Job Loss and Well-Being Among Chinese American Breast Cancer Survivors: The Mediating Role of Income and Perceived Stress

BACKGROUND

A growing number of studies suggest that job loss has detrimental effects on cancer survivors. However, the underlying mechanisms are not well understood. Furthermore, minorities including Asian American cancer survivors remain understudied, yet they suffer from job loss more often. The present study examined the prevalence of job loss in Chinese American breast cancer survivors (CABCS) and investigated the relationship between job loss and well-being in this group and the underlying mechanisms.

METHOD

CABCS completed a questionnaire that included demographic, employment, and clinical information, as well as measures of psychosocial well-being. Descriptive analyses were conducted to gauge the prevalence of job loss, linear regressions were used to test associations between job loss and well-being, and path analyses were conducted to test mediations.

RESULTS

About 45.4% of survivors lost their job after being diagnosed with cancer, and only 35.2% of those who lost their job regained employment up to the assessment time. Job loss was associated with reduced income, which was associated with higher perceived stress, which, in turn, was associated with lower overall quality of life (QoL) and greater depressive symptoms.

CONCLUSIONS

Findings highlight the high prevalence of job loss and its negative effects on QoL and depression among CABCS. It is important for health care professionals to be sensitive to adverse financial events affecting minority BCS. In addition to offering BCS necessary practical assistance, psychosocial interventions focusing on reducing perceived stress associated with the cancer experience may be effective in mitigating some long-term consequences of job loss.

Acculturation and eating disorders: a systematic review

PURPOSE

Acculturation, or the dual process of cultural change that takes place due to the interaction between two or more cultural identities, may contribute to the susceptibility of developing an eating disorder (ED). We conducted a systematic review exploring the relationship between acculturation-related constructs and ED pathology.

METHODS

We searched the PsychINFO and Pubmed/Medline databases up to December 2022. Inclusion criteria were: (1) having a measure of acculturation or related constructs; (2) having a measure of ED symptoms; and (3) experiencing cultural change to a different culture with Western ideals. 22 articles were included in the review. Outcome data were synthesized by narrative synthesis.

RESULTS

There was variability in the definition and measure of acculturation in the literature. Overall, acculturation, culture change, acculturative stress, and intergenerational conflict were associated with ED behavioral and/or cognitive symptoms. However, the nature of the specific associations differed depending on the specific acculturation constructs and ED cognitions and behaviors measured. Furthermore, cultural factors (e.g., in-group vs. out-group preferences, generational status, ethnic group, gender) impacted the relationship between acculturation and ED pathology.

DISCUSSION

Overall, this review highlights the need for more precise definitions of the different domains of acculturation and a more nuanced understanding of the specific relationship between various acculturation domains and specific ED cognitions and behaviors. Most of the studies were conducted in undergraduate women and in Hispanic/Latino samples, limiting generalizability of results.

LEVEL OF EVIDENCE

Level V, Opinions of respected authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.

Asian students in the anglosphere - unravelling the unique familial pressures contributing to eating pathology: a systematic review

BACKGROUND

There is no clear consensus on the specific familial pressures affecting Asian students in the Anglosphere, despite the validation of the Tripartite Influence model of eating disturbances in this group. However, traditional familial risk factors for disordered eating can be elevated for immigrant Asians with collectivistic-oriented familial dynamics, necessitating an examination of the culture-specific risk profile for eating pathology in student-aged Asians. This systematic review aims to consolidate and critically examine the literature on the most widely studied familial pressures related to disordered eating in Asian students in the Anglosphere.

METHODS

A systematic search was conducted in five databases for peer-reviewed articles measuring familial pressures and eating pathology in Asian students > 10 years old from an Anglosphere country. Following PRISMA guidelines, papers were screened by title, abstract and full text based on the eligibility criteria. Eligible studies were qualitatively analysed and synthesised narratively to assess the relationship between familial pressures and eating pathology.

RESULTS

In total, 14 papers were eligible for inclusion in the review. Eight topics related to familial stressors were identified (1) intergenerational conflict; (2) lack of familial cohesion; (3) parental overprotection; (4) low parental care; (5) familial achievement orientation; (6) parental expectations; (7) parental criticism; and (8) direct parental influence. In multiple studies, intergenerational conflict, maternal overprotection, and familial achievement orientation were significantly elevated and associated with disordered eating in US and UK Asian students, compared to white students. The studies examining parental criticism and familial cohesion had more heterogeneous findings.

CONCLUSION

The findings demonstrate the perception of Asian parenting styles as overprotective and incompatible with individualist-oriented Western values could increase eating pathology in adolescent and university students living in Anglosphere countries. The synthesised findings of the literature also indicate disordered eating acts as a compensatory mechanism for the ongoing psychological distress generated from intergenerational conflict and familial achievement orientation. Conversely, traditional eating disorder literature on familial cohesion and low parental care may not be applicable to young Asians. Future research should focus on how social appearance anxiety and psychological factors can mediate the link between disordered eating and familial stressors in Asian students.

Moderation Effects of Ethnic-Racial Identity on Disordered Eating and Ethnicity Among Asian and Caucasian Americans

Background: The current study was designed to examine whether ethnic-racial identity (ERI) moderated the relationship between disordered eating and primary ethnic identification. Methods: Three hundred and ninety-eight undergraduate women (M age = 19.95, SD = 3.09) were recruited from a large university in Hawai'i. Participants completed the Eating Disorder Examination Questionnaire (EDE-Q), the ERI measure, and reported their primary ethnicity as an index of ethnicity. Results: There was a significant correlation between eating concerns and centrality, r (357) = 0.127, p < 0.05. Moderation analyses indicated that only ERI centrality moderated the predictive effect of ethnicity on the importance of eating concerns, b = 0.05, t (347) = 2.37, p = 0.018. Conclusions: The results suggest that the relationship between self-reported primary ethnicity and EDEQ scores is greater when ethnicity is more central to the individual's identity or when the in-group affect is important to an individual. Findings underscore the need for further research on the underlying mechanisms that account for the differing ways that ERI may affect eating concerns.

The clash of culture and cuisine: A qualitative exploration of cultural tensions and attitudes toward food and body in Chinese young adult women

OBJECTIVE

Accumulating evidence suggests that the prevalence of eating disorders among Chinese women is a public health concern. Prior studies have drawn linkages between conflicting cultural values, identity confusion, and eating disorder symptomatology, which may be relevant for understanding the rise of eating disorders amidst China's rapid economic and sociocultural transformation. Here, we explore how women's experiences with traditional eating norms and modernizing norms of femininity may shape their food and body attitudes.

METHOD

Chinese young adult women (N = 34; aged 18-22 years) participated in semi-structured interviews focusing on experiences with norms surrounding eating and ideal feminine appearance, perceived conflict between these norms, and their responses to perceived conflict. Interviews were conducted via email (n = 27) or via Skype (n = 7). Participants were not asked about past or present diagnoses of eating disorders. Analysis of responses was guided by the principles of thematic analysis.

RESULTS

Women reported encounters with cultural eating norms and feminine appearance norms, and described factors that motivated continued or discontinued adherence to these norms. Women reported strategies of conflict resolution, which resulted in different emotional and behavioral outcomes including eating disorder symptoms.

DISCUSSION

Women's experiences with norms surrounding eating and appearance indicate the centrality of these encounters in the formation of individual and interpersonal values. Our findings suggest the importance for clinicians to assist clients in exploring the meanings behind internalized attitudes toward food and body, and to help clients balance interpersonal and individual needs.