Immigration and acculturation in relation to health and health-related risk factors among specific Asian subgroups in a health maintenance organization

A systematic review of overweight, obesity, and type 2 diabetes among Asian American subgroups

This systematic review synthesizes data published between 1988 and 2009 on mean BMI and prevalence of overweight, obesity, and type 2 diabetes among Asian subgroups in the U.S. We conducted systematic searches in Pub- Med for peer-reviewed, English-language citations that reported mean BMI and percent overweight, obesity, and diabetes among South Asians/Asian Indians, Chinese, Filipinos, Koreans, and Vietnamese. We identified 647 database citations and 23 additional citations from hand-searching. After screening titles, abstracts, and full-text publications, 97 citations remained. None were published between 1988 and 1992, 28 between 1993 and 2003, and 69 between 2004 and 2009. Publications were identified for the following Asian subgroups: South Asian (n=8), Asian Indian (n=20), Chinese (n=44), Filipino (n=22), Korean (n= 8), and Vietnamese (n=3). The observed sample sizes ranged from 32 to 4245 subjects with mean ages from 24 to 78 years. Among samples of men and women, the lowest reported mean BMI was in South Asians (22.1 kg/m(2)), and the highest was in Filipinos (26.8 kg/m(2)). Estimates for overweight (12.8-46.7%) and obesity (2.1-59.0%) were variable. Among men and women, the highest rate of diabetes was reported in Asian Indians with BMI ≥ 30 kg/m(2) (32.9%, age and sex standardized). This review suggests heterogeneity among U.S. Asian populations in cardiometabolic risk factors, yet comparisons are limited due to variability in study populations, methods, and definitions used in published reports. Future efforts should adopt standardized methods to understand overweight, obesity and diabetes in this growing U.S. ethnic population.

Ethnic differences in quality of life in insured older adults with diabetes mellitus in an integrated delivery system

OBJECTIVES

To explore racial and ethnic (ethnic hereafter) differences in health-related quality of life (HRQL) in older adults with diabetes mellitus in an integrated delivery system.

DESIGN

Observational cross-sectional study.

SETTING

Kaiser Permanente Northern California.

PARTICIPANTS

Ethnic-stratified, random sample of 6,096 adults with diabetes mellitus aged 60 to 75 who completed a HRQL questionnaire.

MEASUREMENTS

Physical and mental HRQL were measured based on the Medical Outcomes Study 8-item Short Form Survey (range 0-100, mean 50). Age- and sex-adjusted weighted linear regression models estimated associations between ethnicity and HRQL and evaluated potential mediators (socioeconomic status, acculturation, health behaviors, diabetes mellitus-related conditions). Differences in ethnic-specific, adjusted mean HRQL scores were tested (reference whites).

RESULTS

Physical HRQL was better for Filipinos (48.3, 95% confidence interval (CI) = 47.0-49.6, P < .001), Asians (48.1, 95% CI = 46.8-49.3, P < .001), Hispanics (45.1, 95% CI = 44.2-46.0, P < .001), and blacks (44.2, 95% CI = 43.3-45.1, P = .04) than whites (42.9, 95% CI = 42.6-43.2). Adjusting for potential mediators did not change these relationships. Mental HRQL was better only for Asians (52.7, 95% CI = 51.6-53.7, P = .01) than for whites (51.0, 95% CI = 50.7-51.3), but this difference was small and became nonsignificant after adjustment for socioeconomic status, acculturation, health behaviors, and diabetes mellitus-related conditions.

CONCLUSION

In older adults with diabetes mellitus in a well-established integrated healthcare delivery system, ethnic minorities had better physical HRQL than whites. Equal access to care in an integrated delivery system may hold promise for reducing health disparities in diabetes mellitus-related patient-reported outcomes.

Acculturation, Dietary Acceptability, and Diabetes Management among Chinese in North America

Immigrants to a new country face many challenges when diagnosed with type 2 diabetes, a chronic disease with a complex treatment involving both medical and behavioral interventions. These challenges will depend upon the extent to which the patient has adapted to the new country's social and cultural norms, as well as individual factors such as age, education, and gender. This adaptation is termed acculturation. With respect to nutritional interventions for type 2 diabetes, uptake and adherence over the long term will depend upon overall health literacy, the cultural acceptability of the recommended diet. This review has focused on acculturation and its effects on diabetes management in ethnic Chinese in North America as an example of one populous minority and the challenges faced in adopting nutritional recommendations. Research directions and practical considerations are suggested.

Testing theoretical relationships: factors influencing positive health practices (PHP) in Filipino college students

OBJECTIVE

To examine variables influencing the positive health practices (PHP) of Filipino college students to gain a better understanding of health practices in this ethnic/racial group. Cross-sectional study tested theoretical relationships postulated among (a) PHP, (b) social support (SS), (c) optimism, and (d) acculturation.

PARTICIPANTS

A sample of Filipino college students (N = 226) aged 18 to 21 was obtained in June 2009.

METHODS

Participants completed 4 instruments. Statistical analyses were performed using SPSS 16.0.

RESULTS

Positive correlations were found between PHP and SS (r = .39, p = .01) and optimism and PHP (r = .36, p = .01). No correlation was found between PHP and acculturation. Optimism and SS predicted performance of PHP (R (2) = .18, F[2, 221] = 24.927, p < .001). A difference was found in acculturation levels between participants who grew up in the United States (t[223] = 4.5, p < .001) and those who did not.

CONCLUSIONS

Findings help health practitioners and educators to better understand the underlying factors that influence PHP in this population.

Resurgent ethnicity among Asian Americans: ethnic neighborhood context and health

In this study I investigate the associations of neighborhood socioeconomic and social environments with the health of Asian Americans living in both Asian ethnic neighborhoods and non-Asian neighborhoods. I use a sample of 1962 Asian Americans from the National Latino and Asian American Study (NLAAS, 2003-04). Three key findings emerge. First, absolute levels of socioeconomic and social resources do not differ greatly between the Asian ethnic neighborhoods and non-Asian neighborhoods in which Asian Americans live. Second, the ethnic neighborhood context conditions the effects of neighborhood education on health so that higher neighborhood education is related to better self-rated health among Asian Americans only when they live in Asian ethnic neighborhoods. Finally, the social environment, measured by everyday discrimination and social cohesion, does not differ in its health effects for individuals living in Asian ethnic and non-Asian neighborhoods. Together, these findings illuminate the complex ways that racial and ethnic neighborhood concentration impacts health.

Going against the tide: increasing incidence of colorectal cancer among Koreans, Filipinos, and South Asians in California, 1988-2007

OBJECTIVE

Colorectal cancer has declined markedly in California for all major racial/ethnic groups, including Asian/Pacific Islanders as a whole. Analyzing cancer data for Asian/Pacific Islanders collectively masks important differences that exist between individual Asian subgroups. This study examines secular, sex-, age-, and socioeconomic-specific trends in colorectal cancer incidence among six Asian subgroups-Chinese, Japanese, Filipino, Korean, Vietnamese, and South Asian-to determine whether these groups experienced a decline in colorectal cancer incidence and to assess possible differences in colorectal cancer incidence trends among these groups.

METHODS

Cases of invasive colorectal cancer diagnosed among Japanese, Chinese, Filipinos, Koreans, Vietnamese, and South Asians between 1988 and 2007 were identified using the California Cancer Registry database. Secular, sex-, age-, and socioeconomic-specific trends in the age-adjusted colorectal cancer incidence rates for each Asian subgroup were examined using joinpoint analysis to estimate the annual percent change (APC).

RESULTS

Among males, Koreans (APC, 3.6 %) were the only group that experienced a significant increase in colorectal cancer incidence. Among females, Koreans (APC, 2.7 %), South Asians (APC, 2.8 %), and Filipinos (APC, 1.6 %) experienced significant increases. Stratification by age at diagnosis revealed that Korean males (APC, 3.4 %) and females (APC, 2.9 %) as well as Filipino females (APC, 1.8 %) aged 50 years and older experienced a significant increase in colorectal cancer incidence. Korean males aged less than 50 years (APC, 3.4 %) also experienced a significant increase. Japanese (APC, -1.2 %) and Chinese (APC, -1.6 %) males aged 50 years and older experienced a significant decrease in colorectal cancer incidence. Stratification by socioeconomic status (SES) revealed that Korean males (APC, 2.5 %) and females (APC, 2.9 %) as well as Filipino females (APC, 2.1 %) in the lowest SES category experienced a significant increase in colorectal cancer incidence. Korean males (APC, 5.2 %) and females (APC, 3.1 %) as well as Filipino males (APC, 1.5 %) in the highest SES category also experienced a significant increase. Japanese males (APC, -2.5 %) and females (APC, -2.0 %) as well as Chinese males (APC, -2.8 %) and females (APC, -2.9 %) in the lowest SES category experienced a significant decrease. Chinese males in the middle (APC, -3.4 %) and highest (APC, -3.5 %) SES categories also experienced significant decreases in colorectal cancer incidence.

CONCLUSIONS

In contrast to the decreasing trends in colorectal cancer incidence reported among all major racial/ethnic groups including Asian/Pacific Islanders, colorectal cancer is actually increasing among some Asian subgroups in California including Korean males and females, as well as South Asian and Filipino females. Furthermore, the colorectal cancer incidence trends for these Asian subgroups differ with respect to age at diagnosis and socioeconomic status. These findings suggest that more efforts need to be made to target these populations with culturally sensitive cancer prevention and screening programs. More research is needed to examine the differences in the colorectal cancer burden among these populations.

A review of the literature: evaluating dietary intake of Filipino Americans at risk for type 2 diabetes

The purpose of this literature review is to investigate the research on the dietary intake of Filipino Americans. Evaluating the dietary practices of Filipino Americans may have an effect on the development of type 2 diabetes. Data collection was obtained, and four databases were included: Pub Medical, Cumulative Index of Nursing and Allied Health Literature, Journals at OVID, and Medline. The key words used in the search were "diet,""type 2 diabetes," and "Filipinos." A total of nine articles were relevant and met the inclusion criteria. The following articles were excluded: studies in a foreign language, letters to the editor, and program descriptions.

Nativity and papillary thyroid cancer incidence rates among Hispanic women in California

BACKGROUND

Overall, the incidence of papillary thyroid cancer in Hispanic women residing in the United States (US) is similar to that of non-Hispanic white women. However, little is known as to whether rates in Hispanic women vary by nativity, which may influence exposure to important risk factors.

METHODS

Nativity-specific incidence rates among Hispanic women were calculated for papillary thyroid cancer using data from the California Cancer Registry (CCR) for the period 1988-2004. For the 35% of cases for whom birthplace information was not available from the CCR, nativity was statistically imputed based on age at Social Security number issuance. Population estimates were extracted based on US Census data. Incidence rate ratios (IRRs) and 95% confidence intervals (CIs) were also estimated.

RESULTS

In young (age <55 years) Hispanic women, the incidence of papillary thyroid cancer among US-born women (10.65 per 100,000) was significantly greater than that for foreign-born women (6.67 per 100,000; IRR, 1.60 [95% CI, 1.44-1.77]). The opposite pattern was observed in older women. The age-specific patterns showed marked differences by nativity: among foreign-born women, rates increased slowly until age 70 years, whereas among US-born women, incidence rates peaked during the reproductive years. Incidence rates increased over the study period in all subgroups.

CONCLUSION

Incidence rates of papillary thyroid cancer vary by nativity and age among Hispanic women residing in California. These patterns can provide insight for future etiologic investigations of modifiable risk factors for this increasingly common and understudied cancer.

Factors associated with health care access and outcome

This study aims to (1) assess ethnic differences in health care access and health outcome between Asian Americans and whites and between Asian American subgroups, (2) examine effects of cultural factors, and (3) investigate moderating effects of health risk behaviors between cultural characteristics and health care access and outcome. Data were derived from the 2007 California Health Interview Survey. Asian Americans (n = 4,462) and whites (n = 4,470) were included. There were significant ethnic differences in health care access and health perception between Asian Americans and Whites and across Asian American subgroups. Health risk behaviors moderated relationships between cultural factors and health care access and outcome. Findings reveal that ethnicity affects an individual's health care access and health perception, and their health behaviors are an important factor that may improve or worsen outcomes. This study may increase our knowledge base of research and interventions to enhance ethnic minority populations' health care accessibility and perceptions.

Concept analysis of acculturation in Filipino immigrants within health context

Although acculturation has been widely used as a health research variable among other immigrant populations, it is nonexistent to the Filipino immigrant population. Accurate assessment, measurement, and exploration of acculturation of Filipinos in the United States can help improve the overall health care of this population. The work of Walker and Avant is used as a guide to analyze and clarify the operational definition of acculturation of this group within the context of health.

Psychometric validation of a short acculturation scale for Korean immigrants

BACKGROUND

Acculturation has been identified as a determinant of health behavior and outcome among ethnic minorities. The high prevalence of lifestyle-related chronic diseases and risk factors among Korean immigrants calls for a valid short acculturation scale to use in clinical practice and health research settings.

OBJECTIVES

The aim of this study was to validate the psychometric properties of a short acculturation scale originally developed for Hispanics after translating the scale to Korean (SAS-K) to determine its suitability for use with Korean immigrants.

METHODS

A self-administered questionnaire was completed by 143 Korean immigrants with Type 2 diabetes aged 30-80 years from a Korean community in Southern California. Confirmatory factor analysis, criterion validity, and internal reliability were utilized to evaluate the psychometric properties of the SAS-K.

RESULTS

Using a second-order confirmatory factor analysis, a 3-factor structure, χ(51) = 121.49, p < .001 (comparative fit index = .950, standardized root mean squared residual = .055, root mean square error of approximation = .099), was confirmed. The SAS-K was associated positively with length of residence, age of arrival, and English proficiency. Reliability for the total SAS-K was .93. Cronbach's alpha coefficients for each subscale of the SAS-K ranged from .80 (Ethnic Social Relations) to .95 (Media).

DISCUSSION

The 12-item, easy-to-use SAS-K showed satisfactory reliability and validity and, thus, is an appropriate instrument for measuring acculturation in Korean immigrants. The short nature and ease of administration of the SAS-K make it an ideal choice for healthcare providers and researchers to assess acculturation levels quickly and easily and to further the development and use of more culture-appropriate interventions.

The role of acculturation in diabetes self-management among Chinese Americans with type 2 diabetes

AIMS

We sought to examine the acculturation level and its relationship with diabetes self-management among Chinese Americans with type 2 diabetes.

METHODS

We conducted a cross-sectional survey research study in a convenience sample of 211 Chinese Americans with type 2 diabetes. We measured acculturation and diabetes self-management and evaluated the association between acculturation and self-management behaviors after controlling participants' characteristics using structural equation modeling.

RESULTS

The majority of the participants was born outside the U.S. and had a low level of acculturation. Women and older individuals were less acculturated, and those who had higher social economic status and lived in the U.S. for a longer period were more acculturated. The results of the structural equation modeling demonstrated that acculturation was significantly associated with DM self-management, and more-acculturated individuals were more likely to perform DM self-management than less-acculturated ones after controlling demographic characteristics.

CONCLUSIONS

The results of this study indicated that Chinese Americans diagnosed with diabetes may benefit from acculturation to mainstream society probably because increased acculturation was associated with increased help seeking behaviors and increased use of professional services.

Factors that influence self-reported general health status among different Asian ethnic groups: evidence from the Roadmap to the New Horizon: Linking Asians to Improved Health and Wellness study

Little is known about the determinants of self-reported general health status among different Asian ethnic subgroups. Using a community-based participatory research approach, we designed, administered, and analyzed a cross-sectional survey of 705 Asians (292 Chinese, 226 Korean, 187 Vietnamese) in the Portland, Oregon region to describe associations between general health status and several sociodemographic and health-related factors in pooled and ethnic-group-stratified samples. Ethnic variation existed in all covariate distributions, except employment, public-service use, language use, health status, visiting healthcare providers, sleep habits, and use of prayer, meditation, yoga or acupuncture. Acculturation measures were strong predictors of poor/fair health in logistic regression models regardless of ethnicity. Ethnic variation in outcome status existed for all remaining covariates. Most health-related research overlooks the heterogeneity within the Asian population. These findings highlight substantial variability in the associations between self-reported general health status and sociodemographic and health-related measures between Asian ethnic groups.

Conceptual parameters of acculturation within the Asian and Pacific Islander American populations: applications for nursing practice and research

TOPIC

Asian and Pacific Islander Americans (A&PIAs) are experiencing health inequities. For example, A&PIA is the only racial/ethnic group in America to experience cancer as their leading cause of death. Several studies within the A&PIA population have pointed to acculturation as a significant variable to explain their health and health-seeking behaviors. Acculturation is a key construct in understanding the health of the A&PIA population.

OBJECTIVE

The purpose of this concept analysis is to provide a current conceptual understanding of the relationship between acculturation and health, especially within the A&PIA populations, which will serve as a pragmatic guideline for nursing practice and research. Understanding the contemporary issues surrounding the conceptual application of acculturation will aid in the development of appropriate programs to reduce health inequities.

METHODS

Acculturation was explored using the Morse method of concept analysis. An iterative historical and contemporary literature review across the disciplines of anthropology, sociology, psychology, medicine, and nursing was completed. Analytical questions asked of the resultant data provided the theoretical definition, antecedents, key attributes, outcomes, and implications.

RESULTS

The concept analysis resulted in a new theoretical definition that includes multidimensional concepts of acculturation. Dilemmas in the measurement of key attributes of acculturation include unidirectional and bidirectional analysis, psychometric issues, and the appropriateness of proxy measurements. Outcomes of acculturation on health can be positive or negative and depend on an individual's or group's ability to navigate freely with necessary supports. Results of the conceptual analysis resulted in recommendations for nursing practice and future acculturation research.

CONCLUSION

While debate continues about the appropriate use and definition of acculturation, researchers agree that it is an important construct in understanding the health of migrating individuals and groups. Currently there is no testable framework that delineates the role of acculturation in health. Further research is indicated to clarify the relationship between acculturation and health.

Choosing to be a designated organ donor on their first driver's license: actions, opinions, intentions, and barriers of Asian American and Pacific Islander adolescents in Hawaii

CONTEXT

The factors associated with Asian American and Pacific Islander adolescents' decision to be a designated organ donor on their first driver's license are largely unknown.

OBJECTIVE

To assess knowledge and attitudes about organ donation and sociocultural factors associated with designated organ donor status in Asian American and Pacific Islander youth in Hawaii.

DESIGN AND SETTING

Written surveys and focus groups were conducted at high schools and churches.

PARTICIPANTS

Two hundred eight Asian American and Pacific Islander teens, mean age 16 (SD, 2) years, 52.6% females, and 53.4% Catholic.

MAIN OUTCOME MEASURES

Donor status on driver's license, awareness, attitudes, intentions, and barriers to becoming a designated organ donor.

RESULTS

Eighteen percent of teens with a driver's license are designated organ donors. Twenty-one percent have talked to their parents about becoming a designated donor on their license. Of those without a license, 27.7% intended to become a designated donor. Sex, grade level, and immigrant status were not associated with designated organ donor status; however, Catholics were significantly less likely to be donors. Key barriers to being a designated donor included a lack of knowledge or misperceptions due to urban myths about organ donation, parents completing "organ donor" question on driver's license application, and not wanting to have their body "cut up."

CONCLUSIONS

Future organ donor campaigns should educate ethnic minority adolescents about the importance of becoming a designated organ donor on their first driver's license and counter urban myths about deceased organ donation. Guidelines for how to initiate family discussions about organ donation should be sensitive to cultural and religious beliefs.

Papillary thyroid cancer incidence rates vary significantly by birthplace in Asian American women

OBJECTIVE

To investigate how birthplace influences the incidence of papillary thyroid cancer among Asian American women.

METHODS

Birthplace- and ethnic-specific age-adjusted and age-specific incidence rates were calculated using data from the California Cancer Registry for the period 1988-2004. Birthplace was statistically imputed for 30% of cases using a validated imputation method based on age at Social Security number issuance. Population estimates were obtained from the US Census. Incidence rate ratios (IRR) and 95% confidence intervals (CI) were estimated for foreign-born vs. US-born women.

RESULTS

Age-adjusted incidence rates of papillary thyroid cancer among Filipina (13.7 per 100,000) and Vietnamese (12.7) women were more than double those of Japanese women (6.2). US-born Chinese (IRR = 0.48, 95% CI: 0.40-0.59) and Filipina women (IRR = 0.74, 95% CI: 0.58-0.96) had significantly higher rates than those who were foreign-born; the opposite was observed for Japanese women (IRR = 1.55, 95% CI: 1.17-2.08). The age-specific patterns among all foreign-born Asian women and US-born Japanese women showed a slow steady increase in incidence until age 70. However, among US-born Asian women (except Japanese), substantially elevated incidence rates during the reproductive and menopausal years were evident.

CONCLUSIONS

Ethnic- and birthplace-variation in papillary thyroid cancer incidence can provide insight into the etiology of this increasingly common and understudied cancer.

Choosing to Be a Designated Organ Donor on Their First Driver's License: Actions, Opinions, Intentions, and Barriers of Asian American and Pacific Islander Adolescents in Hawaii

Context

The factors associated with Asian American and Pacific Islander adolescents' decision to be a designated organ donor on their first driver's license are largely unknown.

Objective

To assess knowledge and attitudes about organ donation and socio-cultural factors associated with designated organ donor status in Asian American and Pacific Islander youth in Hawaii.

Design and Setting

Written surveys and focus groups were conducted at high schools and churches.

Participants

Two hundred eight Asian American and Pacific Islander teens, mean age 16 (SD, 2) years, 52.6% females, and 53.4% Catholic.

Main Outcome Measures

Donor status on driver's license, awareness, attitudes, intentions, and barriers to becoming a designated organ donor.

Results

Eighteen percent of teens with a driver's license are designated organ donors. Twenty-one percent have talked to their parents about becoming a designated donor on their license. Of those without a license, 27.7% intended to become a designated donor. Sex, grade level, and immigrant status were not associated with designated organ donor status; however, Catholics were significantly less likely to be donors. Key barriers to being a designated donor included a lack of knowledge or misperceptions due to urban myths about organ donation, parents completing “organ donor” question on driver's license application, and not wanting to have their body “cut up.”

Conclusions

Future organ donor campaigns should educate ethnic minority adolescents about the importance of becoming a designated organ donor on their first driver's license and counter urban myths about deceased organ donation. Guidelines for how to initiate family discussions about organ donation should be sensitive to cultural and religious beliefs.

"So We Adapt Step by Step": Acculturation experiences affecting diabetes management and perceived health for Chinese American immigrants

This study examines how acculturation affects type 2 diabetes management and perceived health for Chinese American immigrants in the U.S. Acculturation experiences or cultural adaptation experiences affecting diabetes management and health were solicited from an informant group of immigrant patients and their spouses (N = 40) during group, couple and individual interviews conducted from 2005 to 2008. A separate respondent group of immigrant patients and their spouses (N = 19) meeting inclusion criteria reviewed and confirmed themes generated by the informant group. Using interpretive phenomenology, three key themes in patients' and spouses' acculturation experiences were identified: a) utilizing health care, b) maintaining family relations and roles, and c) establishing community ties and groundedness in the U.S. Acculturation experiences reflecting these themes were broad in scope and not fully captured by current self-report and proxy acculturation measures. In the current study, shifting family roles and evaluations of diabetes care and physical environment in the U.S. significantly affected diabetes management and health, yet are overlooked in acculturation and health investigations. Furthermore, the salience and impact of specific acculturation experiences respective to diabetes management and perceived health varied across participants due to individual, family, developmental, and environmental factors. In regards to salience, maintaining filial and interdependent family relations in the U.S. was of particular concern for older participants and coping with inadequate health insurance in the U.S. was especially distressing for self-described lower-middle to middle-class participants. In terms of impact, family separation and relocating to ethnically similar neighborhoods in the U.S. differentially affected diabetes management and health due to participants' varied family relations and pre-migration family support levels and diverse cultural and linguistic backgrounds, respectively. Implications for expanding current conceptualizations and measures of acculturation to better comprehend its dynamic and multidimensional properties and complex effects on health are discussed. Additionally, implications for developing culturally-appropriate diabetes management recommendations for Chinese immigrants and their families are outlined.

Associations of acculturation and kidney dysfunction among Hispanics and Chinese from the Multi-Ethnic Study of Atherosclerosis (MESA)

BACKGROUND

Acculturation affects health, but it has never been studied with kidney disease.

METHODS

We studied the association of language spoken at home, generation and birth place with kidney function among Hispanics and Chinese in the Multi-Ethnic Study of Atherosclerosis (n = 2999). Kidney function was determined by cystatin C (eGFRcys) and albumin/creatinine ratio (ACR). We evaluated mediators in models: Model 1 = age, sex, income, education; Model 2 = Model 1 + behaviors; and Model 3 = Model 1 + comorbidities.

RESULTS

Among Hispanics, speaking mixed Spanish/English was significantly associated with lower eGFRcys (- 2.83 mL/min/1.73 m(2), - 5.69-0.04) and higher ACR (RD 40%, 17-68%) compared with speaking Spanish only; this was mildly attenuated by behaviors (- 2.29, - 5.33-0.75; RD 42%, 18-72%) but not comorbidities (- 3.04, - 5.83 to - 0.23); RD 35%, 14-59%). US-born Hispanics had lower eGFRcys compared with foreign-born Hispanics [1.83 mL/min/1.73 m(2) lower (0.97-1.31) for Generation 1; 1.37 mL/min/1.73 m(2) lower (0.75-1.57) for Generation ≥ 2]. In contrast, Chinese who spoke any English had higher eGFRcys (2.53, 95% CI: - 1.70-6.78), but similar ACR (RD - 5%, 95% CI: - 26-23%) compared with those speaking Chinese only, but associations were not statistically significant.

CONCLUSION

Higher acculturation was associated with worse kidney function in Hispanics, mediated perhaps by behavioral factors but not comorbidities. Associations may be in the opposite direction among Chinese. Future studies are needed to elucidate these mechanisms.

Self-care behaviors of Filipino-American adults with type 2 diabetes mellitus

AIM

To examine the diabetes self-care behaviors of Filipino-American (FA) adults with type 2 diabetes mellitus (DM).

METHOD

The Summary of Diabetes Self Care Activities-Revised and Expanded measure was administered to 192 (74 males and 118 females) FA adult immigrants with type 2 DM.

RESULTS

Older FAs (> or =65 years), females, those who were older when they immigrated, and participants diagnosed with type 2 DM longer were more likely to follow recommended medication regimens. Younger FAs (<65 years) and participants diagnosed with type 2 DM for shorter duration of time were less likely to perform blood glucose testing. Most FAs reported following their eating plans; however, those who lived in the United States (US) longer followed healthful eating plans. Likewise, females reported eating five or more servings of fruits and/or vegetables daily. Moreover, older FAs reported evenly spacing carbohydrate intake everyday. Furthermore, older participants, those with less education, participants who were older when they immigrated, and those older when diagnosed with type 2 DM ate fewer foods high in fats. As to physical activity, FA males and participants with higher education exercised more frequently.

CONCLUSION

Younger FAs were less likely to perform optimum type 2 DM self-care behaviors pertaining to diet, medication taking, and blood glucose testing compared to their older counterparts. This finding suggests an increased risk for type 2 DM comorbidities and/or complications in younger FAs, which may require more intensive treatments in later years.

Chronic disease and its risk factors among refugees and asylees in Massachusetts, 2001-2005

INTRODUCTION

Better understanding of the health problems of refugees and people who are granted political asylum (asylees) in the United States may facilitate successful resettlement. We examined the prevalence of risk factors for and diagnoses of chronic disease among these groups in Massachusetts.

METHODS

We retrospectively analyzed health screening data from 4,239 adult refugees and asylees who arrived in Massachusetts from January 1, 2001, through December 31, 2005. We determined prevalence of obesity/overweight, hypertension, coronary artery disease (CAD), diabetes, and anemia. Analyses included multivariate logistic regression to determine associations between CAD and diabetes with region of origin.

RESULTS

Almost half of our sample (46.8%) was obese/overweight, and 22.6% had hypertension. CAD, diabetes, and anemia were documented in 3.7%, 3.1%, and 12.8%, respectively. People from the Europe and Central Asia region were more likely than those from other regions to have CAD (odds ratio, 5.55; 95% confidence interval, 2.95-10.47).

CONCLUSION

The prevalence of obesity/overweight and hypertension was high among refugees and asylees, but the prevalence of documented CAD and diabetes was low. We noted significant regional variations in prevalence of risk factors and chronic diseases. Future populations resettling in the United States should be linked to more resources to address their long-term health care needs and to receive culturally appropriate counseling on risk reduction.

Hidden breast cancer disparities in Asian women: disaggregating incidence rates by ethnicity and migrant status

OBJECTIVES

We estimated trends in breast cancer incidence rates for specific Asian populations in California to determine if disparities exist by immigrant status and age.

METHODS

To calculate rates by ethnicity and immigrant status, we obtained data for 1998 through 2004 cancer diagnoses from the California Cancer Registry and imputed immigrant status from Social Security Numbers for the 26% of cases with missing birthplace information. Population estimates were obtained from the 1990 and 2000 US Censuses.

RESULTS

Breast cancer rates were higher among US- than among foreign-born Chinese (incidence rate ratio [IRR] = 1.84; 95% confidence interval [CI] = 1.72, 1.96) and Filipina women (IRR = 1.32; 95% CI = 1.20, 1.44), but similar between US- and foreign-born Japanese women. US-born Chinese and Filipina women who were younger than 55 years had higher rates than did White women of the same age. Rates increased over time in most groups, as high as 4% per year among foreign-born Korean and US-born Filipina women. From 2000-2004, the rate among US-born Filipina women exceeded that of White women.

CONCLUSIONS

These findings challenge the notion that breast cancer rates are uniformly low across Asians and therefore suggest a need for increased awareness, targeted cancer control, and research to better understand underlying factors.

Comparison of disability rates among older adults in aggregated and separate Asian American/Pacific Islander subpopulations

OBJECTIVES

We assessed the prevalence and adjusted odds of 4 types of disability among 7 groups of older Asian American/Pacific Islander (AAPI) subpopulations, both separately and aggregated, compared with non-Hispanic Whites.

METHODS

Data were from the nationally representative 2006 American Community Survey, which included institutionalized and community-dwelling Hawaiian/Pacific Islander (n = 524), Vietnamese (n = 2357), Korean (n = 2082), Japanese (n = 3230), Filipino (n = 5109), Asian Indian (n = 2942), Chinese (n = 6034), and non-Hispanic White (n = 641 177) individuals aged 55 years and older. The weighted prevalence, population estimates, and odds ratios of 4 types of disability (functional limitations, limitations in activities of daily living, cognitive problems, and blindness or deafness) were reported for each group.

RESULTS

Disability rates in older adults varied more among AAPI subpopulations than between non-Hispanic Whites and the aggregated Asian group. Asian older adults had, on average, better disability outcomes than did non-Hispanic Whites.

CONCLUSIONS

This study provides the strongest evidence to date that exclusion of institutionalized older adults minimizes disparities in disabilities between Asians and Whites. The aggregation of Asians into one group obscures substantial subgroup variability and fails to identify the most vulnerable groups (e.g., Hawaiian/Pacific Islanders and Vietnamese).

Perinatal outcomes for Asian, Native Hawaiian, and other Pacific Islander mothers of single and multiple race/ethnicity: California and Hawaii, 2003-2005

OBJECTIVES

We examined characteristics and birth outcomes of Asian/Pacific Islander (API) mothers to determine whether differences in outcomes existed between mothers of single race/ethnicity and multiple race/ethnicity.

METHODS

We used data from California and Hawaii birth certificates from 2003 through 2005 to describe variation in birth outcomes for API subgroups by self-reported maternal race/ethnicity (single versus multiple race or API subgroup), and we also compared these outcomes to those of non-Hispanic White women.

RESULTS

Low birthweight (LBW) and preterm birth (PTB) varied more among API subgroups than between mothers of single versus multiple race/ethnicity. After adjustment for sociodemographic and behavioral risk factors, API mothers of multiple race/ethnicity had outcomes similar to mothers of single race/ethnicity, with exceptions for multiple-race/ethnicity Chinese (higher PTB), Filipino (lower LBW and PTB), and Thai (higher LBW) subgroups. Compared with single-race non-Hispanic Whites, adverse outcomes were elevated for most API subgroups: only single-race/ethnicity Korean mothers had lower rates of both LBW (3.4%) and PTB (5.6%); single-race/ethnicity Cambodian, Laotian, and Marshallese mothers had the highest rates of both LBW (8.8%, 9.2%, and 8.4%, respectively) and PTB (14.0%, 13.7%, and 18.8%, respectively).

CONCLUSIONS

Strategies to improve birth outcomes for API mothers should consider variations in risk by API subgroup and multiple race/ethnicity.

Disparities in breast cancer survival among Asian women by ethnicity and immigrant status: a population-based study

OBJECTIVES

We investigated heterogeneity in ethnic composition and immigrant status among US Asians as an explanation for disparities in breast cancer survival.

METHODS

We enhanced data from the California Cancer Registry and the Surveillance, Epidemiology, and End Results program through linkage and imputation to examine the effect of immigrant status, neighborhood socioeconomic status, and ethnic enclave on mortality among Chinese, Japanese, Filipino, Korean, South Asian, and Vietnamese women diagnosed with breast cancer from 1988 to 2005 and followed through 2007.

RESULTS

US-born women had similar mortality rates in all Asian ethnic groups except the Vietnamese, who had lower mortality risk (hazard ratio [HR] = 0.3; 95% confidence interval [CI] = 0.1, 0.9). Except for Japanese women, all foreign-born women had higher mortality than did US-born Japanese, the reference group. HRs ranged from 1.4 (95% CI = 1.2, 1.7) among Koreans to 1.8 (95% CI = 1.5, 2.2) among South Asians and Vietnamese. Little of this variation was explained by differences in disease characteristics.

CONCLUSIONS

Survival after breast cancer is poorer among foreign- than US-born Asians. Research on underlying factors is needed, along with increased awareness and targeted cancer control.

US acculturation, food intake, and obesity among Asian-Pacific hotel workers

BACKGROUND

Both obesity and immigration continue to increase in the United States. Studies suggest that a transition in lifestyle patterns, such as food intake, may mediate the relationship between immigration and obesity.

OBJECTIVE

We examine obesity among hotel workers in relation to age, sex, race/ethnicity, and indicators of food intake, immigration, and acculturation.

SUBJECTS/SETTING

Four thousand five hundred thirty hotel workers in 30 hotels were studied from the first year of the Work, Weight and Wellness program, before intervention (during 2005-2006).

MAIN OUTCOME MEASURES

Weight and height were measured, whereas race/ethnicity, language, education, immigration, acculturation, and food intake variables were assessed by questionnaire.

RESULTS

The study included 43% male and 57% female hotel workers (mean age 44.4+/-11.3 years; 42% Filipino, 32% other Asian, 13% Pacific Islander, 9% white, 1% black/African American, and 3% other race/ethnicity). On average (mean value), 55% of participants were born outside the United States; 57% were overweight or obese (body mass index [BMI] >25). The BMI of those born in the United States was 1.3 higher than that of those born in another country, adjusting for sex and race/ethnicity. Intake of sweet drinks and meat was positively associated with BMI while intake of fruit was negatively associated with BMI. Age at arrival in United States ("generation") was negatively associated with BMI, whereas greater acculturation was positively associated with BMI.

CONCLUSIONS

Food intake behaviors are probably related to place of birth, generation of migration to the United States, and acculturation. Direct measures of food intake added explanatory power to models, suggesting the importance of food intake to obesity. Further study of the influence of immigration, acculturation, and food intake on obesity using longitudinal study designs is warranted.

Sorting out the competing effects of acculturation, immigrant stress, and social support on depression: a report on Korean women in California

This research identifies stressors that correlate with depression, focusing on acculturation, among female Korean immigrants in California. Telephone interviews were conducted with female adults of Korean descent (N = 592) from a probability sample from 2006 to 2007. Sixty-five percent of attempted interviews were completed, of which over 90% were conducted in Korean. Analyses include descriptive reports, bivariate correlations, and structural equation modeling. Findings suggest that acculturation did not have a direct impact on depression and was not associated with social support. However, acculturation was associated with reduced immigrant stress which, in turn, was related to decreased levels of depression. Immigrant stress and social support were the principal direct influences on depression, mediating the effect for most other predictors. Stressful experiences associated with immigration may induce depressive feelings. Interventions should facilitate acculturation thereby reducing immigrant stress and expand peer networks to increase social support to assuage depression.

Asian Americans: diabetes prevalence across U.S. and World Health Organization weight classifications

OBJECTIVE

To compare diabetes prevalence among Asian Americans by World Health Organization and U.S. BMI classifications.

RESEARCH DESIGN AND METHODS

Data on Asian American adults (n = 7,414) from the National Health Interview Survey for 1997-2005 were analyzed. Diabetes prevalence was estimated across weight and ethnic group strata.

RESULTS

Regardless of BMI classification, Asian Indians and Filipinos had the highest prevalence of overweight (34-47 and 35-47%, respectively, compared with 20-38% in Chinese; P < 0.05). Asian Indians also had the highest ethnic-specific diabetes prevalence (ranging from 6-7% among the normal weight to 19-33% among the obese) compared with non-Hispanic whites: odds ratio (95% CI) for Asian Indians 2.0 (1.5-2.6), adjusted for age and sex, and 3.1 (2.4-4.0) with additional adjustment for BMI.

CONCLUSIONS

Asian Indian ethnicity, but not other Asian ethnicities, was strongly associated with diabetes. Weight classification as a marker of diabetes risk may need to accommodate differences across Asian subgroups.

English proficiency and language preference: testing the equivalence of two measures

OBJECTIVES

We examined the association of language proficiency vs language preference with self-rated health among Asian American immigrants. We also examined whether modeling preference or proficiency as continuous or categorical variables changed our inferences.

METHODS

Data came from the 2002-2003 National Latino and Asian American Study (n = 1639). We focused on participants' proficiency in speaking, reading, and writing English and on their language preference when thinking or speaking with family or friends. We examined the relation between language measures and self-rated health with ordered and binary logistic regression.

RESULTS

All English proficiency measures were associated with self-rated health across all models. By contrast, associations between language preference and self-rated health varied by the model considered.

CONCLUSIONS

Although many studies create composite scores aggregated across measures of English proficiency and language preference, this practice may not always be conceptually or empirically warranted.

Availability and accuracy of medical record information on language usage of cancer patients from a multi-ethnic population

Documentation of language usage in medical settings could be effective in identifying and addressing language barriers and would improve understanding of health disparities. This study evaluated the availability and accuracy of medical records information on language for 1,664 cancer patients likely to have poor English proficiency. Accuracy was assessed by comparison to language obtained from interview-based research studies. For patients diagnosed at facilities where information on language was not abstracted electronically, 81.6% had language information in their medical records, most often in admissions documents. For all 37 hospitals, agreement between medical records and interview language was 79.3% overall and was greater for those speaking English than another language. Language information is widely available in hospital medical records of cancer patients. However, for the data to be useful for research and reducing language barriers in medical care, the information must be collected in a consistent and accurate manner.

Disparities in gastric cancer outcomes among Asian ethnicities in the USA

BACKGROUND

Survival for gastric cancer is reportedly higher in Asians than for other races. It is unclear whether differences in outcome exist among Asian ethnicities. Our objective was to assess gastric cancer survival in Asian ethnic groups in a large heterogeneous population.

METHODS

Asian-Americans treated for gastric adenocarcinoma between 1988 and 2006 were identified from the Los Angeles County Cancer Surveillance Program. Patients were stratified and compared by ethnicity (Korean, Japanese, Chinese, Vietnamese or Filipino).

RESULTS

Of the 1,817 Asian-Americans in the study cohort, 45% (n = 810) were Korean, 25% (n = 462) were Chinese, 11% (n = 193) were Japanese, 10% (n = 188) were Filipino, and 9% (n = 164) were Vietnamese. For the entire cohort Koreans and Filipinos had the longest and shortest median survival (MS), respectively (22.4 and 10.3 months, respectively; P < 0.001). Multivariate analysis demonstrated that Japanese and Filipino ethnicity independently predicted worse survival compared with Korean ethnicity [hazard ratio (HR) 1.37, 95% confidence interval (CI) 1.08-1.73, P = 0.008; and HR 1.71, 95% CI 1.37-2.13, P < 0.001, respectively]. In the surgical cohort, Koreans and Filipinos had the longest and shortest survival, respectively (MS of 57.8 and 21.7 months, respectively; P < 0.001). Multivariate analysis of the surgical cohort also demonstrated that Japanese and Filipino ethnicity independently predicted worse survival compared with Korean ethnicity (HR 1.61, 95% CI 1.22-2.13, P < 0.001; and HR 1.66, 95% CI 1.24-2.22, P < 0.001, respectively).

CONCLUSION

There are differences in gastric cancer survival among Asian ethnicities. Future studies addressing varying environmental exposures and molecular expression patterns in gastric cancer are warranted to better understand these disparities in outcome.

A comparison of the health status and health care utilization patterns between foreigners and the national population in Spain: new evidence from the Spanish National Health Survey

The increasing proportion of immigrants in Spanish society is placing pressure on the National Health Care System to accommodate the needs of this population group while keeping costs under control. In the year 2000, a law was approved in Spain according to which all people, regardless of their nationality, are entitled to use health care services under the same conditions as Spanish citizens, provided that they are registered in the local population census. However, empirical evidence about differences in health status and health care utilization between the immigrant and the Spanish population is insufficient. This paper uses the 2003 and 2006 Spanish National Health Surveys to explore the existence of inequalities in health and in the access to health services for the immigrant population living in Spain, relative to that of Spaniards. Our results show that there are different patterns in the level of health and the medical care use between the national and the foreign population in Spain: while immigrants' self-reported health relative to that of the Spanish population depends upon individual nationality, all immigrants, regardless of their nationality, seem to face barriers of entry to specialized care. Further research is needed to understand the nature of these barriers in order to design more effective health policies.

Glucose control in korean immigrants with type 2 diabetes

Despite the rising incidence of type 2 diabetes in Korean immigrants, little is known about glucose control in these individuals. This descriptive study examined factors influencing glucose control in Korean immigrants with type 2 diabetes. Participants were 143 Korean immigrants with type 2 diabetes who completed questionnaires, a finger stick blood test for glycosylated hemoglobin (HbA1c), and anthropometric measures. The mean HbA1c level was 7.6 % (SD = 1.5; range = 5.6 to 12.5). Less than half of the participants (41.3%) met the American Diabetes Association's goal of less than 7%. After adjusting for demographic and health variables, family diet support, waist-to-hip ratio (WHR), the duration of diabetes, the number of diabetic medications, and age significantly influenced glucose control. Findings support the positive role of family involvement in diabetes management. Patients with long-standing diabetes, higher WHR, and more diabetic medications deserve special attention because they tend to have higher HbA1c levels.

Health behaviors of older Chinese adults living in New York City

The dramatic increase in the number of older immigrants living in the U.S. presents new challenges to policy makers concerned with promoting healthy aging. To date, however, strikingly little is known regarding the health and health trajectories of older immigrants. This paper examines the prevalence and predictors of important health behaviors associated with chronic disease prevention, including current smoking status, physical activity, alcohol use, and body mass index (BMI). We analyzed data from the 2003 New York City Chinese Health Survey (NYC CHS), the largest probability-based sample of Chinese immigrants residing in two distinct communities. In-person interviews were conducted with 517 representative men and women aged 55-75. Logistic regression modeling was used to test the influence of demographic, socioeconomic status, acculturation, and health characteristics on selected health behaviors. Results revealed that having more education and better physical health status were associated with greater participation in physical activity. Gender-specific analyses indicated that the effect of selected predictors varied between the sexes. For example, among older Chinese women, acculturation was negatively associated with alcohol use. This study provides some of the first evidence on health behaviors of one of the fastest growing older immigrant groups in the U.S. Study results add to the emerging literature on the complex nature of immigrant health trajectories, and demonstrate that contrary to prior research, living a greater proportion of time in the U.S. can be associated with selected positive health behaviors. Further longitudinal studies are needed to help inform policy initiatives to encourage healthy aging among diverse older immigrant groups.

Does place of education matter? Contextualizing the education and health status association among Asian Americans

The educational gradient in health is one of the most robust associations in social science research. Results of the current study indicate that, like the pattern observed among other racial and ethnic minority groups, the well-established educational gradient in health is attenuated among Asian Americans. We also show that the gradient association between educational attainment and self-rated health among Asian Americans depends on whether they receive the bulk of their education in the United States or abroad. Compared to the schooling received in the United States, being educated in a foreign country does not result in the same health payoffs for increasing educational attainment. Analysis of an extensive set of mediators indicates that a foreign education restricts economic opportunities, limits positive social interaction, and inhibits English language proficiency. We discuss the implications for Asian Americans, a group composed largely of immigrants who received their education outside the United States.

Differences in knowledge of hepatitis B among korean immigrants in two cities in the rocky mountain region

PURPOSE

To assess knowledge and attitude toward hepatitis B virus (HBV) infection among Korean immigrants in two cities in the Rocky Mountain region and to determine whether sociodemographic and cultural factors are related to the level of HBV knowledge.

METHODS

Community-based participatory study was conducted in five Korean churches in the Rocky Mountain region to develop baseline data on HBV infection and vaccination behavior. All documents, including announcements, brochures, consent forms, and questionnaires were in Korean and English, and trained Korean interviewers collected the surveys by reviewing the questionnaires with participants at the churches.

RESULTS

Knowledge of HBV infection was low and city of residence did not have a statistically significant impact on HBV infection knowledge. In the total sample, 62% identified transmission by sharing utensils and 21% believed that HBV was hereditary, while only 21% thought that HBV was spread through sexual contact. The majority of participants (61%) rated their English level as "minimum". Knowledge of HBV infection was found to be associated with both demographic and acculturation factors (p < .05).

CONCLUSION

This study found not only a low level of knowledge of HBV infection but also misunderstanding of the risks of HBV infection. Knowledge of HBV infection was significantly associated with education and acculturation; therefore, culturally sensitive and group-tailored public health education for Korean and other Asian American Pacific Islanders should be developed to clarify misconceptions and misunderstandings about HBV infection.

Incidence of lymphoid neoplasms by subtype among six Asian ethnic groups in the United States, 1996-2004

OBJECTIVES

To establish baseline data for lymphoid neoplasm incidence by subtype for six Asian-American ethnic groups.

METHODS

Incident rates were estimated by age and sex for six Asian ethnic groups--Asian Indian/Pakistani, Chinese, Filipino, Japanese, Korean, Vietnamese--in five United States cancer registry areas during 1996-2004. For comparison, rates for non-Hispanic Whites were also estimated.

RESULTS

During 1996-2004, Filipinos had the highest (24.0) and Koreans had the lowest incidence (12.7) of total lymphoid neoplasms. By subtype, Vietnamese and Filipinos had the highest incidence for diffuse large B-cell lymphoma (DLBCL) (8.0 and 7.2); Japanese had the highest incidence of follicular lymphoma (2.3). Although a general male predominance of lymphoid neoplasms was observed, this pattern varied by lymphoid neoplasm subtype. Whites generally had higher rates than all Asian ethnic groups for all lymphoid neoplasms and most lymphoma subtypes, although the magnitude of the difference varied by both ethnicity and lymphoma subtype.

CONCLUSIONS

The observed variations in incidence patterns among Asian ethnic groups in the United States suggest that it may be fruitful to pursue studies that compare Asian populations for postulated environmental and genetic risk factors.

Effects of acculturation on smoking behavior in Asian Americans: a meta-analysis

BACKGROUND

Cigarette smoking is the most preventable risk factor for many negative health consequences, such as cancer, heart disease, and lung disease. In the United States, the prevalence rate in Asian immigrants is high (26%-70%), with Southeast Asian men having the highest rate. Acculturation has been associated with smoking behavior in this ethnic group.

OBJECTIVE

The purposes of this meta-analysis are to describe the extent to which acculturation affects smoking behavior in Asian immigrants and to compare the direction and magnitude of the effect between subgroups by gender and age.

METHODS

Databases within PubMed, CINAHL, The Cochrane Library, and PsycINFO were searched. Twenty-one studies published in English or Korean from 1994 through 2005 met criteria, and 9 of these studies contained sufficient data. Among the 9 studies, 3 presented gender-specific data; thus, these studies were entered separately for men and women, making a total of 12 entries for final analysis. The odds ratio was used as an effect size statistic. The values of odds ratios were calculated from the data in the studies.

RESULTS

The average effect size for men was 0.53 (95% confidence interval, 0.28-0.99), indicating that acculturated men are 53% less likely to smoke than nonacculturated or "traditional" men. The average effect size for women was 5.26 (2.75-10.05), suggesting that acculturated women are 5 times more likely to smoke than traditional women. In adolescents, the average effect size was 1.92 (1.22-3.01), indicating that acculturated adolescents are almost 2 times more likely to smoke than traditional adolescents.

CONCLUSIONS

Acculturation may have a protective effect on smoking behavior in Asian men and a harmful effect in Asian women and adolescents. The magnitude of effect is larger in women and adolescents than in men. Smoking cessation programs should target acculturated women, adolescents, and traditional men.

Immigration and generational trends in body mass index and obesity in the United States: results of the National Latino and Asian American Survey, 2002-2003

OBJECTIVES

We examined patterns of body mass index (BMI) and obesity among a nationally representative sample of first-, second-, and third-generation Latinos and Asian Americans to reveal associations with nativity or country of origin.

METHODS

We used data from the National Latino and Asian American Survey (2002-2003) to generate nationally representative estimates of mean BMI and obesity prevalence and explored changes in the distribution of BMI by generational status. Analyses tested the association between generational status and BMI and examined whether this association varied by ethnicity, education, or gender.

RESULTS

We found substantial heterogeneity in BMI and obesity by country of origin and an increase in BMI in later generations among most subgroups. The data suggest different patterns for Latinos and Asian Americans in the nature and degree of distributional changes in BMI with generational status in the United States.

CONCLUSIONS

Generational status is associated with increased BMI and obesity among Latinos and Asian Americans. Aggregate estimates not accounting for nativity and country of origin may mask significant heterogeneity in the prevalence of obesity and patterns of distributional change, with implications for prevention strategies.

Substance use among a sample of foreign- and U.S.-born southeast Asians in an urban setting

Asian Americans (AA) are thought to have the lowest rates of substance use. This study examined substance use prevalence among 494 urban-dwelling Southeast Asians using snowball techniques. Prevalence estimates were age-adjusted proportionate to the U.S. Asian population. Findings show beer and alcohol consumption approximated the national percentage among 25-44 year olds. U.S.-born were about three times likelier to have past month substance use. Foreign-born Vietnamese were likelier than U.S.-born to use all substances except for beer. U.S.- and foreign-born beer consumption rates were similar. Future research is needed to delineate substance use determinants and patterns in foreign and U.S.-born AA sub-groups.

Recent trends in breast cancer incidence among 6 Asian groups in the Greater Bay Area of Northern California

Asians and Pacific Islanders are typically aggregated in United States (US) cancer statistics even though the few studies that have considered subgroups separately have found marked differences in cancer incidence. The objective of this study was to evaluate trends in breast cancer incidence rates separately for US Chinese, Japanese, Filipino, Korean, South Asian and Vietnamese women overall and by age at diagnosis, histologic subtype and stage at diagnosis. Age-adjusted incidence rates and annual percent changes (APC) of new, primary breast cancer diagnosed in the Greater Bay Area Cancer Registry of Northern California (1990-2002) were calculated using SEER*Stat. In women under 50 years of age, annual incidence rates decreased for Japanese (APC = -4.1, p = 0.02) and Filipinas (APC = -1.9, p = 0.11), and increased or fluctuated in other subgroups over the study period. In women 50 years or older, rates of invasive breast cancer increased for most subgroups, except Filipinas (APC = -1.3, p = 0.32), and in Japanese until 1998-2000. Rates of breast cancer in situ increased in most subgroups from 1990 to 2002, as did rates of lobular breast cancer for Chinese (APC = +7.46, p < 0.01) women. In Japanese women, rates of lobular breast cancer were highest in 1995-1997 and decreased thereafter. Our data support the notion that the prevalence of established risk factors influence breast cancer incidence, as breast cancer rates increased for more recently immigrated groups and decreased among more established groups, and may suggest leads into other avenues of research, such as genetic differences, that may explain differences in incidence rates among Asian subgroups.

Filipino child health in the United States: do health and health care disparities exist?

INTRODUCTION

Filipinos are the second largest Asian subgroup in the United States, but few studies have examined health and health care disparities in Filipino children. The objectives of this review are 1) to appraise current knowledge of Filipino children's health and health care and 2) to present the implications of these findings for research, clinical care, and policy.

METHODS

We identified articles for review primarily via a Medline search emphasizing the terms Filipino and United States crossed with specific topics in child and adolescent health that fall under one of Healthy People 2010's 28 focus areas.

RESULTS

Filipino children are underrepresented in medical research. Studies that compare Filipino children and adolescents with white children or children of other Asian Pacific Islander subgroups suggest disparities with regard to gestational diabetes, rates of neonatal mortality and low birth weight, malnutrition in young children, overweight, physical inactivity and fitness, tuberculosis, dental caries, and substance abuse. Studies that compare Filipino adults with white adults describe adult Filipino health problems similar to those of Filipino children, including higher rates of diabetes, hypertension, and metabolic syndrome. Health care disparities remain to be determined.

CONCLUSION

Health and health care disparities appear to exist for Filipino children, but more research is needed to confirm these findings. Practitioners serving this population need to consider social and cultural factors that can increase or diminish risk for health problems. There are priorities in research and policy that, if pursued, may improve the health care and health outcomes of Filipino children.

Behavioural risk factors in two generations of non-Western migrants: do trends converge towards the host population?

Migrant mortality does not conform to a single pattern of convergence towards prevalence rates in the host population. To understand better how migrant mortality develops, it is necessary to further investigate how the underlying behavioural determinants change following migration. We studied whether the prevalence of behavioural risk factors over two generations of Turkish and Moroccan migrants converge towards the prevalence rates in the Dutch population. From a random sample from the population register of Amsterdam, 291 Moroccan and 505 Turkish migrants, aged 15-30, participated in a structured interview that included questions on smoking, alcohol consumption, physical inactivity and weight/height. Data from the Dutch population were available from Statistics Netherlands. By calculating age-adjusted Odds Ratio's, prevalence rates among both generations were compared with prevalence rates in the host population for men and women separately. We found indications of convergence across generations towards the prevalence rates in the host population for smoking in Turkish men, for overweight in Turkish and Moroccan women and for physical inactivity in Turkish women. Alcohol consumption, however, remained low in all subgroups and did not converge towards the higher rates in the host population. In addition, we found a reversed trend among Turkish women regarding smoking: the second generation smoked significantly more, while the first generation did not differ from ethnic Dutch. In general, behavioural risk factors in two generations of non-Western migrants in the Netherlands seem to converge towards the prevalence rates in the Dutch population. However, some subgroups and risk factors showed a different pattern.

Self-rated health among foreign- and U.S.-born Asian Americans: a test of comparability

OBJECTIVES

We investigated differences between foreign- and U.S.-born Asian Americans in self-rating their physical and mental health. In particular, we tested whether the foreign-born respondents underreport the extreme categories of the scale as compared with U.S.-born respondents.

METHODS

We analyzed data from the National Latino and Asian American Study to examine whether immigrants are less likely to use the extreme ends of the 5-category self-rated health scales than their U.S.-born counterparts. We used propensity score matching to derive groups of U.S.- and foreign-born Asian Americans who share similar demographic and health characteristics. We defined propensity scores as predicted probabilities of being U.S. born, given individual background characteristics. The propensity score framework allowed us to make descriptive comparisons of self-rated health responses controlling for background characteristics. We used log-linear symmetry models to examine cross-tabulations of self-rated physical and mental health reports in matched pairs by the 2 (extreme and nonextreme) and 5 ("excellent," "very good," "good," "fair," and "poor") categories.

RESULTS

Controlling for background characteristics, we found no evidence that foreign-born Asian Americans are less likely to endorse extreme categories in self-rated physical or mental health than U.S.-born Asian Americans, as well as no evidence of imbalances in endorsement of any particular self-rated health category between the 2 groups.

CONCLUSIONS

Controlling for demographic and health characteristics, we find no systematic differences between foreign- and U.S.-born Asian Americans in reporting self-rated physical and mental health on the 5-category scales from "excellent" to "poor."

Adolescent participation in preventive health behaviors, physical activity, and nutrition: differences across immigrant generations for Asians and Latinos compared with Whites

OBJECTIVES

We investigated preventive health behaviors (bicycle helmet, seat belt, and sunscreen use), physical activity, television viewing or video game playing, and nutrition (fruit, vegetable, milk, and soda consumption) among Asian and Latino adolescents living in the United States; assessed trends across generations (first-, second-, and third-generation immigrants or later); and compared each generation with White adolescents.

METHODS

We used data from 5801 adolescents aged 12 to 17 years in the representative 2001 California Health Interview Survey.

RESULTS

In multivariate analysis, first-generation Asians measured worse than Whites for preventive health behaviors (lower participation), physical activity (less activity), and television viewing or video game playing (more hours), but improved across generations. For these same behaviors, Latinos were similar to or worse than Whites, and generally showed no improvement across generations. First-generation Asians and Latinos had healthier diets than Whites (higher fruit and vegetable consumption, lower soda consumption). With succeeding generations, Asians' fruit, vegetable, and soda consumption remained stable, but Latinos' fruit and vegetable consumption decreased and their soda consumption increased, so that by the third generation Latinos' nutrition was poorer than Whites'.

CONCLUSIONS

For the health behaviors we examined, Asian adolescents' health behaviors either improved with each generation or remained better than that of Whites. Latino adolescents demonstrated generally worse preventive health behaviors than did Whites and, in the case of nutrition, a worsening across generations. Targeted interventions may be needed to address behavioral disparities.