Acculturation and health in Korean Americans

Despite increasing research on the relationships between acculturation and health, it is unclear whether (1) ethnic group variation occurs in acculturation-health relationships, (2) acculturation components vary differently in relationship to health, (3) biculturalism has beneficial effects on health and (4) multidimensional health relationships occur with acculturation. This study examined the Korean American ethnic group, considering how acculturation was related with five dimensions of health: smoking, physical activity, fat intake, body weight, and reported health. Pretested questionnaires were mailed to a national sample with Korean American surnames, and 55% of the deliverable sample responded, producing 356 usable questionnaires. Acculturation was measured using a two-culture matrix model and Gordon's theoretical work, and showed three distinct groups (acculturated, bicultural and traditional) and four components (American structural, American cultural, Korean structural and Korean cultural). Bicultural men were least likely to smoke, while acculturated and bicultural women were more likely to smoke than traditional women. Korean structural and cultural components were related to men's smoking. Higher acculturation was related to light physical activity, but not to vigorous physical activity. Fat intake did not differ by acculturation status. Higher acculturation was associated with higher body weight and better self-reported health only in men. Higher American cultural component scores were associated with better self-reported health in men. Among Korean Americans, acculturation components varied in their relationships with health, beneficial effects of being bicultural on health were not found, and acculturation-health relationships were multidimensional. Overall, ethnic group variation in health occurred, with Korean Americans similar to some ethnic groups but different than others. Future health research and practice can benefit by acknowledging the complexity of acculturation and its multidimensional effects on health.     

Acculturation and dietary habits of Korean Americans

This is the first study to investigate how food and nutrient intakes vary with the levels of acculturation of Korean Americans using a dietary assessment tool tested for validity and reliability. The respondents were Korean Americans (n 486) resident in the Greater New York metropolitan area, USA. They were divided into two groups according to the total score of acculturation: low- and high-acculturated groups. Using a food-frequency questionnaire and a modified Suinn-Lew Asian self-identity acculturation scale, differences in the frequencies of food items, food groups and nutrient intakes consumed were analysed by level of acculturation. The low-acculturated group tended to consume significantly more rice, mixed rice, soyabean paste chigae (pot stew), saengsun (fish) chigae, kimchi chigae, other fish broiled or baked, eggs, kimchi, spinach, persimmons, and white or brown sugar in coffee or tea. The high-acculturated group demonstrated a statistically greater tendency to consume bread, cereal, spaghetti, ham, green salad, sweetcorn, chocolate, candies and diet soft drinks. The more acculturated an individual, the more significant was the tendency to consume sweets. The more acculturated group had significantly (P<0.05) higher intakes of % energy from total fat, thiamin, vitamin E and folate, while the low-acculturated group consumed greater amounts of Na, niacin and dietary fibre. The information from the present study can be used to describe dietary habits according to various aspects of acculturation, and allows a better understanding of the dynamics of acculturation and dietary habits.     

Unpacking Dietary Acculturation Among New Americans: Results from Formative Research with African Refugees

Epidemiological studies focusing on Latino immigrant health have found links between acculturation (time and language competency), weight gain, and disease risk. Since time and language competency are not mechanisms by which diets and activities change, associations between acculturation and weight change offer little to public health professionals who aim to develop nutrition and health interventions. We present a conceptual model and use a mixed-methods biocultural approach to address the fine-grained details of diet and activity choice for new arrivals to the USA. The results of our anthropological work with Liberian and Somali Bantu refugees indicate that, in addition to standard surveys (individual-level characteristics, socioeconomic status, employment, and acculturation), epidemiological research would benefit from the data generated from ethnography and more nuanced behavioral studies. A focus on the lived experiences of new Americans and the explicit examination of institutional support, peer support, and interactions between children and caretakers might offer points of intervention for immigrant health which is a growing public health concern.     

Acculturation,Food Consumption,and Diet-related Factors among Korean Americans

This study examined how Korean Americans with different levels of acculturation varied in food consumption, and which diet-related factors were important to acculturation and food consumption. Pretested questionnaires were mailed to a national sample, and 55% of the deliverable sample responded, producing 356 usable questionnaires. Sociocultural acculturation was measured with a two-culture matrix model and Gordon's theoretical work and showed four dimensions: American structural, American cultural, Korean structural, and Korean cultural. Food frequency questionnaire responses were divided into American, common, and Korean food consumption. American food consumption increased with higher American structural adaptation and loss of Korean culture. In the relationship of acculturation to frequency of American food consumption, preparing meals themselves, concern about health, and willingness to try other ethnic foods were important. Meal preparation and purchasing power were related to the number of regularly consumed American foods. Korean food consumption decreased with higher familiarity with American culture and less retention of Korean society. Women with someone to prepare meals were most likely to eat more Korean foods. Korean food availability was related significantly only to the number of regularly consumed Korean foods. Future work can benefit by acknowledging acculturation as a multidimensional process and applying several dietary assessment approaches.     

Acculturation and BMI Among Chinese, Korean and Vietnamese Adults

The objective of this study is to examine the association between acculturation and BMI among Asian Americans using multiple measures of acculturation. Data of 847 Chinese, Korean and Vietnamese recruited for a health education program in Maryland during 2009 to 2010 were used. Acculturation was measured by the short version of Suinn-Lew Asian Self-Identity Acculturation Scale (SL-ASIA) and its individual components. Height and weight were measured by trained staff. Multiple linear regressions were used to estimate the association between acculturation and BMI. After adjusting for age, gender, education, income, marital status, and ethnicity, SL-ASIA (β = 0.71, SE = 0.28), having education in the US (β = 0.56, SE = 0.28), younger age of arrival (0–5 years: β = 3.32, SE = 0.76, 6–10 years: β = 1.55, SE = 0.78), self identified as Americans (β = 1.51, SE = 0.77) and equal preference of Asian/American food in restaurants (β = 0.92, SE = 0.28) were significantly associated with increased BMI. The association between acculturation and BMI was stronger among men than women, strongest among Chinese and weakest among Vietnamese. Acculturation was moderately associated with increased BMI among Asian Americans and this association varied by measures of acculturation. The association of acculturation and BMI was moderated by sex and ethnicity groups.     

Negative Acculturation in Sleep Duration Among Mexican Immigrants and Mexican Americans

Negative acculturation, the increase in high-risk profiles as immigrants live longer in the U.S., is found for a range of health behaviors and outcomes among Latino populations. Yet it has never been explored with regard to sleep duration. Using the National Health Interview Survey, we investigate Mexican immigrant and U.S.-born Mexican-American sleep durations. U.S.-born Mexican Americans are around 40% (P < 0.05) more likely to be short sleepers than Mexican immigrants after adjusting for demographic characteristics. These relationships are attenuated with the addition of health behavior variables (OR = 1.25, n.s.). This is explained because U.S.-born Mexican Americans have higher rates of smoking and stress levels, both of which are associated with increased risks of short sleeping. Because chronic partial sleep deprivation may increase health risks directly and indirectly through impaired judgment, sleep may be a mechanism through which health disparities between Mexican immigrants and U.S.-born Mexican Americans emerge.     

Acculturation, meal frequency, eating-out, and body weight in Korean Americans

Consuming regular meals has been studied in relation to better health, while higher regularity of eating-out has been linked to obesity. This study examined whether acculturation was associated with regularity of meals, eating-out, and overweight in Korean Americans. Pre-tested questionnaires were mailed to a U.S. national sample with Korean American surnames, and 55% of the deliverable sample responded, producing 356 usable questionnaires. Acculturation was measured using a two-culture matrix model and Gordon''s theoretical work, and showed there were three distinct groups (acculturated, bicultural, and traditional). Only 36% reported that they regularly ate three meals a day. Breakfast was the least frequent meal of the day with 43% reporting eating breakfast everyday. More than half (58%) reported that they usually eat out or get take-out food at least once a week. After controlling for age, sex, income, education, and working status, higher acculturation was related to greater regularity of eating-out, but not meal regularity. A total of 28% of men and 6% of women were overweight (BMI>25), and there were significant and positive relationships between body weight status and acculturation in men but not women. However, no significant relationships between frequency of meals and eating-out and overweight status were present. This study did not find significant relationships of meal regularity and eating-out with body weight, however, given the positive relationship between acculturation and eating-out among the subjects and the well-established relationship between eating-out and obesity, nutrition education about skipping meals and eating-for Korean Americans may be useful to prevent such relationships from developing.     

Dietary patterns of Korean Americans described by factor analysis

OBJECTIVES: This study tested the hypothesis that the dietary behaviors of Korean Americans (KAs) can be grouped into dietary patterns and subsequently examined relations between major dietary patterns and sociodemographic characteristics. METHODS: A cross-sectional study was conducted with KAs residing in Michigan using a mail survey. Of 1,860 questionnaires mailed to KAs in Michigan, 637 (34%) responded and 497 first-generation KAs (263 men, 234 women, aged 30-87 y) were included in the final analyses. A factor analysis was used to identify dietary patterns from a 93-item food frequency questionnaire developed for KAs (KFFQ). RESULTS: Major dietary patterns of KAs were labeled "vegetable/fruit," and "traditional Korean" in both men and women and "acculturated American" in men and "traditional American" in women. The "traditional Korean" dietary pattern was negatively associated with length of residence in the U.S. for both men and women (p < 0.01). The other major dietary patterns were not associated with other sociodemographic variables examined in men; however, the "vegetable/fruit" dietary pattern was positively associated with length of residence in the U.S. (p < 0.05) and education level (p < 0.05) in women. CONCLUSIONS: Dietary pattern analysis can be used to understand dietary behaviors regarding health risks of ethnically different immigrants including KAs.     

Colorectal Cancer Screening Among Korean Americans: A Systematic Review

The incidence of colorectal cancer (CRC) among Korean Americans (KAs) has increased in recent years, even as the rate in nearly ever other population group in the United States has decreased. Reversing this trend will require improving screening rates, but a variety of sociocultural factors may inhibit this goal. We conducted a systematic review of the published literature on cancer screening among KAs, and identified thirteen eligible studies that examined CRC screening. KAs have CRC screening rates that are significantly lower than the national average. Only about one in four KAs ages 50 and older reports having ever had a fecal ocult blood test (FOBT) and only about 40 % have ever had a sigmoidoscopy or colonoscopy. KA adults are also significantly less likely than the general US population to say they have heard of FOBT, sigmoidoscopy, or colonoscopy. In the KA population, screening rates are higher among adults with higher socioeconomic status, greater acculturation to the United States, more cancer knowledge, more social support, and better access to healthcare services. Improving cultural and financial access to health education and healthcare services may increase CRC screening among KAs and reduce the incidence of the disease.     

Breast Cancer Screening Among Korean Americans: A Systematic Review

Cancer is the leading cause of death for Korean Americans (KAs). Breast cancer (BC) is the most commonly occurring cancer among KA women, and its rate has been rapidly increasing. Low BC screening rates for KAs puts them at greater risk for late-stage breast cancer. We conducted a systematic review of the published literature on cancer screening among KAs, and identified 38 eligible studies. Despite significant increases in mammogram utilization over the past two decades, KAs have consistently lower rates of mammogram screening than other American populations. KA women also report lower rates of clinical breast examination and breast self-examination. Screening rates are higher among adults with higher socioeconomic status, greater acculturation to the United States, more cancer knowledge, higher perceived susceptibility to BC, more social support, and better access to health services. However, fear of finding something wrong, fear of embarrassment or lack of modesty, not knowing where to go for screening, believing that mammography is only necessary when symptoms are present, and perceived time and cost difficulties in accessing mammography were reported as barriers to mammogram screening. Coordinated efforts from clinicians, public health workers, KA cultural and religious organizations, and the broader breast cancer advocacy and awareness community are necessary for improving BC screening among KAs.     

Acculturation and tobacco use among Chinese Americans

OBJECTIVES: We examined the relationship between acculturation and tobacco use behaviors among Chinese Americans. METHODS: Using a Chinese-language instrument based on validated questions from several national surveys, we conducted in-person, household-based interviews with 712 representative adults aged 18-74 years. RESULTS: Observed smoking prevalence was 29% for men and 4% for women. Predictors of smoking cessation included being 35 years and older and having a high level of tobacco-related knowledge. Acculturation was positively associated with a history of never smoking, as was being younger than 35 years and having a high level of tobacco-related knowledge. CONCLUSIONS: Acculturation was positively associated with never smoking among men but not with smoking cessation. However, knowledge of tobacco-related health risks was associated with both. Results indicate a need for language-specific educational interventions.     

Interview Language: A Proxy Measure for Acculturation Among Asian Americans in a Population-Based Survey

We examined health status and access to care among Asian Americans by the following acculturation indicators: nativity, percent lifetime in the US, self-rated English proficiency, and interview language, to assess whether any measure better distinguishes acculturation. Data from the 2003 California Health Interview Survey were used to study the sample of 4,170 US-born and foreign-born Asians by acculturation indicators. We performed t-tests to compare differences in demographics, health status and behaviors, and access to care between the foreign-born and US-born Asians, and between various classifications within foreign-born and the US-born Asian group. Our results showed that foreign-born Asians who interviewed in English more closely resembled US-born Asians than foreign-born Asians who interviewed in languages other than English. Compared to interview language, dichotomizing the sample by other acculturation indicators showed smaller differences between the divided groups. Interview language may serve as a better measure for acculturation especially among foreign-born populations with a high proportion of limited English proficiency. In immigrant public health research studies, interview language may be used as an important covariate for health disparities.     

Acculturation and Cancer Screening Among Asian Americans: Role of Health Insurance and Having a Regular Physician

Cancer is the leading cause of death among Asian Americans, but screening rates are significantly lower in Asians than in non-Hispanic Whites. This study examined associations between acculturation and three types of cancer screening (colorectal, cervical, and breast), focusing on the role of health insurance and having a regular physician. A cross-sectional study of 851 Chinese, Korean, and Vietnamese Americans was conducted in Maryland. Acculturation was measured using an abridged version of the Suinn–Lew Asian Self-Identity Acculturation Scale, acculturation clusters, language preference, length of residency in the US, and age at arrival. Age, health insurance, regular physician, gender, ethnicity, income, marital status, and health status were adjusted in the multivariate analysis. Logistic regression analysis showed that various measures of acculturation were positively associated with the odds of having all cancer screenings. Those lived for more than 20 years in the US were about 2–4 times [odds ratio (OR) and 95 % confidence interval (CI) colorectal: 2.41 (1.52–3.82); cervical: 1.79 (1.07–3.01); and breast: 2.11 (1.25–3.57)] more likely than those who lived for less than 10 years to have had cancer screening. When health insurance and having a regular physician were adjusted, the associations between length of residency and colorectal cancer [OR 1.72 (1.05–2.81)] was reduced and the association between length of residency and cervical and breast cancer became no longer significant. Findings from this study provide a robust and comprehensive picture of AA cancer screening behavior. They will provide helpful information on future target groups for promoting cancer screening.     

Greater Dietary Acculturation (Dietary Change) Is Associated With Poorer Current Self-Rated Health Among African Immigrant Adults

ObjectiveInvestigate the relationship between dietary acculturation and current self-rated health (SRH) among African immigrants, by country or region of origin.DesignCross-sectional, mixed-methods design using baseline data from longitudinal study of immigrants granted legal permanent residence May to November, 2003, and interviewed June, 2003 to June, 2004.Setting2003 New Immigrant Survey.ParticipantsAfrican immigrants from a nationally representative sample (n = 763) averaged 34.7 years of age and 5.5 years' US residency; 56.6% were male, 54.1% were married, 26.1% were Ethiopian, and 22.5% were Nigerian.Main Outcome Measure(s)Current SRH (dependent variable) was measured using 5-point Likert scale questions; dietary acculturation (independent variable) was assessed using a quantitative dietary change scale.AnalysisMultivariate logistic regression tested the relationship of dietary acculturation with current SRH (α = .05; P < .05 considered significant); exploratory qualitative subset dietary analysis (n = 60) examined food/beverages consumed pre-/post-migration.ResultsAfrican immigrants reporting moderate dietary change since arrival in the US had higher odds of poorer SRH status than immigrants reporting low dietary change (odds ratio, 1.903; 95% confidence interval, 1.143–3.170; P = .01). Among most dietary change groups, there was an increase in fast food consumption and decrease in fruit and vegetable consumption.Conclusions and ImplicationsNutrition educators and public health practitioners should develop targeted nutrition education for African immigrants who are older, less educated, and at increased health risk.