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Background: The objective of this study was to evaluate the efficacy of an in‐person, small‐group mammography video discussion (SMVD) intervention on mammography uptake among nonadherent Chinese American immigrant women. Methods: Women (N = 956) were randomized into either an SMVD group, where Chinese‐speaking community health workers (CHWs) used an effective, culturally appropriate video to discuss mammography, or a video‐only group, which viewed the cultural video sent by mail. Outcomes were mammography uptake at 6 months and 21 months postintervention. Results: Women in both groups increased mammography uptake, and an outcome analysis revealed no group differences (adjusted odds ratio [AOR], 1.18; 95% confidence interval [CI],.68–2.06). Overall, 61.2% of the SMVD group and 55.3% of the video‐only group had at least one mammogram during the 21‐month follow‐up period. When considering attendance to the SMVD, SMVD attendees had higher mammography uptake than the video‐only group (AOR, 1.51; 95% CI, 1.19–1.92), and SMVD nonattendees had lower mammography uptake than the video‐only group (AOR,.33; 95% CI,.22–.50). Conclusions: Both intervention strategies were associated with increased mammography uptake. The authors observed that the increase in use was greater among women who participated in the SMVD session compared with those who viewed the cultural video only. Future research may explore a virtual SMVD intervention for higher session attendance and increased mammography uptake (ClinicalTrials.gov identifier NCT01292200). Among Chinese American immigrant women who had not had mammography screening for over 2 years, exposure to an in‐person, small‐group mammography video discussion intervention increased their receipt of a mammogram compared with those who watched a culturally relevant video only. Both interventions were associated with increased screening uptake compared with women who were exposed to neither the small‐group mammography video discussion intervention nor the culturally relevant video. [ABSTRACT FROM AUTHOR]

Background The majority of Chinese Americans is foreign-born, and it is well-documented that immigration to the United States (US) leads to increased risk for chronic diseases including type 2 diabetes. Increased disease risk has been attributed to changes in lifestyle behaviors following immigration, but few studies have considered the psychosocial impact of immigration upon biomarkers of disease risk. Purpose To examine associations of psychological stress and social isolation with markers of type 2 diabetes risk over time among US Chinese immigrants. Methods In this longitudinal study of 614 Chinese immigrants, participants completed assessments of perceived stress, acculturative stress, negative life events, and social isolation annually at three time points. Fasting blood samples were obtained at each time point to measure blood glucose, glycated hemoglobin, and insulin resistance. Mean duration between baseline and follow-up assessments was approximately 2 years. Results Increases in migration-related stress, perceived stress and social isolation were associated with significant increases in fasting glucose at follow-up independent of age, body mass index, length of US residence, and other potential covariates. Moreover, increases in glucose varied depending on perceived stress levels at baseline, such that those with higher baseline stress had a steeper increase in glucose over time. Conclusions Psychological stress and social isolation are associated with increases in fasting glucose in a sample of US Chinese immigrants. Findings suggest that the unique experiences of immigration may be involved in the risk of developing type 2 diabetes, a condition that is prevalent among US Chinese despite relatively low rates of obesity. [ABSTRACT FROM AUTHOR]

Harlow's seminal work on the nature of attachment focused on the importance of warm, responsive, and loving relationships in children's healthy development. While the need for love and care is arguably universal, the ways in which these emotions are expressed can vary across cultural contexts. We examined how Chinese American parents' expressions of love were associated with children's attachment security. A total of 110 Chinese American immigrant parent–child dyads (children 7–11 years old, 49% girls) participated in 3‐min conversations in which parents were instructed to communicate love and care. Proposition‐level analyses in speech (total 8825 propositions) identified three types of affection: training (guan and chiao shun); relational affection (qin); and validation (acceptance and encouragement of child's own expression of emotion, thoughts, and behaviors). Higher training was observed in parents with lower American orientation and lower income. Higher relational affection was observed in parents with lower income. Higher validation was observed in parents with higher income. Using path analyses, training and validation were found to be positively associated with children's attachment security beyond parenting styles. Effects of parents' relational affection were moderated by children's American orientation. Results demonstrate how immigrant parents draw on multiple cultural scripts to express love and care. These findings expand traditional concepts of parental love in immigrant families and illustrate how bicultural expressions of love can shape attachment security in middle childhood. A video abstract of this article can be viewed at https://youtu.be/HqUfIDxkFsE Research Highlights: Analyses of parent‐child discussions identified three parental affection styles (i.e., training, relational affection, and validation) as expressions of love and care in Chinese American immigrant families.Training and validation were positively associated with children's attachment security.Relational affection was associated with lower attachment security for children with higher American cultural orientation, suggesting the effects of parent–child expressions of love are shaped by acculturation. [ABSTRACT FROM AUTHOR]

Objectives: Mental health remains an unmet need among Chinese Americans. This study aims to identify specific needs and strategies that may address the needs. Design: A total of 55 Chinese Americans consented and participated in online focus groups conducted in either Chinese or English using nominal group technique. Participants discussed the following questions, achieved themes, and provided ranking of themes in importance for each: (1) In general, what do people in the Chinese American community think about mental health or emotional well-being? (2) What have you found to be helpful for accessing mental health or emotional well-being services or care in the Chinese American population? And (3) What actions would you suggest to improve mental health and emotional well-being in the Chinese American population? Results: Across the focus groups, we observed high consistency of top ranked themes including lack of knowledge and awareness, negative impression, lack of Chinese-speaking providers, and that the most helpful factor toward access to care was education and increased awareness. Seminars and trainings was the top actionable suggestion. Conclusion: The findings are consistent with previous findings and continue to show that Chinese Americans need more education and training and that providers who can speak the language and understand the culture would be very helpful to increase access to care. This study emphasizes addressing mental health disparities in the Chinese American community through awareness, tailored interventions, and barrier removal. Promoting equal access also underscores the need for ongoing assessment and responsive strategies. [ABSTRACT FROM AUTHOR]

Endorsing conspiracy beliefs about an outgroup typically fosters ingroup bias. However, the response of bicultural individuals to conspiracy theories about one of their ingroups remains understudied. We posited that bicultural individuals' display of ingroup bias in such situations hinges on their levels of bicultural identity integration (BII). Two studies involving Chinese American participants revealed that conspiracy beliefs about China were associated with lower Chinese ingroup bias among those with higher BII levels. In Study 1, high BII Chinese Americans who endorsed conspiracy theories about China reported less favorable perceptions of the Chinese ingroup, but not among low BII Chinese Americans. Study 2 replicated findings in Study 1 in that high (vs. low) BII Chinese Americans with higher conspiracy beliefs about China were less willing to allocate monetary resources to a fictitious Chinese charity and reported lower Chinese patriotism. This research contributes to the identity integration literature by illustrating how bicultural individuals with varying BII levels respond differently to geopolitical tensions in the context of conspiracy beliefs. [ABSTRACT FROM AUTHOR]

Parents' socialization beliefs have implications for the psychological adjustment of their children through their parenting behaviors; however, such pathways have rarely been established among Chinese American families. The present study examined how Chinese American parents' goals for their children to take on bicultural values and behaviors (i.e., bicultural socialization beliefs) influenced their child's level of depressive symptoms in emerging adulthood through their parenting behaviors and the level of parent–child alienation. Data came from Waves 2 (adolescence) and 3 (emerging adulthood) of a longitudinal study of 444 Chinese American families. Mothers' reports of their bicultural socialization beliefs positively predicted adolescents' reports of mothers' autonomy-supporting behaviors and interdependence-focused shaming behaviors. In addition, there was a significant and negative indirect effect of mothers' bicultural socialization beliefs on emerging adult depressive symptoms through adolescents' reports of mothers' autonomy-supporting behaviors and emerging adults' reports of alienation to their parents. In contrast, there was a significant and positive indirect effect from fathers' reports of their bicultural socialization beliefs to emerging adult depressive symptoms, through emerging adults' reports of alienation only. Findings contribute to our understanding of bicultural processes in Chinese American families and establish that parents' beliefs have significant implications for the psychological adjustment of Chinese American youth. Public Significance Statement: Chinese American parents' goals for their adolescent child to be bicultural are important for their child's mental health in emerging adulthood. Practitioners would benefit from giving attention to the bicultural goals that underlie parents' behaviors in understanding how to best serve Chinese American youth and families. [ABSTRACT FROM AUTHOR]

Physical activity (PA) is critical for healthy aging, yet < 16% of U.S. older adults meet federal recommendations for moderate to vigorous PA. Asian Americans are a rapidly growing segment of the older adult population, who are less likely to meet these guidelines, and are frequently under-represented in clinical trials. This quasi-experimental pilot study evaluated the feasibility, acceptability, and preliminary effectiveness of a culturally tailored walking program to improve PA and social engagement for older Chinese Americans in Boston, MA. Participants at two community organizations were assigned to an enhanced walking or walking only condition for 12 weeks. Mixed effect repeated measures analysis addressed the study aims. The enhanced walking group (intervention) had fewer steps at baseline and less of a reduction in steps by 12 weeks as compared with the walking only (control) condition. Mean social engagement scores were significantly higher at 12 weeks (p =.03) for the intervention group. A culturally tailored walking intervention was feasible and acceptable for older Chinese Americans, improving social engagement and PA scores. [ABSTRACT FROM AUTHOR]

America's racial history is largely siloed and compartmentalized, separating minority group experiences as if they were neat rows of isolated, discernable categories. Resisting binary narratives, this article reframes history by focusing on the largely unknown lives of the Chinese immigrants and African American communities in the segregated south. An examination of the intimate histories between the two marginalized groups illuminates how structures of the central white power enforced racial projects that pit Asians and African Americans against each other, laying roots to the tensions we see continuing to play out today. Through my documentary film, Blurring the Color Line, which follows my grandmother's family growing up in a Black neighborhood, I dive into the obscure but illuminating space of in-betweenness to disrupt hegemonic productions of knowledge and to reveal nuanced stories of how cross-pollinating communities moved amongst and against one another in order to survive and thrive. Stories of conformity and co-mingling between two disempowered communities beg us to question how the language of skin informs social placement and how silenced histories speak deeper truths about the processes and consequences of racialization. [ABSTRACT FROM AUTHOR]

Purpose: Few studies have examined experiences of stigma and factors associated with symptoms among cervical cancer survivors from diverse racial and ethnic backgrounds. We investigated survivorship experiences and patient-reported outcomes in the SPADE symptom cluster (sleep disturbance, pain interference, anxiety, depression, and energy/fatigue) among Black, Latina, and Chinese American women diagnosed with cervical cancer. Methods: In two phases of research with cervical cancer survivors, we collected qualitative data through individual interviews (N=12; recruited through community referrals) and quantitative data from an observational cohort study (N=91; recruited through 4 national cancer registries). We coded interview transcripts to describe the survivors' experiences. We then evaluated associations between social support, spirituality, and SPADE symptom cluster domains using linear regression models. Results: Qualitative analysis yielded four themes: perceptions of stigma, empowerment, physical and psychological effects, and social support. These concepts revolved around internal and external stigmas, emotional responses, strengthened faith, and different social support types. Quantitative analyses indicated that greater spirituality was associated with lower symptom burden on all five SPADE domains (p<0.01). We observed nuanced associations between specific types of social support and SPADE domains. Conclusions: The survivorship experiences of Black, Latina, and Chinese American women with cervical cancer are negatively influenced by perceptions of stigma. Higher scores on spirituality and varied types of social support were significantly associated with fewer symptoms in the SPADE symptom cluster. Implications for Cancer Survivors: Results suggest targets for future interventions to reduce symptom burden among women diagnosed with cervical cancer by leveraging spirituality and social support. [ABSTRACT FROM AUTHOR]

Children's temperamental surgency is associated with later child behavioral problems. However, the underlying mechanisms linking child surgency and child aggression, such as negative parental control, are relatively understudied. Moreover, the potential protective effect of a close parent‐child relationship on these associations remains untested, particularly among non‐White families. Participants included 259 Chinese American preschoolers (Mage = 4.5 years, SD =.9 years, 50% girls) and their mothers (Mage = 37.9 years, SD = 4.7 years), the present study examined the moderating effects of parent‐child relationship quality on the association between mother‐rated child surgency and teacher‐rated child aggression as mediated by maternal psychological control. Overall, results showed that child surgency was linked positively to maternal psychological control, which, in turn, led to higher levels of child aggression six months later, but only when the parent‐child relationship quality was less optimal. These findings indicate that psychological control is one underlying mechanism linking child temperament and child maladjustment, and that parent‐child relationship quality is an important protective factor. Findings also expand an existing theoretical framework by explicating how these variables are applicable to an Asian American population, suggesting the critical buffering role that parent‐child relationship quality plays. The study findings inform efforts to mitigate the potential negative effect of psychological control in reducing childhood aggression. [ABSTRACT FROM AUTHOR]

Racial disparities in hospice use are a longstanding concern in the U.S. Asian Americans are among the least likely to receive hospice care and to be included in studies on this topic. This study examined the knowledge, attitudes, and preferences related to hospice care among older Chinese immigrants and associated factors. A sample of 262 Chinese immigrants age 60+ was recruited from six older adult centers in NYC. In-person interviews were conducted in Mandarin and Cantonese. Non-English-speaking older Chinese immigrants had very limited knowledge about hospice care. Only 26% of respondents had heard of hospice, and a few could correctly define any components. After receiving a comprehensive definition of hospice care, study participants expressed a positive attitude and a strong willingness to use hospice if near the end of life. Notably, some respondents still held misconceptions about hospice and were less positive in their attitude and preference for hospice care. These findings underscore the necessity for clear and accessible information about hospice among this population throughout the trajectory from good health to end of life. Further research is needed to identify the range of factors that influence the attitudes and preferences of older Chinese immigrants toward hospice care. [ABSTRACT FROM AUTHOR]

Age-friendly public spaces can improve older adults’ life quality and health. This study investigates low-income Chinese American/immigrant older adults’ needs, preferences, and encountered challenges in public space at two different contexts: central-city Chinatown and suburban Monterey Park in metropolitan Los Angeles. Findings reveal both common and different cultural preferences for public space activities, features, and facilities in these two contexts, as well as the importance of security, proximity, accessibility of neighbourhood public spaces, and culture-related activities and programmes in Chinese. Focusing on this underrepresented group, the study aims to enhance equitable public space planning and design. [ABSTRACT FROM AUTHOR]

Objective: To describe whether or not there are gender differences in lower urinary tract symptoms (LUTS) prevalence and risk factors in community-dwelling older Chinese Americans. Methods: We performed a secondary analysis of a prospective cross-sectional population-based survey of Chinese Americans aged 60 years and older between January 2011 and December 2013 in English, Mandarin, Cantonese, Taishanese, or Teochew. A clinical review of systems was used to assess LUTS, which included urinary frequency, urgency, burning and/or pain, blood in urine, and urinary incontinence. Results: Of the total 3157 people queried, 42% were men and 58% were women. More men reported LUTS compared to women (32.9% vs. 28.6%, p=0.01). In a multivariable analysis, female gender (adjusted odds ratio [aOR] 0.60, 95% confidence interval [CI] 0.49–0.73), being married (aOR 0.79, 95% CI 0.65–0.97), and smoking (aOR 0.66, 95% CI 0.49–0.88) were found to be protective, while traditional Chinese medicine use (aOR 1.51, 95% CI 1.28–1.78), heart disease (aOR 1.54, 95% CI 1.24–1.91), and anxiety (aOR 1.69, 95% CI 1.25–2.28) were most strongly associated with increased odds of LUTS. When examining genders separately, being married was found to be protective only in women. Meanwhile, unique factors found in men were hypertension, heart disease, and practice of Tai Chi. Conclusion: In this large population-based study, LUTS were more prevalent in older Chinese American men than women. We also found gender-specific factors that influenced the odds of reporting LUTS; however, traditional Chinese medicine use was the only factor that was shared by both genders. Future longitudinal investigations are needed to elucidate these underlying mechanisms to provide evidence-based and culture-specific guidelines for this rapidly growing population.

The COVID-19 pandemic has made historically rooted anti-Asian racism, xenophobia, and civic activism in the United States highly salient, creating a heightened need for Asian American youth to redress racial injustice through civic engagement. However, little is known about Chinese American adolescents' civic engagement in response to racial discrimination. The present study investigated the age-varying associations between Chinese American adolescents' experiences of COVID-19-related racial discrimination and their political civic engagement at the intersection of race and gender, as well as the moderating roles of ethnic identity affirmation and parental civic socialization in these associations. The participants were 295 10- to 18-year-old Chinese American adolescents (Mage = 14.1 years, SD = 2.2 years; 52% girls) and their parents (Mage = 44.2 years, SD = 6.0 years; 79% mothers). Time-varying effect modeling showed that experiences of racial discrimination were negatively associated with political civic engagement in middle adolescence. This negative association was found only among girls but not boys. High ethnic identity affirmation and parental civic socialization not only buffered Chinese American adolescents against the impact of racial discrimination but even promoted their greater political civic engagement across adolescence. These findings revealed the age trends and important individual and contextual facilitators of Chinese American adolescents' political civic participation in the context of the racialized pandemic of COVID-19, which can inform culturally and developmentally targeted education and intervention efforts that promote the civic development of Chinese American adolescents. [ABSTRACT FROM AUTHOR]

Purpose: The assumption that patient–provider communication may mediate patients' sense of control over cancer to affect health outcomes has limited evidence. This study examines whether patient-perceived cancer care communication quality (PPCQ) mediates stress appraisal and coping behavior, affecting physical functioning across different racial groups. Methods: Two hundred and twenty Chinese American and 216 non-Hispanic White (NHW) women (ages 28–80) with stage 0–III breast cancer, 1–5 years post-diagnosis, and without recurrence, enrolled and completed a cross-sectional telephone survey. Physical functioning was measured by the NIH-PROMIS short form. Validated measures of PPCQ, patients' evaluation of their socioeconomic well-being, stress appraisal (perceived severity and control), use of coping strategies, treatment-related symptoms, and comorbidities were also assessed. Path analyses were used to examine the mediation for each racial group. Results: Regardless of race, treatment-related symptoms, comorbidities, and socioeconomic well-being were all directly related to physical functioning (p < 0.05). The impact of PPCQ on physical functioning was mediated by perceived control in the Chinese American group (p < 0.05), but not in the NHW group. Perceived severity and coping were not mediators of physical functioning in either group. Conclusions: The mediational pathway from PPCQ to perceived control to physical functioning in Chinese American survivors may be partially explained by their lower socioeconomic well-being and culturally valued conformity to physicians as a medical authority. These sociocultural dynamics reinforce the importance of cancer care communication. For NHW survivors, the impact of treatment-related symptoms and socioeconomic well-being on physical functioning outweighed their PPCQ and perceived control. [ABSTRACT FROM AUTHOR]

This interview delves into Russell Leong's complex coming-of-age as a Chinese American poet, influenced by US–Sino relations, the notorious Joseph McCarthy anti-Red and anti-China era of the 1950s, and the local status of being a person and writer of colour in a post-World War Two America during the past 70 years. The interview explores why Leong considers himself to be more a "man in a blue T-shirt" than a diasporic colonial in exile; how scholars in China view Chinese Americans, and Leong's response in terms of his life, identity, and poetry; the relation between theory and practice in Leong's work; how Chinese American works as "diasporic"; whether he was "orientalized" by studying Asian Americans; how he would characterize his own work; and how, as a fellow poet, Hart sees Leong's work as a poet and visual artist. The interview ends with Hart's "Musings on the Interview" and his sample close reading. [ABSTRACT FROM AUTHOR]

Physical inactivity is a modifiable behavioral risk factor for breast cancer. Chinese American women have an increased breast cancer incidence and a low prevalence of meeting physical activity (PA) recommendations, yet little is known about their knowledge and experience regarding PA and breast cancer prevention. Given the significant cultural differences between Eastern and Western societies, effective interventions to promote PA among Chinese American women require understanding their knowledge levels regarding PA in breast cancer prevention and their PA experiences through a cultural lens. This qualitative descriptive study used virtual semi-structured individual interviews to explore Chinese American women's knowledge and perception of PA, their understanding of the role of PA in breast cancer prevention, and influence of culture and acculturation on PA experience. Twenty-one Chinese American women residing in eight states were interviewed. Using thematic analysis, four themes emerged: A limited appreciation of the preventability of breast cancer, variability in PA perception, Chinese culture norms and lifestyles influencing PA behavior, and the influence of the process of acculturation on PA behavior. Chinese American women had a limited understanding of PA in breast cancer prevention. Chinese culture, lifestyles, and traditional Chinese medicine positively and negatively influence Chinese American women's PA behaviors. When exposed to American culture, Chinese American women tended to adopt new PA behaviors, including increasing leisure-time PA while decreasing occupation- and transportation-related PA. Interventions to increase PA and reduce breast cancer risk among Chinese American women should address cultural factors and acculturation along with education and behavioral change strategies. [ABSTRACT FROM AUTHOR]

This study aims to explore how a group of Chinese American families transcend essentialist thinking through negotiating with different ideological orientations toward their heritage language and how these families' different ideological profiles could influence the home language maintenance. Data were collected through three rounds of semi-structured interviews with six Chinese migrant families in Boston, U.S. Qualitative content analysis was carried out to analyze the complexity of parents' ideologies. The findings revealed these migrant families' capability of perceiving their heritage language as a problem, a right, and a resource to cope with real-life problems they encounter in the host country. Moreover, the possible coexistence and contradiction of multiple ideological orientations within each family may be associated with the intergenerational linguistic transmission. The study uncovers the underlying process of language preservation at the micro-level, elicits a more expansive understanding of language ideology as a complex assemblage, and substantiates Ruiz's tripartite orientations as a practical heuristic for analyzing the interplay of differing beliefs. Crucially, whether to maintain one's heritage language in migrant families is less of a nostalgia for their home country, but rather more of an ongoing process situated in their agentive attempts for meaning-making as members of their new multilingual society. [ABSTRACT FROM AUTHOR]

Religious and cultural factors play an important part in shaping attitudes about mental health. This study focuses on mental health-related beliefs of a specific ethnocultural population: Chinese American Christians. Using an online adaptation of nominal group technique (NGT), self-identified Chinese American Christians (N = 39) were asked to describe how Christian beliefs/ practices and Chinese American identity affect responses to mental health problems, as well as actionable ways for their communities to better support people struggling with mental health issues. Helpful themes included supportive relationships within Christian communities and hope derived from Christian faith. Harmful themes included language and communication barriers, lack of mental health literacy, and stigma attributed by participants to Chinese cultural values. Actionable areas included the cultivation of safe spaces dedicated to open dialogue, integration of Christian belief and psychological perspectives, and general mental health awareness and education. [ABSTRACT FROM AUTHOR]

This paper discusses Amy Tan's novel The Kitchen God's Wife (1991). Its aim is to interpret the theme of women's silence between mother and daughter, including intercultural impacts of raising Chinese American girls by Chinese mothers. The intergenerational and intercultural splits between Chinese mother and her "more-American" daughter, when juxtaposed with each other, are deepened by the unbearable silence and secrets kept by the women. Both women's attitudes seem to be more apparent due to a brief outline of Confucius teachings that continuously dominated twentieth-century China. [ABSTRACT FROM AUTHOR]

Many Chinese American parents desire for their children to take on both Chinese heritage and mainstream American values and behaviors, referred to as their bicultural socialization beliefs. Parents' development of such beliefs appears linked with parent–adolescent conflict concerning cultural values, yet the direction and temporal ordering of this relation is unclear. The present study aimed to resolve discrepancies in the literature through examining the bidirectional relations between Chinese American parents' bicultural socialization beliefs and the acculturative family conflict they experience with their children. Relations were examined across two developmental periods of the children: adolescence and emerging adulthood. Data came from a longitudinal study of 444 Chinese American families from the west coast of the United States. Mothers and fathers reported on their own bicultural socialization beliefs for their children. Mothers, fathers, and adolescents/emerging adults each reported on levels of acculturative family conflict within mother–adolescent and father–adolescent dyads. Higher levels of family conflict in adolescence consistently predicted greater increases in parents' desires for their children to be bicultural in emerging adulthood. Results have implications for interventions with Chinese American families and demonstrate Chinese American parents as capable of adapting and growing from challenging, culturally based interactions with their children. [ABSTRACT FROM AUTHOR]

Emotion talk (ET), an emotion socialization practice theorized to promote children's emotion understanding and emotion regulation, has been linked to better socioemotional adjustment in diverse samples. Immigrant children face developmentally unique challenges and opportunities related to their multi‐lingual and multi‐cultural experiences. The present study aimed to identify sociocultural correlates of parent ET in two groups of low‐income immigrant families with preschool‐age children: Mexican American (MA) and Chinese American (CA) families. In 90 parent‐child dyads (child age = 38 to 70 months, 59% girls; 46 Mexican American and 44 Chinese American) recruited from Head Start programs, parents' (mostly mothers') ET quality and quantity (i.e., use of emotion words, emotion questions and explanations, and overall elaborateness of ET) were coded from verbal transcripts of a shared picture book reading task. First, we found similarities and differences in ET across the two groups. Both MA and CA parents used emotion words, emotion questions, and emotion reasoning, whereas linking the story to personal emotion experience was infrequent. MA parents used more negative emotion words, emotion reasoning, and engaged in more elaborate ET than CA parents. Second, we examined the unique relations of multiple socio‐cultural factors (SES, cultural orientations, parent and child demographics) to parent ET. Parent education and child age were associated positively with emotion questions, income was associated positively with emotion reasoning, and parents' heritage culture orientation was associated positively with the elaborateness of ET. The findings highlight the need to consider socio‐cultural variations in emotion socialization practices when adapting and disseminating socioemotional learning interventions. [ABSTRACT FROM AUTHOR]

Introduction: Type 2 diabetes (T2D) is prevalent among Asian Americans, yet limited health care studies report on the recruitment and retention of this population. This study focuses on recruiting Chinese American dyads for family support of T2D management. Method: This is a descriptive study using active and passive recruitment strategies. Dyads consist of parents with T2D and their adult children without diabetes. All materials are culturally tailored and available in Chinese. Results: The final sample included 54 dyads. There were characteristic differences among parent participants in English language proficiency and education levels. Filial piety manifested as respect and care for one's parents among Chinese American families contributed to recruitment success. Discussion: This article shares strategies for recruiting Chinese American dyads to explore family support dynamics for T2D self-management. The findings potentially add to current knowledge about culture, nursing, and health care. [ABSTRACT FROM AUTHOR]

This study aims to see how Chinese American people as immigrants in America construct their identity while facing two different cultures in society. This research is a descriptive qualitative study and using postcolonial approach. This study used novel by Mambo in Chinatown by Jean Kwok as the main data. Another document, journal, and author's interview as the secondary data. Ambivalence by Homi K. Bhabha will used as the main theory of this research. The main data collected after the researcher goes through close reading of the novel. The result of this study show that ambivalence occur through this novel. This study also highlights that the struggle of the character in the novel reflect the reality life of Chinese American immigrant in America. Seen from their arrival in America and how the first-generation immigrant transferring Chinese culture and value to their children as the secondgeneration in America. [ABSTRACT FROM AUTHOR]

The Chinese American population is one of the fastest-growing communities in the United States, composed of ∼5.4 million people, and represents ∼5.5% of overseas Chinese populations. With an expected exponential population rise, Chinese American patients who experience serious illness or approach end-of-life (EOL) may find their cultural values influencing the medical care they receive. Palliative care clinicians must recognize diverse cultural beliefs and preferences of Chinese American patients and their families. In this study, we provide 10 cultural pearls to guide the provision of palliative and EOL care for Chinese American patients, including discussions of Chinese traditions, communication strategies for Chinese patients and families, advance care planning, and EOL care beliefs. [ABSTRACT FROM AUTHOR]

Although prior research suggests Asian Americans experience physical health advantages relative to other racial/ethnic groups, increasing evidence points to health inequalities within Asian American subgroups. Disparities are especially pronounced among middle-aged Asian American women, who remain an understudied population, despite studies showing that midlife corresponds with distinct social stressors and changes in the availability of protective resources, such as social support. Thus, the purpose of the study was to examine racial/ethnic differences in social support and self-rated health (SRH) among middle-aged women. With data from the Study of Women's Health Across the Nation (SWAN; N = 1258), we used modified Poisson regression models to estimate incidence rate ratios (IRR), examining how social support shaped the risk of fair-to-poor SRH by race/ethnicity. We tested interactions between perceived stress, social support and race/ethnicity to determine whether the stress-buffering role of social support varies by group. Results demonstrate racial/ethnic differences in SRH. Higher levels of social support were linked to higher fair-to-poor SRH among Chinese American women (IRR = 1.24; 95% CI [1.02, 1.52]); while greater social support conferred lower risk among White women. Interaction analyses revealed additional nuances in the stress-buffering effects of social support among Chinese American women, such that the health benefits of social support depended on levels of perceived stress (IRR = 0.75; 95% CI [0.57, 1.00]). These findings highlight important distinctions in the ways that psychosocial factors shape health across racial/ethnic groups. In particular, this study helps advance our understanding of important subgroup differences in the stress-buffering role of social support for Asian American midlife women. Interventions should focus on identifying sources of social strain among Asian American women that can increase the risk for poor health and identify alternative sources of support that mitigate stressors to improve health. [ABSTRACT FROM AUTHOR]

In "Rail Road Standard Time" and "The Eat and Run Midnight People," published in the short story collection titled The Chinaman Pacific and Frisco R.R. Co. (1988), Frank Chin focuses on several issues such as cultural heritage and transmission, identity, railroad narrations, food, and masculinity. In the first short story, Chin is going to his mother's funeral, and during this journey, he jumps between his memories that help the reader to see the trails of his Chinese American identity formation. In the second story, Chin once more returns to his memories by taking up the role of the narrator and reveals the issues of double discrimination, masculinity, and the influences of American culture on his identity formation. The aim of this article is to analyze Chin's selected short stories from a thematic and social perspective. The article also aims to reveal how the author tries to maintain his ethnicity and reflect his identity molded by two different cultures. [ABSTRACT FROM AUTHOR]

Abstract Background Chinese Americans have lower breast and cervical cancer screening rates than the national average and experience multiple barriers to cancer care. Patient navigators have improved screening and follow-up rates for medically underserved populations, yet investigations of cancer navigation programs and their implementation among Chinese Americans are limited. To address this gap, we used the Consolidated Framework for Implementation Research (CFIR) to examine facilitators and barriers to implementing the Chicago-based Chinatown Patient Navigation Program (CPNP) for breast and cervical cancer screening, follow-up, and treatment. Methods Stakeholders from clinical care, supportive care services, and community organizations were invited to participate in qualitative interviews to illuminate implementation processes and stakeholder perspectives of facilitators and barriers to implementing the CPNP. Interviews were audio-recorded, transcribed, and deductively coded according to CFIR domains, including (1) intervention characteristics; (2) outer setting; (3) inner setting; and (4) the implementation process. Results We interviewed a convenience sample of 16 stakeholders representing a range of roles in cancer care, including nurses, clinical team members, administrators, physicians, a community-based organization leader, and a CPNP navigator. Findings detail several facilitators to implementing the CPNP, including patient navigators that prepared Chinese-speaking patients for their clinic visits, interpretation services, highly accessible patient navigators, and high-quality flexible services. Barriers to program implementation included limited regular feedback provided to stakeholders regarding their program involvement. Also, early in the program’s implementation there was limited awareness of the CPNP navigators’ roles and responsibilities, insufficient office space for the navigators, and few Chinese language patient resource materials. Conclusions These findings provide valuable information on implementation of future patient navigation programs serving Chinese American and other limited-English speaking immigrant populations.

This study investigated the potential benefit of a pilot culturally sensitive group support intervention, named Joy Luck Academy (JLA), in fostering posttraumatic growth among Chinese American breast cancer survivors. Eighty-six Chinese American breast cancer survivors participated in an eight-week single-arm pre-/post-test trial of an intervention program, which included educational lectures and peer mentor support. The JLA participants were compared with an independent sample of 109 Chinese American breast cancer survivors who went through routine care. Both groups completed baseline and eight-week follow-up assessments of the five facets of posttraumatic growth (meaningful interpersonal relationships, finding new possibilities in life, personal strength, appreciation of life, and spirituality). From baseline to follow-up, the JLA participants displayed significant improvements in the total score of posttraumatic growth, meaningful interpersonal relationships, appreciation of life, finding new possibilities in life, and personal strength. In contrast, the routine care participants showed no significant change in any of these outcome variables. The findings suggest the potential benefit of a culturally sensitive group support intervention in facilitating posttraumatic growth for Chinese American breast cancer survivors, indicating the need for a randomized controlled trial. The educational lectures and peer mentor support may be adapted to tailor the needs of other ethnic minority cancer patients. [ABSTRACT FROM AUTHOR]

Background: Smoking remains a major public health issue among Chinese immigrants. Smoking cessation programs that focus on this population are scarce and have a limited population-level impact due to their low reach. Mobile messaging interventions have the potential to reach large audiences and expand smokers' access to smoking cessation treatment. Objective: This study describes the development of a culturally and linguistically appropriate mobile messaging smoking cessation intervention for Chinese immigrant smokers delivered via WeChat, the most frequently used social media platform among Chinese people globally. Methods: This study had 2 phases. In phase 1, we developed a mobile message library based on social cognitive theory and the US Clinical Practice Guidelines for Treating Tobacco Use and Dependence. We culturally adapted messages from 2 social cognitive theory-based text messaging smoking cessation programs (SmokefreeTXT and Decídetexto). We also developed new messages targeting smokers who were not ready to quit smoking and novel content addressing Chinese immigrant smokers' barriers to quitting and common misconceptions related to willpower and nicotine replacement therapy. In phase 2, we conducted in-depth interviews with 20 Chinese immigrant smokers (including 7 women) in New York City between July and August 2021. The interviews explored the participants' smoking and quitting experiences followed by assessment of the text messages. Participants reviewed 17 text messages (6 educational messages, 3 self-efficacy messages, and 8 skill messages) via WeChat and rated to what extent the messages enhanced their motivation to quit, promoted confidence in quitting, and increased awareness about quitting strategies. The interviews sought feedback on poorly rated messages, explored participant preferences for content, length, and format, discussed their concerns with WeChat cessation intervention, and solicited recommendations for frequency and timing of messages. Results: Overall, participants reported that the messages enhanced their motivation to quit, offered encouragement, and made them more informed about how to quit. Participants particularly liked the messages about the harms of smoking and strategies for quitting. They reported barriers to applying some of the quitting strategies, including coping with stress and staying abstinent at work. Participants expressed strong interest in the WeChat mobile messaging cessation intervention and commented on its potential to expand their access to smoking cessation treatment. Conclusions: Mobile messages are well accepted by Chinese immigrant smokers. Research is needed to assess the feasibility, acceptability, and efficacy of WeChat mobile messaging smoking cessation interventions for promoting abstinence among Chinese immigrant smokers. [ABSTRACT FROM AUTHOR]

Background: Chinese American adults experience health disparities at the end of life. Culturally tailored advance care planning (ACP) may promote goal-concordant care across the continuum of serious illness. However, seriously ill Chinese Americans' preferences for ACP remain unknown. Objective: To explore barriers and facilitators to ACP among Chinese patients with advanced cancer and their caregivers. Design: Informed by socioecological theory, we conducted an exploratory qualitative study using semistructured interviews that were thematically analyzed. Setting/Participants: We recruited participants at one U.S. comprehensive cancer center. Of 27 eligible patients approached, we recruited 20 patients (74.1%) and 8 accompanying caregivers. Overall, participants were middle aged (55.6 ± 13.5 years), 60.7% female, 85.7% partnered/married, 89.3% college educated, and had low acculturation (mean Suinn-Lew Asian Self-Identify Acculturation = 2.0 ± 1.6/5.0). More patients were privately insured (35%) than self-pay (30%), Medicare (25%), and Medicaid (10%). Caregivers were split between "spouse" and "child." Results: Findings highlight participants' trust in their clinicians and the study institution as primary supports for clinicians to lead ACP. However, participants' preconceptions of clinicians' professional responsibilities and participants' belief in an uncertain future may hinder an open discussion of goals and values for future medical care. A key moderating factor in how participants view ACP may be their level of acculturation to local care, behavioral, and communication norms. Conclusions: Chinese patients may prefer a routinized clinician-led ACP approach that supports their actionable priorities in the present by leveraging patient–clinician trust, gauging acculturation level, and using indirect communication strategies. Future studies should investigate preferred communication strategies to support in-the-moment care planning. [ABSTRACT FROM AUTHOR]

Background/Context: Despite research that has rebutted the tiger parent stereotype, the perception that Asian immigrant parents enact overly strict and controlling educational practices continues to be widespread and entrenched. This stereotype is problematic because it constrains the understanding of Asian Americans to a one-dimensional group and engenders a false narrative of Asian American educational success as expected. Purpose/Objective/Research Question/Focus of Study: Using an intersectional lens, this study interrogates the stereotype of Asian immigrant parents as tiger parents. We examine how one subgroup of Asian American youth—lower income Chinese American adolescents (children of Chinese immigrants) spoke about their parents' involvement in their schooling and educational expectations. Our aim is to center young people's explanations to explore how they perceive parental educational socialization and whether it conforms to notions of tiger parenting. We posed the following three specific research questions: (1) How do these students speak about and understand the ways in which their parents monitor their schoolwork? (2) How do these students describe and understand their parents' messaging of educational expectations? and (3) In what ways do these students depict parent–child communication in their families? Research Design: Participants were 32 ninth-grade low-income Chinese American children of immigrants. We conducted individual interviews focused on educational socialization in the home. We used a combination of inductive and theoretically driven thematic analysis and explored the extent to which students' perspectives of their parents converged or diverged with the tiger parent stereotype. We adopted a working definition of tiger parenting based on categories related to parenting, including close monitoring of schoolwork, perceptions of high parent expectations for school performance and educational/career attainment, and parent-initiated communications regarding children's academic lives and decisions. Findings/Results: Our analysis revealed that participants did not experience their parents' educational involvement as conforming to the tiger parent stereotype. Instead, students were largely self-directed and described their parents as exercising basic monitoring of schoolwork, conveying generic and pragmatic educational and career expectations, and trusting their children overall to manage schoolwork and share key school-related information as needed. We introduce a concept that we call "informed distance" as more salient for understanding our participants' experiences. Conclusions/Recommendations: Educators must interrupt the tiger parent and model minority stereotypes to make room for a fuller and more complex understanding of Asian American students' experiences and ensure their educational needs are equitably addressed. Teachers and counselors can play an affirmative role in educational guidance for Chinese American students. [ABSTRACT FROM AUTHOR]

Objective: To examine whether a cultural adaptation of an early childhood obesity prevention program promotes healthy infant feeding practices., Methods: Prospective quasi-experimental study of a community-engaged multiphasic cultural adaptation of an obesity prevention program set at a federally qualified health center serving immigrant Chinese American parent-child dyads (N = 298). In a group of historical controls, we assessed early infant feeding practices (breastfeeding, sugar-sweetened beverage intake) in 6-month-olds and then the same practices alongside early solid food feeding practices (bottle weaning, fruit, vegetable, sugary or salty snack consumption) in 12-month-olds. After implementation, we assessed these practices in an intervention cohort group at 6 and 12 months. We used cross-sectional groupwise comparisons and adjusted regression analyses to evaluate group differences., Results: At 6 months, the intervention group had increased odds of no sugar-sweetened beverage intake (aOR: 5.69 [95% confidence interval (CI): 1.65, 19.63], P = .006). At 12 months, the intervention group also had increased odds of no sugar-sweetened beverage intake (aOR: 15.22 [95% CI: 6.33, 36.62], P < .001), increased odds of bottle weaning (aOR: 2.34 [95% CI: 1.05, 5.23], P = .03), and decreased odds of sugary snack consumption (aOR: 0.36 [0.18, 0.70], P = .003). We did not detect improvements in breastfeeding, fruit, vegetable, or salty snack consumption., Conclusions: A cultural adaptation of a primary care-based educational obesity prevention program for immigrant Chinese American families with low income is associated with certain healthy infant feeding practices. Future studies should evaluate cultural adaptations of more intensive interventions that better address complex feeding practices, such as breastfeeding, and evaluate long-term weight outcomes., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.)

Sleep-related issues may be one significant pathway through which socioeconomic disadvantages are associated with worse self-reported states in cancer. The present study examined the relationships between SES (income and education level) and two important biobehavioral factors (cancer-related fatigue and perceived stress), as well as mediation through sleep-related problems (sleep medication use, daytime dysfunction, and sleep quality) among a sample of Chinese American breast cancer survivors. 136 Chinese American breast cancer survivors completed a self-reported questionnaire. We found that relative to those with the lowest annual household income, those with the highest income have lower perceived stress. This relationship was mediated by lower sleep quality. Relative to those with a high school degree or less, those with graduate degrees have lower daytime dysfunction, and in turn lower cancer-related fatigue. Our findings point to the importance of addressing sleep-related issues, perceived stress, and cancer-related fatigue among Chinese American breast cancer survivors with low SES backgrounds., Competing Interests: Conflicts of Interest: The Authors declare that there is no conflict of interest.

Background: Chinese Americans have lower breast and cervical cancer screening rates than the national average and experience multiple barriers to cancer care. Patient navigators have improved screening and follow-up rates for medically underserved populations, yet investigations of cancer navigation programs and their implementation among Chinese Americans are limited. To address this gap, we used the Consolidated Framework for Implementation Research (CFIR) to examine facilitators and barriers to implementing the Chicago-based Chinatown Patient Navigation Program (CPNP) for breast and cervical cancer screening, follow-up, and treatment.Methods: Stakeholders from clinical care, supportive care services, and community organizations were invited to participate in qualitative interviews to illuminate implementation processes and stakeholder perspectives of facilitators and barriers to implementing the CPNP. Interviews were audio-recorded, transcribed, and deductively coded according to CFIR domains, including (1) intervention characteristics; (2) outer setting; (3) inner setting; and (4) the implementation process.Results: We interviewed a convenience sample of 16 stakeholders representing a range of roles in cancer care, including nurses, clinical team members, administrators, physicians, a community-based organization leader, and a CPNP navigator. Findings detail several facilitators to implementing the CPNP, including patient navigators that prepared Chinese-speaking patients for their clinic visits, interpretation services, highly accessible patient navigators, and high-quality flexible services. Barriers to program implementation included limited regular feedback provided to stakeholders regarding their program involvement. Also, early in the program's implementation there was limited awareness of the CPNP navigators' roles and responsibilities, insufficient office space for the navigators, and few Chinese language patient resource materials.Conclusions: These findings provide valuable information on implementation of future patient navigation programs serving Chinese American and other limited-English speaking immigrant populations. [ABSTRACT FROM AUTHOR]

A systematic assessment of the effect of COVID-19 on the food retail environment—an important determinant of health—has not been conducted. Our objective was to assess the impact of COVID-19 on closures of restaurants, food retail stores, and fresh produce vendors in New York City (NYC). We conducted a cross-sectional study following the peak of COVID-19 in six neighborhoods in NYC. Two Chinese ethnic neighborhoods and four higher/lower resourced comparison neighborhoods were selected a priori based on 14 sociodemographic indicators. The primary outcome was indefinite/temporary closures or absence of food businesses. Of 2720 food businesses identified, produce vendors and restaurants were more likely to close than food retail stores. A higher proportion of food businesses closed in Chinese ethnic neighborhoods vs. comparison neighborhoods. COVID-19 impacted food businesses in six NYC neighborhoods examined in this period, with the greatest effect observed for Chinese ethnic neighborhoods. [ABSTRACT FROM AUTHOR]

Objective: Fear of cancer recurrence (FCR) is commonly experienced among Caucasian and Chinese American breast cancer survivors (BCS). Emerging studies have suggested that Caucasian BCS' communication with family members contributes to their FCR. However, whether such findings apply to Chinese American BCS has yet to be explored. This study examined the association between social constraints (i.e., perceived barriers from significant others inhibiting cancer‐related disclosure) and FCR among 136 Chinese American BCS, plus proposed that self‐stigma (i.e., internalized feelings of shame about having cancer), bodily pain, and ambivalence over emotional expression (AEE; conflict between the desire to express emotions and the fear of its consequences) would mediate the association. Methods: Participants recruited through cancer associations in the USA were invited to complete a cross‐sectional survey measuring their socio‐demographic/cancer‐related variables and the above‐mentioned psychological variables. Results: Higher levels of social constraints, AEE, self‐stigma, and bodily pain were associated with higher FCR (rs ranged from 0.27 to 0.40, ps < 0.01). After controlling for covariates, path analysis results supported the proposed mediation model with satisfactory fit indices (χ2(7) = 2.08, Comparative Fit index = 1.00, Tucker Lewis Index = 1.08, Root Mean Square Error of Approximation = 0.00). Specifically, social constraints were associated with higher FCR through increased self‐stigma (β = 0.10, 95% confidence interval [CI] = 0.02, 0.17), AEE (β = 0.14, 95% CI = 0.01, 0.27), and bodily pain (β = 0.09, 95% CI = 0.02, 0.17), indicating significant mediation effects. After considering the mediators, the direct effect from social constraints to FCR was no longer significant. Conclusions: The association between social constraints and higher FCR could be mediated by increased self‐stigma, AEE, and bodily pain among Chinese American BCS. Interventions targeting to address those variables may reduce FCR among those BCS. [ABSTRACT FROM AUTHOR]

At any time, a medical crisis could result in an individual too sick to make one's own health care decisions. Advance care planning (ACP) is an important step to ensure that each person receives the medical care desired. Despite its significant importance and proven benefits, the completion rate for advance directive is approximately one-third among the general population in the United States and lower among Chinese Americans. This study explored Chinese Americans' knowledge and attitudes about ACP following completion of a web-based culturally tailored health education program. Ninety-six individuals completed the study between October 1 and December 31, 2020. Prestudy-poststudy outcomes measured included the Advance Directive Knowledge Survey and Advance Directive Attitude Scale administered before and after completion of the education program. Each measure has 9 questions and 16 questions, respectively. Participants' Advance Directive Knowledge Survey scores (pre: mean, 6.04 [SD, 2.28]; post: mean, 8.75 [SD, 0.53]; P <.01) and Advance Directive Attitude Scale scores (pre: mean, 47.31 [SD, 5.69]; post: mean, 53.59 [SD, 4.37]; P <.01) increased significantly following program completion. Findings indicated feasibility for integration of web-based technology and culturally tailored approaches to promote ACP knowledge and attitudes among Chinese Americans. [ABSTRACT FROM AUTHOR]

Christine Wang was a pioneering art therapist in Washington DC and Baltimore in the 1960s through the 1980s and the first Chinese-American art therapist in the United States. This biographical inquiry re-presents her role through interviews, historical documents, and publications. She made notable contributions to art therapy practice, research, and service (professional association and education). The intersections of her Chinese identity with her art therapy practice are explored through historical-cultural-political contexts and the model minority myth. Restoring Wang as a prominent figure in art therapy broadens the base of pioneers and increases racial representation in the profession. [ABSTRACT FROM AUTHOR]

Asian Americans have become a major factor in the debate over affirmative action and college/school admission policies. Yet most often their role is relegated to one side or the other of the argument - either grouped with other oppressed minorities, or else grouped with privileged white students. However, Asian Americans have their own agency and self-determination that requires attention. Beginning in the 1990s, San Francisco's Asian American community resisted mainstream hegemony and charted their own course forward. This study uses a comparative approach towards these early Asian American activists, comparing and contrasting their motivations and actions with Black activists of the time, and also with a respected federal judge, scion of one of San Francisco's wealthiest and traditional legal dynasties. News articles, notes and newsletters of Chinese American activist groups, internal school district reports, and 24 interviews are used to express how early generations of Asian Americans stood up to fight when they felt their version of the American dream was under attack, and how they focused on present-day tactical actions instead of futurelooking strategies or past historical experiences. This study also reveals practical principles that these specifically Chinese American activists employed which may have applications for all groups resisting domination and/or assimilation. The methods and tactics employed by these second-generation Asian Americans that grew up in a community remade by the 1965 Immigration Act, helps us understand how the Asian American community has developed since then, and how it is continuing to move forward. [ABSTRACT FROM AUTHOR]

Background: First-generation Chinese American patients have low engagement in advance care planning (ACP). Among the causes may be clinician uncertainty about traditional cultural values.Aim: Based on a survey identifying barriers to ACP among older ethnic Chinese American patients, we created a toolkit to support clinicians in culturally relevant ACP practices and conducted a pilot test to evaluate usability, acceptability, and preliminary outcomes.Design/setting/participants: The toolkit includes culturally relevant information and an ACP guideline with a prompt list of questions. Six clinicians (three physicians, two nurse practitioners, and one physician assistant) in two New York City-based practices piloted the toolkit through discussions with 66 patients.Results: Patients' age averaged 70.2 years (SD=12.4); 56.1% were women. Almost two-thirds had not finished high school and 53.0% spoke only Cantonese. More than three-quarters (78.8%) did not understand the purpose of ACP before the discussion. During the discussion, 58 patients (87.9%) completed a new proxy naming a health care agent, 21 (31.8%) requested a nonhospital DNR order, and two (3%) completed a living will. Topics discussed included treatment preferences (discussed with 80.3% of patients); health care values (77.3%); treatment decisions (72.7%); goals of care (68.2%), and hospice (1.5%). Five of the six clinicians expressed satisfaction ("very" or "somewhat") with the toolkit, four were "very" comfortable using it, and three stated that it helped them "a lot" with effective discussions.Conclusions: An ACP toolkit may facilitate culturally relevant ACP discussions by increasing clinician competency and patient engagement. Further studies of this approach are needed. [ABSTRACT FROM AUTHOR]