Acculturation, Biculturalism and Cancer Risk and Preventive Behaviors Among Pacific Islander Immigrant Youths in Hawaii

Abstract

Background: Culture is an important force which affects health behaviors linked to cancer risks among immigrants. Studies have demonstrated the process of acculturation can produce a form of stress that impact health negatively. On the other hand, research suggests that biculturalism, defined as the combining and practicing of customs from two cultures, may be a healthy approach to acculturation. Biculturalism is especially relevant for youth immigrants as their cultural identities are still developing. Pacific Islanders, a fastest growing populations in the US, often experience discrimination in the society at large and in the health care system. Pacific Islander youth in the US navigate between two cultural identities: their native culture as they live in a close-knit community that still maintains strong cultural norms and values, and the dominant American culture that they face once they step outside their community. This is one of the rare studies that examine the relationship between acculturation and cancer preventive behaviors among Pacific Islander youth. Aim: We aim to study the process through which biculturalism influences cancer risk and preventive behaviors such as smoking, sunscreen applications, physical activity and healthy eating among Pacific Islander youth immigrants in Hawaii. Specifically, we map the process of influence that links biculturalism to self-esteem and to these cancer risk and preventive behaviors. Methods: Using survey data from 284 Pacific Islander youth, we developed and tested a theoretically driven model that specifies the relationship among variables listed above. Results: Results show that self-esteem serves as an important mediator connecting biculturalism to cancer preventive behaviors. While biculturalism did not have a direct influence on behaviors and outcomes, it led to increased self-esteem which, in turn, directly influenced attitudes about sunscreen application, physical activity and healthy eating. However, there was neither direct nor indirect link between biculturalism and smoking. Conclusion: While numerous studies have shown links between biculturalism and health, not many studies focus on the specific process through which the influence is exerted. This study provides an important insight into the process through which biculturalism impacts cancer preventive behaviors among minority youth in America. Data from the study showed a clear relationship between biculturalism, self-esteem, their attitudes and behavior related to cancer prevention among Pacific Islander youth living in Hawaii. This study provides insights into potentially novel methods and interventions designed to increase cancer preventive behaviors among migrant youth by dually promoting adoption of U.S. cultural norms, while concurrently embracing an individual´s historic cultural identity.