Comparison of the ductal carcinoma in situ between White Americans and Chinese Americans

Currently, the wide-spread use of screening mammography has led to dramatic increases in ductal carcinoma in situ (DCIS). However, DCIS of Chinese Americans, the largest Asian subgroup in American, has rarely been comprehensively studied over the past decade. This work compared the DCIS characteristics and prognosis of Chinese American patients with White Americans in the USA to determine the characteristics and prognosis of DCIS patients of Chinese Americans.The data were obtained using the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) data. The diagnosis and treatment variables between the two groups were compared by means of Chi-square tests. Survival was determined with the use of the Kaplan-Meier method and the multivariable Cox proportional hazard regression model.From 1975 to 2016, 81,745 White Americans and 2069 Chinese Americans were diagnosed with ductal carcinoma in situ. Compared with the white patients, the Chinese Americans were younger (P < .001) with smaller tumors (P < .001) and higher family income (P < .001). DCIS patients of Chinese American group accounted for a higher percentage of all breast cancers than the whites (P < .001). In the multivariable Cox proportional hazard regression analysis, Chinese American was an independent favorable prognostic factor in terms of overall survival (OS) (HR, 0.684; 95% CI, 0.593-0.789; P < .001) compared with the white group.In conclusion, DCIS characteristics of the Chinese group, which exhibited a higher proportion of younger age, a higher DCIS ratio, and a better prognosis, were distinct from those of the White Americans.

Comparison of Online Dementia Information in Chinese and in English Languages

Introduction

There is a deficit of avenues for obtaining dementia information in the Asian American community. This study aims to compare the content and quality differences between websites providing information on dementia as found by a Google search conducted both in simplified Chinese characters and in English.

Methods

A Google search was performed for the phrase “dementia” in simplified Chinese characters and in English. The resultant websites were categorized by whether they were commercial in nature, the type of website, and whether the website provided an explanation of dementia signs and symptoms. The quality of the websites was assessed via readability and the Health on the Net Code of Conduct (HONcode). Chi-squared analyses were performed to establish differences between the English and simplified Chinese results.

Results

The simplified Chinese search websites were more likely to be commercial (p=0.045) and were more likely to not meet HONcode standards (p=0.008). No statistical significance was observed between the types of websites (p=0.127), the prevalence of signs and symptom explanations (p=0.073), and the readability of the website (p=0.151).

Conclusion

The quality of websites obtained from the simplified Chinese character Google search was lower than those obtained from searches using the English language. Given the limited sources of language and culturally appropriate information on dementia, improvement of Internet resources may help to improve health outcomes of dementia patients in the Asian American population.

Comparison of Mental Health Service Utilization by Asian Americans and Non-Hispanic Whites versus Their Cardiovascular Care Utilization

INTRODUCTION

This study will determine whether racial/ethnic disparities persist in various psychiatric disorders among Asian Americans.

METHODS

Secondary analyses of data from the second largest public health system in the US (total N=22294) were performed. Chi-squared statistics were used to compare the race for mental health service utilization for five psychiatric diagnoses. Cardiovascular care utilization by Asian Americans and non-Hispanic whites was used as a proxy for overall healthcare utilization rates between the two racial groups and constituted the expected values for the analysis.

RESULTS

Asian Americans were less likely to utilize mental health services for bipolar disorder, schizophrenia, anxiety, depression, and intellectual disabilities.

CONCLUSION

The results of this study call for ways to increase mental health service utilization on par with cardiovascular healthcare utilization among Asian Americans.

Dementia Health Promotion for Chinese Americans

Introduction This study aims to describe the results of a dementia awareness campaign in the Chinese American community.  Methods The campaign consisted of a health fair, four dementia seminars, radio shows, television episodes, and a YouTube series. Descriptive statistics and qualitative data were obtained from various health communication channels.    Results There were 156 and 313 participants in the health fair and dementia seminars, respectively. The participants in each component of the campaign also provided qualitative data on barriers and effective ways to disseminate awareness of dementia and brain health.  Conclusion A dementia awareness campaign may be an effective way to reduce health disparities and dementia in the Chinese American community.

Assessing the cultural in culturally sensitive printed patient-education materials for Chinese Americans with type 2 diabetes

Type 2 diabetes affects Chinese Americans at an alarming rate. To address this health disparity, research in the area of cultural sensitivity and health literacy provides useful guidelines for creating culturally appropriate health education. In this article, we use discourse analysis to examine a group of locally available, Chinese- and English-language diabetes print documents from a surface level and deep structure level of culture. First, we compared these documents to research findings about printed health information to determine whether and how these documents apply current best practices for health literacy and culturally appropriate health communication. Second, we examined how diabetes as a disease and diabetes management is being constructed. The printed materials addressed surface level culture through the use of Chinese language, pictures, foods, and exercises. From a deeper cultural level, the materials constructed diabetes management as a matter of measurement and control that contrasted with previous research suggesting an alternative construction of balance. A nuanced assessment of both surface and deeper levels of culture is essential for creating health education materials that are more culturally appropriate and can lead to increased health literacy and improved health outcomes.

Perceptions, expectations, and attitudes about communication with physicians among Chinese American and non-Hispanic white women with early stage breast cancer

PURPOSE

Asian Americans have consistently reported poorer communication with physicians compared with non-Hispanic Whites (NHW). This qualitative study sought to elucidate the similarities and differences in communication with physicians between Chinese and NHW breast cancer survivors.

METHODS

Forty-four Chinese and 28 NHW women with early stage breast cancer (stage 0-IIa) from the Greater Bay Area Cancer Registry participated in focus group discussions or individual interviews. We oversampled Chinese women because little is known about their cancer care experiences. In both interview formats, questions explored patients' experiences and feelings when communicating with physicians about their diagnosis, treatment, and follow-up care.

RESULTS

Physician empathy at the time of diagnosis was important to both ethnic groups; however, during treatment and follow-up care, physicians' ability to treat cancer and alleviate physical symptoms was a higher priority. NHW and US-born Chinese survivors were more likely to assert their needs, whereas Chinese immigrants accepted physician advice even when it did not alleviate physical problems (e.g., pain). Patients viewed all physicians as the primary source for information about cancer care. Many Chinese immigrants sought additional information from primary care physicians and stressed optimal communication over language concordance.

CONCLUSIONS

Physician empathy and precise information were important for cancer patients. Cultural differences such as the Western emphasis on individual autonomy vs. Chinese emphasis on respect and hierarchy can be the basis for the varied approaches to physician communication we observed. Interventions based on cultural understanding can foster more effective communication between immigrant patients and physicians ultimately improving patient outcomes.

A mixed method exploration of survivorship among Chinese American and non-Hispanic White breast cancer survivors: the role of socioeconomic well-being

PURPOSE

Cancer-related stress is heavily influenced by culture. This study explored similarities and differences in survivorship care concerns among Chinese American and non-Hispanic White (NHW) breast cancer survivors.

METHODS

A sequential, mixed-method design (inductive/qualitative research-phase I and deductive/quantitative research-phase II) was employed. Eligible women identified from the Greater Bay Area Cancer Registry were age ≥21, diagnosed with stage 0-IIa breast cancer between 2006 and 2011, and had no recurrence or other cancers. In phase I, we conducted 4 Chinese (n = 19) and 4 NHW (n = 22) focus groups, and 31 individual telephone interviews (18 Chinese immigrants, 7 Chinese US-born, and 6 NHW). Content analysis was conducted to examine qualitative data. In phase II, another 296 survivors (148 NHW age-matched to 148 Chinese cases) completed a cross-sectional survey. Descriptive statistics and linear regression analysis were conducted to examine quantitative data.

RESULTS

Qualitative data revealed "socioeconomic well-being" (SWB) as a dominant survivorship concern, which was operationalized as a cancer survivor's perceived economic and social resources available to access care. Quantitative data showed that low-acculturated Chinese immigrants reported the poorest SWB, controlling for covariates. Highly acculturated Chinese immigrants and the US-born Chinese/NHW group reported similar SWB. Women who had low-income levels or chemotherapy had poorer SWB.

CONCLUSIONS

SWB emerged as an important aspect of breast cancer survivorship. Immigration stress, cancer care costs, and cultural values all contributed to immigrants' socioeconomic distress. Immigrant and US-born breast cancer survivors experienced different socioeconomic circumstances and well-being following treatment. Our findings warrant further investigation of socioeconomic distress and survivorship outcomes.

Depression, anxiety, and suicidal ideation among Chinese Americans: a study of immigration-related factors

The aim of this study was to identify anxiety, depression, and suicidal ideation disparities among Chinese Americans and how immigration-related factors affected the outcomes. We tried to explain the differences as a function of the Chinese culture. Data were derived from the National Latino and Asian American Study, the first national epidemiological survey of these populations in the United States. We used only the Chinese sample (N = 600) and focused on depressive disorder, anxiety disorder, and suicidal ideation. The United States-born Chinese and those Chinese who immigrated to the United States at 18 years or younger were at higher risk for lifetime depressive or anxiety disorders or suicidal ideation than were their China-born counterparts who arrived in the country at or after 18 years of age. For Chinese Americans, immigration-related factors were associated with depression and anxiety disorders and suicidal ideation. The higher prevalence of these disorders might be attributed to the psychological strains experienced by those who are at higher risk of cultural conflicts.

The influence of ethnicity and culture on dementia caregiving: a review of empirical studies on Chinese Americans

The purpose of this article is to pinpoint the cultural and ethnic influences on dementia caregiving in Chinese American families through a systemic review and analysis of published research findings. Eighteen publications on Chinese American dementia family caregivers published in peer-reviewed journals between 1990 and early 2011 were identified. Based on a systematic database search and review process, we found that caregivers' beliefs concerning dementia and the concept of family harmony as evidenced through the practice of filial piety are permeating cultural values, which together affect attitudes toward research and help-seeking behaviors (ie, seeking information on diagnosis and using formal services). There is also evidence to suggest that these cultural beliefs impinge on key elements of the caregiving process, including caregivers' appraisal of stress, coping strategies, and informal and formal support. The study concludes with recommendations for future research and practice with the Chinese American population.

A pilot study of lay health worker outreach and colorectal cancer screening among Chinese Americans

The research team recruited eight Chinese American (seven females, one male) lay health workers (LHWs). They received 12 h of training about colorectal cancer (CRC), its screening, and basic health education techniques. Each LHW were asked to recruit ten participants and conduct two educational sessions. Of the 81 participants recruited, 73 had not received colorectal cancer screening. Their mean age was 63.0 years, and 72.6% were women. Knowledge of colorectal cancer, its causes, and its screening increased significantly. Receipt of first colorectal cancer screening test increased from 0.0% at baseline to 55.7% for fecal occult blood tests, 7.1% for sigmoidoscopy, and 7.1% for colonoscopy. LHW outreach is feasible and may be effective in promoting CRC screening among Chinese Americans.

Physical discipline in Chinese American immigrant families: An adaptive culture perspective

Research on ethnic minority parenting has examined heritage cultural influences and contextual stressors on parenting processes. However, rarely are adaptive cultural processes considered, whereby ethnic minority parents bring their cultural values to bear in adapting to contextual demands in the host society. A survey of 107 Chinese American immigrant parents examined whether use of physical discipline can be predicted by cultural values, contextual stressors, and their interactions. Results indicated that distinct domains of cultural values were related to physical discipline in disparate ways, with some values decreasing risk and others indirectly increasing risk. There was some evidence that cultural values interacted with contextual stress to predict physical discipline. Parent-child acculturation conflicts were only related to physical discipline when parents held strong values about the importance of firm parental control. The findings illustrate how heritage cultural influences and current ecological demands may converge to shape parenting in immigrant families.

Research article: Antidepressant use among Asians in the United States

OBJECTIVES

We examined the prevalence and predictors of past-year antidepressant use in a nationally representative sample of Asian Americans and non-Latino Whites.

METHODS

Analyses of 12-month antidepressant medication use were based on data from the Collaborative Psychiatric Epidemiology Surveys that surveyed Asian (Chinese, Filipino, Vietnamese, and others; N=2,284) and non-Latino White (N=6,696) household residents ages 18 years and older in the 48 contiguous United States and Hawaii.

RESULTS

Prevalence rates for 12-month antidepressant use for Asians with major depression ranged from 8.7% among Vietnamese to 17% among Chinese respondents. Compared to non-Latino Whites (32.4%), all Asians (10.9%) meeting criteria for 12-month depressive and anxiety disorders, but especially Filipinos (8.8%) were less likely to report past-year antidepressant use.

CONCLUSIONS

We found disparities in past-year antidepressant use among all the examined major Asian groups meeting criteria for 12-month depressive and anxiety disorders. These disparities were not explained by mental health need or socioeconomic factors that enable access to care.

Disparity in prevalence of self-reported visual impairment in older adults among U.S. race-ethnic subgroups

PURPOSE

Prevalence of visual impairment (VI) in the United States (U.S.) has not been carefully examined by race-ethnic subgroups. This study examines self-reported VI prevalence in race-ethnic subgroups using data representative of the U.S. population age > or =45 years.

METHODS

The National Health Interview Survey (NHIS) is a population-based multipurpose and multistage area probability annual survey of the U.S. civilian non-institutionalized population conducted by the National Center for Health Statistics. Data from a total of 122,649 participants age > or =45 years from the pooled 1999-2006 National Health Interview Surveys were used. VI prevalence was based on two questions asked to participants, "Do you have any trouble seeing, even when wearing glasses or contact lenses?" (some VI), and "Are you blind or unable to see at all?" (severe VI).

RESULTS

For middle-aged adults age 45-64 years, race/ethnic groups with high age-adjusted rates of any self-reported VI (some or severe VI) include Native Americans, Puerto Ricans, Dominicans, and those reporting mixed race/ethnicity. Among older adults age > or =65 years, understudied race/ethnic groups with high age-adjusted rates of any self-reported VI include Native Americans, Chinese Americans, Puerto Ricans, Dominicans, and Central/South Americans. Among older adults with severe VI, the results suggest high VI prevalence in Filipinos, Chinese Americans, Dominicans, Cubans, and Puerto Ricans and those reporting mixed race/ethnicity.

CONCLUSIONS

Among understudied U.S. race-ethnic groups, older Native Americans, Chinese Americans, Puerto Ricans, Dominicans, and Central/South Americans generally have high rates of self-reported VI suggesting further targeted epidemiologic and intervention studies may be warranted.

Validation of the Patient Health Questionnaire-9 for depression screening among Chinese Americans

OBJECTIVE

The objective of this study was to validate the Chinese Bilingual version of the Patient Health Questionnaire (CB-PHQ-9) for screening for depression among Chinese Americans in primary care.

METHOD

Chinese-American patients attending a primary care clinic were screened for major depressive disorder (MDD) using the CB-PHQ-9. All patients who scored 15 or higher on the CB-PHQ-9 were interviewed using the Chinese-bilingual Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, patient version. Eight percent of patients who scored less than 15 on the CB-PHQ-9 were randomly selected and interviewed with the depression module of the Chinese-bilingual Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, patient version.

RESULTS

During the study, 1940 unduplicated patients completed the CB-PHQ-9. The CB-PHQ-9 had high internal consistency (alpha = 0.91), and the scores of each of its 9 items had moderate to moderately high correlations (0.52-0.85) with the total scores. The sensitivity and specificity of the CB-PHQ-9 for recognizing MDD were found to be 81% and 98%, respectively, and the area under the receiver operating characteristic curve was estimated to be 0.97 (SE, 0.01).

CONCLUSION

The CB-PHQ-9 is a valid and useful instrument for screening for MDD among Chinese Americans in primary care.

Feasibility and Acceptability of an English-as-a-Second Language Curriculum on Hepatitis B for Older Chinese American Immigrants

Asian immigrants to the U.S. have an increased prevalence of hepatitis B virus (HBV) infection compared to native born individuals; an estimated 10 percent of Chinese immigrants are infected with HBV. Using qualitative data from focus groups, we developed an English-as-a-Second Language (ESL) curriculum that aimed to improve knowledge about key hepatitis B facts. The curriculum was pilot-tested among 56 students aged 50 and older from intermediate-level ESL classes at a community-based organization that serves Chinese immigrants. Post-curriculum data showed increases in knowledge that hepatitis B can cause liver cancer (73% at pre-test vs. 91% at post-test; p value = 0.01) and that individuals can be infected with hepatitis B for life (34% vs. 81%; p value <0.0001). These findings suggest that an ESL curriculum can successfully improve knowledge about the severity of hepatitis B and its routes of transmission among older Chinese American adults.

The relative effect of household and workplace smoking restriction on health status among Chinese Americans living in New York City

Households and workplaces are the predominant location for exposure to secondhand smoke. The purpose of this study is to examine the association between health status and smoking restrictions at home and work and to compare the relative effect of household and workplace smoking restrictions on health status. This study uses data from a cross sectional representative probability sample of 2,537 Chinese American adults aged 18-74 living in New York City. The analysis was limited to 1,472 respondents who work indoors for wages. Forty-three percent of respondents reported a total smoking ban at home and the workplace, 20% at work only, 22% home only, and 15% reported no smoking restriction at home or work. Nonsmokers [corrected] who live under a total household smoking ban only or both a total household and total workplace ban were respectively 1.90 and 2.61 times more likely to report better health status compared with those who reported no smoking ban at work or home. Before the NYC Clean Indoor Air Act second-hand smoke (SHS) exposure among this immigrant Chinese population at home and work was high. This study finds that household smoking restrictions are more strongly associated with better health status than workplace smoking restrictions. However, better health status was most strongly associated with both a ban at work and home. Public health efforts should include a focus on promoting total household smoking bans to reduce the well-documented health risks of SHS exposure.

Identifying older Chinese immigrants at high risk for osteoporosis

BACKGROUND

Data about whether Asian Americans are a high-risk or a low-risk group for osteoporosis are limited and inconsistent. Few previous studies have recognized that the heterogeneity of the Asian American population, with respect to both nativity (foreign- vs U.S.-born) and ethnicity, may be related to osteoporosis risk.

OBJECTIVE

To assess whether older foreign-born Chinese Americans living in an urban ethnic enclave are at high risk of osteoporosis and to refer participants at high risk for follow-up care.

DESIGN

Cross-sectional survey and osteoporosis screening, undertaken as a collaborative project by the Chinese American Service League and researchers at the University of Chicago.

SETTING

Chicago's Chinatown.

PARTICIPANTS

Four hundred sixty-nine immigrant Chinese American men and women aged 50 and older.

MEASUREMENTS AND MAIN RESULTS

Chinese Americans in this urban setting are generally recent immigrants from south China with limited education and resources: mean age at immigration was 54, 56% had primary only or no education, and 57% reported "fair" or "poor" self-rated health. Eighteen percent are uninsured and 55% receive Medicaid. Bone mineral density (BMD) of the calcaneus was estimated using quantitative ultrasound. Immigrant Chinese women in the study had lower average BMD than reference data for white women or U.S.-born Asian Americans. BMD for immigrant Chinese men in the study was similar to white men at ages 50 to 69, and lower at older ages. Low body mass index, low educational attainment and older age at immigration were all associated with lower BMD.

CONCLUSIONS

Foreign-born Chinese Americans may be a high-risk group for osteoporosis.

Knowledge of cervical cancer risk factors among Chinese immigrants in Seattle

Chinese American immigrants are a growing part of the United States population. Cervical cancer is a significant cause of morbidity and mortality among Chinese Americans. Pap smear testing is less common in Chinese American immigrants than in the general population. During 1999, we conducted a community-based survey of Chinese American women living in Seattle. We assessed knowledge of cervical cancer risk factors and history of Pap smear testing along with socioeconomic and acculturation characteristics. The overall estimated response rate was 64%, and the cooperation rate was 72%. Our study sample included 472 women. Most cervical cancer risk factors were recognized by less than half of our participants. Factors independently associated with knowledge of cervical cancer risk factors included marital status, employment, and education. Respondents with the highest knowledge had greater odds of ever receiving a Pap smear, compared to those respondents with the lowest knowledge (OR 2.5; 95% CI: 1.1,5.8). Our findings suggest a need for increased recognition of cervical cancer risk factors among Chinese American immigrants. Culturally and linguistically appropriate educational interventions for cervical cancer risk factors should be developed, implemented and evaluated.

Cervical cancer screening among Chinese Americans

STUDY PURPOSE

Chinese women in North America have high rates of invasive cervical cancer and low levels of Papanicolaou (Pap) testing use. This study examined Pap testing barriers and facilitators among Chinese American women.

BASIC PROCEDURES

A community-based, in-person survey of Chinese women was conducted in Seattle, Washington during 1999. Four hundred and thirty-two women in the 20-79 years age-group were included in this analysis. The main outcome measures were a history of at least one previous Pap smear and Pap testing within the last 2 years.

MAIN FINDINGS

Nineteen percent of the respondents had never received cervical cancer screening and 36% had not been screened in the previous 2 years. Eight characteristics were independently associated with a history of at least one Pap smear: being married, thinking Pap testing is necessary for sexually inactive women, lack of concerns about embarrassment or cancer being discovered, having received a physician or family recommendation, having obtained family planning services in North America, and having a regular provider. The following characteristics were independently associated with recent screening: thinking Pap testing is necessary for sexually inactive women, lack of concern about embarrassment, having received a physician recommendation, having obtained obstetric services in North America, and having a regular provider.

PRINCIPAL CONCLUSIONS

Pap testing levels among the study respondents were well below the National Cancer Institute's Year 2000 goals. The findings suggest that cervical cancer control interventions for Chinese are more likely to be effective if they are multifaceted.