Category Archives: Asian Health

Say what? Many patients struggle to learn the foreign language of health insurance

health literacy 1 300

Jessie Yuan, physician at the Eisner Pediatric & Family Health Center in Los Angeles, treats diabetic patient Oscar Gonzales. Gonzalez was unaware he had been switched to Medi-Cal until Yuan informed him about the change (Photo by Anna Gorman/KHN).

This KHN story also ran in .

As soon as Deb Emerson, a former high school teacher from Oroville, Calif., bought a health plan in January through the state’s insurance exchange, she felt overwhelmed.

She couldn’t figure out what was covered and what wasn’t.

Why weren’t her anti-depressant medications included?

Why did she have to pay $60 to see a doctor?

The insurance jargon – deductible, co-pay, premium, co-insurance – was like a foreign language. What did it mean?

“I have an education and I am not understanding this,” said Emerson, 50. “ I wonder about people who don’t have an education — how baffling this must be for them.” Continue reading


Know your hepatitis ABCs for Hepatitis Awareness Month – CDC


From the US Centers for Disease Control and Prevention

Graphic: Millions of Americans are living with viral hepatitis.

  • Hepatitis A: Outbreaks in the US do occur.
  • Hepatitis B: Asian Americans and Pacific Islanders have higher rates.
  • Hepatitis C: New treatments can cure the disease.

Viral hepatitis is a major global health threat and affects over 4.4 million Americans. In observance of May as Hepatitis Awareness Month, here are brief overviews of each of the three most common types of viral hepatitis in the United States: Hepatitis A, Hepatitis B and Hepatitis C.

Hepatitis A: Outbreaks in the US can and do occur

Continue reading


Tobacco use among Asian and Pacific Islanders varies widely


Cigarette SmokeBy Stephanie Stephens
Contributing Writer
Health Behavior News

While past research has shown that, as a whole, Asian Americans and Native Hawaiian/Pacific Islanders living in the U.S. smoke at a lower rate than the national average, a new study in American Journal of Health Behaviorfinds significant differences in tobacco use when analyzed by specific Asian or Pacific Islander ethnicity.

Dramatic social, demographic and behavioral differences exist between Asian American (AA) and Native Hawaiian/Pacific Islander (NHPI) groups, said lead study author Arnab Mukherjea, Dr.P.H., M.P.H., who was a postdoctoral scholar at the Center for Tobacco Control Research & Education at the University of California, San Francisco at the time of the study. Continue reading


How states are tackling ‘health disparities’


Question Q&ABy Michael Ollove
Stateline Staff Writer

African-Americans are more likely to suffer heart disease and diabetes than whites. The cancer death rate for men is a good deal higher than it is for women.

American Indians and Alaska Natives are more likely to smoke tobacco than Hispanics, blacks or whites.

And Native Hawaiian adults are less likely to exercise than other ethnic groups.

These differences are called “health disparities,” and in the last two decades, the federal government and the states have focused on eliminating them. Continue reading


California bill would extend coverage to undocumented residents


Flag_of_CaliforniaBy Anna Gorman
FEB 18, 2014

In a push to cover immigrants excluded from the nation’s health reform law, a California state senator has proposed legislation that would offer health insurance for all Californians, including those living here illegally.  Continue reading


Obamacare thrives in San Francisco’s Chinatown


By Sarah Varney
KHN Staff Writer

This KHN story was produced in collaboration with NPR

San Francisco Chinatown's Chinese Hospital (Photo courtesy of Chinese Hospital).

San Francisco Chinatown’s Chinese Hospital (Photo courtesy of Chinese Hospital).

Feb 6, 2014 – Chinatown here is a city within a city. Built by immigrants in the latter half of the 19th century, Chinatown was a refuge from the era’s vicious prejudice. But the crowded blocks of Chinatown were also somewhat of a prison.

Chinese residents feared leaving the area after dark, and they were barred from local schools and the city’s hospitals — even during an outbreak of bubonic plague in San Francisco. Continue reading


King County to host two events to help people enroll in health insurance this weekend


Find enrollment assistance, with help in many languages


By Keith Seinfeld
Public Health – Seattle & King County

Buying insurance online with Washington Healthplanfinder is getting faster every week.

But many people still need in-person help, so King County and its network of assisters are hosting two enrollment events this weekend with room to handle large numbers of people.

Continue reading

Jigsaw puzzle with one piece to add

How will immigrants fare under Obamacare? It’s complicated.


By Lornett Turnbull, The Seattle Times
This story was produced in partnership with 

Jigsaw puzzle with one piece to add

Photo: Willi Heidelbach

Likos Afkas is a native of the Federated States of Micronesia, part of a cluster of islands in the Pacific where nuclear testing by the U.S. government during the Cold War left behind high rates of cancer.

Together with neighboring Palau and the Marshall Islands, the Federated States of Micronesia has a special compact with the U.S. under which its people, heavily recruited by the U.S. military, can live and work here indefinitely — but as noncitizens, they are denied certain federal benefits.

Afkas, 48, first came to the U.S. a year ago, suffering from diabetes and heart problems, and was immediately diagnosed with kidney failure that requires three-times-a-week dialysis.

Last month, he was notified that he lacked sufficient job credits to continue receiving the Medicare coverage he’s depended on to cover some of his medical bills.

Now, like untold numbers of his countrymen and other immigrants, Afkas is taking stock of his health-care options as the clock counts down to the Oct. 1 opening day for enrolling in health coverage under the federal government’s Affordable Care Act (ACA). Coverage begins Jan. 1.

“If I go back home, I’d only be going back to die.”

For him, the prospects aren’t promising.

Ultimately, how he and other immigrants fare under this massive health-care overhaul will depend on many factors: their income, immigration status, how long they’ve lived in this country and — in the case of people like Afkas — their country of origin.

While his household income would otherwise qualify him for Medicaid, the primary option under ACA for delivering health coverage to low-income people, Afkas’ immigration status makes him ineligible.

He worries he’ll be required to buy health insurance under the law or face a penalty — neither of which he says he can afford. However, he is likely exempt from that requirement if the cost of insurance premiums would be more than 8 percent of his household income, or if he makes so little that he doesn’t file a tax return.

Returning to Chuuk, his home state in Micronesia, is not an option, he said, because of the woefully inadequate health system there.

“If I go back home, I’d only be going back to die.”

Lacking insurance

The health-care-overhaul law, commonly known as Obamacare, targets people who lack health insurance — an estimated 1.09 million residents of Washington state.

It’s unclear what percentage of them are immigrants.

Studies have shown that in general, immigrants tend to be healthier than the rest of the population — they are younger and are subject to medical examination to obtain green cards — though many of the same studies also suggest they become less healthy over time.

“There are some people who have gotten used to being uninsured, so we need to provide a whole other level of information about why they’d even want to be insured now that it’s available to them,” said Michael McKee, health-services director of theInternational Community Health Services, whose clinics serve large numbers of immigrants.

“Part of it is also helping them understand the penalties,” he said. “That’s going to be totally new to everybody.”

As complicated as the law will be for the average American, immigrant advocates worry it will be even more daunting for those whose primary language is not English and for whom regular visits to a doctor are not a cultural tradition.

“We look at access to care and coverage as opportunities to address health disparities,” McKee said. “It’s incumbent on us to educate people on the importance of preventive care and healthy options so they can avoid some of the costly outcomes.”

Options for uninsured

Under the ACA, the majority of the state’s uninsured will be required to buy health-care coverage, or face a penalty.

They can purchase an individual insurance plan on their own or from the state-administered health-insurance marketplace, the Washington Health Benefit Exchange.

Those with the lowest income — about a third — will qualify for Medicaid, the free or near-free health-insurance program that will be expanded under Obamacare to deliver health care to the poorest Americans.

How and where immigrants fit into all this are questions many advocacy groups continue to unravel.

“I don’t think there’s any question the majority of immigrants will benefit from this,” said Jenny Rejeske, policy analyst for the National Immigration Law Center. “It’s going to require vigilance from advocates and people who want this to work. It’s not going to be perfect on day one.”

Mary Wood, section manager at Washington State Health Care Authority, said the rules related to immigrants’ eligibility for Medicaid under the health law haven’t changed: If their immigration status made them ineligible before the law took effect, they’ll remain ineligible.

U.S. citizens and legal permanent residents or green-card holders who have been in this country for five years or longer will be treated the same as U.S.-born citizens when it comes to coverage. They can apply for Medicaid under the program’s broadened guidelines if their income is low enough.

Other types of immigrants will also qualify regardless of how long they’ve been in this country: asylum seekers and refugees, special immigrants from Iraq and Afghanistan, victims of trafficking and immigrants who served in the armed services.

They will be among an estimated 250,000 people who state officials estimate will become newly eligible under the expanded Medicaid limits for those with incomes up to 138 percent of the federal poverty level — or $15,856 for a single person.

Meanwhile, other legal immigrants — those with higher incomes or those here for fewer than five years, people temporarily in this country, such as students and work-visa holders, as well as people like Afkas — won’t qualify for Medicaid.

They may, however, purchase insurance from the exchange, using the Washington Healthplanfinder.

Those among them with incomes between 139 and 400 percent of the federal poverty level — $45,960 for a single person — will qualify for subsidies and tax credits to help cover insurance premiums.

And all low-income children, regardless of their immigration status, will be covered under any number of federal and state health care programs.

Unlawful residents

For adults in the country unlawfully, the government has little to offer.

While most undocumented immigrants work in jobs that do not provide health insurance, it is estimated that 25 percent of them do have coverage.

Still, undocumented immigrants account for about 14 percent of Washington state’s uninsured. And those with no coverage — an estimated 127,530 — will continue to go without.

Undocumented adult immigrants are unable to participate in Medicaid or Medicare and that won’t change. They are also ineligible to purchase from the health exchange. But unlike most other groups, they won’t face a penalty for not having insurance.

There is coverage available for low-income women during pregnancy regardless of their immigration status, and like everyone else, undocumented immigrants continue to qualify for emergency care under federal law.

And those whose incomes would otherwise entitle them to Medicaid but for their immigration status can qualify for emergency Medicaid for emergent conditions, such as heart attacks.

Particular status

And then there are people like Afkas, whose status most Americans do not know.

Micronesia, Palau and the Marshall Islands are former United Nations trust territories, which the U.S. Navy administered between 1947 and 1951.

Today, they are sovereign nations, each with a Compact of Free Association with the United States under which their people can work and live in this country indefinitely, though they are neither U.S. citizens or nationals.

In 1996, when Congress reformed welfare, it barred most legal immigrants from Medicaid and other federal health programs for the first five years of residency. It also indefinitely barred those from the compact states from receiving Medicaid.

Many use their immigration privilege to seek treatment — mostly state-funded — for the cancer and other health problems plaguing their countries, usually in Hawaii, but increasingly in places like Washington state, said Xavier Maipi, who runs a nonprofit agency to advocate for residents from compact countries.

An estimated 2,000 — mostly Marshallese and Micronesians — live here.

Afkas lived on the island state of Chuuk in Micronesia before he came to the Seattle area a year ago, his health failing.

Already suffering heart problems and diabetes, he was diagnosed with kidney failure at Seattle’s Harborview Medical Center, whose reputation as a source for indigent care he and others say has become well known in the islands.

The medical bill for his monthlong stay totaled $100,000, which Medicare covered.

But in July, Afkas was notified he lacked sufficient job credits to continue receiving $700 in monthly Supplemental Security income and Medicare.

He’ll continue to receive weekly dialysis through a state program geared to those whose immigration status disqualifies them for Medicaid but will have to go uncovered for everything else.

Afkas’ wife earns a small amount to provide home health care for him from another part of the same program that covers his dialysis. “Right now, I don’t know what I’m going to do,” he said.

Like many people, he doesn’t know much about the Affordable Care Act and hasn’t given it much thought. Paying for health insurance — any amount — isn’t in the household budget.

“Many of these folks are simply trying to survive,” Maipi said. “For health care, they go to the emergency room — and usually that’s when they’re at death’s door.”

‘A lot of questions’

Immigrant advocates know they face a daunting task preparing clients and constituents for the coming change.

While information about the exchange will be available in eight different languages, thewebsite the public will use to sign up for care will be available only in English and Spanish.

“Many of our clients are refugees and immigrants and 60 percent of them have limited English proficiency,” McKee said.

Health clinics like his and other federally funded health centers that now serve anyone who walks through their doors will continue to do so — regardless of their insurance status or ability to pay.

“This is the largest sea change in public policy since Social Security,” McKee said.

“Everyone wants to get it right. And at the end of the day, there will be a lot of questions and the hope is that we can, with this first run, enroll as many people who will benefit.”

Seattle Times reporter Carol M. Ostrom contributed to this report.

This article was reprinted from with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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Abortion laws force closure of women’s health clinics serving the poor

Abortion Knoxville-march-for-life-2013-3

Photo: Brian Stansberry / Creative Commons

By Jake Grovum, Staff Writer

New state restrictions on clinics that provide abortions could leave millions of women—many of them poor and uninsured—without easy access to cancer screenings and other basic health care services.

In recent years, abortion opponents have tried to limit abortions by barring them after a certain number of weeks and by requiring women who want to end their pregnancies to have ultrasounds. Those strategies target abortion directly.

Now abortion opponents in some states are pushing for new standards for clinics, such as requiring doctors to have admitting privileges at a nearby hospital, that may be difficult or impossible for them to meet.

Abortion rights supporters fear the new rules could force many clinics to close—a result that would make it more difficult for women to get a broad array of health care services, not just abortions.

“Every time a clinic closes, the women who would be using those clinics, it’s not as if those women stop existing,” said Kimberly Inez McGuire of the National Latina Institute for Reproductive Health, an advocacy group. “It will affect whether women can get cancer screenings, whether women can get to a provider to get their blood pressure checked.”

“Clinics that serve women who may not have insurance are literally a lifeline,” McGuire said.

Fifteen states now require clinic doctors to have hospital admitting privileges, according to the Guttmacher Institute, which supports abortion rights.

In addition, 26 states require abortion-providing clinics to meet surgical facility standards, which stipulate everything from the size of certain rooms, the types of light switches used and the width of hallways.

Supporters say such requirements are common-sense public health measures. They cite high-profile examples of poor oversight and gruesome malpractice cases, most notably the Kermit Gosnell case in Philadelphia.

“What is so wrong about having high health standards in place?” asked Alabama Rep. Mary Sue McClurkin, who sponsored legislation which includes clinic regulations and requirements for doctors that has been blocked by a federal judge. “If they would just do what was in the best interest of the patient, it would not be a problem.”

Opponents of such laws say they might close a vital health care entryway for women. In many states, the clinics offer services ranging from sexually transmitted disease testing and treatment to mammograms, Pap tests and cancer screenings.

They also offer family planning counseling and birth control services—in many cases at reduced fees for the uninsured.

In 2011 and 2012, the Guttmacher Institute conducted a survey of women receiving services at family planning centers located in communities in which there were other health care options.

About four in 10 women said they used a clinic as their exclusive health care provider in the past year. Among other reasons, the women said they preferred going to a clinic because staff there knew more about women’s health and it was easier to talk to them about sex.

The connection between the clinics, public health care programs and women’s health was further underscored by a Kaiser Family Foundation study.

The report noted that in many states, there are few providers willing to accept Medicaid or other subsidized insurance programs. In those places, the clinics are a vital, and sometimes the only, option for low-income people.

For example, in 2011 Texas blocked Planned Parenthood-affiliated health centers from receiving funds from the state’s Medicaid Women’s Health Program.

Prior to the funding cut-off, those centers were caring for nearly 50,000 patients. The program served 63 percent fewer women the year after the cuts, state data showed.

The American Congress of Obstetricians and Gynecologists has also argued that clinic closings could damage women’s health. The group blasted Texas’ new abortion law and measures under consideration in North Carolina.

Those who back the laws argue the regulations would make the clinics safer.

So far, courts haven’t bought that argument, seeing laws that could shutter clinics as potentially unconstitutionally restrictive of abortion.

Courts already have blocked physician requirements in Mississippi and Alabama. Last week, Wisconsin’s law was temporarily blocked by a federal judge and advocates are preparing to fight Texas’ law as well.

“The courts have seen right through the arguments that this is somehow supposed to protect women’s health,” said Julie Rikelman of the Center for Reproductive Rights, which is involved in the legal fights.  “These laws really hurt women’s health, not help them.”

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Stateline is a nonpartisan, nonprofit news service of the Pew Center on the States that provides daily reporting and analysis on trends in state policy.

Asian American PI hepatitis thumbnail

Hepatitis B affects 1 in 12 Asians Americans and Pacific Islanders


From the CDC

Hepatitis B is common in many parts of the world, with an estimated 350 million people living with the disease worldwide. In the US, an estimated 1.2 million Americans are infected.

However, hepatitis B disproportionately affects Asian Americans and Pacific Islanders because it is especially common in many Asian and Pacific Island countries.

While AAPIs make up less than 5% of the total U.S. population, they account for more than 50% of Americans living with chronic hepatitis B.

Asian American PI hepatitis

Hepatitis B is serious

Hepatitis B affects 1 in 12 Asian Americans; most don’t know it. Talk to a doctor about getting tested for Hepatitis B if you or your parents were born in Asia or the Pacific Islands.As many as 2 in 3 Asian Americans with hepatitis B don’t know they are infected

If left untreated, up to 25 percent of people with hepatitis B develop serious liver problems such as cirrhosis and even liver cancer. In the US, chronic hepatitis B infection results in thousands of deaths per year. Liver cancer caused by the hepatitis B virus is a leading cause of cancer deaths among Asian Americans.

People can live with hepatitis B without having any symptoms or feeling sick. Many people with chronic hepatitis B got infected as infants or young children. It is usually spread when someone comes into contact with blood from someone who has the virus.

As many as 2 in 3 AAPIs living with the virus do not know they are infected. Often, people do not know they have hepatitis B until they have been tested.

Who should get tested for Hepatitis B?

  • Anyone born in Asia or the Pacific Islands (except New Zealand and Australia)
  • Anyone born in the United States, who was not vaccinated at birth, and has at least one parent born in East or Southeast Asia (except Japan) or the Pacific Islands (except New Zealand and Australia)

Hepatitis B testing identifies people living with chronic hepatitis B so they can get medical care to help prevent serious liver damage. Testing also helps to find other people who may not have hepatitis B, but are at risk for getting infected. This can include people living with someone with hepatitis B.

For more information, talk to a doctor about getting tested for Hepatitis B.

More Information


Despite challenges, community health centers win high satisfaction rates


Doctor at deskBy Valerie DeBenedette
HBNS Contributing Writer

Low-income Americans are more likely to be satisfied with the care they receive at federally qualified health centers (FQHC) than at mainstream health care providers, reveals a new study in the Journal of Health Care for the Poor and Underserved.

The level of satisfaction shown by people who use the health centers was surprising, said lead author Leiyu Shi, DrPH, MBA, MPA, professor at the Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, Baltimore, M.D.

Because the centers treat a more vulnerable population, they often have a more difficult time addressing their patients’ needs, he noted. Yet, the study shows that health centers appear to be reducing gaps in both quality of service and accessibility, he said.

Federally funded health centers are usually located in medically underserved communities, making them more likely to be either in inner city or rural areas, explained Shi.

Patients using these centers are more racially and ethnically diverse than the national population and more likely to be uninsured (39 percent compared to 17 percent) or to receive Medicare or Medicaid (54 percent compared to 27 percent) and to be in fair to poor health than the general population.

But patients at FQHCs also reported better access to primary care and were more likely to be satisfied with the care they received (97.7 percent) than low-income Americans getting health care elsewhere (87.2 percent).

Patients at FQHCs also reported better access to primary care and were more likely to be satisfied with the care they received (97.7 percent) than low-income Americans getting health care elsewhere.

“This study tells us a lot about the role of a safety net system,” said Georges C. Benjamin, M.D., executive director of the American Public Health Association in Washington, D.C.

Federally qualified health centers have become like other health providers, but are more focused on primary care and preventive medicine, he noted.

They are based in the community, with one federal requirement being that 51 percent of the members of their board of directors be from the community. They can bill private health insurance, Medicare and Medicaid, he said.

“They have a range of ways for the completely uninsured to pay, usually on sliding fee scale,” he added. “They are much more sensitive to the individual who does not have any money or the ability to pay it back.”

Study authors suggest that there should be broader adoption of the FQHC model of care, which includes comprehensive and preventive primary care, a focus on vulnerable populations such as minorities and the uninsured, consumer participation, and cultural and linguistic sensitivity, among other features.


Shi L, LeBrun-Harris LA, Daly CA, et al.: Reducing disparities in access to primary care and patient satisfaction with care: The role of health centers. J Health Care Poor Underserved. 24 (2013): 56–66

Reach CFAH’s Health Behavior News Service at (202) 387-2829 or

<strong><em><a title=”HBNS” href=”” target=”_blank”>Health Behavior News Service</a> is part of the </em></strong><strong><em><a title=”Center for Advancing Health” href=”” target=”_blank”>Center for Advancing Health</a></em></strong></p>

<strong>The Health Behavior News Service disseminates news stories on the latest findings from peer-reviewed research journals. HBNS covers both new studies and systematic reviews of studies on (1) the effects of behavior on health, (2) health disparities data and (3) patient engagement research. The goal of HBNS stories is to present the facts for readers to understand and use for themselves to make informed choices about health and health care.</strong>

Soda Pop Top

King County health officials say consumption of sugary drinks contributing to obesity among the young


Photo: Alessandro Paiva

Close to a third of high school students, or 26,000 youth, drink soda daily in King County, and 8,000 students drink two or more sodas per day, according to a new “Youth consumption of sugary drinks in King County” report.

Sugary drinks are the largest single source of calories in the U.S. diet and account for almost half of all added sugars that Americans consume.

With 1 in 5 youth in King County is either overweight or obese “reducing the amount of sugary drinks our children consume is a key strategy for improving health,” said Dr. David Fleming, Director & Health Office for Public Health – Seattle & King County.

A person who drinks two 20-ounce regular colas per day consumes 4.7 cups of sugar per week — or 243 cups of sugar per year — from soda alone. The consumption of sugary drinks has been linked to risks for obesity, diabetes, heart disease, stroke, and hypertension.

According to the new “Youth consumption of sugary drinks in King County” Data Watch Report:

  • Two out of three King County middle and high school students report drinking sugary drinks, including sodas, sports drinks or other flavored sweetened drinks, at school.
  • Of those youth who drink sugary drinks at school, 43% bring them from home, 9% get them from friends, 29% buy them at school, and 20% obtain them in other ways
  • Among high school students, daily consumption of at least one soda is highest among American Indian/Alaskan Native youth (40%), Hispanic/Latino youth (39%), Native Hawaiian/ Pacific Islander youth (38%) and African American youth (37%) versus 30% for white, non-Hispanic youth.

Sugary drinks are beverages with added sugars, such as regular sodas (or “pop”), energy drinks, sports drinks, sweetened fruit drinks, and sweetened coffees and teas.

On average, a 20-ounce bottle of regular soda has more than 16 teaspoons of sugar and 240 calories. This is double the total amount of added sugar allowed for an entire day based on a 2,000 calorie diet.

During the last two years as part of Communities Putting Prevention to Work (CPPW), a one-time federal stimulus-fund initiative, King County organizations have been taking steps to decrease access to sugary drinks and offer healthier options, such as water or low-fat milk.

As part of CPPW, the Childhood Obesity Prevention Coalition launched Soda Free Sundays, a community level campaign to take a break from sodas one day a week.  Over 1,000 individuals and 55 organizations took the pledge to go soda free on Sundays.

“This report demonstrates that sugary drink overconsumption continues to be a real problem in King County,” said Victor Colman, Director of the Childhood Obesity Prevention Coalition. “We know that with action at the individual, organizational, and community-wide levels we can see real progress and make healthier beverage choices within reach for everyone.”

Steps families and organizations can take to cut down on sugary drinks:

  • Purchase, serve and enjoy low-sugar options like water, low-fat milk, unsweetened tea and coffee drinks, and small portions (4 ounces or less) of 100% fruit juice.
  • If you do have a sugary drink as an occasional treat, cut calories and save money by ordering a small size and saying “no thanks!” to refills.
  • Ensure easy access to cool, fresh water at work, in organizations that serve kids and in public spaces.
  • Use the King County Board of Health’s Healthy Vending Guidelines to make sure that your vending machines offer the healthiest beverage options
  • .Limit the availability of sugary drinks at your workplace or organization by using the King County Vending Guidelines to identify the types of healthy drinks to make available.

To learn more about sugary drinks and what you can do, visit:

  • Public Health’s sugary drinks webpages, includes new  “10 things parents should know about sugary drinks” and “10 things families and organizations can do to cut down on sugary drinks” fact sheets
  • Soda Free Sundays, a community-wide challenge to take a break from soda and other sugary drinks for just one day out of the week.

Story photo and thumbnail photo courtesy of Alessandro Pavla.

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Tobacco Thumb

Decline in smoking stalls in King County


The decline in the number of adults who smoke in Kind County has stalled, Public Health – Seattle & King County finds in a new report

Today, an estimated 155,000 King County adults continue to be cigarette smokers and an additional 26,000 use smokeless tobacco, according to the county’s new “Tobacco use in King County” Data Watch Report.

Tobacco remains the leading preventable cause of death nationally, and in King County it accounts for 1 in 5 deaths and $343 million annually in health care expenses and lost wages, the report finds.

Other highlights from the report:

  • After a nearly 50% decline from 1996 to 2007, smoking rates among adults flattened in the most recent 5 year period of 2007-2011. About 10% of King County adults smoke, plus an additional 2% use smokeless tobacco products.
  • More than 15,000 students (including 1 in 4 12th graders) used cigarettes or other tobacco products in the past month.
  • Adult smoking rates are highest among African-Americans, low-income residents and lesbian, gay, bisexual and transsexual (LGBT) groups.
  • For youth, the highest smoking rates are among American Indian/Alaska Native, Native Hawaiian/ Pacific Islander and Latino youth.
  • Youth also use alternative tobacco products such as chewing tobacco, snuff, dip, cigars, cigarillos and little cigars – many of which are flavored to taste like fruit, candy, or alcohol.
  • In all, 50% of female and 67% of male tobacco users reported using multiple tobacco types.

Though King County has an overall smoking rate that is among the lowest in the country, the county has the most extreme smoking gap between communities with low smoking rates and those that have high smoking rates of the 15 largest metropolitan counties in the United States.

To learn more, visit:

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Lost in translation: Lack of trained interpreters can lead to medical errors


Trained interpreters for patients with limited English help avoid medical mishaps

By Michelle Andrews

A visit to the emergency department or a physician’s office can be confusing and even frightening when you’re trying to digest complicated medical information, perhaps while you’re feeling pain or discomfort.

For the 25 million people in the United States with limited English proficiency, the potential for medical mishaps is multiplied.A trained medical interpreter can make all the difference. Too often, however, interpreter services at hospitals and other medical settings are inadequate.

Family members, including children, often step in, or the task falls to medical staff members who speak the required language with varying degrees of fluency.

According to a study published in March, such ad hoc interpreters make nearly twice as many potentially clinically significant interpreting errors as do trained interpreters.

The study, published online in the Annals of Emergency Medicine, examined 57 interactions at two large pediatric emergency departments in Massachusetts. These encounters involved patients who spoke Spanish at home and had limited proficiency in English.

Researchers analyzed audiotapes of the visits, looking for five types of errors, including word omissions, additions and substitutions as well as editorial comments and instances of false fluency (making up a term, such as calling an ear an “ear-o” instead of an “oreja”)

They recorded 1,884 errors, of which 18 percent had potential clinical consequences.

For professionally trained interpreters with at least 100 hours of training, the proportion of errors with potential clinical significance was 2 percent. For professional interpreters with less training, the figure was 12 percent.

Ad hoc interpreter errors were potentially clinically significant in nearly twice as many instances — 22 percent. The figure was actually slightly lower — 20 percent — for people with no interpreter at all.

A Civil Rights Issue

It makes sense that trained interpreters, especially those with more experience, would make fewer errors, says Glenn Flores, a professor and director of the division of general pediatrics at UT Southwestern Medical Center and Children’s Medical Center of Dallas, who was the study’s lead author.

Experienced interpreters “know the medical terminology, ethics, and have experience in key situations where you need a knowledge base to draw on,” he says.

More From This Series: Insuring Your Health

Title VI of the Civil Rights Act of 1964 prohibits discrimination based on race, color or national origin. Courts have interpreted that to mean that all health-care providers that accept federal funds — because they serve Medicare and Medicaid recipients, for example — must take steps to ensure that their services are accessible to people who don’t speak English well, according to the National Health Law Program, a nonprofit that advocates for low-income and underserved people. (Doctors whose only federal payments are through Medicare Part B are exempt from this requirement, however.)

The Census Bureau estimates that nearly 9 percent of the population age 5 or older has limited English proficiency, which the bureau defines as people who describe themselves as speaking English less than “very well.”

Hospitals and other medical providers are in a tough spot, say experts. The law prohibits them from asking patients to pay for translation services, and they may not receive adequate or in some cases any other reimbursement.

“It’s a civil rights law, not a funding law,” says Mara Youdelman, managing attorney in the Washington office of the National Health Law Program.

A dozen states and the District reimburse hospitals, doctors and other providers for giving language services to enrollees in Medicaid, the joint federal-state program for low income people, and in CHIP, a federal-state health program for children, according to Youdelman.

A 2008 survey by America’s Health Insurance Plans, an industry trade group, found that 98 percent of health insurers provide access to interpreter services, but providers and policy experts question that figure. According to a survey by the Health Research and Educational Trust, in partnership with the American Hospital Association, 3 percent of hospitals received direct reimbursement for interpreter services, most of that from the Medicaid program.

“Most hospitals that make this a priority make it a budget item,” says Youdelman.

Lost In Translation

Hospitals and other providers realize that providing competent interpreter services can help ensure that they don’t miss or misdiagnose a condition that results in serious injury or death, say experts. Trained interpreters can also help providers save money by avoiding unnecessary tests and procedures.

Youdelman cites the example of a Russian-speaking patient in Upstate New York who arrived at an emergency department saying a word that sounded like “angina.” The emergency staff ran thousands of dollars’ worth of tests, thinking he might be having a heart attack. The real reason for his visit: a bad sore throat.

Like many hospitals, Children’s Medical Center of Dallas provides interpreter services around the clock via varying modes of communication — face-to-face, telephone and video — delivered by a mix of trained staff interpreters and outside contractors.

When Nadia Compean, 23, was six months pregnant, her doctor in Odessa, Texas, told her that her baby had spina bifida, a condition in which the spinal cord doesn’t close properly, leading to permanent nerve and other damage.

The local hospital wasn’t equipped to handle the birth and subsequent surgery that her daughter would require, so Nadia and the child’s father traveled to Dallas, about 350 miles away.

Neither speaks much English, but at Children’s Medical Center of Dallas, interpreters helped them understand what to expect, Nadia said (through an interpreter).

Nadia says she learned that her daughter, Eva, would be born with a lump on her back and would require immediate surgery. She also learned about problems that Eva may experience walking and using the toilet, she says.

Eva was born on March 6. Because of her medical needs and the lack of adequate interpreter services in Odessa, the couple is considering relocating to Dallas, where the father hopes he can find construction work.

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This article was reprinted from with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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Hepatitis Awareness

What you should know about hepatitis


More than 4 million Americans have viral hepatitis and an estimated 85,000 become infected each year, according the U.S. Centers for Disease Control and Prevention (CDC).

In some cases, people come down with a serous illness that can last for months but often people experience only a mild illness and some have no symptoms at all.

Some forms of viral hepatitis go away on their own, but others, like Hepatitis B and Hepatitis C, can go one to become chronic, lifelong infections, which can lead to serious health problems including liver damage, cirrhosis, liver cancer, and even death, the CDC warns.

Most people with chronic hepatitis do not know they are infected and can go 20 or 30 years without showing symptoms.

A simple blood test can determine whether you have hepatitis.

The month of May has been designated Hepatitis Awareness Month in the United States, and tomorrow, May 19th, is being recognized as the first ever Hepatitis Testing Day in the United States.

The National Digestive Diseases Information Clearinghouse has prepared the following material to explain about the different kinds of hepatitis, how to avoid infection and what you can do if you are infected.

Viral Hepatitis: A through E and Beyond

What is viral hepatitis?

Viral hepatitis is inflammation of the liver caused by a virus. Several different viruses, named the hepatitis A, B, C, D, and E viruses, cause viral hepatitis.

All of these viruses cause acute, or short-term, viral hepatitis. The hepatitis B, C, and D viruses can also cause chronic hepatitis, in which the infection is prolonged, sometimes lifelong. Chronic hepatitis can lead to cirrhosis, liver failure, and liver cancer.

Researchers are looking for other viruses that may cause hepatitis, but none have been identified with certainty. Other viruses that less often affect the liver include cytomegalovirus; Epstein-Barr virus, also called infectious mononucleosis; herpesvirus; parvovirus; and adenovirus.

Key Points

  • Viral hepatitis is inflammation of the liver caused by the hepatitis A, B, C, D, or E viruses.
  • Depending on the type of virus, viral hepatitis is spread through contaminated food or water, contact with infected blood, sexual contact with an infected person, or from mother to child during childbirth.
  • Vaccines offer protection from hepatitis A and hepatitis B.
  • No vaccines are available for hepatitis C, D, and E. Reducing exposure to the viruses offers the best protection.
  • Hepatitis A and E usually resolve on their own. Hepatitis B, C, and D can be chronic and serious. Drugs are available to treat chronic hepatitis.

Local Resources:

What are the symptoms of viral hepatitis?

Symptoms include

  • jaundice, which causes a yellowing of the skin and eyes
  • fatigue
  • abdominal pain
  • loss of appetite
  • nausea
  • vomiting
  • diarrhea
  • low grade fever
  • headache

However, some people do not have symptoms.

Hepatitis A

How is hepatitis A spread?

Hepatitis A is spread primarily through food or water contaminated by feces from an infected person. Rarely, it spreads through contact with infected blood.

Who is at risk for hepatitis A?

People most likely to get hepatitis A are

  • international travelers, particularly those traveling to developing countries
  • people who live with or have sex with an infected person
  • people living in areas where children are not routinely vaccinated against hepatitis A, where outbreaks are more likely
  • day care children and employees, during outbreaks
  • men who have sex with men
  • users of illicit drugs

How can hepatitis A be prevented?

The hepatitis A vaccine offers immunity to adults and children older than age 1. The Centers for Disease Control and Prevention recommends routine hepatitis A vaccination for children aged 12 to 23 months and for adults who are at high risk for infection. Treatment with immune globulin can provide short-term immunity to hepatitis A when given before exposure or within 2 weeks of exposure to the virus. Avoiding tap water when traveling internationally and practicing good hygiene and sanitation also help prevent hepatitis A.

What is the treatment for hepatitis A?

Hepatitis A usually resolves on its own over several weeks.

Hepatitis B

How is hepatitis B spread?

Hepatitis B is spread through contact with infected blood, through sex with an infected person, and from mother to child during childbirth, whether the delivery is vaginal or via cesarean section.

Who is at risk for hepatitis B?

People most likely to get hepatitis B are

  • people who live with or have sexual contact with an infected person
  • men who have sex with men
  • people who have multiple sex partners
  • injection drug users
  • immigrants and children of immigrants from areas with high rates of hepatitis B
  • infants born to infected mothers
  • health care workers
  • hemodialysis patients
  • people who received a transfusion of blood or blood products before 1987, when better tests to screen blood donors were developed
  • international travelers

How can hepatitis B be prevented?

The hepatitis B vaccine offers the best protection. All infants and unvaccinated children, adolescents, and at-risk adults should be vaccinated. For people who have not been vaccinated, reducing exposure to the virus can help prevent hepatitis B. Reducing exposure means using latex condoms, which may lower the risk of transmission; not sharing drug needles; and not sharing personal items such as toothbrushes, razors, and nail clippers with an infected person.

What is the treatment for hepatitis B?

Drugs approved for the treatment of chronic hepatitis B include alpha interferon and peginterferon, which slow the replication of the virus in the body and also boost the immune system, and the antiviral drugs lamivudine, adefovir dipivoxil, entecavir, and telbivudine. Other drugs are also being evaluated. Infants born to infected mothers should receive hepatitis B immune globulin and the hepatitis B vaccine within 12 hours of birth to help prevent infection.

People who develop acute hepatitis B are generally not treated with antiviral drugs because, depending on their age at infection, the disease often resolves on its own. Infected newborns are most likely to progress to chronic hepatitis B, but by young adulthood, most people with acute infection recover spontaneously. Severe acute hepatitis B can be treated with an antiviral drug such as lamivudine.

Cirrhotic liver showing scarring (Photo by Nephron under a Creative Common license).

Hepatitis C

How is hepatitis C spread?

Hepatitis C is spread primarily through contact with infected blood. Less commonly, it can spread through sexual contact and childbirth.

Who is at risk for hepatitis C?

  • People most likely to be exposed to the hepatitis C virus are
  • injection drug users
  • people who have sex with an infected person
  • people who have multiple sex partners
  • health care workers
  • infants born to infected women
  • hemodialysis patients
  • people who received a transfusion of blood or blood products before July 1992, when sensitive tests to screen blood donors for hepatitis C were introduced
  • people who received clotting factors made before 1987, when methods to manufacture these products were improved

How can hepatitis C be prevented?

There is no vaccine for hepatitis C. The only way to prevent the disease is to reduce the risk of exposure to the virus. Reducing exposure means avoiding behaviors like sharing drug needles or personal items such as toothbrushes, razors, and nail clippers with an infected person.

What is the treatment for hepatitis C?

Chronic hepatitis C is treated with peginterferon together with the antiviral drug ribavirin.

If acute hepatitis C does not resolve on its own within 2 to 3 months, drug treatment is recommended.

Hepatitis D

How is hepatitis D spread?

Hepatitis D is spread through contact with infected blood. This disease only occurs at the same time as infection with hepatitis B or in people who are already infected with hepatitis B.

Who is at risk for hepatitis D?

Anyone infected with hepatitis B is at risk for hepatitis D. Injection drug users have the highest risk.

Others at risk include

  • people who live with or have sex with a person infected with hepatitis D
  • people who received a transfusion of blood or blood products before 1987

How can hepatitis D be prevented?

People not already infected with hepatitis B should receive the hepatitis B vaccine. Other preventive measures include avoiding exposure to infected blood, contaminated needles, and an infected person’s personal items such as toothbrushes, razors, and nail clippers.

What is the treatment for hepatitis D?

Chronic hepatitis D is usually treated with pegylated interferon, although other potential treatments are under study.

Hepatitis E

How is hepatitis E spread?

Hepatitis E is spread through food or water contaminated by feces from an infected person. This disease is uncommon in the United States.

Who is at risk for hepatitis E?

People most likely to be exposed to the hepatitis E virus are

  • international travelers, particularly those traveling to developing countries
  • people living in areas where hepatitis E outbreaks are common
  • people who live with or have sex with an infected person

How can hepatitis E be prevented?

There is no U.S. Food and Drug Administration (FDA)-approved vaccine for hepatitis E. The only way to prevent the disease is to reduce the risk of exposure to the virus. Reducing risk of exposure means avoiding tap water when traveling internationally and practicing good hygiene and sanitation.

What is the treatment for hepatitis E?

Hepatitis E usually resolves on its own over several weeks to months.

What else causes viral hepatitis?

Some cases of viral hepatitis cannot be attributed to the hepatitis A, B, C, D, or E viruses, or even the less common viruses that can infect the liver, such as cytomegalovirus, Epstein-Barr virus, herpesvirus, parvovirus, and adenovirus.

These cases are called non-A–E hepatitis. Scientists continue to study the causes of non-A–E hepatitis.

Hope through Research

The National Institute of Diabetes and Digestive and Kidney Diseases, through its Division of Digestive Diseases and Nutrition, supports basic and clinical research into the nature and transmission of the hepatitis viruses, and the activation and mechanisms of the immune system. Results from these basic and clinical studies are used in developing new treatments and methods of prevention.

The U.S. Government does not endorse or favor any specific commercial product or company. Trade, proprietary, or company names appearing in this document are used only because they are considered necessary in the context of the information provided. If a product is not mentioned, the omission does not mean or imply that the product is unsatisfactory.

For More Information

American Liver Foundation

75 Maiden Lane, Suite 603

New York, NY 10038–4810

Phone: 1–800–GO–LIVER (465–4837), 1–888–4HEP–USA (443–7872), or 212–668–1000

Fax: 212–483–8179




Centers for Disease Control and Prevention

Division of Viral Hepatitis

1600 Clifton Road

Mail Stop C–14

Atlanta, GA 30333

Phone: 1–800–CDC–INFO (232–4636)

Fax: 404–371–5488




Hepatitis Foundation International

504 Blick Drive

Silver Spring, MD 20904–2901

Phone: 1–800–891–0707 or 301–622–4200

Fax: 301–622–4702




You may also find additional information about this topic by visiting MedlinePlus at

This publication may contain information about medications. When prepared, this publication included the most current information available. For updates or for questions about any medications, contact the U.S. Food and Drug Administration toll-free at 1–888–INFO–FDA (1–888–463–6332) or visit Consult your doctor for more information.

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