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Asians are the fastest growing racial and ethnic group in the United States, and in Michigan, Asians represent 3.4% of the state's population. Asians have long been aggregated as a homogeneous group and stereotyped as a "model minority." Asians, however, are very diverse, and each subgroup has different values, histories, beliefs, and dialects. The diversity among populations and variations in chronic disease risks demonstrate the importance of disaggregating Asian American ethnicities with respect to health promotion, which must be culturally and linguistically tailored to make the biggest impact. This article describes our challenges and successes in health communication messaging with Asian Americans during the 4 years of our Racial and Ethnic Approaches to Community Health (REACH) Cooperative Agreement.

Asian Americans are at increased risk for nutrition-related chronic diseases, including type 2 diabetes. The prevalence of type 2 diabetes among Asian Americans in the United States is 16.7% compared to 11.3% among the general U.S. population. Genetic factors such as higher body fat and lower muscle mass result in a predisposition for the development of diabetes at a lower body mass index (BMI). Social determinants including food insecurity and physical environment may also impact risk and need further examination. This study investigated type 2 diabetes-related indicators and food insecurity and satisfaction with types and quality of foods provided through food box distributions with a focus on Asian American populations in Michigan. Data were collected via a survey implemented in partnership with community organizations that administer food box distributions. Nearly half of respondents were not aware that Asian Americans are at increased risk of developing type 2 diabetes. The mean BMI for overall study participants was 25.6 , and 61.8 % of participants had a BMI of ≥23 . Food insecurity was also negatively associated with BMI with study participants who were overweight reporting less food insecurity. Overall, participants reported being satisfied with both the types and quality of foods provided in the food boxes. Findings support the need for increased diabetes education and testing among Asian Americans and assessment of the types of culturally relevant foods offered by food distribution organizations.

The Bangladeshi American community in Michigan is growing rapidly. Little is known about the correlates of health status and preventive health services among Bangladeshi Americans. The purpose of this study was to examine the relationships between demographic factors, preventive health practices, chronic conditions and health status of this population. Data were collected through self-administered surveys during community events in Hamtramck, Michigan and analyzed using descriptive statistics and multiple linear regression. The surveys were completed by 166 Bangladeshi Americans. A majority reported not having an up-to-date physical/dental exams, colorectal, cervical, or breast cancer screening. The length of U.S. residency was associated with cancer screening utilization while employment status was correlated with self-reported health status. Our results demonstrate a need for development and implementation of language-appropriate and cultural interventions to address the unique healthcare needs of this growing population.

Since the implementation of the Patient Protection and Affordable Care Act (ACA), significant increases in the percent of insured United States residents has steadily increased. Studies have shown that there is an increase in preventative services usage and a decrease in chronic disease burden with increased access to insurance. However, very little has been studied about how the implementation of ACA has impacted utilization of health services and health status among Asian Americans. In this study, we recruited 427 Asian Americans who attended health fairs and examined (1) changes in health care coverage and utilization of preventive health services before and after ACA, (2) health status on chronic disease risk factors, (3) comparing health services utilization by insurance status and types of insurance, and (4) identifying relationships between health care utilization and demographic factors. Study results indicate that even though the percentage of insured Asian Americans in Michigan increased significantly over study periods, health care utilization and chronic disease burden did not change significantly. The insured tended to utilize preventive health services more than the uninsured, but the types of insurance did not affect health care utilization. Gender and having a primary care physician were significant predictors in determining health care utilization. There is a need in this population for language-appropriate and culturally-sensitive education about the importance and availability of preventive services, which could improve adherence to preventive health services, thereby reducing health disparities.

Although the Asian American population has steadily increased since 1980s, there remains a paucity of literature on cancer screening utilization on this population. The purpose of this study was to evaluate preventive health and screening practices by examining demographic predictors of health and screening behaviors among 217 Asian Americans living in state of Michigan. Several demographic and acculturation-related factors were found to be associated with "ever screened" status in the bivariate analyses. This included the examination of the relationships among refugee status and cancer screening practices among Asian Americans. After adjusting for other demographic correlates, Asian Americans in the refugee group had lower screening rates in colorectal and breast cancer. Our findings emphasize the need for effective interventions to increase cancer screening rates in this vulnerable population.

Background: Breast cancer consistently is the most commonly diagnosed cancer and the second most common cause of cancer mortality among Asian Americans in the United States. The incidence of breast cancer in Asian American women has been increasing at a much higher rate than in white women., Objectives: A randomized control single-blind study was conducted comparing the efficacy of an individually tailored telephone counseling and National Cancer Institute brochure., Methods: The sample consisted of 193 Chinese American women with no breast cancer history. The participants were randomly assigned to either an intervention or a control group. Self-reported data that included demographic variables, knowledge, beliefs, and screening behaviors were collected at baseline and 4 months., Results: The intervention group had increased screening to 40% compared with 33% for the control group at 4 months; the difference was not statistically significant. When the subanalyses were performed, the intervention is effective in certain demographic groups (ie, elderly women aged ≥65 years and recent immigrants). The study intervention was well accepted by participants and perceived as feasible and culturally appropriate based on process evaluation., Conclusions: The study also demonstrates the feasibility of recruiting and retaining eligible women to participate, and the results show that both study intervention and printed materials increase awareness of the importance of breast cancer screening and screening behaviors for Chinese American women., Implications for Practice: Oncology nurses and advanced practice nurses can play critical roles on this medically underserved population that experiences disparities in breast cancer mortality by providing culturally appropriate counseling to promote screening adherence.

Cancer is the leading cause of death for Asian Americans, and breast cancer is the leading cancer diagnosed among Asian American women. Despite the alarming facts, Asian American women have low breast cancer screening rates. This study examined the effects of a culturally appropriate community-based breast intervention program on participants' knowledge about breast cancer and intention for screening among Southeast Asian and South Asian women in Michigan. Data were collected from 166 women. At baseline, participants had limited knowledge of breast cancer screening guidelines and misconceptions about the risk factors of breast cancer. After the educational intervention, participants reported significantly higher knowledge scores related to breast cancer and screening recommendations and intentions to obtain follow-up CBE and mammograms. This culturally appropriate intervention provides strategies to overcome personal instructional barriers to meet the needs of this group for early detection and cancer control.

Asian Indians are the largest Asian subgroup in the state of Michigan; however, data on the prevalence and correlates of cardiovascular disease for this group is limited. The sample consisted of 273 Asian Indians (AI) recruited through health fairs for surveys and blood tests throughout the state of Michigan. The prevalence of self-reported diabetes (20.1%) and elevated/abnormal glycated hemoglobin A1C levels (22.6%) exceeds the percentages of other ethnic groups reported in 2006-2008 Michigan Behavioral Risk Factor Survey. More than half of respondents had elevated body max index. The gender disparity in hypertension prevalence (50% for males vs. 19.3% for females) has not been observed in other similar studies and prevalence of male participants with hypertension also is higher than reported in other studies. In the multivariate analysis after adjusting demographic and access to health care factors, the results showed that the prevalence of metabolic syndrome increases among AI female participants but not among AI males. The data highlight the need for developing culturally-tailored interventions to effectively reduce multiple risk factors in this group.

Asian Americans are at least 4% of the US population, but there are very few studies about the prevalence of cardiovascular risk factors among this group. Cardiovascular disease (CVD) is the leading cause of death among Asian Americans in the United States. Limited research that studied cardiovascular risks among Asian Americans were available, therefore, more information is urgently needed. Cross-sectional surveys and blood tests were conducted at community-based health fairs in southeastern Michigan. A total of 388 Asian participants provided data for this analysis. The results showed that four Asian groups differ in the level of specific risk factors; in particular, the most urgent hypertension and cholesterol problems were found among Chinese and Filipino participants, while the risk of diabetes may be highest among the Hmong participants. The results from the multivariate analysis showed that after controlling for demographic and medical care-related factors in the model, ethnicity is still a significant predictor that contributed to the differences in CVD risks. The results show that cardiovascular and diabetes risks are high in the Asian American populations studied. Attention needs to be paid to the extent and nature of ethnic-specific health problems because each culture's health-related habits and beliefs affect their entry into preventive care so that strategies can be designed and implemented to effectively reduce and ultimately eliminate health disparities.

Title: Correlates of recent and regular mammography screening among Asian-American women., Aim: This paper is a report of a study of the health beliefs, knowledge and selected demographic variables that influence mammography utilization among Asian-American women., Background: Breast cancer is the most frequently occurring cancer in Asian-American women and its incidence is increasing at a greater rate than for other racial and ethnic groups in the United States of America (USA). Compared to White women, breast cancer also is more likely to be diagnosed at a later stage with larger tumours in Asian-Americans., Method: A self-administered questionnaire was used with Asian-American women residing in the USA. Data were collected in 2005 and 315 women participated in the study., Results: Fifty-five per cent of participants reported having their last mammogram within the past 13 months, and 33% reported having annual mammograms in each of the past 5 years. Based on multivariate logistic regression analyses, clinical breast examination, barriers and knowledge of recommendations of the frequency of mammography screening were associated with both recent and regular mammography practice after controlling for all other demographic, psychosocial and behavioural variables in the model., Conclusion: Intervention strategies tailored to knowledge, language and cultural factors associated with mammography use should target at-risk subgroups, particularly those who are recent immigrants and those with limited English language ability. Culturally appropriate strategies should be developed to promote lifelong mammography screening for this rapidly growing and diverse population.

Asian American women have the lowest mammography screening rate and are often diagnosed at later stages of breast cancer compared with other ethnic groups. This study applied the Transtheoretical Model and examined the relationships between stages of mammography adoption and mammography-related beliefs while controlling for socio-demographic factors. The study consisted of a convenience sample of 315 participants from four populous Asian ethnic groups in Michigan (109 Asian Indians, 51 Chinese, 36 Koreans and 119 Filipinos). In this relatively small sample, Koreans appeared to be more likely to be at the pre-contemplation stage and less likely to be at the maintenance stage. Perceived barriers and decisional balance scores differed by stage, with pre-contemplators reporting highest barriers and lowest scores in decisional balance. In terms of specific barrier items, pre-contemplators also displayed significantly greater agreement for most of the barrier items. Participants in the action stage have less favorable decisional balance than those in two earlier stages (i.e. contemplation and relapse). Common barriers for this sample of Asian participants included the items related to access and modesty issues. Overall, the study supports the notion that assessing differences in mammography-related beliefs by stage of screening behavior may facilitate the development of stage-matched interventions for Asian ethnic groups.

Objective: The purpose of this study was to identify and compare the differences in perceived barriers for mammography screening among four ethnic groups of Asian-American women., Methods: Self-administered questionnaires were completed by 315 women in these four groups., Results: The results from the multivariate analyses indicated that even after taking into account insurance coverage and demographic variables, specific barriers still prevent Asian-American women from seeking mammography., Discussion: Recognizing similarities and differences in the barriers among demographic variables such as ethnicity, age, and length of U.S. residency among Asian subgroups can assist health professionals to address their needs when promoting adherence to mammography guidelines.

Cancer is the leading cause of death among Asian American women, and the death rate has increased almost 200% since 1990. Previous research has applied the transtheoretical model constructs to examine cancer screening behavior; however, to our knowledge, this is the first such investigation to examine relationships between stages of mammography adoption and decision balance among Asian American women. This article presents study findings from a convenience sample of 228 women aged 40 to 81 years (mean = 55.0, SD = 9.6) residing in southeastern Michigan. The current study demonstrates excellent support for the psychometric properties of a pros and cons measure, with promising Cronbach alphas above .70. Results from confirmatory factor analysis also support the factor structure derived from exploratory factor analysis with good model fit indices. This study also provides some support on transtheoretical model-hypothesized relationships in this sample of Asian American women that, as the stages of adoption of mammography proceeded from earlier to later ones, the decisional balance would become more favorable. The specific beliefs (both positive and negative) associated with the various stages of mammography adoption have implications for health professionals in developing stage-matched interventions to motivate women in adopting regular mammography.

Background: Cultural-appropriate strategies can be designed to promote cancer screening if the unique needs and characteristics of ethnic groups are identified. Most of the data available for Asian immigrants living in the U.S. has been aggregated under the Asian-American/Pacific Islanders (AAPI) ethnic category., Methods: A total of 125 women completed self-administered questionnaires that assessed screening practices (i.e. breast self-exam, clinical breast exam, and mammography), related beliefs and knowledge. This paper reports examined cancer-related practices and beliefs among three subgroups of Asian-American women (47 Filipinos, 40 Chinese, and 38 Asian-Indians)., Results: The sample mean age was 50.2 years and majority of women (76%) were married. Their length of residence in the United States ranged from less than one year to 37 years, with an average length of residence of 18 years. Results from two-way analyses of variance (ANOVAs) showed the strong influence of ethnicity on perceptions of susceptibility [F(2, 95) = 5.11, p = 0.01] and seriousness [F(2, 99) = 4.85, p = 0.01] related to breast cancer, in addition to an interaction detected between ethnicity and income in terms of perceived barriers [F(5, 107) = 3.04, p = 0.01]. The results also indicated that three common barriers were reported in all three ethnic groups, and three unique barriers were more frequently identified by Chinese (i.e. do not need mammogram if I feel ok [OR = 5.450, 95%; CI = (1.643, 18.081)] and waiting time is too long [OR = 5.070, 95%; CI = (1.674, 15.351)]) and Asian-Indian women (i.e. do not know where to get a mammogram [OR = 9.237, 95%; CI = (3.153, 27.059)])., Conclusions: These findings can be used to develop interventions that are tailored to the special characteristics of immigrant women from different Asian groups.

Objective: To explore factors influencing breast cancer screening behavior among Chinese women residing in the United States., Design: A descriptive study guided by the health belief model adapted for Chinese American women. An English-language questionnaire was modified, translated, and pretested before use in the study sample. Data were analyzed using descriptive and multivariate analysis techniques., Setting: An urban area in Michigan in 2001., Participants: A consecutive nonprobability sample of 206 Chinese American women age 40 and older., Main Outcome Measure: The percentage of women age 40 and older who received a mammogram in the past year., Results: Access to health care, perceived barriers to mammography screening, need for breast health care, and information-seeking behavior had direct effects on Chinese American women's mammography screening utilization. Cultural affiliation had an indirect effect on breast cancer screening behavior, moderated through access to health care. The variance in mammography screening explained by these factors was 51%., Conclusion: Effective strategies for promoting breast cancer screening among Chinese American women should address ways to improve information-seeking behaviors and access to health care. Cultural affiliation and beliefs should be considered when counseling Chinese American women regarding breast cancer screening.

The aim of this study is to explore the relationship of culturally based attitudes on breast cancer screening behavior of Chinese women currently residing in the United States. This cross-sectional study used a survey instrument that was administered to a consecutive nonprobability sample of 202 Chinese women residing in an urban Michigan county. Mood's strength of cultural affiliation scale (SCAS) was modified for cultural appropriateness prior to being translated into Chinese, back-translated, and pretested prior to use for this study. Data were analyzed using descriptive, correlational, and multivariate analysis techniques. Statistical analyses revealed that cultural diversity within the Chinese sample was associated with differing health behaviors and that the SCAS had indirect effects, through access to health care, on women's mammography screening use (R2 = 28.3%). These study's findings reveal that cultural affiliation and beliefs are related to the breast cancer screening behavior of immigrant Chinese women.

Breast cancer is the leading cancer diagnosed among Chinese, Filipino and Korean women. Despite the efficacy of breast cancer screening, Asian American women have one of the lowest rates of mammography and clinical breast exam (CBE) of all U.S. ethnic groups. I provided a systematic overview to document factors related to three modalities of breast cancer screening (breast self-exam [BSE], CBE and mammography) among four subgroups of Asian American women (i.e., Chinese, Korean, Filipino, and Asian Indian). Results showed that the existing studies provided evidence of demographic correlates to screening practice; however, fewer studies focused on cognitive and social-cultural correlates, and limited results were available with Filipino and Asian Indian groups.

Cancer is the leading cause of death for Asian American women, and the breast is a primary site of cancer in Chinese women. Although a number of studies have used constructs from the Health Belief Model (HBM) to examine their relation to mammogram screening, the validity and reliability of the instruments on HBM constructs among Chinese women have not been consistently examined. The purpose of this study was to describe the psychometric properties of a culturally sensitive questionnaire for measuring Chinese women's beliefs (susceptibility, seriousness, benefits, and barriers) related to breast cancer and mammogram screening. The items developed for the questionnaire were drawn from a comprehensive literature review and focus groups. The instrument was translated using back translation technique and evaluated by a panel of professional experts and lay experts. A total of 220 Chinese American women ages 40 to 85 years residing in a suburban Midwestern community were included in the sample. Psychometric testing demonstrated satisfactory internal consistency and validity of the instrument for this group of women. The Cronbach alpha for the subscales ranged from.77 to.90. Construct validity was supported by exploring the factor structure of the instrument using confirmatory factor analysis and testing correlations with mammography compliance.