Chinese American Immigrants Research Articles

Cultural Perspectives on Tobacco Use and Cessation Among Chinese American Immigrants: A Community-Engaged Qualitative Study.

Tobacco use is a preventable cause of death among ethnic minorities. Chinese Americans have high smoking rates and underutilize evidence-based cessation therapies. Community members' perspectives on tobacco use and cessation may help bridge treatment gaps and ensure that cessation approaches are aligned with cultural values. Focus group methods were used to explore cultural factors influencing tobacco use and cessation among 50 Chinese immigrants. Emerging themes were identified using thematic analysis. The three emerging themes are (a) tobacco use is influenced by Chinese American immigrants' socioecological environment, (b) self-discipline determines the ability to quit, and (c) complex family dynamics influence quitting. Cessation approaches framed within cultural perspectives may help bridge treatment gaps. Innovations such as leveraging soft technologies that are widely used in the community may extend the reach of health promotion campaigns and treatments.

Comparing Concomitant Therapy Eradication Rates of Helicobacter pylori Between Immigrant Chinese and General American Populations in an Urban Setting

Comparing Concomitant Therapy Eradication Rates of Helicobacter pylori Between Immigrant Chinese and General American Populations in an Urban Setting

Dietary Patterns in Chinese Americans are Associated with Cardiovascular Disease Risk Factors, the Chinese American Cardiovascular Health Assessment (CHA CHA).

Little is known about the dietary patterns of Chinese Americans. Understanding their dietary patterns can provide insights for addressing cardiovascular disease (CVD) risk among Chinese American immigrants. The objective of this study was to identify dietary patterns among Chinese American immigrants living in New York City (NYC) and to describe associations with demographic and CVD risk factors. A validated Food Frequency Questionnaire assessed usual dietary intake in Chinese American immigrants living in NYC as part of the Chinese American Cardiovascular Health Assessment (CHA CHA) in 2010-2011 (n = 1973, age range 21-89years). Principal components analysis with varimax rotation retaining three factors with eigenvalues > 1.5 identified dietary patterns. Multivariable linear regression models tested associations between CVD risk factors and dietary pattern scores. In multivariable analyses, each unit of increase in the Sweets factor was associated with 0.76 ± 0.33 (mean ± SD) mg/dL higher HDL cholesterol and a 6.2 ± 2.7% increase in HOMA-IR. In contrast, each unit increase in the Fried Noodles factor was associated with a 0.27 ± 0.11 inch greater waist circumference, - 0.89 ± 0.40mg/dL lower HDL cholesterol, and also a 6.9 ± 2.6% increase in HOMA-IR. Each unit increase in the Vegetables factor was associated with a - 1.40 ± 0.43mmHg and - 0.95 ± 0.27mm Hg decrease in systolic and diastolic blood pressure, respectively. Dietary patterns are significantly associated with CVD risk factors among Chinese American immigrants in NYC. Future work will inform how dietary patterns relate to level of acculturation in order to guide the development of dietary interventions to reduce CVD risk.

Development and Assessment of a Helicobacter pylori Medication Adherence and Stomach Cancer Prevention Curriculum for a Chinese American Immigrant Population.

Chinese American immigrants are at increased risk for Helicobacter pylori infection and stomach cancer. Despite their increased risk, very few prevention strategies exist which target this vulnerable population. The purpose of this article is to present the stakeholder engaged development, review, assessment, refinement, and finalization of a H. pylori treatment adherence and stomach cancer prevention curriculum specifically designed to engage vulnerable, limited English proficient Chinese Americans in New York City.

CE: Original Research: Physical Activity Among Chinese American Immigrants with Prediabetes or Type 2 Diabetes.

We sought to learn more about this population's knowledge of physical activity, the types and intensity levels performed, and the barriers to such activity. A concurrent mixed-methods design was used. The short version of the International Physical Activity Questionnaire-Chinese was used to quantitatively measure participants' levels of exercise intensity. Semistructured face-to-face interviews were conducted to obtain qualitative information regarding participants' knowledge about physical activity, the types performed, and the barriers to such activity. A total of 100 Chinese American immigrants were recruited for the study from January to July 2012 in New York City. On average, participants had lived with a diagnosis of prediabetes or type 2 diabetes for 3.3 years and had lived in the United States for 21.5 years. Energy expenditure was measured in metabolic equivalent of task (MET) units; intensity was measured in cumulative MET-minutes per week. The mean total intensity score was 2,744 MET-minutes per week. This was achieved mainly through walking. The mean intensity score for walking was 1,454 MET-minutes per week; the mean duration was 79 minutes per day. Vigorous physical activity was least common. The mean intensity score for vigorous physical activity was 399 MET-minutes per week, and the mean duration was 17 minutes per week. Regarding types of physical activity, the most common were housekeeping, walking up stairs, and taking walking or stretching breaks every hour during the workday. Based on the interviews, three themes emerged regarding barriers to moderate or vigorous physical activity: insufficient education about physical activity, health concerns about physical activity, and work-related barriers to physical activity. The majority of Chinese American immigrants with prediabetes or type 2 diabetes do not engage in sufficient physical activity, performing at a rate significantly below that of the general U.S. Increases in the intensity and duration of physical activity should be promoted as part of diabetes management for Chinese American immigrants.

1.5 CE Test Hours: Original Research: Physical Activity Among Chinese American Immigrants with Prediabetes or Type 2 Diabetes

AJN, American Journal of Nursing 118(2):p 33,41, February 2018. | DOI: 10.1097/01.NAJ.0000530222.25588.26

The Role of Physician Recommendation in Colorectal Cancer Screening Receipt Among Immigrant Chinese Americans.

Chinese Americans have low colorectal cancer (CRC) screening rates. It is unclear whether physicians should offer all CRC screening modalities (fecal occult blood test [FOBT], sigmoidoscopy, colonoscopy) to Chinese Americans to increase screening. Seven hundred and twenty-five Chinese Americans were asked in a survey if their physician had ever recommended CRC screening and to self-report receipt and type of CRC screening. Participants whose physician had recommended all CRC screening modalities were significantly more likely to report ever having screening (adjusted odds ratio 4.29, 95% CI 1.26-14.68) and being up-to-date (4.06, 95% CI 2.13-7.74) than those who reported that their physician only recommended FOBT. Participants who received a recommendation of only one type of screening did not report a significant difference in ever having or being up-to-date for screening. A potential strategy to increase CRC screening among Chinese Americans is for clinicians to recommend all available CRC screening modalities to each patient.

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

ObjectiveTo understand the experiences and perceptions of having cervical cancer screening tests and to explore the extant barriers to having the tests among first-generation Chinese American women in the United States. DesignQualitative, descriptive, phenomenological research. SettingLos Angeles, California. ParticipantsSnowball and purposive sampling of 12 Chinese American immigrant women ages 20 to 65 years. MethodsIndividual face-to-face, in-depth, semistructured interviews in which participants were asked about their experiences and perceptions about cervical cancer screening. Interviews were audiotaped, transcribed, and translated into English. Data analysis included comparing and distinguishing, collecting and counting, and presupposing and inferring. ResultsThrough the analysis process, we identified four major themes that reflected the experiences, perceptions, and barriers to having cervical cancer screening among Chinese American women: Belief in a Healthy Lifestyle, Maintaining Privacy for Female Health Problems, Fear of Losing Control, and Feeling Vulnerable in an Unfamiliar Health Care System. These themes indicated that Chinese immigrant women in the United States face challenges to their cultural health beliefs and practices with regard to decision-making and health-seeking behaviors related to cervical cancer screening. They felt more vulnerable as immigrants because of systematic barriers to navigation of the unfamiliar health care system and limited resources. ConclusionWomen's health care providers should be aware of and give consideration to cultural differences through the provision of more educational information and comfort to Chinese immigrant women who seek cervical cancer screening. Ultimately, the development of culturally appropriate and affordable cancer prevention programs with effective strategies is important to ease Chinese American women's senses of vulnerability.

Exploring the Social Needs and Challenges of Chinese American Immigrant Breast Cancer Survivors: a Qualitative Study Using an Expressive Writing Approach.

Little is known about the psychological well-being and social barriers among immigrant Chinese American breast cancer survivors. The aim of the present study was to explore the social needs and challenges of Chinese American immigrant breast cancer survivors. This study used the expressive writing approach to explore the experiences among 27 Chinese American breast cancer survivors. The participants were recruited through community-based organizations in Southern California, most of whom were diagnosed at stages I and II (33 and 48%, respectively). Participants, on average, had been living in the USA for 19years. Participants were asked to write three 20-min essays related to their experience with breast cancer (in 3weeks). Participants' writings were coded with line-by-line analysis, and categories and themes were generated. Emotion suppression, self-stigma, and perceived stigma about being a breast cancer survivor were reflected in the writings. Interpersonally, participants indicated their reluctance to disclose cancer diagnosis to family and friends and concerns about fulfilling multiple roles. Some of them also mentioned barriers of communicating with their husbands. Related to life in the USA, participants felt unfamiliar with the healthcare system and encountered language barriers. Counseling services addressing concerns about stigma and communication among family members may benefit patients' adjustments. Tailor-made information in Chinese about diagnosis and treatment for breast cancer and health insurance in the USA may also help patients go through the course of recovery.

Breast Cancer Screening Beliefs Among Older Chinese Women in Chicago's Chinatown.

Chicago's Chinatown is home to a sizeable community of first-generation Chinese American immigrants. This qualitative study seeks to describe the attitudes toward, and barriers and facilitators of, breast cancer screening among Chinese women in Chicago's Chinatown to inform strategies for future interventions. We conducted six focus groups among Chinese-speaking adult women aged 45 and older. Focus groups were transcribed, coded, and analyzed for emergent themes. Forty-seven women participated in focus groups; 10 (21%) had received a breast cancer diagnosis in their lifetime, all participants were foreign-born, and 80% have resided in the United States for over 10 years. Participants expressed a range of breast cancer beliefs, attitudes toward screening, barriers encountered, and facilitators. Some differences were noted between women with cancer and those without. Barriers described include language, time, not wanting to burden their adult children, and transportation. Navigation services and physician recommendation were suggested facilitators to screening. Our findings have important implications for development of interventions and policies to bolster breast cancer screening among Chinese women. We highlight the need to connect Chinese older adults with resources to navigate the health care system and present opportunities for community stakeholders, researchers, health professionals, and policy makers to improve the health of Chinese Americans.

2. Acculturation and Bicultural Efficacy in Chinese American Immigrants' Diabetes and Health Management

2. Acculturation and Bicultural Efficacy in Chinese American Immigrants' Diabetes and Health Management

The Effectiveness of Telepsychiatry-Based Culturally Sensitive Collaborative Treatment for Depressed Chinese American Immigrants

This study evaluates the effectiveness of a telepsychiatry-based culturally sensitive collaborative treatment (T-CSCT) intervention to improve treatment outcomes for depressed Chinese American immigrants. Participants were Chinese Americans recruited from primary care settings from February 1, 2009, to July 31, 2012, with DSM-IV major depressive disorder (MDD) identified by the Mini-International Neuropsychiatric Interview. Eligible patients were randomized to receive either T-CSCT or treatment as usual (TAU) for 6 months. T-CSCT involves (1) cultural consultation via videoconference and (2) care management. The primary outcome measure was the 17-item Hamilton Depression Rating Scale (HDRS₁₇); positive response was defined as a ≥ 50% decrease in HDRS₁₇ score, and remission was defined as HDRS₁₇ score ≤ 7. Secondary outcome measures were the Clinical Global Impressions-Severity of Illness (CGI-S) and Improvement (CGI-I) scales and the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q). Outcomes were compared using multivariate logistic regression and mixed-model for repeated measures methods. Among participants (N = 190), 63% were female, and the mean (SD) age was 50 (14.5) years. They were randomized to T-CSCT (n = 97; 51%) or TAU (n = 93; 49%). Using multivariate logistic regression analyses, the odds of achieving response and remission were significantly greater for the T-CSCT group compared to the control group (odds ratio [OR] = 3.9 [95% CI, 1.9 to 7.8] and 4.4 [95% CI, 1.9 to 9.9], respectively). Multivariate general linear model analyses showed that patients in the T-CSCT group had significantly greater improvement over time in HDRS₁₇ (F4,95 = 4.59, P = .002), CGI-S (F4,95 = 4.22, P = .003), and CGI-I (F4,95 = 2.95, P = .02) scores. T-CSCT is effective in improving treatment outcomes of Chinese immigrants with MDD. ClincialTrials.gov identifier: NCT00854542.

Acculturation and activity behaviors in Chinese American immigrants in New York City.

Asian Americans have lower levels of physical activity (PA) compared to other racial/ethnic groups; however, there is little understanding of the social and cultural determinants of PA in this population. Few analyses describe specific PA domains (occupation-, transportation-, recreation-related), focus on one Asian subgroup, or use validated scales. The study objective was to assess the association between acculturation and activity behaviors (meeting 2008 PA guidelines, activity minutes by PA domain, sitting time) in a cross-sectional sample of urban-dwelling, Chinese American immigrants. Data were from the Chinese American Cardiovascular Health Assessment (CHA CHA) 2010–11 among participants with valid reports of PA minutes, assessed by the WHO Global Physical Activity Questionnaire (n = 1772). Acculturation was assessed using the Stephenson Multigroup Acculturation Scale, a 32-item instrument which characterizes two acculturative dimensions: ethnic society (Chinese) immersion and dominant society (American) immersion (maximum possible scores = 4). Multivariable models regressing activity behaviors on acculturation were run, adjusting for age, sex, household income, education, and age at immigration. Ethnic society immersion was high (mean = 3.64) while dominant society immersion was moderate (mean = 2.23). Higher ethnic society immersion was associated with less recreation-related PA (− 40.7 min/week); higher dominant society immersion was associated with a higher odds of meeting PA guidelines (OR: 1.66 (1.25, 2.20), p < 0.001) and more recreation-related PA (+ 36.5 min/week). Given low PA levels in Chinese adults in China, results suggest that PA for leisure may increase and become a more normative behavior among Chinese American immigrants with acculturation. Understanding acculturation level may inform strategies to increase PA in Chinese Americans.

Bidirectional Associations Between Teacher–Child Relationship Quality and Chinese American Immigrant Children’s Behavior Problems

The goal of the study was to test the bidirectional associations between teacher–child relationship quality and behavior problems in an elementary school age sample of Chinese American immigrant children. A socioeconomically diverse sample (N = 258) of first- and second-generation Chinese American children (M ages = 7.4 and 9.2 years at Wave 1 and Wave 2, respectively; 48% girls) was recruited from schools and communities and followed for 1 to 2 years. Two waves of data on dimensions of teacher–child relationship quality (i.e., warmth, closeness, and conflict) and children’s externalizing and internalizing problems were collected through parents’, teachers’, and children’s report. Path analyses were conducted to test the bidirectional associations between teacher–child relationship quality and behavior problems, controlling for prior levels, child demographic characteristics, and teacher ethnicity. Transactional associations between teacher–child relationship quality and children’s behavior problems were found for externalizing problems. That is, teacher-rated externalizing problems negatively predicted child-rated closeness, and teacher-rated conflict positively predicted parent-rated externalizing problems. On the other hand, teacher–child relationship quality did not predict subsequent internalizing problems. However, parent-rated internalizing problems negatively predicted teacher-rated warmth, and teacher-rated internalizing problems negatively predicted teacher-rated conflict. Using a multiple informant approach and a diverse sample of Chinese American immigrant children, this study extends our knowledge of the reciprocal associations between teacher–child relationship quality and children’s behavior problems. Based on the results of this study, the authors provide recommendations for educators and future research with this understudied population.

Acculturation and bicultural efficacy effects on Chinese American immigrants' diabetes and health management.

The primary goal of this study was to examine effects of bicultural efficacy, or perceived confidence in dealing with bicultural acculturation stressors, on type 2 diabetes management and health for first-generation, Cantonese-speaking, Chinese American immigrants (N=162) recruited for a larger community-based diabetes intervention study (Chesla et al. in Res Nurs Health 36(4):359-372, 2013. doi: 10.1002/nur.21543 ). The current study also tested whether a new Bicultural Efficacy in Health Management (BEFF-HM) scale is a more robust predictor of diabetes and health outcomes than proxy (years in the U.S.) and general acculturation measures. Hierarchical regression analyses of cross-sectional data revealed that high BEFF-HM was significantly related to positive outcomes on five of six diabetes and health measures as hypothesized after accounting for participant characteristics, proxy and general acculturation measures, and social support. Proxy and general acculturation measures failed to predict any study outcome supporting our secondary hypothesis that BEFF-HM is a better predictor of Chinese American immigrants' diabetes and health management. An immigrant-focused research approach advances understanding of acculturation and bicultural efficacy effects on health by identifying key acculturation domains for study.

Healthcare Communication Barriers and Self-Rated Health in Older Chinese American Immigrants.

Older Chinese immigrants are a growing population in the United States who experience multiple healthcare communication barriers such as limited English proficiency and low health literacy. Each of these obstacles has been associated with poor health outcomes but less is known about their effects in combination. This study examined the association between healthcare communication barriers and self-rated health among older Chinese immigrants. Cross-sectional survey data were obtained from 705 Chinese American immigrants ages 50-75 living in San Francisco, California. Communication barriers examined included spoken English proficiency, medical interpreter needs, and health literacy in written health information. The study sample (81% females, mean age=62) included 67% who spoke English poorly or not at all, 34% who reported needing a medical interpreter, and 37% who reported "often" or "always" needing assistance to read health information. Two-thirds reported poor self-rated health; many reported having access to racial-concordant (74%) and language-concordant (86%) healthcare services. Both poor spoken English proficiency and low health literacy were associated with poor self-rated health, independent of other significant correlates (unemployment, chronic health conditions, and having a primary doctor who was ethnic Chinese). Results revealed that spoken English proficiency and print health literacy are independent communication barriers that are directly associated with health status among elderly Chinese American immigrants. Access to racial- or language-concordant health care services did not appear to resolve these barriers. These findings underscore the importance of addressing both spoken and written healthcare communication needs among older Chinese American immigrants.

Chinese-Americans’ Confusion and Pursuit of Their Ethical Identity in Steer Toward Rock

Steer Toward Rock, a novel written by the female Chinese-American writer Fae Myenne Ng, presents the process of Jack’s confusion and pursuit of his own ethical identity during The Chinese Confession Program period. Because of the special historical period and his personal experience, Jack, as a Chinese immigrant, is in displacement and confusion of his family ethical identity as well as in absence of biological and social ethical identity, which puts him in an ethical predicament. The displacement and absence of Jack’s ethical identity coupled with his hard pursuit are closely related to the special ethical environment of Chinese-American immigrants in the middle of 20th century, which show the traumas and disasters caused by American racial immigration policies ? the Chinese Exclusion ACT, and uncover the early Chinese-American immigrants’ history of silence.

Understanding Family Connections and Help Seeking Behavior in Chinese American Immigrant Adults who Attempt Suicide

Aim: This study explores the influence of beliefs, values and norms in Chinese family culture as they relate to attitudes and beliefs about mental health and mental health services. It examines family and acculturative stressors occurring in the immigrant’s social context on attitudes about suicidal distress and help-seeking behaviors, and focuses on appropriate forms of services for suicidal behaviors among adult immigrants experiencing suicidal behaviors. Methods: The study design is descriptive, using a qualitative approach. Six Chinese American immigrant adults who had attempted suicide participated in semi-structured interviews in Mandarin or Cantonese. The content was analyzed using a constant comparative approach. Results: Study participants exhibited various reactions to suicidal distress, attitudes about needing help and usefulness and relevance of existing intervention strategies and services that reflected influences of Chinese family culture. Interactions with family members negatively impacted study participants’ attitudes about using services and hindered pathways to care. Acculturative stressors, along with weak family ties and the absence of strong community networks exacerbated the strategies for effective services. Conclusion: This study raises the question of the efficacy of several Western-culture based service delivery models on help-seeking behaviors on such populations. Furthermore, the study discusses ethnic sensitive approaches with core roles for family, peers and community for supporting those at risk of attempting suicide and linking them to appropriate community-based services.

Marital Conflict of Chinese American Immigrant Couples: A Mediator of Socioeconomic Incorporation and Children’s Behavioral Problems

This study examined Chinese American immigrant couples’ marriage conflict, and the relations among socioeconomic incorporation, marital conflict, and their school-age children’s behavior problems. A total of 230 parents (81 % mothers, 19 % fathers) as the participating parent provided demographic and background information, rated their own marital conflict and their children’s behavioral problems. Findings indicated that: (a) the score of Chinese American immigrant couples’ marital conflict was low, child exposure to conflict was much lower than frequency of marital conflict; (b) marital conflict mediated the relation between socioeconomic incorporation and children’s behavioral problems. We found that frequency of marital conflict partially mediated the relationship between maternal education level and children’s internalizing problems; it also totally mediated the relationship between maternal education level and children’s externalizing problems; child exposure to conflict totally mediated the relationship between family estimated per capita income and children’s internalizing and externalizing problems. The results promote understanding of family processes that influence the relationships between family socioeconomic incorporation, marital conflict, and children’s behavioral problems among Chinese American immigrant families.

The San Francisco Chinese Food Security Module: Validation of a Translation of the US Household Food Security Survey Module

There are no validated scales for measuring the prevalence of food insecurity among U.S. Chinese speakers. We validated the newly developed SF Chinese Food Security Module (a translation of the U.S. Household Food Security Survey Module) among 483 Chinese-speaking adults at a street fair. Most (8/10) of the translated items performed well compared to national statistics. Food insecure households had lower income and higher financial stress and used more food coping strategies. We conclude that the translated scale successfully identifies food insecure households in a community-based sample of Chinese-speaking adults. The module is suitable for use among Chinese American immigrants, although further development is needed to assess severe food insecurity.