Korean American Immigrants Research Articles

Migratory grief and mental health in first-generation Korean American immigrants.

The purpose of this study was to examine first-generation Korean immigrants' migratory grief in relation to cultural, social, and mental health variables. We examined (a) how behavioral and value acculturation and enculturation as well as mainstream and ethnic connectedness predicted migratory grief and (b) how mainstream and ethnic connectedness moderated the relationships of migratory grief and mental health outcomes (i.e., depression, life satisfaction, positive and negative affect). Data were collected from 188 self-identified first-generation Korean immigrant adults (N = 188, Mage = 43.63, SD = 12.18) and were analyzed using hierarchical multiple regression. Age and behavioral enculturation positively predicted migratory grief, while European American values and mainstream connectedness negatively predicted migratory grief. Migratory grief and mainstream and ethnic connectedness had significant main effects on mental health, but social connectedness did not moderate the relationships between migratory grief and mental health. Acculturation, enculturation, and social connectedness were significant predictors of first-generation Korean immigrants' migratory grief. Additionally, migratory grief and social connectedness significantly predicted mental health. We discussed implications for research and practice. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Health Literacy among Korean American Immigrant Women in the USA: Role of Social Support

ABSTRACT Health literacy is associated with health behaviors and outcomes. Using Andersen’s Behavioral Model of Health Services Use, this study examined the role of limited English proficiency (LEP) and social support for the health literacy of Korean American immigrant women, one of the most affected groups by LEP. Researchers surveyed 232 Korean American immigrant women in a metro area in a Southeastern state, U.S. Health literacy was measured by the CDC Behavioral Risk Factor Surveillance System Questionnaire and the California Health Interview Survey. Participants with better English proficiency and larger social support had higher health literacy. LEP and social support interaction was significantly associated with health literacy, illustrating social support as a buffer that mitigates the negative impact of LEP on health literacy. Community programs that enhance social support through community health advocates or peer educators may increase health literacy and reduce health disparities among Korean American immigrant women with LEP.

FACTORS INFLUENCING OLDER KOREAN AMERICAN IMMIGRANTS’ FRAILTY: A QUALITATIVE STUDY

Abstract The older immigrant population, characterized by unique attributes such as diverse cultural backgrounds, health beliefs, health behaviors, language barriers, and low health literacy, requires a specific focus on identifying factors that influence frailty. This study aims to explore the influencing factors of frailty among older Korean American immigrants (OKAIs) residing in suburban areas with limited Korean healthcare infrastructure. Semi-structured interviews were conducted with 9 OKAIs residing in Lee County, Alabama, focusing on four factors associated with frailty: health literacy, physical activity, diet, and mental health. Qualitative content analysis was employed to analyze the data. Validated assessment tools for frailty, health literacy, physical activity, nutrition, depression, and cognitive impairment were also used to gather participant characteristics and complement the qualitative findings. Participants exhibited significant differences in health literacy scores between the Korean and English versions. Content analysis yielded seven categories and twenty-two sub-categories were derived from the eighty identified codes. In addition to typical age-related changes observed among older adults in general, their social activities, health behaviors, and healthcare visits were constrained by different environments/healthcare systems compared to Korea, as well as limited English proficiency and healthcare resources. Participants expressed a need for Korean healthcare providers or interpreters during their healthcare visits and emphasized their preference for Korean food and sought ways to maintain vitality. To prevent and manage frailty among OKAIs, interventions need to consider their unique characteristics, facilitators, and barriers. This approach may also benefit other ethnic minority populations facing similar challenges, thus enhancing healthcare for these communities.

Human Papillomavirus (HPV) and HPV Vaccine Awareness among Korean American Immigrants in Alabama: Would Internet Use Improve Health Awareness?

Although the HPV vaccine is known to prevent associated cancers, studies found a low awareness among Korean Americans (KA). This study aimed to examine the HPV and HPV vaccine awareness among KA in Alabama. A cross-sectional survey was conducted with a convenience sample of 278 KA residing in Alabama to understand the levels of HPV and HPV vaccine awareness and associated factors. Those who heard of HPV were 31.7% and 29.5% for HPV vaccine. Those who were older than 50 years old and married were less likely to hear of HPV and HPV vaccine. Those who were female and had annual health check-ups were more likely to hear of both. Using the Internet for health information was positively associated with HPV vaccine awareness. HPV education tailored to sociodemographic and using the Internet might be an effective strategy in improving the HPV and HPV vaccine awareness levels.

Depression among Korean American immigrants living in rural Alabama: use of social determinants of health framework

ABSTRACT Objectives Depression among Korean American (KA) immigrants in rural Alabama is understudied. This study aims to utilize the social determinants of health (SDOH) framework to explore factors associated with depressive symptoms among KA immigrants living in rural communities of Alabama. Design Data were collected from two sites in rural Alabama from September 2019 to February 2020. Convenience sampling was conducted to recruit study participants from the KA community. A total number of 261 KA immigrants aged 23–75 were included in the study. All measures originally in English were translated into Korean using back-translation to assure comparability and equivalence in the meaning of measures. Multiple linear regression modeling was used to explore the predictors of depression. Results Perceived race discrimination was significantly associated with greater depressive symptoms (β = .180, SE = .534, p < .01). Three SDOH were identified to have significant relationship with depressive symptoms. Participants who could not see a doctor because of cost (β = .247, SE = 1.118, p < .001), had lower level of health literacy (β = -.121, SE = .280, p < .05), and had higher social isolation scores (β = .157, SE = .226, p < .05) tended to have higher scores of depressive symptoms. Conclusion Rural-living KA immigrants’ depression can be significantly affected by race discrimination and SDOH factors, emphasizing the need for culturally competent interventions and services. Policymakers, federal and local governments, non-governmental organizations, and social workers can make joint efforts to address racial discrimination and improve the mental health services among immigrant populations, especially those living in rural areas.

COVID-19 Vaccine Acceptance Among Korean American Immigrants in the United States: A Qualitative Study.

Immigrant populations in the United States are at increased risk of reduced COVID-19 vaccine acceptance. Currently, no qualitative research focuses on COVID-19 vaccine acceptance among Korean American immigrants (KAIs). This phenomenological study aims to uncover needs, beliefs, and practices that may affect COVID-19 vaccine acceptance within this immigrant group. Twelve study participants answered 10 semi-structured interview questions. Inclusion criteria for participants are as follows: (a) above 18 years, (b) has immigrated from Korea, and (c) can understand and speak English. Interview data were analyzed using Colaizzi's data analysis method. Eight themes emerged from the study. Themes included apprehension and indifference, disruption of normalcy, patterns of acceptance, duty to protect, fear of contagion, perceived self-efficacy, relief and safety, and acceptance of new normal. Findings from this study can inform health care professionals of cultural factors related to COVID-19 vaccine acceptance and health promotion behaviors among the KAIs.

Risk of Sleep Apnea Is Associated with Abdominal Obesity Among Asian Americans: Comparing Waist-to-Hip Ratio and Body Mass Index.

This study examines associations between the risk of sleep apnea and abdominal obesity (assessed by waist-to-hip ratio (WHR)) and general obesity (assessed by body mass index (BMI)) in a sample of Chinese and Korean American immigrants. The dataset included Chinese and Korean participants aged 50-75 who were recruited from primary care physicians' clinics from April 2018 to June 2020 in the Baltimore-Washington D.C. Metropolitan area (n = 394). Abdominal obesity was determined if WHR ≥ 0.9 in men and WHR ≥ 0.85 in women. General obesity was determined if BMI ≥ 30. The risk of sleep apnea was determined by using the Berlin questionnaire. Poisson regression models examined associations between sleep apnea risk and obesity. Models controlled for socio-demographic risk factors. Twelve percent of the study participants were classified as a high risk for sleep apnea, and 75% had abdominal obesity whereas 6.4% had general obesity. High risk of sleep apnea was positively associated with abdominal obesity (PR = 1.31, 95% CI: 1.17-1.47) and general obesity (PR = 2.19, 95% CI: 0.90-5.32), marginally significant at p < 0.1). Chinese and Korean immigrants living in the USA who are at high risk of sleep apnea have higher abdominal obesity, even after accounting for sociodemographic characteristics. Abdominal obesity may be a better indicator than general obesity when examining the risk of sleep apnea among Asian Americans. Name: Screening To Prevent ColoRectal Cancer (STOP CRC) among At-Risk Asian American Primary Care Patients NCT Number: NCT03481296; Date of registration: March 29, 2018 URL: https://clinicaltrials.gov/ct2/show/NCT03481296?term=Sunmin+Lee&draw=2&rank=1.

UNDERSTANDING SOCIAL AND CULTURAL DIVERSITIES AND AGING FOR HEALTH AND WELL-BEING IN KOREAN AND KOREAN AMERICANS

Abstract Guided by the socio-ecological model and the cultural diversity perspective, this symposium aims to enhance the understanding of critical issues in health and well-being among Koreans and Korean Americans with three primary focuses: aging, social-ecological and multilevel factors, and identifying social and cultural contexts. Five studies examined multilevel factors—individual, relational/interpersonal, community, and societal—that are associated with health and well-being, conducted in Korea as well as in the United States. Study 1 examined psychological well-being among older Koreans, specifically its association with intergenerational relationships and social support using longitudinal multilevel modeling to estimate depression trajectories. Study 2 examined childhood experiences and midlife cultural engagement associations among middle-aged Korean couples, considering the influences of their spouses’ experiences and cultural resources. Study 3 explored the experiences of the nature-based virtual reality program among older Korean Americans, using in-depth interviews and providing an innovative approach using technology as a therapeutic tool. Study 4 examined social determinants of health associated with Korean American immigrants’ willingness for end-of-life discussions and the factors affecting willingness (awareness of hospice, communication with family/doctors, and social isolation). Study 5 examined health insurance coverage and its association with immigration-related factors (English proficiency, generational status, and age at immigration) among Korean Americans using national data. The various health, mental health, and well-being issues in Koreans and Korean Americans will be discussed from contextually responsive approaches. This symposium will provide implications for practices, education, research, and policy to promote health, mental health, and well-being in the Korean and Korean American populations.

SOCIAL DETERMINANTS OF HEALTH AND WILLINGNESS FOR END-OF-LIFE DISCUSSION AMONG KOREAN AMERICAN IMMIGRANTS

Abstract This study aimed to examine social determinants of health (SDH) associated with Korean American (KA) immigrants’ willingness for end-of-life discussions with family and doctors. A self-administered, cross-sectional survey was conducted with 259 KAs in Alabama. Demographic, health, acculturation, and SDH information were collected. Binary logistic regression analyses were conducted to examine associations between SDH and willingness for end-of-life discussion. Most participants were willing to discuss with family (94%) and doctors (82%). Those aware of hospice care were more likely to have willingness for discussion with family and doctors. Those who could not see a doctor because of cost and who had higher threats to interpersonal safety were less likely to have willingness for discussion with family. Those with more chronic conditions and higher social isolation were less likely to have willingness for discussion with doctors. Interventions aimed to promote KAs' end-of-life discussions should consider the SDH identified in this study.

Traumatic chain: Korean-American immigrants' transgenerational language and racial trauma in Native Speaker.

The premise of this study is to look at the intergenerational transferal of language and racial trauma of Asian immigrants in general and Korean-American immigrants in particular to a western country, the United States of America. This study investigates trauma from a psychological standpoint, based on Chang-Rae Lee's novel Native Speaker. In describing a marker of citizenship, the novel's title also points to who is the native language speaker and who is a native of a country, and why one who is not may be excluded. The Korean immigrants' vulnerability to the English language and racial differences highlights their status as minority "others," and they suffer from transgenerational trauma. As a result of transgenerational traumatic effects, Henry (the protagonist) has various traumatic side effects such as dysphasia, aphasia, and parasomnia and finally leaves no stone unturned to recuperate from trauma. The Trauma of the Unspeakable theory by Michelle Balaev is used in this article to show how trauma affects people's minds.

Social determinants of willingness to discuss end-of-life care with family and doctors among Korean American immigrants: Findings from a cross-sectional survey in Alabama.

Prior research reported lower engagement in end-of-life discussions and planning among Korean American (KA) immigrants; however, there is a dearth of research investigating factors associated with their willingness to discuss their end-of-life care wishes. This study aimed to examine the willingness to have end-of-life discussions with family and doctors among KA immigrants and social determinants of health (SDH) associated with willingness. A self-administered, cross-sectional survey was conducted with a convenience sample of 259 KA immigrants recruited from two counties in Alabama. Demographic, health, acculturation and SDH information were collected. Logistic regression analyses were conducted to examine associations between SDH and willingness for end-of-life discussion with family and doctors, respectively. The majority of the sample was willing to discuss end-of-life care with family (94%) and doctors (82%). Those with hospice awareness were more likely to have willingness for discussion with family (OR=27.70, p < 0.001) and doctors (OR=5.01, p < 0.001). Those who could not see a doctor because of cost (OR=0.03, p < 0.01) and who had higher threats to interpersonal safety (OR=0.74, p < 0.05) were less likely to have willingness for discussion with family. Those who had more chronic conditions (OR=0.60, p < 0.05) and higher levels of social isolation (OR=0.77, p < 0.05) were less likely to have willingness for discussion with doctors. The SDH identified in this study should be considered in developing interventions to promote end-of-life discussions in the KA immigrant community. Future research should investigate the associations explored in this study in a larger and more representative sample.

A Pilot Study of the Gut Microbiota Associated With Depressive Symptoms and Sleep Disturbance Among Chinese and Korean Immigrants in the United States.

Depression is prevalent among Asian Americans (AsA) during the COVID-19 pandemic, and depression often leads to sleep disturbance in this population. The gut microbiota (GM) plays a critical role in mental health and sleep quality, and the composition of the GM is largely unknown among AsA. Examine associations of the GM with depressive symptoms and sleep disturbance among Chinese and Korean American immigrants. Depressive symptoms (PROMIS Short Form-Depression) and sleep quality (Pittsburgh Sleep Quality Index [PSQI]) were collected via surveys. PROMIS measure T-score > 55 indicates positive depressive symptoms, and a total PSQI score > 5 indicates sleep disturbance. 16S rRNA V3-V4 gene regions were sequenced from fecal specimens to measure GM. Permutational multivariate analysis of variance and linear discriminant analysis effect size were applied to examine associations of the GM with symptoms. Among 20 participants, 55% (n = 11) reported depressive symptoms and 35% (n = 7) reported sleep disturbance. A higher α-diversity was marginally associated with lower depressive symptoms: Chao1 (r = -0.39, p = 0.09) and Shannon index (r = -0.41, p = 0.08); β-diversity distinguished participants between categories of depressive symptoms (weighted UniFrac, p=0.04) or sleep disturbance (Jaccard, p=0.05). Those with depressive symptoms showed a higher abundance of Actinobacteria, while those without depressive symptoms had a higher abundance of Bacteroidetes. No significant taxa were identified for sleep disturbance. Gut microbial diversity showed promising associations with depressive symptoms and sleep disturbance among Chinese and Korean immigrants. Specific taxa were identified as associated with depressive symptoms. Future studies with a larger sample size are warranted to confirm our findings.

Understanding the Ethnic Self: A Qualitative Study of 1.5 Generation Korean American Immigrants

This study examined the experiences of bicultural identity development of 1.5 generation Korean immigrants living in predominantly White regions. Using grounded theory methodology, this study highlights dynamic forms of 1.5 generation Korean immigrants’ bicultural identities as both Korean and American. The study found that as these immigrants are largely influenced by interpersonal relationships and race-related discrimination experiences, they develop different forms of bicultural identity through five stages (from anxiety and fear to acceptance), differ from first- and second-generation immigrants. Through viewing 1.5 generation immigrants as a unique population with their own needs, the implications center on the opportunity to support 1.5 generation, Korean immigrants, in coping with negative experiences and developing bicultural identity across various contexts.

Korean American Immigrant Women's Perceived Breast Cancer Risk and Prevention Beliefs: A Qualitative Study.

With the goal of informing culturally appropriate intervention strategies, the purpose of this qualitative study was to understand the Korean American immigrant women's (KAIW) perceptions of breast cancer risk and how their perceived risk, along with normative breast cancer prevention beliefs, shaped their attitudes toward mammography. Semi-structured individual interviews were conducted with 30 Korean women in Los Angeles County, Los Angeles, California. Braun and Clarke's thematic analysis was used to code and analyze interview data. Two major themes were identified: (a) perceived risk of breast cancer and attitudes to prevention (e.g., worried and using all means of prevention) and (b) influences on attitudes to breast cancer prevention (e.g., family members and friends' cancer experiences). Breast cancer prevention interventions for KAIW should target perceived breast cancer risk, social factors such as women's family roles and social networks, and health information evaluation skills.

Correlates of Undiagnosed Hypertension Among Chinese and Korean American Immigrants.

Asian Americans are more likely to be unaware that they have hypertension compared to non-Hispanic white Americans, despite having higher risk of hypertension at lower body-mass indices. Furthermore, immigrants are more likely than their United States (U.S.)-born counterparts to have undiagnosed hypertension, placing them at greater risk of subsequent morbidity and mortality. This study examines the social determinants of undiagnosed hypertension among Asian American immigrants. Using a study of foreign-born Chinese and Korean Americans between the ages of 50–75 years-old recruited from physicians’ clinics in the Baltimore-Washington DC Metropolitan Area (n = 355), we used blood pressure readings measured by trained staff members, self-reported diagnosis by a medical professional, and self-reported hypertension medication use to determine hypertension status—whether patients were non-hypertensive, had diagnosed hypertension, or had undiagnosed hypertension. Using multinomial logistic regression, we examined how demographic, socioeconomic, and immigration-related factors were associated with hypertension status. Results indicated that older age, male gender, Korean subgroup, and marital status were associated with having diagnosed hypertension compared to being non-hypertensive. Lack of health insurance was the strongest predictor of having undiagnosed hypertension compared to being non-hypertensive. Acculturation variables had no strong associations with hypertension status. We then explored correlates of health insurance status for Chinese and Korean American immigrants. Those without health insurance were more likely to have lower income and to be not currently employed. Our findings point to the importance of increasing health insurance access for Asian American immigrant groups to ensure that hypertension is not left undiagnosed and untreated.

Evaluation of a Diabetes Prevention Intervention for Korean American immigrants at Risk for Diabetes.

PurposeDespite the small but growing number of studies documenting the increasing prevalence of diabetes among Korean Americans, no culturally adapted interventions have been developed for Korean Americans at risk for diabetes. We evaluate the efficacy of a culturally tailored lifestyle intervention among Korean American immigrants at risk for diabetes in New York City (NYC).MethodsKorean Americans at risk for diabetes were recruited into a culturally adapted, community health worker (CHW) intervention in NYC. Treatment group participants received 6 group sessions and 10 follow-up phone calls from CHWs over the 6-month period. Control participants received only the first session. Study outcomes included changes in weight, body mass index (BMI), blood pressure, physical activity (PA) and PA behaviors, nutrition behaviors, and diabetes knowledge. Paired t-tests and chi-square tests assessed group differences for each group for each outcome measure.ResultsThe treatment group reported significant positive changes in recommended weekly PA, PA self-efficacy, PA barriers, nutrition self-efficacy, diabetes knowledge, weight, BMI, and systolic blood pressure compared with control participants. Generalized estimated equations models for repeated measures assessed change across time while adjusting for study arm, time point, and the interaction between study arm and time point. The intervention effect was significant for weekly moderate and vigorous PA, recommended weekly PA, PA self-efficacy, and diabetes knowledge.ConclusionsResults suggest that a culturally adapted lifestyle intervention for Korean American immigrants at risk for diabetes have the potential to improve behaviors associated with cardiovascular disease outcomes and diabetes prevention. Further research among Korean Americans is warranted.

Correlates of mental health literacy among first-generation Korean American immigrant women

ABSTRACT Korean American immigrants historically have and continue to underutilize mental health services and treatment. A lower level of mental health literacy has been found to account for low rates of mental health services. This study examined mental health literacy and its correlates in a sample of first-generation Korean American immigrant women (N = 243) from a large metro area in the Southeast U.S. Those with higher English proficiency, social support, and lower depression levels were more likely to have higher mental health literacy levels. Strategies to increase mental health literacy among Korean American immigrant women are discussed.

Knowledge of Hospice Care among Korean American Immigrants in Deep South

Despite the benefits of hospice care in end-of-life care, there is a dearth of research on the knowledge or perceptions of hospice care, particularly among immigrants. A handful number of existing studies with this population have mainly used qualitative research methods. The purpose of the current study was to investigate the knowledge about hospice care and identify its predictors. We used cross-sectional data from 256 Korean American immigrants living in Alabama (Mean age = 44.78, range 23–70, 50.4% female). The outcome variable was measured by whether the respondents had heard of hospice care. Independent variables included sociodemographic (age, gender, education, and income), health (functional limitation and chronic conditions), health care access (health literacy, health insurance, unmet medical needs due to the cost, and social isolation). Logistic regression analyses were performed. About 78% of the respondents reported that they had heard of hospice care. Older age (OR=1.05, 95% CI=1.01-1.09, p <.05), being female (OR=7.13, 95% CI=3.18-15.98, p <.001), and higher levels of education (OR=1.68, 95% CI=1.15-2.45) were significantly related to increased odds of knowledge about hospice care. There were no significant roles of health and health care access factors. Our findings suggest sociodemographic gradients present in immigrants’ knowledge about hospice care, emphasizing the need for a targeted intervention to increase the hospice care knowledge.

Online Health Information-Seeking Behavior Among Korean American Immigrants in Rural Alabama: Dose Discrimination Matter?

Little attention has been paid to online health information seeking (OHIS) among immigrants residing in rural areas. This study examines the intensity of OHIS among Korean American (KA) immigrants living in rural Alabama. A total number of 261 KA immigrants aged 23 to 75 participated in the study. Multiple linear regression analyses were conducted. Age (B = - 0.044, p < 0.05), marital status (B = 1.132, p < 0.05), race/ethnic discrimination (B = 0.821, p < 0.05), having computer or tablet (B = 1.286, p < 0.05), and access to internet (B = 1.778, p < 0.01) were associated with the intensity of OHIS. Substantial efforts should be devoted to narrowing the access gap by providing offline health information services for those without internet access and with limited health literacy. Moreover, culturally competent healthcare services and information should be provided to serve racial/ethnic minority populations better.

The Association Between Fatalism and Mammography Use in Korean American Immigrant Women.

Fatalism is reported as a salient cultural belief that influences cancer screening disparities in racial and ethnic minority groups. Previous studies provide a range of measures and descriptions of cancer fatalism, but no studies to our knowledge have analyzed how fatalistic views cluster together within subgroups to form distinct profiles, and how these profiles can be predicted. This study identified subgroups of Korean American immigrants with similar fatalistic beliefs toward cancer and examined the influence of fatalism, health belief variables, and health literacy on mammography use. A cross-sectional survey design was used to obtain a convenience sample of 240 Korean American immigrant women in Los Angeles, California. Latent class analysis was used to identify unobserved subgroups of fatalism. Hierarchical logistic regression models were used to identify predisposing, enabling, and need factors associated with recent mammography use. The latent class analysis model identified three cancer fatalism subgroups: high fatalism (17.8%), moderate fatalism (36.7%), and low fatalism (45.5%). Women in the high fatalism subgroup were more likely to have had a mammogram within the past 2 years than women in the low fatalism subgroup. Regression analysis revealed three facilitators of recent mammogram use: level of fatalism, perceived barriers to mammogram, and family history of cancer. Although cultural beliefs can have a powerful influence on health-seeking behavior, it is important to weigh individual and contextual factors that may weaken or mediate the relationship between fatalism and engaging in preventive care such as having a mammogram.