Lohr, Abby M.

Background: Southeast Asian Americans (SEAAs) experience a disproportionately high burden of hepatocellular carcinoma (HCC), with incidence in several subgroups (i.e., Cambodian, Laotian, and Vietnamese individuals) reaching up to nine times that of non-Hispanic Whites. HCC in SEAAs is largely driven by chronic hepatitis B (HBV), hepatitis C (HCV), metabolic dysfunction–associated steatotic liver disease (MASLD), and alcohol-associated liver disease (ALD). Despite established screening guidelines, under-detection and delayed diagnosis remain common. Objective: To summarize epidemiologic patterns, risk factors, screening challenges, and potential interventions aimed at reducing HCC disparities among SEAAs. Design and Methods: This narrative review synthesized evidence from population based epidemiologic studies, community-based interventions, health services research, and policy analyses. Attention was given to studies reporting disaggregated SEAA subgroup data. Findings derived from SEAA specific studies were distinguished from evidence drawn from broader Asian American or general cirrhosis populations, with inferential steps explicitly noted where subgroup specific data were limited. Key Findings: HCC incidence varies widely across SEAA subgroups, with elevated HBV- and HCV-related HCC in Vietnamese, Cambodian, and Laotian communities, and increasing MASLD-related HCC including among lean individuals who fall outside many surveillance frameworks. Screening and surveillance remain suboptimal, with fewer than 30% of patients with cirrhosis receiving recommended semiannual HCC surveillance and even lower uptake among SEAAs. Barriers include low HBV/HCV screening rates, limited disease awareness, language barriers, underinsurance, provider knowledge gaps, and lack of automated EHR-based reminders. Structural challenges such as poverty, transportation barriers, and limited access to specialty care further delay diagnosis. Proposed Interventions: Culturally tailored outreach programs, bilingual navigators, and community-based screening initiatives have demonstrated improved HBV/HCV testing and linkage to care. AI-enabled EHR tools may enhance identification of high-risk patients, streamline follow-up, and increase surveillance adherence. Expanded use of non-invasive fibrosis assessment and recognition of MASLD-related risk in non-obese individuals may support earlier detection. Policy priorities include mandatory Asian subgroup data disaggregation, expanded insurance coverage, and strengthened community-level healthcare infrastructure. Conclusions: SEAAs face a substantial and preventable HCC burden. A coordinated approach combining culturally tailored community engagement, improved provider support systems, and policy reforms is essential to improving early detection and reducing HCC disparities in this diverse population.

Abstract Background Immigrants to the United States often face challenges from limited healthcare access and less healthy environments which contribute to rising obesity and cardiovascular risk. Purpose To assess the feasibility and effectiveness of a community-based social network intervention for cardiovascular risk reduction among Hispanic and Somali adults. Methods A social network-informed, community-based participatory research-derived health promotion intervention was delivered by Hispanic and Somali lay health promoters (HPs) to members of their social networks over 1 year (12 biweekly sessions in months 0-6; 12 biweekly check-ins in months 7-12). Using a closed-cohort stepped wedge cluster randomized design, social networks were randomly assigned to receive the intervention immediately or after a delay of 1 year. Measurements at baseline, 6 months, and 12 months were derived from 6 of the American Heart Association’s “Life’s Simple 7”: BMI, blood pressure, fasting glucose, cholesterol, physical activity and dietary quality (range 0-12, with higher values indicating lower cardiovascular risk). Waist circumference and proportion of participants who achieved >5% body weight loss were also assessed. Results Four hundred seventy-five participants were enrolled among 51 HPs (29 Hispanic; 22 Somali). There was a statistically significant improvement in cardiovascular risk in the intervention group (n = 246) compared with controls (n = 229) at 6 months (0.4 [1.8] vs. −0.1 [1.7]; P = .03) that was not sustained at 12 months (0.5 [1.9] vs. 0.3 [1.8]; P = .38). There was a statistically significant higher proportion of participants who lost >5% of body weight in the intervention group compared with controls at 12 months (37% [15] vs. 18% [7.9]; P = .02). Reductions in weight and waist circumference in the intervention group compared with controls did not achieve statistical significance. Conclusion A social network intervention, delivered by lay HPs was feasible and resulted in a modest improvement of cardiovascular risk and clinically significant weight loss. Clinical Trial Identification Number NCT05136339.

Due to systemic barriers, policymakers in the United States may be unaware of immigrants’ health-related priorities. In response, Rochester Healthy Community Partnership, a 22-year community-engaged partnership, collaborated with 14 Hispanic/Latino and Somali immigrant health promoters in fall 2023 using Photovoice to document their health-related assets and needs. After taking photos, the health promoters reflected, discussed the issues revealed in their images, and developed policy recommendations. Guided by Public Health Critical Race Praxis, we used thematic analysis to analyze health promoters’ reflections. Three themes emerged: healthy choices, inclusion of people and cultural celebrations, and access to opportunity. Health promoters want to expand healthy choices in Southeast Minnesota by growing community garden programming, protecting the environment, making healthy options accessible, and opening an affordable gym. They highlighted the importance of integrating culture and community into youth education, access to culturally appropriate foods, and the need to address Islamophobia. Health promoters wanted increased access to job opportunities, affordable housing, and health care. They saw these opportunities as vehicles for self-improvement but emphasized time management as essential in the United States. Ensuring that immigrants have a meaningful voice in shaping policies that affect health is critical. Policymakers can leverage these findings by demonstrating responsiveness to community-identified priorities and acting on health promoters’ policy recommendations. We encourage future Photovoice researchers to apply explicitly anti-racist frameworks, such as Public Health Critical Race Praxis, to document and challenge systemic oppression.

Diabetes self-management education (DSME) programs are evidence-based interventions that improve glycemic control and self-care behaviors, yet their effectiveness may be limited by unaddressed health-related social needs (HRSN) (e.g., food insecurity, housing or utility instability, transportation barriers). This qualitative multiple case study examined the feasibility of integrating HRSN assessments into DSME delivery within three community-based organizations (CBOs) across urban and rural U.S. settings. Guided by the Consolidated Framework for Implementation Research, semi-structured interviews were conducted with 15 DSME facilitators and program leadership to identify contextual factors influencing implementation. Findings revealed that while DSME’s structured, manualized design promotes fidelity and client autonomy, it constrains responsiveness to the client’s HRSN. Facilitators expressed openness to integrating HRSN screening, particularly during intake, yet cited limited infrastructure, role clarity, and training as key barriers. CBOs were recognized as trusted, accessible spaces for holistic care, but growing expectations to address HRSN without adequate resources for referral created sustainability concerns. Participants recommended a parallel support model involving navigators or community health workers to manage HRSN screening and referrals alongside DSME sessions. Integrating HRSN assessment processes into DSME may enhance engagement, reduce attrition, and extend the reach of diabetes education to populations most affected by HRSN. However, successful implementation requires dedicated funding, workforce development, and cross-sector coordination. Findings underscore the importance of supporting CBOs as critical partners in bridging diabetes education and social care to advance whole-person, chronic disease management.

Rochester Healthy Community Partnership, a 20-year community based participatory research partnership, used photovoice to learn about Hispanic/Latino and Somali immigrants’ health concerns. Participants photographed their health-related priorities, reflected, developed policy recommendations, and shared photographs at a public event and rotating exhibit in 2024. More than 100 people attended the event (19 decision makers, 64 members of the public, 11 immigrant leader participants, 11 research staff). All decision-maker and public survey respondents reported learning something new about the priorities of Hispanic/Latino and Somali immigrants. ( Am J Public Health. 2025;115(S2):S120–S125. https://doi.org/10.2105/AJPH.2025.308098 )

Introduction: Despite being healthier than the general population on arrival, immigrants to the US often face systemic barriers to healthy lifestyle behaviors and increased risk of cardiovascular disease (CVD). Self-efficacy has been associated with healthy diet and physical activity behaviors, but associations and construct validity have not been well studied in large samples of immigrant populations. Hypothesis: Self-efficacy for a healthy diet and physical activity will be associated with better dietary quality and intake and more physical activity, respectively. We also assessed the construct validity of measurement scales in this population. Methods: Set in southeast Minnesota and embedded with the Rochester Healthy Community Partnership, a 20-year community-based participatory research partnership, the Healthy Immigrant Community study enrolled Hispanic/Latinx and Somali immigrants into a randomized intervention to reduce obesity and CVD risks. Baseline assessments included biometric measures and self-reports of dietary intake, physical activity, and quality of life in English, Spanish, or Somali. Two self-efficacy items (“How confident are you that you can eat a healthy diet?”; “How confident are you that you can participate in regular exercise or physical activity?”) were rated as a percentage interval (0%=not at all confident; 25%; 50%=somewhat confident; 75%; 100%=very confident). Results: In total, 451 participants, 268 (59%) Hispanic/Latinx and 183 (41%) Somali, completed baseline assessments for this analysis. The mean age was 45 years (range=18-87), 59% were female, and 37% lacked health insurance over ≤12 months. Participants reporting more confidence to eat a healthy diet were more likely to eat fruits and vegetables as snacks ( p =<0.001), and less likely to drink fruit drinks or sports drinks ( p =0.02) or regular soda ( p =<0.001). Those reporting more confidence to be physically active were also reported higher levels of physical activity ( p =0.001). Validated self-efficacy scales had a wide distribution of scores, suggesting that the measures can be appropriately used among these immigrant communities. Conclusion: Higher self-efficacy for a healthy diet and physical activity were significantly associated with healthier eating and physical activity behaviors. Lifestyle interventions to reduce CVD risk may benefit from incorporating culturally tailored strategies to enhance self-confidence and support health equity in immigrant communities.

Abstract Background: Self-efficacy theory proposes that confidence to engage in a health behavior is associated with engaging in that specific behavior. Most research examining self-efficacy has been conducted with white young adult populations. This secondary analysis examined the association of self-efficacy (i.e., confidence) for healthy eating and physical activity in two immigrant communities. Methods: At enrollment into the Healthy Immigrant Community study, a clinical weight management and cardiovascular risk reduction intervention set in southeastern [state], 475 participants completed assessments about their confidence for healthy eating and physical activity. Measurements also included self-reports of dietary quality and intake, physical activity, quality of life, and biometric assessments. Study materials were available in English, Spanish, and Somali. Results In total, 450 adults (Hispanic/Latinx = 267; Somali = 183) completed measures at baseline and were included for analysis. Their average age was 45 years (range 18–87) and 59% were female. Confidence for healthy eating was significantly associated with self-report of eating healthy snacks ( p = < 0.0001) and less consumption of high-calorie drinks ( p = 0.02) and regular soda ( p = < 0.0001). Confidence to be physically active was significantly associated with more self-reported physical activity ( p = < 0.01). Conclusions Confidence to eat healthy and be physically active appears to be associated with having a healthier diet and higher levels of physical activity. Given the large sample size and strength of the associations, it also appears that the theoretical model of self-efficacy can be effectively measured and applied within these immigrant populations. Self-efficacy theory may be useful in understanding potential mediating mechanisms when designing future interventions with immigrant communities. ClinicalTrials.gov registration: NCT05136339; April 23, 2022

Importance Hispanic adults with type 2 diabetes (T2D) are more likely to develop complications and die from the disease than the US general population. Digital storytelling interventions are narrative-based videos elicited through a community-based participatory research approach to surface the authentic voices of participants overcoming obstacles to health-promoting behaviors that perpetuate health inequities; research on the effect of digital storytelling on T2D outcomes among Hispanic adults is lacking. Objective To assess the impact of a digital storytelling intervention on glycemic control and its acceptability among Hispanic patients with poorly controlled T2D. Design, Setting, and Participants This was a multicenter, randomized clinical trial conducted within 2 primary care networks in Minnesota and Arizona among Hispanic adults with poorly controlled T2D (hemoglobin A 1c level ≥8%). Enrollment and follow-up were conducted between February 14, 2019, and November 1, 2023. Intervention The intervention group viewed a 12-minute digital storytelling video. The video included 4 Spanish-language stories that reinforced 4 diabetes self-management behavioral goals (healthful diet for diabetes, physical activity, medication adherence, and glucose self-monitoring). The control group received printed, culturally tailored T2D education materials. Main Outcomes and Measures The primary outcome was the mean change from baseline to 3 months for hemoglobin A 1c levels, adjusting for baseline hemoglobin A 1c , age, gender, education, and income. Acceptability and narrative quality of the intervention were assessed through questionnaires. Results There were 451 study participants, with 227 (mean [SD] age, 54.3 [9.3] years; 158 [69.3%] women) randomized to the intervention group and 224 (mean [SD] age, 54.5 [9.1] years; 156 [69.3%] women) to the control group. Of these, 390 completed 3-month follow-up of the primary outcome (86% retention). There was a small improvement in the mean (SD) hemoglobin A 1c level in the intervention group compared with the control group in the adjusted model (9.1% [1.7] to 8.4% [1.6] vs 9.4% [1.8] to 8.8% [2.0]; P = .04] but not in the unadjusted model. Acceptability and narrative quality of the intervention were high. Conclusions and Relevance In this randomized clinical trial, a digital storytelling intervention developed with and for Hispanic adults with T2D was highly acceptable and feasibly implemented within primary care settings and resulted in a modest improvement of glycemic control. This was a highly scalable intervention that may be integrated into clinical practice as part of a longitudinal diabetes self-management program for Hispanic adults. Trial Registration ClinicalTrials.gov Identifier: NCT03766438

Introduction: Immigrants to the United States often experience structural barriers to healthy nutrition and physical activity, which increases their risk of developing obesity, cardiovascular disease (CVD), and other chronic conditions. In our prior work with immigrant communities to co-develop interventions to improve nutrition and physical activity, mood was identified as a possible mediating factor. Hypothesis: We hypothesized that self-reported negative mood would be associated with unhealthy lifestyle behaviors such as poor nutrition and less physical activity. We also evaluated the relationship between mood and sociobehavioral factors such as social support and community belongingness. Methods: The Healthy Immigrant Community (HIC) study, set in Rochester, Minnesota and embedded with the Rochester Healthy Community Partnership, is a randomized, waitlist-controlled obesity and CVD risk reduction intervention. Community-based mentoring and education for health behaviors are delivered by trained health promoters, who are members of the immigrant populations, to their social networks. Baseline self-reported and biometric measures assessed nutrition, physical activity, self-efficacy, and sociobehavioral effects on healthy lifestyle behaviors. On a single-item rating of mood over the past 7 days, responses of poor or fair were considered “negative”, while good, very good, or excellent were considered “positive”. Results: The HIC study enrolled 475 adult participants; 268 Hispanic/Latino and 181 Somali participants completed baseline measures and were included in this analysis. Of the 449 participants, 107 (24%) reported “negative” mood. This group was more likely to be Hispanic/Latino (74%), female (68%), uninsured in the past 12 months (46%), or younger age (mean = 41 years; range = 18-79). Participants who endorsed negative mood at baseline had lower healthy nutrition scores ( p =0.02), lower physical activity scores ( p =0.03), and less confidence in eating healthily ( p =0.001). Those reporting negative mood also reported less support from family and friends to eat healthy ( p =<0.001) and be physically active ( p =0.01), accessed community resources for healthy eating ( p =0.001) and physical activity ( p =<0.01) less often, and reported less sense of belonging to their community ( p =0.01) than those with positive mood. Conclusion: Negative mood was significantly associated with eating a less healthy diet and being sedentary, lower confidence in maintaining a healthy diet, less perceived social support for healthy behaviors, and less sense of belonging to the community among Hispanic/Latino and Somali immigrants. Behavioral interventions designed to support a healthy lifestyle may benefit from incorporating culturally-aligned mood management and sociobehavioral strategies to reduce CVD risk and promote health equity in immigrant populations.

Abstract Background Immigrants to the United States, on average, accumulate cardiovascular risk after resettlement, including obesity. There is a need to co-create interventions to address these disparities, and mood may be an important mediating factor.Methods The Healthy Immigrant Community (HIC) study, set in southeast Minnesota, enrolled 475 adult participants in a weight loss intervention to reduce cardiovascular risk. Baseline questionnaires assessed mood, nutrition, physical activity, self-efficacy for healthy eating and physical activity, social support, and cohesion. A single-item mood rating of poor or fair was considered “negative”, while ratings of good, very good, or excellent were considered “positive”.Results A total of 449 HIC participants (268 Hispanic/Latino and 181 Somali) with complete baseline measures and were included in this analysis. Participants endorsing negative mood compared to those endorsing positive mood had lower scores for healthy eating (p = 0.02) and physical activity levels (p = 0.03), lower confidence in eating a healthy diet (p = 0.001), and felt less of a sense of belonging to their community (p = 0.01). Those endorsing negative mood also reported receiving less social support from their family and friends to eat healthy (p = < 0.001) and be physically active (p = 0.01), and less often accessed community resources for healthy eating (p = 0.001) and physical activity (p = < 0.01) compared to participants reporting positive mood.Conclusions Negative mood was associated with less healthy nutrition, lower confidence in eating healthy, sedentary lifestyle, and perceived lack of belonging to the community. Integrating mood management and self-efficacy strategies may enhance the effectiveness of lifestyle interventions among immigrants who report negative mood.ClinicalTrials.gov registration: NCT05136339; April 23, 2022