Heart disease risk factors in the Vietnamese community of southwestern Sydney

Representativeness of Three Survey Methods in Ethnic Health Research

Study objective: To identify the survey method which generates the most representative sample of respondents in an ethnic community

Design: Three survey methods (including sampling from the telephone book and telephone surveys, cluster sampling of households from areas with known high concentrations of migrants from the target community and face-to-face interviews, and sampling of persons listed on the electoral roll and a mailed survey) were employed concurrently in a defined area.

Setting: Metropolitan Sydney, Australia.

Participants: Persons aged 18 years or more born in Lebanon.

Main results: The telephone survey method consistently outperformed cluster sampling and sampling from the electoral roll in terms of cost, response and contact rates, ease and speed of administration and representativeness of the sample. All methods generated a similar age profile but over-represented females compared with census data for the study area. There was relatively little duplication of respondents. The proportion of respondents who rated their health as fair or poor was comparable.

Conclusions: Telephone surveying of migrant populations is a recommended strategy for health research in the Lebanese migrant population in metropolitan Sydney, and is also likely to be recommended for migrant populations with ethnically identifiable surnames.

Low knowledge and high infection rates of hepatitis in Vietnamese men in Sydney

Objective: To describe hepatitis B and C knowledge and self-reported infection and risk behaviour in a group of Vietnamese men living in inner-urban Sydney, in order to assist with future program planning. Methods: Data were collected through telephone interviews conducted in Vietnamese using a structured questionnaire from 499 of 761 eligible men contacted, giving a response rate of 66%. The data were weighted to be consistent with the age distribution of Vietnamese men in the area. The findings were compared with a published national telephone study. Results: Low knowledge levels of hepatitis B and C were found when compared with data from a published national telephone study. The factors associated with higher mean knowledge scores for hepatitis B were being highly acculturated (P < 0.001), ever having been tested for HIV (P < 0.001) and knowing someone with HIV (P < 0.0001). For hepatitis C, the factors were being highly acculturated (P < 0.001), ever injecting drugs (P < 0.05) and being vaccinated for hepatitis B (P < 0.001). Knowledge regarding hepatitis B was particularly poor. High rates of self-reported hepatitis B infection were noted. Of the participants, 7.2% were aware that they had ever been infected with hepatitis B, more than 10 times the rate in the national telephone study. Conclusion: Lower levels of hepatitis B knowledge have been identified in a community with higher numbers of people living with chronic hepatitis B. Targeted community-wide awareness-raising campaigns and health care worker education is required to improve knowledge of hepatitis B and rates of screening in the Australian Vietnamese community.

Sexual behaviour and risk in Vietnamese men living in metropolitan Sydney

OBJECTIVE

To describe sexual risk in Vietnamese men who have sex with female sex workers by describing the prevalence of sexual risk behaviours among Vietnamese men living in inner Sydney and comparing this prevalence with national data.

METHOD

Telephone interviews were completed with a random sample of 499 Vietnamese men, selected from the electronic telephone book using a list of common Vietnamese surnames.

RESULTS

Of the 761 eligible men contacted, data were obtained from 499 men, giving a response rate of 66%. 20% reported having had sex with a sex worker, including 12% of Vietnamese men who had had sex with a sex worker outside Australia, predominantly in Vietnam. Of the men who had had sex with a sex worker in the past year, 28% had unprotected vaginal or anal sex at their most recent commercial sexual encounter. Ever having paid for sex was significantly associated with a higher lifetime number of sexual partners (p<0.001), history of a sexually transmitted infection (p<0.001) and ever having an HIV test. 1% of respondents reported injecting non-prescription drugs. Less than 1% said they had had sex with another man.

CONCLUSION

Vietnamese men living in Sydney generally show lower levels of sexual and related risk behaviours than other Australian men. However, sex with a sex worker is common among Vietnamese men in Sydney and also when they travel outside Australia. Unprotected vaginal sex with sex workers is surprisingly common. Programmes are needed to deal with vulnerabilities in these areas.

Risk factors for coronary heart disease in two similar Indian population groups, one residing in India, and the other in Sydney, Australia

OBJECTIVE

To identify the prevalence of coronary risk factors among South Asian Indians in Australia and India.

DESIGN

Cross-sectional intercountry comparison.

SUBJECTS

Healthy volunteers aged 23-75 y recruited from the Indian community in Sydney Australia (n=125), and their nominated relatives in India, (n=125).

RESULTS

The two groups were of similar background with over 90% of the group in India being siblings, parents or relatives of the group in Australia. There was no difference in the populations between India and Australia with regard to mean age (40+/-11.5 vs 39+/-10.3 y), body mass index (BMI) (25+/-3.3 vs 25+/-3.5 kg/m(2)), lipoprotein (a) (178 vs 202 mg/l), total cholesterol (5.3+/-1.3 vs 5.3+/-1.2 mmol/l) or triglyceride (1.7+/-0.8 vs 1.7+/-0.8 mmol/l). The group in India had higher insulin (median values) (139 vs 83 pmol/l, P=0.0001), waist-to-hip ratio (WHR) (0.88+/-0.08 vs 0.85+/-0.09, P=0.01), exercise time (23.7+/-32.7 vs 17.2+/-23.2 h/week, P=0.07), lower waist (83+/-10.0 vs 85+/-11.1 cm, P=0.05) and high-density lipoprotein (0.9+/-0.3 vs 1.1+/-0.6 mmol/l, P=0.02). Women in India had lower BMI (22.7+/-2.9 vs 25.3+/-4.2 kg/m(2), P<0.001), higher insulin (182 vs 90 pmol/l, P<0.001), WHR (0.86+/-0.08 vs 0.77+/-0.06, P<0.001)) and prevalence of abdominal obesity (% WHR >0.8, 73 vs 23%, P<0.001; odds of waist >90 cm=2.3, P<0.05). Men in India had the same BMI, lower waist (85.5+/-8.8 vs 92.9+/-7.2 cm, P<0.001) and WHR (0.89+/-0.09 vs 0.93+/-0.05, P<0.01) but higher insulin (137 vs 76 pmol/l).

CONCLUSION

The group in Australia (especially women) have a more favourable disease risk profile than those in India. The fact that the groups are of such similar background and partly related, make it unlikely that changes due to migration have a strong genetic bias. In contrast to other studies, the absence here of excessive weight gain on migration may be a key factor in disease risk prevention.

A descriptive study of hypertension in Vietnamese Americans

This study focused on the extent of hypertension (HTN) and risk factors in 201 Vietnamese in a Gulf Coast community. Blood pressure and pulse were measured by a Welch-Allyn Vital Signs Monitor (Model AD-9000, Armstrong Medical, Lincolnshire, IL). The survey tool consisted of demographic information, health status, medications, dietary habits, smoking and alcohol use, education, family configuration, family health history, and 12 true or false items on HTN knowledge. Participants believed that HTN was inherited, presented symptoms, was caused by stress and lack of daily exercise, and had no cure. Of the factors correlated with high blood pressure, the most significant item was the total knowledge score. Nearly 44% of the participants in this sample were hypertensive. Other significant correlation findings included smoking r = .45, p < .05) and exercise r = .15, p < .05) were related to high blood pressure. Cultural sensitivity was found to be critical in the data collection process. This study demonstrates a profound need for health education related to cardiovascular disease, smoking, and alcohol use in Vietnamese Americans.

Factors associated with delayed tobacco uptake among Vietnamese/Asian and Arabic youth in Sydney, NSW

OBJECTIVE

To describe the smoking behaviour and possible reasons for delayed uptake of tobacco smoking among Arabic and Vietnamese/Asian speaking senior school students in Sydney

METHOD

A descriptive study involving four adult in-depth interviews and five student focus groups plus a quantitative survey of 2,573 school students attending Years 10 and 11 from 12 high schools with high Vietnamese and Arabic populations was conducted in Sydney in 1998. Self-reported smoking behaviour and peer, parent, school and cultural background information was collected.

RESULTS

Students who smoke were more likely to have more than $20 a week pocket money, be from an English-speaking background, have no rules at home about smoking, have family members who smoke, not feel close to their father, spend three or more evenings a week out with friends, and have negative perceptions of the school environment and of the level of teacher support. They were less likely to smoke if they perceived their peers to be unsupportive.

CONCLUSIONS

These results confirm the delayed uptake of smoking among students from a Vietnamese/Asian and Arabic-speaking backgrounds compared with those from an English-speaking background. A number of family and school factors were associated with smoking.

IMPLICATIONS

Positive parental modelling, active parenting including awareness of or supervision of student leisure time, strict rules about not smoking and less pocket money are important strategies for preventing smoking among all adolescents.

Substance use in high school students in New South Wales, Australia, in relation to language spoken at home

PURPOSE

To examine for the first time adolescent substance use by ethnicity, given the high proportion of migrants from non-English-speaking countries in New South Wales, (NSW), Australia.

METHODS

Data from four surveys of NSW secondary school students in 1983, 1986, 1989, and 1992 were used for this analysis. The prevalence of substance use by whether English was spoken at home was stratified by sex and age using data from the most recent survey year. Adjusted odds ratios and 95% confidence intervals were produced by simultaneous logistic regression, adjusting for sex, age group, and the interaction term of sex and age for each of these substances, and for each survey year separately. Data from 1989 and 1992 were pooled together to examine rates of substance use by ethnic subgroups which reflect migration patterns.

RESULTS

The prevalence of smoking and alcohol and illicit drug use was consistently lower among NSW adolescents speaking a language other than English at home, compared with those speaking English at home in all survey years. Only the prevalence of solvent sniffing was higher among younger adolescents speaking a language other than English at home. Students from Southeast Asia showed consistently lower rates of usage of all substances compared to all other groups.

CONCLUSIONS

There may be different opportunities for the prevention of adolescent substance use among native English speakers to be gained from non-English-speaking cultures.

Estimates of smoking and related behaviour in an immigrant Lebanese community: does survey method matter?

OBJECTIVE

To estimate the prevalence of smoking, stage-of-change and GP advice to quit in the Sydney Lebanese community and whether these findings varied by survey method.

METHOD

Three methods--telephone interviews using sampling from the electronic White Pages, personal interviews of a household member selected using cluster sampling and a mailed survey using an electoral roll sample--were used in separate surveys of persons born in Lebanon living in three postcode areas of Sydney in 1997.

RESULTS

Smoking prevalence was consistent across the three methods, with male smoking averaging 49% and female smoking averaging 29%. About two-thirds of smoking respondents across each of the survey methods had no plans for quitting.

CONCLUSIONS

As smoking prevalence did not vary across the three sampling and survey methods used here, the simplest and most inexpensive method (the electronic White Pages and telephone surveying of identifiable ethnic surnames) should be preferred.

IMPLICATIONS

Smoking prevalence in the Sydney Lebanese community is determined consistently using a variety of survey methods.

Smoking and lipid cardiovascular risk factors in Vietnamese refugees in Australia

BACKGROUND

The effects of smoking and sex on lipid risk factors for cardiovascular disease were examined among Vietnamese people newly arrived in Australia.

METHODS

Immigrants recruited through Refugee Screening had anthropometric data recorded and blood collected to measure total cholesterol (TC), high-density lipoprotein cholesterol (HDL), and triglyceride (TG) by Reflotron; apolipoprotein A-1 (apo A-1) and apolipoprotein B-100 (apo B) by immunoturbidimetric analyses (Turbitimer); and lipoprotein (a) (LP (a)) by ELISA. A questionnaire determined behavioral variables known to influence cardiovascular risk and Statview, Minitab, and SPSS were employed for data analysis.

RESULTS

Lipoprotein profiles of men (n = 242) and women (n = 159) were compared. Crude TC and apo B were similar; HDL, apo A-1, and LP (a) were higher in women, TG was higher in men. After adjustment (age, BMI, WHR, years of smoking, and drinks per week), only apo A-1 and LP (a), were higher in women. "At risk" levels of TC or apo B did not differ by gender; risk of low apo A-1 was higher among men. Smokers had a significant risk (crude and adjusted) of low HDL, low apo A-1, and high LP (a). The sex difference in HDL was removed by a single adjustment for smoking; male smokers had higher LP (a) than male nonsmokers.

CONCLUSION

Male and female Vietnamese immigrants had similar adjusted lipid profiles. Smoking had a marked detrimental effect on lipids.

A longitudinal study of smoking in year 7 and 8 students speaking English or a language other than English at home in Sydney, Australia

OBJECTIVE

To compare the rates and predictors of smoking uptake between adolescents speaking English and those speaking a language other than English (LOTE) at home.

DESIGN

A cross-sectional survey of year 7 and 8 students (aged 12 and 13 years) was conducted in 1994 and repeated 12 months later. A cohort of students was identified with respondents at baseline matched at follow up. chi 2 and logistic regression were used for analysis.

SETTING

38 schools in southern, east, and northern Sydney, Australia.

SUBJECTS

Year 7 and 8 students in the schools were included and examined on two occasions, with complete data for 5947 (80%) students at baseline and 6177 (98%) students at a 12-month follow up. Records were able to be matched perfectly for 3513 respondents (59%).

MAIN OUTCOME MEASURES

Smoking rates and predictors of smoking uptake among students speaking English or a LOTE at home.

RESULTS

At baseline, 6.1% of students surveyed were smokers. Twelve months later, 15.8% of student surveyed were smokers. There were significantly lower smoking rates among students speaking a LOTE at home compared with those speaking English at home at baseline and at 12 months. Using matched data, for students speaking English at home, five variables were significant predictors of smoking uptake: thinking it acceptable to smoke, perceived benefits of smoking, and having a brother, sister, or close friend who smokes. For students speaking a LOTE, the only predictor was the smoking status of close friends.

CONCLUSIONS

Despite the higher smoking prevalence among men with a non-English-speaking background, and the reported strong association between fathers' smoking status and smoking onset of their children, adolescents speaking a LOTE at home were significantly less likely to be smokers than their English-speaking counterparts. Thus, there would seem to be a delay of smoking onset among students speaking a LOTE at home. The smoking rates among respondents speaking a LOTE at home in this study are lower than those obtained from the studies conducted in Europe and the United States. Effective smoking prevention interventions need to be implemented at an early stage of adolescence.

Mental health status of Iranian migrants in Sydney

OBJECTIVE

The aim of this study was to determine the levels and predictors of psychological distress within the Iranian community in Sydney, Australia.

METHOD

Participants (n = 161) were identified using snowball sampling, and a questionnaire incorporating the General Health Questionnaire (GHQ-20) and other migration-related factors was mailed to their preferred address.

RESULTS

A relatively high proportion of respondents (37%) had GHQ-20 scores above the recommended threshold (4+). Students were significantly more likely to report psychological distress compared with respondents who worked full-time. A feeling that migration had contributed to their distress was also found to be significantly associated with above-threshold GHQ-20 scores.

CONCLUSIONS

Iranian migrants in Sydney may need mental health programs to address migration-related distress.

The development and application of a scale of acculturation

As Australia is one of the most multicultural societies in the world, acculturation of migrants and changes in migrants' health status should be an important focus of public health research. The absence of an accepted measure of acculturation is one barrier to exploring the relationship between acculturation and health. This paper presents data from a study of 851 Arabic-speaking adults attending 20 Arabic-speaking general practitioners in Canterbury, Sydney. An eight-item scale assessing acculturation was developed with a structural equation modelling program (LISREL). This acculturation scale was based on similar scales used with Hispanic populations, was theoretically grounded and had high internal consistency and criterion-related validity. To show the application of a scale of acculturation, patients' preferences for participation in medical decision making, according to level of acculturation, were examined. After adjustment for age, sex and highest level of formal education, significant inverse associations between acculturation and preferences for patient (versus family) involvement in medical decision making were found. Mechanisms for how acculturation affects health need to be explored.

The traditional humoral food habits of pregnant Vietnamese-Australian women and their effect on birth weight

Vietnamese-Australian women have infants with lower birth weight than Australian-born women. Traditional humoral food habits, based on ancient Chinese medicine, are more likely to be followed during life changes like pregnancy. These food habits may influence maternal energy intake, weight gain and therefore infant birth weight. This study determined the proportion of pregnant Vietnamese women in southwestern Sydney who practise traditional humoral food habits, and their effect on birth weight. A cohort of 113 pregnant Vietnamese-born women were questioned on smoking status, height, weight, parity, food practices and demographics. Dietary intake was measured in each trimester. Known risk factors and infant birth weights were collected from medical records for participants and nonresponders. Fifty-seven per cent practised the traditional food habits. There were no differences in energy intake or weight gain between the two groups. After adjusting for confounders, birth weight was estimated to be 3257 g (95 per cent confidence interval (CI) 3205 to 3309) and 3272 g (CI 3211 to 3333) for the infants of traditional and nontraditional women respectively. Following humoral food habits does not appear to affect birth weight. Women who choose to follow these traditions should not be discouraged from doing so.