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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]

Objective: This study examined the effects of the first family health history (FHH)-based colorectal cancer (CRC) prevention education on 1) FHH of CRC communication with family members and primary care physicians (PCPs), 2) fecal occult blood test (FOBT) uptake, and 3) CRC preventive lifestyle modifications among 50- to 75-year-old Chinese Americans non-adherent to CRC screening guidelines.Methods: Using a community-based participatory research approach, we developed and implemented 62 culturally and linguistically appropriate, theory-driven, FHH-based CRC prevention educational workshops across Texas for 344 Chinese Americans (mostly with low education/income) aged 50-75 years who were non-adherent to CRC screening guidelines.Results: Linear mixed modeling analyses showed that participants' FHH of CRC communication with PCPs and family members significantly increased two-week post-workshop compared to pre-workshop data (ps<0.001). Moreover, at two-weeks post-workshop, 91.9 % of participants underwent FOBT. Nevertheless, no significant changes were found in participants' lifestyles.Conclusion: Our educational workshops successfully increased Chinese Americans' FHH of CRC communication and FOBT uptake. Personalized education with longer follow-ups may be needed in future studies to promote lifestyle changes among Chinese Americans.Practice Implications: Health and public health professionals may adopt our workshop educational materials to provide patient and public CRC prevention education for Chinese Americans. [ABSTRACT FROM AUTHOR]

Abstract Purpose This study aimed to examine the short-term efficacy of a smartphone-based intervention for Chinese American adolescents who are overweight or obese and to explore factors associated with decreased body mass index (BMI). Methods A randomized controlled study design was used. Intervention group received culturally appropriate and tailored educational program for weight management while control group received general health information. Anthropometrics, blood pressure, levels of physical and sedentary activity, diet, self-efficacy, and quality of life were assessed at baseline, 3 months, and 6 months. Linear mixed-effects models and regression models were used to analyze outcomes. Results The study included 40 adolescent participants. Adolescents in the intervention reduced their BMI (z = −4.89, p <.001), BMI z score (z = −4.72, p <.001), sugary beverage (z = −.44, P =.001), and TV and computer time (z = −.51, p <.001) and increasing in self-efficacy in nutrition and physical activity significantly more than those in the control group. BMI reduction was significantly correlated with decreased fast food consumption and increased physical activity (F = 6.99, p =.007, r 2 =.40). Being female and decreased sugary beverage consumption were related to decreased BMI z score (F = 8.38, p =.003, r 2 =.511). Conclusions A culturally appropriate smartphone-based intervention has great potential to reduce obesity and improve adherence to a healthy lifestyle. Reducing sugary beverages and fast food intake and decreasing sedentary time are associated with decreased BMI among adolescents who are overweight or obese. [ABSTRACT FROM AUTHOR]

Expressive writing interventions confer mental health benefits for non-Hispanic Whites. However, research is lacking in adapting this paradigm for minoritized groups. This study evaluated the impacts of two culturally adapted expressive writing interventions on depressive and anxiety symptoms and potential mediators (perceived stress and intrusive thoughts) among Chinese American breast cancer survivors (CABCS). Methods and Results : CABCS (N = 136) were randomly assigned to one of three conditions to write three weekly essays: enhanced self-regulation condition (ESR) to write about stress and coping (Week 1), deepest feelings (Week 2), and finding benefits (Week 3); self-regulation condition (SR) to write about deepest feelings (Week 1), stress and coping (Week 2), and finding benefits (Week 3); and control condition to write about facts relevant to their cancer experience (Weeks 1–3). Compared with the control condition, the ESR but not SR, reduced depressive and anxiety symptoms at all follow-up time points (1, 3, and 6-months) through reductions in perceived stress. Conclusion: A cultural adaptation altering the order of expressive writing prompts resulted in the greatest benefit for CABCS' depressive and anxiety symptoms. Research testing both the content and ordering of components may be vital to advance cultural adaptation science and optimize intervention efficacy. Clinical trial registration number: NCT02946619. • Culturally normative ordering of writing benefits Chinese breast cancer survivors. • Cognitive reappraisal before emotional disclosure improved depression and anxiety symptoms. • Earlier reductions in perceived stress explained why the enhanced self-regulation writing intervention reduced depression and anxiety symptoms at 6 months. • Intrusive thoughts decreased following the writing intervention but did not explain the decreases in depression and anxiety symptoms. [ABSTRACT FROM AUTHOR]

Introduction Childhood obesity is one of the most prevalent public health concerns. Method A pre and post study design was used to explore the efficacy of an obesity prevention program. Children had weight, height, blood pressure, and waist circumference measured, and completed self-reported questionnaires on food intake, knowledge, self-efficacy, and health-related quality of life. Parents completed demographic and acculturation surveys. Results Seventy children participated in the study. Results demonstrated significant reduction of BMI, systolic blood pressure, and fast food consumption and improvement of self-efficacy, knowledge, and quality of life. Discussion Childhood obesity intervention is feasible and has short-term efficacy. [ABSTRACT FROM AUTHOR]

Underutilization of mental health services in the U.S. is compounded among racial/ethnic minorities, especially Chinese Americans. Culturally based illness beliefs influence help-seeking behavior and may provide insights into strategies for increasing utilization rates among vulnerable populations. This is the first large descriptive study of depressed Chinese American immigrant patients’ illness beliefs using a standardized instrument. 190 depressed Chinese immigrants seeking primary care at South Cove Community Health Center completed the Explanatory Model Interview Catalogue, which probes different dimensions of illness beliefs: chief complaint, labeling of illness, stigma perception, causal attributions, and help-seeking patterns. Responses were sorted into categories by independent raters and results compared to an earlier study at the same site and using the same instrument. Contrary to prior findings that depressed Chinese individuals tend to present with primarily somatic symptoms, subjects were more likely to report chief complaints and illness labels related to depressed mood than physical symptoms. Nearly half reported they would conceal the name of their problem from others. Mean stigma levels were significantly higher than in the previous study. Most subjects identified psychological stress as the most likely cause of their problem. Chinese immigrants’ illness beliefs were notable for psychological explanations regarding their symptoms, possibly reflecting increased acceptance of Western biomedical frameworks, in accordance with recent research. However, reported stigma regarding these symptoms also increased. As Asian American immigrant populations increasingly accept psychological models of depression, stigma may become an increasingly important target for addressing disparities in mental health service utilization. [ABSTRACT FROM AUTHOR]

Background Innovation in information and communication technology has been transforming health service delivery. Methods This study aims to compare YouTube against traditional talk-based workshops in delivering dementia knowledge to the Chinese-American population. Results Results reveal that E-mental health has enormous potential; however, for the older Chinese-American ethnic population, talk-based workshop is still more desired in delivering dementia education to targeted age groups. Discussion As YouTube has become a readily available and widely distributed media for prevention and psychoeducational efforts, this study demonstrates the utility of YouTube in delivering dementia knowledge. Nevertheless, viewer appeals need to be addressed by making the first few minutes engaging. [ABSTRACT FROM AUTHOR]

The article presents the study on the persistence of depressive symptoms and frequency of antidepressant use among Chinese-American subjects with cognitive impairment. It mentions that the study, involving patients with mild cognitive impairment and Alzheimer disease, sought to identify clinical and demographic predictors of depressive symptoms. It concludes that elderly Chinese-American subjects with cognitive impairment are at higher risk for unrecognized and untreated depression than whites.

Abstract: Introduction: Colorectal cancer (CRC) is the third most commonly diagnosed cancer in all racial and ethnic groups. Although CRC screening is very cost-effective, screening rates are low among most ethnic groups, including Asian Americans. Given the high use of traditional Chinese medicine (TCM) among Chinese Americans, one potentially useful approach to promote CRC screening in these communities could involve TCM providers in outreach efforts. Methods: A two-phase study was conducted. The perceived suitability of TCM providers in CRC prevention was explored in Phase 1. Guided by Phase 1 findings, in Phase 2, a 38-page integrative educational flipchart was developed and tested. Focus groups and observations were conducted with TCM providers (acupuncturists and herbalists) and with limited English proficient Chinese American immigrants living in San Francisco, California. Results: In Phase 1, the role of TCM providers as CRC screening educators was deemed acceptable by both providers and community members, although some providers had reservations about engaging in CRC outreach activities due to lack of expertise. The majority of providers were not aware of regular CRC screening as a preventive measure, and most were not up-to-date in their own screening. In Phase 2, the integrative CRC education flipchart was perceived as culturally appropriate based on stakeholder input and feedback. Conclusion: This study shows that TCM providers have the potential to be a valuable and culturally appropriate community resource for providing information on CRC screening. It suggests a potential role for traditional healers as change agents in the immigrant community health network. [Copyright &y& Elsevier]

Abstract: Parents and early childhood teachers in Chinese societies and the United States have had dissimilar views about appropriate art instruction for young children. The Chinese view is that creativity will emerge after children have been taught essential drawing skills. The American view has been that children''s drawing skills emerge naturally and that directive teaching will stifle children''s creativity. Forty second-generation Chinese American and 40 European American young children participated in this longitudinal study at ages 5, 7, and 9 to explore possible cultural differences in and antecedents of their drawing skills and creativity. Chinese American children''s person drawings were more mature and creative and their parents reported more formal ways of fostering creativity as compared to their European American counterparts. Correlations showed that children who had more opportunities to draw and who received more guidance in drawing were more advanced in their drawing. For Chinese Americans, fathers’ personal art attitudes and children''s Time 1 drawing skills predicted 53% of the variance in children''s drawing scores four years later. [Copyright &y& Elsevier]

Abstract: Three types of parent involvement—communicating, volunteering at school, and learning at home—were explored in two cultures within the United States. Immigrant Chinese parents and European American parents of young children reflect their different traditions in the ways they involve themselves in their child''s academic life. European American parents volunteered more in schools, while Chinese American parents focused more on systematic teaching of their children at home. Chinese American parents were more critical of typical primary school report cards without ABC grades. Parents’ home teaching methods showed stability over time, demonstrating that parents who used formal, structured methods at Time 1 continued to do two and four years later. [Copyright &y& Elsevier]

Abstract: Informed by Antonovksy''s salutogenic model, the current study examined sense of coherence as a mediator in the relationship of parent and peer attachment and college challenges with depressive symptom level in three groups of Chinese American college students. Due to differential acculturation, we hypothesized that peer relationship would be more salient for the most acculturated American-born Chinese, parent relationship would be more salient for the least acculturated, late arriving immigrants, and both parent and peer attachment would contribute to the well-being of early arriving immigrants who have been significantly exposed to both cultures. A sample of 112 American-born Chinese, 121 early immigrants, and 110 late immigrants completed paper–pencil surveys. Sense of coherence mediated the effect of attachment and college challenges on depressive symptoms in all three groups. Furthermore, our hypotheses regarding American-born Chinese and early immigrants were supported. For late immigrants, both parent and peer attachment predicted sense of coherence, but only parent attachment contributed to depressive symptom level. Implications for mental health interventions are discussed. [Copyright &y& Elsevier]

Objective: Posttraumatic stress disorder (PTSD) is a significant condition and frequently observed among breast cancer survivors. Extant literature has demonstrated the effectiveness of expressive writing interventions in reducing PTSD among breast cancer survivors. However, little is known about how different PTSD symptom clusters influence each other over time during and after the expressive writing intervention among breast cancer survivors. We investigated how the three PTSD symptom clusters (reexperiencing, avoidance and hyperarousal) influence each other during and after an expressive writing intervention among Chinese American breast cancer survivors.Methods: Chinese American breast cancer survivors (n = 136) completed an expressive writing intervention. Their PTSD symptoms were assessed at baseline, 1-, 3-, and 6-month follow-ups.Results: Using cross-lagged panel analysis, the model with hyperarousal symptoms at each assessment wave predicting the subsequent severity of avoidance and reexperiencing symptoms indicated the best fit, χ2(52) = 65.422, p = .100; CFI = 0.990, RMSEA = 0.044, 95% CI [0.000, 0.074].Conclusion: The results suggest that hyperarousal symptoms predict the subsequent severity of reexperiencing and avoidance symptoms over time during and after the expressive writing intervention. The findings highlight the importance of early diagnosis, monitoring and treatment of hyperarousal symptoms in enhancing the efficacy of PTSD interventions and reducing the chronicity in PTSD among Chinese American breast cancer survivors. Clinical Trial Registration atClinicalTrials.gov: NCT02946619. [ABSTRACT FROM AUTHOR]

Summary Background Accuracy of body weight perception is an individual's perception of their body weight in comparison with actual body weight and is associated with weight-related behaviors. Chinese Americans have increased risk for obesity but no studies have examined accuracy of body weight perception. Methods This study was a descriptive and cross-sectional study, which was conducted in a community health center in New York. Study subjects were all Chinese-American adults. Demographic information, accuracy of perception of body weight, anthropometric measures (weight, height, body mass index [BMI], waist circumference [WC], hip circumference [HC], weight to height ratio, weight to hip ratio), fasting plasma glucose (FPG), glycosylated hemoglobin (HbA1C) and obesity-related diseases (hypertension, diabetes, heart disease, and stroke) were assessed. Results A total of 162 Chinese Americans were recruited. 52 subjects (32%) did not perceive body weight correctly: 32 subjects had underestimation and 20 subjects had overestimation of body weight. Significant differences were found among subjects in the three groups of different accuracy of body weight perception in terms of gender ( p = 0.003), age ( p = 0.003), education years ( p = 0.047), WC ( p < 0.001), HC ( p ≤ 0.001), weight/height ratio ( p = 0.001), and BMI ( p < 0.001). Accuracy of perception of body weight significantly predicted WC ( p < 0.001), HC ( p < 0.001), weight to height ratio ( p = 0.001), BMI ( p < 0.001) and weight (< 0.001) even after controlling for all demographic factors. Discussion and conclusion The study identified that around one-third of Chinese Americans did not perceive their body weight correctly. Intervention studies for obesity management in Chinese Americans should address gender difference, target on older subjects, and focus on educating the normal values and significances of WC, HC and HbA1C among Chinese Americans. [ABSTRACT FROM AUTHOR]