Researcher’s Community-Engaged Studies to Halt Health-Related Miseducation, Misinformation, and Misconceptions in Her Asian Community

Conversation with Dr. Sunmin Lee, University of California, Irvine

Meet Sunmin Lee, Sc.D., M.P.H., principal investigator in minority health and health disparities research.

Dr. Sunmin Lee is a professor at the University of California, Irvine School of Medicine, and co-leader of the Cancer Control Program at the Chao Family Comprehensive Cancer Center. As a social epidemiologist and health disparities researcher, Dr. Lee’s research over the last two decades focuses on reducing health disparities among minority and immigrant populations, especially Asian American populations.

Dr. Lee has led multiple NIH- and CDC-funded studies. She currently leads two NIMHD-funded research projects.

• STOP CRC: Screening TO Prevent ColoRectal Cancer (5R01MD012778-06) aims to increase colorectal cancer screening among Chinese and Korean primary care patients using a shared decision-making model.
• DREAMS: Disparities Research to Evaluate Asian Americans’ Multifaceted Stressors on Sleep and Health (5R01MD015186-04) is a longitudinal examination of stressors, sleep, and cardiometabolic health among Chinese, Korean, and Vietnamese American populations.

Dr. Lee received her doctoral degree in social epidemiology from the Harvard T. H. Chan School of Public Health, and she completed her post-doctoral training in aging research at Harvard Medical School. Dr. Lee received her M.P.H. in health policy and bachelor’s degree in English from Seoul National University in South Korea.

Q&A with Dr. Sunmin Lee

What is your project’s goal, purpose, and aim?
The leading cause of death for Asian American populations is cancer, and it’s reported that the colorectal cancer screening rate is lower for Asian American communities than for other racial and ethnic groups. I proposed STOP CRC, a culturally adapted randomized controlled trial to increase colorectal cancer screening among 400 Chinese and Korean American patients.

My other NIMHD-funded study, DREAMS, comes from my personal experiences living and working in the United States as a first-generation Korean immigrant woman. I’ve had challenges with language barriers and adjusting to a new culture and environment. Sometimes, these stressors took a toll on my health, making it more difficult for me to sleep at night. By talking with people in Asian communities, I learned that many others had similar experiences.

Sleep data for Asian Americans are significantly lacking. In one of my sleep studies that’s still in progress, I am working with a cohort of 750 Asian American individuals in Southern California. The participants have completed a survey, worn a sleep actigraphy device, a type of wearable device that tracks the wearer’s movements during sleep, for two weeks, and provided blood samples for biomarker collection.

How is your work advancing the science of minority health and the health of populations that experience health disparities? Are you seeing specific changes in particular communities or groups?
My work fills a crucial gap by providing greater representation of disaggregated data for Asian American populations in health research. Related to this, my work contributes to developing and testing culturally tailored interventions to overcome health challenges faced by Asian American communities.

The DREAMS study is one of the first studies to rigorously investigate the impact of sleep dysfunction and other stressors specific to Chinese, Korean, and Vietnamese American communities on the health of those communities. Our findings will inform the design of a behavioral intervention to promote sleep health among Asian American populations.

My other NIMHD-funded project, STOP CRC, is one of the first culturally adapted shared decision-making screening programs for Chinese and Korean American populations designed to prevent colorectal cancer. Most interventions focus on increasing knowledge of colorectal cancer and universal colorectal cancer screening, but we provided screening plans based on one-to-one decision counseling. By talking with participants, we learned that one significant reason Chinese and Korean American individuals do not adhere to colorectal cancer screening guidelines as often as other populations is that providers need to inform them about their colorectal cancer screening options, namely the stool blood test.

Most physicians only recommended a colonoscopy, which many participants did not want due to its invasive nature and potentially high cost. Learning about the stool blood test offered participants a more agreeable colorectal cancer screening option. Many participants thanked the research team for the positive change this made to their health care.

What has surprised you about the discoveries from your work and your experiences engaging with communities?
I’ve been surprised by the prevalence of misconceptions and misinformation regarding health in Asian American communities. For example, some Asian American individuals believe that they are at lower risk of colorectal cancer because their diet includes more vegetables and less meat than the standard Western/American diet.

Also, Asian American communities often fail to recognize the importance of sleep for optimal health. Sadly, many Asian immigrants try to achieve the American dream by working hard and long hours, often curtailing sleep to do so. The harms to health from smoking, drinking, and lacking physical activity are much more commonly recognized within Asian American communities than to the harm of getting insufficient sleep.

Another surprise, this one pleasant: Shortly after I received NIMHD funding to conduct the DREAMS project, I received a letter from U.S. Congresswoman Katie Porter’s office. She represents the 47th District of California, and in her letter, she congratulated me on the award and asked me to update her office with my research findings. I look forward to communicating with her office, and I hope my research findings will contribute to policy changes to reduce health disparities experienced by Asian American communities.

What inspired you to become a researcher in minority health and health disparities?
I came to the United States to study social epidemiology. As mentioned before, stressors from living and working here as a first-generation Korean immigrant woman and speaking with others about their similar experiences helped me recognize that reducing health disparities among Asian American populations is an important area of study, and I might be a good fit for this work. Furthermore, I wanted to use my knowledge and experience to positively impact the lives of others in need.

How do we encourage the next generation to advance community-engaged research?
We must help the next generation of researchers understand the unique and significant role of community-engaged research, especially when many are pursuing big data analysis instead. Community-engaged research provides perspectives on specific communities, including insights into their priorities and any particular challenges they face.

Many junior investigators find community-engaged research daunting because they don’t know where to start. We can help by inviting the next generation of researchers to contribute as investigators to our research and by mentoring them.

What do you envision as the future of minority health and health disparities research?
It’s projected that racial and ethnic minority populations will comprise 54% of the U.S. population by 2050. More research focused on reducing health disparities is critical.

To continue advancing minority health and health disparities research, the following are essential:

• We must disaggregate health data across racial and ethnic minority populations so we can better develop national policy and allocate resources effectively.
• We must secure more funding support for community-engaged primary data collection in racial and ethnic subgroups. This will allow us to better understand the challenges faced by each group and the efficacy of potential interventions.
• We must actively engage communities in all phases of research projects, including selection of topics, formulation of hypotheses, study design, recruitment and retention of participants, and dissemination of findings.
• When using innovative technology in research, we must ensure that these are used in culturally sensitive and linguistically appropriate ways.
• We must provide more training opportunities for researchers from communities under-represented in the sciences. This will contribute to creating a diverse and inclusive research workforce, and this will lead to more scientifically rigorous and high-impact health disparities research.

Page published May 21, 2024