Limited English proficiency (LEP) is a unique vulnerability of older immigrants that poses a significant risk to health and healthcare. Given tha social and environmental contexts play a critical role in the lives of persons with LEP, this application investigates how social connectedness and neighborhood/community characteristics (e.g., ethnic density, health service environments in the neighborhood) influence the link between LEP and health/healthcare. We used Korean American elders as the target group. Our selection was based on the fact that they are members of a rapidly expanding LEP population (i.e., Korean is ranked 4th in the languages spoken by LEP individuals in the U.S.) and that they manifest marked disparities in health and healthcare. The project aims to explore the direct and interactive roles of social connectedness and neighborhood characteristics (1) in the relation between LEP and health and (2) in the relation between LEP and healthcare. The negative impact of LEP on health/healthcare is expected to be greater when individuals lack social connections and/or when they live in areas lack ethnically oriented resources and services. The project employs an innovative and synergistic mix of Social Network Analysis (SNA) and Geographic Information Systems (GIS). To capture the heterogeneity of the population, we will use 3 sites that combine to represent a continuum of Korean American population density: New York (high), Texas (intermediate) and Florida (low). Following focus groups with Community Advisory Boards, direct assessments of ethnic communities will be conducted. At each site, a master list of ethnically oriented services (including health services) will be generated, and each identified service will be geo-coded. Subsequently, 900 Korean Americans (aged e 65, 300 at each site) will be surveyed using a probability sampling procedure. In addition to the traditional survey measures, name-generator approaches will be used to explore participants' social network members and places for healthcare. Using SNA, information from the name generators (names and addresses of people and places) will be indexed to represent (1) social connectedness and (2) engagement with health services at the community. Using GIS, the survey data will be linked to a file combining the 2010 Census and the area resource map derived from the direct community assessment. The combined file will include variables such as proportions of Koreans in the neighborhood and general as well as ethnically-oriented area health services. Multi-Level Models (MLM) will be used to explore the research questions and hypotheses. The results will not only enhance our understanding of the mechanisms underlying LEP vulnerability but also identify individual- and community-level factors (both in people and places) that could be used in health planning and interventions. The overall approach and findings will inform how to develop effective interventions to reduce language barriers and ensure access to appropriate health services for diverse LEP populations.

Public Health Relevance

The application is in response to the NIA's interests in social, behavioral, cultural, and environmental context in addressing racial/ethnic health disparities, and the outcomes will inform how to effectively address health inequities. Results will enhance interventions directed at the 47 million Americans with linguistic barriers.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Research Project (R01)
Project #
7R01AG047106-05
Application #
9812723
Study Section
Health Disparities and Equity Promotion Study Section (HDEP)
Program Officer
Karraker, Amelia Wilkes
Project Start
2015-05-05
Project End
2020-04-30
Budget Start
2018-12-15
Budget End
2019-04-30
Support Year
5
Fiscal Year
2018
Total Cost
Indirect Cost
Name
University of Southern California
Department
Type
Schools of Social Welfare/Work
DUNS #
072933393
City
Los Angeles
State
CA
Country
United States
Zip Code
90089
Jang, Yuri; Kim, Miyong T (2018) Limited English Proficiency and Health Service Use in Asian Americans. J Immigr Minor Health :
Jang, Yuri; Park, Nan Sook; Yoon, Hyunwoo et al. (2018) The risk typology of healthcare access and its association with unmet healthcare needs in Asian Americans. Health Soc Care Community 26:72-79
Jang, Yuri; Rhee, Min-Kyoung; Cho, Yong Ju et al. (2018) Willingness to Use a Nursing Home in Asian Americans. J Immigr Minor Health :
Jang, Yuri; Yoon, Hyunwoo; Park, Nan Sook et al. (2018) Asian Americans' concerns and plans about Alzheimer's disease: The role of exposure, literacy and cultural beliefs. Health Soc Care Community 26:199-206
Jang, Yuri; Yoon, Hyunwoo; Park, Nan Sook et al. (2017) Oral Health and Dental Care in Older Asian Americans in Central Texas. J Am Geriatr Soc 65:1554-1558
Jang, Yuri; Park, Nan Sook; Chiriboga, David A et al. (2017) Latent Profiles of Acculturation and Their Implications for Health: A Study With Asian Americans in Central Texas. Asian Am J Psychol 8:200-208
Jang, Yuri; Park, Nan Sook; Chiriboga, David A et al. (2016) Risk Factors for Social Isolation in Older Korean Americans. J Aging Health 28:3-18
Jang, Yuri; Yoon, Hyunwoo; Park, Nan Sook et al. (2016) Health Vulnerability of Immigrants with Limited English Proficiency: A Study of Older Korean Americans. J Am Geriatr Soc 64:1498-502