New Zarmine Naccashian, PhD, GNP, RN,CDE Assistant Professor, … Conference... · 2016. 2. 29. ·...

Zarmine Naccashian, PhD, GNP, RN,CDE Assistant Professor, CSUN

Felicitas A. dela Cruz, RN, DNSc, FAANP Professor and Director, APU

Center for the Study of Health Disparities

To describe the risk factors of Armenian Americans (AA) in Los Angeles for hypertension (HTN) and diabetes mellitus (DM). Specifically, it sought to: measure their height, weight, blood pressure (BP), lipids, blood sugar, waist and hip circumferences; and identify their risk factors for HTN& DM.

Armenian Americans (AAs) were among first Europeans to come to America in 1618(Mirak, 1983)

Influx of Armenian immigration incremental relative to political situation in the countries of origin, starting early

19th century

Currently, over ½ million Armenians live in LA (Papazian, 2001)

Seldom studied as a group, called hidden minority (Rollins, 1981)

No data are available on health risks of AAs in general, on prevalence of chronic diseases such as HTN and DM

Research design: descriptive (cross-sectional) Setting: Glendale Health Festival

in Glendale, CA

Sample: 272 AAs who attended the community health fair in November 2011

Data collection: Volunteer, trained AA, RNs, members Arm.Amer.Nurs.Assoc.(AANA) measured/tested participants height and weight waist and hip circumferences blood pressure (BP), lipids and blood sugar

Sex and Age of AA Participants SEX •Male = 84 (31%) •Female= 188 (69%)

MEAN Age=53 (SD=13.46)

Age Frequency Valid % <30 23 08.5 30-39 21 07.7 40-49 49 18.1 50-59 87 32.1 60-69 70 25.8 70-79 18 06.6 80-89 3 01.1 Total 271 100.0

Weight BMI Freq % Underwt <18.5 2.9

Nl wt 18.5-25 069 25.4 Overwt 25-30 086 31.6 Obese >30 106 39.4

Missing 003 01.1 Total 272 100

BP BP Freq % Normal <120/80 105 38.6

Low Pre-HTN 120-129 37 13.6 High Pre-HTN 130-139 60 22.1

HTN >140/90 67 24.6 Missing 003 01.1 Total 272 100

Sex

Reference Circumf Mean SD Variance Range

Male (n=84) <40”(91cm) Waist 39.67 7.85 61.85 27-88

Hip 41.73 4.20 17.71 33-63

Fem (n=188) <35” (80 cm) Waist 36.54 5.62 31.68 24-59

Hip 43.85 23.5 553.6 22-355

Waist/Hip Reference Mean SD Coeff Disper

Range

Men <0.90 0.99 0.15 0.072 0.69-2.17

Women <0.85 1.03 0.09 0.069 0.075-1.31

Glu level Reference Freq % bld gluc <60 1 0.40 Normal 60-100 149 54.8 Pre-DM 101-125 77 28.3

DM >126 44 16.2 Missing 01 0.40 Total 272 100

HDL Refere Freq % High risk <40 83 30.5 Optim level >40 124 45.6 Protect level >60 54 19.9 Total; 272 100

LDL by Refer Fre % Opt LDL <70 60 22.1 Near Opt LDL <100 72 26.5 Border High >130 59 21.7 High >160 29 10.7 Very High >200 15 05.5 Missing 37 13.6 Total 272 100

Trig Reference Freq % Optimal <150mg/dl 101 37.1 High Risk 150-200 57 21.0 High >200mg/dl 112 41.2 Missing 02 0.7 Total 272 100

Category Reference Freq % Desirable <200 102 37.5 risk 200-240 102 37.5 High >240 67 24.6 Missing 01 0.4 Total 272 100

Over a third had pre-HTN Over a fourth with HTN Nearly ¾ exceeded normal BMI Nearly half had pre DM or DM Slightly over 2/3 had high total cholesterol (TC) and triglycerides

Anthropometric & laboratory measures revealed substantial percentage of AAs manifesting risk factors for HTN & DM Importance of incorporating waist/hip measurements at each clinic visit

Health fair is effective venue for: ◦Identifying risk factors & case finding ◦Health promotion & disease prevention counseling ◦Channeling uninsured attendees to community clinics for primary care delivery needs

Goal: ◦ Reaching out the uninsured

Planning Committee: ◦ Multidisciplinary ◦ Representatives from City officials

Providers: ◦ Multidisciplinary

Supporters: ◦ Financial

Providers Medical Dental Optometry Nursing Students Referral

Supporters Hospitals Pharm. Co Businesses Non-Profit

Physicians and dentists: ◦Members of the Armenian Medical Society ◦ Local providers:Hospitals in Glendale Advertised via hospital medical staffing office Advertised on FB ◦ Provided: screening, consultation, service ◦ Referral to community clinics

Optometry: ◦ Lion’s Club

WMMC Cancer Registry: ◦ Provided mammogram ◦ Pap test

GAMC Cancer Registry: ◦DRE ◦ PSA

Nursing: ◦ Members:Armenian American Nurses Asso ◦ POCT: Blood lipids, glucose ◦ BP measure ◦ BMI measure ◦ Flu shots through Health Dept. ◦ Education

Referral: ◦ Comprehensive Community Health Center ◦ All for Health, Health for All ◦ QueensCare

CLIA waived license License obtained via Health Dept. with fee

Machines Cholestech LDX Order 300 cassettes or more, get one free

machine (Henry Sheine distributor) Borrow from other clinics

Supplies:

Hospitals ◦ New service/dept. represented

Pharmaceutical companies ◦ Grant money

Businesses ◦ Home Health ◦ Adult Health Day Care Centers

Organizations ◦ Armenian Relief Society (social issues) ◦ LA County Office of Women’s Health

Collaborative work with health care providers Exploring social/health issues/problems Serving community Allowing students opportunities to do

volunteer work or gain community outreach clinical practice hours.

Analyzing data to identify extend of health problem and plan interventions accordingly.