Volumetric bone mineral density at the spine and hip in Chinese American and White women

Asian women have lower rates of hip and forearm fractures compared to other racial groups despite lower areal bone mineral density (aBMD). We have demonstrated microarchitectural differences, including greater cortical thickness (Ct.Th) and cortical volumetric BMD (Ct.BMD), in Chinese American versus white women. Yet it is not known whether greater Ct.BMD in Chinese American women is a result of greater tissue mineral density (TMD) or reduced cortical porosity (Ct.Po). Using an advanced segmentation algorithm based on high-resolution peripheral quantitative computed tomography (HR-pQCT) images, we tested the hypothesis that Chinese American women have better cortical skeletal integrity owing to lower Ct.Po and higher Ct.TMD compared with white women. A total of 78 Chinese American women (49 premenopausal and 29 postmenopausal) and 114 white women (46 premenopausal and 68 postmenopausal) were studied. Premenopausal Chinese American versus white women had greater Ct.Th, Ct.BMD, and Ct.TMD at both the radius and tibia, and decreased Ct.Po (p < 0.05). A similar pattern was observed between postmenopausal Chinese American and white women. As expected, postmenopausal versus premenopausal women had lower Ct.BMD at the radius and tibia in both races (p < 0.001). Ct.Po largely increased between premenopausal and postmenopausal women, whereas Ct.TMD decreased by 3% to 8% (p < 0.001) in both races. Age-related differences in Ct.Po and Ct.TMD did not differ by race. In summary, both reduced Ct.Po and greater Ct.TMD explain higher Ct.BMD in Chinese American versus white women. Thicker and preserved cortical bone structure in Chinese American women may contribute to greater resistance to fracture compared to white women.

We cross-sectionally compared racial differences in bone quality between Chinese women in the United States (US) and Hong Kong (HK) with white women. A total of 514 women were included. We measured bone geometry, mass, microstructure, and stiffness by high-resolution peripheral quantitative computed tomography (HR-pQCT), individual trabecula segmentation (ITS), and microfinite element analysis (μFEA). After adjustment for age and body mass index (BMI), premenopausal Chinese women in the US and HK had smaller bone area but greater radial cortical (Ct.) thickness and Ct. and trabecular (Tb.) volumetric bone mineral density (vBMD) versus white women but did not differ from each other. At the radius, Tb. number was lower and spacing greater in Chinese women from HK and the US versus white women, whereas Chinese women did not differ from each other. Tb. thickness was highest in Chinese women from HK, intermediate in Chinese-Americans, and lowest in white women. Chinese women had more trabecular plates versus white women, leading to greater age- and BMI-adjusted stiffness for premenopausal Chinese women in HK and the US (both p < 0.05) versus white women. Tibial differences were similar in premenopausal women; analogous trends in microstructure were present in postmenopausal women at the tibia, although stiffness did not differ. In contrast, at the radius, cortical, plate-to-rod ratio, and stiffness were similar between postmenopausal HK and white women. Adjusting for age, weight, and height rather than age and BMI tended to reduce differences in bone size and Tb. parameters but accentuate cortical differences such that Chinese premenopausal women in both locations and postmenopausal women from HK had higher stiffness at both skeletal sites compared with white women. Compared with white women, Chinese women in the US and HK have vBMD and microstructural advantages leading to higher or similar mechanical competence in pre- and postmenopausal women, respectively, despite smaller bone size.

Trabecular Bone Score Is Associated With Volumetric Bone Density and Microarchitecture as Assessed by Central QCT and HRpQCT in Chinese American and White Women

Hanging Out:A Research Methodology Jean Pfaelzer It's not just the hunting and gathering—the methods and challenges of location, identification, collection, and re-representation—but the politics of archives that I faced as I curated my first cyber exhibit, "Chinese American Women: A History of Resilience and Resistance" for the National Women's History Museum. This exhibit, which can be found in its entirety at http://www.nwhm.org/Chinese/1.html, depicts the lives of Chinese American women during their first one hundred years in the United States.1 Buried Alive? From the research I had done for my book Driven Out: The Forgotten War Against Chinese Americans, I knew that the "archives"—that liminal but highly material space—would likely deliver documents that exposed violence against Chinese women. There, I would find the mass purges of the first Chinese Americans during the late nineteenth and early twentieth century, buttressed by cartoons, photographs, and sensational journalism. I would find representations of a national policy that prevented most Chinese women from entering the United States. And, as I expected, in the archives I uncovered slavery, violence, and burlesque. But within the ships' logs, newspaper accounts, habeas corpus actions, and immigration files, Chinese female immigrants' own telling seemed to be mostly silenced. I was searching for the voices and self-representations of the first Chinese American women. Could I find them within these damaging images and nativist records? How could I locate images of Chinese American women that resisted the legislative and violent logic of ethnic cleansing of the three hundred pogroms? Some of these first Chinese American women were, in a sense, buried alive in national archives, local county historical societies, medical records, ships' logs, government documents, and clipping files—the usual places. Ultimately, it was by hanging out—talking, sharing resources, telling and retelling this history—that I stumbled upon their stories and found their images. For example, a civil rights lawyer and parent at my daughter's school put me in touch with a police officer who shared his precinct's internal records of early Chinese women and [End Page 140] men. At our annual block party, I chatted with a neighbor who sold antique toys; he contacted his cyber colleagues to locate an antique cap gun from the 1880s that mechanically mimed a Chinese purge. The sound engineer at a PBS shoot talked about how his tribe hid Chinese miners during the purge from Eureka, California, and revealed that he was a biracial descendant from that troubled moment. All of us who dig in the archives are nontraditional detectives. We all believe in informed serendipity in the archives. But as I review my four full file cabinets and my boxes upon boxes of documents, images, short stories, maps, engravings, letters, and photographs, I realize that hanging out has been a very good form of historical methodology. All the Usual Places By law Chinese women were not supposed to have even been in the United States. Initially, I was concerned that I would not find documents and representations of early Chinese American women. My goal was to locate records, images, court cases, legislation, and artifacts that were produced at the time when national policy prevented most Chinese American women from entering the United States, when Congress allowed only the wives of Chinese merchants to enter because with little bound feet they could not leave the house and cause trouble at the time when elected officials and vigilantes worked hand in hand to drive Chinese immigrants out of three hundred towns across the Pacific Northwest (Forty-Third Congress). Once I began looking for archives in all the right places, I found the hidden images and photographs of these women. For example, Chinese friends soon shared dozens of studio photographs of their grandmothers that clearly establish Congress's failure to deliver ethnic cleansing. Still, and paradoxically, in government, legal, and medical records and the holdings of county museums and local libraries, Chinese American women are present even among records that proclaim their absence. This absence is explained both by the legislation that intended to prevent their entry and remove the Chinese already here, and by the violence in...

The study's purpose was to estimate the variety of foods consumed within standard and ethnic food categories by three groups of women between 18 and 35 years of age. Foreign-born Chinese women [N = 21], Chinese-American women [N = 20] and white American women [N = 23] kept 4-day food records, after instruction. Analysis of variance showed that the mean number of different foods consumed by the foreign-born Chinese was significantly [p < 0.05] lower than those eaten by the other two groups for breads/cereals, dairy products, ethnic foods, fats, meats, sweets/sugars, and vegetable categories. White American women consumed significantly more dairy products and legumes/nuts than either of the groups of Chinese women. Diets of the Chinese-American women were more nutrient dense than those of the women in the other groups, containing significantly more energy, riboflavin, iron, folacin, and calcium than those of the foreign-born Chinese women. The percentage of kilocalories derived from fat [33–34%] did not differ among groups. 95% of foreign-born and 85% of Chinese-American women affirmed their ethnic identification by consuming foods belonging to Chinese cuisine; whereas, the percentage [30%] of white American women selecting Chinese food was significantly lower. Mexican and Italian foods were selected by significantly more white and Chinese-American women than by foreign-born Chinese women. Approximately 20% of both groups of Chinese women, but 49% of white American subjects, ate Japanese food. Chinese-American women retained a preference for Chinese food, similar to that of the foreign-born Chinese women. However, the Chinese-American women consumed cheeses, legumes, raw vegetables in salads, and foods from Italian and Mexican cuisines, indicating their acceptance of foods commonly consumed by white American women. Dietary acculturation among the Chinese-American women improved their diets over those of the foreign-born Chinese women and these results support the theory that consumption of a greater variety of foods increases nutrient density of diets.

Cervical Cancer Screening Experiences Among Chinese American Immigrant Women in the United States

Chinese-American women have lower rates of hip and forearm fracture than white women despite lower areal bone density (aBMD) by dual X-ray absorptiometry (DXA). We recently reported higher trabecular (D(trab) ) and cortical (D(comp) ) bone density as well as greater trabecular (Tb.Th) and cortical thickness (C.Th) but smaller bone area (CSA), as measured by high-resolution peripheral quantitative computed tomography (HR-pQCT), in premenopausal Chinese-American compared with white women. These findings may help to account for the lower fracture rate among Chinese-American women but were limited to measurements in premenopausal women. This study was designed to extend these investigations to postmenopausal Chinese-American (n = 29) and white (n = 68) women. Radius CSA was 10% smaller in the Chinese-American versus the white group (p = .008), whereas their C.Th and D(comp) values were 18% and 6% greater (p < .001 for both). Tibial HR-pQCT results for cortical bone were similar to the radius, but Tb.Th was 11% greater in Chinese-American versus white women (p = .007). Tibial trabecular number and spacing were 17% lower and 20% greater, respectively, in Chinese-American women (p < .0001 for both). There were no differences in trabecular or whole-bone stiffness estimated by microstructural finite-element analysis, but Chinese-American women had a greater percentage of load carried by the cortical bone compartment at the distal radius and tibia. There was no difference in load distribution at the proximal radius or tibia. Whole-bone finite-element analysis may indicate that the thicker, more dense cortical bone and thicker trabeculae in postmenopausal Chinese-American women compensate for fewer trabeculae and smaller bone size.

Conceptualizing menopause and midlife: Chinese American and Chinese women in the US

BackgroundStage-specific survival, according to the eighth edition of the American Joint Committee on Cancer (AJCC) pathological prognostic staging (PPS) on breast cancer (BC), between Chinese and White American women remains unclear.ObjectiveThis study aimed to assess stage-specific survival in BC between Chinese and White American women according to the eighth AJCC PPS.MethodsWe included Chinese and White American women with BC diagnosed between 2010 and 2018 from the Surveillance, Epidemiology, and End Results database. A chi-square test, the Kaplan–Meier method, a receiver operating characteristic (ROC) curve, and multivariate Cox proportional hazards models were used for data analysis.ResultsWe included 376,818 individuals in this study: 369,522 White American and 7296 Chinese. Of them, 149,452 (39.7%) migrated from the seventh AJCC anatomic staging (AS) to the eighth AJCC PPS, 22,516 (6.0%) were upstaged, and 126,936 (33.7%) were downstaged. With a median follow-up duration of 44 months, the 5-year overall survival and cancer-specific survival (CSS) for the entire group were 87.4% and 95.9%, respectively. The seventh AJCC AS (P<.001) and the eighth AJCC PPS (P<.001) could significantly predict the survival outcomes of BC, and multivariate analysis revealed that both staging systems were significant prognostic indicators of CSS. The ROC curve revealed that the PPS had a better discriminating ability than the AS (area under the curve [AUC] 0.769 vs 0.753, P<.001). Similar trends were observed after stratification by the 2 ethnic groups. The eighth AJCC PPS had better discriminating ability than the seventh AJCC AS among both White American (AUC 0.769 vs 0.753, P<.001) and Chinese patients (AUC 0.790 vs 0.776, P<.001). In the seventh AJCC AS, Chinese women had better CSS in stage IA (P=.02), stage IIA (P=.005), and stage IIIB (P=.04) disease than White American women, but no significant CSS was observed in stage IB, IIB, IIIA, and IIIC disease between the 2 ethnic groups. Regarding the eighth AJCC PPS, Chinese women had better CSS in stage IA (P=.002) and IIIA (P=.046) disease than White American women, and CSS was similar in Chinese and White American women in other substages.ConclusionsThe eighth AJCC PPS has a similar discriminative ability between White American and Chinese individuals with BC compared with the seventh AJCC AS. Therefore, the eighth AJCC PPS is also applicable to Chinese individuals with BC.

Objective: Like the barrio advantage theory related to Mexican Americans, a theory about the protective effects of Chinese American enclaves is developing. Such protections were examined among socioeconomically vulnerable people with colon cancer. Design: A colon cancer cohort established in California between 1995 and 2000, and followed until the enactment of the Affordable Care Act was utilized in this study. Secondary analysis was conducted on the 5-year survival among 127 Chinese Americans and 4524 other Americans (3810 non-Hispanic white and 714 Hispanic people). A third of the original cohort was selected from high poverty neighborhoods. Chinese American enclaves were neighborhoods where typically 25% or more of the residents were Chinese Americans. Effects were tested with Cox regressions and group differences described with age and stage-standardized survival rate ratios (RR). Results: Though they were less adequately insured, Chinese American women residing in Chinese American enclaves (63%) were more likely to survive than were other Americans (50%, RR = 1.26). The protective effect of being married was also larger for Chinese Americans (RR = 1.31) than for others (RR = 1.17). Chinese American women (61%) were more likely than men (46%) to live in such enclaves and a large enclave survival advantage was observed among Chinese American women only (RR = 1.59). Conclusions: There is consistent evidence of the relatively protected status of Chinese American women, particularly those who were married and resided in Chinese American enclaves. Mechanisms that explain their apparent advantages are not yet well understood, though relatively large, kin-based social networks seem instrumental. Research on the influence of social networks as well as the possible effects of acculturation is needed. This study also exposed structural inequities related to the institutions of marriage, health care and communities that disadvantage others. Policy makers ought to be aware of them as future reforms of American health care are considered.

Objective: Although prior research suggests Asian Americans experience physical health advantages relative to other racial/ethnic groups, increasing evidence points to health inequalities within Asian American subgroups. Disparities are especially pronounced among middle-aged Asian American women, who remain an understudied population, despite studies showing that midlife corresponds with distinct social stressors and changes in the availability of protective resources, such as social support. Thus, the purpose of the study was to examine racial/ethnic differences in social support and self-rated health (SRH) among middle-aged women. Design: With data from the Study of Women’s Health Across the Nation (SWAN; N = 1258), we used modified Poisson regression models to estimate incidence rate ratios (IRR), examining how social support shaped the risk of fair-to-poor SRH by race/ethnicity. We tested interactions between perceived stress, social support and race/ethnicity to determine whether the stress-buffering role of social support varies by group. Results: Results demonstrate racial/ethnic differences in SRH. Higher levels of social support were linked to higher fair-to-poor SRH among Chinese American women (IRR = 1.24; 95% CI [1.02, 1.52]); while greater social support conferred lower risk among White women. Interaction analyses revealed additional nuances in the stress-buffering effects of social support among Chinese American women, such that the health benefits of social support depended on levels of perceived stress (IRR = 0.75; 95% CI [0.57, 1.00]). Conclusions: These findings highlight important distinctions in the ways that psychosocial factors shape health across racial/ethnic groups. In particular, this study helps advance our understanding of important subgroup differences in the stress-buffering role of social support for Asian American midlife women. Interventions should focus on identifying sources of social strain among Asian American women that can increase the risk for poor health and identify alternative sources of support that mitigate stressors to improve health.

Previous data from this group demonstrate that the murine lung can metabolize estrogen. Production of 4-hydroxyestrogens (4-OHEs), putative carcinogens, is elevated within the lungs of females vs. males and accelerated by tobacco smoke exposure. The goal of this study was to assess the ability of the human lung to metabolize estrogen and determine if metabolism is altered either during lung tumorigenesis or by tobacco smoke, gender or race. Urine and lung tissue, tumor (T) and adjacent normal (N), were obtained from surgical non-small cell lung cancer (NSCLC) patients (men and women). Urine was also collected from healthy postmenopausal Caucasian and Chinese American women. Estrogen synthesis (CYP17A1, CYP21, HSD17B3 and HSD17B7) and metabolism (CYP1B1, GSTA4, GSTT1, NQO1 and COMT) genes were expressed in 50-100% of the lung specimens (T and N), as determined by qRT-PCR. Transcripts for CYP19 and HSD3B1 were detected only in tumors, while levels of HSD17B3 (produces testosterone) were lower in tumor vs. normal tissue (P = 0.02). To determine the functional significance of the detected expression, the level of estrogen and its metabolites (EMs) were measured in human lung tissue by LC-MS2. Analyses of paired specimens (T and N) from NSCLC patients (18 women, 15 men) revealed 3 estrogens (E1, E2, E3) and 6 estrogen metabolites (2-OHE1, 2-OHE2, 4-OHE1, 4-OHE2, 2-OMeE1, 2-OMeE2). Levels of each EM were higher in tumors than in adjacent normal tissue and in tissue (T and N) from women as compared to men (P&amp;lt;0.05). 4-OHEs were a larger proportion of the total EMs in lung tumors (from men and women) than in matching normal lung tissue (P = 0.03), suggesting a shift towards the carcinogenic 4-hydroxylation pathway during tumorigenesis. In addition, 4-hydroxylation was increased in normal lung tissue from female current (n = 10) vs. never (n = 9) smokers (P = 0.004), with similar trends observed in urine (P = 0.04). P values were based on Wilcoxon tests. Based on the elevated risk of lung cancer among nonsmoking Chinese American women, the urinary EM profile of healthy, never-smoking Chinese vs. Caucasian American women (age 55 - 65) matched for age and body mass index (20/group) was compared. The level of 4-OHEs (4-OHEs/total EMs) in the urine of postmenopausal Chinese women was 1.8-fold higher than that of Caucasian women (P = 0.015), suggesting estrogen metabolism may contribute to racial differences in lung cancer susceptibility. In summary, these data demonstrate that the human lung can metabolize estrogen, in particular to produce 4-OHEs. A shift towards 4-hydroxylation during lung tumorigenesis may contribute to the risk conferred by smoking, gender or race. Future studies will confirm these results in a larger population and evaluate the utility of urinary EM profiles as noninvasive biomarkers for the early detection of lung cancer. (Supported by the Estate of Jane Villon, the Kitty Jackson Fund, and Aurora and Timothy Hughes.) Citation Format: Jing Peng, Xia Xu, William E. Smith, Sibele I. Meireles, Stacy L. Mosier, Guo Zhang, Shumenghui Zhai, Xiang Ma, Michael J. Slifker, Karthik Devarajan, Mindy S. Kurzer, Grace X. Ma, Margie L. Clapper. Estrogen metabolism within the human lung: impact of tumorigenesis, tobacco smoke, gender and race. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr LB-090. doi:10.1158/1538-7445.AM2015-LB-090

Objective Asian American female non-smokers face nearly twice the risk of lung cancer compared to their White counterparts. Among Chinese Americans, smoking is predominantly a male behavior, influenced by cultural norms, with approximately 25% of Chinese American men being current smokers. Given that over 88% of them are married, Chinese American women face heightened exposure to secondhand smoke (SHS), a known risk factor for lung cancer. Family and cultural dynamics may shape SHS exposure patterns, influencing the adoption of indoor no-smoking policies. This study examines the barriers and facilitators to implementing such policies among Chinese American women using the Health Belief Model. Methods Our study recruited 86 Chinese American women aged 50 and older who had ever lived with a smoker. Participants completed a survey assessing indoor smoking policies at home, with selected questions developed based on the Health Belief Model. The survey measured perceived susceptibility to secondhand smoke (SHS), perceived severity of SHS, perceived benefits of a smoke-free environment, self-efficacy in implementing no-smoking policies, and cues to action. Results Binary logistic regression results showed that Chinese women who expressed higher levels of self-efficacy were 1.8 times more likely to implement no-smoking policies at home after controlled for covariates. Conclusion Higher self-efficacy significantly increased the likelihood of implementing indoor no-smoking policies among Chinese American women. Culturally tailored interventions that enhance self-efficacy may be key to reducing secondhand smoke exposure and lung cancer risk in this population.

While osteoporosis is common among women of Chinese descent, a readily available bone mineral density (BMD) referent database for Chinese American women does not exist. Fracture risk among this population is currently assessed using a Caucasian reference as well as diagnostic criteria for osteoporosis developed for postmenopausal Caucasian women. Many studies indicate that there are important racial differences in skeletal health and fracture risk, an observation that makes the application of Caucasian data to all groups problematical. This study was undertaken to establish a BMD referent database in Chinese American women and to compare it with a Caucasian female database. It is expected that a race-specific database will be useful in the assessment of bone health for Chinese American women. Healthy Chinese American women (n=359), ages 20-90, were recruited. Along with dual-energy X-ray absorptiometry (DXA) of the total hip and lumbar spine, demographic, medical, familial, nutritional, and behavioral data were obtained. The mean and standard deviation for BMD at each site was calculated for each 10-year age group and compared to mean BMD values for Caucasian women supplied as found in the Hologic DXA instrument. Osteoporosis diagnosis rates for this cohort, calculated with the Caucasian and newly established Chinese American BMD referent values, were compared with each other. Compared with Caucasian women, Chinese American women have significantly lower BMD at the lumbar spine, total hip, and femoral neck across a wide spectrum of age groups. As a consequence, more than one-half of Chinese American women>or=50 years of age, who would be characterized as osteoporotic using a Caucasian referent, would not be diagnosed as such if a Chinese American referent were utilized. Chinese American reference BMD values are significantly lower than those for Caucasian women. Future studies relating Chinese American BMD values to fracture risk are necessary in order to determine if ethnic database-derived T-scores would be more predictive of fracture risk and to develop meaningful diagnostic criteria for this population.

Substantial racial differences in bone mass and bone loss rate have been reported, but the extent of the difference between native Chinese women and women of different races in the United States is not clear. We used a DXA bone densitometer to measure bone mineral density (BMD), bone mineral content (BMC), bone area (BA), and volumetric BMD (vBMD) in different regions of the proximal femur in 3614 Chinese women aged 20 years and older. Regression models were chosen to best fit the changes of these parameters with increasing age. The values in their fitted curves were determined by the Cartesian coordinate numeration system. Subsequently, we compared these fitted curves to full-matched data of non-Hispanic black, non-Hispanic white, and Mexican American women reported by the third National Health and Nutrition Examination Survey (NHANES III). We found that all fitted curves of bone mass of non-Hispanic black women were significantly higher than those of Chinese, non-Hispanic white, and Mexican American women (P = 0.000). The BMD and BMC fitted curves in various regions of the hip for non-Hispanic blacks were 22%-28% and 26%-43% higher than those for Chinese women, 8.3%-13% and 7.9%-9.5% higher than those for non-Hispanic whites, and 8.8%-10% and 13%-19% higher than those for Mexican Americans, respectively. However, when the expression of difference was transformed from BMD to vBMD at the femoral neck, the difference between Chinese and non-Hispanic black women was reduced from 22% to 18% and that between Chinese and non-Hispanic white women from 7.4% to 0.8%, but the difference increased from 3.2% to 9.6% between non-Hispanic white and Mexican American women and from 13% to 17% between non-Hispanic white and non-Hispanic black women. By the age of 80 years, the accumulated bone loss rate in various regions of the proximal femur for Chinese, Mexican Americans, non-Hispanic whites, and non-Hispanic blacks were -38.9% +/- 1.8%, -34.4% +/- 3.1%, -27.8% +/- 5.9%, and -28.4% +/- 4.8%, respectively. In conclusion, bone mass in the proximal femur of native Chinese women is significantly lower, and the bone loss rate greater, than those of non-Asian women in the United States. At the femoral neck, the vBMD of Chinese women is similar to that of non-Hispanic white women.