Acculturation and health in Korean Americans

Attitudes, knowledge, and health-seeking behaviors of five immigrant minority communities in the prevention and screening of cancer: a focus group approach

Despite an observed decrease in overall cancer death rates in the USA, immigrant minorities continue to experience disproportionately higher cancer incidence and mortality rates. Thirteen focus groups were conducted in the Haitian, English-Speaking Caribbean, Latino, Korean, and Chinese communities of New York City to better understand their health-seeking behaviors with respect to cancer prevention, screening, and treatment. Focus groups addressed the degree to which cultural, linguistic, and systematic barriers impact these behaviors and explored methods to support salutary behaviors. Findings underscored that, while there are many similarities across immigrant groups, there are significant variations between the immigrant groups to necessitate a tailored community-based approach. The prevalent misinformation observed among all groups warrants the prompt development of culturally competent programs for cancer control with immigrant minorities.

The sociocultural context of korean american men's smoking behavior

The purpose of this article is to explore the sociocultural context wherein Korean male immigrants learned and maintained smoking behavior. Participants were 11 current and 11 former cigarette smokers who resided in New York City. The participants attended one of four focus groups and talked about their experiences of smoking initiation, changes in smoking behavior over time, smoking in Korea and the United States, strategies used for smoking cessation, and suggestions for a smoking cessation program. The focus group interviews were audiotaped and transcribed verbatim. Themes were identified from answers to the five topic questions and then compared across the four focus groups. Smoking is a common thread in Korean men's social world and a prime component of Korean men's gender identity. In contrast, smoking in the United States is increasingly being stigmatized.

Korean male smokers' perceptions of tobacco control policies in the United States

The purpose of this secondary data analysis is to report Korean male smokers' perceptions of tobacco control policies in the United States. Descriptive data from four focus groups held in New York City in 2003 are presented. Focus group interviews were used to collect data, and the two investigators independently analyzed all four recorded group sessions. Korean male immigrants living in New York City area were recruited, and 22 volunteered to participate. Exclusion criteria included immigration to the United States before age 12, no smoking history, and use of chemical substance other than tobacco. Korean men differed in perceptions of the policies based on smoking status and length of U.S. residency. Among current smokers, recent immigrants had difficulty understanding smoking restrictions, whereas longtime residents complained of price increases. Both groups suggested that policies target the tobacco industry and do not target smokers. In contrast, former smokers supported more regulation of public smoking and suggested use of more aggressive antismoking campaigns. Public policymakers should take into consideration cultural attitudes and beliefs about smoking behavior in the design and implementation of tobacco control policies that affect ethnic groups whose cultural and value orientations may differ from the mainstream.

Ethno-specific patterns of adolescent tobacco use and the mediating role of acculturation, peer smoking, and sibling smoking

AIMS

The objectives of this study are to identify the relationship between ethnic identity and tobacco use, and to examine the mediating effects of peer and sibling smoking and acculturation.

DESIGN AND MEASUREMENTS

Data were drawn from a cross-sectional survey of 3400 Toronto students, sampled from 30 schools between 1998 and 2000. Primary ethnic identity was based on adolescents' self-identification of their ethnic heritage condensed to 12 groups for analysis. Tobacco use was measured as a dichotomy, predicting non-smoking in the past year. Multivariate logistic regression models were employed to test for baseline differences in non-smoking by ethnic identity. Subsequent models adjusted for controls (age, gender, social class, religious attendance, educational achievement) and introduced mediators.

FINDINGS

Results indicated that smoking varied among adolescents of differing ethnic identities. Adolescents of western European, eastern European and southern European ethnicity were considerably less likely to be non-smokers, while Chinese, South Asian and East Indian and West Indian youth were more inclined to be non-smokers. The discrepancies in rates of non-smoking among western European and South Asian and East Indian adolescents were explained by a combination of peer and sibling smoking and acculturation; among southern European and eastern European youth via peer and sibling smoking; and by neither peer and sibling smoking nor acculturation for Chinese and West Indian youth.

CONCLUSIONS

This paper demonstrates that disparities in tobacco use among certain ethnic groups can be explained by peer and sibling smoking and acculturation; however, for other ethnic groups, knowledge of the processes that account for differences in tobacco use remains less clear.

Self-reported health as a cultural health determinant in Arab and Jewish Israelis

Subjective health (SH) status serves as a measure of health in many studies of health-related issues as it is a good predictor of mortality, morbidity, and use of health services. The measure is used in many population groups. However, the degree to which it measures the same condition in different ethnic groups is not clear. Within Israel's first National Health and Nutrition Survey (MABAT) conducted during 1999-2001, face-to-face interviews were held with 3222 Israeli interviewees, 2379 Jews and 843 Arabs, aged between 25-64 years. Respondents reported their SH, co-morbidity, and other socioeconomic characteristics. Arabs reported higher levels of SH than Jews. In logistic regression analysis, co-morbidity was a much stronger correlate of poorer SH in the Arab than in the Jewish population. The association between socioeconomic variables depended on ethnic group and sex. The findings indicate that SH in Jews and Arabs does not necessarily have the same meaning in relation to objective measures of health, and caution should be exercised in the use of this measure in different population groups with different cultures. Arabs tend to evaluate health better than Jews even though life expectancy is lower and morbidity and mortality are higher in the former population group. Yet diagnosis of a disease increases the frequency of reporting lower SH, more in Arabs than in Jews.

Leisure time, non-leisure time, and occupational physical activity in Asian Americans

PURPOSE

Asian American immigrants' risk of heart disease, diabetes, and obesity increase with duration of residence in the United States (US). Regular physical activity reduces the risk of these diseases, yet little is known about physical activity in Asian Americans and how it changes after immigration.

METHODS

Data from the 2001 California Health Interview Survey, which oversampled Asian Americans, were analyzed to investigate the effects of ethnicity, nativity, and years in the US on leisure time physical activity (LTPA), non-leisure time physical activity (NLTPA), and occupational physical activity. A total of 4226 Asian Americans and 29,473 US-born non-Asians were included.

RESULTS

Asian Americans were much less likely to meet recommended levels of LTPA than US-born non-Asians (odds ratio [OR], men=0.51, 95% confidence interval [CI], 0.42, 0.61, OR, women = 0.48, 95% CI, 0.40, 0.57). Foreign-born Asians were least likely to participate in LTPA; LTPA increased as years in the US increased. After accounting for NLTPA, Asian Americans had significantly lower estimated weekly energy expenditure than US-born non-Asians.

CONCLUSIONS

Asian Americans, especially immigrants, are at risk for low levels of LTPA and high levels of physical inactivity. NLTPA does not offset these lower levels of LTPA. Increasing physical activity is key to protecting the health of this rapidly growing population.

Health behaviors, chronic disease prevalence and self-rated health of older Asian Indian immigrants in the U.S

The purpose of this study was to examine the correlates of healthy behaviors and self-rated health in middle-aged and older Asian Indian immigrants in the U.S. Asian Indian men (n=162) and women (n=64), 50 years of age or older completed a telephone survey which collected information regarding demographics, behavioral risk factors, acculturation, perceived control, quality of social support, depression, body mass index, chronic disease prevalence, and self-rated health. Participants' average length of residence in the U.S. was 25 years, 52% were normal weight, 41% were vegetarians, 55% incorporated aerobic activity into daily lifestyle, and only 5% smoked. Hypertension and diabetes were most common chronic diseases (31 and 18%, respectively). Younger age, longer length of residence and a bicultural or more American ethnic identity were associated with greater participation in physical activity. Likewise, higher income, a bicultural or more American ethnic identity and depression were associated with higher fat intake. Poor self-rated health was associated with older age, female gender, BMI>25, satisfaction with social support, and greater number of chronic disease conditions. A multitude of factors influence the practice of healthy behaviors and the perceived health of Asian Indian immigrants, which should be addressed when developing culturally appropriate health promotion interventions.

Tobacco use, secondhand smoke exposure and their related knowledge, attitudes and behaviors among Asian Americans

The present study examined tobacco use, secondhand smoke exposure and related knowledge, attitudes and behaviors among Asian Americans in the Delaware Valley of Pennsylvania and New Jersey, and the relationship between acculturation and smoking, social influence patterns on smoking, and stages of change of smoking among Asian subgroups. Study sample was 1174 Chinese, Koreans, Vietnamese, Cambodians, and other Asians. Findings revealed mean age of initiation to be 18.3, 40% ever and 30% current users. Significant differences were reflected in smoking by gender, ethnicity, educational level, marital and employment status. While knowledge and attitudes about smoking and secondhand smoke were associated with these variables, ethnic pride and smoking status played significant roles. Fathers and brothers had greater social influence on young male smoking behavior; smoking friends had influence on both genders. Stages of change of smoking and acculturation impact on smoking varied with gender, age, and time living in the U.S. Findings provide comprehensive insights into tobacco use and related KAB among Asian Americans that reflect the need for developing culturally appropriate programs for this underserved population.

Acculturation and Its Relationship to Smoking and Breast Self-Examination Frequency in African American Women

The concept of acculturation has been used to understand differences in health behaviors between and within a variety of racial and ethnic immigrant groups. Few studies, however, have examined the potential impact of acculturation on health behaviors among African Americans. The present study has two goals: 1) to reconfirm relations between acculturation and cigarette smoking; 2) to investigate the impact of acculturation on another type of health behavior, cancer screening and specifically breast self-examination (BSE). African American women (N = 66) attending an inner-city cancer-screening clinic completed study questionnaires. Results reconfirmed psychometric properties of the African American Acculturation Scale (AAAS); replicated the negative association between acculturation and lifetime smoking status; and found relations between acculturation and women's adherence to BSE frequency guidelines. Findings from this study raise the possibility that specific aspects of acculturation may better explain specific health behaviors.

Validity of Self-Reported Weight and Height: Comparison Between Immigrant and Non-Immigrant Mexican Americans in NHANES III

This study examined whether 1) the immigrant Mexican Americans reported weight and height differently from the non-immigrant Mexican Americans and, 2) self-reporting errors influenced weight classification. A U.S. national sample of 3085 Mexican Americans from the third National Health and Nutrition Examination Survey was used to investigate validity using paired t-tests, multiple linear regressions, sensitivity and specificity. While immigrant Mexican American women reported their weight and height higher than non-immigrant women, no significant differences were found between immigrant and non-immigrant Mexican American men. Sensitivity and specificity of weight classification with self-reported weight and height were not different between immigrant and non-immigrant Mexican Americans; however, underweight Mexican Americans showed the lowest sensitivity. Therefore, self-reported weight and height can be used for the purpose of weight classification with immigrant and non-immigrant Mexican Americans, with an exception of underweight Mexican Americans.

Personal factors influencing Korean American men's smoking behavior: addiction, health, and age

The purpose of this qualitative study was to identify factors influencing Korean American men's smoking behavior. Focus-group research method was used, and participants were 22 Korean male smokers in New York City. They talked about their experiences of smoking and smoking cessation. Addiction, health, and age emerged as major personal factors affecting Korean men's smoking behavior. Their experiences in relation to addiction were similar to those reported in other racial/ethnic groups, whereas the dramatic change in the perception of smoking-related health risks coming with their forties, some cessation strategies used by former smokers, and preference for group meetings over individual counseling appeared to be specific to Korean men.

Acculturation and physical activity among North Carolina Latina immigrants

The objective of this study was to examine the association between acculturation and physical activity among first generation Latina (Hispanic women) immigrants living in North Carolina. As part of the multi-site Women's Cardiovascular Health Network, 671 first generation Latina immigrants 20-50 years of age completed in-person interviews on physical activity, acculturation (measured by a language scale, length of residence in the US, and age at arrival in the US) and other potential individual and contextual correlates of physical activity. All statistical models were adjusted for age, general health, number of children in the home, marital status, and education, with self-reported physical activity as the dependent variable. Among participants, 37.4% met recommendations for physical activity, 41.9% reported insufficient activity, and 20.7% reported no moderate or vigorous activity. Latinas with higher English language acculturation were more likely to be physically active than women with lower English language acculturation. Likewise, women who arrived to the US when they were younger than 25 years were more likely to be physically active than women who arrived when they were 25 years or older. Length of residence in the US was not associated with physical activity. These relationships persisted when restricting the sample to Mexican born women. We conclude that among first generation immigrants living in North Carolina, those with higher English language acculturation or who arrived to the US at younger ages were more likely to report being physically active. These findings suggest that future epidemiologic studies and physical activity interventions should measure and tailor programs based on English-language use and age of arrival to the US among Latina immigrants.

Culture Change and Ethnic-Minority Health Behavior: An Operant Theory of Acculturation

Data on acculturation and ethnic-minority health indicate that acculturation has opposite effects on the same health behavior among different ethnic groups; opposite effects on different health behaviors within an ethnic group; opposite effects on the same health behavior for the women vs. the men of most ethnic groups; and no effect whatsoever on some health behaviors for some ethnic groups. This evidence is so incoherent that it is unintelligible, and hence it continues to be largely useless to health psychology and behavioral medicine. This paper presents a new theory of acculturation that renders these confusing data coherent by predicting such changes in minority health behavior a priori. By so doing, the operant model of acculturation has the potential to improve health promotion and disease prevention and thereby reduce ethnic health disparities.

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

OBJECTIVES

We sought to determine how risk factors for disease vary among Asian subgroups.

METHODS

Using data from a case-control study conducted at Northern California Kaiser Medical Centers (from 1996 to 2001), we compared prevalence of selected risk factors among Asian subgroups and evaluated the associations of these risk factors with sociodemographic factors.

RESULTS

Chinese and Japanese patients had a lower body mass index (kg/m(2)) than did other Asians. In all subgroups, being born in the United States was associated with having a body mass index greater than 25 kg/m(2). Compared with other Asians, more Japanese and multiple-race Asians smoked, and more Filipino and multiple-race Asian smokers started smoking at 18 years or younger. Filipinos and multiple-race Asians also were more likely to report diabetes.

CONCLUSIONS

These data support the importance of efforts to distinguish among Asian subgroups in public health practice and research.

The association between length of residence and obesity among Hispanic immigrants

BACKGROUND

Newly arrived Hispanic immigrants are generally healthier than the U.S.-born population, but this distinction tends to diminish over time as immigrants adapt to a new and different sociocultural environment.

OBJECTIVE

This study sought to determine whether length of residence in the United States was associated with obesity (body mass index [BMI]>30 kg/m(2)) among Hispanic immigrants.

METHODS

Data for 2420 foreign-born Hispanic adults aged > or =18 years were obtained from the 1998 National Health Interview Survey.

RESULTS

The prevalence of obesity among those with 0 to 4, 5 to 9, 10 to 14, and > or =15 years of residence in the United States was 9.4%, 14.5%, 21.0%, and 24.2%, respectively. A logistic regression model adjusted for smoking, physical inactivity, self-assessed health, chronic conditions, functional limitations, nonspecific psychological distress, several sociodemographic characteristics, and access to health services found that longer-term Hispanic immigrants (> or =15 years) experienced a nearly four-fold greater risk of obesity than did recent immigrants (<5 years).

CONCLUSIONS

The higher risk for obesity associated with length of residence may be due to acculturation processes such as the adoption of the unhealthy dietary practices (i.e., a diet high in fat and low in fruits and vegetables) and sedentary lifestyles of the host country. The results of this study may facilitate the planning of public health interventions that are directed at subgroups of the Hispanic population.

Acculturation and health risk behaviors among Californians of Korean descent

BACKGROUND

This study examined the effects of acculturation on health behaviors among Korean-Americans in California compared to Koreans in Seoul.

METHODS

Telephone interviews were conducted with 2,830 Korean-American adults in California (completion rate exceeding 86%) and 500 Korean adults in Seoul (completion of about 50%).

RESULTS

Among Korean-Americans, acculturated women were more likely to smoke and drink while acculturated men were more likely to become obese. All Korean-American men reported significantly decreased rates of smoking and drinking compared to Koreans in Seoul. Among both men and women in California, acculturation was associated with high consumption of American foods, and low consumption of traditional Korean foods.

CONCLUSIONS

These results indicate that more acculturated Korean-Americans were exposed to greater health risk than those who were less acculturated.

Acculturation and tobacco use among Chinese Americans

OBJECTIVES

We examined the relationship between acculturation and tobacco use behaviors among Chinese Americans.

METHODS

Using a Chinese-language instrument based on validated questions from several national surveys, we conducted in-person, household-based interviews with 712 representative adults aged 18-74 years.

RESULTS

Observed smoking prevalence was 29% for men and 4% for women. Predictors of smoking cessation included being 35 years and older and having a high level of tobacco-related knowledge. Acculturation was positively associated with a history of never smoking, as was being younger than 35 years and having a high level of tobacco-related knowledge.

CONCLUSIONS

Acculturation was positively associated with never smoking among men but not with smoking cessation. However, knowledge of tobacco-related health risks was associated with both. Results indicate a need for language-specific educational interventions.

When cultures meet in general practice: intercultural differences between GPs and parents of child patients

Although health care professionals in The Netherlands are increasingly confronted with diverse immigrant groups, medical counselling and treatment of these groups has not been the subject of extensive research yet. From other studies it is well known that intercultural differences can have serious consequences for health care, e.g. in terms of risk of incorrect diagnoses or non-compliance. Eighty-seven autochthonous Dutch and immigrant (mainly from Turkey and Surinam) parents of child patients and their general practitioners (GPs) were recruited to investigate the influence of cultural differences on mutual understanding and patient compliance. Analyses of questionnaires and home interviews revealed that there is a relation between the cultural background of the patient and effectiveness of communication. Communication in consultations between GPs and persons from ethnic minorities is less effective than in consultations with Dutch persons: there is more misunderstanding, and also more non-compliance. In general, mutual understanding between GP and patient proves to be a strong predictor for patient compliance. These findings hold especially true for patients living in two worlds, i.e. a mixture of traditional and western cultures. The results are discussed in terms of methodological issues and practical implications for the health care providers.

Measuring culture: a critical review of acculturation and health in Asian immigrant populations

The number of studies examining how acculturation affects the health of Asian immigrants has increased in recent years. The proliferation of studies reflects the growing size and heterogeneity of Asian immigrant populations in the United States, Canada, Australia, New Zealand, and the United Kingdom. This paper compares various approaches to acculturation within the health literature on Asian immigrants by reviewing the literature in three-health domains (1) mental health (2) physical health and (3) health services use. The review critically examines the conceptualizations and measures of acculturation in these three domains and presents major findings. We observe that measurement difficulties posed by the experiences of heterogeneous Asian groups compound theoretical and disciplinary disparities between acculturation instruments. The extent to which conceptual and methodological critiques of acculturation studies in Hispanic populations apply to studies of Asian populations is also discussed. The critical review thus provides insights into the diverse ways that the relationship between culture and health is measured in this complicated and growing literature.

Predictors of older Korean Americans' participation in colorectal cancer screening

BACKGROUND

Cancer is the second leading cause of death among Korean Americans aged 65 and older. Colorectal cancer is the second most commonly diagnosed cancer among Korean American women and the third among men. The purpose of this study was to examine the rates of colorectal cancer (CRC) screening and the correlates of screening tests.

METHODS

The study employed cross-sectional face-to-face interviews with a sample of 205 Korean American elderly aged 60 and older.

RESULTS

About 18% of respondents had ever had a fecal occult blood test (FOBT) and 11%, sigmoidoscopy. A history of bloody stool was related to having FOBT. In multiple logistic regression analyses, government assistance, routine checkups, having insurance, and speaking fluent English were associated with having FOBT. Marital status, proportion of time spent in the U.S., and general health status were related to having sigmoidoscopy.

CONCLUSIONS

The findings suggest a need for further research addressing barriers to cancer screening in Korean Americans.

Regional variations in dietary intake and body mass index of first-generation Asian-Indian immigrants in the United States

Asian Indians (AIs) have considerable within-group diversity in education levels, socioeconomic status, language, and diet based on the region of origin in India. The objective of this study was to determine if dietary intake patterns vary based on region of origin among first generation AI immigrants and if these differences influence body mass index (BMI). AI men and women (n=237), over 40 years, in southern US participated in a telephone survey. Responses to the Block food frequency questionnaire suggest that the diet of the study participants was low in dietary fiber while dietary fat intake was within guidelines. Intake of individual foods varied by region of origin. BMI also varied by region of origin (P<.05), with individuals from the north having a higher BMI (26.3) compared to those from the south and west (24.3). Regression analysis showed BMI to be significantly related to total fat intake, physical activity, and north region. Results suggest that dietary advice and lifestyle recommendations should be individualized.

Korean women: breast cancer knowledge, attitudes and behaviors

INTRODUCTION

Clustered within the nomenclature of Asian American are numerous subgroups, each with their own ethnic heritage, cultural, and linguistic characteristics. An understanding of the prevailing health knowledge, attitudes, and screening behaviors of these subgroups is essential for creating population-specific health promotion programs.

METHODS

Korean American women (123) completed baseline surveys of breast cancer knowledge, attitudes, and screening behaviors as part of an Asian grocery store-based breast cancer education program evaluation. Follow-up telephone surveys, initiated two weeks later, were completed by 93 women.

RESULTS

Low adherence to the American Cancer Society's breast cancer screening guidelines and insufficient breast cancer knowledge were reported. Participants' receptiveness to the grocery store-based breast cancer education program underscores the importance of finding ways to reach Korean women with breast cancer early detection information and repeated cues for screening. The data also suggest that the Asian grocery store-based cancer education program being tested may have been effective in motivating a proportion of the women to schedule a breast cancer screening between the baseline and follow-up surveys.

CONCLUSION

The program offers a viable strategy to reach Korean women that addresses the language, cultural, transportation, and time barriers they face in accessing breast cancer early detection information.