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PubMed1996

The effect of lifestyle on wheeze, atopy, and bronchial hyperreactivity in Asian and white children.

There is increasing evidence linking Western culture to increasing prevalence of asthma. We have measured the prevalence of symptoms of asthma, bronchial hyperreactivity, and atopy in a sample of white and Asian inner city schoolchildren aged 8-11 yr in the U.K. and assessed the influence of certain aspects of western culture on these variables. Bronchial reactivity was measured by methacholine challenge, atopy by allergen skin prick tests, and symptoms of asthma and aspects of lifestyle by questionnaire. Degree of Westernization was assessed from dietary habit categorized as exclusively Asian, mostly Asian, mixed, or exclusively English. The questionnaire was completed by 92% of children. The 308 white and 539 Asian children were of similar age (mean 9.3 yr versus 9.4 yr) with slightly more girls in the Asian group (52.6% versus 47.4%). The white children reported more wheeze within the past year (14.2% versus 8.8%, p = 0.01) but less were atopic (29.5% versus 38.4%, p = 0.01) with no significant difference in the prevalence of hyperreactivity (31.5% versus 29.6%, p = 0.57). Most Asians (97%) included Asian food in their diet; 35% ate a mostly Asian diet, 45% ate a mixed English and Asian diet, and 17% ate an exclusively Asian diet. After controlling for confounding factors whites were at higher risk of hyperreactivity and lower risk of atopy, and the risk of hyperreactivity and to a lesser extent atopy among Asian children was related to diet in a dose response fashion. The relative odds for hyperreactivity with an exclusively Asian, mostly Asian, or a mixed diet relative to an English diet were 0.31 (95% CI 0.15 to 0.62), 0.88 (0.56 to 1.37), and 0.99 (0.65 to 1.49), and for atopy were 1.22 (0.72 to 2.06), 1.47 (0.99 to 2.19), and 1.78 (1.23 to 2.58). These results suggest that diet or other closely related factors associated with Westernization are involved in the etiology of atopy and hyperreactivity.

Asian People↗

PubMed2005

Health problems and hospitalizations among Asian-American ethnic groups.

OBJECTIVES: To study health status and hospitalization risk among Asian Americans. DESIGN: Cross-sectional analyses and cohort study. SETTING: Comprehensive prepaid health care program in Northern California. PATIENTS: Adult Asian Americans (N=13,592), self-classified at health examinations as 6050 (44.5%) Chinese, 1707 (12.6%) Japanese, 4232 (31.1%) Filipinos, 714 (5.3%) South Asians, and 889 (6.5%) Other Asians. INTERVENTIONS: None except data analysis. OUTCOME MEASURES: With Chinese and Whites (n=72,019) as referents, comparison of symptom composites by logistic regression and hospitalization risk by Cox proportional hazards models. RESULTS: Compared to Chinese, Filipinos, South Asians, and other Asians more frequently reported coronary, respiratory, gastrointestinal, and emotional problems. Chinese and Japanese generally had the lowest hospitalization risk. Compared to Chinese, hospitalization risk was higher (P<.05) among Filipinos for circulatory (men or women), respiratory (men), and digestive (women) conditions (relative risks [RR] range from 1.5 to 1.7) and among South Asian men for cardiovascular conditions (RR=2.2). While Asian groups generally had similar or lower hospitalization risk than Whites, risks were higher for asthma (Filipino and South Asian men, RRs >3.0), peptic ulcer (Chinese men, Filipino men and women, other Asian women [RRs 1.9-5.6]), and coronary disease (South Asian men (RR=2.3) and Filipino women (RR=1.5). CONCLUSIONS: Variations in risk of hospitalization and frequency of reported health problems point out differences in health problems and health needs among subgroups of Asian Americans. This diversity shows the need to study Asian ethnic groups separately.

Adult↗

PubMedDate not supplied

Study on size distribution of total aerosol and water-soluble ions during an Asian dust storm event at Jeju Island, Korea.

Soil dust particles transported from loess regions of the Asian continent, called Asian dust, highly influences the air quality of north-eastern Asia and the northern Pacific Ocean. In order to investigate the effects of these dust storms on the chemical composition of atmospheric aerosol particles with different size, measurements of size distributions of total aerosol and major ion species were carried out on Jeju Island, Korea during April 2001. Juju Island was chosen for the study because the levels of emissions of anthropogenic air pollutants are very low. A 5-stage cascade impactor was used to sample size-fractionated aerosol particles. Samples were analyzed for major water-soluble ions using Dionex DX-120 ion chromatograph. The average mass concentration of total aerosol was found to be 24.4 and 108.3 microg m(-3) for non-Asian dust and Asian dust periods, respectively. The total aerosol size distribution, measured during the non-Asian dust period, was bimodal, whereas the coarse particles dominated the size distribution of total aerosol during the Asian dust period. It was found that SO4(2-), NH4+ and K+ were mainly distributed in fine particles, while Cl-, NO3-, Na+, Mg2+ and Ca2+ were in coarse particles. Although SO4(2-) was mainly distributed in fine particles, during the Asian dust period, the concentrations in coarse particles were significantly increased. This indicates heterogeneous oxidation of SO2 on wet surfaces of basic soil dust particles. The NH4+ was found to exist as (NH4)2SO4 in fine particles, with a molar ratio of NH4+ to SO4(2-) of 2.37 and 1.52 for non-Asian dust and Asian dust periods, respectively. Taking into account the proximity of the sampling site to the sea, and the observed chloride depletion, coarse mode nitrate, during the non-Asian dust period, is assumed to originate from the reaction of nitric acid with sodium chloride on the surfaces of sea-salt particles although the chloride depletion was not shown to be large enough to prove this assumption. During the Asian dust period, however, chloride depletion was much smaller, indicating coarse nitrate particles were mainly produced by the reaction of nitric acid with surfaces of basic soil particles. Most chloride and sodium components were shown to originate from sea-salt particles. Asian dust aerosols, arriving at Jeju Island, contained considerable amounts of sea-salt particles as they passed over the Yellow Sea. Ca2+ was shown to be the most abundant species in Asian dust particles.

Aerosols↗

PubMed2000

Involutional entropion and ectropion of the Asian lower eyelid.

PURPOSE: A clinical observation showed that involutional entropion of the lower eyelid in Asians may occur more commonly than ectropion. A review of surgical cases was performed to examine this hypothesis. METHODS: A retrospective review of the number of Asian lower lid involutional ectropion and entropion repairs was performed in three different clinical practice settings. These data were compared and statistically analyzed with similar data for non-Asian patients. RESULTS: The frequency of ectropion among Asians was significantly less than in non-Asians (chi-square, p < 0.001). Asian entropion repair represented 11.4% of the 604 eyelid operations performed on Asians, whereas Asian ectropion repair made up only 1.5% of cases. Non-Asian entropion and ectropion repairs were 3.7% and 6.2%, respectively, of the 1,849 eyelid procedures performed on non-Asians. CONCLUSIONS: Because of the normal anteriorly protruding position of the orbital fat within the Asian lower eyelid, Asians may be more predisposed than whites to the development of involutional entropion rather than ectropion. Removal of lower eyelid fat should be considered in entropion repair of the Asian lower eyelid.

Adipose Tissue↗

PubMed1989

Disturbances of insulin in British Asian and white men surviving myocardial infarction.

OBJECTIVE: To examine the role of insulin as a cardiovascular risk factor in British Asian and white men. DESIGN: Case-controlled study of survivors of first myocardial infarction. SETTING: District general hospital. PATIENTS: Consecutive series of 76 white and 74 Asian men who survived first myocardial infarction compared with 58 white and 61 Asian male controls without coronary artery disease who were randomly sampled from the community. RESULTS: More Asians than white subjects had impaired glucose tolerance or overt diabetes as measured by the two hour glucose tolerance test (23/74 (32%) v 11/76 (15%) (p less than 0.001) among patients; 17/61 (28%) v 3/58 (6%) (p less than 0.001) among controls). Insulin and C peptide concentrations were higher in both patient groups than in respective controls (p less than 0.001) and higher in Asian than in white subjects, irrespective of their glucose tolerance. Triglyceride concentrations were higher in patients than in controls (1.92 (SD 1.05) v 1.43 (0.82) mmol/l among Asian men; 1.65 (0.83) v 1.3 (0.61) mmol/l among white subjects; p less than 0.001). Total cholesterol concentrations were lower in both groups of Asians than in respective white subjects (5.78 (0.99) v 6.22 (1.04) mmol/l (p less than 0.01) among patients; 5.54 (1.01) v 5.65 (1.11) mmol/l (p less than 0.6) among controls). High density lipoprotein cholesterol concentrations were lower in Asian than in white subjects. The ratio of total cholesterol to high density lipoprotein cholesterol was significantly higher (p less than 0.001) in both patient groups (6.69 (1.81) in Asian patients and 6.31 (1.91) in white patients) than in respective controls (5.24 (1.19) and 4.77 (1.43)). Regression analysis identified C peptide concentration and the ratio of total to high density lipoprotein cholesterol as powerful independent predictors of myocardial infarction in Asian and white men. Total cholesterol concentration predicted infarction in white but not in Asian men. CONCLUSIONS: Secretion and hepatic extraction of insulin are high in survivors of myocardial infarction and especially high in British Asians. Tissue resistance to the action of insulin, giving rise to increased pancreatic secretion, may be an important risk factor for coronary artery disease in both ethnic groups and may be partly responsible for the high incidence of diabetes and coronary artery disease in Asian populations.

Asia↗

PubMed1996

The admission of Asian patients to intensive therapy units and its implications for kidney donation: a preliminary report from Coventry, UK.

OBJECTIVE: To determine the relative admission rates of Asian and non-Asian patients to intensive therapy units (ITUs) in Coventry and to explore the implications of these rates for the transplantation of organs to Asian people. DESIGN: Examination of 1991 census data and a retrospective review of ITU admissions books. Data were collected on ethnic background, presenting diagnosis, and clinical outcome for each admission. SETTING: The three ITUs in Coventry. PATIENTS: All admissions to the ITUs from 1990-93 inclusive. RESULTS: Asian patients were admitted to ITUs disproportionately to their numbers in the Coventry population. Members of the Asian community were less than half as likely to be admitted to an ITU (p < 0.001) and more likely to die while there (p = 0.007) than members of the non-Asian population in Coventry. The proportions of patients referred to the transplant unit and the rates of subsequent donation do not seem to differ significantly for Asian and non-Asian patients (p = 0.26 in both cases). CONCLUSIONS: There are clear implications for the availability of cadaveric kidney transplantation to Asian patients, given that few kidneys from non-Asian donors are histocompatible with Asian recipients. Indeed, in Asians, promotion of living related donation may be more effective in countering the organ shortfall than efforts to increase consent to cadaveric transplantation. However, it may be valuable to investigate any patterns of morbidity or social or cultural factors that might explain the initial low admissions rates to ITUs for Asian patients.

Asia↗

PubMed2007

Risk factors for early myocardial infarction in South Asians compared with individuals in other countries.

CONTEXT: South Asians have high rates of acute myocardial infarction (AMI) at younger ages compared with individuals from other countries but the reasons for this are unclear. OBJECTIVE: To evaluate the association of risk factors for AMI in native South Asians, especially at younger ages, compared with individuals from other countries. DESIGN, SETTING, AND PARTICIPANTS: Standardized case-control study of 1732 cases with first AMI and 2204 controls matched by age and sex from 15 medical centers in 5 South Asian countries and 10,728 cases and 12,431 controls from other countries. Individuals were recruited to the study between February 1999 and March 2003. MAIN OUTCOME MEASURE: Association of risk factors for AMI. RESULTS: The mean (SD) age for first AMI was lower in South Asian countries (53.0 [11.4] years) than in other countries (58.8 [12.2] years; P<.001). Protective factors were lower in South Asian controls than in controls from other countries (moderate- or high-intensity exercise, 6.1% vs 21.6%; daily intake of fruits and vegetables, 26.5% vs 45.2%; alcohol consumption > or =once/wk, 10.7% vs 26.9%). However, some harmful factors were more common in native South Asians than in individuals from other countries (elevated apolipoprotein B(100) /apolipoprotein A-I ratio, 43.8% vs 31.8%; history of diabetes, 9.5% vs 7.2%). Similar relative associations were found in South Asians compared with individuals from other countries for the risk factors of current and former smoking, apolipoprotein B100/apolipoprotein A-I ratio for the top vs lowest tertile, waist-to-hip ratio for the top vs lowest tertile, history of hypertension, history of diabetes, psychosocial factors such as depression and stress at work or home, regular moderate- or high-intensity exercise, and daily intake of fruits and vegetables. Alcohol consumption was not found to be a risk factor for AMI in South Asians. The combined odds ratio for all 9 risk factors was similar in South Asians (123.3; 95% confidence interval [CI], 38.7-400.2] and in individuals from other countries (125.7; 95% CI, 88.5-178.4). The similarities in the odds ratios for the risk factors explained a high and similar degree of population attributable risk in both groups (85.8% [95% CI, 78.0%-93.7%] vs 88.2% [95% CI, 86.3%-89.9%], respectively). When stratified by age, South Asians had more risk factors at ages younger than 60 years. After adjusting for all 9 risk factors, the predictive probability of classifying an AMI case as being younger than 40 years was similar in individuals from South Asian countries and those from other countries. CONCLUSION: The earlier age of AMI in South Asians can be largely explained by higher risk factor levels at younger ages.

Adult↗

PubMed2005

Burn patterns of Asian ethnic minorities living in West Yorkshire, UK.

Whereas burn morbidity and mortality have been well studied among natives of Southeast Asia, few have studied the epidemiology of burn injury among UK Asian ethnic minority immigrants. A 1 year prospective study of all patients presenting with burns to Bradford Royal Infirmary was carried out. Four hundred and sixty patients were studied, 188 (41%) were Asian ethnic minorities. The average patient age was 17 years for the Asian group and 27 years for the non-Asian patients. Contact burns were responsible for 29% of injuries in Asian patients and 19% in the other group. Thirty-seven percent of contact burns in the Asian ethnic minority group were caused by hot irons. Eleven percent of Asian patients had treated their burn with inappropriate remedies including saiti, butter, and toothpaste. There were no significant differences between Asian and non-Asian patients in terms of large or deep burns, nor in mortality. Morbidity and mortality from burn injury among UK Asian patients and other groups in the UK are similar; however, a disproportionate number of Asian patients sustain smaller burns. Much of this is behaviour related, and it is hoped that through preventative measures a marked reduction in the number of Asian ethnic minority burns can be achieved.

Adolescent↗

PubMed1992

Does the MRCGP examination discriminate against Asian doctors?

OBJECTIVE: To ascertain whether the membership examination for the Royal College of General Practitioners (MRCGP) discriminates against doctors of Indian subcontinent ethnic origin ("Asian doctors"). DESIGN: Retrospective analysis of data from five administrations of the MRCGP examination (December 1988-December 1990). SETTING: United Kingdom national examination body. SUBJECTS: 3686 doctors taking the examination for the first time, 244 of whom were classified as Asian, the remainder as non-Asian. MAIN OUTCOME MEASURES: Comparison of performance in each of the written and oral components of the examination between Asian doctors, identified by their names and classified into subgroups by countries of birth and primary medical training from data provided at registration, and non-Asian doctors. RESULTS: On written components of the examination (multiple choice paper mean score Asians versus non-Asians 42.3 v 48.6, modified essay paper 40.9 v 48.9, practice topic/critical reading paper 41.5 v 48.7, all p less than 0.001 by t testing). But analysis by countries of birth and primary training showed that these differences were due largely to poor performance by certain groups of Asian doctors, especially those born and trained in the Indian subcontinent or elsewhere outside the United Kingdom. Asian doctors born and trained in the United Kingdom and those born in Africa or the West Indies and trained in the United Kingdom performed similarly to the non-Asian doctors. CONCLUSIONS: The examination does not systematically discriminate against Asian doctors, but the poor performance of the two subgroups of Asians is cause for serious concern and requires investigation.

Asia↗

PubMed1998

Generational continuity and change in British Asian health and health behaviour.

OBJECTIVES: To trace patterns of health and health behaviour in those with ancestry in the Indian subcontinent (British Asians) compared with the general population of their age (1) in the younger generation age 14-15 mainly born in the UK and (2) in the older mainly migrant generation. DESIGN: Cross sectional random sample surveys of two age groups in Glasgow. SAMPLES: 334 British Asians (86% born in the UK) and 490 non-Asians, all aged 14-15; 173 British Asians aged 30-40 (mean age 35, 93% born abroad), and 344 general population aged 35. MEASURES: Health: self assessed health/fitness, longstanding/limiting illness, chronic phlegm, accidents, symptoms, tooth loss. Health behaviour: smoking, alcohol, drugs, exercise. RESULTS: At age 14-15, compared with non-Asian counterparts: fewer British Asian girls reported limiting illness (p < 0.05) or chronic phlegm (p < 0.01), fewer boys reported accidents (p < 0.01), and fewer of both sexes had lost second teeth (p < 0.05); more of both sexes reported not smoking, drinking alcohol, or using drugs (p < 0.01 or below), fewer reported frequent exercise (p < 0.05 or below). Smoking patterns were consistently related to ethnic differences in chronic phlegm, and patterns of alcohol consumption to those in accidents. In health, British Asian girls aged 14-15 generally compared more favourably with non-Asian counterparts than did those aged 30-40. The reverse was true for British Asian male subjects. In health behaviour, British Asians of both sexes aged 14-15 showed strong continuities with those aged 30-40. CONCLUSIONS: Favourable health behaviour has brought a health advantage to young British born Asians, even though this was not the case in the migrant generation. Female health disadvantage is also much less marked than in migrants aged 30-40, but may re-emerge between ages 15-30. Migrant Asian male subjects may have had misleadingly high respiratory health levels because of positive selection.

Adolescent↗

PubMed2006

[Prevalence of diabetes mellitus in young Asian Indian immigrants in Santa Coloma de Gramenet (Spain)].

BACKGROUND AND OBJECTIVE: There is a general agreement to consider Asian Indian subjects, specially those who immigrated to Western countries, as a high-risk population to develop type 2 diabetes mellitus (DM2). This could be mainly explained by reasons based on the immigration changes, particularly the metabolic impact of a westernized diet (environmental hypothesis) or reasons based in the presence of tissue resistance to insulin (genetic hypothesis). The aim of the study was to estimate the prevalence of DM2 in 3 populations of Asian Indian immigrants, non-Asian Indian immigrants and autochthonous subjects. POPULATION AND METHOD: An observational multicenter study was performed in 3 primary care centers from Santa Coloma de Gramenet (Barcelona, Spain). Subjects from Asian Indian, non-Asian Indian and autochthonous origin born between 1948-73 were compared. Their DM2 prevalence as well as sociodemographic and clinical data among diabetic patients were analyzed. RESULTS: The overall prevalence of DM2 was 4.6 %. The prevalence of DM2 was higher among Asian Indian immigrants (20.9%, 95% CI, 12.1-29.1) compared with autochthonous (3.6%; 95% CI, 2.9-9.3; p < 0.001) and non-Asian Indian immigrants (9.7%; 95% CI, 5.3-14.1; p = 0.013). Nevertheless, differences between autochthonous and non-Asian Indian immigrants were found (p < 0.001). Asian Indians subjects had an earlier diagnosis age, especially those younger than 44 years, than those of non-Asian Indian immigrants and autochthonous groups (p < 0.002 and p < 0.006, respectively). CONCLUSIONS: Taken together, these results suggest that young immigrant populations have a higher prevalence of DM2 compared with autochthonous ones. Indeed, the prevalence of DM2 among immigrant Asian Indians represents the highest reported in the European Union so far and shows differences with non-Asian Indian immigrants. In spite of this, these differences are not totally conclusive in statistical terms; further studies are needed to compare both populations.

Adult↗

PubMed2000

Methylenetetrahydrofolate reductase 677 C-->T mutation and coronary heart disease risk in UK Indian Asians.

Plasma homocysteine concentrations are elevated in UK Indian Asians and may contribute to twice as many coronary heart disease (CHD) deaths in this group compared with European whites. The mechanisms underlying elevated homocysteine concentrations among Indian Asians are not well understood. In this study, we have investigated the extent to which the methylenetetrahydrofolate reductase (MTHFR) 677 C-->T mutation accounts for elevated plasma homocysteine and increased CHD risk in Indian Asians compared with European whites. We investigated 454 male cases (with myocardial infarction or angiographically proven CHD: 224 Indian Asians, 230 European whites) and 805 healthy male controls (381 Indian Asians, 424 European whites). Fasting homocysteine concentrations, MTHFR 677 C-->T genotype, and conventional CHD risk factors were measured. The prevalence of homozygous MTHFR 677T in Indian Asian controls was less than one third that in European white controls (3.1% versus 9. 7%, P<0.001). In Indian Asians, the TT MTHFR genotype was not associated with homocysteine concentrations and was not present in any of the Asian controls with hyperhomocysteinemia (>15 micromol/L). In contrast, among European whites, the TT MTHFR genotype was strongly related to elevated plasma homocysteine concentrations and was found in 27% of the European controls with hyperhomocysteinemia. Elevated homocysteine in Indian Asian compared with European white controls was accounted for by their reduced levels of B vitamins but not by the MTHFR 677T genotype. However, neither the TT MTHFR genotype nor B vitamin levels explained the elevated homocysteine concentrations in CHD cases compared with controls. TT MTHFR was not a risk factor for early-onset CHD in Indian Asians (odds ratio, 0.5; 95% confidence interval, 0.1 to 2.4; P=0.39), unlike in European whites (odds ratio, 2.1; 95% confidence interval, 1.1 to 4. 1; P=0.02). We conclude that the MTHFR 677T: mutation does not contribute to elevated plasma homocysteine concentrations or increased CHD risk in Indian Asians compared with European whites. Our results suggest that novel genetic defects and/or environmental factors influence homocysteine metabolism in Indian Asians residing in the United Kingdom.

Adult↗

PubMed2004

Involving South Asian patients in clinical trials.

OBJECTIVES: To investigate how South Asian patients conceptualise the notion of clinical trials and to identify key processes that impact on trial participation and the extent to which communication difficulties, perceptions of risk and attitudes to authority influence these decisions. Also to identify whether 'South Asian' patients are homogeneous in these issues, and which factors differ between different South Asian subgroups and finally how professionals regard the involvement of South Asian patients and their views on strategies to increase participation. DATA SOURCES: A review of the literature on minority ethnic participation in clinical trials was followed by three qualitative interview studies. Interviews were taped and transcribed (and translated if required) and subjected to framework analysis. Face-to-face interviews were conducted with 25 health professionals; 60 South Asian lay people who had not taken part in a trial and 15 South Asian trial participants. RESULTS: Motivations for trial participation were identified as follows: to help society, to improve own health or that of family and friends, out of obligation to the doctor and to increase scientific knowledge. Deterrents were concerns about drug side-effects, busy lifestyles, language, previous bad experiences, mistrust and feelings of not belonging to British society. There was no evidence of antipathy amongst South Asians to the concept of clinical trials and, overall, the younger respondents were more knowledgeable than the older ones. Problems are more likely to be associated with service delivery. Lack of being approached was a common response. Lay-reported factors that might affect South Asian participation in clinical trials include age, language, social class, feeling of not belonging/mistrust, culture and religion. Awareness of clinical trials varied between each group. There are more similarities than differences in attitudes towards clinical trial participation between the South Asian and the general population. Important decisions, such as participation in clinical trials, are likely to be made by those family members who are fluent in English and younger. Social class appears to be more important than ethnicity, and older South Asian people and those from working class backgrounds appear to be more mistrustful. Approachable patients (of the same gender, social class and fluent in English) tend to be 'cherry picked' to clinical trials. This practice was justified because of a lack of time and resources and inadequate support. South Asian patients might be systematically excluded from trials owing to the increased cost and time associated with their inclusion, particularly in relation to the language barrier. Under-representation might also be due to passive exclusion associated with cultural stereotypes. Other characteristics such as gender, age, educational level and social class can also affect trial inclusion. CONCLUSIONS: Effective strategies for South Asian recruitment to clinical trials include: using multi-recruitment strategies; defining the demographic and social profiles of the population to be included; using focus groups to identify any potential barriers; consulting representative community members to provide assistance in the study; ensuring eligibility criteria are set as wide as possible; developing educational and recruitment approaches to attract ethnic minority health professionals; ensuring health professionals are adequately trained in culturally and ethnically orientated service provision; determining the most effective mass media to use in study promotion and recruitment; and targeting inner-city, single-handed practices likely to have high ethnic minority populations. Future research should consider: responses when invited to participate; the role of methodological and organisational barriers to recruitment; the complexities of recruitment from a health professional perspective; developing culturally sensitive research methods; the magnitude of the problem of under-recruitment; strategies to encourage inner-city, single-handed GP participation; and other factors affecting trial inclusion, such as age, gender, educational level and socio-cultural background.

Attitude of Health Personnel↗

PubMed1993

Lessons Learned and Baseline Data from Initiating Smoking Cessation Research with Southeast Asian Adults.

PURPOSES OF THE PAPER: The purposes of this paper are as follows: (1) discuss seven design considerations and their respective lessons learned or resolutions in initiating the National Institutes of Health's only funded smoking cessation grant targeting Asian Americans; (2) present empirical findings that resulted from the design considerations alluded to previously; and (3) delineate unresolved challenges on conducting smoking cessation research particularly for adult Southeast Asians. SUMMARY OF METHODS UTILIZED: The authors base this paper on their empirical data collected as part of the "Lay-led Smoking Cessation Approach for S.E. Asian men" study. Data collected include baseline data from 1553 adult Southeast Asians (721 women and 832 men) in Ohio as well as subsequent data collected on selected individuals. The investigators faced seven major, conceptual issues in initiating smoking cessation research focusing on Southeast Asian adults. These seven considerations related to: language, culture, nicotine addiction characteristics, verification of smoking exposure and smoking status, knowledge of the health consequences of smoking, social environmental factors, and criteria for evaluating effectiveness of the proposed intervention. Smoking cessation interventions must be conducted in the appropriate Asian language because current smokers are the least likely to understand spoken English. Culturally speaking, Cambodian and Laotian male smokers are significantly more likely to have traditional Southeast Asian values than their never smoker counterparts. As a measure of addiction to nicotine, the median time until the first cigarette was 30 minutes for both Cambodians and Vietnamese suggesting that these men are highly addicted. Cotinine levels were negatively correlated with time to the first cigarette and positively correlated with numbers of cigarettes. Knowledge of the health consequences of smoking is lower than mainstream populations. Almost 100 per cent of Southeast Asian male smokers have at least one "best" friend who smokes. Verification of smoking status through saliva cotinine testing suggest that actual smoking rates among Southeast Asians are higher than selfreport rates. The largest proportion of Cambodian and Vietnamese smokers are in the precontemplation stage while Laotian smokers are proportionally more likely to be in the contemplation stage. CONCLUSIONS: Design considerations discussed represent considerations beyond those that are normally considered in communitybased research for majority populations. The quality and quantity of empirical data collected with due attention to these conceptual considerations appear to substantiate the validity of these considerations. Authors delineated challenges for initiating smoking cessation research among Southeast Asians. RELEVANCE TO ASIAN PACIFIC ISLANDER AMERICAN POPULATIONS: This paper is particularly relevant for increasing the data base on adult Cambodians, Laotians, and Vietnamese. KEY WORDS: Asian Americans, Cambodians, Laotians, Vietnamese, culture, language, tobacco, smoking cessation, nicotine

Journal Article↗

PubMed1999

Survival advantage in Asian American end-stage renal disease patients.

UNLABELLED: Survival advantage in Asian American end-stage renal disease patients. BACKGROUND: An earlier study documented a lower mortality risk for end-stage renal disease (ESRD) patients in Japan compared with the United States. We compared the mortality of Caucasian (white) and Asian American dialysis patients in the United States to evaluate whether Asian ancestry was associated with lower mortality in the United States. METHODS: The study sample from the U.S. Renal Data System census of ESRD patients treated in the United States included 84,192 white or Asian patients starting dialysis during May 1995 to April 1997, of whom 18,435 died by April 30, 1997. Patient characteristics were described by race. Relative mortality risks (RRs) for Asian Americans relative to whites were analyzed by Cox proportional hazards regression models adjusting for characteristics and comorbidities. Population death rates were derived from vital statistics for the United States and Japan by age and sex. RESULTS: Adjusting for demographics, diabetes, comorbidities, and nutritional factors, the RR for Asian Americans was 0.75 (P = 0.0001). Race-specific background population death rates accounted for over half of the race-related mortality difference. For whites, mortality decreased as the body mass index (BMI) increased. For Asians, the relationship between BMI and survival was u-shaped. The ratio of Asian American/white dialysis death rates and the ratio of Asian American/white general population death rates both varied by age in a similar pattern. The population death rates of Asian American and Japanese were also similar. CONCLUSION: Among dialysis patients, Asian Americans had a markedly lower adjusted RR than whites. The effect of BMI on survival differed by race. Compared with the respective general population, dialysis patients had the same relative increase in death rates for both races. The difference in death rates between the United States and Japan does not appear to be primarily treatment related, but rather is related to background death rates.

Adult↗

PubMed2000

Asian gastric cancer patients at a southern California comprehensive cancer center are diagnosed with less advanced disease and have superior stage-stratified survival.

The 5-year overall survival after curative gastrectomy for gastric cancer is markedly different in the West from that in the Far East. Japanese surgeons feel that extended lymphadenectomy contributes to this superior survival, although survival differences may reflect improved staging or less aggressive tumor biology. We analyzed consecutive cases of gastric adenocarcinoma diagnosed and treated at the University of California, Irvine Medical Center from 1989 through 1998 to determine whether patients of Asian descent diagnosed with gastric cancer in Southern California have improved outcome. Fifty-two cases (36%) occurred in patients of Asian descent (39% Vietnamese, 31% Chinese, 13% Korean, 6% Filipino, and 2% Japanese). Only one Asian patient was born in the United States. Non-Asian patients (67% white, 30% Latino, and 3% black) were younger (59 years vs 64 years; P < 0.05) and more likely to have tumors of the gastroesophageal junction (33% vs 4%; P < 0.001). Asian patients were less likely to have distant metastases (24% vs 39%; P = 0.08), were more likely to undergo formal gastrectomy (71% vs 45%; P < 0.01), and were more likely to undergo a curative resection (40% vs 18%; P < 0.01). The overall survival of Asian patients at 3 years was significantly higher than the overall survival of non-Asians (39.4% vs 19.6%, P < 0.05). Asians with regional (node-positive) disease had superior survival (40.2% vs 14.8%, P < 0.05), which can be largely attributed to greater rates of resectability. We conclude that the clinical behavior of gastric cancer in Asians in Southern California differs from that in non-Asians. The increased proportion of resectable disease and improved survival of patients of Asian descent likely reflects less aggressive tumor biology.

Adenocarcinoma↗

PubMed1999

The Asian upper eyelid: an anatomical study with comparison to the Caucasian eyelid.

OBJECTIVE: To evaluate the differences between Asian and Caucasian upper eyelid anatomy through cadaver dissection, histopathological study, and magnetic resonance imaging. MATERIALS AND METHODS: Upper eyelids of 9 Korean and 5 Caucasian cadavers were dissected, and then were studied microscopically with hematoxylin-eosin, Masson trichrome, and elastin stains. Four healthy young Korean men were studied by dynamic high-resolution magnetic resonance imaging with regard to demonstration of upper eyelid structure. RESULTS: More subcutaneous and suborbicularis fat, with a pretarsal fat component, is present in Asian eyelids. The Asian double eyelids showed an amount of fat intermediate between Asian single eyelids and Caucasian eyelids. Asian single eyelids showed fusion of the orbital septum to the levator aponeurosis below the superior tarsal border, while fusion is above the superior tarsal border in Caucasians. The preaponeurotic fat pad descends anteriorly to the tarsal plate in the Asian single eyelid, but not in the Caucasian eyelid. A pretarsal fat pad is identified in the Asian single eyelids. CONCLUSIONS: The causes of absent or lower crease in the Asian upper eyelid are as follows: (1) the orbital septum fuses to the levator aponeurosis at variable distances below the superior tarsal border; (2) preaponeurotic fat pad protrusion and a thick subcutaneous fat layer prevent levator fibers from extending toward the skin near the superior tarsal border; and (3) the primary insertion of the levator aponeurosis into the orbicularis muscle and into the upper eyelid skin occurs closer to the eyelid margin in Asians. Structural differences relating to increased fat in the Asian upper eyelid include the presence of a pretarsal fat pad and a moderate fat increase in the double Asian eyelid.

Adipose Tissue↗

PubMed2002

Neonatal jaundice in Asian, white, and mixed-race infants.

BACKGROUND: East Asians have inherently higher bilirubin levels at birth than whites. The potential for unnecessary treatment makes jaundice a problem of public health and clinical significance. OBJECTIVES: To report the occurrence of jaundice diagnoses in East Asian and mixed East Asian/white infants in Washington State in recent years, and to compare the risk of diagnosis with neonatal jaundice among these infants, relative to white infants. DESIGN: Population-based cohort study in Washington state. Participants were infants of full East Asian parentage (n = 3000), maternal Asian parentage (n = 2997), paternal Asian parentage (n = 2048), and white parentage (n = 3000). Diagnoses of jaundice and "severe jaundice" were identified using International Classification of Diseases, Ninth Revision (ICD-9) diagnosis and procedure codes from hospital discharge records. RESULTS: Infants of full East Asian parentage were more likely to be diagnosed with jaundice than were white infants (relative risk [RR], 1.37; 95% confidence interval [CI], 1.16-1.62). For infants with Asian mothers and white fathers, the RR was 1.09 (95% CI, 0.91-1.30). Infants with Asian fathers and white mothers had an RR of 1.26 (95% CI, 1.05-1.52). The risk of severe jaundice requiring phototherapy, blood transfusion, or rehospitalization, however, was significantly elevated only for infants of full East Asian parentage (RR, 1.7; 95% CI, 1.12-2.58). CONCLUSIONS: Diagnoses of neonatal jaundice occurred more often among East Asian and mixed Asian/white infants than among white infants. However, the risk of jaundice requiring extended hospital stay, rehospitalization, phototherapy, or blood transfusion was elevated only for infants of full East Asian parentage.

Adult↗