Creativity needed to reach minority elderly

Projects across the country are using innovative approaches to convince older Asian-, Hispanic- and African-Americans to get their flu and pneumonia shots.

By Victoria Stagg Elliott, amednews staff. April 14, 2003.

Shirley Bordelon, Centers for Medicare & Medicaid Services regional immunization coordinator in San Francisco, is making arrangements with a local manufacturer to have her message: "Get the flu shot, not the flu" stamped in Spanish in the middle of tortillas sold during next year's flu season. Her goal: Reaching older Hispanic-Americans who might otherwise go unprotected.

"We're so excited. We think this is going to be one of our best projects," said Bordelon, at the 37th Annual National Immunization Conference in Chicago last month. "You've got to think outside the box to reach the communities you want to speak to."

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This is just one of many ideas designed to address the significant differences in vaccination rates for minority elderly. According to the Centers for Disease Control and Prevention, the influenza vaccination rate for Caucasians is 68%, but only 48% for African-Americans and 57% for Latinos. Asian-Americans actually do slightly better with a flu vaccination rate of 71%.

Rates for pneumococcal vaccinations, however, are even worse. Sixty percent of Caucasians receive that shot, but only 40% of Asian-Americans, 38% of African-Americans and 38% of Latinos get it.

"The minority elderly are not getting their shots," said Donald Furman, MD, chief medical officer of CareMore Medical Group in Downey, Calif. "But this is something we can do something about. The problem is simple, and the answer is fairly simple. It's not like curing cancer."

There are a lot of projects attempting to even out the disparity. Little is known, however, about what actually works and what doesn't.

Flu vaccination rates are 48% for elderly African-Americans and 57% for elderly Hispanic-Americans.

To address this issue and develop more effective interventions, the Dept. of Health and Human Services has launched READII -- Racial and Ethnic Adult Disparities in Immunization Initiative -- a set of pilot projects in one rural and four urban areas.

"We've had a lot of success in improving rates in children. Now, we need to translate that success to adults," said James A. Singleton, a CDC epidemiologist who spoke at the joint conference of the National Council on the Aging and the American Society on Aging last month in Chicago.

The projects will be trying everything from targeted public health campaigns to hiring more people to administer the shots. If something works, it'll be replicated elsewhere.

"We're trying to reduce and understand these disparities," said Singleton. "Everybody should have access to these vaccines."

There are many theories about the cause of the differences in the vaccination rates. A consensus paper -- "A Report on Reaching Underserved Ethnic and Minority Populations to Improve Adolescent and Adult Immunization Rates" -- issued last year by the National Foundation for Infectious Diseases suggested that physicians and others providing vaccinations may neglect to offer the shots. Minority elderly may be less aware that they need the shots. Minority neighborhoods may have fewer health care facilities, reducing access to care. And, there may be language barriers.

"Is the provider not offering or is the patient refusing?" said Singleton. "Are there system issues? What about cultural or language barriers?"

Pneumococcal vaccination rates are 40% or less for the minority elderly.

Experts stress, though, that a solution for one community may not be appropriate for another, and that solving this problem will take tailored interventions and increased understanding of the targeted communities.

The projects must also address the diversity within the communities included in the larger racial categories. Asian-Americans, for example, are a group that includes people from numerous countries with different cultures and languages.

"People assume that Asian-Americans are all the same, but there's incredible diversity," said Claudia Lee, who is program manager at the National Asian Women's Health Organization. "There's a real need for culturally competent health care services for Asian-Americans and Pacific Islanders."

ADDITIONAL INFORMATION:

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READII, the Racial and Ethnic Adult Disparities in Immunization Initiative, Centers for Disease Control and Prevention (http://www.cdc.gov/nip/specint/readii/)