Gender, Motherhood, and Ethnicity: ‘Dialectical Social Imaginaries’ among South and Southeast Asian Women in Hong Kong

Perinatal Outcomes Among Different Asian Groups With Gestational Diabetes Mellitus in Ontario: A Cohort Study.

Human papillomavirus (HPV) vaccines are safe and effective in preventing HPV infection and HPV-related cancers. However, the HPV vaccine uptake rate is lower among the ethnic minority population than in the majority population. This qualitative study explored the barriers and facilitators influencing South Asian minority and Chinese mothers’ decisions to vaccinate their daughters against HPV in Hong Kong. South Asian and Chinese mothers with at least one daughter aged 9 to 17 years were recruited to this study. Twenty-two semi-structured focus group interviews were conducted, and the transcripts were analysed via content analysis. Two barriers and three facilitating factors were common among South Asian and Chinese mothers: inadequate knowledge of cervical cancer, HPV or the HPV vaccine and high perceived barriers to HPV vaccination due to vaccine cost, the receipt of reliable information from schools or the government, high perceived benefits of HPV vaccination to health, and the presence of vaccination programme arranged by school or government. Despite these commonalities, South Asian mothers experienced more barriers to making the decision to vaccinate than Chinese mothers. Particularly, obtaining family support was an important factor for South Asian mothers. The vaccination decision was considered a joint decision between the mother and father, and the father’s agreement was of particular importance to Pakistani mothers. This study identified the factors that hindered and facilitated South Asian and Chinese mothers’ decisions to vaccinate their daughters against HPV. The comparison between groups improves our understanding of the distinct needs of South Asian in Hong Kong.

Although the fastest growing minority group, Asian Americans receive little attention in mental health research. Moreover, aggregated data mask further diversity within Asian Americans. This study aimed to examine depression risk by detailed Asian American subgroup, and further assess determinants within and between three Asian ethnic subgroups. Needs assessment surveys were collected in 16 Asian American subgroups (six Southeast Asian, six South Asian, and four East Asian) in New York City from 2013-2016 using community-based sampling strategies. A final sample of N=1,532 completed the PHQ-2. Bivariate comparisons and multivariable logistic models explored differences in depression risk by subgroup. Southeast Asians had the greatest depression risk (19%), followed by South Asians (11%) and East Asians (9%). Among Southeast Asians, depression risk was associated with lacking health insurance (OR=.2, 95% CI: 0-.6), not having a provider who speaks the same language (OR=3.2, 95% CI: 1.3-8.0), and lower neighborhood social cohesion (OR= .94, 95% CI: .71-.99). Among South Asians, depression risk was associated with greater English proficiency (OR=3.9, 95% CI: 1.6-9.2); and among East Asians, depression risk was associated with ≤ high school education (OR=4.2, 95% CI: 1.2-14.3). Additionally, among Southeast Asians and South Asians, the highest depression risk was associated with high levels of discrimination (Southeast Asian: OR=9.9, 95% CI: 1.8-56.2; South Asian: OR=7.3, 95% CI: 3.3-16.2). Depression risk and determinants differed by Asian American ethnic subgroup. Identifying factors associated with depression risk among these groups is key to targeting limited public health resources for these underserved communities.

ObjectiveTo investigate the ethnicity-specific association between body mass index (BMI) and diabetes in pregnancy, with a focus on the appropriateness of using BMI cut-offs to identify pregnant women at risk of diabetes.Study designAnalysis of routinely-collected data from a maternity unit in London, UK. Data were available on 53 264 women delivering between 2004 and 2012. Logistic regression was used to explore the association between diabetes in pregnancy and BMI among women of different ethnicities, and adjusted probability estimates were used to derive risk equivalent cut-offs. ROC curve analysis was used to assess the performance of BMI as a predictor of diabetes in pregnancy.ResultsThe prevalence of diabetes in pregnancy was 2.3% overall; highest in South and East Asian women (4.6% and 3.7%). In adjusted analysis, BMI category was strongly associated with diabetes in all ethnic groups. Modelled as a continuous variable with a quadratic term, BMI was an acceptable predictor of diabetes according to ROC curve analysis. Applying a BMI cut-off of 30 kg/m2 would identify just over half of Black women with diabetes in pregnancy, a third of White (32%) and South Asian (35%) women, but only 13% of East Asian women. The ‘risk equivalent’ (comparable to 30 kg/m2 in White women) threshold for South Asian and East Asian women was approximately 21 kg/m2, and 27.5 kg/m2 for Black women.ConclusionsThis study suggests that current BMI thresholds are likely to be ineffective for diabetes screening in South and East Asian women, as many cases of diabetes will occur at low BMI levels. Our results suggest that East Asian women appear to face a similarly high risk of diabetes to South Asian women. Current UK guidelines recommend diabetes screening should be offered to all pregnant South Asian women; extending this recommendation to include women of East Asian ethnicity may be appropriate.

Ethnic differences in the relationships of anthropometric measures to metabolic risk factors in Asian patients at risk of atherothrombosis: Results from the REduction of Atherothrombosis for Continued Health (REACH) Registry

During the past three decades there have been many studies of transnational migration. Most of the scholarship has focused on one side of the border, one area of labor incorporation, one generation of migrants, and one gender. In this path-breaking book, Manuel Barajas presents the first cross-national, comparative study to examine a Mexican-origin community's experience with international migration and transnationalism. He presents an extended case study of the Xaripu community, with home bases in both Xaripu, Michoacan, and Stockton, California, and elaborates how various forms of colonialism, institutional biases, and emergent forms of domination have shaped Xaripu labor migration, community formation, and family experiences across the Mexican/U.S. border for over a century. Of special interest are Barajas' formal and informal interviews within the community, his examination of oral histories, and his participant observation in several locations. Barajas asks, What historical events have shaped the Xaripus' migration experiences? How have Xaripus been incorporated into the U.S. labor market? How have national inequalities affected their ability to form a community across borders? And how have migration, settlement, and employment experiences affected the family, especially gender relationships, on both sides of the border?

253 Background: Asian American, Native Hawaiian, and Pacific Islander (AANHPI) individuals exhibit stark disparities in gastric cancer mortality rates, with AANHPI men facing a two-fold higher risk of death and AANHPI women encountering a 2.5-fold elevated risk compared to their Non-Hispanic White (NHW) counterparts. However, the AANHPI community is a diverse group, including over 21 ethnic groups. Here, we identify disparities among AANHPI subpopulations with gastric adenocarcinoma. Methods: Using the National Cancer Database, which gathers data from over 1,500 accredited hospitals and facilities across the United States, this retrospective cohort study identified 141,906 patients with gastric adenocarcinoma (ICD code “8140”). Races listed as “unknown/other” or “Other Asian” were excluded. Kaplan Meier and Cox Regression model were performed. Results: This study compared mean overall survival (OS) of NHW (n=111,137), East Asian (EA) (n=3,745), South Asian (SA) (n=760), Southeast Asian (SEA) (n=1,379), and Native Hawaiian or Pacific Islander (NHPI) (n=325) patients with gastric adenocarcinoma. When aggregated, AANHPI had statistically significant improved OS compared to NHW (21.6 months vs 14.1 months, p < 0.001). After disaggregating, the mean OS was 26.9 months for EA; 21.3 months for SA; 14.5 months for SEA; and 14.3 months for NHPI. Only SA and EA had significantly improved OS than NHW (p<0.001 for both). SEA and NHPI had significantly worse outcomes than EA (p<0.001 for both) and SA (p<0.001 for SEA, and p = 0.033 for NHPI). Multivariate analysis accounted for age at diagnosis, insurance status, median income quartile, Charlson-Deyo comorbidity score, facility type, stage at diagnosis, and time to treatment. SA (HR=0.82; 95% CI, 0.726 to 0.925; p<0.001)), EA (HR=0.644; 95% CI, 0.609 to 0.68; p<0.001), and SEA (HR=0.896; 95% CI, 0.821 to 0.978, p=0.014) had lower survival hazard ratios compared to NHW. NHPI (HR=0.931, 95% CI 0.775 to 1.119, p=0.448) did not have a statistically significant relationship compared to NHW. EA (HR = 0.637; 95% CI 0.548 to 0.741, p<0.001) and SA (HR = 0.793; 95% CI 0.667 to 0.943, p=0.007) had significantly lower survival hazard ratios compared to NHPI. Conclusions: Survival disparities exist among AANHPI subgroups with gastric adenocarcinoma. At first glance, OS appeared significantly greater for AANHPI patients compared to NHW. However, disaggregation of AANHPI subpopulations revealed that Southeast Asian and NHPI actually had comparable OS with NHW. After controlling for socioeconomic factors, NHPI had significantly worse hazard ratios compared to South Asian and East Asian. This highlights the need to disaggregate AANHPI data so that disparities among these diverse subpopulations can be identified, investigated and ultimately addressed.

Southeast Asian women have high rates of cervical cancer and yet are among the least likely to be screened. There is sparse literature on communication patterns among Southeast Asian women, specifically related to cervical cancer and Pap test uptake. Little is known about the influence of Southeast Asian mothers and daughters on each other's cervical cancer beliefs and screening behaviors. We examined the perceptions of and barriers to cervical cancer screening among Cambodian and Lao mothers and daughters and explored how they converse about women's health issues, specifically cervical cancer and Pap testing. We conducted in-depth interviews with Cambodian and Lao mother-daughter dyads, aged 18 years and older, living in a large Midwestern city between February and September of 2015. Descriptive statistics were calculated to summarize the sample demographic characteristics. Bivariate tests (contingency table analyses, independent t-tests, and Pearson correlations) were conducted to test for differences between the mothers and daughters in demographic characteristics and measures of health status and beliefs. Qualitative data were analyzed using content analysis. In-depth interviews were conducted with three Cambodian and eight Lao mother-daughter dyads. The daughters were significantly more acculturated to English, had greater education, and were mostly employed full time. The mothers and daughters evaluated their health status much the same, their medical mistrust equally, and all of the mothers and nine of the daughters were Buddhist. Themes in mother-daughter communication included what mothers and daughters do and do not talk about with regard to sexual health, refugee experiences, what hinders mother-daughter communication, and relationship dynamics. The mothers were embarrassed and uncomfortable discussing cervical cancer, Pap testing, and other women's health issues with their daughters. Although mothers did not influence women's health promotion or cervical cancer prevention with their daughters, daughters did influence their mothers' health and healthcare decisions. Daughters were critical in navigating healthcare systems, engaging with providers, and making medical decisions on behalf of their mothers. By leveraging the unique and dynamic intergenerational bond that mothers and daughters who identify as Southeast Asian have, we can develop strategies to influence the cultural dialogue related to cervical cancer and early detection.

As a region that has experienced major socio-political and economic transitions in recent decades, Southeast Asia provides a rich and variegated terrain to explore the gendered lives and experiences of men and women in a globalizing world of increased migrations and mobilities. Relations of equality and complementarity between Southeast Asian men and women have long been thought to be a regional characteristic (Andaya 2007) but much has changed in recent times. Deeper incorporation of the region into the global world order provides a mobile context shaping the gendered experiences and micropolitics that men and women sustain in reproducing and resisting socio-cultural change and economic development. By the closing decades of the twentieth century, Southeast Asian women, in particular, have seen their lives transformed by rapid but uneven economic growth and development, the penetrating reach of global capital and international business, the strengthening of economic-cum-cultural nationalisms, the accelerated pace of urbanization, downward trends in fertility, and the increasing feminization of labor migration in the region (Yeoh, Teo and Huang 2002). At the same time, Southeast Asian men are also experiencing pressures to perform masculine subjectivities differently or more flexibly, even if deep-seated transformations in gender ideologies or scripts are more resistant to change (Hoang and Yeoh 2011; Ford and Lyons 2012).

Breast Cancer Subtype Variation by Race and Ethnicity in a Diverse Population in British Columbia

Introduction Immigrant populations continue to face challenges in accessing quality healthcare, particularly sexual and reproductive health services (SRH). A key component of bodily autonomy and sexual health knowledge and access is menstrual equity. Menstrual equity is recognized as access to affordable and safe menstrual products, to sanitary and stigma-free spaces to manage cycles, and menstruation education. Limited data exists on menstrual experiences of South and Southeast Asian communities-culturally and religiously distinct groups—in the US, raising concerns for ongoing, understudied barriers impeding menstrual equity in the immigrant diaspora. Additionally, there is limited research on South Asian immigrant access to sexual health clinics in the United States; understanding the barriers to menstrual equity in this population will highlight future pathways to improve sexual health access. Objective 1. To identify specific generational, cultural, and religious barriers to accessing menstrual supplies, knowledge, and clinical care in the South Asian and Southeast Asian immigrant population 2. To explore how menstrual inequities impact sexual health and bodily autonomy in this population. Methods This IRB approved qualitative study (IRB 24-1129) involved Zoom-based interviews for thematic analysis on topics of reproductive justice in the United States within the South Asian and Southeast Asian communities. Purposeful sampling technique was utilized. Inclusion criteria include age 18 years or older, self-identification as South Asian or Southeast Asian, current US residency, English-speaking, and having a uterus and menstrual cycles. Rapid and rigorous qualitative analysis was used to identify codes and themes. Descriptive statistics were used to categorize demographics data. Results Respondents (n = 11), 91% (n = 10) self-identify as South Asian. A majority use pads for managing their cycles (n = 9). One third of the respondents reported feeling embarrassed by their periods initially, and nearly half report self-advocating for supplies and menstrual management upon entering college. Many respondents report trepidation using hormone treatments for menstrual management, with concerns of negatively impacting their long-term sexual and menstrual health based on their parents’ concerns. About one-third report increased comfort with a race-concordant and gender-concordant gynecologist, with several noting cultural and generational biases against discussing sexual health within families and with gynecologists. About one third of respondents reported experiences of bias and racism with their gynecologists. Nearly 66% of respondents struggled silently with menstrual health and sexual health pathologies during adolescence without clinical treatment. Conclusions This pilot study highlights the need for additional resources and attention on the needs of immigrants in the United States, particularly from the South and Southeast Asian communities, when it comes to menstrual equity and associated sexual healthcare access. Cultural and religious barriers include generational misinformation, menstrual silence, fear of hormonal contraception, and discomfort with non-gender concordant gynecologists. Additionally, patient misinformation on sexual health prevented desired discussions on individual menstrual and sexual health needs in clinical settings. Addressing cultural barriers is paramount to ensuring equitable access to sexual health medicine and knowledge for all immigrant communities. Future directions include increased community and clinical engagement around menstrual and sexual health needs and support for these unique and understudied populations. Disclosure No.

The planetary ecological crisis has reached a magnitude beyond human comprehension. The acceleration of denuded ecological patterns and the lack of a sensitive, mutual relational sustenance between the personal and planetary remain pressing issues that demand immediate attention. While the emergent field of environmental humanities calls for a reimagining of alternative ecological futures, numerous impacted, but prolific voices still remain muffled in discussions of these critical global ecological issues. Chitra Sankaran’s Women, Subalterns, and Ecologies in South and Southeast Asian Women’s Fiction focuses on the diverse voices of South and Southeast Asian Women’s ecological fiction. A groundbreaking book, by and on women (and subalterns), Sankaran’s study compellingly foregrounds a powerful range of sociocultural connections between humans and nature. The book presents a vibrant corpus of more than thirty econarratives by women writers from twelve countries. Sankaran’s field-defining book provides a nuanced understanding of the ecofeminist consciousness of two significant regions of Asia.

Childbearing KAP in Minority of Southeast Asian

The notion that the spread of Christianity should be primarily credited to intentional, organized missionary efforts has long been predominant in the study of the religion. Migration often finds a more prominent role in historical treatments of Christianity’s expansion after the mid-nineteenth century—given technological advances and other factors that encouraged widespread dislocations of people groups. The changes brought by modern European colonialism and the Reformation have also captured, for good reason, the imagination of scholars who have paid attention to how cross-cultural encounters and migration have helped shape Christianity after the sixteenth century. Coherent and concise assessments of the role of migration in the expansion and diversification of Christianity around the world during the centuries that preceded the Reformation, however, are less common. Although a few scholarly volumes have addressed the development of Christianity beyond the West since its beginnings, Jehu J. Hanciles’s Migration and the Making of Global Christianity fills an important gap in the scholarly literature by addressing the importance of migration in this broader dynamic.Hanciles provides an ambitious sociohistorical study of the first fifteen hundred years of Christianity in which migrants take center stage as agents of Christianity’s expansion and diversification. Hanciles’s choices for showing the continuing significance of migration in global Christianity are broad in scope and geography. From the Roman Empire to Persia and from medieval Europe to Asia and the Mongol Empire, Hanciles narrates, analyzes, and interprets critical moments in the history of Christianity in which migration took center stage not only in Christianity’s spread but also in its theological development. Throughout the history of Christianity, migration was, Hanciles claims correctly, “often a theologizing experience” (118). This migration-informed theologizing was widespread as different people tried to make sense of new social, cultural, and linguistic contexts at different times. Examples abound; they include the discourse of exile in the Hebrew Bible, the incorporation of non-Jewish Christians in the New Testament, numerous Christian leaders who incorporated in their theologies aspects of the transnational lives they lived, and migrant experiences on the ground that influenced people to appropriate and translate top-down Christian messages in different ways.Despite this book’s many historical contributions, Migration and the Making of Global Christianity is not an encyclopedic account of one fact after another. As a matter of fact, the primary contributions of Hanciles’s work may reside in his methodological decisions and outlook. At the heart of Hanciles’s project lies the goal of decentering missionaries as singular, primary agents of Christian expansion and introducing migrant experiences as key to the development of Christian history and theology. He does that without romanticizing migrant encounters and experiences—intra-Christian and otherwise—as necessarily benign. Migration and the Making of Global Christianity reminds us that migration is intertwined with the development of Christianity, often despite or because of uncomfortable phenomena created by particular historical contexts. Diverse contextual challenges encountered by migrant groups and individuals—such as violence, economic struggle, underdeveloped cultural repertoires, linguistic limitations, misunderstandings, power differentials, and narrow theological convictions—were crucial for Christianity’s expansion, diversification, and theological development. By decentering missionaries as primary agents of expansion, Hanciles also questions the sufficiency of what he calls “the empire argument” that traces a strong relationship between political and religious development. For him, “the empire argument distorts historical understanding not only because it places disproportionate emphasis on formal structures, official agency, and state resources that played a minimal role in Christian expansion but also because it minimizes the importance of the recipient societies and the agency of potential converts” (415). Although Hanciles’s take on empire might be read as potentially lacking a robust account of empire in all its forms, Migration and the Making of Global Christianity does engage the issue of conversion and religious appropriation in ways that help qualify arguments that reduce Christian expansion to a function of imperialism.To address sufficiently the different dynamics involved, Migration and the Making of Global Christianity is conversant with several disciplines such as theology, migration studies, and sociology. Hanciles’s approach is, therefore, explicitly historical in general and sociohistorical in particular, but it has strong interdisciplinary elements. Historians judging by the standards of traditional historical practice will notice that Hanciles relies overwhelmingly on secondary accounts. His historical interpretation is often layered on top of other interpretations rather than resulting from vigorous engagement with primary sources. This is understandable considering the ambitious conceptual, historical, chronological, and geographical scope of the book. Yet, Hanciles’s command of sources in different fields is impressive. Migration and the Making of Global Christianity should be read by historians, theologians, and sociologists for its contributions in showing that migration is a core element in the expansion, diversification, and theological development of Christianity. Hanciles’s work is indispensable reading for scholars and practitioners interested in migration studies and world Christianity, and may soon be considered necessary reading in mission studies.

The experience of migration includes costs and benefits to migrants and sending communities. In the tradition of a “letters” type discussion, this paper presents a synthesis of recent work from a longitudinal study from Zambia, Africa that used a mixed-methods approach to investigate the experience and outcomes of migration among the Gwembe Tonga. In this ethnographic study, we argue that including anthropometric methods in migration studies enhances our ability to empirically assess impacts of mobility to better understand the experience of migration. In this particular African context we see, on average, a beneficial outcome for migrants’ nutritional status, and livelihoods.