Cardiovascular Disease in Korean Americans: A Systematic Review

The Moderating Role of Collectivism on Physical Activity and Family Support: A Cross-Sectional Design

BACKGROUND

An important value among Korean Americans is collectivism or giving a group priority over the individual. This value, family support, and demographic characteristics have been reported to influence health behaviors among this group. Yet, no study has examined how collectivism, family support, and demographic characteristics interact with each other and then influence physical activity among Korean American adults. The purpose of the study was to examine the association between family support and physical activity, and the moderating role of demographic characteristics and collectivism on this association among Korean American adults.

METHODS

A descriptive, cross-sectional study was conducted with a sample of 110 Korean American adults 18 years and older, residing in a Southwestern city in the United States. Self-administered questionnaires were used to measure demographics, collectivism, family support, and physical activity.

RESULTS

Data analysis using a zero-inflated negative binomial regression model revealed a positive relationship between family support and physical activity, while age and gender were moderators of the relationship between family support and physical activity. Collectivism was positively related to physical activity and moderated the relationship between family support and physical activity.

CONCLUSION

These findings indicate the significance of collectivism and family support that influence Korean American adults' physical activity.

A Technology-Enhanced Physical Activity Intervention: A Feasibility Study

Using a single-group, pre-posttest design, we evaluated feasibility and acceptability of a technology-enhanced physical activity intervention in 43 midlife (aged 35-64) first-generation Korean American adults who were physically inactive. The intervention consisted of bi-weekly education sessions for 4 weeks, monthly small group walks for the following 8 weeks, and weekly reminder text messages during the entire intervention period. A 100% retention rate, 93% adherence, and 88.4% satisfaction supported the feasibility and acceptability of the intervention. Paired t-tests revealed the intervention was successful and effective as demonstrating a significant increase in self-efficacy and moderate physical activity and improved cardiometabolic health. This easy and motivation enhancing intervention has a wide potential applicability for other ethnic groups. Further intervention research is suggested in a large sample, multisite, for a longer-term with a randomized controlled trial design, which may lead us to narrow the gap in physical activity engagement and cardiometabolic health disparities.

The effects of acculturation and environment on lifestyle behaviors in Korean immigrants: the mediating role of acculturative stress and body image discrepancy

OBJECTIVES

Despite high rates of cardiometabolic diseases in Korean immigrants (KIs), little is known about cultural and environmental factors contributing to lifestyle behaviors. The purpose of this cross-sectional study was to examine the relationships among acculturation, environment, and lifestyle behaviors (dietary behavior, physical activity, and sedentary behavior) through culturally sensitive psychological mediators, body image discrepancy and acculturative stress in middle-aged KIs.

DESIGN

A cross-sectional study was conducted. KIs aged 30-65 years were recruited online and at Korean community centers and churches in the Northeastern US Participants completed validated measures of dietary behavior (the Nutrition Subscale of the Health Promoting Lifestyle Profile (HPLP) II), physical activity (the International Physical Activity Questionnaire (IPAQ) - short form), and sedentary behavior (the Sedentary Behavior Questionnaire). Acculturative stress was measured by the Acculturative Stress Index and body image discrepancy was measured by the Stunkard Figure Rating Scale. Acculturation was defined as a latent variable measured by Korean and American orientation (Vancouver Index of Acculturation), age of immigration to the US, length of residency in the US, and English proficiency. Data were analyzed with structural equation modeling (SEM).

RESULTS

The sample included 361 KIs (mean age = 41.77 ±10.28 years, 48.1% female, and 46.4% overweight or obese). In the SEM model, acculturation had significant indirect effects on dietary behavior, physical activity, and sedentary behavior through body image discrepancy. Acculturative stress mediated the relationship between acculturation and sedentary behavior. Greater environmental support for physical activity and better healthy food accessibility were related to higher levels of physical activity and healthier dietary behavior, respectively.

CONCLUSION

In our study, acculturation and environmental support for physical activity and healthy food simultaneously influenced KIs' lifestyle behaviors. Addressing an unhealthy body image and acculturative stress may be additional strategies for lifestyle intervention programs to prevent cardiometabolic diseases in KIs.

Is Colorectal Cancer Screening Associated with Stages of Weight Control Among Korean Americans Aged 50-75 Years Old?: Implications for Weight Control Practice

OBJECTIVE

To examine the associations of colorectal cancer (CRC) screening with stages of weight control among Korean Americans (KAs) using the transtheoretical model and provide implications for their weight control practice.

METHODS

A quantitative, cross-sectional survey was employed to collect data on current weight control behaviors and intentions, CRC screening history, previous cancer diagnosis, body mass index, number of chronic conditions, perceived health status, health insurance, and sociodemographics. Purposive sampling was implemented to recruit KA participants in the Atlanta metropolitan area in the USA from May 2015 to February 2016. A total of 433 KAs aged 50 to 75 years completed a self-report survey questionnaire. Descriptive and bivariate analyses and multiple logistic regressions were performed using Stata Version 14/MP software.

RESULTS

Applying the stages of the transtheoretical model 53% were positioned in the first two stages (precontemplation and contemplation) of weight control with 47% being in the last two stages (action and maintenance). Participants who had been screened for CRC were more likely to be in the last two stages of weight control compared with those who had not been screened (OR = 2.49; p = 0.003).

CONCLUSIONS

The findings suggest that preventive healthcare such as CRC screening may provide the opportunity for health education interventions to help encourage weight control efforts and behaviors in the KA community. Future research is warranted to investigate the underlying mechanism behind the link between CRC screening and weight control to guide the development of interventions for eliminating health disparities.

Gender Differences in Acculturative Stress and Habitual Sleep Duration in Korean American Immigrants

Korean American immigrants (KAIs) face diverse sociocultural stressors in the acculturation process. While stress is known to cause short sleep, little is known about how acculturative stress affects sleep differently for KAI men and women. The purpose of this cross-sectional study was to examine gender differences in the association between diverse domains of acculturative stress and sleep duration among KAIs. Middle-aged KAIs were recruited in community settings and online. KAIs completed validated measures of acculturative stress (homesickness, social isolation, employment barriers, discrimination, civic disengagement, and family problems) and sleep duration. Multiple linear regression analysis was performed and stratified by gender. 343 KAIs participated (mean age = 41 ± 10 years, 47% female, 11% short sleepers [< 6 h]). After adjustment for covariates, higher homesickness (β = - 23.19, p < 0.05) and lower civic disengagement (β = 17.75, p < 0.05) were associated with shorter sleep duration in women, while higher isolation was associated with shorter sleep duration in men (β = - 13.73, p < 0.05). Discussion: Results suggest gender-specific associations between acculturative stress and sleep duration. Future research should take into account gender differences in the experience and effects of acculturative stress when developing interventions to improve sleep health in KAIs.

Examination of the Association Between Latent Variables for Social Determinants of Health and Blood Pressure Control in Immigrants using Structural Equation Modeling

BACKGROUND

Hypertension is responsible for about 12.8% of deaths around the world. Immigrants' risk of developing hypertension increases with length of residency. There is limited work on the role of social determinants of health and blood pressure control in immigrants. We created a theory-based conceptual model for immigrant-specific and general social determinants variables and their relationship to blood pressure.

PURPOSE

Use a theory-based model to identify latent variables for immigrant-specific social determinants using confirmatory factor analysis (CFA) and structural equation modeling (SEM) to test theoretical validity and relationship with blood pressure (BP).

METHODS

CFA was used to identify latent variables for global socioeconomic status, stressors of immigration, adaptation to immigration, acculturation, and burden of disease. SEM was used to test the structural relationships between latent variables and BP.

RESULTS

181 immigrants were included in the analysis. The final model (chi2 (68, n = 181) = 149.87, p < 0.001, RMSEA = 0.055, CFI = 0.94, TLI = 0.91, CD = 0.99) found burden of disease was significantly related to BP (r = 0.35, p < 0.001).

CONCLUSIONS

One latent variable measuring need was significantly associated with BP in an immigrant sample. This suggests that interventions targeting burden of disease are likely to be effective in controlling blood pressure in immigrants.

A Study of Physical Activity Determinants among High-Risk Hypertensive Filipino and Korean Americans

Physical activity (PA) serves a critical role in maintaining health and preventing chronic diseases, though its influence on high-risk Asian American populations is unclear. The purpose of this study was to determine PA levels among Filipino and Korean Americans at high risk of hypertension and to identify sociodemographic and health-related factors associated with PA levels in these populations. A cross-sectional survey was administered to 137 participants in the Greater Philadelphia Area. Data was collected on PA levels, sociodemographic factors, and health factors. Multinomial logistic regression was conducted to determine predictors associated with low, moderate, and high PA and predictive probabilities were calculated for interaction terms, incorporating ethnicity and blood pressure variables. Overall, 42.33% of participants belonged to the moderately active PA group and 21.90% belonged to the highly active group. In the final multinomial regression model, it was found that having gone to college increased the odds of being in the moderately active PA group (coef. = 1.96, p = 0.034), while having high blood pressure reduced the odds of being in the moderately active PA group (coef. = -2.21, p = 0.022). Lastly, being Korean versus Filipino reduced the odds of being in the highly active category (coef. = -2.89, p = 0.035). Based on predictive probabilities, Koreans and Filipinos with high blood pressure were more likely to belong in the low active PA category (52.31% and 46.33%). These findings highlight the need for culturally relevant PA interventions for promoting and increasing PA levels to prevent and manage hypertension among these populations.

A Pilot Primary Stroke Prevention Program for Elderly Korean Americans

BACKGROUND

Stroke is a significant health issue with devastating consequences among older adults in the United States. However, it can be prevented by improving stroke knowledge and managing risk factors. Many stroke education programs have been shown to be effective. Unfortunately, a minority of older adults, such as older Korean Americans, have not benefited from the programs because of language barriers.

OBJECTIVE

The purpose of this study was to examine the feasibility and preliminary impact of a primary stroke prevention program on stroke knowledge, healthy eating, and physical activity behaviors among Korean Americans.

METHODS

A randomized controlled pilot trial was conducted. A total of 73 persons were randomly assigned to either an intervention group (n = 37) or a control group (n = 36). The intervention program included in-person lectures and discussions. Sociodemographic data were analyzed using descriptive statistics. Analyses of covariance and logistic regression analysis were used to evaluate the effects of the intervention program.

RESULTS

The mean age of participants was 71.49 ± 6.25 years, and most participants were female (74.0%) and married (65.8%). Upon intervention completion, the intervention group showed greater improvements than the control group in stroke knowledge and intake of sodium and total fats (F = 11.89, P = .001, ηp = 0.151; F = 4.04, P = .048, ηp = 0.057; and F = 4.51, P = .037,= ηp = 0.062, respectively). Step counts showed marginal effects (F = 3.27, P = .075, ηp = 0.049).

CONCLUSION

This study demonstrated feasibility and effectiveness of the program to improve stroke knowledge and healthy behaviors in elderly Korean Americans.

Interventions for Cardiovascular Disease Risk Reduction in Korean Americans: A Systematic Review

This systematic review was to identify and synthesize literature that described the cultural appropriateness and effectiveness of interventions aimed at cardiovascular risk reduction in Korean Americans. We searched multiple electronic databases for studies published between January 2000 and August 2017 and identified 14 eligible research reports. All reviewed studies targeted first-generation Korean American adults. Most of the reviewed studies incorporated components of surface structure, and leveraged deep structure in those interventions. Significant changes in cardiovascular health outcomes were reported in most of the reviewed studies; however, the role of cultural factors in the outcomes was rarely evaluated, and few reported long-term effects. Future research needs to consider long-term effects. Deploying cultural factors and evaluating their contributions to the target outcomes will enhance the research on cardiovascular health disparities.