A descriptive study of hypertension in Vietnamese Americans

Self-Reported Prevalence of Hypertension and Antihypertensive Medication Use Among Asian Americans: Behavioral Risk Factor Surveillance System 2013, 2015 and 2017

Asian Americans are one of the fastest growing races in the US. The objectives of this report were to assess self-reported hypertension prevalence and treatment among Asian Americans. Merging 2013, 2015, and 2017 Behavioral Risk Factor Surveillance System data, we estimated self-reported hypertension and antihypertensive medication use among non-Hispanic Asian Americans (NHA) and compared estimates between NHA and non-Hispanic whites (NHW), and by NHA subgroup (Asian Indian, Chinese, Filipino, Japanese, Korean, and Vietnamese/other). The prevalence of hypertension was 20.8% and 33.5%, respectively, for NHAs and NHWs (p < 0.001). Among those with hypertension, the prevalence of antihypertensive medication use was 71.6% and 78.2%, respectively, for NHAs and NHWs (p < 0.001). Among NHA subgroups, a wide range of hypertension prevalence and medication use was found. Overall NHA had a lower reported prevalence of hypertension and use of antihypertensive medication than NHW. Certain NHA subgroups had a burden comparable to high-risk disparate populations.

Efficacy of a Culturally and Linguistically Competent Community Health Coach Intervention for Chinese with Hypertension

Purpose: To develop and pilot test the efficacy of a culturally and linguistically sensitive, community health coach (CHC)-based intervention in Chinese immigrants in improving blood pressure control and medication adherence.

Design: This study was conducted in 2017 with a cross-sectional design (n = 23). A CHC intervention was implemented using one 25-minute group educational presentation plus one 10-minute question and answer session at baseline, followed by four, 10-minute bi-weekly group question-and-answer sessions.

Findings: There was a significant reduction in both systolic and diastolic blood pressure from baseline to week 8: Systolic BP −17.33 (±11.32) (p < 0.005) and diastolic BP −9.58 (±6.57) (p < 0.005). The mean score for medication adherence was 10.56 (±3.24) (possible range 3–15) at baseline and there was no significant change at week 8 (mean 10.89 ± 3.95) (p = 0.86).

Conclusion: The CHC-based hypertension management program showed significant reductions in both systolic and diastolic blood pressures in Chinese immigrants. Since the proposed CHC-based hypertension management program is low cost and easy to establish, further investigation is recommended to generate more results for comparison.

Practice Implications: There is potential for the CHC intervention to be implemented in clinical settings to help Chinese immigrants at large achieve optimal blood pressure control.

Hypertension Prevalence, Treatment, and Related Behaviors Among Asian Americans: An Examination by Method of Measurement and Disaggregated Subgroups

BACKGROUND

Data on hypertension among Asian Americans is lacking and often aggregated, which can mask important ethnic differences. This study aims to provide a comprehensive view of hypertension and hypertension-related behaviors, including hypertension treatment, management, and information seeking, among Chinese, Korean, and Vietnamese Americans.

METHODS

Data were collected from 600 foreign-born Asian Americans (201 Chinese, 198 Korean, and 201 Vietnamese participants) in the Washington-Baltimore metropolitan area, aged 18 years and over, from 2013 to 2014. Hypertension was assessed using direct measurement and self-report of having ever been told by a physician. Hypertension prevalence was compared based on the method of assessment, ethnicity, and sex.

RESULTS

The age-adjusted hypertension prevalence from direct measurement was 27.5%, which is higher than the 2011-2014 National Health and Nutrition Examination Survey estimate for Asians (24.9%). Hypertension prevalences from self-report among Chinese, Korean, and Vietnamese were 13.4%, 23.2%, and 22.9%, respectively, which are lower than 2014 California Health Interview Survey estimates (15.6%, 18.4%, and 25.8%) with the exception of Korean participants. In regard to hypertension-related behaviors, 67.8% of hypertensive adults received management, 64.3% took antihypertensive medication, and 67.0% sought information to improve their hypertension.

CONCLUSIONS

Disaggregated data on hypertension based on measured blood pressure may prevent underestimation from self-report, particularly among those with limited healthcare access. More accurate and objective assessment of hypertension is needed for improved monitoring of hypertension among Asian-American subgroups.

Knowledge of cardiovascular health among Chinese, Korean and Vietnamese immigrants to the US

Cardiovascular disease (CVD) is the leading cause of death among Asian Americans, the majority of whom are foreign-born. However, CVD and risk factor data is sparse for specific Asian immigrant populations. To assess knowledge and understanding of CVD and risk factors within Chinese, Korean and Vietnamese immigrant populations, we conducted eight focus groups of 77 participants between 36 and 84 years old. Participants correctly identified signs and symptoms for heart attacks while knowledge about stroke was incomplete. While poor diet, lack of exercise, older age, and high cholesterol were frequently discussed as risk factors, mechanisms perceived as contributing to heart disease were influenced primarily by non-Western paradigms. Non-Western remedies were discussed in detail among Chinese and Vietnamese participants. All participants desired more information, and identified barriers to effective communication with healthcare providers. A deeper understanding of beliefs and barriers faced by Asian immigrants can help guide health promotion efforts.

Using photovoice to understand cardiovascular health awareness in Asian elders

Photovoice, a qualitative methodology using photography by study participants, is an ideal tool for collecting information on awareness of cardiovascular health from the perspective of persons of different cultural backgrounds and English-speaking abilities who are often subject to health disparities. Participants of Chinese, Vietnamese, and Korean ethnicity were provided disposable cameras to photograph their perceptions of scenes promoting or acting as barriers to cardiovascular health. After the pictures were developed, they returned for a discussion in their native languages to contextualize the stories told in their photographs. Group facilitators spoke the respective native languages and transcribed sessions into English. Twenty-three adults participated (7 to 9 persons per ethnicity), ranging in age from 50 to 88 (mean 71.6) years; 48% were women. The photographs stimulated conversations of knowledge, beliefs, and concerns regarding heart disease and stroke. Issues surrounding food and exercise were most dominant across ethnic groups, focusing on fat and salt intake and the need to remain active. Cultural beliefs and issues of emotional health, including stress and loneliness related to living in a new country, were also depicted. Photovoice provided insight into perceptions of cardiovascular health that is vital for developing health promotion and education interventions in limited-English-speaking communities.

Cardiovascular risk factors and knowledge of symptoms among Vietnamese Americans

BACKGROUND

There are few population-based studies of cardiovascular risk factors, knowledge, and related behaviors among Vietnamese Americans.

OBJECTIVE

To describe cardiovascular risk factors, knowledge, and related behaviors among Vietnamese Americans and compare the results to non-Hispanic whites.

DESIGN

Comparison of data from two population-based, cross-sectional telephone surveys.

PARTICIPANTS

Vietnamese Americans in Santa Clara County, California, and non-Hispanic whites in California, aged 18 and older.

MEASUREMENTS

Survey measures included sociodemographics, diagnoses, body mass index, fruit and vegetable intake, exercise, and tobacco use. Knowledge of symptoms of heart attack and stroke was collected for Vietnamese Americans.

MAIN RESULTS

Compared to non-Hispanic whites (n = 19,324), Vietnamese Americans (n = 4,254) reported lower prevalences of obesity, diabetes mellitus, coronary heart disease, and hypertension, and similar prevalences of stroke and hypercholesterolemia. Fewer Vietnamese Americans consumed fruits and vegetables five or more times daily (27.8% vs 16.3%, p < 0.05), and more reported no moderate or vigorous physical activity (12.1% vs 40.1%, p < 0.05). More Vietnamese men than non-Hispanic White men were current smokers (29.8% vs 19.0%, p < 0.05). Vietnamese Americans who spoke Vietnamese were more likely than those who spoke English to eat fruits and vegetables less frequently, engage in no moderate or vigorous physical activity, and, among men, be current smokers. Only 59% of Vietnamese Americans knew that chest pain was a symptom of heart attack.

CONCLUSIONS

There are significant disparities in risk factors and knowledge of symptoms of cardiovascular diseases among Vietnamese Americans. Culturally appropriate studies and interventions are needed to understand and to reduce these disparities.

Influenza and pneumococcal vaccination rates among Vietnamese, Asian, and non-Hispanic white Americans

BACKGROUND

Vaccination data for Asian Americans are comparable to those for whites, possibly because they are reported in aggregate rather than for subgroups. We compared influenza and pneumococcal vaccination rates among eligible Asian Americans and white Americans, and for Vietnamese Americans as a subgroup, and assessed factors associated with these vaccinations.

METHODS

Cross-sectional study of data collected from three ethnic groups over 4 years by telephone survey. Data were weighted for selection probability and population estimates and analyzed by multivariate logistic regression.

RESULTS

Vietnamese Americans had a higher rate of influenza vaccination (61%) than Asian Americans (45%) and white Americans (52%), and lower rate of pneumococcal vaccination (41%) than Asian Americans (56%), both lower than white Americans (67%).

CONCLUSION

When analyzed as a subgroup, Vietnamese Americans had a higher influenza vaccination rate, but a lower pneumococcal vaccination rate, compared to Asian Americans and white Americans, which may indicate that health behaviors and outcomes can differ widely among Asian subgroups. Analyses of preventive care measures in Asian Americans should focus on subgroups to ensure accuracy and quality of assessments.

Heart disease prevention practices among immigrant Vietnamese women

BACKGROUND

Cardiovascular disease is a leading cause of death in the United States as well as in many countries around the world, including Vietnam.

METHODS

Using data from a household survey of Vietnamese American women aged 20-79 years in Seattle, Washington, collected in 2006 and 2007, we examined heart disease prevention practices. Multivariable analyses were conducted to examine the relationship between demographic factors and preventive behaviors.

RESULTS

A total of 1523 immigrant women completed interviews. The average daily consumption of fruits and vegetables was 3.5 servings, and 31% of our sample reported being physically active (engaging in at least 30 minutes of physical activity 5 or more days per week). Few respondents reported being current smokers (1.5%). Over three quarters of women had received a recent blood pressure check and a recent cholesterol check. Age and length of time in the United States were strongly associated with several cardiovascular prevention behaviors.

CONCLUSIONS

Our findings confirm the need for continued efforts to develop and implement targeted educational campaigns to reduce the risk of cardiovascular disease among Vietnamese American women.

The illness beliefs, perceptions, and practices of Filipino Americans with hypertension

PURPOSE

The purpose of this study was to describe the illness beliefs, perceptions, and practices of Filipino Americans (FAs) with hypertension (HTN) to reveal their explanatory models (EMs) of the illness.

DATA SOURCES

Audiotapes and transcripts of focus group interviews and observational notes were subjected to content analysis. Medical records and related empirical studies provided supporting data.

CONCLUSIONS

In general, the EMs of FAs with HTN correspond to the biomedical model in relation to causes, consequences, and treatment of HTN. However, in spite of this biomedical knowledge, FAs with HTN have difficulty maintaining the required lifestyle changes and adhering to the medication regimen to control their illness.

IMPLICATIONS FOR PRACTICE

It is important for NPs to assess the EMs of FAs with HTN, including their use of traditional folk remedies and practitioners of folk medicine. The challenge is to provide cardiovascular health promotion and education in a culturally sensitive, congruent, and tailored manner to FAs with HTN to help them control their illness.

Does knowledge matter?: intentional medication nonadherence among middle-aged Korean Americans with high blood pressure

AIM

To examine predictors of intentional and unintentional nonadherence to antihypertensive medication regimens and their relationships to blood pressure outcomes.

BACKGROUND

Although poor adherence to medical regimens is a major concern in the care of patients with high blood pressure (HBP), our understanding of the complex behavior related to adherence is limited. Moreover, few studies have been devoted to understanding adherence issues in ethnic minority groups, such as the interplay between cultural beliefs and HBP medication-taking behaviors.

DESIGN

A cross-sectional analysis was performed to assess the factors affecting nonadherence to antihypertensive medication regimens.

METHODS

The data used in this analysis came from an ongoing HBP intervention trial involving middle-aged (40-64 years) Korean Americans with HBP. A total of 445 Korean Americans with HBP was enrolled in the trial at baseline. Of these, 208 participants who were on antihypertensive medication were included in the analysis. Using multivariate logistic regression, we examined theoretically selected variables to assess their relationships to intentional and unintentional nonadherence in this sample.

RESULTS

Approximately 53.8% of the subjects endorsed 1 or more types of nonadherent behaviors. After controlling for demographic variables, multivariate analysis revealed that a greater number of side effects from the medication (adjusted odds ratio [OR], 1.19; 95% confidence interval [CI], 1.07 to 1.33) and a lower level of HBP knowledge (adjusted OR, 0.89; 95% CI, 0.79 to 0.99) were significantly associated with intentional nonadherence. Unintentional nonadherence was less strongly associated with the study variables examined in the analysis.

CONCLUSION

Our findings indicate that intentional nonadherence to antihypertensive medication that stems from incomplete knowledge of HBP treatment is prevalent among middle-aged Korean Americans with HBP. The results highlight the strong need for an intervention that focuses on increasing patient knowledge about HBP, including the benefits and side effects of antihypertensive medication. This type of focused intervention may help reduce intentional nonadherence to antihypertensive medications and ultimately result in achieving adequate BP control in this high-risk group.

Perceptions of Asian American men about tobacco cigarette consumption: a social learning theory framework

Little information exists regarding the perceptions that ethnic-specific groups of Asian American men have about tobacco cigarette smoking. Thirty Asian American men of immigrant status living in Seattle, Washington, were stratified by ethnicity (Chinese and Vietnamese), language (Mandarin, Cantonese, Vietnamese) and age to comprise six focus groups (two Mandarin speaking men aged 20-40 years and 10 aged 41-65+ years; three Cantonese men aged 20-40 years and another six aged 41-65+ years; four Vietnamese men aged 20-40 years and another five aged 41-65+ years). All group interviews were audio-taped and six separate hard-copy transcripts were produced, independently theme-coded by three investigators to ensure inter-rater reliability, and analyzed with QRS NUD*IST ethnographic software. Bandura (1969, 1986) categorized emergent contextual themes within the constructs of "predisposing, enabling, and reinforcing" behavioral determinants from Social Learning Theory. Smoking to be sociable emerged as the most salient theme. Awareness of tobacco-related diseases other than lung cancer was less evident, as was a self-perceived lack of will-power to quit. Concerns about side-stream smoking affecting family members, along with smoking to alleviate stress, were key findings. Further tobacco-related research is needed that incorporates considerations for cultural dynamics.

Adherence With Hypertension Care Among Hmong Americans

To assess contexts of adherence with hypertension care among Hmong Americans, in-person interviews were conducted with a convenience sample of 323 adults using culturally adapted survey instruments. The mean age of participants was 58 years; 91% had no education, and 86% spoke no English. Although more than 90% had health insurance and were treated with medications, the rate of blood pressure control was low (27%). A majority (> 90%) suffered from psychological distress, and 46% lived with physical illness. Over 50% reported nonadherence with hypertension care. Respondents who were 50 years of age or older, had no physical illness, did not know that hypertension was preventable, or believed that American medicine was too strong, were more likely to report nonadherence with proper medication consumption. Findings suggest that adherence was not due to lack of health care coverage; instead, it may be due to gaps in health services.

Acculturation and cardiovascular disease risk in midlife immigrant women from the former Soviet Union

This study examines relationships among acculturation, depression, and cardiovascular risk factors in midlife women from the former Soviet Union and identifies factors predicting Framingham Risk Scores. Data were collected at baseline and 1 year later from 218 participants in a longitudinal study of postimmigration health. The leading risk factors were obesity, dyslipidemia, and depression. Older women had lower American Behavioral Acculturation subscale scores, higher Russian Behavioral Acculturation subscale scores, and higher depression scores. Length of residence was significantly correlated with American behavioral acculturation but not Russian behavioral acculturation. Baseline body mass index, both acculturation scores, and depression scores predicted Framingham Risk Scores after 1 year, but serum glucose did not. The results suggest that contrary to findings in other immigrant groups, women from the former Soviet Union may decrease their risk for coronary heart disease as they assume a more American lifestyle. Nursing interventions to address the high cardiovascular disease risk in this population are suggested.