CITY OF PORTLAND, MAINE Health and Human Services Department, Public Health Division

1. CITY OF PORTLAND, MAINE Health and Human Services Department, Public Health Division Minority Health Program HEALTH (CANCER) RISK ASSESSMENT: TELESCOPING THROUGH THE CULTURAL EYES Presentation by Kolawole A. Bankole, M.D., M.S.

2. Let’s celebrate diversity

3. Contents • Project Aim / Goal • Background/Demographic paradigm • Diversity in Maine • Methodology and Approach • Results and Outcome analyses • Clinical / Public health implications • Minority Health Program’s interventions • Conclusion

4. Project Aims / Goals • Reduce health disparities among Portland, Maine’s racial/ethnic minority through computerized health risk assessments, counseling and referral for quality and affordable services.

5. Background/Demographic paradigm • Changes in the diversity of Portland, Maine demographics with > 57 different ethnic language groups • Increase in primary & secondary immigrants • Largest 11 ethnic/language groups: Khmer, Arabic, Spanish, Acholi, Somali, Serbian/Croatian, Vietnamese, Nuer, French, Chinese, and, Russian.

6. Diversity in Maine In 2005: • 20,000 Hispanics • 19,000 Asians • 8,000 African Americans • 7,000 Native Americans • Source: www.pressherald.com • National Center for Cultural Competence, 2004 ACS: American Community Survey

7. City Fact sheet: Portland, Maine Summary City Data (and Source) Population (2003 CB est.): 63,635 Population (2000 Census): 64,249 Foreign-born Population (2000 Census):4,895 Share Foreign Born (2000): 7.6% Population Projection 2025 (FAIR*): 64,000 *FAIR: Federation for American Immigration Reform

8. Pre-migration: exposure to infectious & parasitic diseases, physical & psychic trauma During migration: malnutrition, exposure to the elements, physical & psychic trauma Post-migration: increasing susceptibility to chronic diseases, problems of resettlement (racism, unemployment, ESL, crime, etc.) Journey to “Well-Being”Link between migration & resettlement health burden:

9. Methodology and Approach • Exploratory, outreach/research Project ~ Aug. ‘05 – June, ’06. • Sample size: 202 individuals across 6 racial/ethnic groups • Africans~A/Americans: Somali, Sudanese, Great Lakes of Africa/French • Asians: Cambodian, Vietnamese • Caucasians: Russian • Eleven community meetings and outreach educational sessions held. • Confidential individualized health risk assessment (HRA) survey implemented • Survey results with computer software analyses (TRALE, Inc. software)

10. Cancer / health risk variables assessed • Demography: Gender, Age, and Ethnicity • Tobacco smoking status and Alcohol • Nutrition and physical activity • Stress and depression • Current health status & medical care status • Family history • Women and Men’s health statuses • Vehicle safety • Readiness to change • Biometric measures ~ height, weight, blood pressure

11. Results and Outcomes analyses • Overall wellness score was 67. • A score below 80 indicates elevated likelihood of developing certain medical conditions • Individual variable scores below

12. Overall Wellness: Score 67

13. Risk Areas

14. Demographic: Gender

15. Demographic: Age

16. Demographic: Ethnicity

17. Cancer Risks • Controllable cancer risks: Weight, Nutrition, and Tobacco use • Uncontrollable cancer risks: Family history, age, race, and sex • Overall cancer score: 68

18. Direct Cancer Risk effects • Overall Score: 68 • Some cancers directly affected 3% of the groups' population • Runs in families: • Breast cancer 2% • Ovarian cancer 24.8% • Colon or Rectal cancers 11.4%

19. Cancer Risk Factors

20. Men’s Health

21. Self-Testicular Exam

22. Women’s Health

23. Women’s Health • 106 female participants • 59.4% ~ Pap smear within past 3yrs • 26.5% ~ Digital rectal exam within past 2yrs • 61.2% ~ Mammogram within past 2yrs (aged >40yrs) • 2.8% ~ Have at least one immediate relative who had breast cancer

24. Tobacco

25. Cigarette Smoking

26. Physical Activity: Score 49

28. Body Mass Index: Average Women~18.2; Men~17.2

29. Weight Management

30. Mental Wellness: Score 69

31. Stress and Depression

32. Nutrition: Score 51

33. Nutrition Risk

34. Alcohol: Score 94

35. Blood Pressure: Score 51

36. Diabetes: Score 61

37. Self-reported Blood Sugar

38. Heart Health

39. Motor Vehicle Safety: Score 84

41. Clinical / Public health implications • Qualitative health status information for public health interventions • Counseling and referrals for needed services • Improved racial/ethnic data collections • Attempts to reflect goals & objectives of Maine Comprehensive Cancer Control Plan/ ME CDC & Prevention

42. Clinical / Public health implications • Improving awareness and understanding of health care services • Strengthening health care providers’ capacities to better understand risk areas and create infrastructure to meet health needs of communities • Acknowledge value of holistic approaches in health healing within ethnic minority communities

43. Minority Health Program’s Interventions • “Latinos Exercise for Health and Love” event: • 737 participants • 85 screened for diabetes & HPTn; 4 alarm values • 67 without PCPs; 41 now connected with PCPs • “3rd Annual Latino Soccer Tournament” 6 teams; 577 attended • “2nd Annual Festival of Nations’ Soccer Tournament”; 8 teams; ~655 attended • “Somali/Sudanese Walk for Life” event 65 participants

44. Minority Health Program’s Interventions • “BRISK”/ breast cancer prevention project • Diabetes prevention & healthy nutrition • DM prevention & mgt educational series • “Let’s Go” Healthy Weight Initiative • “Somali/Sudanese Exercise for Health and Love” event: May 19, 2007

46. Contact info. Kolawole A. Bankole, M.D., M.S. Minority Health Program Coordinator / Access Project Director Public Health Division Health & Human Services Department City of Portland, Maine 389 Congress St., Portland, ME 04101 Tel 207-874-8773, Fax 207.874.8913 Email: bak@portlandmaine.gov Web site: http://www.portlandmaine.gov/hhs/phminority.asp