Perceptions of Diet and Physical Activity Among California Hmong Adults and Youths

IntroductionWe conducted a qualitative study to inform the design of a proposed community-wide campaign to promote increased physical activity and fruit and vegetable consumption among low-income Hmong families.MethodsWe held eight focus groups with parents of children aged 5 to 14 years and with youths aged 11 to 14 years, interviews with key informants in several Hmong communities, and interviews with professionals who conducted physical activity and nutrition activities in these communities. Sessions were tape-recorded and transcribed. We organized data using ATLAS.ti software and then analyzed the content.ResultsFindings suggest that physically active lifestyles and dietary patterns emphasizing fresh foods including fruits and vegetables are valued in the Hmong culture and perceived as essential to good health. Barriers to a healthy lifestyle include limited access to safe spaces, time for adequate physical activity, access to land to grow fresh produce, and time for home preparation of food. Low incomes and marketing of unhealthy foods, particularly to children, are also problematic. Information on the healthy aspects of both traditional foods and American foods is needed in accessible formats and delivered through media and trusted community sources.ConclusionLike other Asian groups, the majority of Hmong are first-generation immigrants. An increase in nutrition-related chronic diseases can be prevented by encouraging and reinforcing the maintenance of traditional eating patterns and active lifestyles

Breast and Cervical Cancer Screening Practices for Low-Income Asian American Women in Ethnic-Specific Clinics

Introduction: Early detection and screening are the most effective means to reduce cancer mortality in all populations. Asian American (AA) women have among the lowest rates in aggregate for use of early detection, and screening practices of all ethnic populations. The only nationally disaggregated populationbased data on these ethnic groups at the time of the study was the 1993-1994 National Health Interview Survey (NHIS) of English speaking AA, but 70% of the AA population is non-English speaking. Our study presents heretofore unavailable data for cancer screening for monolingual AA women for a comparable time period in California between 1992 and 1994, prior to initiation of the state and Federal programs targeting this group of women. Methods: Retrospective chart reviews of randomly selected medical records were conducted for the breast and cervical cancer screening practices of low-income, non-English speaking Chinese, Korean, and Thai women attending ethnic specific community-based health clinics. All women seen in the clinics between 1992-1994 who were within the appropriate screening age categories were eligible. Results: Asian American women utilizing ethnic specific clinics had equal to or better screening rates for mammography and Pap tests than mainstream services for English-speaking AA women in a national survey. These screening rates, however, were still well below nationally recommended screening rates for breast and cervical cancer according to Healthy People 2000 or 2010 goals. Conclusion: These data support the effectiveness of Community Based Clinics (CBOs) to reach these hard to reach women and address the call for the elimination of health disparities. In addition, we compare our findings with national data to highlight within group variations

A Culturally Sensitive Social Support Intervention for Chinese American Breast Cancer Survivors (Joy Luck Academy): Protocol for a Randomized Controlled Trial

© Qian Lu, Krystal Warmoth, Lingjun Chen, Christine S Wu, Qiao Chu, Yisheng Li, Matthew W Gallagher, Annette L Stanton, Marjorie Kagawa Singer, Lucy Young, Alice Loh. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/),BACKGROUND: Breast cancer is the most prevalent type of cancer among Asian American women. Chinese American immigrant breast cancer survivors face unique challenges because of cultural and socioecological factors. They report emotional distress and the need for social, emotional, and spiritual support. However, culturally and linguistically appropriate information for managing survivorship health care is often unavailable. OBJECTIVE: To improve the health outcomes for this underserved and understudied population, we developed, designed, and launched a randomized controlled trial to test the health benefits of a culturally sensitive social support intervention (Joy Luck Academy). In this paper, we describe the research protocol. METHODS: This randomized controlled trial will enroll Chinese-speaking, stage 0 to 3 breast cancer survivors who have completed treatment within the previous 36 months using a community-based participatory research approach. We will randomly assign 168 participants to the intervention or control group. The intervention arm will attend 7 weekly 3.5-hour peer mentor and educational sessions. The control group will receive the educational information. We will assess health outcomes at baseline, immediately after the Joy Luck Academy, and at 1- and 4-month follow-ups. The primary outcome is quality of life, as measured by the Functional Assessment of Cancer Therapy scale. Secondary outcomes include depressive symptoms, positive affect, fatigue, and perceived stress. We will also explore how the intervention influences cortisol levels. To identify how and to whom the program is effective, we will measure social and personal resources and theorized mechanisms and perform qualitative interviews with a subsample of participants to enhance the interpretation of quantitative data. RESULTS: Recruitment began in February 2015, and data collection was completed in February 2019. We expect to complete data management by August 2021 and publish results in 2022. CONCLUSIONS: If the Joy Luck Academy is demonstrated to be effective, it may be easily disseminated as an intervention for other groups of Asian American immigrant breast cancer survivors. Furthermore, similar programs could be integrated into other diverse communities.Peer reviewedFinal Published versio

Adapting Evidence-Based Strategies to Increase Physical Activity Among African Americans, Hispanics, Hmong, and Native Hawaiians: A Social Marketing Approach

IntroductionUsing a social marketing approach, we studied how best to adapt proven, evidence-based strategies to increase physical activity for use with underserved racial or ethnic groups.MethodsWe conducted focus groups with low-income Hispanic women in Texas, Hmong parents and their children in California, low-income African American women and men in the Mississippi Delta, and Native Hawaiian college students in Hawaii. We also interviewed key leaders of these communities. Topics of discussion were participants' perceptions about 1) the benefits of engaging in physical activity, 2) the proposed evidence-based strategies for increasing each community's level of physical activity, and 3) the benefits and barriers to following the proposed interventions for increasing physical activity. A total of 292 individuals participated in the study.ResultsAll groups considered that being physically active was part of their culture, and participants found culturally relevant suggestions for physical activities appealing. Overwhelmingly, strategies that aimed to create or improve social support and increase access to physical activity venues received the most positive feedback from all groups. Barriers to physical activity were not culturally specific; they are common to all underserved people (lack of time, transportation, access, neighborhood safety, or economic resources).ConclusionResults indicate that evidence-based strategies to increase physical activity need to be adapted for cultural relevance for each racial or ethnic group. Our research shows that members of four underserved populations are likely to respond to strategies that increase social support for physical activity and improve access to venues where they can be physically active. Further research is needed to test how to implement such strategies in ways that are embraced by community members

The Role of Medical Interpretation on Breast and Cervical Cancer Screening Among Asian American and Pacific Islander Women

We examined whether the impact of medical interpretation services was associated with the receipt of a mammogram, clinical breast exam, and Pap smear. We conducted a large cross-sectional study involving four Asian American and Pacific Islander (AAPI) communities with high proportions of individuals with limited English proficiency (LEP). Participants were recruited from community clinics, churches and temples, supermarkets, and other community gathering sites in Northern and Southern California. Among those that responded, 98% completed the survey rendering a total of 1,708 AAPI women. In a series of multivariate logistic regression models, it was found that women who typically used a medical interpreter had a greater odds of having received a mammogram (odds ratio [OR] = 1.85; 95% confidence interval [CI] = 1.21, 2.83), clinical breast exam (OR = 3.03; 95% CI = 1.82, 5.03), and a Pap smear (OR = 2.34; 95% CI = 1.38, 3.97) than those who did not usually use an interpreter. The study provides support for increasing language access in healthcare settings. In particular, medical interpreters may help increase the utilization of breast and cervical cancer screening among LEP AAPI women

From Genes to Social Science: Impact of the Simplistic Interpretation of Race, Ethnicity, and Culture on Cancer Outcome

Over the last 30 years, dramatic advances have been made in understanding the cell biology of cancer and the genetic changes involved in oncogenesis. Many tumors now are curable and overall, cancer mortality has decreased significantly. Cancer has been transformed from a primarily fatal disease into a chronic condition. To accelerate these trends, the American Cancer Society has set its goals for the year 2015 to reduce the burden of cancer in this country. The goals are to decrease mortality by 50% and decrease the rate of incidence by 25%, as well as increase the quality of life for all individuals with cancer. However, to achieve these goals, changes must occur on two levels, in cancer control research and programming. Greater resources must be directed toward social and behavioral research, and conceptual clarity must be developed so that refinements can be made in the methodologies used to study the effects of cultural differences on health behavior. This paper provides a broad overview of the complex, intricate, and interrelated interaction that is emerging as a salient area of study. To our knowledge, the information to date is in disparate disciplines and needs to be integrated within an overarching framework for cancer control in diverse populations