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Ryu S, Morey BN, Shi Y, Lee S. Acculturation and self-rated health among Chinese and Korean immigrants aged 49 to 75. Front Public Health 2023; 11:1272428. [PMID: 38179574 PMCID: PMC10766358 DOI: 10.3389/fpubh.2023.1272428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 12/04/2023] [Indexed: 01/06/2024] Open
Abstract
Background Given the rapidly growing Asian populations in the U.S. due to immigration, and the aging demographic of Asian immigrants, it is crucial to understand how acculturation shapes health among older adult Asian immigrants. We study the relationship between acculturation and self-rated health (SRH) and moderating roles of age and Asian subgroup. Methods Our cross-sectional study consisted of 200 Chinese and 200 Korean immigrants aged 49-75 living in Baltimore-Washington DC metropolitan area, who were recruited from primary care physicians' clinics in Maryland and Northern Virginia. The participants completed the survey either in-person or by phone in their preferred language. Multidimensional proxies were used to measure acculturation: years living in the U.S. (≥23 years, <23 years), English proficiency (fluently/well, so-so, poorly/not at all), and ethnic identity (very Asian, mostly Asian, bicultural/westernized). SRH was measured using the question "How would you rate your general health?" (excellent/very good/good, fair/poor). Poisson regression models with robust error variance examined associations between acculturation and SRH, accounting for socioeconomic and health insurance factors. Results Speaking English so-so and fluently/well had 0.73 (95% confidence intervals (CI): 0.55-0.97) and 0.51 (95% CI: 0.30-0.87) times the prevalence of having fair or poor SRH compared to speaking English poorly/not at all, respectively. The magnitudes and statistical significance of these associations were stronger among Chinese participants than Korean participants. Moreover, individuals who self-identified as bicultural/westernized had 0.63 times the prevalence of having fair or poor SRH (95% CI: 0.43-0.92) as those who self-identified as very Asian. The association was more pronounced among older participants (≥58) compared to younger participants (<58). Conclusion Further research should identify the possible mechanisms linking acculturation with health to find effective strategies to enhance health among aging Asian immigrant populations.
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Affiliation(s)
- Soomin Ryu
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Brittany N. Morey
- Program in Public Health, Department of Health, Society, and Behavior, University of California, Irvine, Irvine, CA, United States
| | - Yuxi Shi
- Department of Medicine, School of Medicine, University of California, Irvine, Irvine, CA, United States
| | - Sunmin Lee
- Department of Medicine, School of Medicine, University of California, Irvine, Irvine, CA, United States
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Morey BN, Ryu S, Shi Y, Park HW, Lee S. Acculturation and Cardiometabolic Abnormalities Among Chinese and Korean Americans. J Racial Ethn Health Disparities 2022:10.1007/s40615-022-01347-x. [PMID: 35705844 PMCID: PMC9200372 DOI: 10.1007/s40615-022-01347-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 05/16/2022] [Accepted: 05/31/2022] [Indexed: 11/26/2022]
Abstract
Background Studies generally show that higher acculturation is associated with greater cardiovascular disease (CVD) risk among immigrants in the United States (US). However, few studies have compared how proxies of acculturation are differentially associated with metabolic abnormalities measured using objective biomarkers, self-reported diagnosis, and medication use, particularly among East Asian Americans. Methods Survey data and biomarker measurements collected from random (non-fasting) blood samples of Chinese and Korean immigrants in the US (n = 328) were used to examine the associations between two proxies for acculturation (years living in the US and English speaking proficiency) with three cardiometabolic abnormalities (high triglyceride levels, diabetes, and hypercholesterolemia). Poisson regression models estimated prevalence ratios adjusted for demographic characteristics, socioeconomic factors, and body mass index. Gender, Asian subgroup, and household income were tested as potential effect modifiers. Results Living longer in the US was associated with greater likelihood of having high triglycerides. In addition, living longer in the US was associated with greater likelihood of diabetes for people with lower household income and greater likelihood of hypercholesterolemia for people with higher household income. Higher level of English proficiency was less consistently associated with higher cardiometabolic risk, although there was a significant association with greater likelihood of hypercholesterolemia. Conclusions Longer time lived in the US is associated with higher risk of cardiometabolic abnormalities among Chinese and Korean Americans. Future studies of acculturation and cardiometabolic risk should carefully consider potential mechanisms and what proxy measures of acculturation capture. Trial Registration Number NCT03481296, date of registration: 3/29/2018.
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Affiliation(s)
- Brittany N Morey
- Program in Public Health, Department of Health, Society, & Behavior, University of California, Irvine, 653 E. Peltason Dr., Anteater Instruction and Research Building (AIRB) 2022, Irvine, CA, 92697-3957, USA.
| | - Soomin Ryu
- School of Public Policy, University of Maryland, College Park, MD, USA
| | - Yuxi Shi
- Department of Medicine, School of Medicine, University of California, Irvine, Irvine, CA, USA
| | - Hye Won Park
- Department of Medicine, School of Medicine, University of California, Irvine, Irvine, CA, USA
| | - Sunmin Lee
- Department of Medicine, School of Medicine, University of California, Irvine, Irvine, CA, USA
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Mahmoodi M, George RM, Gokhale D. Dietary acculturation of international students in Pune, India: a cross-sectional study. Nutr Health 2022; 28:271-276. [PMID: 34187230 DOI: 10.1177/02601060211019678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Dietary acculturation refers to how a migrant group adopts the eating patterns of the host country. It results in changes in dietary behavior, dietary intake, and nutritional status of this vulnerable group. AIM To study dietary acculturation of international students in Pune, India. METHODS International students from three Universities in Pune were enrolled. Information on demography, dietary behavior, and dietary intake (using a food frequency questionnaire) was recorded using an interviewer-administered questionnaire. The height and weight of the students were measured using standard, calibrated equipment. The data were analyzed using descriptive and analytical statistics. RESULTS A total of 100 international students from Iran, Africa, and South Korea were grouped by nationality. Considerable variation was detected in the daily number of meals consumed, skipping meals, portion size changes, packaged food consumption, and supplement intake following migration between the groups. The intake of non-vegetarian food had declined drastically for all groups. However, the specific non-vegetarian item showing the greatest change differed according to the group's nationality. The intake of biscuits and cake had increased among all groups. African students showed an increase of 3.33 kg in body weight following migration. The intake of protein and micronutrients declined for all groups. CONCLUSIONS This study highlights the changes in dietary behavior, dietary intake, and nutritional status of international students of different nationalities following migration to Pune, India. Thus, it emphasizes the need for nutrition interventions in international students in India.
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Affiliation(s)
- Mahnaaz Mahmoodi
- Symbiosis School of Biological Sciences, 29630Symbiosis International (Deemed University), Pune, Maharashtra, India
| | - Roopan Miriam George
- Symbiosis School of Biological Sciences, 29630Symbiosis International (Deemed University), Pune, Maharashtra, India
| | - Devaki Gokhale
- Symbiosis Institute of Health Sciences, 29630Symbiosis International (Deemed University), Pune, Maharashtra, India
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De Souza LR, Chan KT, Kobayashi K, Karasiuk A, Fuller-Thomson E. The prevalence and management of diabetes among Vietnamese Americans: A population-based survey of an understudied ethnic group. Chronic Illn 2022; 18:306-319. [PMID: 33054356 DOI: 10.1177/1742395320959422] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Although obesity remains relatively rare among Vietnamese Americans, the prevalence of diabetes has increased in this population. This study aims to: 1. Estimate the prevalence of diabetes among non-obese Vietnamese American adults compared to non-obese non-Hispanic whites (NHW). 2. Identify factors associated with diabetes among non-obese Vietnamese Americans. 3. Examine whether Vietnamese Americans and NHW with diabetes are equally as likely to receive optimal frequency of diabetes care (i.e., hemoglobin A1C monitoring, foot care, eye care). METHODS We conducted a secondary analysis of non-obese adult Vietnamese Americans using pooled data from the 2007, 2009, 2011 and 2013-2016 waves of the California Health Interview Survey (CHIS). RESULTS Only 9% of Vietnamese Americans with diabetes are obese. Non-obese Vietnamese Americans have 60% higher adjusted odds of diabetes compared to non-obese NHW. Among non-obese Vietnamese Americans, those who were older, ever smokers and born outside US had a higher prevalence of diabetes. We found both Vietnamese Americans and NHW with diabetes received similar levels of care. DISCUSSION Non-obese Vietnamese Americans have much higher odds of diabetes than NHW. Health professionals can effectively minimize disparities between Vietnamese Americans and NHW with diabetes through appropriate monitoring of foot care, eye care and A1C levels.
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Affiliation(s)
- Leanne R De Souza
- Institute for Life Course and Aging, University of Toronto, Toronto, Canada
| | - Keith T Chan
- School of Social Welfare, University at Albany, Albany, USA
| | - Karen Kobayashi
- Department of Sociology, University of Victoria, Victoria, Canada
| | - Alexis Karasiuk
- Institute for Life Course and Aging, University of Toronto, Toronto, Canada
| | - Esme Fuller-Thomson
- Institute for Life Course and Aging, University of Toronto, Toronto, Canada.,Factor-Inwentash Faculty of Social Work and Department of Family & Community Medicine, University of Toronto, Toronto, Canada
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Health-Promoting Lifestyle Behaviors of Korean American Breast Cancer Survivors: Adherence to the American Cancer Society Guidelines. Cancer Nurs 2022:00002820-990000000-00024. [PMID: 35439213 DOI: 10.1097/ncc.0000000000001092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Breast cancer incidence has been increasing in Korean American women. However, there are limited data on Korean American breast cancer survivors' health-promoting lifestyle behaviors. The American Cancer Society (ACS) publishes guidelines on weight, diet, physical activity, and alcohol for cancer survivors. Because of limited data on Korean American breast cancer survivors, their level of adherence to ACS guidelines is unknown. OBJECTIVE The aim of this study was to examine Korean American breast cancer survivors' level of adherence to ACS guidelines. METHODS Korean American breast cancer survivors (N = 50) participated in a cross-sectional study. Diet data including alcohol consumption were collected with 4-day diet records. Physical activity data were collected with the International Physical Activity Questionnaire. Total score of adherence to ACS guidelines was assessed with a systematic scoring system that ranged from 0 to 8. RESULTS Participants' average body mass index was 23.7 (±2.7). Average daily serving of fruits and vegetables was 3.3 (±2.9), red meat was 0.8 (±1.5), and alcohol was 0. On average per week, participants had 51.8 (±85.2) minutes of moderate physical activity, 35 (±78.3) minutes of vigorous physical activity, and 69.1 (±73.7) minutes of walking. The average total adherence score to ACS guidelines was 5.3 (±1.3). CONCLUSIONS Findings indicate modest adherence to ACS guidelines, with the alcohol guideline score contributing the most and diet guideline score the least. IMPLICATIONS FOR PRACTICE Findings from this study can be used to inform healthcare providers to educate Korean American breast cancer survivors on improving their diet and physical activity behaviors.
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Acculturation and biological stress markers: A systematic review. Psychoneuroendocrinology 2021; 132:105349. [PMID: 34246155 PMCID: PMC8527572 DOI: 10.1016/j.psyneuen.2021.105349] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/25/2021] [Accepted: 06/27/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND The association of acculturation with health among immigrant populations is believed to be mediated, in part, by acculturation-related stress and stress biology. OBJECTIVES To review and qualitatively synthesize empirical findings on the relationship of acculturation with stress-related inflammatory and endocrine biomarkers and composite allostatic load (AL) scores. METHODS A literature search was performed in the PubMed and PsycInfo databases. Article titles, abstracts or full-texts were screened and checked for match with the search criteria. Studies were eligible if they empirically tested the relationship between acculturation and inflammatory/endocrine stress biomarkers or composite AL scores, and were published in the English language. RESULTS Among the 41 articles identified as relevant and included in this review, the majority were published after 2010, included adult Hispanic U.S.-based populations, used cross-sectional study designs, operationalized acculturation as a unidimensional construct, and varied considerably in the selection of covariates in the analyses. Acculturation was significantly associated with stress biomarkers in 29 studies, but the direction of effects varied across studies. Specifically, acculturation, operationalized as a higher orientation towards the host culture, was associated with inflammatory biomarkers in 10 of 14 studies, with endocrine stress biomarkers in 12 of 20 studies, and with composite AL scores in 7 of 8 studies. Overall, language-based proxy measures of acculturation were related to higher levels of stress-related inflammatory and endocrine biomarkers and to lower levels of AL scores, whereas nativity-, generation status- and length of stay-based proxy measures of acculturation were related to higher levels of inflammatory biomarkers and AL score. DISCUSSION The majority of studies reported associations between measures of acculturation and stress biomarkers, however the directions of effects varied across studies. We suggest this heterogeneity may, in part, be a function of limitations imposed by cross-sectional research designs and unidimensional measures of acculturation measures, and we highlight the need for longitudinal studies and use of multidimensional measures of acculturation to better uncover the biobehavioral mechanisms and pathways linking acculturation with health outcomes.
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Kwon S, Wang-Schweig M, Kandula NR. Body Composition, Physical Activity, and Convenience Food Consumption among Asian American Youth: 2011-2018 NHANES. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E6187. [PMID: 32858944 PMCID: PMC7504455 DOI: 10.3390/ijerph17176187] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/20/2020] [Accepted: 08/21/2020] [Indexed: 12/20/2022]
Abstract
The primary purpose of this study was to describe obesity, body composition, convenience food consumption, physical activity, and muscle strength among Asian American youth compared to other racial/ethnic groups. The secondary purpose was to examine whether obesity, body composition, convenience food consumption, physical activity, and muscle strength differed by acculturation levels among Asian American youth. A secondary analysis was conducted using data from 12,763 children aged 2 to 17 years that participated in the 2011-2018 US National Health and Nutrition Examination Survey (NHANES). In the NHANES interview, acculturation, dietary behavior, and physical activity questionnaires were administered. The acculturation level was indicated by the language spoken at home. In the NHANES examination, anthropometry, dual-energy X-ray absorptiometry (DXA), and muscle strength assessments were conducted. Compared to non-Hispanic White American boys, Asian American boys had similar levels of obesity, central obesity, and fat mass. Among the five racial/ethnic groups examined, lean body mass, muscle mass, convenience food consumption, and daily physical activity were the lowest in the Asian group. More acculturated Asian American boys, but not girls, were more likely to be obese (OR = 3.28 (1.63, 6.60)). More acculturated Asian American youth more frequently consumed convenience food (1.4 more meals/month (1.2, 1.6)). This study highlights the obesity problem among Asian American boys, which worsens with acculturation to America. The study results also suggest that although Asian American youth consume less convenience food overall than non-Hispanic White American youth, increasing acculturation may negatively influence food choices.
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Affiliation(s)
- Soyang Kwon
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL 60611, USA
| | - Meme Wang-Schweig
- Division of Community Health Sciences, University of Illinois Chicago School of Public Health, Chicago, IL 60607, USA;
| | - Namratha R. Kandula
- Department of Medicine and Preventive Medicine, Northwestern University, Chicago, IL 60611, USA;
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Peters BA, Yi SS, Beasley JM, Cobbs EN, Choi HS, Beggs DB, Hayes RB, Ahn J. US nativity and dietary acculturation impact the gut microbiome in a diverse US population. THE ISME JOURNAL 2020; 14:1639-1650. [PMID: 32210364 PMCID: PMC7305110 DOI: 10.1038/s41396-020-0630-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 02/18/2020] [Accepted: 02/28/2020] [Indexed: 02/03/2023]
Abstract
Little is known regarding the impact of immigrant acculturation on the gut microbiome. We characterized differences in the gut microbiome between racially/ethnically diverse US immigrant and US-born groups, and determined the impact of dietary acculturation on the microbiome. Stool samples were collected from 863 US residents, including US-born (315 White, 93 Black, 40 Hispanic) and foreign-born (105 Hispanic, 264 Korean) groups. We determined dietary acculturation from dissimilarities based on food frequency questionnaires, and used 16S rRNA gene sequencing to characterize the microbiome. Gut microbiome composition differed across study groups, with the largest difference between foreign-born Koreans and US-born Whites, and significant differences also observed between foreign-born and US-born Hispanics. Differences in sub-operational taxonomic unit (s-OTU) abundance between foreign-born and US-born groups tended to be distinct from differences between US-born groups. Bacteroides plebeius, a seaweed-degrading bacterium, was strongly enriched in foreign-born Koreans, while Prevotella copri and Bifidobacterium adolescentis were strongly enriched in foreign-born Koreans and Hispanics, compared with US-born Whites. Dietary acculturation in foreign-born participants was associated with specific s-OTUs, resembling abundance in US-born Whites; e.g., a Bacteroides plebeius s-OTU was depleted in highly diet-acculturated Koreans. In summary, we observed that US nativity is a determinant of the gut microbiome in a US resident population. Dietary acculturation may result in loss of native species in immigrants, though further research is necessary to explore whether acculturation-related microbiome alterations have consequences for immigrant health.
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Affiliation(s)
- Brandilyn A. Peters
- 0000 0004 1936 8753grid.137628.9Department of Population Health, NYU School of Medicine, New York, NY USA ,0000000121791997grid.251993.5Present Address: Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY USA
| | - Stella S. Yi
- 0000 0004 1936 8753grid.137628.9Department of Population Health, NYU School of Medicine, New York, NY USA
| | - Jeannette M. Beasley
- 0000 0004 1936 8753grid.137628.9Department of Medicine, NYU School of Medicine, New York, NY USA
| | - Emilia N. Cobbs
- 0000 0004 1936 8753grid.137628.9Department of Population Health, NYU School of Medicine, New York, NY USA
| | - Hee Sun Choi
- 0000 0004 1936 8753grid.137628.9Department of Population Health, NYU School of Medicine, New York, NY USA
| | - Dia B. Beggs
- 0000 0004 1936 8753grid.137628.9Department of Population Health, NYU School of Medicine, New York, NY USA
| | - Richard B. Hayes
- 0000 0004 1936 8753grid.137628.9Department of Population Health, NYU School of Medicine, New York, NY USA ,0000 0004 1936 8753grid.137628.9NYU Perlmutter Cancer Center, New York, NY USA
| | - Jiyoung Ahn
- 0000 0004 1936 8753grid.137628.9Department of Population Health, NYU School of Medicine, New York, NY USA ,0000 0004 1936 8753grid.137628.9NYU Perlmutter Cancer Center, New York, NY USA
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Zhang Q, Liu R, Diggs LA, Wang Y, Ling L. Does acculturation affect the dietary intakes and body weight status of children of immigrants in the U.S. and other developed countries? A systematic review. ETHNICITY & HEALTH 2019; 24:73-93. [PMID: 28406037 PMCID: PMC6120814 DOI: 10.1080/13557858.2017.1315365] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE This paper reviews available studies on the relationship between acculturation and obesity among children of immigrants who have at least one foreign-born parent. METHODS A systematic review of relevant studies was undertaken using PubMed, Web of Science, and PsychInfo. RESULTS The initial search identified 1317 potentially relevant publications, of which 21 were retained after three rounds of screening. Most studies were conducted in the U.S. The majority of studies used BMI or overweight/obesity prevalence as the outcome variable, while two studies used dietary intake. Three studies used standardized acculturation scales, while most of the studies used generation, duration of residency in host country, and language as proxy measures of acculturation. The relationship between acculturation and outcomes varied between the host countries and origin countries for children of immigrants. CONCLUSION This study suggests children of immigrants with different cultural backgrounds may interact with host countries to varying degrees, ultimately influencing their diet behaviours and body weight status. Researchers are encouraged to adopt standardized acculturation scales to compare the results across countries and populations.
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Affiliation(s)
- Qi Zhang
- School of Community and Environmental Health, Old Dominion
University, Norfolk, VA, USA
- Sun Yat-sen Center for Migrant Health Policy, Sun Yat-sen
University, Guangzhou, China
| | - Ruicui Liu
- School of Community and Environmental Health, Old Dominion
University, Norfolk, VA, USA
| | - Leigh A Diggs
- School of Community and Environmental Health, Old Dominion
University, Norfolk, VA, USA
| | - Youfa Wang
- Fisher Institute of Health and Well-Being, Ball State
University, Muncie, IN, USA
| | - Li Ling
- Sun Yat-sen Center for Migrant Health Policy, Sun Yat-sen
University, Guangzhou, China
- Faculty of Medical Statistics and Epidemiology, School of
Public Health, Sun Yat-sen University, Guangzhou, China
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Tan N, Cho H. Cultural Appropriateness in Health Communication: A Review and A Revised Framework. JOURNAL OF HEALTH COMMUNICATION 2019; 24:492-502. [PMID: 31132946 PMCID: PMC7101074 DOI: 10.1080/10810730.2019.1620382] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
A revised framework for cultural appropriateness is offered on the basis of a systematic review of operationalizations in 44 cancer screening interventions for Asian Americans. Studies commonly conveyed the epidemiological bases of the intervention (97.7%) and used the language of the population (95.5%). Less commonly reported were strategies central to health communication: cultural features of the intervention messages (77.3%) and the cultural beliefs and values that the intervention focused on (43.2%). Few used cultural tailoring (4.5%) and none aimed to address acculturation or cultural identity. The theoretical framework most frequently used was the health belief model (27.3%) which does not explain the role of culture. More studies focused on cultural barriers (20.5%) than cultural strengths (9.1%). Our revised framework comprises six cultural appropriateness strategies of cultural identity, linguistic, perceptual features, content, constituent-involving, and socioeconomic context-adaptive. It prioritizes cultural identity to recognize the dynamics within racial ethnic groups and to inform adaptive efforts for cultural appropriateness. It emphasizes examining cultural strengths that can facilitate change, as well as reducing cultural barriers. Future research and action should address the disparities in extant health disparities research in which theory and methods are underdeveloped and underutilized for Asian Americans.
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Jang M, Jeon S, Nam S, Song HJ, Whittemore R. Relationships of Obesity-Related Behavior Patterns With Socioeconomic Status and Acculturation in Korean American Women. Clin Nurs Res 2018; 29:440-447. [PMID: 29932007 DOI: 10.1177/1054773818783467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There is limited understanding about the obesity-related behaviors of diet, physical activity, and sedentary behavior in Korean American women. The purpose of this study was to cluster obesity-related behavior patterns of Korean American women and to examine group differences in acculturation, socioeconomic status (SES), and body mass index (BMI). A secondary analysis from a cross-sectional study was conducted using two-step cluster analysis for clustering groups. A total of 137 Korean American women (M age = 42.7 years, SD = 3.9 years; M BMI = 23.1 kg/m2, SD = 3.1 kg/m2; 47.7% BMI ⩾ 23 kg/m2) participated. Three clusters were identified: healthy lifestyle, unhealthy lifestyle, and low physical activity but healthy diet group. The unhealthy lifestyle group was more likely to have high acculturation compared with other groups (p = .03). SES and BMI were not significantly different between groups. Further intervention is needed to improve obesity-related behaviors of acculturated Korean American women.
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Bharmal NH, McCarthy WJ, Gadgil MD, Kandula NR, Kanaya AM. The Association of Religious Affiliation with Overweight/Obesity Among South Asians: The Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study. JOURNAL OF RELIGION AND HEALTH 2018; 57:33-46. [PMID: 27460674 PMCID: PMC5269531 DOI: 10.1007/s10943-016-0290-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Religiosity has been associated with greater body weight. Less is known about South Asian religions and associations with weight. Cross-sectional analysis of the MASALA study (n = 906). We examined associations between religious affiliation and overweight/obesity after controlling for age, sex, years lived in the USA, marital status, education, insurance status, health status, and smoking. We determined whether traditional cultural beliefs, physical activity, and dietary pattern mediated this association. The mean BMI was 26 kg/m2. Religious affiliation was associated with overweight/obesity for Hindus (OR 2.12; 95 % CI: 1.16, 3.89), Sikhs (OR 4.23; 95 % CI: 1.72, 10.38), and Muslims (OR 2.79; 95 % CI: 1.14, 6.80) compared with no religious affiliation. Traditional cultural beliefs (7 %), dietary pattern (1 %), and physical activity (1 %) mediated 9 % of the relationship. Interventions designed to promote healthy lifestyle changes to reduce the burden of overweight/obesity among South Asians need to be culturally and religiously tailored.
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Affiliation(s)
| | - William J. McCarthy
- UCLA Fielding School of Public Health Department Cancer Prevention & Control Res/FSPH & JCCC BOX 956900, A2-125 CHS Los Angeles, CA 90095-6900, USA
| | - Meghana D. Gadgil
- UCSF Division of General Internal Medicine 1545 Divisadero Street San Francisco, CA 94115, USA
| | - Namratha R. Kandula
- Northwestern University Feinberg School of Medicine, Department of General Internal Medicine 750 N Lake Shore Drive, 10 Floor Chicago, IL 60611, USA
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Alidu L, Grunfeld EA. A systematic review of acculturation, obesity and health behaviours among migrants to high-income countries. Psychol Health 2017; 33:724-745. [PMID: 29172700 DOI: 10.1080/08870446.2017.1398327] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Objective There is extensive evidence for weight gain among people migrating from low/middle-income to high-income countries, which may be due, in part, to acculturation factors. This review aimed to identify associations between acculturation and body weight among immigrants to high-income countries and identify if studies accounted for the role played by health behaviours. Methods A systematic literature search using keywords was performed with three databases (Medline, PsychINFO and EMBASE). The 35 studies were included that utilised quantitative methodology and presented empirical findings focused on acculturation and body weight among adult immigrants. Findings There was evidence presented across multiple studies for an association between acculturation (measured with standard measures or as duration of stay) and obesity. Most studies were cross sectional, which did not allow the exploration of drivers of change in health behaviours and weight gain. Conclusion This is the first review to examine associations between acculturation and body weight among migrants utilising both acculturation scales and proxy measures of acculturation and to examine the role of health behaviours. Evidence from this review suggests that health interventions should target first generation migrants to promote retention of their original healthy behaviours. Recent migrant groups report healthier behaviours than comparative host country populations, and therefore interventions should be promoted at the initial stages following migration to avoid uptake of unhealthy behaviours.
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Affiliation(s)
- L Alidu
- a School of Psychology , University of Birmingham , Birmingham , UK
| | - E A Grunfeld
- b Department of Psychological Sciences , University of London, Birkbeck College , London , UK
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Jin K, Gullick J, Neubeck L, Koo F, Ding D. Acculturation is associated with higher prevalence of cardiovascular disease risk-factors among Chinese immigrants in Australia: Evidence from a large population-based cohort. Eur J Prev Cardiol 2017; 24:2000-2008. [PMID: 29064273 DOI: 10.1177/2047487317736828] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background Acculturation is associated with increased prevalence of cardiovascular disease (CVD) risk-factors among immigrants in Western countries. Little is known about acculturation effects on CVD risks among Chinese immigrants, one of the fastest growing populations in Western countries. In this study, we aim to examine the association between acculturation and CVD risk-factors among Chinese immigrants, Australia's third-largest foreign-born group. Methods We accessed a subsample of Chinese immigrants ( n = 3220) within the 45-and-Up Study (2006-2009). Poisson regression model with a robust error variance examined the association between acculturation and CVD risk-factors, and prevalence ratios were reported, adjusted for socio-demographic characteristics. Indicators of acculturation included age at migration, length of Australian residence and language spoken at home. The outcomes were self-reported CVD diagnosis and six risk-factors (hypertension, diabetes, high cholesterol, smoking, overweight/obesity, physical inactivity). Results Mean age of Chinese participants was 58.9-years (SD = 10.7) and 55.5% were women. Chinese migrating to Australia aged <18 years were significantly more likely to report diabetes (prevalence ratio = 1.71; p < 0.01), overweight/obesity (prevalence ratio = 1.49; p < 0.001) and ≥ 3 CVD risk-factors (prevalence ratio = 1.47; p < 0.05) compared with those who migrated after 18-years-old. Chinese immigrants who lived in Australia for ≥ 30 years were significantly more likely to have diabetes (prevalence ratio = 1.84; p < 0.01) and ≥ 3 CVD risk-factors (prevalence ratio = 1.84; p < 0.01). There were no significant differences by language spoken at home. The association between indicators of acculturation and CVD risk-factors appeared to differ by sex. Conclusion Greater acculturation was associated with adverse CVD risk-factors among Chinese immigrants in Australia.
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Affiliation(s)
- Kai Jin
- 1 Sydney Nursing School, University of Sydney, Australia
| | - Janice Gullick
- 1 Sydney Nursing School, University of Sydney, Australia
| | - Lis Neubeck
- 2 School of Health and Social Care, Edinburgh Napier University, UK
| | - Fung Koo
- 1 Sydney Nursing School, University of Sydney, Australia
| | - Ding Ding
- 3 Charles Perkins Centre, Sydney School of Public Health, University of Sydney, Australia
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Cultural Factors relevant to Korean Americans in Health Research: A Systematic Review. J Community Health 2017; 43:421-432. [PMID: 28905156 DOI: 10.1007/s10900-017-0418-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
To eliminate health disparities in the United States, identifying cultural contexts salient to the target populations in an intervention study is critical; however, little research has been conducted on the identification of cultural contexts among Korean Americans who have significant risk factors for chronic diseases. This systematic review identifies critical cultural contexts central to the literature discussed in health research on Korean Americans. We examined 14 research reports of 801 potentially eligible articles published between 2000 and 2016 and analyzed their contribution to cultural contexts among Korean Americans based on the PEN-3 model. This review highlights how cultural contexts impact health and health behaviors of Korean Americans, and may contribute to health disparities in the United States. The key cultural contexts highlighted in this review include social support/social network, family, gender role expectations, and a holistic view of health and illness. These cultural contexts should be incorporated in designing culturally relevant, effective, and sustainable health interventions for Korean Americans, which will contribute to eliminating health disparities for this ethnic group who experience great obstacles to healthcare access and healthy behaviors.
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Diep CS, Leung R, Thompson DI, Gor BJ, Baranowski T. Culture and Diet Among Chinese American Children Aged 9-13 Years: A Qualitative Study. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2017; 49:275-284.e1. [PMID: 28027858 DOI: 10.1016/j.jneb.2016.11.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 11/01/2016] [Accepted: 11/06/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To examine Chinese American children's behaviors, food preferences, and cultural influences on their diet. DESIGN Qualitative individual interviews using constructs from the proposed model of dietary acculturation. SETTING Community centers and Chinese schools in Houston, TX. PARTICIPANTS Twenty-five Chinese American children aged 9-13 years. PHENOMENON OF INTEREST Diet, favorite restaurants, and parents' cooking and grocery shopping habits. ANALYSIS Content analysis and thematic data analysis to identify code categories and themes. Coders also identified patterns based on demographic and acculturation factors. RESULTS Overall, participants described their diets and associated behaviors as Asian and non-Asian. Key themes included preference for Asian and non-Asian foods; consumption of non-Asian foods for breakfast and lunch, but Asian foods for dinner; infrequent dining at restaurants; grocery shopping at Asian and non-Asian stores; and familial influences on diet. Acculturated children and children of higher socioeconomic status appeared to prefer and consume a more Westernized/non-Asian diet. CONCLUSIONS AND IMPLICATIONS Results illustrate that Chinese American children in this study practiced both Asian and non-Asian dietary behaviors. Findings corroborated existing acculturation research with parents and caregivers; supported constructs in the model of dietary acculturation; and provide guidance for research and programs related to dietary behaviors, determinants, and culture among this population.
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Affiliation(s)
- Cassandra S Diep
- US Department of Agriculture/Agricultural Research Service Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX; Department of Health Disparities Research, University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Randall Leung
- Department of Health Sciences, Boston University, Boston, MA
| | - Debbe I Thompson
- US Department of Agriculture/Agricultural Research Service Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Beverly J Gor
- Office of Planning, Evaluation and Research for Effectiveness, Houston Health Department, Houston, TX
| | - Tom Baranowski
- US Department of Agriculture/Agricultural Research Service Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX
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Serafica R, Angosta AD. Acculturation and changes in body mass index, waist circumference, and waist–hip ratio among Filipino Americans with hypertension. ACTA ACUST UNITED AC 2016; 10:733-40. [DOI: 10.1016/j.jash.2016.07.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 07/03/2016] [Accepted: 07/09/2016] [Indexed: 01/11/2023]
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Park BK, Nahm ES, Rogers VE. Development of a Teen-Friendly Health Education Program on Facebook: Lessons Learned. J Pediatr Health Care 2016; 30:197-207. [PMID: 26254744 DOI: 10.1016/j.pedhc.2015.06.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 06/29/2015] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Facebook is the most popular online platform among adolescents and can be an effective medium to deliver health education. Although Korean American (KA) adolescents are at risk of obesity, a culturally tailored health education program is not available for them. Thus, our research team developed a health education program for KA adolescents on Facebook called "Healthy Teens." The aim of this study was to discuss important lessons learned through the program development process. METHOD This program includes culturally tailored learning modules about healthy eating and physical activity. The program was developed on the basis of the social cognitive theory, and the online program was developed by applying Web usability principles for adolescents. Upon completion, the usability of the program was assessed using heuristic evaluation. RESULTS The findings from the heuristic evaluation showed that the Healthy Teens program was usable for KA adolescents. DISCUSSION The findings from this study will assist researchers who are planning to build similar Facebook-based health education programs.
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Tseng M, Fang CY. Acculturation and Insulin Resistance among US Chinese Immigrant Women. Ethn Dis 2015; 25:443-50. [PMID: 26672487 DOI: 10.18865/ed.25.4.443] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Chinese immigrants in the United States undergo a transition to increased chronic disease risk commonly attributed to acculturative changes. Longitudinal data to confirm this are lacking. We examined acculturation in relation to insulin resistance in a sample of Chinese immigrant women to determine differences by level of education and possible mediation by anthropometry and diet. DESIGN Longitudinal study. SETTING Philadelphia, Pennsylvania. PARTICIPANTS 305 Chinese immigrant women recruited October 2005 to April 2008 and followed until April 2010. MAIN OUTCOME MEASURES Association of acculturation, measured using the General Ethnicity Questionnaire - American version (GEQA), with homeostasis model assessment (HOMA) score as an indicator of insulin resistance, modeled using generalized estimating equations to account for repeated measures over time. RESULTS GEQA was associated with log HOMA score, but only in women with <9 years of education (beta [SE] = .09 [.04], P=.02; interaction P=.02). The association persisted with adjustment for body mass index, waist circumference, and dietary variables. CONCLUSIONS These findings provide longitudinal evidence that insulin resistance increases with acculturation. However, the association was apparent only in less-educated immigrants and may be mediated by a pathway other than changes in anthropometry and diet.
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Affiliation(s)
- Marilyn Tseng
- 1. Kinesiology Department, California Polytechnic State University, San Luis Obispo, Calif
| | - Carolyn Y Fang
- 2. Cancer Prevention & Control Program, Fox Chase Cancer Center, Philadephia, Penn
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Chen WT, Guthrie B, Shiu CS, Wang L, Weng Z, Li CS, Lee TSH, Kamitani E, Fukuda Y, Luu BV. Revising the American dream: how Asian immigrants adjust after an HIV diagnosis. J Adv Nurs 2015; 71:1914-25. [PMID: 25740206 DOI: 10.1111/jan.12645] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2015] [Indexed: 12/13/2022]
Abstract
AIM We explored how acculturation and self-actualization affect depression in the HIV-positive Asians and Pacific Islanders immigrant population. BACKGROUND Asians and Pacific Islanders are among the fastest growing minority groups in the USA. Asians and Pacific Islanders are the only racial/ethnic group to show a significant increase in HIV diagnosis rate. DESIGN A mixed-methods study was conducted. METHODS Thirty in-depth interviews were conducted with HIV-positive Asians and Pacific Islanders in San Francisco and New York. Additionally, cross-sectional audio computer-assisted self-interviews were conducted with a sample of 50 HIV-positive Asians and Pacific Islanders. Content analysis was used to analyse the in-depth interviews. Also, descriptive, bivariate statistics and multivariable regression analysis was used to estimate the associations among depression, acculturation and self-actualization. The study took place from January-June 2013. DISCUSSION Major themes were extracted from the interview data, including self-actualization, acculturation and depression. The participants were then divided into three acculturation levels correlating to their varying levels of self-actualization. For those with low acculturation, there was a large discrepancy in the Center for Epidemiologic Studies Depression Scale scores between those who had totally lost their self-actualization and those who believed they could still achieve their 'American dreams'. Among those who were less acculturated, there was a significant difference in depression scores between those who felt they had totally lost their ability to self-actualize and those who still believed they could 'make their dreams come true.' CONCLUSION Acculturation levels influence depression and self-actualization in the HIV-positive Asians and Pacific Islanders population. Lower acculturated Asian Americans achieved a lower degree of self-actualization and suffered from depression. Future interventions should focus on enhancing acculturation and reducing depression to achieve self-actualization.
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Affiliation(s)
- Wei-Ti Chen
- School of Nursing, Yale University, Orange, Connecticut, USA
| | - Barbara Guthrie
- School of Nursing, Northeastern University, Boston, Massachusetts, USA
| | - Cheng-Shi Shiu
- School of Social Work, University of Washington, Seattle, Washington, USA
| | - Lixuan Wang
- School of Public Health, Yale University, New Haven, Connecticut, USA
| | - Zhongqi Weng
- School of Nursing, Yale University, Orange, Connecticut, USA
| | - Chiang-Shan Li
- Department of Psychiatry and Neurobiology, Yale University, New Haven, Connecticut, USA
| | - Tony Szu-Hsien Lee
- Department of Health Promotion and Education, National Taiwan Normal University, Taipei, Taiwan
| | - Emiko Kamitani
- School of Nursing, University of California, San Francisco, California, USA
| | - Yumiko Fukuda
- APICHA Community Health Center, New York, New York, USA
| | - Binh Vinh Luu
- HIV/AIDS Service, Chinese-American Planning Council Inc, New York, New York, USA
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A bi-national comparative study of health behaviors of Koreans in South Korea and Korean Americans in California. J Immigr Minor Health 2014; 15:1073-81. [PMID: 22918692 DOI: 10.1007/s10903-012-9706-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Few studies have compared health behaviors of Koreans in their home country and Korean Americans. Using 2009 data from the Community Health Survey (South Korea) and the California Health Interview Survey (USA), we compared native Koreans and Korean Americans, grouped by level of acculturation, on prevalence of specific health behaviors and self-rated health, and conducted multiple logistic regression comparing the odds of these behaviors among the groups adjusted for demographic variables. While Korean Americans exhibit healthier behaviors than Koreans in some areas (e.g., reduced smoking and binge drinking in men, increased utilization of flu vaccinations), we also identified problem behaviors (e.g., increased body weight in Korean American men, uptake of alcohol drinking and smoking among Korean American women). Findings support the critical need for health promotion programs addressing these health behaviors to prevent future health problems among Korean Americans.
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Chen WT, Guthrie B, Shiu CS, Yang JP, Weng Z, Wang L, Kamitani E, Fukuda Y, Luu BV. Acculturation and perceived stress in HIV+ immigrants: depression symptomatology in Asian and Pacific Islanders. AIDS Care 2014; 26:1581-5. [PMID: 25059642 DOI: 10.1080/09540121.2014.936816] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Asians and Pacific Islanders (API) are among the fastest growing minority groups within the USA, and this growth has been accompanied by an increase in HIV incidence. Between 2000 and 2010, the API HIV infection rate increased from 4.5% to 8.7%; however, there is a paucity of HIV-related research for this group, and even less is known about the prevalence and correlates of antiretroviral therapy adherence behavior, quality of life, impact of stress, and efficacious self-management among HIV+ API Americans. This paper examines how acculturation and perceived stress affect depression symptomatology and treatment seeking in the HIV+ API population. A series of cross-sectional audio computer-assisted self-interviews were conducted with a convenience sample of 50 HIV+ API (29 in San Francisco and 21 in New York City). The relationship between acculturation and perceived stress was analyzed, and the results indicate that for those HIV+ API who reported low or moderate acculturation (as compared to those who reported high acculturation), stress was significantly mediated by depression symptomology. Interventions to address acculturation and reduce perceived stress among API generally and Asians specifically are therefore needed.
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Affiliation(s)
- Wei-Ti Chen
- a School of Nursing , Yale University , Orange , CT , USA
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Influence of information sources on hepatitis B screening behavior and relevant psychosocial factors among Asian immigrants. J Immigr Minor Health 2014; 15:779-87. [PMID: 23238580 DOI: 10.1007/s10903-012-9753-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
This study examines how different information sources relate to Health Belief Model constructs, hepatitis B virus (HBV) knowledge, and HBV screening. The Maryland Asian American Liver Cancer Education Program administered a survey of 877 Asian immigrants. The most common sources of information identified by the multiple-answer questions were newspapers (39.8 %), physicians (39.3 %), friends (33.8 %), TV (31.7 %), and the Internet (29.5 %). Path analyses-controlling for age, sex, educational level, English proficiency, proportion of life in U.S., health insurance coverage, and family history of HBV infection-showed that learning about HBV from physicians had the strongest direct effect; friends had a marginal indirect effect. Perceived risk, benefits, and severity played limited roles in mediation effects. Path analysis results differed by ethnicity. Physician-based HBV screening intervention would be effective, but should be complemented with community health campaigns through popular information sources for the uninsured.
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Juon HS, Lee S, Strong C, Rimal R, Kirk GD, Bowie J. Effect of a liver cancer education program on hepatitis B screening among Asian Americans in the Baltimore-Washington metropolitan area, 2009-2010. Prev Chronic Dis 2014; 11:130258. [PMID: 24503341 PMCID: PMC3921910 DOI: 10.5888/pcd11.130258] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Asian Americans have the highest incidence of hepatocellular carcinoma (HCC), the major form of primary liver cancer, of all ethnic groups in the United States. Chronic hepatitis B virus (HBV) infection is the most common cause of HCC, and as many as 1 in 10 foreign-born Asian Americans are chronically infected with HBV. We tested the effectiveness of a culturally tailored liver cancer education program for increasing screening for HBV among Chinese, Korean, and Vietnamese Americans residing in the Baltimore-Washington metropolitan area, from November 2009 through June 2010. METHODS We used a cluster randomized controlled trial to recruit volunteer participants from community-based organizations (CBOs) in the Baltimore-Washington metropolitan area. We selected 877 participants by using a pretest survey. People were eligible to participate if they had not attended a hepatitis B-related education program in the past 5 years. The intervention group (n = 441) received a 30-minute educational program, and the control group (n = 436) received an educational brochure. After attending the educational program, the intervention group completed a post-education survey. Six months later, participants in both groups were followed up by telephone. Receipt of HBV screening was the outcome measure. RESULTS Approximately 79% (n = 688) of participants completed the 6-month follow-up telephone survey. Among those who had not had HBV screening at baseline (n = 446), the adjusted odds of self-reported receipt of HBV screening at the 6-month follow-up to the educational program were significantly higher for the intervention group than for the control group (odds ratio = 5.13; 95% confidence interval, 3.14-8.39; P < .001). Chinese Americans and Vietnamese Americans had significantly higher odds of having HBV screening in the 6-month period than Korean Americans. CONCLUSION Culturally tailored education programs that increase liver cancer awareness can be effective in increasing HBV screening among underserved Asian American populations.
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Affiliation(s)
- Hee-Soon Juon
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 704, Baltimore, MD 21205. E-mail:
| | - Sunmin Lee
- University of Maryland School of Public Health, College Park, Maryland
| | - Carol Strong
- National Cheng Kung University, Tainan City, Taiwan
| | - Rajiv Rimal
- George Washington University, Washington, DC
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Ethnic differences in prevalence and barriers of HBV screening and vaccination among Asian Americans. J Community Health 2013; 37:1071-80. [PMID: 22302652 DOI: 10.1007/s10900-012-9541-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Our study identifies the prevalence of HBV virus (HBV) screening and vaccination among Asian Americans, and ethnic differences for factors associated with screening and vaccination behaviors. In 2009-2010 we recruited 877 Korean, Chinese, and Vietnamese Americans 18 years of age and above through several community organizations, churches and local ethnic businesses in Maryland for a health education intervention and a self-administered survey. Prevalence of HBV screening, screening result and vaccinations were compared by each ethnic group. We used logistic regression analysis to understand how sociodemographics, familial factors, patient-, provider-, and resource-related barriers are associated with screening and vaccination behaviors, using the total sample and separate analysis for each ethnic group. Forty-seven percent of participants reported that they had received HBV screening and 38% had received vaccinations. Among the three groups, the Chinese participants had the highest screening prevalence, but lowest self-reported infection rate; Vietnamese has the lowest screening and vaccination prevalence. In multivariate analysis, having better knowledge of HBV, and family and physician recommendations was significantly associated with screening and vaccination behaviors. Immigrants who had lived in the US for more than a quarter of their lifetime were less likely to report ever having been screened (OR = 0.39, 95% CI: 0.28-0.55) or vaccinated (OR = 0.62, 95% CI: 0.44-0.88). In ethnic-specific analysis, having a regular physician (OR = 4.46, 95% CI: 1.62-12.25) and doctor's recommendation (OR = 2.11, 95% CI: 1.05-4.22) are significantly associated with Korean's vaccination behaviors. Health insurance was associated with vaccination behaviors only among Vietnamese (OR = 2.66, 95% CI: 1.21–5.83), but not among others.
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Deng F, Zhang A, Chan CB. Acculturation, Dietary Acceptability, and Diabetes Management among Chinese in North America. Front Endocrinol (Lausanne) 2013; 4:108. [PMID: 23986745 PMCID: PMC3753561 DOI: 10.3389/fendo.2013.00108] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 08/07/2013] [Indexed: 12/16/2022] Open
Abstract
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.
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Affiliation(s)
- Feiyue Deng
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, Canada
| | - Anran Zhang
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, Canada
| | - Catherine B. Chan
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, Canada
- Department of Physiology, University of Alberta, Edmonton, AB, Canada
- *Correspondence: Catherine B. Chan, 6-002 Li Ka Shing Centre, University of Alberta, Edmonton, Alberta T6G 2R3, Canada e-mail:
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Juon HS, Park BJ. Effectiveness of a culturally integrated liver cancer education in improving HBV knowledge among Asian Americans. Prev Med 2013; 56:53-8. [PMID: 23159302 PMCID: PMC3540148 DOI: 10.1016/j.ypmed.2012.11.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Revised: 11/06/2012] [Accepted: 11/07/2012] [Indexed: 02/01/2023]
Abstract
OBJECTIVE The aim of this study was to assess the effectiveness of a hepatitis B virus (HBV) educational program in increasing HBV knowledge. METHODS Using a cluster randomized control trial to recruit participants from the community-based organization in the Baltimore-Washington Metropolitan Area; a total of 877 Asian American participants completed a self-administered pretest. HBV knowledge was the outcome measure. The intervention group received a 30-minute educational program. After the educational program, the intervention group completed a post-education survey. Six months after the education, all participants were followed by phone. RESULTS The intervention group showed significantly higher knowledge scores than the control group at the 6-month follow-up (between-group difference was 1.44 for knowledge of transmission modes and 0.59 for sequelae, p < 0.01). For the intervention group, the increase in knowledge of HBV transmission modes in post-education was much higher than that at the 6-month follow-up (4.18 vs. 2.07), p < 0.01) compared to baseline. Age was also an important factor on the educational effect: Those older than 60 years reported the lowest scores in all three points. CONCLUSIONS Findings suggest that this culturally integrated liver cancer educational program increased HBV knowledge. Differential strategies are needed to target age groups, separately educating those younger and those older.
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Affiliation(s)
- Hee-Soon Juon
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, USA.
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