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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

New Zarmine Naccashian, PhD, GNP, RN,CDE Assistant Professor, … Conference... · 2016. 2. 29. · To describe the risk factors of Armenian Americans (AA) in Los Angeles for hypertension

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Page 1: New Zarmine Naccashian, PhD, GNP, RN,CDE Assistant Professor, … Conference... · 2016. 2. 29. · To describe the risk factors of Armenian Americans (AA) in Los Angeles for hypertension

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

Page 2: New Zarmine Naccashian, PhD, GNP, RN,CDE Assistant Professor, … Conference... · 2016. 2. 29. · To describe the risk factors of Armenian Americans (AA) in Los Angeles for hypertension

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.

Page 3: New Zarmine Naccashian, PhD, GNP, RN,CDE Assistant Professor, … Conference... · 2016. 2. 29. · To describe the risk factors of Armenian Americans (AA) in Los Angeles for hypertension

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

Page 4: New Zarmine Naccashian, PhD, GNP, RN,CDE Assistant Professor, … Conference... · 2016. 2. 29. · To describe the risk factors of Armenian Americans (AA) in Los Angeles for hypertension

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

Page 5: New Zarmine Naccashian, PhD, GNP, RN,CDE Assistant Professor, … Conference... · 2016. 2. 29. · To describe the risk factors of Armenian Americans (AA) in Los Angeles for hypertension

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

in Glendale, CA

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

Page 6: New Zarmine Naccashian, PhD, GNP, RN,CDE Assistant Professor, … Conference... · 2016. 2. 29. · To describe the risk factors of Armenian Americans (AA) in Los Angeles for hypertension

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

Page 7: New Zarmine Naccashian, PhD, GNP, RN,CDE Assistant Professor, … Conference... · 2016. 2. 29. · To describe the risk factors of Armenian Americans (AA) in Los Angeles for hypertension
Page 8: New Zarmine Naccashian, PhD, GNP, RN,CDE Assistant Professor, … Conference... · 2016. 2. 29. · To describe the risk factors of Armenian Americans (AA) in Los Angeles for hypertension
Page 9: New Zarmine Naccashian, PhD, GNP, RN,CDE Assistant Professor, … Conference... · 2016. 2. 29. · To describe the risk factors of Armenian Americans (AA) in Los Angeles for hypertension
Page 10: New Zarmine Naccashian, PhD, GNP, RN,CDE Assistant Professor, … Conference... · 2016. 2. 29. · To describe the risk factors of Armenian Americans (AA) in Los Angeles for hypertension
Page 11: New Zarmine Naccashian, PhD, GNP, RN,CDE Assistant Professor, … Conference... · 2016. 2. 29. · To describe the risk factors of Armenian Americans (AA) in Los Angeles for hypertension

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

MEAN Age=53 (SD=13.46)

Page 12: New Zarmine Naccashian, PhD, GNP, RN,CDE Assistant Professor, … Conference... · 2016. 2. 29. · To describe the risk factors of Armenian Americans (AA) in Los Angeles for hypertension

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

Page 13: New Zarmine Naccashian, PhD, GNP, RN,CDE Assistant Professor, … Conference... · 2016. 2. 29. · To describe the risk factors of Armenian Americans (AA) in Los Angeles for hypertension

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

Page 14: New Zarmine Naccashian, PhD, GNP, RN,CDE Assistant Professor, … Conference... · 2016. 2. 29. · To describe the risk factors of Armenian Americans (AA) in Los Angeles for hypertension

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

Page 15: New Zarmine Naccashian, PhD, GNP, RN,CDE Assistant Professor, … Conference... · 2016. 2. 29. · To describe the risk factors of Armenian Americans (AA) in Los Angeles for hypertension

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

Page 16: New Zarmine Naccashian, PhD, GNP, RN,CDE Assistant Professor, … Conference... · 2016. 2. 29. · To describe the risk factors of Armenian Americans (AA) in Los Angeles for hypertension

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

Page 17: New Zarmine Naccashian, PhD, GNP, RN,CDE Assistant Professor, … Conference... · 2016. 2. 29. · To describe the risk factors of Armenian Americans (AA) in Los Angeles for hypertension

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

Page 18: New Zarmine Naccashian, PhD, GNP, RN,CDE Assistant Professor, … Conference... · 2016. 2. 29. · To describe the risk factors of Armenian Americans (AA) in Los Angeles for hypertension

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

Page 19: New Zarmine Naccashian, PhD, GNP, RN,CDE Assistant Professor, … Conference... · 2016. 2. 29. · To describe the risk factors of Armenian Americans (AA) in Los Angeles for hypertension

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

Page 20: New Zarmine Naccashian, PhD, GNP, RN,CDE Assistant Professor, … Conference... · 2016. 2. 29. · To describe the risk factors of Armenian Americans (AA) in Los Angeles for hypertension

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

Page 21: New Zarmine Naccashian, PhD, GNP, RN,CDE Assistant Professor, … Conference... · 2016. 2. 29. · To describe the risk factors of Armenian Americans (AA) in Los Angeles for hypertension

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

Page 22: New Zarmine Naccashian, PhD, GNP, RN,CDE Assistant Professor, … Conference... · 2016. 2. 29. · To describe the risk factors of Armenian Americans (AA) in Los Angeles for hypertension

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

Page 23: New Zarmine Naccashian, PhD, GNP, RN,CDE Assistant Professor, … Conference... · 2016. 2. 29. · To describe the risk factors of Armenian Americans (AA) in Los Angeles for hypertension

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

Page 24: New Zarmine Naccashian, PhD, GNP, RN,CDE Assistant Professor, … Conference... · 2016. 2. 29. · To describe the risk factors of Armenian Americans (AA) in Los Angeles for hypertension

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

Page 25: New Zarmine Naccashian, PhD, GNP, RN,CDE Assistant Professor, … Conference... · 2016. 2. 29. · To describe the risk factors of Armenian Americans (AA) in Los Angeles for hypertension

Goal: ◦ Reaching out the uninsured

Planning Committee: ◦ Multidisciplinary ◦ Representatives from City officials

Providers: ◦ Multidisciplinary

Supporters: ◦ Financial

Page 26: New Zarmine Naccashian, PhD, GNP, RN,CDE Assistant Professor, … Conference... · 2016. 2. 29. · To describe the risk factors of Armenian Americans (AA) in Los Angeles for hypertension
Page 27: New Zarmine Naccashian, PhD, GNP, RN,CDE Assistant Professor, … Conference... · 2016. 2. 29. · To describe the risk factors of Armenian Americans (AA) in Los Angeles for hypertension

Providers Medical Dental Optometry Nursing Students Referral

Supporters Hospitals Pharm. Co Businesses Non-Profit

Page 28: New Zarmine Naccashian, PhD, GNP, RN,CDE Assistant Professor, … Conference... · 2016. 2. 29. · To describe the risk factors of Armenian Americans (AA) in Los Angeles for hypertension

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

Page 29: New Zarmine Naccashian, PhD, GNP, RN,CDE Assistant Professor, … Conference... · 2016. 2. 29. · To describe the risk factors of Armenian Americans (AA) in Los Angeles for hypertension

Optometry: ◦ Lion’s Club

WMMC Cancer Registry: ◦ Provided mammogram ◦ Pap test

GAMC Cancer Registry: ◦DRE ◦ PSA

Page 30: New Zarmine Naccashian, PhD, GNP, RN,CDE Assistant Professor, … Conference... · 2016. 2. 29. · To describe the risk factors of Armenian Americans (AA) in Los Angeles for hypertension

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

Page 31: New Zarmine Naccashian, PhD, GNP, RN,CDE Assistant Professor, … Conference... · 2016. 2. 29. · To describe the risk factors of Armenian Americans (AA) in Los Angeles for hypertension
Page 32: New Zarmine Naccashian, PhD, GNP, RN,CDE Assistant Professor, … Conference... · 2016. 2. 29. · To describe the risk factors of Armenian Americans (AA) in Los Angeles for hypertension

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:

Page 33: New Zarmine Naccashian, PhD, GNP, RN,CDE Assistant Professor, … Conference... · 2016. 2. 29. · To describe the risk factors of Armenian Americans (AA) in Los Angeles for hypertension
Page 34: New Zarmine Naccashian, PhD, GNP, RN,CDE Assistant Professor, … Conference... · 2016. 2. 29. · To describe the risk factors of Armenian Americans (AA) in Los Angeles for hypertension

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

Page 35: New Zarmine Naccashian, PhD, GNP, RN,CDE Assistant Professor, … Conference... · 2016. 2. 29. · To describe the risk factors of Armenian Americans (AA) in Los Angeles for hypertension

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.

Page 36: New Zarmine Naccashian, PhD, GNP, RN,CDE Assistant Professor, … Conference... · 2016. 2. 29. · To describe the risk factors of Armenian Americans (AA) in Los Angeles for hypertension