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The PINE Study

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Population Study of ChINese Elderly in Chicago
AbbreviationThe PINE Study
PurposeTo improve the health and quality of life of the U.S. Chinese Aging population through education, research, advocacy, poly and sustainable community-engagement.
Location
MethodsCommunity-based participatory research
Official language
English, Mandarin, Cantonese, Taishanese, Teochew
Main organ
Chinese Health, Aging, and Policy Program, Rush Institute for Healthy Aging, Rush University Medical Center
AffiliationsNorthwestern University,

Chinese American Service League,

Xilin Asian Community Center
Budget
NIH funded
The PINE logo

The Population Study of ChINese Elderly in Chicago (PINE) Study is the collaborative effort between the Chinese Health, Aging, and Policy Program (CHAP) at Rush University, Northwestern University and several community services organizations, including Chinese American Service League , Midwest Asian Health Association (MAHA) and Xilin Asian Community Center as the main community partners. This synergistic academic-community partnership is led by XinQi Dong MD, MPH at Rush University, Melissa A Simon, MD, MPH, Esther Wong, ACSW, and guided by community-based participatory research (CBPR) approach. [1] [2] The PINE Study is an extensive study that examines the health and well-being of Chinese older adults in the greater Chicago area- the largest cohort of Chinese elderly ever assembled for epidemiological research in Western countries. [1] The image of "PINE" in Chinese culture symbolizes longevity, resilience, respect and successful aging, which was a suitable name for the study, in parallel to the research objectives. [1]

Between 2011 and 2013, 3,159 face-to-face interviews were conducted with elderly living in the community, ages ranging from 60 to 105. [1] [3] Each participant’s interview was personalized according languages or dialects they preferred, such as English, Cantonese, Taishanese, Mandarin or Teochew. [4] Data were assembled using a web-based program application which had English, Chinese traditional and simplified characters. [1]


Background

Overall Chinese population

The Chinese population constitutes 56 different ethnicities, with 53 language dialects, 21 of which possessed their own written scripts. [5]

Chinese population in United States

The Asian population in the States, including those who are of mixed race, is estimated to be 18.2 million in 2010; those who identify only as Asian is estimated to total 14.7 million, approximately 4.8 percent of the population. [6] According to the Census BureauExternal Web Site Icon, it is projected that there will be more than 40.6 million Asians present in the United States, comprising 9.2 percent of the total U.S. population by the year of 2050. [7] Amongst the Asian population, Chinese population (except Taiwanese descent) is one the largest Asian group in United States in 2011, constituting 4 million people. [6] [8] The Chinese American population was found to be mostly distributed in California (1,122,187, 40 percent), New York (451,859 16 percent), Hawaii (170,803), Texas (121,588), New Jersey (110, 263) and Massachusetts (92,380) with Illinois (86,095). [9][10] Chicago is among the top 10 cities where Chinese Americans are concentrated. . [6] [10] In most major US Cities, Chinese communities are mostly dominant in Chinatowns, usually called as "Tang2 Ren2 Jie1" in Mandarin and "Tong yan gai" in Cantonese. [10] One of the largest Chinatowns in North American is Chinatown, Chicago, where first few Chinese immigrants settled when they arrived in Chicago in 1870s. [11]

Chicago Chinatown Gate at Night

Among 56 ethnic groups in China, Mandarin is the predominant dialect that is spoken. In the Chicago area, in addition to Mandarin, Cantonese, Taishanese and Teochew are predominantly spoken.

Chinese population in Chicago

In 1910, Chinese population in Chicago passed the number of 1,000. 2 years later, due to the increasing living costs and racial discrimination, majority of the Chinese moved towards the south side of Chicago, leading to the establishment of the new Chinatown near Wentworth and Cermak. [11] [12] After the Chinese Exclusion Act was repealed in 1943, a second wave of immigration occurred where they sought economic opportunities and family reunion. The revolution that occurred in mainland China in 1952 and the Tiannanmen Square protests in 1989 further increased the settlement of Chinese in the US. [12] [11] The Chinese population from Hong Kong, Taiwan and China further increased with the Immigration and Nationality Act of 1965 in addition to the increase the visa quota by 40% in 1990. In 1970s, Chicago has the 4th largest Chinese population in the US and by 2012, Census 2010 data recorded 42,060 Chinese in Chicago. [12] After the conclusion of Vietnam war in 1975, a large number of ethnic Chinese from Vietnam, Cambodia, Thailand and Laos settled at uptown Argyle. [11] In Illinois, Chinese community is growing rapidly and increased 35.4% between year 2000 to 2010. [13] This rate is much faster than the Black (decreased 1%), Hispanic (increased 33%) and White (decreased 3%) population. [14] Similar trends are seen in Cook County and the city of Chicago. In the past 10 years, the Chinese population has experienced an increase of 30% in Cook County, while the number of overall population has declined. The city of Chicago also experienced a similar pattern; Chinese population increased by 35.7% whereas the total population decreased by 7%. [2]

Project Goal

With rapidly increasing global aging population, it is estimated that China's elderly population aged over 60 will hit 360 million by 2030. [15]At the same time, it is projected that between 2012 and 2050, United States will also experience considerable growth in its older population, from 43.1million to 83.7 million, due to the baby boomers. [16] Amongst the Asian subpopulation, Chinese American community was found to be one of the oldest, largest and among the fastest growing. Furthermore, they are also graying rapidly with a growth rate of almost four times higher than of overall U.S. older adult population from 2000 to 2010.

Despite national statistics reports where U.S. Chinese older adults possess a longer life expectancy as compared to the general population, the initial phase of PINE Study discovered that elderly may not be enjoying the best quality of life. [2] By shedding light on the health and well-being of Chicago Chinese older adults, the goal is to improve the health and quality of life of the Chinese aging population through education, research, advocacy, policy and sustainable community engagement in the Greater Chicago Area and beyond. [17]

Methods

The PINE Report

Community-Based Participatory Research

To assess Chicago Chinese population's health needs congruent to Chinese social, cultural and linguistic background, the PINE Study team executed a community-based participatory research approach to lay the foundation required for community health promotion. [1] [17] This research design uses exhaustive health inquiry for education, empowerment and affecting sustainable social change, and engagement the participation of community members affected by health issues. For the last decade, this academic-community partnership has been catered to improve the health and well-being of Chicago’s Chinese population. [18]

Data Collection

Chinese older adults, 60 years old and over, in the greater Chicago area were invited to participate in the study. Participants have been contacted in community settings, such as community-based organizations, social services agencies, churches, educational and outreach activities, senior apartments, newsletters and advertisements in community centers, and also by word of mouth. [1] [4] Multicultural and multilingual interviewers were trained to conduct in-home interviews face-to-face with participants in their preferred language and dialect, predominantly Cantonese, Taishanese, English, Mandarin and Teochew dialects. [1] [4] During the 2011-2013 period, over 3,000 interviews were conducted. Questions were selected from scales that were validated in social science and public health research, translated into Chinese (if Chinese version was not available) and translated it back to English. The survey questionnaires were further inspected by investigator to ensure content and validity. Data were then collected using state-of-science web-based software that recorded in English, Chinese traditional and simplified characters. [1] This technological platform minimized any information that may be "lost in translation" therefore providing further meaning in the data that was collected. [1]

Partners

Academic Partners

Rush Institute for Healthy Aging (RIHA) RIHA was formed in 1990 with the goal to better understand the health of community through rigorous research. Through the years, RIHA has participated in 50 research projects, with over 300 studies, providing knowledge and information in regards to health disparities, cognitive and physical function, quality of life, psychosocial and other issues in the community.

Community Organizations

  • Chinese American Service League (CASL)
  • Xilin Asian Community Center
  • Midwest Asian Health Association (MAHA)

Community Advisory Board

Role

The Chinese Community Advisory Board was created to better understand community’s needs and represent the diverse population of Chinese population in Chicago. The Board has played a role in providing overall guidance and advice to the PINE Study, ranging from project conceptualization and preparation, survey implementation, recruitment and finding dissemination. The members are composed of community leaders and stakeholders from a variety of organizations and disciplines who have frequent interactions with the elderly population and an expert in their own fields. [4] Board meetings are held every 1-2 months with continuous feedback to ensure community steady support and to refine project goals and procedures.

Funding

The PINE Study is funded by the National Institutes of Health and is consistent with NIH's goal of improving health and aging and reducing health disparities in all racial/ethnic groups. [19]

Data and Findings

Demographic Profile

  • The average age of participants was 73 years old with 59% of women. 58% of the elderly are married while 1/4 of them live alone. [13]
  • Despite elderly in this sample population lived, on average, in the US for about 20 years, 76% of them still exclusively read or speak Chinese, 91% of them socialize with only Chinese people, and 89% have only Chinese friends. [2]
  • Elderly in this study have lower education and are more likely to be living with significant financial hardships as compared to national estimates of all US elderly. 86% of them live below the poverty line. [2]
  • 36% of the participants consider religion to be important part of their lives with 54% of them performed religious services at home in the last year when we interviewed them. [2]

Health

  • The three most common diseases found amongst Chinese population were hypertension (56%), hypercholesterolemia (49%) and osteoarthritis (39%). [20] [21] These levels were similar and slightly higher than US National estimates.
  • The leading causes of mortality were heart disease (25%), cancer (23%) and stroke. [2]
  • 8% of study participants reported limitation of at least one aspect of Activities of Daily Living (ADL), predominantly walking and bathing. [22]
  • 51% of participants reported at least one limitation of Instrumental Activities of Daily Living (IADL), predominantly shopping, doing housework and laundry. [22] [20]

Healthcare Utilization

  • Chinese elderly uninsured rate is 5 times higher than national estimate. At time of interview, 24% of elderly do not have insurance. [3] [20]
  • Chinese elderly are found to not receive lesser preventive health care as compared to the national estimate, with 28% receiving a colonoscopy and 35% receiving a mammogram in the last 2 years. [23]
  • Traditional Chinese Medicine is used commonly by 76% of participants reported the use of traditional health remedies in the past year. [3]

Mental Health

  • Mental health is a significant health burden in Chinese elderly population with an alarmingly high amount of older adults experiencing various form of psychological distress. 74% of older adults report life stress, 66% experience anxiety symptoms [24] and 55% of elderly reports depressive symptoms. [25] [20] [21]
  • Suicidal ideation and attempts are disproportionately prevalent with 3.7% of Chinese elderly over the age of 60 report suicidal thoughts in a year as compared to 2.3% of US older adults aged 50 and over. [26] [20] 9.4% of them had suicidal thoughts at some point during their lifetime, with 2 out of 1000 participants attempted suicide in the past year. Lifetime suicide attempts were prevalent at 9 out of 1000. [20]

Elder Abuse

  • Elder abuse is an alarming health issue that was faced by Chinese older adults[27] , with 24% experienced some form of abuse, predominantly psychological abuse (10%) and financial exploitation (10%). [28] [29] [21] [30] [20]
  • 32% of elderly have also experience other forms of violence before they turned 60, including child abuse and domestic partner violence. [29] [28] [20]

Social Well-Being

  • Chinese older adults' social networks tend to center around family than friends, with 71% of elderly participants able to identify more than 4 close family members. [3] On the other hand, 14% of participants report not having any friends. [3]
  • It was found that older adults are more likely to perceive social support from family members (90%) than friends (70%) and depend on family's support (90%) than friends (60%). [3] [31]
  • Chinese older adults continue to expect the value filial piety, which is a culturally critical factor that expects children's caregiving obligations. This expectation is mainly placed upon the emotional aspect of care such as respect (90%) which is twice the expectation of instrumental care like financial support (43%). [3]
  • Chinese elderly exhibit a high sense of belonging in the community where they reside, alongside the feeling that the neighborhood is a good place to live in and feel right at home in the community they are in. [32] [3]

Implications

With the data that is collected from the PINE Study, it is shown that there are many health disparity issues that are found in the fastest growing aging US communities. At present, there are very few services that cater to the need of Chinese older adults and their families, which is also deprived of a workforce that would be able to provide linguistically and culturally appropriate care. Consequently, this is a clear and current call for increased social and health care services in the interest of this vulnerable population. A multi-disciplinary partnership must be built to provide them with a much needed disease prevention, intervention and support strategies for successful aging. [33]

Future Directions

Longitudinally

Currently, the study is in PINE 2.0 phase, where PINE study team follows up on the Chinese older adults to examine the health status changes over time in order to better understand the risk and protective factors associated with health disparities.

Additional Studies

Patient Navigation Project

This project targets low-income women and to guide navigation around the U.S. healthcare and preventive care systems, in attempt to eliminate access barriers in addition to provide early intervention and prevention measures to promote healthy and successful aging. [34]

Suicide Intervention Project

This program attempts to identify older adults at risk for suicidal ideation in order to provide culturally sensitive outreach programs to increase support systems. Health promotion programs expansion intends to raise awareness and level of health knowledge including under-recognized medical conditions like psychological distress and elderly abuse. [35] [4]

Focus Group Discussions

Focus groups discussions examine key issues, such as mental health, cancer and intergenerational relationships that Chinese elderly face, via in-depth in person or interactive group interviews, where participants talk freely about the discussed topics. [27]

Data Sharing

As described in the National Institutes of Health (NIH) Data Sharing Policy, data sharing encourages the use of exclusive data, advocates quality collaborations that across institutions, and expedite rapid translation of research data into publicly accessible knowledge. [36] Collaborative research effort through data sharing is critical to the success of the ongoing effort promote health and well-being among Chinese older adults.

References

  1. ^ a b c d e f g h i j http://jah.sagepub.com/content/26/7/1085.long
  2. ^ a b c d e f g http://chinesehealthyaging.org/pinereports.html
  3. ^ a b c d e f g h http://www.worldjournal.com/view/wjilnews/22191812/article-%E8%A8%AA3000%E8%80%86%E8%80%81-%E8%8F%AF%E4%BA%BA%E6%9D%BE%E5%B9%B4%E5%A0%B1%E5%91%8A%E5%87%BA%E7%88%90?instance=il1
  4. ^ a b c d e http://www.asianfortunenews.com/2014/12/no-more-parachutes/
  5. ^ http://www.edb.gov.hk/attachment/sc/about-edb/press/consultation/devt_of_sg_to_chi_ncs_e.pdf. Experiences in Mainland China, page 17. Retrieved on Jan 22, 2015
  6. ^ a b c http://www.census.gov/prod/cen2010/briefs/c2010br-11.pdf
  7. ^ http://www.cnn.com/2008/US/08/13/census.minorities/. Minorities expected to be Majority in 2050. Retrieved on Jan 22, 2015
  8. ^ http://www.cdc.gov/minorityhealth/populations/REMP/asian.html Asian American Population Demographics. Retrieved on Nov 18, 2014
  9. ^ Baylor Ronald H. (2011). "Multicultural America: An Encyclopedia of Newest Americans, Volume 1", Appendix 1 Table 49. Greenwood. ISBN 978-0313357862. Retrieved on Jan 22, 2015
  10. ^ a b c http://www.ameredia.com/resources/demographics/chinese.html
  11. ^ a b c d http://www.chicago-chinatown.info/chinatown-history.html
  12. ^ a b c http://chinesehealthyaging.org/files/PINE_Final_Reports/6.pdf
  13. ^ a b http://jah.sagepub.com/content/26/7/1100.full
  14. ^ http://igpa.uillinois.edu/content/census-reveals-population-change-illinois Population Change in Illinois. Retrieved on Jan 22, 2015
  15. ^ http://jah.sagepub.com/content/26/7/1079.extract
  16. ^ http://www.census.gov/prod/2014pubs/p25-1140.pdf An Aging Nation: The Older Population in the United States: Population Estimates and Projections. Retrieved on Nov 18, 2014
  17. ^ a b http://www.suhichicago.org/files/building%20a%20chinese%20comm%20survey_2008%20dec.pdf
  18. ^ http://www.healthit.gov/facas/sites/faca/files/PSWG_Background_Leslie_Francis_NCVHS_Toolkit_2014-12-08.pdf Toolkit for Communities using Heath Data, Community Engagement, page 22. Retrieved on Jan 22, 2015
  19. ^ https://www.rush.edu/news/press-releases/nih-grant-spurs-health-science-research-chicagos-chinatown NIH Grant Spurs Health Science Research in Chicago’s Chinatown. Retrieved on Jan 22, 2015
  20. ^ a b c d e f g h http://www.chineseofchicago.com/Content.aspx?nid=3857
  21. ^ a b c http://www.dnainfo.com/chicago/20130412/chinatown/chicagos-chinese-american-seniors-report-high-level-of-abuse
  22. ^ a b http://biomedgerontology.oxfordjournals.org/content/69/Suppl_2/S31.short
  23. ^ http://biomedgerontology.oxfordjournals.org/content/69/Suppl_2/S7.full Preventive Care Service Usage Among Chinese Older Adults in Greater Chicago Area. Retrieved on Jan 22,2015
  24. ^ http://biomedgerontology.oxfordjournals.org/content/69/Suppl_2/S61.full. Anxiety Among Community-Dwelling US Chinese Older Adults. Retrieved on Jan 22, 2015
  25. ^ http://www.ncbi.nlm.nih.gov/pubmed/25239971 Depressive Symptoms Among Community-Dwelling Chinese Older Adults in Greater Chicago Area. Retrieved on Jan 22, 2015
  26. ^ http://jah.sagepub.com/content/26/7/1189.full Suicidal Ideation in an Older US Chinese Population. Retrieved on Jan 22, 2015
  27. ^ a b https://www.rush.edu/news/press-releases/elders-us-chinese-community-perceive-mistreatment-pervasive-problem
  28. ^ a b http://jah.sagepub.com/content/26/7/1209.abstract
  29. ^ a b http://biomedgerontology.oxfordjournals.org/content/69/Suppl_2/S68.full.pdf
  30. ^ http://ny.stgloballink.com/community/2014/1107/151819.shtml
  31. ^ http://jah.sagepub.com/content/26/7/1137.full The Perception of Social Support Among US Chinese Older Adults. Retrieved on Jan 22, 2015
  32. ^ http://www.aimspress.com/aimsmeds/ch/reader/view_abstract.aspx?file_no=20140103&flag=1 Sense of Community among Chinese Older Adults in Greater Chicago Area. Retrieved on Jan 22, 2015
  33. ^ http://biomedgerontology.oxfordjournals.org/content/69/Suppl_2/S1.full
  34. ^ http://www.worldjournal.com/view/wjilnews/16639426/article-%E4%B9%B3%E7%99%8C%E9%A0%90%E9%98%B2%E8%AC%9B%E5%BA%A7-%E8%81%BD%E8%80%85%E5%8F%97%E7%9B%8A?instance=il_news
  35. ^ https://clinicaltrials.gov/ct2/show/NCT02096432?term=xinqi+dong&rank=1 Clinicaltrials.gov. Suicide Prevention in Chinese Older Adults. Retrieved on Jan 22, 2015
  36. ^ http://grants.nih.gov/grants/policy/data_sharing/. NIH Data Sharing Policy. Retrieved on Jan 22, 2015
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