The Evaluation of IDEAL-REACH Program to Improve Nutrition among Asian American Community Members in the Philadelphia Metropolitan Area.

Objective Asian Americans' food purchasing, cooking, and eating patterns are not well understood. Greater insight into these behaviors is urgently needed to guide public health interventions of dietary behaviors in this population. The present study aims to examine the effects of a community-level intervention on food purchasing and preparation, nutrition knowledge, and health awareness in Asian Americans. Methods From 2015 to 2017, we conducted the Improving Diets with an Ecological Approach for Lifestyle (IDEAL-REACH) intervention to increase access to healthy food or beverage options for the Asian-American population in the Philadelphia metropolitan area. Participants (1110 at pre- and 1098 at post-assessment) were recruited from 31 community-based organizations (CBOs). We assessed Asian Americans' dietary behaviors, nutrition knowledge, and awareness of heart health. Results The results of pre-post intervention comparisons showed that the IDEAL-REACH intervention was successful in promoting whole grains consumption, reducing sodium consumption, and raising knowledge and awareness related to nutrition and heart health. Conclusions To our knowledge, this is one of the first initiatives in the U.S. to engage CBOs to promote healthier dietary behaviors. The findings show that CBOs serve as a powerful platform for community-level interventions to improve healthy nutrition behaviors in Asian-American communities.

Evaluation of a Healthy Chinese Take-Out Sodium-Reduction Initiative in Philadelphia Low-Income Communities and Neighborhoods.

OBJECTIVES: Sodium reduction in restaurant foods is important because 77% of sodium in the United States is consumed by eating prepared and restaurant foods. We evaluated a sodium-reduction intervention, Healthy Chinese Take-Out Initiative, among Chinese take-out restaurants in low-income neighborhoods in Philadelphia, Pennsylvania. Our objectives were to (1) analyze changes in the sodium content of food samples and (2) collect data on changes in chefs' and owners' knowledge about the health risks of sodium overconsumption, perceptions of the need for sodium reduction, self-efficacy for lowering sodium use, and perceptions of training needs for sodium-reduction strategies. METHODS: The initiative trained chefs from 206 Chinese take-out restaurants on strategies to reduce sodium in prepared dishes. We analyzed changes in the sodium content of the 3 most frequently ordered dishes-shrimp and broccoli, chicken lo mein, and General Tso's chicken-from baseline (July-September 2012) to 36 months after baseline (July-September 2015) among 40 restaurants. We conducted a survey to examine the changes in chefs' and owners' knowledge, perceptions, and self-efficacy of sodium reduction. We used multilevel analysis and repeated-measures analysis of variance to examine effects of the intervention on various outcomes. RESULTS: We found significant reductions in the sodium content of all 3 dishes 36 months after a low-sodium cooking training intervention (coefficients range, -1.06 to -1.69, P < .001 for all). Mean knowledge (range, 9.2-11.1), perceptions (range, 4.6-6.0), and self-efficacy (range, 4.2-5.9) ( P < .001 for all) of sodium reduction improved significantly from baseline (August 2012) to posttraining (also August 2012), but perceptions of the need for sodium reduction and self-efficacy for lowering sodium use returned to baseline levels 36 months later (August 2015). CONCLUSIONS: The intervention was a useful population health approach that led to engaging restaurants in sodium-reduction practices. Local public health agencies and professionals could partner with independent restaurants to introduce environmental changes that can affect population health on a broad scale, particularly for vulnerable populations.

Hepatitis B screening among Chinese Americans: a structural equation modeling analysis.

BACKGROUND: Hepatitis B Virus (HBV) disproportionately affects new immigrants from endemic regions such as China. Untreated infections increase health risks for liver diseases including cancer. Yet most of those infected are unaware of their disease limiting prevention and early treatment options. The purpose of this community based study was to evaluate a heuristic model identifying factors contributing to Hepatitis B (HBV) screening among Chinese Americans. METHODS: A cross-sectional design included a sample of 924 Chinese men and women 18 years of age and older of which 718 had complete data for final analysis. Confirmatory factor analysis verified conceptual indicators including access/satisfaction with health care and enabling, predisposing, cultural, and health belief factors. Structural equation modeling was used to identify direct and indirect predictors of Hepatitis B screening. RESULTS: Bivariate analysis revealed that Chinese respondents who were never screened for HBV were significantly more likely to be below age 40 (69.8%), male (69.2%), had less than a high school education (76.4%), with less than 6 years living in the US (72.8%) and had no health insurance (79.2%). The final model identified enabling factors (having health insurance, a primary health care provider to go to when sick and more frequent visits to a doctor in the last year) as the strongest predictor of HBV screening (coefficient = 0.470, t = 7.618, p < .001). Predisposing factors (education variables) were also significantly related to HBV screening. Cultural factors and Satisfaction with Health care were associated with HBV screening only through their significant relationships with enabling factors. CONCLUSIONS: The tested theoretical model shows promise in predicting HBV testing among Chinese Americans. Increasing access to health care by expanding insurance options and improving culturally sensitivity in health systems are critical to reach new immigrants like Chinese for HBV screening. Yet such strategies are consistent with DHHS Action plan for the Prevention and Treatment of Viral Hepatitis. Implementing community-based strategies like partnering with relevant Community-Based Organizations are important for meeting HBV policy targets.

Pathways of Breast Cancer Screening Among Chinese American Women.

OBJECTIVE: The purpose of this community-based study was to develop a structural equation model for factors contributing to breast cancer screening among Chinese American women. METHODS: A cross-sectional design included a sample of 440 Chinese American women aged 40 years and older. The initial step involved use of confirmatory factor analysis, which included the following variables: access/satisfaction with health care, enabling, predisposing, and cultural and health belief factors. Structural equation model analyses were conducted to evaluate factors related to breast cancer screening in Chinese American women. RESULTS: Initial univariate analyses indicated that women without health insurance were significantly more likely to report being never-screened compared to women with health insurance. Structural equation modeling techniques were used to evaluate the utility of the Sociocultural Health Behavior model in understanding breast cancer screening among Chinese American women. Results indicated that enabling and predisposing factors were significantly and positively related to breast cancer screening. Cultural factors were significantly associated with enabling factors and satisfaction with healthcare. Overall, the proposed model explained 34% of the variance in breast cancer screening among Chinese American women. CONCLUSIONS: The model highlights the significance of enabling and predisposing factors in understanding breast cancer screening behaviors among Chinese American women. In addition, cultural factors were associated with enabling factors, reinforcing the importance of providing translation assistance to Chinese women with poor English fluency and increasing awareness of the critical role of breast cancer screening. Partnering with community organizations may help to facilitate and enhance the screening rates.

Pathways of cervical cancer screening among Chinese women.

BACKGROUND: The purpose of this community-based study was to develop a structural equation model for factors contributing to cervical cancer screening among Chinese American women. METHODS: A cross-sectional design included a sample of 573 Chinese American women aged 18 years and older. The initial step involved use of confirmatory factor analysis, that included the following variables: access to and satisfaction with health care, and enabling and predisposing cultural and health beliefs. Structural equation model analyses were conducted on factors related to cervical cancer screening. RESULTS: Age, marital status, employment, household income, and having health insurance, but not educational level, were significantly related to cervical screening status. Predisposing and enabling factors were positively associated with cervical cancer screening. The cultural factor was significantly related to the enabling factor or the satisfaction with health care factor. CONCLUSION: This model highlights the significance of sociocultural factors in relation to cervical cancer screening. These factors were significant, with cultural, predisposing, enabling, and health belief factors and access to and satisfaction with health care reinforcing the need to assist Chinese American women with poor English fluency in translation and awareness of the importance of cervical cancer screening. Community organizations may play a role in assisting Chinese American women, which could enhance cervical cancer screening rates.

Social influences on Cigarette Smoking Among Mainland Chinese and Chinese Americans: A Comparative Study.

The purpose of this cross-national study was to determine the leading social influences on smoking among Chinese Americans and mainland Chinese adults with the aim of improving prevention and intervention strategies to reduce smoking rates. A comparative cross-sectional design was used and a stratified-cluster sampling technique was employed in identifying the study sample. An 80-item questionnaire was administered in Chinese to 1222 participants, 812 in China and 410 in the U.S. Data were analyzed using descriptive and inferential statistical tests. Results contain comparative data on social influences of smoking among Chinese Americans and mainland Chinese, as well as factors influencing smoking behavior which include cultural beliefs, gender roles, and family relationship dynamics. Grandparents were influential and significantly correlated with current smokers in China. Findings indicate differential effects of social influences on smoking behavior. Similarities and differences provide a basis for improving and/or developing smoking intervention programs of mutual benefit to China and the U.S..

Health seeking behavioral analysis associated with breast cancer screening among Asian American women.

OBJECTIVE: The purpose of this community-based study was to apply a Sociocultural Health Behavior Model to determine the association of factors proposed in the model with breast cancer screening behaviors among Asian American women. METHODS: A cross-sectional design included a sample of 682 Chinese, Korean, and Vietnamese women aged 40 years and older. The frequency distribution analysis and Chi-square analysis were used for the initial screening of the following variables: sociodemographic, cultural, enabling, environmental, and social support. Univariate and multivariate analyses were conducted on factors for breast cancer screening using multinomial logistic regression analysis. RESULTS: Correlates to positive breast cancer screening included demographics (ethnicity), cultural factors (living in the United States for 15 years or more, speaking English well), enabling factors (having a regular physician to visit, health insurance covering the screening), and family/social support factors (those who had a family/friend receiving a mammogram). CONCLUSIONS: The results of this study suggest that breast cancer screening programs will be more effective if they include the cultural and health beliefs, enabling, and social support factors associated with breast cancer screening. The use of community organizations may play a role in helping to increase breast cancer screening rates among Asian American women.

Prostate cancer screening among chinese american men: a structural model.

OBJECTIVE: To test the Sociocultural Health Behavior Model in relation to the health behavior of prostate cancer (PCa) screening among Chinese American men. METHODS: Confirmatory factor analysis and structural equation model analyses were conducted among Chinese American men. RESULTS: The path analysis supported the components of the sociocultural model and indicated a positive and significant relationship between PCa screening and the enabling factors; between cultural factors and predisposing, enabling, and access/satisfaction with health care factors; and between enabling factors and access/satisfaction with health care. CONCLUSIONS: The model highlights the significance that sociocultural factors play in relation to PCa screening.

Factors associated with cervical cancer screening compliance and noncompliance among Chinese, Korean, Vietnamese, and Cambodian women.

OBJECTIVE: The purpose of this study was to determine factors associated with cervical cancer screening compliance and noncompliance among Chinese, Korean, Vietnamese, and Cambodian women aged 18 years and older. METHODS: A cross-sectional design was used. The sample consisted of 1049 women aged 18 or older, of whom 37.94% reported never having been screened for cervical cancer, 23.55% reported noncompliance, and 38.51% were in compliance with screening guidelines. The sample was comprised of Chinese, 50.58%; Koreans, 17.50%; Vietnamese, 16.15%; and Cambodians, 15.77%. RESULTS: Education was significantly associated with never having been screened for cervical cancer for Cambodians. Low income (<$10000) was significantly associated with never having been screened for Cambodian and Chinese women. Not having health insurance was significantly correlated with not getting screened for all ethnic groups. Age and living in the United States less than 15 years were significantly correlated with never having been screened for Vietnamese, Korean, and Chinese women. Marital status was significantly correlated with not getting screened for Korean and Chinese women. English fluency was significantly associated with screening for Cambodians, Koreans, and Chinese. Barriers associated with women who were never screened compared to those barriers for women who were screened and were compliant included lack of knowledge, psychosocial, no insurance, language, transportation, and lack of time, but these barriers were different among the 4 ethnic groups. CONCLUSION: Compliance with cervical cancer screening guidelines among Asian American women can be enhanced significantly by providing culturally and linguistically appropriate educational and early intervention programs.

Cancer screening behaviors and barriers in Asian Americans.

OBJECTIVES: To determine differences in screening for routine physical exam and cancers among Chinese, Korean, Vietnamese, and Cambodian Americans. METHODS: The sample consisted of 2011 participants. Chi square was used to identify relationships between demographic/acculturation factors and screenings. RESULTS: Never-screened rates were high for all Asian subgroups. Never-screened rates for mammography ranged from 20.1% to 78.5% for Pap test, 28% to 75.6% for prostate cancer, 56.7% to 97% for colorectal cancer, 65.3% to 94.9%. Koreans had the highest never screened for health checkups (34.7%). CONCLUSIONS: Efforts should be made to comply with screening guidelines among Asian Americans.

Health educators' perceptions of ethics in professional preparation and practice.

This commentary reflects health educators' views concerning perceptions of the need for increased awareness of the Code of Ethics for the Health Education Profession, improvement in professionals' ability to engage in ethical reflection, and the need for incorporation of ethical considerations into health education practice.

Ethics and patient-provider communication.

Effective health educator-client communication processes are a prerequisite to the acquisition and appropriate application of new knowledge, to discussions that focus on treatment risks and options, and to the mediation of (a) optimal self-management practices, (b) adherence to health recommendations, (c) client satisfaction, (d) autonomous, responsible decision making, and (e) provision of supportive and helpful advice. But is there room for improvement? To provide more uniform high-quality communications to all citizens and to support the practice principles embedded in the Health Education Code of Ethics, this article outlines results of the related literature, the authors' research, and a specific post hoc analysis of a national sample that strongly suggests that much more needs to be done to ensure health providers effectively communicate health promotion messages without bias in at least five related communication domains.

Knowledge, attitudes, and behaviors of Chinese hepatitis B screening and vaccination.

OBJECTIVE: To measure the knowledge, attitudes, and behaviors of Hepatitis B (HBV) screening and vaccination in the Chinese American population. METHODS: A cross-sectional study was conducted among 429 Chinese in New York City. Participants were recruited from Chinese community-based organizations. Descriptive statistics and chi-square tests of independence were conducted. RESULTS: Knowledge level of HBV risk factors and screening and vaccination rates are low. There were significant differences in screening and vaccination by marital and health insurance status, language, gender, education, and income. CONCLUSIONS: Findings suggested that interventions for Chinese Americans and health care providers can substantially increase screening and vaccination rates.

Health department faculty perceptions about ethics in professional preparation.

The purpose of this article is to report the key preliminary findings of a survey conducted among university faculty serving health education and health promotion programs. Few distinct courses in ethics are offered in graduate health education programs and even fewer are offered at the undergraduate level. Most programs address ethics throughout several courses in the program. Among those that offer distinct ethics courses, fewer than half require the course for graduation. Faculty can influence improvement in health professionals' ability to engage in ethical reflection, with the subsequent outcome of the incorporation of the necessity of ethical deliberation into health education practice.

Knowledge, attitudes, and behaviors of hepatitis B screening and vaccination and liver cancer risks among Vietnamese Americans.

Hepatitis B Virus (HBV) infection is a serious health problem among Asian Americans. Vietnamese Americans are disproportionately affected by liver cancer compared with other racial and ethnic groups. Vietnamese males have the highest incidence of liver cancer of any racial group; incidence of liver cancer among Vietnamese males is 11 times higher than among White males. Nearly 80% of liver cancer is attributed to HBV. This study measured knowledge, attitudes, and behaviors related to HBV screening and vaccination. The study was conducted among 256 Vietnamese Americans in the greater Philadelphia and New Jersey area, with a large number of underserved, recent immigrants with low socioeconomic status and limited English proficiency. Participants were recruited from Vietnamese community-based organizations. Overall, 46.3% of the sample had heard of HBV or knew about the availability of screening (32.6%) or vaccination (35.5%) while 7.5% were ever screened and 6.3% had been vaccinated. Community-based, culturally appropriate interventions for Vietnamese Americans and health care providers should increase screening and vaccination rates.

Risk perceptions and barriers to Hepatitis B screening and vaccination among Vietnamese immigrants.

Hepatitis B (HBV) infection plays a primary role in the development of liver cancer, contributing to nearly 80% of liver cancer cases. Vietnamese males have the highest incidence of liver cancer of any ethnic group, and HBV infection is a serious and prevalent health problem among Vietnamese immigrants. Guided by the Health Belief Model framework, the purpose of the present study was to assess levels of perceived risk, severity, barriers and benefits, and cues to action in HBV screening and vaccination in relation to actual screening and vaccination behavior in a sample of Vietnamese adults. The study consisted of 359 Vietnamese adults residing in Pennsylvania and New Jersey. The majority of participants were immigrants (98.1%) and had low socio-economic and educational status. Only 8.8% of participants reported being screened and 7.3% vaccinated for HBV. Participants who had been screened reported feeling at higher risk and perceived HBV infection to be more likely to lead to liver cancer and death than those who had not been screened. In addition, participants who had been screened reported fewer perceived barriers and more cues to action than unscreened participants. Compared to participants who had been vaccinated, unvaccinated participants were more likely to report feeling healthy and a lack of knowledge about where to obtain HBV testing as barriers. Multivariate logistic regression analyses indicated that perceived barriers were negatively associated with screening behavior as well as vaccination behavior. These results suggest that community-based, culturally appropriate interventions for Vietnamese Americans should directly address barriers to screening and vaccination in order to enhance screening and vaccination rates in this underserved population.

Asian Tobacco Education and Cancer Awareness Research Special Population Network. A model for reducing Asian American cancer health disparities.

Asian Americans are the fastest growing and the second largest foreign-born ethnic group in the United States. Cancer is a leading cause of death among Asian Americans. The Asian Tobacco Education and Cancer Awareness Research (ATECAR) Special Population Network, Center for Asian Health, aimed to reduce or eliminate cancer health disparities in these diverse, underserved populations in Pennsylvania, New Jersey, Delaware, and New York. The ATECAR logic model was adapted from a variety of conceptual frameworks to develop and implement the network's multifaceted cancer health disparities research, training, awareness, and outreach programs. The model was the basis for the developmental phases of the network that included (1) needs assessment, infrastructure, and partnership building; (2) intervention research, training, and mentorship; and (3) evaluation, dissemination, and diffusion. Community involvement occurred at every operational level to ensure program and network sustainability. Between 2000 and 2005, the ATECAR network consisted of 88 partners, representing a cross-section of Asian communities, academia, cancer centers, and health service agencies, ensuring a viable infrastructure for the network's multidimensional cancer health disparities programs. ATECAR's research covered tobacco control, cancer prevention and intervention, and clinical trials. More than 22 research projects were conducted and their results disseminated in peer-reviewed journals. ATECAR also trained 76 junior researchers and special population investigators and 1014 community professionals in disparity issues. ATECAR's multimedia cancer awareness education program reached over 116,000 Asians. The ATECAR network's achievements have had a profound impact on Asian Americans and established a trend toward reducing cancer health disparities, especially among underserved Asian Americans. Cancer 2006. (c) 2006 American Cancer Society.

Evaluation of the energize your life! Social marketing campaign pilot study to increase fruit intake among community college students.

In this study, the authors evaluated the effectiveness of the Energize Your Life! social-marketing campaign pilot study to improve knowledge, attitudes, and fruit intake among community college students. The authors used a cross-sectional, quasi-experimental, pre- and posttest design. They randomly selected community college students (N = 1,367) and exposed the intervention campus to fruit fairs to distribute fresh fruit, 100% fruit juice, and fruit smoothie samples and information about fruit to students. The authors also addressed policy change to increase the accessibility of fruit on campus. There was a significant increase in fruit intake between pre- and posttest at the intervention campus. Although students had positive attitudes toward intake, most did not achieve the minimum recommended daily 2 servings of fruit. Approximately 25% of the students had insufficient funds, which affected their food intake. Longer-term social marketing interventions may be an effective means of improving the dietary quality of community college students.

Tobacco dependence, risk perceptions and self-efficacy among Korean American smokers.

Psychosocial variables related to smoking cessation may differ among ethnic groups. This research focuses on Korean Americans, a group that receives little attention in smoking cessation research, yet has an elevated smoking rate when compared with that of the general US population. This article reports our findings on tobacco dependence, risk perceptions and self-efficacy and examines potential associations between these psychosocial variables and key demographic variables. One hundred Korean American adult smokers enrolled in the study and completed the psychosocial measurement. The majority of the participants (61%) were heavy smokers. The findings indicated that demographic factors were associated with key psychosocial variables that have been demonstrated to play a role in smoking cessation behaviors. In particular, younger age and higher educational level were associated with greater self-efficacy in quitting smoking. No differences in risk perception were observed by any of the demographic indicators assessed. The findings suggest that enhancing self-efficacy among older and less educated smokers may improve the efficacy of smoking cessation efforts that target Korean smokers.