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.

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.

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.

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..

OBJECTIVE:The purpose of this study was to validate a Sociocultural Health Behavior Model using a structural equation analysis to determine the direction and magnitude of the interdependence of model components in relation to health behavior associated with colorectal cancer (CRC) screening among Chinese Americans.METHODS:A cross-sectional design included a sample of 311 Chinese American men and women age 50 and older. The initial step involved use of confirmatory factor analysis which included the following variables: access/satisfaction with health care, enabling, predisposing, cultural, and health belief factors. Structural equation modeling analyses were conducted on factors for CRC screening.RESULTS:Education and health insurance status were significantly related to CRC screening. Those with less than a high school education and without health insurance were more likely to be "never screened" for CRC than those having more education and health insurance. The path analysis findings also lend support for components of the Sociocultural Health Belief Model and indicated that there was a positive and significant relationship between CRC 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 CRC screening and reinforced the need to assist Chinese with poor English proficiency in translation and awareness of the importance of CRC screening. The use of community organizations may play a role in assisting Chinese to enhance colorectal cancer screening rates.

OBJECTIVEThe purpose of this community-based study was to develop a structural equation model for factors contributing to breast cancer screening among Chinese American women.METHODSA 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.RESULTSInitial 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.CONCLUSIONSThe 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.

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.

The purpose of this community-based participatory study was to identify factors associated with colorectal cancer (CRC) screening compliance and non-compliance among Cambodians, Vietnamese, Koreans and Chinese men and women 50 years and older living in the United States. A cross-sectional design was used in the study. The completed sample included 815 Asian Americans which included Cambodians (N=215), Vietnamese (N=195), Koreans (N=94) and Chinese (N=311). A 95-item questionnaire was developed and pilot tested for content validity and reliability. An in-person data collection approach was utilized and participants were given choice in responding in English or their native language. Of the 815 participants, 79.1% (N=645) reported never-screened, 7.9% (N=64), non-compliance, and 13.0% (N=106) compliance. Education was significantly associated with never-screened for CRC for Vietnamese and Chinese; employment status for Cambodians and Koreans; lack of health insurance for Cambodians, Korean and Chinese; English fluency and years lived in the U.S. for Vietnamese, Koreans, and Chinese. Less acculturated Asian Americans were more likely to be never screened, but differentially across ethnic subgroups. Barriers to screening included lack of knowledge, language, transportation, and time. Increased culturally-targeted public awareness and education programs are needed to improve CRC screening and compliance among high risk Asian American ethnic subgroups.

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.

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.

ABSTRACT Objective This study examines the knowledge about the risk factors and symptoms of oral cancer, attitudes toward oral cancer and associated behaviors of college students using constructs of the Health Belief Model and the predictors of oral screening of college students. Participants College of Health Science students (N = 300) at a State university located in the Northeastern US were surveyed. Methods A 25-item questionnaire was administered during the Fall 2009 semester, which measured knowledge and behaviors related to oral cancer risk factors. Results Participants perceived their oral health to be good (63.6%), were unaware of dental diseases (95.5%), visited a dentist (60.5%), had a dental visit (62.2%) within the last 6 months, and scheduled one (66.3%) in the next 6 months. There was a significant correlation between the behavior of use of tobacco and the perceived susceptibility to oral cancer (t = 8.10, p < 0.05) and perceived severity (t = 2.22, p < 0.05) if a person got oral cancer. There were no significant variables which predicted oral cancer screening. Having a dental visit best predicted the scheduling of a future dental visit. Conclusions Findings from this study may further assist in future health education and dental screening programs for this population group across the US.

Introduction: In Asian countries, the reported incidence rate and its subsequent mortality have been on the rise. Asian Americans have increased prostate cancer rates over those of Asians in their native lands. Chinese represent the largest ethnic group among Asian Americans, but there is lack of studies regarding their behavior in prostate cancer (PCa) screening. The purpose of this community based study was to develop a structural equation model for factors contributing to prostate cancer screening among Chinese American men. Methods: A cross-sectional design included a sample of 163 Chinese men age 50 and older. The initial step involved use of confirmatory factor analysis. Structural equation model analyses were conducted on factors for prostate cancer screening. Results: Education, annual income, and health insurance status were significantly related to PCa screening. Those with less than a high school education, low annual incomes, and without health insurance were more likely to be “never screened” for PCa than those having more education, higher annual income, and health insurance. The path analysis findings also lent support for components of the Sociocultural Model and indicated that there was 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 and reinforces the need to assist Chinese men with poor English fluency in translation and awareness of PCa screening. Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A5.

OBJECTIVESTo determine differences in screening for routine physical exam and cancers among Chinese, Korean, Vietnamese, and Cambodian Americans.METHODSThe sample consisted of 2011 participants. Chi square was used to identify relationships between demographic/acculturation factors and screenings.RESULTSNever-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%).CONCLUSIONSEfforts should be made to comply with screening guidelines among Asian Americans.

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.

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.

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.

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.

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.

This study examined Asian subgroup differences in sources of health information and cancer screening, comparison of Asians and Whites in screening, and the association between health information and screening behavior. A nationally representative sample of 6,722 adults in the US, including those who speak, Chinese, Vietnamese and Korean was selected. Questionnaire items developed by the Commonwealth Fund included demographic variables, health status, cancer screening, health care experiences, health information sources, and use of an interpreter in the patient-provider interaction. There were differences between subgroups in source of health information. Indians from India were more likely to use the World Wide Web than Chinese, Koreans, and Filipinos. There were differences in ease of reading or understanding instructions on the prescription bottle, information booklets provided by physicians, and in difficulty speaking with a physician. There were differences in getting a general physical and a pap test between Asian ethnic subgroups and between Asians and Whites. Certain sources of health information were positively correlated with specific screening tests. Development of particular sources of health information relevant to specific Asian subgroups and for specific screening tests may enhance their decision making prior to and in conjunction with receiving medical care services.