adolescent- health-topics/mental-health/home.html 12.Keenan-Miller D, Hammen CL, Brennan PA. Health outcomes related to early adolescent depression. Journal of Adolescent Health. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2034364/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2034364/ 13.CDC. Mortality Among Teenagers Aged 12-19 Years: United States, 1999-2006. http://www.cdc.gov/nchs/data/databriefs/db37.htm http://www.cdc.gov/nchs/data/databriefs/db37.htm 14.National Institute of Mental Health. Many Teens Considering Suicide Do Not Receive Specialized Mental Health Care. 2012. http://www.nimh.nih.gov/news/science- news/2012/many-teens-considering-suicide-do-not-receive-specialized-mental- health-care.shtmlhttp://www.nimh.nih.gov/news/science- news/2012/many-teens-considering-suicide-do-not-receive-specialized-mental- health-care.shtml 15.National Cancer Institute. Cancer Staging. http://www.cancer.gov/cancertopics/factsheet/detection/staging http://www.cancer.gov/cancertopics/factsheet/detection/staging 16.DHS. Wisconsin Minority Health Report, 2001-2005 (PPH-5716), pages 79-108 (“Asians”). http://www.dhs.wisconsin.gov/health/minorityhealth/ReportPDF/asians.pdfhttp://www.dhs.wisconsin.gov/health/minorityhealth/ReportPDF/asians.pdf 17.Foote M, Matloub J. Comprehensive Cancer Control Program Surveillance Brief. Determining Practices for Reporting Hmong Cancer Cases in Wisconsin. Special Supplement: Cancer Incidence Data for Hmong. http://www.wicancer.org/uploads/pub_34566.pdf http://www.wicancer.org/uploads/pub_34566.pdf References 34

35. ASIAN POPULATION 18.World Health Organization (WHO). Hepatitis B. http://www.who.int/mediacentre/factsheets/fs204/en/ http://www.who.int/mediacentre/factsheets/fs204/en/ 19.WHO. Tuberculosis (TB). http://www.who.int/topics/tuberculosis/en/http://www.who.int/topics/tuberculosis/en/ References 35

36. ASIAN POPULATION Links to additional reports and resources Centers for Disease Control and Prevention, Minority Health, Asian American Populations: http://www.cdc.gov/minorityhealth/populations/REMP/asian.html http://www.cdc.gov/minorityhealth/populations/REMP/asian.html Centers for Disease Control and Prevention, Immigrant and Refugee Health: http://www.cdc.gov/immigrantrefugeehealth/http://www.cdc.gov/immigrantrefugeehealth/ Links 36

37. ASIAN POPULATION Contacts Evelyn Cruz, Minority Health Officer Wisconsin Division of Public Health, Office of Policy and Practice Alignment E-mail: Evelyn2.Cruz@dhs.wisconsin.govEvelyn2.Cruz@dhs.wisconsin.gov Karl Pearson, Demographer Wisconsin Division of Public Health, Office of Health Informatics E-mail: KarlT.Pearson@dhs.wisconsin.govKarlT.Pearson@dhs.wisconsin.gov Savitri Tsering, Coordinator Wisconsin Division of Public Health, Refugee Health Services E-mail: Savitri.Tsering@dhs.wisconsin.govSavitri.Tsering@dhs.wisconsin.gov Contacts 37