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Food preferences, beliefs, and practices of Southeast Asian refugee adolescents.

Food preferences, beliefs, and practices were assessed among 207 Southeast Asian refugee high school students, all of whom had been in the U.S. five years or less. Questionnaires typed both in English as well as their native language of either Cambodian, Vietnamese, or Hmong, were administered to all students in a classroom setting. Results indicated Southeast Asian refugee youth have maintained strong ties to their native foods and traditional meal patterns. In the U.S., as in Southeast Asia, rice remains the staple food in their diet. High status foods in Southeast Asia such as fruits, meats, and soft drinks remain highly preferred in the U.S. While milk is well-liked, cheese remains a strongly disliked food item. Fruits and vegetables are frequently consumed. Nutritionally weak American foods such as candy bars, cake, and potato chips are not consumed frequently. However, soft drinks are consumed daily by almost one-third of the students. Breakfast was missed by almost 60% of females and 37% of males. Forty-five percent of the youth reported they had primary responsibility for evening meal preparation.

Adolescent↗

Health education lessons learned: the H.A.P.I. Kids Program.

Challenges exist for effective health communication and health education within diverse populations of the United States. This article addresses the development process for educational materials and lessons learned from the Healthy Asian and Pacific Islander (H.A.P.I.) Kids Program, a vaccination demonstration project funded by the Centers for Disease Control and Prevention to promote catch-up hepatitis B vaccination for older American Asian and Pacific Islander children. Simplicity and a common message were incorporated in multiple strategies to disseminate information to a diverse population. Community representatives from the Cambodian, Hmong, Filipino, Lao, and Vietnamese communities were instrumental in the material development process, which included needs assessment, design, and translation. By making the target community part of the development process, important health messages can be disseminated effectively, carrying great impact to an otherwise hard-to-reach community.

Adult↗

HeLa cell-adherent enteropathogenic Escherichia coli in children under 1 year of age in Thailand.

Enteropathogenic Escherichia coli (EPEC) was isolated from 11% of 148 Hmong children under 1 year old with diarrhea at a refugee camp in northern Thailand. Of 16 children with EPEC-associated diarrhea, 11 were infected with EPEC that adhered to HeLa cells in a diffuse pattern, 3 were infected with EPEC that adhered to HeLa cells in a localized adherence (LA) pattern, and 2 were infected with EPEC that were nonadherent. In Bangkok, EPEC was isolated from 6% of 64 children under 1 year old with diarrhea and 7% of 56 children of the same age without diarrhea. Of four children with diarrhea, two were infected with EPEC with an LA pattern, and two were infected with nonadherent EPEC. Of four children without diarrhea, one was infected with EPEC with an LA pattern, one was infected with EPEC that adhered in a diffuse pattern, and two were infected with nonadherent EPEC. The 21 EPEC isolates with an LA pattern hybridized with the EPEC adherence factor DNA probe. EPEC was the only enteric pathogen identified in 16 (80%) of 20 children with EPEC-associated diarrhea. EPEC was as frequently isolated from children under 1 year old as were other bacterial enteric pathogens. The problem of identifying EPEC with pools of polyvalent antisera are described, and the need to identify additional enteropathogenic determinants of EPEC is discussed.

Bacterial Adhesion↗

Physical disorders among Southeast Asian refugee outpatients with psychiatric disorders.

OBJECTIVE: The study assessed the prevalence and duration of axis III physical disorders and the resulting level of disability among Southeast Asian refugee outpatients with axis I psychiatric disorders. METHODS: A total of 266 consecutive patients who were evaluated in a psychiatric outpatient clinic were assessed for the presence of axis III conditions through questions about physical symptoms, a medical history and review of records, physical examination, and laboratory screening. The sample included 158 Hmong, 58 Laotian, 43 Vietnamese, and seven Cambodian patients. RESULTS: Fifty-five percent of the patients had one or more axis III disorders, most of which were chronic and were not associated with extreme disability. Neurological conditions were most common, and the sequelae of war-related trauma were prominent. No associations were found between the presence of axis III conditions and age, gender, marital status, or ethnic group. In 48 cases, the axis III condition may have caused or exacerbated the axis I condition. CONCLUSIONS: Routine medical history and a physical examination, including a neurological examination, are recommended for all psychiatric patients, including outpatients.

Adult↗

Effectiveness of the toll-free line for public insurance programs.

Toll-free lines for public insurance programs are a major point of entry to inquire about information. More than 1 million Californians are eligible for public insurance programs based on income but not yet enrolled. In 2000 and 2002, a "mystery-shopper" survey was conducted to ascertain overall effectiveness and interlanguage variation for information provided in Armenian, Cantonese, English, Farsi, Hmong, Khmer, Korean, Russian, Spanish, and Vietnamese. Although the 2002 study showed statistically significant improvements from 2000, many constructs remained problematic. In 2002, for example, statistically significant interlanguage variation was identified in discussing and checking eligibility for the program. Specifically, Spanish and Armenian callers were less likely than other language callers to have eligibility checked or deemed eligible. Removing barriers to enrollment in public insurance programs often requires political solutions, but improving customer service for the toll-free line necessitates efficiency and a focus on continuous quality improvement.

California↗

A literary approach to teaching cultural competence.

Cultural competence is a necessity in today's diverse society and an essential component of clinical practice. As an adjunct to other sources, literature can enrich teaching and sensitize students to cultural issues in health care. The Spirit Catches You and You Fall Down is a beautifully written and compelling story well suited for instructional purposes. Although widely recommended, nurses are largely ignored in this story of a Hmong family seeking medical care. The book describes how the health care system failed to provide adequate care to patients from a different cultural background despite providers' good intentions. Nurse educators can use structured discussion guides to synthesize literary accounts such as The Spirit Catches You and You Fall Down with theory and research about cultural competence.

Clinical Competence↗

The cultural parameters of lead poisoning: a medical anthropologist's view of intervention in environmental lead exposure.

This article identifies four culturally shaped sources of lead exposure in human societies: modern and historic technological sources: food habits; culturally defined health beliefs; and beauty practices. Examples of these potential sources of lead poisoning are presented from current cultures. They include the use of lead-glazed cooking pottery in Mexican-American households; folk medical use of lead in Hispanic, Arabic, South Asian, Chinese, and Hmong communities; as well as the use of lead as a cosmetic in the Near East, Southeast Asia, and South Asia. Four interacting cultural conditions that create barriers to the reduction of lead exposure and lead poisoning are identified and discussed. These are knowledge deficiencies, communication resistance, cultural reinterpretations, and incongruity of explanatory models.

Anthropology, Cultural↗

Pharmacy-related health disparities experienced by non-english-speaking patients: impact of pharmaceutical care.

OBJECTIVES: To identify the availability of foreign language services in pharmacies near a medical clinic serving a large immigrant population and determine whether the type of observed drug therapy problems differed between English- and non-English-speaking patients at this clinic. SETTING: A community health care center in a diverse neighborhood of Minneapolis, Minnesota. PARTICIPANTS: 40 pharmacies near the clinic and in the surrounding Minneapolis-St. Paul area known to provide services to patients in languages in addition to English and 91 clinic patients, including 38 for whom English was not their primary language, seen for full pharmaceutical care assessments. INTERVENTIONS: Comprehensive drug therapy assessments were conducted for English- and non-English-speaking patients (with assistance from interpreters) in a primary care setting secondary to physician referral. Patient-specific data and the results of the pharmacist's assessment were recorded in a patient management database. MAIN OUTCOME MEASURES: Language services provided by area pharmacies, frequency of drug therapy problems in English- and non-English-speaking patients, and the status of patient's medication conditions before and after provision of pharmaceutical care. RESULTS: Of the six primary languages other than English (Vietnamese, Hmong, Laotian, Somali, Spanish, and Cambodian) spoken by clinic patients, written or verbal information was available for five languages in one or more area pharmacies. The clinic pharmacist completed comprehensive assessments for 91 patients via 230 patient encounters, identifying 186 drug therapy problems. Problems related to adherence were significantly more prevalent in non-English-speaking patients compared with English-speaking patients (31% versus 12%). In all 91 patients, the percentage achieving desired drug therapy outcomes improved by 24% after a pharmacist joined the team of clinic providers. CONCLUSION: Despite the availability of clinic-based interpreters and foreign language services in pharmacies, adherence-related problems are significantly more common in non-English-speaking patients. Pharmacists committed to providing pharmaceutical care must consider the impact of language barriers when working to optimize drug therapy outcomes.

Adult↗

The story catches you and you fall down: tragedy, ethnography, and "cultural competence".

Anne Fadiman's The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures (Noonday Press, 1997) is widely used in "cultural competence" efforts within U.S. medical school curricula. This article addresses the relationship between theory, narrative form, and teaching through a close critical reading of that book that is informed by theories of tragedy and ethnographies of medicine. I argue that The Spirit Catches You is so influential as ethnography because it is so moving as a story; it is so moving as a story because it works so well as tragedy; and it works so well as tragedy precisely because of the static, reified, essentialist understanding of "culture" from which it proceeds. If professional anthropologists wish our own best work to speak to "apparitions of culture" within medicine and other "cultures of no culture," I suggest that we must find compelling new narrative forms in which to convey more complex understandings of "culture."

Anthropology, Cultural↗

Asian and Asian-American college students' awareness of osteoporosis.

STUDY OBJECTIVE: To quantify Asian and Asian-American college students' knowledge of osteoporosis and preventive health behaviors. DESIGN: Sixty-four-question survey SETTING: University of Minnesota. SUBJECTS: One hundred sixty-eight male and female Asian and Asian-American students, mean age 21 +/- 3.4 years. MAIN RESULTS: About half of the students consumed 0-1 servings/day of dietary calcium, 42% consumed 2 cups/day or more of caffeinated beverages, 8% smoked cigarettes, and 61% exercised 2.5 hours/week or less. At least 1 serving/day of phytoestrogen was consumed by 80% of the students. Only 11% of students answered at least 75% of osteoporosis fact questions correctly. Women (p = 0.011) and the United States-born participants (p = 0.006) were more apt to change their health behaviors to prevent or treat osteoporosis than men and Asia-born participants. Thirty-eight percent of Hmong participants attributed osteoporosis to fate, chance, or luck whereas Vietnamese participants were more likely to attribute osteoporosis to diet. Most participants (63%) did not know whether their culture objected to estrogen replacement therapy, and 42% said menopause was a natural occurrence for which pharmacologic treatment should not be administered. CONCLUSIONS: Many Asian and Asian-American college students did not practice health behaviors to prevent osteoporosis, and most lacked sufficient knowledge about the condition.

Adult↗

Indochinese refugee fertility rates and pregnancy risk factors, Oregon.

Matching 471 Oregon birth certificates with official Indochinese arrival lists reveals a fertility rate of 126.7, 1.8 times the US rate of 68.5. Greater maternal and infant risk rates were noted, particularly for Hmong. Data indicate improvements in obtaining prenatal care and in reducing the number of low birth weight infants for refugees who have resided in the US three or more months: however, the improvements appear to be reversed after 12 months of US residency.

Adolescent↗

Social distance and trait attribution among four Southeast Asian ethnic groups in the United States.

This study explored social distance and trait attribution and the relationship between the two variables in persons of four Southeast Asian ethnic groups. 100 Cambodians, 102 Hmong, 102 Laotians, and 101 Vietnamese in the United States were administered a modified Bogardus Social Distance Scale with respect to seven different ethnic groups (the other three Southeast Asian groups, African American, Hispanic, and White), and rated these other groups on 10 traits: friendly and likable, in good health, unattractive, law abiding, hardworking, loyal, peaceful, unfair and dishonest, unintelligent, and have good morals. Cambodians expressed willingness to have the closest social distance with Whites and Laotians and their trait attributions were more favorable for these two groups. Theoretical and practical implications were suggested.

Adolescent↗

Southeast Asian immigrants' perceptions of good adolescents and good parents.

The authors examined the extent to which Southeast Asian immigrant parents and adolescents agree on what it means to be a "good" parent and a "good" adolescent. Thirty-six parents and 37 adolescents of Cambodian, Hmong, Lao, and Vietnamese descent participated in a series of focus groups. Content analyses of their discussions showed that good adolescents were obedient, helpful around the house, and respectful to parents and elders, and good parents were those who provide for, nurture, and monitor children's activities. The findings suggest that ideas about good parents and good adolescents are influenced by both the parents' traditions and by adolescents' acculturation to American values.

Adolescent↗

Use of cultural themes in promoting health among Southeast Asian refugees.

PURPOSE: Vietnamese, Cambodian, and Hmong refugee populations in the United States face serious physical and psychosocial health issues. Literature on these populations is largely descriptive of illnesses and of cultural beliefs or behavior patterns related to illness. There is minimal literature linking beliefs and behaviors to the underlying cultural themes. The purpose of this paper was to search the literature for cultural themes from which culturally relevant health promotion strategies could be designed. SEARCH METHODS: Literature was reviewed from the fields of health, social, and political science, history, and Southeast Asian folklore. Search methods included review of 147 writings from library and MEDLINE search and 123 interviews with refugees and key professionals in the field. This manuscript includes 106 selections as well as content from 93 interviews. FINDINGS AND CONCLUSIONS: From the literature emerged two cultural themes common to these population, kinship solidarity and the search for equilibrium. The use of these cultural themes as carriers of health messages is suggested. Examples of ways to link the message with the cultural theme are presented, including the use of folklore, recognition of cultural illnesses, and use of cultural knowledge in addressing new situations such as inner city urban survival. Cultural themes are a means of conveying health messages addressing such issues as transition in family structure, depression, and substance abuse.

Asian↗

Sero- and molecular typing of Duffy blood group in Southeast Asians and Oceanians.

Duffy blood group was studied among malaria-endemic Thai and Indonesian populations: Hmong (n = 103), Akha (n = 218), Lisu (n = 44), Bugis (n = 95), Toraja (n = 77), Dani (n = 44), Mee (n = 80) and Irianese (n = 81). Phenotypes were studied by the ordinal indirect Coombs' test and genotypes were determined by the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) test. DNA analysis was used to type the Duffy blood group system. Deduced allele frequencies of Fya (0.958-1.0) based on the phenotypes were similar to those in other populations in Southeast Asia and Oceania. The study revealed the presence of Fya-antigens showing weak reactivity to antisera as well as a discrepancy between the genotype shown by the PCR-RFLP study and that predicted by the phenotype. The PCR-RFLP study also suggested the presence of an alternative genetic basis for the Fy(a- b-) phenotype, which differs from the African type.

Alleles↗

Application of the Behavioral Model to Health Studies of Asian and Pacific Islander Americans.

PURPOSE. The purpose of this study is to review the literature to synthesize empirical health services research on Asian and Pacific Islander American (APIA) populations. Health studies of APIA are summarized using the Behavioral Model of Health Care Utilization, which has been expanded for racial and ethnic groups. METHODS. The MEDLINE databases from 1980 to 1994 were searched for all studies focusing on APIA populations using selected key words. In addition, we searched for comparative studies of APIA with other ethnic groups. Screened studies were assigned codes based on the expanded Behavioral Model using information contained in the abstracts. PRINCIPAL FINDINGS. Although the _number_ of studies that have been published on APIA populations have increased over the past 15 years, the _proportion_ of studies that focus on specific subgroups of the population has decreased. The populations that are most understudied relative to their size are Koreans and Filipinos. Most of the studies included population characteristics and evaluated/clinical outcomes, while studies of preceived and consumer satisfaction outcomes were relatively infrequent. CONCLUSIONS. Given the rapid growth of the APIA population, this group is underrepresented in the published work. Studies are needed that determine cultural influences on health status and outcomes of the health care system for ethnic subgrups of the APIA population. KEY WORDS. Asian Americans; Pacific Islanders; Behavioral Model; Asian Indian; Cambodian; Chinese; Filipino; Guamanian; Hawaiian; Hmong; Indochinese, Japanese, Koreans, Laos; Laotian; Samoan; Southeast Asian; Thai; and Vietnamese.

Journal Article↗

Fadiman and beyond--the dangers of extrapolation.

Cross-cultural patient care is an issue that challenges healthcare providers. Caring for patients who reject some biomedical treatments because of religious or cultural reasons requires knowledge of that person's beliefs for effective treatment. This essay looks at several case studies involving Hmong patients and the way the medical staff reacted to treatment difficulties because of cultural and religious conflicts with surgery. The dangers of universalizing communication methods are stressed.

Asian↗

Cancer occurrence in Southeast Asian children in California.

OBJECTIVES: To estimate misclassification of ethnicity and cancer incidence in Southeast Asian children using the population-based California Cancer Registry. METHODS: Asian race/ethnicity was evaluated using lists of Asian surnames. Average annual incidence rates (per million) for 1988 to 1992 were calculated for non-Hispanic white, black, Hispanic, and Asian children (age <15 years). Proportional incidence ratios (PIRs) for 1988 to 1995 were used to compare Southeast Asian children to non-Hispanic white children. RESULTS: Of the Asian children, 4.2% (30/722) were misclassified by subgroup, predominantly Hmong listed as Laotian. The Asian cancer rate was 134.2 versus 159.2 for non-Hispanic whites. The germ cell tumor rate was higher in Asians (9.9) than in non-Hispanic whites (4.8), but the Wilms tumor rate was two-thirds lower (3.1 vs. 9.2). The rates of Hodgkin lymphoma and central nervous system tumors were lower (2.8 vs. 5.6 and 20.0 vs. 33.8) in Asians than non-Hispanic whites. Compared with non-Hispanic whites, the PIR for Wilms tumor in Southeast Asian children was reduced (PIR = 0.1). Southeast Asian children had increased PIRs for Burkitt lymphoma (PIR = 2.6) and leukemias not classified as acute lymphocytic leukemia or acute nonlymphocytic leukemia (PIR = 3.5). CONCLUSIONS: Accurate race/ethnicity classification of Southeast Asian children is a concern. Marked differences were found in the incidence and PIRs of specific cancers among Southeast Asian children, other Asian children, and other children in California.

Adolescent↗