Association of language spoken at home with health and school issues among Asian American adolescents

Testing the Multiple Disadvantage Model of Health with Ethnic Asian Children: A Secondary Data Analysis

This study of ethnic Asian children in the United States asked whether their health exhibited relationship with any of six factors: social disorganization, social structural factors, social relationships, the health of their parents, their access to medical insurance, acculturation. The sample of 1350 ethnic Asian children was extracted from the 2018 National Survey of Children's Health. Logistic regression results showed that these children's excellent/very good/good health was associated positively with safe neighborhoods, family incomes, family cohesiveness, family support, and receipt of Temporary Assistance for Needy Families (TANF). In turn, health was associated negatively with single-mother households. Implications of the present results in terms of interventions promoting family support, TANF participation, safe neighborhoods, and professionals' cultural competency are discussed.

Acculturation and ethnic group differences in well-being among Somali, Latino, and Hmong adolescents

Research addressing the linkages between acculturation and markers of adolescent well-being across multiple ethnic minority groups is limited in scope and breadth, even though children of immigrant origin are the fastest growing population. We examined cross-sectional relationships between acculturation and substance use, socioemotional well-being, and academic achievement. Somali, Latino, and Hmong adolescents in Minnesota provided data as part of the EAT 2010 (Eating and Activity in Teens) cohort study (N = 1,066). Acculturation was based on nativity, language usually spoken at home, and length of residence in the United States. Chi-square, ANOVA, and regression models were used to test for differences in adolescent well-being by acculturation and ethnic group, and interaction terms were added to models to test effect modification by ethnicity. Hmong adolescents had the highest mean acculturation scores (4.4 ± 1.5), whereas Somali adolescents (2.2 ± 1.8) were the least acculturated. Independent of ethnicity, acculturation was positively associated with marijuana (OR: 1.38; CI [1.25, 1.53]) and alcohol use (OR: 1.12; CI [1.02, 1.22]), and was negatively associated with academic achievement, based on grade point average (β = -0.07; CI [-0.12, -0.03]). Interaction effects indicated significant differences by ethnicity only for academic achievement; significant associations between acculturation and academic achievement were evident only for Somali and Latino youth. Prevention programming should include supports for multilingual and multicultural learners and account for cultural assets within immigrant origin families that maintain and nurture protective factors as adolescents acculturate and transition into young adulthood. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Family weight teasing, ethnicity and acculturation: Associations with well-being among Latinx, Hmong, and Somali Adolescents

OBJECTIVE

This study examines the prevalence of weight-based teasing by family members and associations with unhealthy weight control behaviors, body satisfaction, self-esteem, and depressive symptoms among adolescents from three immigrant communities (Latinx, Hmong, and Somali).

METHODS

Data come from EAT 2010, a population-based study of weight and related behaviors (N = 1577, mean age = 14.5 years). Adjusted models tested associations between weight-based teasing and well-being, controlling for BMI and ethnic group; effect modification by ethnic group and acculturation were also explored.

RESULTS

Family weight-based teasing was common (12.1%-42.9% reporting this experience across gender and ethnic groups) and was associated with all four measures of well-being in the expected direction. Associations were statistically equivalent in all ethnic groups and were not modified by acculturation.

CONCLUSION

Youth from immigrant communities experience family weight-based teasing and associated threats to well-being. Additional research is needed to further understand the cultural context of weight-based teasing and develop relevant prevention messages.

Factors Associated with Home Fire Escape Plans in New South Wales: Multinomial Analysis of High-Risk Individuals and New South Wales Population

The preparation and practice of home-escape plans are important strategies for individuals and families seeking to reduce and/or prevent fire-related injury or death. The aim of this study was to assess the prevalence of and factors associated with, home-escape plans in the state of New South Wales (NSW), Australia. The study used data from two surveys—a 2016 fire safety attitudes and behaviour survey administered to high-risk individuals (n = 296) and a 2013 NSW health survey covering 13,027 adults aged 16 years and above. It applied multinomial logistic regression analyses to these data to identify factors associated with having a written home-fire escape plan, having an unwritten home-fire escape plan and not having any home-fire escape plan. The prevalence of written home-escape plans was only 4.3% (95% CI: 2.5, 7.5) for the high-risk individuals and 7.9% (95% confidence interval [CI]: 7.3, 8.6) for the entire NSW population. The prevalence of unwritten escape plans was 44.6% (95% CI: 38.8, 50.5) for the high-risk individuals and 26.2% (95% CI: 25.1, 27.2) for the NSW population. The prevalence of no-escape plan at all was 51.1% (95% CI: 45.2, 56.9) for the high-risk individuals and 65.9% (95% CI: 64.8, 67.1) for the NSW population. After adjusting for other covariates, the following factors were found to be significantly associated with unwritten-escape plan and no-escape plan prevalence: speaking only the English language at home, practicing home-fire escape plans infrequently, being married, being female and testing smoke alarms less often. Future fire interventions should target people who speak only English at home and people who test their smoke alarms infrequently. These interventions should be accompanied by research aimed at reversing the trend toward use of more flammable materials in homes.

Patients’ Understanding of Anticoagulant Therapy in a Multiethnic Population

To investigate whether knowledge and perceptions of antithrombotic therapy differ between ethnic groups in the UK, we conducted a cross-sectional questionnaire survey of patients attending anticoagulation clinics in three Birmingham teaching hospitals. 180 consecutive patients were recruited—135 white European, 29 Indo-Asian, 16 Afro-Caribbean.

The average knowledge score was 5.5 out of 9, with no significant differences between the groups. Indo-Asians were significantly less likely than the other groups to know the name of the anticoagulant they were taking (warfarin) and Afro-Caribbeans to know the condition for which they were being anticoagulated. Few patients of any group were able to specify more than one side-effect of warfarin or the dose they were on. In logistic regression analysis the factors associated with a low score were age >gT 61 years, having been born outside the UK, and the perception of difficulty in comprehension. Nearly half the Indo-Asians felt unable to understand what was said to them in the clinic, and 62% expressed a preference for a doctor of the same ethnic group.

Although there were no significant between-group differences, this study points to gaps in the knowledge of patients from ethnic minorities and to deficiencies in the provision of information. In patient education, these groups should receive special attention.

Use of health care by young Asian New Zealanders: findings from a national youth health survey

AIM

To examine the use of health services and perceived barriers to accessing health care among young Asian New Zealanders.

METHODS

Secondary analysis of data from Youth2000, a cross-sectional survey of secondary school students in New Zealand (NZ) conducted in 2001. Of the 9567 survey participants (aged 12-18 years), this study was restricted to students who identified with an 'Asian' ethnic category (n = 922).

RESULTS

Chinese and Indian students (the largest Asian ethnic groups in NZ) reported levels of overall health comparable to NZ European (NZE) students. However, relative to NZE students, Chinese students were more likely to report (i) not having a usual location for health care (adjusted OR 3.28; 95% CI: 2.51-4.43); and (ii) having problems getting health care when they needed it (adjusted OR 1.61; 95% CI: 1.32-1.96). Asian students who had been in NZ for 5 years or less (compared with NZ-born students), as well as those who did not speak English at home (compared with those who did) were less likely to report having a usual source of health care, even after adjusting for their overall health (adjusted OR 2.13, 95% CI: 1.27-3.56; and adjusted OR 1.69, 95% CI: 1.11-2.56, respectively).

CONCLUSION

Young Asian New Zealanders are less likely to access health care than their NZE counterparts. The perceived barriers require explicit attention within the broader platforms of health-care quality, and professional and cultural competence of health-care services.

The assessment and documentation of language and communication needs in healthcare systems: current practices and future directions for coordinating safe, patient-centered care

Several issues surface when one considers the task of unpacking health disparities and examining features of health care systems that influence patient access, utilization, and outcomes. Although progress has been made in the collection of language data across healthcare systems, little attention has been devoted to examining how a patient's English proficiency and the need for interpretation services are being determined, and how this information is communicated to providers. A lack of a standardized approach to these system-based processes exposes potential limitations in the ability of systems and providers to effectively coordinate care that meets patients' needs and minimizes disparate outcomes. Attention must be given to standardizing these processes to ensure safe, patient-centered care and enable meaningful analyses of access, utilization, and outcomes across linguistically diverse populations. Nurses play a key role in developing and evaluating information systems with which accurate and reliable data can be collected, documented, retrieved, and utilized.

Voices of Asian American youth: important characteristics of clinicians and clinical sites

OBJECTIVE

The purpose of this work was to explore clinician and site characteristics that are important to Chinese and Vietnamese immigrant and first-generation youth.

METHODS

A 3-stage mixed qualitative-quantitative design consisting of exploratory focus groups, a survey, and explanatory focus groups was used to ensure that all of the ideas were generated, prioritized, and explained by youth. Adolescents of Chinese and/or Vietnamese descent and aged 13 to 18 years were recruited in community centers and schools. In stage 1, 55 adolescents in 8 focus groups shared their views on factors that attract or deter them from seeking care. In stage 2, youth responded to a survey including 27 teen-generated items regarding clinicians and sites. In stage 3, 87 teens in 11 groups explained the top-rated items and offered suggestions on how to meet their needs. All of the stages were conducted in English, Mandarin Chinese, and Vietnamese.

RESULTS

Most of the 245 survey respondents (77%) were born in Asia, and 70% had lived in the United States for <3 years. The 27 items were divided into 6 priority ranks by the marginal homogeneity test. Clinician cleanliness and experience shared first rank. Second rank was shared by Asian teens being treated like other teens, site cleanliness, clinician honesty, and clinician friendliness and attitude. The third rank was shared by respect, privacy, completeness, clinicians explaining their actions, and lower health care costs. Interspersed among ranks 5 and 6 were items specific to the needs of Asian youth: the clinician would offer more explanation because Asian families might not ask questions; the clinician would not assume that Asian teens are drug and sex free; the clinician would understand that Asian families may use traditional healing; the clinician would not assume that Asians do not know English; adolescents would not translate for parents; and the teen would be able to choose an Asian clinician. There was little variation in ratings by age, gender, ethnicity, or socioeconomic status. However, 11 of 27 items differed by acculturation. Examples include the greater importance ascribed by more acculturated youth to not being judged, to not having to translate, and to the clinician addressing behavioral issues. Acculturation also affected the youths' views regarding confidentiality and translation.

CONCLUSIONS

Asian American adolescents value the same concerns as all adolescents: respect, honesty, competency, cleanliness, privacy, and nonjudgmental service. However, they also have unique perspectives, and youth at varying levels of acculturation differ in some of their views.

Low rates of colorectal, cervical, and breast cancer screening in Asian Americans compared with non-Hispanic whites: Cultural influences or access to care?

BACKGROUND

Asian Americans have lower cancer screening rates compared with non-Hispanic whites (NHWs). Little is known about mechanisms that underlie disparities in cancer screening. The objectives of the current study were 1) to determine the relation between nativity, years in the United States, language, and cancer screening in NHWs and Asian Americans, independent of access to care and 2) to determine whether Asians reported different reasons than NHWs for not obtaining cancer screening.

METHODS

This population-based study included 36,660 NHWs, 1298 Chinese, 944 Filipinos, 803 Koreans, 857 Vietnamese, and 1036 Other Asians from the 2001 California Health Interview Survey. The main study outcomes were 1) self-reported colorectal, cervical, and breast cancer screening and 2) reasons for not obtaining cancer screening.

RESULTS

After adjusting for access to care, several Asian subgroups still had significantly lower rates of all types of cancer screening compared with NHWs. Adjusting for nativity, years in the United States, and English language attenuated the relation between Asian ethnicity and lower rates of colorectal and breast cancer screening. When they were asked what the most important reason was for not having each screening test, foreign-born Asians were significantly more likely than United States-born NHWs to report that they "didn't have problems/symptoms" (P < .01).

CONCLUSIONS

Nativity, years in the United States, and English language may be markers of cultural differences that are mediating cancer screening disparities. Foreign-born Asians may believe that cancer screening is in response to symptoms rather than tests that are used prior to the development of symptoms. Health education messages must consider how to communicate effectively that "cancer screening is valuable, because it finds cancer before it is advanced enough to cause symptoms."

Parental English proficiency and children's health services access

OBJECTIVES

We examined the relation between parents' level of English proficiency and their children's access to health care.

METHODS

Using the 2001 California Health Interview Survey, we conducted bivariate and multivariate analyses of several measures of children's access to health care (current health insurance status, usual source of care, emergency room visits, delayed or forgone care, traveling to another country for health care, and perceived discrimination in health care) and their association with parents' English proficiency.

RESULTS

Compared with English-speaking households, children in non-English-speaking households were more likely to lack health insurance, to not have doctor contact, and to go to other countries for health care and were less likely to use emergency rooms. Their parents were less likely to report their children's experiencing delayed or forgone care or discrimination in health care.

CONCLUSION

English proficiency is a strong predictor of access to health insurance for children, and children in non-English-speaking families are especially likely to rely on other countries for their health care. English proficiency may mitigate the effects of race/ethnicity commonly observed in health care access and utilization studies.

Characteristics of participants visiting the Canada on the move website

BACKGROUND

The Internet is a potential medium to attain large groups of Canadians for physical activity monitoring and interventions, however, little is known about the characteristics of participants who could be recruited on a national level. Our objectives were to determine: 1) the extent to which our sample was representative of the Canadian population; 2) the demographic, social-cognitive and physical activity behaviour, and environmental characteristics of one-time and multi-time users of the Canada on the Move website; and 3) whether certain recruitment strategies were more likely to reach specific demographic subgroups.

METHODS

Web-based self-report measures were collected on demographic, social-cognitive, physical activity behaviour, and environmental factors. Descriptive statistics were employed to address the study's research objectives.

RESULTS

Significant differences (p<0.001) were found between our total sample and 2001 Canadian census/Canadian Community Health Survey (CCHS) data on all demographic and physical activity behaviour measures. One-time and multi-time users significantly differed on age (p<0.005) and being responsible for children under age 13 (p=0.01). No differences existed between the groups on any of the social-cognitive, behavioural or environmental variables. Source of knowledge about the Canada on the Move website between one-time and multi-time users was not significantly different.

CONCLUSION

The Canada on the Move website presents a viable approach to reaching diverse demographic groups. Further work needs to be undertaken to: 1) develop engaging websites; 2) detail the monitoring of the web-based access information; 3) integrate the website with other organizations promoting physical activity; and 4) expand the number of recruitment sources.

Parental awareness of health and community resources among immigrant families

OBJECTIVES

To examine the association between parental immigrant status and awareness of health and community resources to help address common family problems.

METHODS

Using the 1999 National Survey of America's Families, a survey of the health, economic, and social characteristics of children and adults, bivariate and multivariate analyses were conducted on 35,938 children to examine the relationship between parents' immigrant status (U.S.-born citizens, naturalized citizens, and noncitizens) and their responses to questions about their awareness of specific health and community resources.

RESULTS

Compared to U.S.-born citizens, noncitizens were at the highest risk of not being aware of health and community resources for most outcomes, followed by naturalized citizens. The services of which noncitizens were most likely to be unaware were places to get help for family discord, child care issues, and family violence. Multivariate analyses indicate that parental race/ethnicity, education level, employment status, and child age were other significant independent risk factors.

CONCLUSIONS

Immigrant parents are at particularly high risk of alienation from systems of health care and support services that are available to low-income and other vulnerable populations in the United States. These findings clearly document disparate awareness among parents of different immigrant status. Community and health resources should reach out to immigrant populations, in linguistically and culturally appropriate ways, to alert them to the availability of their services.

Acculturation, income, education, safety belt use, and fatal motor vehicle crashes in California

This paper investigates the role that acculturation, income, and education play in safety belt nonuse among Californian drivers involved in fatal Motor Vehicle Crashes (MVCs). To achieve this goal, measures of acculturation, income, and education were stochastically incorporated into the Fatality Analysis Reporting System (FARS). Using the 1990 California Tobacco Survey and U.S. Census data, we estimated the combination of zip-code-based measures that most accurately predicts an individual, language-based acculturation index for Hispanics and Asians. Logistic regression was used to investigate the role of these variables in safety belt nonuse in fatal MVCs. We found that acculturation has a positive direct effect on safety belt use among Hispanics. We hypothesize that this positive direct effect is caused by Hispanic immigrants learning the benefits of wearing safety belts. However, our study also suggests an indirect negative effect of acculturation on safety belt use through drinking and driving. Prevention programs aimed at increasing the safety of Hispanic drivers not only need to take acculturation differences into account, but also need to be comprehensive in their message, simultaneously targeting both seat belt nonuse and drinking-and-driving problems.

Parent's language of interview and access to care for children with special health care needs

OBJECTIVE

To examine the association between the parent's language of interview and the access to care for children with special health care needs (CSHCN).

METHODS

We used the 2001 National Survey of Children with Special Health Care Needs to compare socio-demographic characteristics and health care access variables among CSHCN with parents who interviewed in English and another language. Additional multivariate analyses explored the effect of language of interview on access to health care for the subgroup of Hispanic respondents.

RESULTS

CSHCN with non-English-speaking parents were from less-educated and lower-income families and were more likely to lack insurance and have conditions that greatly affected their activities. These children were also more likely to have inadequate insurance (odds ratio [OR]=11.29), have an unmet need for family support services (OR=1.88), lack a personal doctor or nurse (OR=1.98), lack a usual source of care (OR=1.89), and lack family-centered care (OR=1.74). Non-English-speaking parents were more likely to report having employment consequences (OR=1.94) and spending over $500 out-of-pocket annually on the child's health care needs (OR=1.49). The likelihood of Hispanic children experiencing health care access barriers compared with non-Hispanic children was reduced when language was controlled for and several disparities between Hispanic children and other children became insignificant.

CONCLUSIONS

CSHCN with non-English-speaking parents were more likely to be from disadvantaged families and to experience barriers to access than were CSHCN with English-speaking parents. Systems of care for CSHCN should consider the needs and challenges experienced by families whose primary language is not English.

Health status and health services utilization among US Chinese, Asian Indian, Filipino, and other Asian/Pacific Islander Children

OBJECTIVE

This study examines the health status and health services access and utilization characteristics of US Chinese, Asian Indian, Filipino, other Asian/Pacific Islander (API), and non-Hispanic white children by using nationally representative data.

METHODS

We analyzed the aggregated data file from the National Health Interview Survey from 1997 to 2000 including 334 Chinese, 287 Asian Indian, 292 Filipino, 696 "other API," and 29,016 non-Hispanic white children <18 years old. Bivariate and multivariate analyses were conducted to examine the relationship between Asian ethnicities and dependent variables including components of health status, health services access, and utilization.

RESULTS

Logistic regression reveals that all Asian American children were less likely to miss school because of illness or injury or have learning disabilities compared with non-Hispanic whites. Other APIs were less likely to be taking prescription medication for at least 3 months, and Asian Indian children were half as likely to have chronic conditions. Chinese, Filipino, and other API children were more likely to be without contact with a health professional within the past 12 months. Citizenship/nativity status, maternal education attainment, and poverty status were all significant independent risk factors for health care access and utilization.

CONCLUSIONS

Asian ethnicities and being foreign-born are generally associated with more favorable health status measures such as school absence, learning disability, use of prescription medications, and chronic conditions. However, these attributes are negatively associated with health care access and utilization, suggesting the need for outreach to Asian immigrant populations to educate them on accessing the US health care system.

Acculturation and the health and well-being of U.S. immigrant adolescents

PURPOSE

To examine the association of acculturation, as measured by language spoken at home, with the health, psychosocial, school, and parental risk factors of adolescents of various racial/ethnic groups.

METHODS

Using the U.S. component of the 1997-98 World Health Organization Study of Health Behavior in School Children, bivariate and multiple logistic regression analyses were conducted of records for adolescents in four racial/ethnic groups to explore the relationship between the language spoken at home and outcome variables regarding health status and risks, psychosocial and school risk factors, and parental factors. Data were analyzed using Software for the Statistical Analysis of Correlated Data (SUDAAN).

RESULTS

Adolescents of all racial and ethnic groups who primarily speak a language other than English at home are at elevated risk for psychosocial risk factors such as alienation from classmates and being bullied, and parental risk factors such as feeling that their parents are not able or willing to help them. Those who speak a combination of languages are also at risk for being bullied and for high parental expectations. Language spoken at home is generally not associated with health and safety measures for adolescents across racial/ethnic groups.

CONCLUSIONS

Adolescents whose primary language at home is not English experience higher psychosocial, school, and parental risks than non-Hispanic white English-speakers. New immigrant youths of all races and ethnic groups would potentially benefit from preventive and risk-reduction services.

Patients' understanding of anticoagulant therapy in a multiethnic population

To investigate whether knowledge and perceptions of antithrombotic therapy differ between ethnic groups in the UK, we conducted a cross-sectional questionnaire survey of patients attending anticoagulation clinics in three Birmingham teaching hospitals. 180 consecutive patients were recruited-135 white European, 29 Indo-Asian, 16 Afro-Caribbean. The average knowledge score was 5.5 out of 9, with no significant differences between the groups. Indo-Asians were significantly less likely than the other groups to know the name of the anticoagulant they were taking (warfarin) and Afro-Caribbeans to know the condition for which they were being anticoagulated. Few patients of any group were able to specify more than one side-effect of warfarin or the dose they were on. In logistic regression analysis the factors associated with a low score were age >61 years, having been born outside the UK, and the perception of difficulty in comprehension. Nearly half the Indo-Asians felt unable to understand what was said to them in the clinic, and 62% expressed a preference for a doctor of the same ethnic group. Although there were no significant between-group differences, this study points to gaps in the knowledge of patients from ethnic minorities and to deficiencies in the provision of information. In patient education, these groups should receive special attention.