Overcoming Barriers to Better Health for Underserved Asian Americans


Dr. Fang and Dr. Ma smiling
The research of Dr. Carolyn Fang and Dr. Grace Ma focuses on understanding and overcoming health disparities for Asian Americans and other high-risk minority populations.

Research That Addresses Significant Data Gaps 

Innovations in cancer treatments start with discoveries in the laboratory – which is where Fox Chase Cancer Center has made powerful inroads for more than 100 years to advance care for patients in the local community and throughout the world.

Although Asian Americans are among the fastest-growing ethnic/racial groups in the United States, they are highly underrepresented in biomedical research. There is a tremendous data gap regarding the risk factors of many diseases among these populations and the health disparities they face.

That’s why Dr. Carolyn Y. Fang of Fox Chase and Dr. Grace X. Ma of the Lewis Katz School of Medicine at Temple University have dedicated their life’s work to understanding and overcoming the barriers to care for Asian Americans and other underserved minority populations.

Dr. Fang, Associate Director for Population Science and a Professor in the Cancer Prevention and Control program, leads a research lab that studies and addresses the psychosocial and behavioral factors in cancer prevention, risk management and survivorship. Dr. Ma, Associate Dean for Health Disparities and Founding Director of the Center for Asian Health, is an internationally recognized behavioral health scientist and research leader in cancer and health disparities. Through more than 20 years of collaboration, these two pioneers are uncovering new insights to reduce the burden of cancer for Asian American populations in the Philadelphia region and across the country.

Historic Study for Asian American Cohort

Dr. Fang and Dr. Ma’s newest collaborative project is among their most impactful: They are among the principal investigators on the Asian American Community Cohort and Equity Study, part of a new seven-year epidemiological cohort study of Asian Americans, Native Hawaiians and Pacific Islanders (AsA-NHPI).

In response to the lack of health data for these populations, the study drills down into the risk factors that drive cardiovascular disease, metabolic disorders, diabetes, cancer, mental health and other chronic conditions by collecting a number of biospecimens to analyze for this study and others in the future.

The research team, which includes members from several other centers nationwide, is recruiting at least 2,000 Asian Americans in the greater Philadelphia region for the study. The data will contribute to a larger national cohort of 10,000 AsA-NHPI participants. In addition to learning more about the current health status of these populations, the researchers will follow individuals over time to monitor changes in health through psychosocial, behavioral, clinical and biological data.

“This study is considered historic because it’s the first national effort to establish a comprehensive cohort of Asian Americans, Native Hawaiians and Pacific Islanders,” says Dr. Fang. “It is a critically important step for obtaining the information we need to improve the health of AsA-NHPI communities – both in our backyard and across the United States.”

The epidemiological cohort study is funded by the National Heart, Lung, and Blood Institute, along with four other institutes from the National Institutes of Health (NIH), which is the world’s largest public funder of biomedical research. The team of Drs. Fang and Ma is one of only five in the United States to receive this critical NIH funding for their research supporting Asian American health.

Battling Cultural Factors in Low Screening Rates

Other key collaborative projects include Drs. Fang and Ma as principal investigators on the first large-scale study evaluating a method that enables Asian American women to self-collect samples to test for the presence of human papillomavirus (HPV). HPV, the most common sexually transmitted infection in the United States, can lead to other serious health issues like cervical cancer – for which the majority of Asian Americans do not get routine screenings.

“Cervical cancer screening rates are suboptimal among Asian American women, despite considerable efforts to improve Pap test screening,” Dr. Fang says. “Many of the barriers to screening reported by this population cannot be easily remedied with traditional health promotion programs, so we sought to explore novel approaches for increased participation in cervical cancer screening,” Dr. Ma says.

Although earlier studies have demonstrated that HPV self-sampling can be offered in community settings nationwide, none have focused on Asian American women specifically, despite the fact that this population has among the lowest cervical cancer screening rates, Dr. Fang says. Factors contributing to those low rates include cost, lack of insurance or healthcare access, limited English proficiency, embarrassment about sexual health, or limited time to obtain screening due to work hours.

“These factors speak a lot to the hesitations of Asian American women in participating in screening, and for this population, they are very realistic,” Dr. Ma says. “Stemming from many of them growing up as immigrants or in their native countries when they were young, there was probably no clear guideline for cervical cancer screening at a certain age. It never was part of their life or became a priority.”

This $3.1 million, five-year grant from the National Cancer Institute supports researchers in examining the self-collection of samples for HPV testing in a sample of over 1,000 Asian American women recruited from community sites. Half of the community sites received a previously tested community education program on cervical cancer screening, along with HPV self-sampling kits. The other half received the same education program plus navigation to clinic-based screening. Navigation support could include assistance with language or insurance barriers, transportation issues, or identifying a nearby clinic.

“Unfortunately, we have found that many women have difficulty in accessing preventive care or getting a Pap smear, so this research is informing future health promotion programs for patients who are unable to receive clinic-based cervical cancer screening,” says Dr. Fang. “It also allows us to explore whether this approach is a cost-effective strategy, which is valuable information for policymakers who establish national screening guidelines.”

The Impact of SRD on Care for Liver Disease

Among the 2.4 million Americans living with chronic hepatitis B virus (HBV), Asian Americans are disproportionately affected, with the highest rates of HBV infection and liver cancer. Even while this extraordinarily high risk for HBV infection is known, nearly three-quarters of the Asian American population has never been screened for HBV – which may be driven in large part by structural racism and discrimination (SRD).

SRD shapes persistent health disparities by limiting access to care and directly affecting health and health behaviors. Most research on SRD in the health sector, however, has focused on Black American and Latinx populations. Through a five-year, $4 million grant award from the National Institute on Minority Health and Health Disparities of the NIH – the first of its kind on this topic – Dr. Ma, Principal Investigator, and colleagues are studying the impact of SRD on liver cancer and liver disease among Asian Americans.

Their research focuses on three ethnic subgroups – Chinese, Korean and Vietnamese Americans – in the greater Philadelphia, New Jersey and New York City areas, where Temple researchers have cultivated partnerships with regional and community-based organizations and clinical partners.

“Our research is a deep dive into structural and systemic issues related to liver disease disparities in Asian Americans at three levels: the patient population, the healthcare system and the community,” Dr. Ma says. “It’s a key step in a critical paradigm shift in research on Asian American health issues – moving from individual-level to multi-level investigations.”

Socio-historical hardship and trauma, structural barriers, lack of culturally and linguistically appropriate services and resources, segregation, mistrust of the health system, racism, immigration, and poverty are notable SRD factors that drive disparities in HBV and liver disease. Using integrative analyses, the researchers examine these factors as well as associations between individual, institutional, and community-level SRD and HBV screening uptake and linkage to care.

“About 300 million people worldwide are living with chronic hepatitis B infection, even though infection is preventable through vaccination,” Dr. Ma says. “Our hope is that this first multi-level and longitudinal study will not only help us understand how structural racism drives disparities in HBV infection and liver disease in Asian-American populations, but also how to improve quality of care and advance hepatitis elimination initiatives overall.”

Collaborative Partnerships, Measurable Community Impact

Drs. Ma and Fang each have a long list of scientific innovations that have furthered efforts to control and prevent cancer, and they are highly involved in driving community-based interventions that proactively address health disparities for Asian Americans.

In 2000, Dr. Ma established Temple University Center for Asian Health, one of the first in the nation dedicated to reducing cancer and health disparities among Asian-Pacific Americans. In partnership with community leaders, Dr. Ma co-founded the first Asian Community Cancer Coalition and Cancer Health Disparity Network in the U.S. Eastern Region, including Pennsylvania, New Jersey, New York City, Delaware and D.C./Maryland.

Built on two decades of her leadership, Dr. Ma and her research team have established partnerships with more than 400 community organizations to engage Asian-Pacific American and other minority populations in health disparities research and interventions. Her community-based participatory research and patient-centered outcome research have focused on improving early detection, patient navigation, cancer prevention and control, smoking cessation, and access/quality of healthcare.

In addition, Dr. Ma has directed more than 100 intervention or observational longitudinal research studies – including large-scale cluster randomized intervention trials along with implementation and dissemination studies at worksites, community health centers, primary care clinics, community-based organizations and churches.

Dr. Fang’s research lab focuses on developing interventions for patients with cancer, as well as populations at increased risk for developing cancer. Projects involve collaborating with area partners to implement community-engaged interventions targeting cancer screening and risk reduction behaviors in Asian Americans, making significant contributions to informing evidence-based approaches for addressing health disparities for cancer and other diseases.

Notably, Dr. Fang has developed a unique and comprehensive biobehavioral framework of Asian American immigrant health that models how individual- and neighborhood-level factors may interact to confer biological vulnerability to disease risk. Her lab established one of the first cohorts focused specifically on Chinese immigrants, examining how stressors associated with the immigrant experience contribute to disease risk via inflammatory pathways, and how the specific neighborhoods in which immigrants reside may modify these effects.

These findings aim to enable the identification of the most vulnerable individuals and at-risk communities to target for outreach, and the neighborhoods in which community-based programs might have the greatest impact for promoting health and well-being.

Research, Care, Community

Fox Chase is home to some of the nation’s top cancer specialists, with robust research programs and cutting-edge clinical trials that are not easily accessible elsewhere. As research is accelerating to identify and address health disparities, unique approaches and strategies are evolving to support high-risk populations in accessing the care they need.

That is the ultimate goal of the exhaustive studies by researchers like Drs. Fang and Ma – and a key benefit of Fox Chase’s elite standing as an NCI-designated Comprehensive Cancer Center, currently one of only 56 in the nation. These extraordinarily talented scientists thrive in a setting that is ideal for making fundamentally important discoveries.

Dr. Fang, who has spent her entire career at Fox Chase, has always found tremendous value in an environment where she not only can learn and be supported, but also benefits from collaborating with peer scientists like Dr. Ma.

“There are so many spectacular and wonderfully accomplished female leaders here, as well as a strong peer network,” Dr. Fang says. “I tell my students and mentees that makes the professional journey a lot more enjoyable and meaningful, and it can be helpful along the way when you do encounter barriers, to have that network of really smart people to give you advice and support – or just to listen.”

Dr. Ma agrees: “We’ve always felt like we’re in the same family even before Temple and Fox Chase integrated. We use this kind of structure to leverage all of our expertise and strengths so we can support each other’s work and build on it together.”

Through support from its partnership with Temple Health’s research, treatment and prevention programs, Fox Chase Cancer Center is making a world of difference for underrepresented populations in the greater Philadelphia region and all other communities it serves.

“Together, we’ve been able to make a huge impact by shining a light on the disparities experienced by this population,” Dr. Fang says. “There have been a lot of misperceptions that Asian Americans as a whole do not experience disparities, so the work that all of us have done has helped to educate the public as well as other scientists that this is not the case. That ultimately gives us all the opportunity to be more proactive in collaborating with underserved and understudied populations to better promote health.”

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