Riti Shimkhada

Background: The U.S. Office of Management and Budget (OMB) categorizes Filipino Americans as Asian; however, many may not identify as such, opting instead for “other” or Pacific Islander (PI). This study examines the extent to which Filipino Americans select PI or “other” rather than Asian, using a large population-based survey of Californians. Methods: We analyzed data from the 2019, 2020, and 2021 California Health Interview Survey (CHIS), the largest state health survey in the U.S. that includes write-in prompts for detailed race and ethnicity data. The focus was on participants who identified as Pacific Islanders and wrote in 'Filipino,' those who selected 'Asian' and specified 'Filipino,' and respondents who chose 'other' and wrote in 'Filipino.' Results: Our analysis included 1,859 Filipino respondents, revealing that 8.8% identified as Pacific Islander, 85.2% as Asian, and 6.1% as "other." Those identifying as PI were more likely to also identify as Latino/Hispanic, be older, and possess U.S. citizenship compared to those identifying as Asian. Discussion: Disaggregating Filipino Americans from the broader Asian category in surveys is vital for accurately identifying the community's unique needs. We recommend incorporating open-ended write-in prompts in surveys that ask respondents to first identify their broader race category (e.g. Asian). These prompts help identify and reclassify Filipino respondents who may have identified as PI. Such prompts are also important for other racial/ethnic communities who may be uncertain about how to categorize themselves. Ongoing, dynamic community-driven research is essential for understanding identities and effectively categorizing Filipino Americans and other communities.

This Research Letter describes the increasing trend of almost-constant social media use among California adolescents and the association with serious psychological distress, focusing on the influence of familial and experiential factors.

BACKGROUND While the U.S. Office of Management and Budget (OMB) places Filipino Americans under the Asian category, some Filipino Americans may not identify as Asian and opt to identify as “other” or as Pacific Islander (PI). OBJECTIVE We examine here the extent to which Filipino Americans choose Pacific Islander or “other” instead of Asian using a large population-based survey of Californians. METHODS This study used data from the 2019, 2020, and 2021 rounds of the California Health Interview Survey (CHIS), the largest state health survey in the United States, and one of the few data systems that includes write-in prompts for the collection of detailed race data. The study focused on participants who identified as Pacific Islanders and wrote-in 'Filipino,' those who selected 'Asian' and specified 'Filipino,' and respondents who selected 'other' and wrote-in 'Filipino' for their detailed race group. RESULTS Our analysis included 1,859 Filipino respondents of which 8.77% identified as Pacific Islander, 85.15% as Asian, and 6.08% as "other." Those who identified as PI tended to also identify as Latino/Hispanic, be older, and have U.S. citizenship compared to those who identified as Asian. CONCLUSIONS We recommend the inclusion of open-ended prompts in health surveys and the disaggregation of Filipino Americans from the general Asian category. We posit expanded data collection standards and region-based classifications for Asian subgroups can better capture the full extent of the diversity of the aggregate group. Further community-driven research is needed to address the specific health needs of Filipino Americans CLINICALTRIAL N/A

UNSTRUCTURED This Research Letter describes the increasing trend of almost constant social media use among California adolescents aged 12-17 between 2019-2021 and an examination of the association between social media use with serious psychological distress. Using multivariate logistic regression models, this study finds a positive association between almost constant social media use and serious psychological distress, controlling for demographics, family connection, and adverse childhood experiences (ACEs). While acknowledging the cross-sectional nature of the data as a limitation, the findings add to the growing literature on the possible implications of growing social media use on mental health and underscore the importance of considering familial and experiential factors in examining mental health implications of pervasive social media use among adolescents.

Building fair, equitable, and beneficial partnerships between institutions collaborating in research in low- and middle-income countries (LMIC) and high-income countries (HIC) has become an integral part of research capacity building in global health in recent years. In this paper, we offer an example of an academic collaboration between the University of California Los Angeles, Center for Health Policy and Research (UCLA CHPR) and the University of Philippines, Manila, College of Public Health (UPM CPH) that sought to build an equitable partnership between research institutions. The partnership was built on a project to build capacity for research and produce data for policy action for the prevention and care of non-communicable diseases (NCDs) through primary healthcare in the Philippines. The specific objectives of the project were to: (1) locally adapt the Primary Care Assessment Tool for the Philippines and use the adapted tool to measure facility-level primary care delivery, (2) conduct focus group discussions (FGDs) to gather qualitative observations regarding primary care readiness and capacity, and (3) conduct a comprehensive population-based health survey among adults on NCDs and prior healthcare experience. We describe here the progression of the partnership between these institutions to carry out the project and the elements that helped build a stronger connection between the institutions, such as mutual goal setting, cultural bridging, collaborative teams, and capacity building. This example, which can be used as a model depicting new directionality and opportunities for LMIC-HIC academic partnerships, was written based on the review of shared project documents, including study protocols, and written and oral communications with the project team members, including the primary investigators. The innovation of this partnership includes: LMIC-initiated project need identification, LMIC-based funding allocation, a capacity-building role of the HIC institution, and the expansion of scope through jointly offered courses on global health.

In October of 2021, California enacted SB 428, the ACEs Equity Act, which mandates commercial insurance coverage of adverse childhood experiences (ACEs) screening in addition to ACEs screening already covered for the state9s Medicaid enrollees. California is the first state to expand ACEs screening coverage, but it is possible other states may follow similar paths given the increasing interest in policy action to address ACEs. Increase in stress and trauma among Americans and evidence of the disproportionate impact ACEs have on historically marginalized and disadvantaged communities has increased the urgency with which policy makers, clinicians and researchers have sought to address ACEs and encourage trauma-informed care delivery to better meet the needs of patients. Family practice and other primary care providers are at the core of prevention and are arguably the largest group of stakeholders at the forefront of movements toward increasing ACEs screenings. However, debate persists among policy makers, clinicians, and researchers on whether the ACEs screening approach improves outcomes and avoids harms. In this health policy article, we describe key issues under debate with regards to ACEs screening and estimate potential change in screening utilization and expenditures due to the new ACEs legislation in California. The lessons being learned in California are applicable to other states and the US as a whole.

Background: Little data exist on the well-being of older adults from Asian American (AA) communities. Methods: Using data from the 2018 California Health Interview Survey, we examined 2 well-being metrics among AAs and AA subgroups (Korean, Filipino, Vietnamese, Chinese) 65 years and older. Results: AA older adults reported lower life satisfaction and not having needed social and emotional support compared with all other race/ethnicities. Current life satisfaction among AA older adults was 54% compared with 80% for all other race/ethnicities; 56% of AA older adults reported usually or always receiving social/emotional compared with 80% for all other race/ethnicities. Within the AA category, life satisfaction was 40% for Korean, 48% for Chinese, 47% for Vietnamese, and 77% for Filipino older adults. Among Korean older adults, 30% reported receiving needed social/emotional support, 57% among Chinese, 59% among Filipino, and 65% among Vietnamese older adults. Conclusion: AA older adults report lower life satisfaction and not needed receiving social and emotional support compared with all other race/ethnicities. Among AAs, Korean older adults were most likely to report poorer well-being. AA older adult communities may be in urgent need of further research and investment in interventions.

Background: Real-time, rapid assessment of barriers to care experienced by patients can be used to inform relevant health care legislation. In recent years, online communities have become a source of support for patients as well as a vehicle for discussion and collaboration among patients, clinicians, advocates, and researchers. The Breast Cancer Social Media (#BCSM) community has hosted weekly Twitter chats since 2011. Topics vary each week, and chats draw a diverse group of participants. Partnering with the #BCSM community, we used Twitter to gather data on barriers to care for patients with metastatic breast cancer and potential policy solutions. Metastatic breast cancer survival rates are low and in large part conditioned by time-sensitive access to care factors that might be improved through policy changes. Objective: This study was part of an assessment of the barriers to care for metastatic breast cancer with the goal of offering policy solutions for the legislative session in California. Methods: We provided 5 questions for a chat specific to metastatic breast cancer care barriers and potential policy solutions. These were discussed during the course of a #BCSM chat on November 18, 2019. We used Symplur (Symplur LLC) analytics to generate a transcript of tweets and a profile of participants. Responses to the questions are presented in this paper. Results: There were 288 tweets from 42 users, generating 2.1 million impressions during the 1-hour chat. Participants included 23 patient advocates (most of whom were patients themselves), 7 doctors, 6 researchers or academics, 3 health care providers (2 nurses, 1 clinical psychologist), and 2 advocacy organizations. Participants noted communication gaps between patient and provider especially as related to the need for individualized medication dosing to minimize side effects and maximize quality of life. Timeliness of insurance company response, for example, to authorize treatments, was also a concern. Chat participants noted that palliative care is not well integrated into metastatic breast cancer care and that insurance company denials of coverage for these services were common. Regarding financial challenges, chat participants mentioned unexpected copays, changes in insurance drug formularies that made it difficult to anticipate drug costs, and limits on the number of physical therapy visits covered by insurance. Last, on the topic of disability benefits, participants expressed frustration about how to access disability benefits. When prompted for input regarding what health system and policy changes are necessary, participants suggested a number of ideas, including expanding the availability of nurse navigation for metastatic breast cancer, developing and offering a guide for the range of treatment and support resources patients with metastatic breast cancer, and improving access to clinical trials. Conclusions: Rapid assessments drawing from online community insights may be a critical source of data that can be used to ensure more responsive policy action to improve patient care.

BACKGROUND Real-time, rapid assessment of barriers to care experienced by patients can be used to inform relevant health care legislation. In recent years, online communities have become a source of support for patients as well as a vehicle for discussion and collaboration among patients, clinicians, advocates, and researchers. The Breast Cancer Social Media (#BCSM) community has hosted weekly Twitter chats since 2011. Topics vary each week, and chats draw a diverse group of participants. Partnering with the #BCSM community, we used Twitter to gather data on barriers to care for patients with metastatic breast cancer and potential policy solutions. Metastatic breast cancer survival rates are low and in large part conditioned by time-sensitive access to care factors that might be improved through policy changes. OBJECTIVE This study was part of an assessment of the barriers to care for metastatic breast cancer with the goal of offering policy solutions for the legislative session in California. METHODS We provided 5 questions for a chat specific to metastatic breast cancer care barriers and potential policy solutions. These were discussed during the course of a #BCSM chat on November 18, 2019. We used Symplur (Symplur LLC) analytics to generate a transcript of tweets and a profile of participants. Responses to the questions are presented in this paper. RESULTS There were 288 tweets from 42 users, generating 2.1 million impressions during the 1-hour chat. Participants included 23 patient advocates (most of whom were patients themselves), 7 doctors, 6 researchers or academics, 3 health care providers (2 nurses, 1 clinical psychologist), and 2 advocacy organizations. Participants noted communication gaps between patient and provider especially as related to the need for individualized medication dosing to minimize side effects and maximize quality of life. Timeliness of insurance company response, for example, to authorize treatments, was also a concern. Chat participants noted that palliative care is not well integrated into metastatic breast cancer care and that insurance company denials of coverage for these services were common. Regarding financial challenges, chat participants mentioned unexpected copays, changes in insurance drug formularies that made it difficult to anticipate drug costs, and limits on the number of physical therapy visits covered by insurance. Last, on the topic of disability benefits, participants expressed frustration about how to access disability benefits. When prompted for input regarding what health system and policy changes are necessary, participants suggested a number of ideas, including expanding the availability of nurse navigation for metastatic breast cancer, developing and offering a guide for the range of treatment and support resources patients with metastatic breast cancer, and improving access to clinical trials. CONCLUSIONS Rapid assessments drawing from online community insights may be a critical source of data that can be used to ensure more responsive policy action to improve patient care.