1. Tuberculosis and the Asian Population of Tarrant County, TX By: Jessica McCallister

2. Definition of Foreign-Born by CDC “A U.S.-born person was defined as someone born in the United States or its associated jurisdictions or someone born in a foreign country but having at least one U.S.- born parent. Persons not meeting this definition were classified as foreign-born.” (CDC, 2008)

3. Problem According to the CDC’s National TB Surveillance System, “progress (in TB elimination) has slowed in recent years; the average annual percentage decline in the TB rate decreased from 7.3% per year during 1993-2000 to 3.8% during 2000-2008.” (CDC, 2008)

4. Research Question Is tuberculosis more prevalent in groups that have a high percentage of foreign-born persons? How severe is tuberculosis prevalence among Asians in the US? What factors drive tuberculosis transmission among Asians in Tarrant County?

5. Literature Review Tuberculosis (TB) in native-born Americans has declined from 1993-2007, but foreign-born persons and racial/ethnic minority populations continue to be affected disproportionately (CDC, 2008). In the United States alone, the percentage of Asians with tuberculosis has risen from 20 to 26 percent from 1998 to 2007 (CDC 2007). Traditional programs targeting high-risk populations usually exclude Asians (with high rates of TB) and threaten the progress toward TB elimination in the US (CDC, 2008).

6. Rate of native-born cases vs. foreign- born cases (CDC, 2008)

7. Tuberculosis by State (CDC, 2008) -Texas was one of four states reported by the CDC to have more than 500 cases in 2008. (CDC, 2008) - “These four states accounted for approximately half of all TB cases in 2008.” (CDC, 2008)

8. Tuberculosis Cases in Texas

9. Research Question Are traditional high-risk behaviors (i.e. alcohol abuse, drug use, homelessness, sexual behavior, etc.) responsible for high rates of tuberculosis in Asians? How does the Asian population’s participation in risky behaviors compare to other race/ethnic groups?

10. Methodology Data from tuberculosis- screening program in Tarrant County, Texas, 1993-2006. Using contingency tables analysis with chi-square test of significance studying: – Homelessness – Incarceration – Drug use – Sexual behavior – Alcoholism, etc. NoYesTotal Non-Asian464210674 Asian1462148 Total610212822 Drug User- Crosstab

11. Results Asians comprise 4.2% of the population but contributed 18% of TB cases. Whites are 56% of the population and reported 26% of total cases.

12. Results continued.. Asians are less likely to participate in high- risk behaviors compared to other ethnic/minority groups: – drug use (Χ 2 =57.426, p=.000) – alcoholism (Χ 2 =39.776, p=.000) – homelessness (Χ 2 =37.029, p=.000) – previous incarceration (Χ 2 =27.359, p=.000)

13. Research Question Since Asian Americans have been proven not to participate in the normal high-risk behaviors usually associated with TB, what is their mode of transmission? What needs to be done in order to help decrease the rates of TB in the Asian American culture?

14. Conclusion Most Asians acquire TB in their home countries before entering US. About 96% of Asian TB cases in Tarrant County were foreign-born. Majority do not participate in the traditional high-risk behaviors usually associated with TB. Specific target-programs are needed to control TB in the Asian community in order to facilitate TB elimination in the United States.

15. Programs in Tarrant County, Texas Tarrant County offers TB skin tests, chest x- rays, medications, refills, and doctor visits for low costs to county residents (TCPH, 2009). There was no mention of screening programs that targeted specific members of the community.

16. What needs to be done? Specific target-programs are needed to control TB in the Asian community in order to facilitate TB elimination in the United States.

17. References CDC Statistics. 2007. Tuberculosis cases, percentages, and case rates per 100,000 population by race only: United States, 1993-2007. http://www.cdc.gov/tb/surv/2007/pdf/table3.pdf. Accessed 10 October 2008. CDC Statistics. 2008. MMWR: Trends in Tuberculosis—United States, 2007. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5711a2.htm Moonan, Patrick K, Manuel Bayona, Teresa N Quitugua, Joseph Oppong, Denise Dunbar, Kenneth C Jost Jr, Gerry Burgess, Karan P Singh, and Stephen E Weis. 2004. Using GIS technology to identify areas of tuberculosis transmission and incidence. International Journal of Health Geographics 3:23. Tarrant County Public Health. Client Services: Tuberculosis, 2009. http://www.tarrantcounty.com/ehealth/cwp/view.asp?A=763&Q=4 30433 Texas Department of State Health. Tuberculosis Statistics: 2006 TB Cases in Texas map. www.dshs.state.tx.us/idcu/disease/tb/statistics /

18. Acknowledgements I would like to thank the following: - Dr. Joseph Oppong - Dr. Susan Eve - Dr. Gloria Cox and the Honors College

19. Questions?