Prevalence of and Risk Factors for Diseases in Korean Americans and Native Koreans Undergoing Health Checkup / 가정의학회지

BACKGROUND: Korean Americans constitute the fifth largest subgroup in the Asian American population. Despite their increasing population, research and guidelines regarding their health status assessment and disease screening are lacking. This study aimed to compare the prevalence of diseases in Korean Americans and native Koreans to determine the risk factors and guidelines for disease screening. METHODS: Patients who visited the Gangnam Severance Hospital from February 2010 to May 2015 for a health checkup were enrolled in this study. Baseline characteristics, laboratory data, and the organs (stomach, colon, thyroid, brain, prostate, lung, liver, kidney, pancreas, adrenal gland, and heart) of patients were examined. Data regarding patients' dietary patterns were also obtained. Overall, 1,514 Korean Americans (group 1) and 1,514 native Koreans (group 2) were enrolled. RESULTS: The following diseases were more prevalent in group 1 than in group 2: reflux esophagitis (12.9% vs. 10%), gastric ulcer (3.0% vs. 5.5%), colorectal polyp (37.7% vs. 28.7%), hemorrhoids (32.2% vs. 29.9%), and benign prostatic hyperplasia (30.2% vs. 14.3%). Although not statistically significant, coronary artery disease has a high prevalence rate of >20% in both groups. Dietary patterns were not significant between the two groups. CONCLUSION: This study showed that the prevalence of several diseases in Korean Americans differed from that observed in native Koreans. Therefore, a foundation for setting up new guidelines for disease screening among Korean Americans is established.

Cross-cultural Validation of Instruments Measuring Health Beliefs about Colorectal Cancer Screening among Korean Americans

PURPOSE: The purpose of this study was to report the instrument modification and validation processes to make existing health belief model scales culturally appropriate for Korean Americans (KAs) regarding colorectal cancer (CRC) screening utilization. METHODS: Instrument translation, individual interviews using cognitive interviewing, and expert reviews were conducted during the instrument modification phase, and a pilot test and a cross-sectional survey were conducted during the instrument validation phase. Data analyses of the cross-sectional survey included internal consistency and construct validity using exploratory and confirmatory factor analysis. RESULTS: The main issues identified during the instrument modification phase were (a) cultural and linguistic translation issues and (b) newly developed items reflecting Korean cultural barriers. Cross-sectional survey analyses during the instrument validation phase revealed that all scales demonstrate good internal consistency reliability (Cronbach's alpha=.72~.88). Exploratory factor analysis showed that susceptibility and severity loaded on the same factor, which may indicate a threat variable. Items with low factor loadings in the confirmatory factor analysis may relate to (a) lack of knowledge about fecal occult blood testing and (b) multiple dimensions of the subscales. CONCLUSION: Methodological, sequential processes of instrument modification and validation, including translation, individual interviews, expert reviews, pilot testing and a cross-sectional survey, were provided in this study. The findings indicate that existing instruments need to be examined for CRC screening research involving KAs.

Cultural Factors Associated with Breast and Cervical Cancer Screening in Korean American Women in the US: An Integrative Literature Review

PURPOSE: This study examined current research theories and methods, cultural factors, and culturally relevant interventions associated with breast and cervical cancer screening in Korean American (KA) women. METHODS: Based on Ganong's guidelines, the literature on cultural factors associated with breast and cervical cancer screening in KA women was searched using MEDLINE and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases. Sixty-eight articles on breast cancer screening and 66 articles on cervical cancer screening were retrieved from both databases, and a total of 22 articles were included in the literature review based on the selection criteria. RESULTS: Of the 22 studies reviewed, 14 (63.6%) were descriptive and 8 (36.4%) were interventional. Many studies have used individual focused cognitive theories such as health belief model and different types of operationalization for measures of cultural beliefs. Cultural factors associated with breast and cervical cancer screening in KA women that were identified in descriptive quantitative and qualitative studies included family, embarrassment, preventive health orientation, fatalism, and acculturation. Most culturally relevant interventional studies used education programs, and all education was conducted by bilingual and bicultural health educators at sociocultural sites for KA women. CONCLUSIONS: Theories focusing on interpersonal relationships and standardized, reliable, and valid instruments to measure cultural concepts are needed to breast and cervical cancer screening research in KA women. Traditional cultural factors associated with cancer screening should be considered for practical implications and future research with KA women.

Psychometric Properties of a Measure Assessing Attitudes and Norms as Determinants of Intention to Use Oral Contraceptives

PURPOSE: Asian immigrant and Asian American women are less likely to use oral contraceptives (OCs) and tend to rely on low-efficacy methods of contraception. This contraceptive pattern remains poorly understood, in part, because no theory-driven measurement exists to assess psychosocial determinants essential in explaining behaviors related to OC use in this population. The current study aimed to evaluate the psychometric properties of a measure of attitudes and subjective norms toward OC use among Korean American women as a first step to determine whether the measure can be used in this population and, potentially, in other Asian ethnic groups. METHODS: The sample consisted of 329 Korean immigrant women living in New York City. The theory of reasoned action guided the development of the measure assessing attitudes and norms. Psychometric evaluation included item analysis, internal consistency estimates of reliability, and construct validity (i.e., factorial, discriminant, and predictive). RESULTS: All item-total correlations were above the recommendation of .30. The Cronbach's alpha for the attitudes and subjective norms measure was .88 and .86, respectively. Exploratory factor analyses revealed four interpretable factors, and confirmatory factor analyses confirmed that the factor structures derived from the exploratory factor analyses fit the data well. Discriminant and predictive validity of the measure were also established. CONCLUSIONS: The study provides support for the validity and reliability of the measure and its use for determining the degree to which Korean immigrant women intend to use OCs.

Changes in and Factors Affecting Second-hand Smoke Exposure in Nonsmoking Korean Americans in California: A Panel Study

PURPOSE: We evaluated changes in and factors affecting second-hand smoke (SHS) exposure in a panel study of nonsmokers. METHODS: This study was based on data from a larger study of tobacco use among a representative sample of adults of Korean descent residing in California. Participants included 846 males and 1,399 females who were nonsmokers at baseline (2005-2006) and at follow-up (2007-2009). Participants were selected by probability sampling and were interviewed by telephone. RESULTS: At baseline, 50.0% were exposed to any SHS, and at follow-up 2 years later, 60.4% were exposed to any SHS (p < .001). SHS exposure at baseline was associated with acculturation, employment, spousal smoking, and having a friend who smoked (p < .001). Employment, spousal smoking, and other family members smoking were associated with SHS at follow-up (p < .001). The odds ratio of SHS in the employed group declined from 2.01 at baseline to 1.53 at follow-up, that of the group having a smoking spouse increased from 1.88 to 2.36, and that of the group having other family members smoking increased from 1.20 to 1.69. CONCLUSIONS: We showed that SHS exposure increased among Korean American nonsmokers in California, and the most important variables explaining the change in SHS exposure involved smoking among others with whom the subject is associated. These findings could be used as objective evidence for developing public health policies to reduce SHS exposure.

Korean Americans' Beliefs about Colorectal Cancer Screening

PURPOSE: The purpose of this study was to assess Korean Americans' (KAs) health and cultural beliefs about colorectal cancer (CRC) and their CRC screening utilization in order to understand how health and cultural beliefs play a role in CRC screening utilization and why KAs have a low rate of CRC screening. METHODS: Face-to-face, individual interviews with 26 Korean immigrants aged 50 and older were conducted in Korean. A semi-structured interview guide with open-ended questions was used to explore participants' health and cultural beliefs about CRC and CRC screening. Recorded audio interviews were transcribed verbatim in Korean and coded using thematic analysis. RESULTS: The themes that emerged from analyzing the individual interview data were: (a) valuing their families before themselves; (b) seeing a doctor only if they have symptoms; (c) believing that they would not get CRC; (d) balancing the will to stay healthy and fatalism; and (e) refusing health information. CONCLUSION: Results show the critical need for in-depth understanding of unique health and cultural beliefs about CRC screening in KAs. These beliefs could be useful for future intervention strategies to change health and cultural beliefs in order to increase CRC screening participation in KAs.

Prevalence of and Risk Factors for Gastrointestinal Diseases in Korean Americans and Native Koreans Undergoing Screening Endoscopy

BACKGROUND/AIMS: In South Korea, health check-ups are readily accessible to the public. We aimed to compare the prevalence of upper gastrointestinal (GI) and lower GI diseases in Korean Americans and native Koreans to determine differences and risk factors. METHODS: In total, 1,942 subjects who visited Gangnam Severance Hospital from July 2008 to November 2010 for a health check-up were enrolled. Basic characteristics and laboratory data for the subjects were collected. Esophagogastroduodenoscopy and colonoscopy were performed. In total, 940 Korean Americans (group 1) and 1,002 native Koreans (group 2) were enrolled. RESULTS: The overall prevalence of GI diseases for each group (group 1 vs group 2) were as follows: reflux esophagitis (RE) (9.65% vs 7.9%), gastric ulcer (2.8% vs 3.4%), duodenal ulcer (2.3% vs 3.6%), gastric cancer (0.4% vs 0.3%), colorectal polyp (35.9% vs 35.6%), colorectal cancer (0.5% vs 0.5%), and hemorrhoids (29.4% vs 21.3%). The prevalence of hemorrhoids was significantly higher in group 1 than in group 2 (p=0.001). In the multivariable analysis of group 1, male sex, age over 50 years, hypercholesterolemia and hypertriglyceridemia predicted colorectal polyps. Male sex and high fasting glucose levels were associated with RE. CONCLUSIONS: Our study showed that the prevalence of GI diseases (except hemorrhoids) in Korean Americans was similar to that observed in native Koreans. Therefore, the Korean guidelines for upper and lower screening endoscopy may be applicable to Korean Americans.

Experiences of Korean-American Women with High Risk Hereditary Breast Cancer

PURPOSE: This micro-ethnographic study aimed to understand coping experiences of Korean-American (K-A) women after diagnosis with breast cancer due to a hereditary gene mutation. METHODS: Participatory observation and in-depth interviews were performed at one breast cancer screening center in Southern California, in 2005 with eleven first generation K-A immigrant women. All transcribed interviews and field notes were analyzed using ethnographic methodology. RESULTS: K-A women's experience varied based on acculturation risk factors including: limited English speaking ability; disrupted family relationships, individualistic family values, or intergenerational communication barriers; lack of Korean speaking nurses; and Korean physicians' who lacked knowledge about hereditary breast cancer risk. These risk factors led to isolation, loneliness, lack of emotional and social support. In comparison to Korean homeland women in a similar medical situation, these K-A immigrants felt disconnected from the healthcare system, family support and social resources which increased their struggling and impeded coping during their survivorship journey. These women were not able to access self-support groups, nor the valuable resources of nurse navigator programs. CONCLUSION: Professional oncology associations for nurses and physicians have a moral obligation to support and promote knowledge of hereditary cancer risk and self-help groups for non-native speaking immigrants.

Dietary Habits and Taste Preferences of the Korean Americans According to Self Body Image Perception and Length of Residence in US

BACKGROUND: Weight overestimation of Korean Americans may be associated with dietary habits and preferences for foods and tastes. METHODS: The subjects were 100 Korean Americans in New York City and LA and 100 Koreans in Seoul, who were 20-29 years old. Self-reported questionnaire consisted of age, height, weight, length of residence in US, preferences for 10 foods and 5 tastes, dietary habits and perception of self body image. Korean Americans were further divided into 3 groups according to length of residence in US. RESULTS: More Korean American women underestimated (27.3% vs. 5.8%), and less overestimated their body weights, than Korean women (31.8% vs. 53.8%, P=0.008). Korean Americans who overestimated their own body weights had significantly higher preference for salty taste and significantly lower dietary habit score regarding regular meals. CONCLUSIONS: Overestimation of self body size, rather than longer residence in US may be associated with the undesirable dietary habit and taste preference of Korean Americans, highlighting the importance of correct body image.

Relationships between Household Smoking Restrictions and Intention to Quit Smoking among Korean American Male Smokers in California

This cross-sectional study examined the relationships between household smoking restrictions and intentions to quit smoking among Korean American male smokers in California. We used data from the California Korean American Tobacco Use Survey (CKATUS), which was conducted in 2004 using computer-assisted telephone interviewing. Among the 2,545 respondents who participated in the CKATUS, the 387 male smokers who answered a question assessing their intention to quit smoking were included in the final analyses. In univariable analyses, smokers who reported having household smoking restrictions were more likely to intend to quit smoking as compared with those who did not (P<0.01). Other independent correlates of having an intention to quit smoking were being less than 50 yr of age, having spent more than 50% of one's life in the US, being assimilated, and having other smokers in the household. In a multiple logistic regression analysis, the significant correlates of having an intention to quit smoking were household smoking restrictions (complete or partial restriction vs. no restriction on smoking; odds ratio, 2.54; 95% confidence interval, 1.22-5.28) and absence of other smokers in the household. In conclusion, smoking restrictions in the household are associated with an intention to quit smoking among Korean American male smokers in California.

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.

Research on Health and Health Care of the Korean American Elder Population in the United States

No abstract available.

Relationship of Acculturation to Demographics and Dietary Habits Among Korean Americans / 대한지역사회영양학회지

This study investigated how acculturation varies with demographic variables and is related to dietary habits among Korean Americans. The respondents were 162 Korea Americans aged at least 18 years old residing in the Greater New York metropolitan area. The level of acculturation was measured using a modified Suinn-Lew Asian Self-Identity Acculturation(SL-ASIA) scale. Acculturation was operationally defined to be composed of 6 factors, which are language, media use, friendship, food, pride, and ethnic self-identity. Each factor in the level of acculturation was identified by how it is related to demographics and dietary habits in the method of correlation coefficients and stepwise multiple regressions analyses. The reliability of the modified SL-ASIA scale was high as measured by Cronbach alpha of .92. The level of acculturation was related to place of birth, age, length of residence in the U.S., and education. The younger, the longer they had lived in the U.S., and the more they were educated, the more acculturated. Acculturation could be predictable for 52% of its variance with all demographic variables. Among the 6 factors in the level of acculturation, five of them, language, media use friendship, food, and ethnic self-identity were correlated with dietary habit changes after immigration and type of meals. All 6 acculturation factors could predict 21% of change in dietary habits. the information from this study can be used to describe usual describe usual dietary habits according to various aspects of acculturation to better understand the dynamics among acculturation, demographics, and dietary habits.