Health Literacy among Korean American Immigrant Women in the USA: Role of Social Support.

Health literacy is associated with health behaviors and outcomes. Using Andersen's Behavioral Model of Health Services Use, this study examined the role of limited English proficiency (LEP) and social support for the health literacy of Korean American immigrant women, one of the most affected groups by LEP. Researchers surveyed 232 Korean American immigrant women in a metro area in a Southeastern state, U.S. Health literacy was measured by the CDC Behavioral Risk Factor Surveillance System Questionnaire and the California Health Interview Survey. Participants with better English proficiency and larger social support had higher health literacy. LEP and social support interaction was significantly associated with health literacy, illustrating social support as a buffer that mitigates the negative impact of LEP on health literacy. Community programs that enhance social support through community health advocates or peer educators may increase health literacy and reduce health disparities among Korean American immigrant women with LEP.

Examining the Potential Effect of a Salt Sensitivity Biomarker in Korean American Immigrants: A Pilot Study.

The genetic factors involved with salt sensitivity (SS) have been studied using a genetic approach to identify individuals at high risk for developing hypertension and could benefit from a low sodium diet intervention, but this has not been well-studied in Korean American immigrants (KAIs). The purpose of this pilot study was to investigate the influence of SS that moderates blood pressure (BP) in KAIs (n = 34). KAIs were recruited from local communities and completed a blood draw, a 8-day food log, and BP testing. The dietary sodium intake was measured using the Fitbit mobile app, and an SS biomarker was assessed using targeted genotyping. out of five GNAI2 single nucleotide polymorphisms (SNPs) tested, rs4547694 significantly moderated the relationship of dietary sodium intake on BP in KAIs. Conclusions: Further studies are warranted to test the effect of a reduced sodium diet on BP while accounting for the moderating influence of an SS genotype.

Health Literacy and Access to Care in Cancer Screening Among Korean Americans.

BACKGROUND: Health literacy and access to care are critical facilitators for preventive health behaviors. After the passage of the Affordable Care Act in March 2010, little has been studied about how improved health insurance coverage has impacted the use of preventive health services among Korean Americans. OBJECTIVE: The study assessed the impact of access to care, use of services, and health literacy on cancer screening among Korean Americans. METHODS: A descriptive cross-sectional study of 377 Korean Americans age 18 years and older was conducted with a survey and convenient sampling in Texas. KEY RESULTS: Although 79% of the sample had health insurance, 32% had never visited a health care provider, and 14% were delayed in care in the past 12 months. Only 11.6% were confident to complete medical forms, and 69.5% had limited levels of confidence. Cancer screening compliance rates were: mammography (50.4% at age 40-54 years; 46.6% at age 55 years and older), a Pap smear (29.4% at age 21-29 years; 78.4% at age 30-65 years; 72.2% at age 66 years and older), and colorectal cancer screening at age 45 years and older (stool tests 15.1%; sigmoidoscopy 27%; colonoscopy 51.3%). Multiple logistic regression analyses revealed that household income, gender, health insurance, and health literacy were significantly associated with self-reported cancer screening. CONCLUSIONS: Korean Americans who participated in this study are characterized by marginalized health literacy, underused health care services, and significantly lower cancer screening compliance than the goals of Healthy People 2020. The following interventions are suggested to improve health literacy and health insurance literacy on cancer screening: culturally sensitive and linguistically appropriate education for the guidelines concordant with cancer screening, effective communication skills with health care providers, support for navigating the health care system, and development of internet- or social media-based health education programs to meet the preferred communication methods of this population. [HLRP: Health Literacy Research and Practice. 2021;5(4):e310-e318.] Plain Language Summary: Despite having improved health insurance coverage, Korean Americans of this study have marginalized health literacy, limited health insurance literacy, low cancer screening compliance, and underused health care services. The results of this study suggest several strategies to improve health literacy and health insurance literacy for Korean Americans, which may also apply to other groups with similar barriers.

Feasibility of an Advance Care Planning Program (ACP) for Korean Community-Dwelling Older Adults and ACP Training of Advance Practice Nurses.

This study aimed to develop a locally suitable advance care planning (ACP) program for older community-dwelling adults and a training program for nurse facilitators in Korea, and to evaluate their feasibility from the facilitators' experiences. This was a mixed methods pilot study that assessed the feasibility of an ACP program by analyzing survey, checklist, and focus group interview data. The ACP program was named CLOSE (Communicating and Listening to Our Seniors' voices about End-of-life care). Home health care nurses (N = 9) participated in this study. The participants reported that CLOSE was applicable to older community-dwelling adults and the training program was useful for increasing facilitator competency. We suggest some lessons from this pilot study that can be used to improve the ACP program and encourage community health nurses to participate in ACP as facilitators.

The prevalence of persistent metopic sutures comparing the Nepalese bone collection with Korean bone collection / Prevalencia de suturas metópicas persistentes que comparan una colección de huesos nepaleses con una colección de huesos coreanos

SUMMARY: Metopic suture can be visualized from the nasion to the bregma along the arch of the frontal bone in mid-sagittal plane. Persistent metopic suture normally closing between 1st and 2nd year of life has also been related with ethnicity. The present study reports the presence of complete and incomplete metopic sutures in Nepalese and Korean population skulls which helps to shed light on its incidence rate. Out of 121 adult skulls in Nepalese population, metopic suture was found to be present in 33 skulls. Incomplete metopic sutures showed variations of morphology, like linear (6.61 %), V-shaped (8.26 %) and double incomplete (10.74 %) and two cases with complete metopic suture, which showed variation in interdigitation between its anterior and posterior ends. Korean population showed metopic suture to be present in 8 skulls out of 104 with metopism in 3 skulls. Incomplete metopic sutures like double incomplete (1.92 %) and linear (2.88 %) were also noted. Alterations to local strains could be the contributing factor for such variation and complexity of interdigitation, which occur during the growth of the braincase. The knowledge of the metopic suture and its variations according to ethnicity is important and should be considered to prevent wrong diagnosis. The presence of different types of metopic sutures as reported by the present study provides informative value on the presence and variation of such sutures in population depending on ethnicity and ought to be helpful in diagnostic sequences in emergency setting.

RESUMEN: La sutura metópica se puede visualizar desde nasión hasta el bregma a lo largo del arco del hueso frontal en el plano mediano sagital. La sutura metópica persistente que normalmente se cierra entre el primer y segundo año de vida, también se ha relacionado con el origen étnico. El presente estudio informa la presencia de suturas metópicas completas e incompletas en los cráneos de la población nepalesa y coreana, lo que además de entregar información sobre su tasa de incidencia. De 121 cráneos adultos en la población nepalesa, en 33 de ellos se encontró la sutura metópica. Las suturas metópicas incompletas mostraron variaciones de la morfología, como lineal (6,61 %), en forma de V (8,26 %) y doble incompleta (10,74 %), además de dos casos con sutura metópica completa, que mostraron variación en la interdigitación entre sus extremos anterior y posterior. De los 104 cráneos de la población coreana en 8 se presentó la sutura metópica y en 3 metopismo. También se observaron suturas metópicas incompletas como doble incompleta (1,92 %) y lineal (2,88 %). Las alteraciones en las etnias locales podrían ser el factor contribuyente para tal variación y complejidad de la interdigitación, que ocurre durante el crecimiento de la cráneo. El conocimiento de la sutura metópica y sus variaciones según el origen étnico es importante y debe considerarse para prevenir un diagnóstico incorrecto. La presencia de diferentes tipos de suturas metópicas según lo informado en el estudio, proporciona un valor informativo sobre la presencia y la variación de tales suturas en la población, dependiendo de la etnia, y debería ser útil en las secuencias de diagnóstico en situaciones de emergencia.

Genetic structure and forensic characteristics of the Korean population revealed by GoldenEye 20A.

BACKGROUND: In China, most Koreans live in the Northeast, including Jilin (59.64%), Heilongjiang (20.21%), and Liaoning (12.55%) provinces, while the rest are spread to other parts of China. Koreans across China share a common culture, which is similar to Korea. AIM: The Combined DNA Index System or CODIS has been increased from thirteen to twenty loci, so it is important to generate improved profiles with the help of these additional loci. SUBJECTS AND METHODS: In the current study we have analysed 564 unrelated individuals from the Yanbian Korean population using the GoldenEyeTM 20 A kit (Beijing PeopleSpot Inc). Allelic frequencies, population comparisons and forensic statistical parameters of commonly used short tandem repeats were calculated for the Yanbian Korean population from Jilin province, P.R. China. RESULTS: A total of 232 alleles were observed and all the loci were found to be in Hardy-Weinberg equilibrium after Bonferroni correction. The combined power of discrimination was 99. 999999999999999999999913% and the combined power of exclusion was 0.999999995349261. CONCLUSION: Phylogenetic parameters showed that the Yanbian Koreans living in Jilin had the closest genetic relationship with South Koreans and other East Asian populations. The present study provides a precise reference database of Jilin Koreans for forensic applications and studies of population genetics.

Racial/ethnic differences in correlates of psychological distress among five Asian-American subgroups and non-Hispanic Whites.

Objective: Despite their vastly different historical backgrounds, unique languages and variable pre- and post-immigration experiences, Asian-Americans are considered to share stressors surrounding immigration, but there is a gap in describing manifestations of possible mental distress. Thus, the purpose of this study was to explore and compare differences in factors associated with psychological distress among Asian subgroups including Chinese, Filipino, Vietnamese, Korean, Japanese, and non-Hispanic Whites. Design: Using a cross-sectional study design, California Health Interview Survey (CHIS) 2011/2012 data were analyzed. The sample consisted of 29,142 participants: 25,645 non-Hispanic Whites, 3497 non-Hispanic Asian-Americans, 1156 Chinese, 471 Filipinos, 864 Vietnamese, 704 Koreans, and 302 Japanese. Sociodemographic characteristics included gender, age group, marital status, education, poverty level, working status, health insurance, level of acculturation, social cohesion, neighborhood safety, and civic engagement. Physical health status included disability and chronic illness. Psychological distress was evaluated using the Kessler 6 (K6) scale. Results: Results showed that psychological distress levels ranged between 1.96 and 4.52 (p < .05) out of 24 and associated factors were significantly different among the five Asian subgroups and non-Hispanic Whites. Conclusions: The current study highlights the differences in characteristics of psychological distress among Asian subgroups. It underscores the significance of understanding individualized cultural and historical background in each Asian subgroup and subsequently developing and applying appropriate interventions for those groups. In addition, different influencing factors should be applied to assess and prioritize the needs of Asian subgroups to improve psychological distress. The study also warrants further investigation and careful description of each Asian subgroups.

Familiarity, Navigation, and Comprehension: Key Dimensions of Health Literacy in Pap Test Use among Korean American Women.

Health literacy consists of multiple dimensions such as print and oral literacy or numeracy. Different dimensions of health literacy may have more salient impact on certain health behaviors and outcomes. Yet, evidence is limited regarding which dimensions particularly affect cervical cancer screening. The objective of this study was to examine the role of different dimensions of health literacy in cervical cancer screening among Korean American women. We used baseline data obtained from 560 Korean American women in a community-based health literacy-focused intervention study. Backward stepwise logistic regression analysis revealed that familiarity (adjusted odds ratio [AOR] = 1.20, 95% confidence interval [CI] = 1.11-1.31) and navigational health literacy (AOR = 1.10, 95% CI = 1.04-1.16) were associated with lifetime Pap test use and comprehension (AOR = 1.08, 95% CI = 1.02-1.14) with triennial Pap test screening. Prior exposure to healthcare settings and knowing how to navigate the healthcare system were more important than other health literacy dimensions for lifetime Pap test use. Understanding cancer screening-related words was most relevant to triennial Pap test use. In addition to addressing system factors such as insurance and physicians' recommendations, interventions to increase Pap test screening targeted at Korean American women are needed to address certain dimensions of health literacy such as familiarity, navigation, and comprehension.

Cultural barriers to organ donation among Chinese and Korean individuals in the United States: a systematic review.

Asian Americans have the lowest organ donation registration rates in the United States, and the reason for this is incompletely understood. Aiming to understand the reasons for low organ donation registration rate among Asian Americans, more specifically Chinese and Korean Americans, we conducted a systematic search of databases, websites, and gray literature. Altogether, 34 papers were retained after the assessment of relevance and quality. Commonly reported barriers to organ donation registration among Chinese and Koreans in the literature included lack of knowledge about organ donation, distrust of health-care and allocation system, cultural avoidance of discussion of death-related topics, and desire for intact body mainly stemming from the Confucian concept of filial piety. Strong family values coupled with a cultural reluctance to discuss death-related topics among family members appear to underscore the reluctance to organ donation among Chinese and Koreans. Notably, improved knowledge negatively impacted organ donation intent and religion seemed to play a more important role when making decision about organ donation among Koreans, and the distrust of the allocation system is more prominent among Chinese. This information should be used to inform the development of culturally competent organ donation educational materials.

Association of transcription factor 7-like 2 (TCF7L2) gene polymorphism with type 2 diabetes mellitus in Chinese Korean ethnicity population.

Presently, data on the type 2 diabetes mellitus (T2DM) in Chinese Korean ethnicity are very scarce. This study aimed to explore the relationship between the transcription factor 7-like 2 (TCF7L2) and T2DM in Chinese Korean ethnicity population. This case-control study involved 43 T2DM Chinese Korean ethnicity patients (T2DM group) and 43 healthy Chinese Korean ethnicity normoglycemic subjects as controls (Control group). All included participants aged from 40 to 75 years old. Clinical and biological data were collected to determine the phenotypic traits. The restriction fragment length polymorphism-polymerase chain reaction was used to analyze the TCF7L2 by genotyping for rs7903146 (C/T). Spectrophotometer with Chronolab kits was used to conduct the biochemical analyses. TCF7L2 was associated with T2DM in the Chinese Korean ethnicity population (P < .01 for alleles, and P < .05 for genotypes). Significant differences were found 2 groups regarding the T allele (37.2% T2DM patients vs 15.1% healthy subjects, P < .01), and G allele (62.8% T2DM patients vs 84.9% healthy subjects, P < .01). The risk genotypes were GG (83.7% T2DM patients, vs 44.2% healthy control, P < .01), GT (4.7% T2DM patients, vs 20.9% healthy control, P = .04), and TT (11.6% T2DM patients, vs 34.9% healthy control, P = .01). The results of this study demonstrated that TCF7L2 is associated with T2DM in the Chinese Korean ethnicity population, which is an important risk factor for T2DM in this population.

Decreasing sleep-related symptoms through increasing physical activity among Asian American midlife women.

OBJECTIVE: The beneficial effects of physical activities on sleep-related symptoms have been reported in the literature, and physical activity has been suggested as an efficient strategy to reduce sleep-related symptoms among midlife women. The effect of Web-based physical activity promotion programs on sleep-related symptoms have, however, rarely been explored, especially among midlife racial/ethnic minority women. The purpose of this pilot study was to test the preliminary efficacy of a WPAPP on self-reported sleep-related symptoms and physical activity of Asian American midlife women. METHODS: This pilot study was a randomized repeated measures pretest/posttest control group study (14 in an intervention group and 12 in a control group). Multiple instruments were used to measure background characteristics (eg, sociodemographic and health status), sleep-related symptoms and physical activity experiences at pretest, post 1 month, and post 3 months. The data were analyzed using an intent-to-treat linear mixed-model growth curve analysis. RESULTS: After adjusting for covariates and random intercept, the intervention group showed a significant decrease in the total numbers of psychological (P = 0.0956) and total sleep-related symptoms (P = 0.0733) at post 1 month. Also, both groups showed a significant increase in physical activity (active living habits) at post 3 months (P = 0.0353). CONCLUSIONS: The WPAPP is potentially beneficial in decreasing Asian American midlife women's sleep-related symptoms and promoting their lifestyle physical activity.

The Perspectives of Volunteer Counselors of Korean Immigrant Women Experiencing Intimate Partner Violence.

This study investigates what needs to be considered in our current health services to appropriately respond to abused Korean immigrant women. Using a community-based participatory approach, this qualitative interpretive description analyzed counseling documents and semi-structured interviews. Data analyses suggested that intimate partner violence (IPV) screening for ethnic minority women in health care settings can be improved by informing patients about the role of health care providers in addressing IPV, establishing rapport before IPV screening, assuring confidentiality is maintained, respecting Korean immigrant women's unique perspectives and response toward IPV, providing translation services, and collaborating with ethnic minority women's community organizations.

[Association of sodium ion transporter gene polymorphisms with essential hypertension among ethnic Koreans from Mudanjiang].

OBJECTIVE To assess the association of SLC12A3 and SCNN1B gene polymorphisms (rs11643718 and rs12447134) with essential hypertension among ethnic Koreans from Mudanjiang, China. METHODS For 204 patients with essential hypertension and 186 healthy controls, the genotypes of rs11643718 and rs12447134 loci were determined with an improved multiplex ligase detection reaction (iMLDR) method. RESULTS Allelic and genotypic frequencies of rs11643718 of SLC12A3 gene are associated with the onset of disease hypertension (P <0.05) as well as systolic blood pressure (P < 0.01, under a recessive model). No association was found between rs12447134 of SCNN1B gene with the onset of disease (P > 0.05) but diastolic blood pressure (P < 0.05, under a recessive model). CONCLUSION The polymorphisms of rs11643718 locus is associated with the susceptibility for essential hypertension among ethnic Koreans from Mudanjiang area and can be used as a predictor for the disease.

Effects of Perceived Discrimination and Trust on Breast Cancer Screening among Korean American Women.

OBJECTIVE: Korean American (KA) women continue to have lower breast cancer screening rates than other racial groups. Perceived discrimination and trust have been associated with breast cancer screening adherence, but little is known about the associations in KA women. METHODS: Surveys were completed by 196 KA women in the Chicago metropolitan area. Multiple and Firth logistic regression analyses were performed to identify factors (perceived discrimination, trust, acculturation, cultural beliefs, health care access) influencing breast cancer screening adherence (mammogram). In addition, SPSS macro PROCESS was used to examine the mediating role of trust between perceived discrimination and breast cancer screening adherence. RESULTS: Ninety-three percent of the women surveyed had health insurance and 54% reported having a mammogram in the past 2 years. Predictors of having a mammogram were knowing where to go for a mammogram, having a regular doctor or usual place for health care, greater trust in health care providers, and lower distrust in the health care system. Perceived discrimination had an indirect effect on breast cancer screening through trust. CONCLUSIONS: The breast cancer screening rate among KA women is low. Perceived discrimination in health care, trust in health care providers, and distrust in the health care system directly or indirectly influenced breast cancer screening adherence in KA women. Trust is a factor that can be strengthened with educational interventions.

The Chinese and Korean American immigrant experience: a mixed-methods examination of facilitators and barriers of colorectal cancer screening.

OBJECTIVE: Among Asian Americans, colorectal cancer (CRC) is the second leading cause of cancer deaths. Despite strong evidence that screening can reduce CRC-related mortality, fewer Chinese and Koreans receive screening as compared to non-Hispanic whites and blacks. The objective of this study was to examine facilitators and barriers as well as strategies to promote CRC screening in this population. DESIGN: This study employed a mixed-methods design. We conducted 17 key informant interviews and 12 focus groups in the Washington, D.C. metropolitan area. 120 Chinese and Korean focus group participants, aged 50 to 85, also provided quantitative data through self-administered surveys. All participants were asked to discuss facilitators and barriers of CRC screening, including in relation to culture. RESULTS: Participants who had a regular physician and doctor's recommendation for CRC screening were more likely to ever receive a colonoscopy (adjusted odds ratio (aOR) = 3.51; 95% confidence interval (CI): 1.26, 9.79 and aOR = 6.61; 95% CI: 2.63, 16.65, respectively). A doctor's recommendation was also significantly associated with receipt of a fecal occult blood test (FOBT) (aOR = 4.00; 95% CI: 1.43, 11.15). In terms of barriers, those who reported having no time and not having symptoms were less likely to have a colonoscopy (aOR = 0.15; 95% CI: 0.03, 0.82 and aOR = 0.02; 95% CI: 0.002, 0.23, respectively) than those who had time and symptoms. Preventive healthcare was often not viewed as a priority, particularly for those living the'immigrant life,' who gave precedence to work. Cultural barriers to CRC screening included language (e.g. limited English proficiency and low health literacy); fear of finding CRC and burdening the family especially children; fatalism; and stigma towards cancer. CONCLUSIONS: Future interventions and programs aiming to increase CRC screening among Chinese and Korean Americans should address both cultural and non-cultural factors that influence CRC screening uptake.

Ethnic socialization and ethnic identity development among internationally adopted Korean American adolescents: A seven-year follow-up.

The relationship between ethnic socialization by parents, peers, and ethnic identity development was examined over a 7-year time span in a sample of 116 internationally adopted Korean American adolescents. Parent report data was collected in 2007 (Time 1 [T1]) when the adopted child was between 7 and 13 years old and again in 2014 at ages 13 to 20 years old (Time 2 [T2]). Adolescent report data also was collected in 2014. We examined differences in parent and adolescent reports of parental ethnic socialization at T2, changes in parent reports of ethnic socialization from T1 to T2, and the relationship among ethnic socialization by parents at T1 and T2, ethnic socialization by peers at T2, and ethnic identity exploration and resolution at T2. Results indicated parents reported higher levels of parental ethnic socialization than adolescents did at T2. Parent reports of parental ethnic socialization also decreased between childhood and adolescence. Adolescents reported higher parental ethnic socialization than peer ethnic socialization at T2. Path analysis demonstrated positive indirect pathways among parental ethnic socialization at T1, parental ethnic socialization and peer ethnic socialization at T2, and ethnic identity exploration and ethnic identity resolution at T2. The study highlights the cultural experiences of transracial, transnational adopted individuals, the role of both parents and peers in ethnic socialization and ethnic identity development, and the importance of longitudinal and multi-informant methodology. (PsycINFO Database Record

An Alternative View of Living Well: Survival Trajectory of Korean Patients with Kidney Failure on Hemodialysis.

Patients with kidney failure undergoing hemodialysis rely on a hemodialysis machine for survival. Experiences of patients going through this situation were described using a phenomenological approach. These patients experienced early and late transitions within a dual structure of despair and hope, dependence and independence, and activity and passivity. Early transitions included experiencing shock and a struggle for survival. Late transitions included facing up to the reality and maintaining a hemodialysis-life balance. A traditional Korean belief system constituted a buffering system for the difficulties of their reality. These results may help nurses understand the survival trajectory of patients with kidney failure on hemodialysis and to respond more effectively to the needs of such patients in transition periods.

Cosleeping, sleep disturbances, children's behavioral problems, and parenting self-efficacy among Korean American families.

The purpose of this study was to compare sleep disturbances of children and their mothers, children's behavioral problems, and parenting self-efficacy between Korean American families who coslept and those who did not cosleep. Forty-eight mothers of children between 3 and 8 years of age completed the following surveys: Children's Sleep Habits Questionnaire, Pediatric Symptom Checklist, Pittsburgh Sleep Quality Index, Parenting Self-Efficacy Questionnaire, and Acculturation Rating Scale for Mexican Americans II. Overall, 48% (n = 23) of families coslept, and families with younger children coslept more than families with older children (x2=12.48,p<.05). When the families were divided into non-cosleeping (i.e., rarely) and cosleeping (i.e., sometimes and usually) groups, 100% of the cosleeping children had sleep disturbances compared to 56% of the non-cosleeping children (x2=8.67,p<.01). For mothers, 28% (n = 7) of the non-cosleeping mothers reported sleep disturbances, compared to 52% (n = 12) of the cosleeping mothers (x2=2.93,p=.08). Children's behavioral problems were not different between the two groups (F = 1.78, p = NS). Cosleeping mothers reported lower parenting self-efficacy than non-cosleeping mothers (F = 6.26, p < .05). When providing care to Korean American families with young children, their cosleeping, sleep disturbances, and parenting self-efficacy need to be addressed.

Quantitative and Qualitative Evaluations of the Enhanced Logo-autobiography Program for Korean-American Women.

This study extends Bernstein et al.'s (2016) investigation of the effects of the Enhanced Logo-autobiography Program on Korean-American women's depressive symptoms, coping strategies, purpose in life, and posttraumatic growth by analyzing quantitative and qualitative data. This study's participants significantly improved on quantitative measures of depression, coping strategies, purpose in life, and post-traumatic growth at eight weeks post-intervention and follow-up. The qualitative content analysis revealed 17 themes with five essential themes. The program's activity to promote purpose in life through posttraumatic growth facilitated participants' recovery from traumatic experiences. Standardized guidelines are needed to conduct this program in Korean community centers.