Building a conceptual framework to culturally adapt health promotion and prevention programs at the deep structural level.

The debate on the effectiveness and merit for the amount of time, effort, and resources to culturally adapt health promotion and prevention programs continues. This may be due, in large part, to the lack of theory in commonly used methods to match programmatic content and delivery to the culture of a population, particularly at the deep structural level. This paper asserts that prior to the cultural adaptation of prevention programs, it is necessary to first develop a conceptual framework. We propose a multiphase approach to address key challenges in the science of cultural adaptation by first identifying and exploring relevant cultural factors that may affect the targeted health-related behavior prior to proceeding through steps of a stage model. The first phase involves developing an underlying conceptual framework that integrates cultural factors to ground this process. The second phase employs the different steps of a stage model. For Phase I of our approach, we offer four key steps and use our research study as an example of how these steps were applied to build a framework for the cultural adaptation of a family-based intervention to prevent adolescent alcohol use, Guiding Good Choices (GGC), to Chinese American families. We then provide a summary of the preliminary evidence from a few key relationships that were tested among our sample with the greater purpose of discussing how these findings might be used to culturally adapt GGC.

The mediating role of parent-child bonding to prevent adolescent alcohol abuse among Asian American families.

The purpose of this paper is to describe unique culturally-based factors that may increase the vulnerability of Asian American adolescents to engage in alcohol use and abuse and the role of parent-child bonding as a protective factor. In particular, this paper addresses the interactions among acculturation, alcohol use, and parent-child bonding and the challenges Asian American families face in strengthening parent-child bonds. We begin by examining likely causes for alienation that occur as a result of immigration to the United States. We then present the cultural context of Asian American families that can also serve to create distance between parent and child, including the contrasting cultural orientations of individualism and collectivism, Asian traditional values, differences in Eastern and Western parenting styles, and intergenerational cultural dissonance. Next, we present a review of the research that has examined acculturation as a risk factor for alcohol use and abuse among Asian American adolescents, with special attention to the mediating role of parent-child bonding. Finally, we conclude with recommendations for future research on the risk and protective factors for adolescent substance abuse, as well as other risky health behaviors among the growing population of Asian Americans in the United States.

Identifying individual and contextual barriers to seeking mental health services among Korean American immigrant women.

The purpose of this qualitative study was to explore perceptions about barriers to Korean American immigrant women's seeking mental health services. Four focus groups were conducted with 27 Korean American participants, including two groups of providers and two groups of community women. Discussions were recorded and transcribed to identify and code themes. Barriers included language problems, cultural differences, lack of time, financial limitations, lack of transportation, lack of knowledge, lack of funding for community agencies, lack of partnership with churches, and perceived stigma. Recommendations include ethnically and linguistically matched mental health services, community outreach services, training for providers, and community education.

Differential response effects of data collection mode in a cancer screening study of unmarried women ages 40-75 years: a randomized trial.

BACKGROUND: Little is known about the impact of data collection method on self-reported cancer screening behaviours, particularly among hard-to-reach populations. The purpose of this study is to examine the effects of data collection mode on response to indicators of cancer screenings by unmarried middle-aged and older women. METHODS: Three survey methods were evaluated for collecting data about mammography and Papanicolaou (hereafter, Pap) testing among heterosexual and sexual minority (e.g., lesbian and bisexual) women. Women ages 40-75 were recruited from June 2003 - June 2005 in Rhode Island. They were randomly assigned to receive: Self-Administered Mailed Questionnaire [SAMQ; N = 202], Computer-Assisted Telephone Interview [CATI; N = 200], or Computer-Assisted Self-Interview [CASI; N = 197]. Logistic regression models were computed to assess survey mode differences for 13 self-reported items related to cancer screenings, adjusting for age, education, income, race, marital status, partner gender, and recruitment source. RESULTS: Compared to women assigned to CATI, women assigned to SAMQ were less likely to report two or more years between most recent mammograms (CATI = 23.2% vs. SAMQ = 17.7%; AOR = 0.5, 95% CI = 0.3 - 0.8) and women assigned to CASI were slightly less likely to report being overdue for mammography (CATI = 16.5% vs. CASI = 11.8%; AOR = 0.5, 95% CI = 0.3 - 1.0) and Pap testing (CATI = 14.9% vs. CASI = 10.0%; AOR = 0.5, 95% CI = 0.2 - 1.0). There were no other consistent mode effects. CONCLUSION: Among participants in this sample, mode of data collection had little effect on the reporting of mammography and Pap testing behaviours. Other measures such as efficiency and cost-effectiveness of the mode should also be considered when determining the most appropriate form of data collection for use in monitoring indicators of cancer detection and control.

Korean American Men's Perceptions about Smoking-Related Symptomatology: Implications for Intervention.

This study examines what midlife and older (age 45 to 74) Korean American men who are current or former cigarette smokers think cause symptoms or health problems that may be related to smoking cigarettes. The study also examines how those perceptions influence attitudes and behaviors regarding smoking cessation. Separate focus groups were conducted with seven current smokers and nine former smokers in the Korean language in a Korean American. Current smokers experienced few symptoms or health problems that they attribute to smoking, and they generally do not regard smoking as a cause of symptoms or health problems. Former smokers generally quit smoking in response to experiencing a wide range of symptoms or health problems that they attribute to smoking or that they believe smoking exacerbates. A pervasive theme among both groups is that health is a function of a person's physical constitution. The perception is that those born with a strong or special physical constitution are able to smoke and be healthy; persons with a weak physical constitution or who are predisposed to be ill should not smoke or should quit smoking. Smoking-cessation interventions for midlife and older Korean American men should take these findings into account.