International Journal of Environmental Research and Public Health
Objective Asian Americans’ food purchasing, cooking, and eating patterns are not well understood.... more 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 ...
The purpose of this teaching strategy is to demonstrate the experience of drug dependency for ado... more The purpose of this teaching strategy is to demonstrate the experience of drug dependency for adolescents through the use of broken story telling. The strategy ends with a debriefing session.
The purpose of this study was to describe the relationship between parents’ knowledge and attitud... more The purpose of this study was to describe the relationship between parents’ knowledge and attitudes about sunscreen use and their reported sunscreen use behaviors with their children, ages one to twelve, when playing outside and at the pool or beach in a rural and diverse population. Door-to-door surveys were conducted in randomly selected neighborhoods. Knowledge of doctors’ minimum SPF recommendation was found to be significant in how often sunscreen was used outside and at the pool or beach. Knowledge of the sun’s strongest hours was significantly related to how often sunscreen was used with children when at the pool or beach. Knowledge of consequences from a bad sunburn was found to be significant in how often sunscreen is used outside with children. Participants knowing that most of skin damage occurs prior to eighteen years old was significantly related to how often participants use sunscreen with children at the pool or beach. A weak positive correlation was found for serious...
Public health reports (Washington, D.C. : 1974), 2018
Sodium reduction in restaurant foods is important because 77% of sodium in the United States is c... more 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. 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 af...
The purpose of this study was to examine racial/ethnic differences in adolescent smoking behavior... more The purpose of this study was to examine racial/ethnic differences in adolescent smoking behavior, sources of tobacco, knowledge of and attitudes toward youth tobacco restriction policies, and perceptions of tobacco availability by adolescents. The study is important as it will add to the growing body of literature regarding tobacco use by minors, and will help policymakers and public health professionals develop efficacious policies and interventions to prevent and reduce tobacco use among adolescents. Minors obtain tobacco from social and commercial sources. Previous studies have emphasized rural homogeneous populations and so the present study addresses the need to determine these sources of tobacco to youth in a large urban, heterogeneous population, such as Philadelphia. A stratified multistage purposive sampling procedure was used to ensure an ethnically/racially sample. A 68-item questionnaire was administered to 645 students in Grades 8-10 in five public and nonpublic funded schools in a culturally diverse part of Philadelphia. Correlations between selected independent variables and smoking behavior were determined. Results from this study indicate that rates of smoking are high among students, with 50% of students ever having smoked, 19% within the last month, 17% weekly, and 15% smoke daily. Further, there were differences in rates of smoking between ethnic/racial groups. Social sources were the most common sources of tobacco reported, with friends being the most frequent source. There were differences in social and commercial ever sources of cigarettes between ethnic/racial groups and in perceived school and parental sanctions for tobacco use. The results of this study suggest that more financial and educational resources should be committed to prevent and reduce smoking behaviors among adolescents. Educational prevention programs, especially parenting programs should be employed to reduce smoking.
The purpose of this cross-national study was to determine the leading social influences on smokin... more 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..
Background: Cancer is major cause of death amongst Asians Americans and this group has the lowest... more Background: Cancer is major cause of death amongst Asians Americans and this group has the lowest screening rates of all ethnic groups in the US. Cancer and screening rates vary by Asian American subgroups but little is understood about barriers in place. Purpose: The purpose was to determine differences in demographic and acculturation factors, in cancer screening use for breast, cervical, prostate, liver, colorectal cancers and routine health screening among Chinese, Korean, Vietnamese, and Cambodian Americans. Methods: A cross-sectional design utilizing face-to-face data collection with language assistance. The sample participants included 2,011 Asian men and women, composed of Chinese (45.9%), Korean (19.1 %), Vietnamese (18.1%), and Cambodian (16.9%) Americans. Data were analyze by the chi square test to identify relationships between demographic and acculturation factors and screenings with 95% confidence intervals. Results: Across the four ethnic groups differences were found...
Problem/Objective: Despite the proven survival benefits associated with breast cancer screening, ... more Problem/Objective: Despite the proven survival benefits associated with breast cancer screening, utilization of the mammography continues to be suboptimal in some ethnic minority populations, particularly Chinese women immigrants who report considerable barriers to screening. The incidence rate of breast cancer for this population continues to rise. Predictors of predisposing and enabling factors and barriers to mammography screening behaviors were examined amongst Chinese immigrants. Methods: Women (n= 474) were recruited from Chinese community centers. The study, guided by Health Belief Model and Behavioral Model of Health Service Utilization, tested two hypotheses. Hypothesis 1: predisposing factors (perceived barriers, risks, severity, benefits, self-efficacy and demographic variables) and enabling factors (health insurance, income and regular physician availability) predict Mammography screening. Hypothesis 2: Personal factors (trust in physicians and satisfaction with access t...
Problem/Objective: The purpose of this study was to determine demographic and acculturation facto... more Problem/Objective: The purpose of this study was to determine demographic and acculturation factors associated with breast cancer screening compliance and non-compliance among Chinese, Korean, Vietnamese and Cambodian women 40 years and older. Methods: A cross-sectional design utilized face-to-face data collection approach with language assistance. The sample participants included 894 Asian women, composed of Chinese (50.1%), Cambodians (18.06%), Vietnamese (16.24%), and Koreans (15.64%). The variables associated with mammogram screening consisted of demographics, acculturation, and barriers. Data were analyzed by the chi square test, odds ratios, and 95% confidence intervals with logistic regression modeling. Results: Among participants, 33.6% reported never screened, 22.8% reported non-compliance, and 43.6% compliance. Education and low income (<10,000) was significantly associated with never screening for breast cancer for Cambodians. Not having insurance was associated with l...
This study examined racial/ethnic differences in primary and secondary preventive health behavior... more This study examined racial/ethnic differences in primary and secondary preventive health behaviors and use of complementary and alternative medicine (CAM). A questionnaire was administered to 6305 White, African-American, Hispanic and Asian households. A random-digit dialing method was employed utilizing a stratified minority sample design. The questionnaire was translated into Spanish, Mandarin, Cantonese, Vietnamese, and Korean. There were significant differences in physician visitations, in health care location types, attitudes toward self-care, fatalism, health decisions left to a physician, health problems impairing daily activity, health problem types, preventive health behaviors, and use of CAM. Overall, 31.6% used CAM. Hispanics used CAM because they were cheaper, and Asians because of cultural beliefs. Fatalism was inversely associated with CAM use. Increased understanding of specific differences between ethnic/racial groups in preventive health care behaviors and CAM use, ...
Most of the sodium Americans consume comes from processed and restaurant foods. An upstream globa... more Most of the sodium Americans consume comes from processed and restaurant foods. An upstream global strategy to promote health is to work with local restaurants to reduce sodium content in their food offerings, while accounting for food taste and economic considerations. In urban communities, Chinese take-out restaurants serve meals with large amounts of sodium and are clustered in low-income, racial/ethnic minority communities with a high prevalence of hypertension. The objective of this study is to assess baseline knowledge, attitudes, and behaviors related to sodium use/consumption among Chinese take-out owners and chefs recruited to participate in the Philadelphia Healthy Chinese Take-Out Initiative. A cross-sectional study of 221 Chinese take-out restaurants was conducted from August 2012 to February 2013. Items measured knowledge, attitudes, and behaviors related to salt use, salt consumption, and health. Most owners/chefs knew that excess sodium consumption contributes to high...
Journal of community medicine & health education, Jan 19, 2013
The purpose of this community-based study was to develop a structural equation model for factors ... more 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. 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. 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 enablin...
The purpose of this article is to report the key preliminary findings of a survey conducted among... more 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.
Effective health educator-client communication processes are a prerequisite to the acquisition an... more 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&amp;amp;amp;amp;amp;amp;#39; 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.
International Journal of Environmental Research and Public Health
Objective Asian Americans’ food purchasing, cooking, and eating patterns are not well understood.... more 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 ...
The purpose of this teaching strategy is to demonstrate the experience of drug dependency for ado... more The purpose of this teaching strategy is to demonstrate the experience of drug dependency for adolescents through the use of broken story telling. The strategy ends with a debriefing session.
The purpose of this study was to describe the relationship between parents’ knowledge and attitud... more The purpose of this study was to describe the relationship between parents’ knowledge and attitudes about sunscreen use and their reported sunscreen use behaviors with their children, ages one to twelve, when playing outside and at the pool or beach in a rural and diverse population. Door-to-door surveys were conducted in randomly selected neighborhoods. Knowledge of doctors’ minimum SPF recommendation was found to be significant in how often sunscreen was used outside and at the pool or beach. Knowledge of the sun’s strongest hours was significantly related to how often sunscreen was used with children when at the pool or beach. Knowledge of consequences from a bad sunburn was found to be significant in how often sunscreen is used outside with children. Participants knowing that most of skin damage occurs prior to eighteen years old was significantly related to how often participants use sunscreen with children at the pool or beach. A weak positive correlation was found for serious...
Public health reports (Washington, D.C. : 1974), 2018
Sodium reduction in restaurant foods is important because 77% of sodium in the United States is c... more 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. 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 af...
The purpose of this study was to examine racial/ethnic differences in adolescent smoking behavior... more The purpose of this study was to examine racial/ethnic differences in adolescent smoking behavior, sources of tobacco, knowledge of and attitudes toward youth tobacco restriction policies, and perceptions of tobacco availability by adolescents. The study is important as it will add to the growing body of literature regarding tobacco use by minors, and will help policymakers and public health professionals develop efficacious policies and interventions to prevent and reduce tobacco use among adolescents. Minors obtain tobacco from social and commercial sources. Previous studies have emphasized rural homogeneous populations and so the present study addresses the need to determine these sources of tobacco to youth in a large urban, heterogeneous population, such as Philadelphia. A stratified multistage purposive sampling procedure was used to ensure an ethnically/racially sample. A 68-item questionnaire was administered to 645 students in Grades 8-10 in five public and nonpublic funded schools in a culturally diverse part of Philadelphia. Correlations between selected independent variables and smoking behavior were determined. Results from this study indicate that rates of smoking are high among students, with 50% of students ever having smoked, 19% within the last month, 17% weekly, and 15% smoke daily. Further, there were differences in rates of smoking between ethnic/racial groups. Social sources were the most common sources of tobacco reported, with friends being the most frequent source. There were differences in social and commercial ever sources of cigarettes between ethnic/racial groups and in perceived school and parental sanctions for tobacco use. The results of this study suggest that more financial and educational resources should be committed to prevent and reduce smoking behaviors among adolescents. Educational prevention programs, especially parenting programs should be employed to reduce smoking.
The purpose of this cross-national study was to determine the leading social influences on smokin... more 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..
Background: Cancer is major cause of death amongst Asians Americans and this group has the lowest... more Background: Cancer is major cause of death amongst Asians Americans and this group has the lowest screening rates of all ethnic groups in the US. Cancer and screening rates vary by Asian American subgroups but little is understood about barriers in place. Purpose: The purpose was to determine differences in demographic and acculturation factors, in cancer screening use for breast, cervical, prostate, liver, colorectal cancers and routine health screening among Chinese, Korean, Vietnamese, and Cambodian Americans. Methods: A cross-sectional design utilizing face-to-face data collection with language assistance. The sample participants included 2,011 Asian men and women, composed of Chinese (45.9%), Korean (19.1 %), Vietnamese (18.1%), and Cambodian (16.9%) Americans. Data were analyze by the chi square test to identify relationships between demographic and acculturation factors and screenings with 95% confidence intervals. Results: Across the four ethnic groups differences were found...
Problem/Objective: Despite the proven survival benefits associated with breast cancer screening, ... more Problem/Objective: Despite the proven survival benefits associated with breast cancer screening, utilization of the mammography continues to be suboptimal in some ethnic minority populations, particularly Chinese women immigrants who report considerable barriers to screening. The incidence rate of breast cancer for this population continues to rise. Predictors of predisposing and enabling factors and barriers to mammography screening behaviors were examined amongst Chinese immigrants. Methods: Women (n= 474) were recruited from Chinese community centers. The study, guided by Health Belief Model and Behavioral Model of Health Service Utilization, tested two hypotheses. Hypothesis 1: predisposing factors (perceived barriers, risks, severity, benefits, self-efficacy and demographic variables) and enabling factors (health insurance, income and regular physician availability) predict Mammography screening. Hypothesis 2: Personal factors (trust in physicians and satisfaction with access t...
Problem/Objective: The purpose of this study was to determine demographic and acculturation facto... more Problem/Objective: The purpose of this study was to determine demographic and acculturation factors associated with breast cancer screening compliance and non-compliance among Chinese, Korean, Vietnamese and Cambodian women 40 years and older. Methods: A cross-sectional design utilized face-to-face data collection approach with language assistance. The sample participants included 894 Asian women, composed of Chinese (50.1%), Cambodians (18.06%), Vietnamese (16.24%), and Koreans (15.64%). The variables associated with mammogram screening consisted of demographics, acculturation, and barriers. Data were analyzed by the chi square test, odds ratios, and 95% confidence intervals with logistic regression modeling. Results: Among participants, 33.6% reported never screened, 22.8% reported non-compliance, and 43.6% compliance. Education and low income (<10,000) was significantly associated with never screening for breast cancer for Cambodians. Not having insurance was associated with l...
This study examined racial/ethnic differences in primary and secondary preventive health behavior... more This study examined racial/ethnic differences in primary and secondary preventive health behaviors and use of complementary and alternative medicine (CAM). A questionnaire was administered to 6305 White, African-American, Hispanic and Asian households. A random-digit dialing method was employed utilizing a stratified minority sample design. The questionnaire was translated into Spanish, Mandarin, Cantonese, Vietnamese, and Korean. There were significant differences in physician visitations, in health care location types, attitudes toward self-care, fatalism, health decisions left to a physician, health problems impairing daily activity, health problem types, preventive health behaviors, and use of CAM. Overall, 31.6% used CAM. Hispanics used CAM because they were cheaper, and Asians because of cultural beliefs. Fatalism was inversely associated with CAM use. Increased understanding of specific differences between ethnic/racial groups in preventive health care behaviors and CAM use, ...
Most of the sodium Americans consume comes from processed and restaurant foods. An upstream globa... more Most of the sodium Americans consume comes from processed and restaurant foods. An upstream global strategy to promote health is to work with local restaurants to reduce sodium content in their food offerings, while accounting for food taste and economic considerations. In urban communities, Chinese take-out restaurants serve meals with large amounts of sodium and are clustered in low-income, racial/ethnic minority communities with a high prevalence of hypertension. The objective of this study is to assess baseline knowledge, attitudes, and behaviors related to sodium use/consumption among Chinese take-out owners and chefs recruited to participate in the Philadelphia Healthy Chinese Take-Out Initiative. A cross-sectional study of 221 Chinese take-out restaurants was conducted from August 2012 to February 2013. Items measured knowledge, attitudes, and behaviors related to salt use, salt consumption, and health. Most owners/chefs knew that excess sodium consumption contributes to high...
Journal of community medicine & health education, Jan 19, 2013
The purpose of this community-based study was to develop a structural equation model for factors ... more 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. 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. 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 enablin...
The purpose of this article is to report the key preliminary findings of a survey conducted among... more 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.
Effective health educator-client communication processes are a prerequisite to the acquisition an... more 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&amp;amp;amp;amp;amp;amp;#39; 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.
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