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OBJECTIVES: Inspired by the notion of double jeopardy positing the dual disadvantage in the coexistence of different sources of vulnerability, the present study examined health risks posed by social and linguistic isolation in older Korean Americans. DESIGN: A cross-sectional study, using a four-cell classification to compare isolation types (no isolation, social isolation only, linguistic isolation only, and dual isolation) and to examine their impacts on physical (self-rated health), mental (mental distress), and cognitive (cognitive performance) health. SETTING, PARTICIPANTS: Data are from the Study of Older Korean Americans (SOKA) survey of Korean immigrants aged 60 or older (n = 2,032), conducted in five states in the U.S. (California, New York, Texas, Hawaii, and Florida). MEASUREMENT: Social isolation was indexed by the Lubben Social Network Scale−6; linguistic isolation, by a question on English-speaking ability. Physical, mental, and cognitive health were indicated by a single-item self-rating of health, the Kessler Psychological Distress Scale 6, and the Mini-Mental State Examination, respectively. RESULTS: The dual-isolation group exhibited notable sociodemographic and health disadvantages. The odds of having fair/poor health, mental distress, and cognitive impairment were 2.21−3.17 times higher in the dual-isolation group than in the no-isolation group. CONCLUSION: Our findings confirm that both social relationships and language proficiency are key elements for older immigrants’ social connectedness and integration, the deprivation of which puts them at heightened risk in multiple dimensions of health.

Purpose: The purpose of this study was to investigate the health status and needs of the Asian American/Pacific Islander (AAPI) population with diabetes in Texas. Methods: This was a cross-sectional secondary analysis of data collected from the Behavioral Risk Factors Surveillance System in Texas from 2015 to 2019 for non-Hispanic White (NHW) and AAPI adults. Results: Although the overall crude diabetes prevalence was lower in AAPI adults, age-adjusted diabetes prevalence was higher than in NHWs. Significant risk factors associated with diabetes in the AAPI group included being male, marital status, lower education levels, lower income, being overweight/obese, and having a sedentary lifestyle. Engagement in self-management activities (checking blood glucose, checking feet, attending a diabetes management course) was lower in AAPIs than in NHWs. Conclusions: Given stiff barriers to adequate screening and self-management support in diabetes care among ethnic populations such as AAPIs, targeted efforts to improve diabetes screening and effective care are warranted. Because today’s AAPI populations are predominantly first-generation immigrant groups who suffer from language barriers, efforts should be made to develop health surveys in multiple languages for wider inclusion of understudied groups like AAPIs in diabetes-related research.

Background Although scientific reports increasingly document the negative impact of inadequate health literacy on health-seeking behaviors, health literacy's effect on health outcomes in patients with diabetes is not entirely clear, owing to insufficient empirical studies, mixed findings, and insufficient longitudinal research. Objective The aim of this study was to empirically examine underlying mechanisms of health literacy's role in diabetes management among a group of Korean Americans with Type 2 diabetes mellitus. Methods Data from a randomized clinical trial of a health literacy-focused Type 2 diabetes self-management intervention conducted during 2012-2016 in the Korean American community were collected at baseline and at 3, 6, 9, and 12 months. A total of 250 Korean Americans with Type 2 diabetes participated (intervention, 120; control, 130). Participants were first-generation Korean American immigrants. Health literacy knowledge was measured with the original Rapid Estimate of Adult Literacy in Medicine and the diabetes mellitus-specific Rapid Estimate of Adult Literacy in Medicine. Functional health literacy was measured with the numeracy subscale of the Test of Functional Health Literacy in Adults and the Newest Vital Sign screening instrument, which also uses numeracy. Primary outcomes included glucose control and diabetes quality of life. Multivariate analyses included latent variable modeling. Results A series of path analyses identified self-efficacy and self-care skills as significant mediators between health literacy and glucose control and quality of life. Education and acculturation were the most significant correlates of health literacy. Discussion Despite inconsistent findings in the literature, this study indicates that health literacy may indirectly influence health outcomes through mediators such as self-care skills and self-efficacy. The study highlights the importance of health literacy, as well as underlying mechanisms with which health literacy influences processes and outcomes of diabetes self-management.

Background and Objectives In response to the dearth of information on cognitive health in older ethnic minorities, in the present study, we examined factors associated with self-rated cognitive health (SRCH) in older Korean Americans. Drawing from the World Health Organization’s framework of social determinants of health, we examined how a broad spectrum of factors might influence the way in which older Korean Americans perceive and evaluate their own cognitive health. Research Design and Methods Using data from the Study of Older Korean Americans (SOKA; N = 2,061, mean age = 73.2), a series of hierarchical linear regression models of SRCH was tested with sequential entry of predictors: (1) Mini-Mental State Examination (MMSE) score of cognitive status, (2) demographic variables, (3) physical and mental health status, (4) health behaviors, and (5) socio-cultural and community factors. Results In addition to cognitive screening outcomes, each set of variables made a significant contribution to the predictive model of SRCH. Positive ratings of cognitive health were observed among older individuals with greater education, good physical and mental health, involvement in regular exercise, and socio-cultural resources (social networks, acculturation, and family solidarity). Discussion and Implications The SRCH of older adults goes beyond cognitive screening outcomes, suggesting a need to incorporate the various sources of social determinants when seeking to promote the cognitive health of older populations.

Objectives:The aim of this study was to (1) understand types and amounts of Ebola-related information that health organization employees wanted and obtained through formal, informal, internal, and external organizational communication channels; (2) determine potential discrepancies between information wanted and obtained; and (3) investigate how organizational structure might affect information wanted and obtained through these communication channels.Methods:Primary data were collected from 526 health workers in 9 hospitals and 13 public health departments in Texas from June to November 2015. Survey data were collected for 7 types of Ebola-related information health organization employees wanted and obtained through various types of organizational communication channels. Descriptive statistical analyses, mixed design analysis of variance, regression analyses, and multilevel analyses were used to analyze the data.Results:Hospital employees (mostly nurses in our sample) received more self-care information than they wanted from every communication channel. However, they received less about all other types of information than they wanted from every communication channel separately and combined. Public health department employees wanted more information than they received from every communication channel separately and combined for all 7 types of information.Conclusions:Discrepancies existed between the types of Ebola-related information wanted and obtained by employees of hospitals and public health departments.

Osteoarthritis (OA) is the most common cause of pain in people aged >45 years, and the knee is the most commonly affected joint. There is a growing interest in understanding the biological factors that influence pain among older adults, but few studies have examined the relationship between β-endorphin and experimental pain sensitivity in older adults with knee OA pain. The purpose of this study was to investigate the relationship between resting plasma levels of β-endorphin and experimental pain sensitivity. This study was a secondary analysis of data for 40 adults with knee OA pain in whom quantitative sensory testing was used to measure experimental sensitivity to heat- and mechanically induced pain. The mean age of the sample was 60 years ( SD = 9 years), and approximately half were female (53%). Regression analyses indicated that β-endorphin level was negatively related to pressure pain threshold (β = −17.18, p = .02) and positively related to punctate mechanical pain (β = 17.13, p = .04), after controlling for age, gender, and OA severity. We did not find a significant relationship between β-endorphin and heat pain tolerance. The results suggest that higher circulating levels of β-endorphin at rest are associated with increased sensitivity to mechanical pain in older adults with knee OA. These findings add to the literature regarding biological factors associated with pain sensitivity in older adults with chronic pain. Additional studies are needed to identify mediators of the relationship between β-endorphin and pain sensitivity in OA and other musculoskeletal pain conditions.

Using data from surveys with Korean Americans aged 60 years or above ( n = 2,150), the level of healthcare navigation self-sufficiency was assessed, and its related factors were explored. The overall status of self-sufficiency was low; for example, over half of the sample needed assistance with reading and filling out medical documents, and nearly half needed someone to interpret during medical visits. Diminished self-sufficiency in healthcare navigation was associated with disadvantaged social status (e.g., advanced age, female gender, and low education), early stages of immigration (short length of stay in the U.S. and low English proficiency), and lack of personal health resources (e.g., poor health condition and lack of health insurance). The findings shed light on older immigrants’ challenges in the use of health services in a broad sense and help identify areas of patient burden and avenues for interventions.

Objective To test the efficacy of a hybrid model of the self-help intervention program (hSHIP), which combines a mobile version of SHIP (mSHIP) and personal coaching, to address unique cultural and motivational factors for optimal self-management of type 2 diabetes and prediabetes among Korean Americans (KAs). Methods A single-group feasibility study design was used. The hSHIP utilizes texts and motivational counseling based on well-tested intervention content for KAs. To facilitate the dissemination of hSHIP, we developed a web application adopting the principles of persuasive technology to motivate behavior changes. Results Feasibility assessment found that hSHIP was well accepted by both participants and community health workers who delivered the intervention. An average of 1.3% A1C reduction (from 7.8% to 6.5%) was achieved by KAs with diabetes (n = 165), 51.5% of whom lowered their A1C below 6.5% in 6-months. No one with prediabetes (n = 50) progressed to diabetes. Other clinical outcomes (e.g., weight, depression, and blood pressure) also improved significantly; 41.2% were able to reduce or discontinue antidiabetic drugs. Conclusion The feasibility and initial efficacy of hSHIP were demonstrated. Practice implication This hybrid diabetes self-management model is a viable tool for traditionally underserved groups with diabetes or prediabetes.

Vitamin D deficiency is associated with incidence of type 2 diabetes (T2DM) as well as poor glycemic control among T2DM patients, yet comparative studies of its association among ethnic minority populations are scarce. Using baseline data from a behavioral intervention study of Korean Americans (KAs) with T2DM (N = 250 KAs) and the NHANES data set, we explored differential roles of vitamin D on HbA1C level or T2DM control in several racial groups. Significantly more KAs (55.2%) were vitamin D-deficient (U.S. average, 37.8%). Both common and unique correlates of vitamin D deficiency in minority populations were identified, including significant associations between Vitamin D and HbA1C in both non-diabetic and diabetic populations. Future studies are warranted to explain the causal mechanism of the effect of vitamin D and glycemic control as well as to examine contextual factors associated with vitamin D deficiency in certain minority groups. Clinical Trials Registry: Identifier NCT01264796

In the present study, we examined self-rated health as a mediator between physical health conditions (chronic diseases and functional disability) and depressive symptoms in older Chinese and Korean Americans. Using harmonized data (N = 5,063) from the Population Study of Chinese Elderly (PINE) and the Study of Older Korean Americans (SOKA), we tested direct and indirect effect models. In both groups, chronic diseases and functional disability were closely associated with negative ratings of health and symptoms of depression. Analyses with the PROCESS macro showed that the effect of chronic diseases and functional disability on depressive symptoms was mediated by self-rated health in both groups; the indirect effect was greater in the Korean American sample than in the Chinese American sample. These findings contribute to the understanding of the psychological mechanisms that underlie the mind–body connection and highlight the potential importance of subjective health assessment as a useful tool for health promotion.

Objectives: In older persons with heart failure (HF), an inability to self-manage their disease condition can result in poor health outcomes and quality of life. With the rise in smartphone use and digital game playing among older adults, digital tools such as sensor-controlled digital games (SCDGs) can offer accessible health-promoting tools that are enjoyable and easy to use. However, designing SCDGs that are compelling and aligned with their life values and self-management needs can be challenging. This article describes a qualitative study with older adults with HF who were recruited from a cardiac rehabilitation laboratory in central Texas to identify their perceptions and expectations regarding a SCDG for HF self-management. Materials and Methods: A low-fidelity prototype that demonstrated the features of a SCDG was used to obtain the participants' perceptions about the value of SCDGs for HF self-management with respect to content, customization, flexibility, and usability through qualitative interviews. Results: We interviewed 15 patients with HF (53% women; age range, 53-90 years; 60% white). The concept of SCDGs for HF self-management was highly acceptable (80%). Participants provided suggestions for game characters, progress in the game, and game notifications and incentives. Perceived benefits included helping users track their behaviors and establish routines, become informed on strategies to manage HF, and empower themselves to take charge of their health. Conclusions: The study's findings will guide personalization of SCDG development to motivate patient engagement in HF self-management behaviors.

BACKGROUND/OBJECTIVES. This study explores factors associated with willingness to use a nursing home in Asian Americans. Focus is given to demographic variables (age, gender, ethnicity, marital status, and education), health-related variables (chronic medical condition and self-rated health), immigration-related variables (time in the U.S. and acculturation), and family-related variables (family network and family solidarity). DESIGN. Cross-sectional study. SETTING AND PARTICIPANTS. Data were drawn from 2,553 participants in the 2015 Asian American Quality of Life (AAQoL) Survey (aged 18−98). MEASURES. Participants were asked to indicate whether they would be willing to use a nursing home in the future. An affirmative response indicated a personal willingness to use a nursing home. RESULTS. Approximately 38% of the sample demonstrated willingness to use a nursing home. Higher odds for willingness were observed among those with advanced age, female gender, Korean ethnicity (compared with Chinese), better education, presence of a chronic medical condition, longer years of residence in the U.S., and lower levels of family solidarity. CONCLUSIONS/IMPLICATIONS. Reflecting the current trend of an increase in racial/ethnic minorities in nursing homes, a substantial proportion of the present sample of Asian Americans demonstrated willingness to use a nursing home. Findings on the factors associated with willingness provide implications for policies and services to respond to the long-term care needs of this emerging population.

BACKGROUND: The present study examined the extent to which limited English proficiency (LEP) poses a risk to health service use in Asian Americans. METHODS: With data drawn from the 2015 Asian American Quality of Life Survey (N = 2,594), logistic regression was used to model the odds for four outcomes (no usual place for care, no regular check-up, unmet needs for medical care, and communication problems in healthcare settings). RESULTS: More than 62% of the sample had LEP. In the group with LEP, the odds of not having usual place for care increased by 2.09 times, of not having regular check-up by 1.69 times, of having unmet needs for medical care by 1.89 times, and of having communication problems in healthcare settings by 4.95 times. DISCUSSION: The findings highlight the vulnerabilities of Asian Americans with LEP in health service use and provide implications for health planning and interventions.

The increasing prevalence of type 2 diabetes mellitus (T2DM) and its complications including cardiovascular disease and chronic kidney disease threaten Korean Americans (KAs). High dietary sodium intake contributes to both conditions. The purpose of the study was to assess dietary sodium consumption and to examine the predictors of sodium intake among KA with T2DM. A total 232 KA who had uncontrolled diabetes participated in this study. The majority of the sample (69%) consumed more sodium than current national guidelines. A high level of energy intake was the strongest predictor for sodium intake with gender and marital status also related. Our findings identified predictive factors to excessive sodium intake and these data support the need for culturally-tailored education about appropriate dietary sodium and energy intake are needed for patients about T2DM.

Objectives This study's objective was to explore the possible triggers of clinicians' disruptive behavior and to consider whether the type of trigger resulting in disruptive behavior differed by type of clinician, clinician characteristics, professional role, and ethnic background. Methods Using data collected from 1559 clinicians working at an urban academic medical center in the United States, we examined intrapersonal, interpersonal, and organizational triggers. In addition, we measured 3 subscales of disruptive behavior including incivility, psychological aggression, and violence. Multivariate regression and logit models were used to examine the relationship between triggers and disruptive behavior. Results We found that higher levels of intrapersonal, interpersonal, and organizational triggers related to a greater frequency of disruptive behaviors after controlling for clinician characteristics. Among nurses, all 3 types of triggers were significantly related to disruptive behaviors with the same direction and magnitude of difference. However, in the physician/affiliate group, only intrapersonal and interpersonal triggers were statistically significant factors for disruptive behavior. Conclusions In the present study, important triggers were found to contribute to clinicians' disruptive behaviors. Strategies to prevent disruptive behaviors should be multipronged and reflect intrapersonal and interpersonal features for both clinician groups. For nurses, organizational triggers should be addressed through process and system improvements. Because disruptive behavior continues to be frequent among clinicians, efforts to implement evidence-based practices to prevent disruptive behaviors must continue, and future research should evaluate them.

Objectives: The purposes of the present study were (1) to explore the completion rate of advance directives (ADs) in a sample of Asian Americans and (2) to examine the direct and moderating effects of knowledge of AD, education, and acculturation in predicting AD completion. Education and acculturation were conceptualized as moderators in the link between knowledge and completion of ADs. Methods: Using data from 2609 participants in the 2015 Asian American Quality of Life survey (aged 18-98), logistic regression analyses on AD completion were conducted, testing both direct and moderating effects. Results: The overall AD completion rate in sample was about 12%. The AD knowledge and acculturation independently predicted AD completion. No direct effect of education was found; however, it interacted with AD knowledge. The AD knowledge was more likely to be translated into completion in the group with higher education. Conclusions: The AD completion rate observed in the present sample of Asian Americans was much lower than that of the US general population (26%-36%). The interactive role of education helps to explain the gap between AD knowledge and completion and suggests intervention strategies.

Based on the job demands–resources (JD-R) model, this study explored the impact of job demands (physical injury and racial/ethnic discrimination) and resources (self-confidence in job performance and recognition by supervisor/organization/society) on home health workers’ employee outcomes (job satisfaction and turnover intent). Using data from the National Home Health Aide Survey ( N = 3,354), multivariate models of job satisfaction and turnover intent were explored. In both models, the negative impact of demands (physical injury and racial/ethnic discrimination) and the positive impact of resources (self-confidence in job performance and recognition by supervisor and organization) were observed. The overall findings suggest that physical injury and discrimination should be prioritized in prevention and intervention efforts to improve home health workers’ safety and well-being. Attention also needs to be paid to ways to bolster work-related efficacy and to promote an organizational culture of appreciation and respect.

Introduction: Excess sodium intake can increase the risk of high blood pressure and cardiovascular disease, common comorbidities for those with type 2 diabetes mellitus (T2DM). The purpose of this study is to describe sodium intake and high sodium food sources among Korean Americans (KAs) with T2DM. Method: This study, a descriptive, secondary analysis of baseline data from a clinical trial for diabetes, recruited KAs with T2DM ( n = 232) from the community. Results: Average dietary sodium intake was 3,433 mg. Major sources of dietary sodium were from bicultural diets: noodles and dumplings, Korean-style soups, kimchi, breads and snacks, and boiled or seasoned vegetables. Participants who consumed excessive sodium were more likely to consume more calories and be male, married, and more recently diagnosed with T2DM. Discussion: High consumption of sodium among KAs with T2DM supports the need to develop effective, tailored interventions addressing dietary sodium that incorporates the individual’s culture.

Multiple studies in healthy populations and clinical samples have shown that ethnic minorities have greater pain sensitivity than their majority counterparts. Acculturation is speculated to be one of the sociocultural factors contributing to pain sensitivity since cultural beliefs and practices can influence the way patients perceive and respond to pain. However, the relationship of acculturation to pain sensitivity in minority populations remains poorly understood. Therefore, in this cross-sectional study, we examined the relationship between acculturation and experimental pain sensitivity in 50 Asian Americans residing in North Central Florida with knee osteoarthritis pain. The Suinn-Lew Asian Self Identity Acculturation Scale was used to assess acculturation, and multimodal quantitative sensory testing was performed to measure experimental sensitivity, including heat pain tolerance, pressure pain threshold, and punctate mechanical pain. Descriptive and regression analyses were performed. Participants’ mean age was 55.7 years, and about half of this sample were Korean American (56%). The participants had lived in the United States for 21 years on average. Regression analyses indicated that lower acculturation to American culture may contribute to greater experimental pain sensitivity. Asian Americans who were more acculturated to the American culture had higher heat pain tolerance (beta = 0.61, P=0.01), higher pressure pain threshold (beta = 0.59, P=0.02), and lower ratings of punctate mechanical pain (beta = −0.70, P<0.01). These findings add to the literature regarding sociocultural factors associated with pain in Asian Americans; additional research with a larger and more diverse sample of Asian Americans is warranted for cross-validation.

The present study was undertaken to investigate potential sources of response bias in empirical research involving older ethnic minorities and to identify prudent strategies to reduce those biases, using Korean American elderly (KAE) as an example. Data were obtained from three independent studies of KAE (N = 1,297; age ≥60) in three states (Florida, New York, and Maryland) from 2000 to 2008. Two common measures, Pearlin's Mastery Scale and the CES-D scale, were selected for a series of psychometric tests based on classical measurement theory. Survey items were analyzed in depth, using psychometric properties generated from both exploratory factor analysis and confirmatory factor analysis as well as correlational analysis. Two types of potential sources of bias were identified as the most significant contributors to increases in error variances for these psychological instruments. Error variances were most prominent when (1) items were not presented in a manner that was culturally or contextually congruent with respect to the target population and/or (2) the response anchors for items were mixed (e.g., positive vs. negative). The systemic patterns and magnitudes of the biases were also cross-validated for the three studies. The results demonstrate sources and impacts of measurement biases in studies of older ethnic minorities. The identified response biases highlight the need for re-evaluation of current measurement practices, which are based on traditional recommendations that response anchors should be mixed or that the original wording of instruments should be rigidly followed. Specifically, systematic guidelines for accommodating cultural and contextual backgrounds into instrument design are warranted.

Objective: Given the importance of social ties and connectedness in the lives of older ethnic immigrants, the present study examined the prevalence of social isolation and its risk factors in older Korean Americans. Method: Using survey data from 1,301 participants ( Mage = 70.5, SD = 7.24), risk groups for marginal social ties with family and friends were identified and predictors of each type of social isolation explored. Results: Male gender and poorer rating of health were identified as common risk factors for marginal ties to both family and friends. Findings also present specific risk factors for each type of social isolation. For example, an increased risk of having marginal ties with friends was observed among individuals with perceived financial strain, greater functional impairment, and a shorter stay in the United States. Discussion: The common and specific risk factors should be incorporated in programs to reduce social isolation in older immigrant populations.

Homebound older adults benefit from provider home visits and there is an increasing need for these visits. A study was conducted to evaluate the effect of provider (MD, NP) visits on the caregivers of homebound older adults. Fifty-five caregivers were interviewed to determine any difference in health measures between those whose care recipients had access to a provider and those that did not. The participants completed the SF-36, questionnaires on demographics and access and one opened ended question. Analysis revealed statistically significant differences between the two groups of caregivers. The caregivers whose care recipients did not have access to a provider showed poorer health measures. Providers may have a positive impact on caregiver's health as well as that of the homebound. Developing new and innovative ways to support caregivers while providing care for our patients will be even more important as the population ages and the numbers of available caregivers decrease.

Objective: Advance care planning (ACP) allows individuals to express their preferences for medical treatment in the event that they become incapable of making their own decisions. This study assessed the efficacy of a conversation game intervention for increasing South Asian Indian Americans' (SAIAs') engagement in ACP behaviors as well as the game's acceptability and cultural appropriateness among SAIAs. Design: Eligible community-dwelling SAIAs were recruited at SAIA cultural events held in central Texas during the summer of 2016. Pregame questionnaires included demographics and the 55-item ACP Engagement Survey. Played in groups of 3-5, the game consists of 17 open-ended questions that prompt discussions of end-of-life issues. After each game session, focus groups and questionnaires were used to examine the game's cultural appropriateness and self-rated conversation quality. Postintervention responses on the ACP Engagement Survey and rates of participation in ACP behaviors were collected after 3 months through phone interviews or online surveys. Data were analyzed using descriptive statistics, frequencies, and paired t-tests comparing pre/post averages at a .05 significance level. Results: Of the 47 participants, 64% were female, 62% had graduate degrees, 92% had lived in the U.S. for >10 years, 87% were first-generation immigrants, and 74% had no advance directive prior to the game. At the 3-month follow-up, 58% of participants had completed at least one ACP behavior, 42% had discussed end-of-life issues with loved ones, 15% did so with their healthcare providers, and 18% had created an advanced directive. ACP Engagement Survey scores increased significantly on all four of the process subscales by 3 months postgame. Conclusion: SAIA individuals who played a conversation game had a relatively high rate of performing ACP behaviors 3 months after the intervention. These findings suggest that conversation games may be useful tools for motivating people from minority communities to engage in ACP behaviors.

Using data from the 2015 Asian American Quality of Life Survey (N = 2,609), latent profile analysis was conducted on general (health insurance, usual place for care, and income) and immigrant-specific (nativity, length of stay in the U.S., English proficiency, and acculturation) risk factors of healthcare access. Latent profile analysis identified a three-cluster model (low-risk, moderate-risk, and high-risk groups). Compared with the low-risk group, the odds of having an unmet healthcare need was 1.52 times greater in the moderate-risk group and 2.24 times greater in the high-risk group. Challenging the myth of model minority, the present sample of Asian Americans demonstrates its vulnerability in access to healthcare. Findings also show the heterogeneity in healthcare access risk profiles.

Although the negative impact of disruptive clinician behavior on quality health care delivery has gained attention recently, little systematic effort to address this issue has been reported. To facilitate empirical research to reduce disruptive clinician behaviors, an assessment tool (Johns Hopkins Disruptive Clinician Behavior Survey [JH-DCBS]) with 5 discrete subscales was developed using a 2-step design. First a pool of items was generated from focus group studies and the literature, and then a psychometric evaluation of the survey was conducted with a sample of clinicians (N = 1198) practicing in a large urban academic medical center. The results indicated that the tool was reliable (Cronbach α = .79-.91), showed high content validity (Content Validity Index = .97), and had significantly high correlations with theoretically selected variables. The study team concluded that the JH-DCBS provides a valid empirical assessment of disruptive behavior. Assessment results may be used to design strategies to improve the health and safety of practice environments.

Health-related quality of life (HRQOL) is a key clinical outcome, particularly for individuals with chronic conditions such as hypertension (HTN). While no previous research has examined contributors to HRQOL among Asian Americans in the United States, this study was conducted to identify correlates of HRQOL in hypertensive Korean immigrant elders (≥ 60 years of age) to address the gap. A total of 440 Korean elders with HTN participated in the study. The hierarchical regression model for HRQOL explained 32.8% of the variance. Female gender (β = .109, p = .036), a greater number of comorbid conditions (β = .183, p = .000), lower social support (β = −.240, p = .000), and greater depressive symptoms (β = .402, p = .000) were associated with poorer HRQOL. Depression was the most potent correlate of HRQOL among elderly Korean Americans (KA) with HTN. Future intervention should consider managing depression as an essential component of comprehensive HTN care for this minority population.

Objectives: To determine the level of agreement between dementia rating by trained community health workers (CHWs) based on the Clinical Dementia Rating (CDR) and the criterion standard: physician diagnosis. Design: Cross-sectional validation study. Setting: Community gathering places such as ethnic churches, senior centers, low-income elderly apartments, and ethnic groceries in the Baltimore�Washington metropolitan area. Participants: Ninety community-dwelling Korean-American individuals aged 60 and older. Measurements: The CDR is a standardized clinical dementia staging instrument used to assess cognitive and functional performance using a semistructured interview protocol. Six CHWs trained and certified as CDR raters interviewed and rated study participants. A bilingual geriatric psychiatrist evaluated participants independently for dementia status. Results: CHWs rated 61.1% of the participants as having mild cognitive impairment (MCI; CDR = 0.5) or dementia (CDR?1), versus 56.7% diagnosed by the clinician. A receiver operating characteristic (ROC) curve analysis demonstrated good predictive ability of CDR rating by trained CHWs (area under the ROC curve = 0.86, 95% confidence interval = 0.78�0.93, sensitivity = 85.5%, specificity = 88.6%) in detecting MCI and dementia. Conclusion: The findings provide preliminary evidence that trained CHWs can effectively identify community-dwelling elderly Korean adults with MCI and dementia for early follow-up assessment and care in a community with scarce bilingual caregivers and programs.

To develop and test the prototype of a serious digital game for improving community-dwelling older adults' heart failure (HF) knowledge and self-management behaviors. The serious game innovatively incorporates evidence-based HF guidelines with contemporary game technology.The study included three phases: development of the game prototype, its usability assessment, and evaluation of the game's functionality. Usability testing included researchers' usability assessment, followed by research personnel's observations of participants playing the game, and participants' completion of a usability survey. Next, in a pretest-post-test design, validated instruments-the Atlanta Heart Failure Knowledge Test and the Self Care for Heart Failure Index-were used to measure improvement in HF self-management knowledge and behaviors related to HF self-maintenance, self-management, and self-efficacy, respectively. A postgame survey assessed participants' perceptions of the game.During usability testing, with seven participants, 100%, 100%, and 86% found the game easy to play, enjoyable, and helpful for learning about HF, respectively. In the subsequent functionality testing, with 19 participants, 89% found the game interesting, enjoyable, and easy to play. Playing the game resulted in a significant improvement in HF self-management knowledge, a nonsignificant improvement in self-reported behaviors related to HF self-maintenance, and no difference in HF self-efficacy scores. Participants with lower education level and age preferred games to any other medium for receiving information.It is feasible to develop a serious digital game that community-dwelling older adults with HF find both satisfying and acceptable and that can improve their self-management knowledge.

Our aim is to investigate the prevalence and predictors of suicidal ideation among Korean American older adults and assess the self-rated mental health of Korean American older adults with suicidal ideation with or without depressive syndrome.The Memory and Aging Study of Koreans is a cross-sectional, epidemiologic study of a community-representative sample of Korean American older adults (N = 1116) residing in the Baltimore-Washington area. Participants were interviewed using the Korean version of the Patient Health Questionnaire (PHQ-9K). In addition, demographic information, self-rated mental health, and self-rated physical health status were obtained.In this study, 14.7% of Korean American older adults reported suicidal ideation. Predictors of suicidal ideation included living alone, major or minor depressive syndrome (diagnosed by the PHQ-9K), shorter duration of residency in the USA, and poorer self-rated mental health status. Of those who reported suicidal ideation, 64% did not have minor or major depressive syndrome. However, their self-rated mental health was as poor as that of those with major or minor depressive syndrome but without suicidal ideation.Suicidal ideation without depressive syndromes was common among Korean American older adults. For this group of elders with poor self-rated mental health, future studies should look to improving early detection of suicide risks and developing feasible suicide prevention interventions. Copyright © 2016 John WileySons, Ltd.

Elders living alone may experience worse health outcomes than do those living with spouse and/or children. Using baseline data from a randomized trial to promote high blood pressure (HBP) control in Korean elders (N = 440), we examined the relationship between living arrangements and HBP control. We also interviewed a sub-sample to better understand the patterns of social interactions associated with different types of living arrangements. One in five reported living alone; this group tended to be older and female, and resided in senior group housing. Those living alone were twice as likely as those living with a spouse to have controlled BP (OR = 2.08; 95 % CI 1.09-3.97), even after controlling for study covariates. Those in senior group housing had frequent social interactions that involved conversations around health, encouragement concerning medication taking, and health information sharing. In conclusion, Korean elders living independently are neither socially-isolated nor at increased risk for poor BP control.

While the role of health literacy in chronic disease management is well documented, few intervention studies have been reported. A major barrier to designing and implementing such interventions is the lack of valid health literacy tools. This study developed and tested a novel health literacy scale for individuals with high blood pressure (HBP).A two-step design process was used: In the construction phase, focus group studies and a literature review were conducted to generate a pool of items. The testing phase involved a psychometric evaluation and pilot-testing of the scale on hypertensive Korean Americans (n=386). The end product was a HBP-health literacy scale (HBP-HLS) with two essential domains, print literacy and functional health literacy.Psychometric testing indicated that the scale was reliable (Kuder-Richardson-20 coefficient=0.98), valid (content validity index ≥0.8), and significantly correlated with theoretically selected variables (education, r=0.67, p0.01; HBP knowledge, r=0.33, p0.01).The HBP-HLS demonstrated its utility for evaluating HBP management interventions in the community setting.Utilizing the HBP-HLS should be considered as a potential tool for improving health literacy and evaluating intervention studies in the context of HBP management.

Purpose The purpose of this article is to describe the process of translating evidence-based dietary guidelines into a tailored nutrition education program for Korean American immigrants (KAI) with type 2 diabetes mellitus (DM). Methods Community-based participatory research (CBPR) is a research process involving researchers and communities to build a collaborative partnership. The study was conducted at a community-based organization. In a total of 79 KAI (intervention, n = 40; control, n = 39) with uncontrolled type 2 DM (A1C ≥7.5%), 44.3% were female and the mean age was 56. 5 ± 7.9 years. A culturally tailored nutrition education was developed by identifying community needs and evaluating research evidence. The efficacy and acceptability of the program was assessed. Results In translating dietary guidelines into a culturally relevant nutrition education, culturally tailored dietary recommendations and education instruments were used. While dietary guidelines from the American Diabetes Association (ADA) were used to frame nutrition recommendations, additional content was adopted from the Korean Diabetes Association (KDA) guidelines. Culturally relevant intervention materials, such as Korean food models and an individually tailored serving table, were utilized to solidify nutritional concepts as well as to facilitate meal planning. Evaluation of the education revealed significantly increased DM-specific nutrition knowledge in the intervention group. The participants’ satisfaction with the education was 9.7 on a 0 to10-point scale. Conclusion The systematic translation approach was useful for producing a culturally tailored nutrition education program for KAI. The program was effective in improving the participants’ DM-specific nutrition knowledge and yielded a high level of satisfaction. Future research is warranted to determine the effect of a culturally tailored nutrition education on other clinical outcomes. References 1. Schafer RG, Bohannon B, Franz M, et al. Translation of the diabetes nutrition recommendations for health care institutions: technical review. J Am Diet Assoc. 1997;97:43-51. 2. Narayan KM, Gregg EW, Engelgau MM, et al. Translation research for chronic disease: the case of diabetes. Diabetes Care. 2000;23:1794-1798. 3. Rubin RR, Peyrot M, Saudek CD. Differential effect of diabetes education on self-regulation and life-style behaviors. Diabetes Care. 1991;14:335-338. 4. Haffner SM, Hazuda HP, Mitchell BD, Patterson JK, Stern MP. Increased incidence of type II diabetes mellitus in Mexican Americans. Diabetes Care. 1991;14:102-108. 5. Vijan S, Stuart NS, Fitzgerald JT, et al. Barriers to following dietary recommendation in Type 2 diabetes. Diabet Med. 2005;22:32-38. 6. UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulponylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998;352:837-853. 7. Wylie-Rosett J. In: Proceedings from the American Diabetes Association Annual Scientific Sessions ; June 6, 1989. 8. Samanta A, Campbell JE, Spaulding DL, et al. Eating habits in Asian diabetics. Diabet Med . 1986;3:283. 9. Park SY, Paik HY, Skinner JD, Spindler AA, Park HR. Nutrient intake of Korean Americans, Korean, and American adolescents. J Am Diet Assoc. 2004;104:242-245. 10. Lee SK, Sobal J, Frongillo EA Jr. Acculturation and dietary practices among Korean Americans. J Am Diet Assoc. 1999;99:1084-1089. 11. Brown SA, Hanis CL. A community-based, culturally sensitive education and group-support intervention for Mexican Americans with NIDDM: a pilot study of efficacy. Diabetes Educ. 1995;21:203-210. 12. Kim MT, Han HR, Song H, Lee JE, Kim J, Kim KB. A community-based culturally tailored behavioral intervention for Korean Americans with diabetes. Diabetes Educ. 2009;35:986-994. 13. Fitzgerald JT, Funnell MM, Hess GE, et al. The reliability and validity of a brief diabetes knowledge test. Diabetes Care. 1998;21: 706-710. 14. Han HR, Kim KB, Kim MT. Evaluation of the training of Korean community health workers for chronic disease management. Health Edu Res. 2007;9:137-146. 15. Franz MJ, Bantle JP, Beebe CA, et al. Evidence-based nutrition principles and recommendations for the treatment and prevention of diabetes and related complications. Diabetes Care. 2002;25:148-198. 16. Korean Diabetes Association Web site. http://www.diabetes .or.kr. Accessed September 28, 2009. 17. Szczepura A. Access to health care for ethnic minority populations. Postgrad Med J. 2005;81:141-147. 18. Resnicow K, Baranowski T, Ahluwalia JS, et al. Cultural sensitivity in public health: defined and demystified. Ethn Dis. 1999;9:10-21. 19. Cooper LA, Hill MN, Powe NR. Designing and evaluating interventions to eliminate racial and ethnic disparities in health care. J Gen Intern Med. 2002;17:477-486. 20. Hawthorne K. Asian diabetics attending a British hospital clinic: a pilot study to evaluate their case. Br J Gen Pract. 1990;40: 243-247. 21. Lee JA, Yeo G, Gallagher-Thompson D. Cardiovascular disease risk factors and attitudes towards prevention among Korean American elders. J Cross Cult Gerontol. 1993;8:17-33. 22. Brown JB, Harris SB, Webster-Bogaert S, Wetmore S, Faulds C, Stewart M. The role of patient, physician, and systematic factors in the management of type 2 diabetes mellitus. Fam Pract. 2002;19:344-349. 23. Nicolucci A, Cavaliere D, Scorpiglione N, et al. A comprehensive assessment of the avoidability of long-term complications of diabetes: a case-control study. Diabetes Care. 1996;19:927-933. 24. Lonner TD. The group as a basic asset to ethnic minority patients with diabetes. Diabetes Educ. 2000;26:645-655. 25. Fisher TL, Burnet DL, Huang ES, Chin MH, Cagney KA. Cultural leverage: interventions utilizing culture to narrow racial disparities in health care. Med Care Res and Rev. 2007;64:243S-282S. 26. Fiscella K, Franks P, Doescher MP, Saver BG. Disparities in health care by race, ethnicity, and language among the insured. Medical Care. 2002;40:52-59.

Nurse telephone counseling can improve the management of chronic conditions, but the effectiveness of this approach in underserved populations is unclear. This study evaluated the use of bilingual nurse-delivered telephone counseling in Korean Americans (KAs) participating in a community-based intervention trial to improve management of hypertension.KAs were randomized to receive 12 months of hypertension-related telephone counseling that was more intensive (bi-weekly) or less intensive (monthly). Counseling logs were kept for 360 KAs who completed the pre- and post-intervention evaluations.The overall success rate for the intervention was 80.3%. The level of success was significantly influenced by the dose of counseling, employment status, and years of US residence. Over the 12-month counseling period, both groups showed improvement with regard to medication-taking, alcohol consumption, and exercise but not smoking, with no significant group differences.Bilingual telephone counseling could reach monolingual KAs and improve their hypertension management behavior.Bilingual nurse telephone counseling may have wide applicability, serving as an effective means of disseminating evidence-based chronic disease management guidelines to a linguistically isolated community with limited health resources and information.

The primary objective of this study was to investigate the factors affecting the level of compliance of home blood pressure monitoring (HBPM) and its relation to blood pressure (BP) control among hypertensive adults in a community setting. A total of 377 middle-aged Korean Americans with high BP participated in this study. Along with structured behavioral education, the participants were instructed to measure their BP 3 times in a row upon waking and thrice again at bedtime, at least 2 or more times a week for 48 weeks. Using multivariate logistic regression, the authors examined the patterns and factors affecting HBPM and its relation to BP control status. The analyses revealed that older participants were more compliant with the HBPM instruction than were younger participants (adjusted odds ratio [OR], 5.29; 95% confidence interval [CI], 1.77–15.81) and those with more depressive symptoms were less compliant (OR, 0.19; 95% CI, 0.04–0.88). Participants who were more compliant to HBPM instruction were 4 times more likely than those who were noncompliant to have controlled their BP by the end of the intervention period (OR, 4.28; 95% CI, 1.79–10.23). These results suggest that the participants who checked their BP regularly at home had a stronger tendency to achieve BP control.

Purpose The purpose of this study is to test the efficacy of a culturally tailored comprehensive type 2 diabetes management intervention for Korean American immigrants (KAIs) with type 2 diabetes. Methods A randomized controlled pilot trial with 2 parallel arms (intervention vs control) with a delayed intervention design was used. A total of 79 KAIs, recruited from the Baltimore-Washington area, completed baseline, 18-week, and 30-week follow-ups (intervention, n = 40; control, n = 39). All participants had uncontrolled type 2 diabetes (hemoglobin A1C ≥7.5%) at baseline. The authors’ comprehensive, self-help intervention program for type 2 diabetes management (SHIP-DM) consisted of a 6-week structured psychobehavioral education, home glucose monitoring with teletransmission, and bilingual nurse telephone counseling for 24 weeks. The primary outcome of the study was A1C level, and secondary outcomes included an array of psychobehavioral variables. Results Using analysis of covariance, the findings support that the proposed intervention was effective in significantly lowering A1C and fasting glucose and also in improving psychosocial outcomes in the sample. Specifically, the amount of reduction in A1C among intervention group participants was 1.19% at 18 weeks and 1.31% at 30 weeks, with 10% and 15.5% of the participants achieving the suggested goal of A1C Conclusions The results highlight the clinical efficacy of the SHIP-DM intervention composed of a 6-week education program, self-monitoring, and follow-up counseling, in terms of maintaining the improved intervention effects obtained and in terms of glucose control.

Despite well-known benefits of health care utilization for the effective management of chronic diseases, the underlying mechanism of understanding health care utilization in ethnic minority population has not been systematically explored. The purpose of this paper is to examine the predictive ability of a health care utilization model by analyzing the interplay between predisposing, enabling, and need factors. The sample consisted of hypertensive Korean American immigrants (KAIs) 40-64 years of age who participated in a self-help intervention for high blood pressure care (SHIP-HBP). Using structured questionnaires, data were collected from 445 KAIs at baseline and analyzed with path analysis. Insurance status and relevant medical history were not just strong direct effects but also carried the most total effect on the health care utilization of these patients. Life priorities, years of residence in the US and perceived income level exerted indirect effects through the participants' insurance status. Our statistical analysis indicated a good fit for the proposed model (x (2) = 28.4, P = 0.29; NFI = 0.91; CFI = 0.99; RMSEA = 0.02). Overall, the model explained 18% of the variance in health care utilization of hypertensive KAIs. These findings strongly support a need to improve access to health care for KAIs by introducing a variety of community resources and building sustainable community infrastructures.

This report describes the management and control of high blood pressure (HBP) in a sample of middle-aged (40 to 64 years) Korean Americans (KAs) with HBP. Participants in the Self-Help Intervention Program for HBP care (SHIP-HBP), a culturally tailored clinical trial for HBP management in KAs through lifestyle approaches, underwent baseline assessments to determine HBP control status and knowledge, beliefs, and practices related to HPB control. Data were stratified by sex. In all, 445 Korean patients are described. About 55% of the sample were receiving antihypertensive therapy, and less than one-third had controlled BP (< 140/90 mm Hg). Sex differences were observed in terms of clinical characteristics and anti-hypertensive medication use: women were more likely than men to have controlled BP and lower diastolic BP and to have been on HBP medication. Lower rates of smoking, drinking, and overweight or obesity were also observed more frequently in women. Most participants agreed that taking anti-hypertensive medication lowered BP. When asked what the most important behavioral factor was for controlling BP, about a quarter reported cutting down on salt, followed by exercise and medication taking. While poor HBP control remains a common problem that contributes to significant cardiovascular morbidity and mortality, particularly among ethnic minorities, our findings underscore the need to test the beneficial effects of primary and secondary prevention programs, suitably modified to meet the language, cultural, and individual needs of this high-risk population of hypertensive patients.

Background As international migration becomes a common phenomenon in many countries, the health issues of immigrants are becoming an important area of concern among health care professionals worldwide. Objective Adopting the stress–health outcome framework, this study examined risks and resources of both positive and negative affect (i.e., happiness and depression) among Korean Americans who experienced acculturative and recent life stresses. Methods Hierarchical multiple regression analyses were performed to examine correlates of positive and negative outcomes in the stress process on a final sample of 147 Korean immigrants from a cross-sectional study. Results For happiness, lower levels of acculturative stress and recent life stress, a greater sense of mastery, and greater social support were associated with an increased level of happiness. None of the individual characteristics were significant. R 2 for the full model was .53. For negative affect, acculturative stress and recent life stress explained a significant portion (41%) of the total variance associated with depression ( R 2 = . 51 ). As with the happiness variable, individual characteristics failed to add to the predictiveness of the equation, while sense of mastery and social support functioned as significant resources in reducing depression. Conclusion Increased mastery and greater social support were consistently predictive of greater happiness and less depression. Implications for future immigrant research are discussed.

The use of community health workers (CHWs) or lay health advisors has been increasingly popular as an effective means of secondary prevention for cardiovascular health in hard-to-reach, underserved populations. Yet, published evaluations of the CHW training programs are rare. The purpose of this article is to report the results of an evaluation of a CHW training program for hypertension and diabetes management for Korean-American seniors. Forty-eight hours of training was developed and delivered to 12 Korean CHWs. Evaluation of the training program involved CHW surveys, trainer observation and debriefing and CHW focus groups. Testing of CHW knowledge showed that all CHWs met the minimum required knowledge level of 70%. Independent ratings by two trainer observations revealed that the overall CHW performance was satisfactory. Both CHW ratings and focus group data indicated that the training program met their expectation (average 9.3 on a 10-point scale) and was successful in empowering them to assume their role as a 'health initiator', 'health advertising agent' or 'health role model'. While this course is judged to be effective in general, future research is warranted to determine whether CHW provision of care and support will affect health outcomes in the target population.

A correlational, cross-sectional study with multivariate analysis was conducted to identify factors that influence the depression experience in 154 Korean immigrants. Based on the stress-health outcome framework, four variables (i.e., sense of mastery, socioeconomic status, social support, and acculturation) were tested for their mediating effects between stress and depression experienced by Korean Americans. Path analyses showed that the negative effect of life stress on depression was buffered by higher levels of sense of mastery and social support in the Korean sample. Implications for future cross-cultural depression research and preventive strategies against depression in immigrant populations are discussed.

The intensive care necessary for premature newborns is characterized by multiple procedures, many of which are painful. Given emerging evidence that such early pain during this time of high brain plasticity may affect long-term neurodevelopmental and social-emotional functioning, this study explored the impact of early repeated pain on emotionality and stress responsivity at maturity. From birth through postnatal day 7, Fischer 344 pups underwent either paw needle prick every day versus every other day or daily paw touch, or were left unperturbed. Each paw received the designated perturbation once per day. At maturity, some animals underwent emotionality testing: either a 4-day series of open field exposures or a single elevated plus-maze (EPM) exposure. The paw prick groups exhibited less open field habituation and occupied the EPM open arms more. Two weeks later, all animals were either subjected to forced swim or not. At 1h post-swim, animals underwent either blood withdrawal for plasma corticosterone (CS) levels and ex vivo natural killer cell activity (NKCA) or were injected intravenously with radiolabeled NK-sensitive syngeneic MADB106 tumor cells and assessed for lung tumor retention. Sex was a major factor in the manifestation of perturbation-related differences in the biologic outcomes. Whereas postnatal pain differentially affected baseline tumor retention between males and females, only males exhibited perturbation-related differences in swim stress-induced increases in tumor retention and CS. Finally, male-female differences were evident in CS, NKCA, and tumor responses to swim stress. These findings suggest that early pain affects neurodevelopmental function in the mature organism; however, these relationships are complicated by sex differences, the postnatal pain schedule, and the outcome measured.

Background African American men with hypertension in low socioeconomic urban populations achieve poor rates of hypertension control and suffer early from its complications. Methods In a randomized clinical trial with 309 hypertensive urban African American men aged 21 to 54 years, we evaluated the effectiveness of a more intensive comprehensive educational-behavioral-pharmacologic intervention by a nurse practitioner-community health worker-physician (NP/CHW/MD) team and a less intensive education and referral intervention in controlling blood pressure (BP) and minimizing progression of left ventricular hypertrophy (LVH) and renal insufficiency. Changes in BP, left ventricular mass (LVM), and serum creatinine from baseline to 36 months were compared between groups. Results At 36 months, the mean systolic BP/diastolic BP change from baseline was −7.5/−10.1 mm Hg for the more intensive group and +3.4/−3.7 mm Hg for the less intensive group (P = .001 and .005 for between-group differences in systolic BP and diastolic BP, respectively). The proportion of men with controlled BP (

This article discusses issues related to measuring depression in linguistic and cultural minority groups, using Korean Americans as an example. The article details the process of developing and evaluating a depression-screening tool for Korean Americans. A series of focus groups was conducted in the development stage of the study. In the evaluation phase, 154 first-generation Korean Americans participated in the assessment of the psychometric properties of the newly developed depression scale, the Kim Depression Scale for Korean Americans (KDSKA). The KDSKA showed adequate reliability, validity, and potentially high sensitivity as a depression-screening tool for Korean Americans.

Korean Americans are one of the most underserved ethnic/linguistic minority groups owing to cultural and institutional barriers; there is an urgent need for culturally competent diabetes management programs in the Korean American community for those with type 2 diabetes. The purpose of this study was to test the effectiveness of a community-based, culturally tailored, multimodal behavioral intervention program in an ethnic/linguistic minority group with type 2 diabetes.An RCT with waitlist comparison based on the Predisposing, Reinforcing, and Enabling Constructs in Education/environmental Diagnosis and Evaluation (PRECEDE)-Policy, Regulatory, and Organizational Constructs in Educational and Environmental Development (PROCEED) and self-help models. Data were collected between September 2010 and June 2013 and were analyzed in August-December 2014. Statistical significance was set at p0.05.In a naturally occurring community setting, a total of 250 Korean Americans with type 2 diabetes were randomized into an intervention group (n=120) or a control group (n=130).The intervention consisted of key self-management skill-building activities through 12 hours of group education sessions, followed by integrated counseling and behavioral coaching by a team of RNs and community health workers.Primary (clinical) outcomes were hemoglobin A1c, glucose, total cholesterol, and low-density lipoprotein at baseline and at 3, 6, 9, and 12 months. Secondary (psychosocial and behavioral) outcomes included diabetes-related quality of life, self-efficacy, adherence to diabetes management regimen, and health literacy.During the 12-month project, the intervention group demonstrated 1.0%-1.3% (10.9-14.2 mmol/mol) reductions in hemoglobin A1c, whereas the control group achieved reductions of 0.5%-0.7% (5.5-7.7 mmol/mol). The differences between the two groups were statistically significant. The intervention group showed statistically significant improvement in diabetes-related self-efficacy and quality of life when compared with the control group.RN/community health worker teams equipped with culturally tailored training can be effective in helping an ethnic/linguistic minority group manage diabetes in the community.

Objective: The study explored predictors of dental care utilization and unmet dental needs in older Korean Americans, considering predisposing, enabling (dental insurance, acculturation, and family network), and need (self-rated oral health) variables. Method: Multivariate regression models were used to evaluate the data from 209 Korean Americans (aged ≥60) surveyed in Central Texas. Results: Participants with strong family networks and fair/poor self-ratings of oral health reported higher numbers of dental visits in the past year. The likelihood of having an unmet dental need increased when participants had less education, a shorter stay in the United States, no dental insurance coverage, lower levels of acculturation, more limited family networks, fair/poor self-ratings of oral health, and fewer numbers of dental visits. Discussion: Our findings underscore the vulnerability of individuals who are culturally and linguistically isolated and lack family resources, and they highlight the importance of incorporating social and cultural factors in intervention efforts.

Objectives To estimate the prevalence and identify the predictors of depression among community-dwelling Korean American elderly (KAE). Design A cross-sectional descriptive epidemiological survey using a two-step sampling strategy to obtain a representative community sample. Setting The authors recruited study participants at religious, service, and business establishments in the KA community (26 churches, 6 senior centers, 2 medical daycare centers, 1 supermarket). Participants Community-dwelling first-generation KAE (N = 1,118; mean age ± SD: 70.5 ± 7.0 years; female: 67.2%). Measurements Trained bilingual nurses and community health workers interviewed participants face-to-face for demographic information, chronic conditions, and depression using the Korean versions of the Patient Health Questionnaire (PHQ-9K). Results 30.3% of KAEs were classified as having either mild (PHQ-9K score 5-9; N = 218, 19.5%) or clinical depression (PHQ-9K score ≥10; N = 120, 10.8%), respectively. One of seven KAE (N = 164, 14.7%) endorsed thoughts of death or self-injury, but only 63 (5.7%) reported utilizing mental health services. The authors also identified several predictors of depression, including living arrangement (living alone versus living with family/spouse); having chronic conditions such as diabetes, arthritis, digestive disorders, or chronic bronchitis; years of education; and cognitive impairment. Conclusions The authors' findings reveal a high prevalence of depression among KAE and a low level of mental health service utilization. Because there are urgent needs for culturally and contextually relevant interventions, the authors also discuss the feasibility of community-based interventions to reduce the burden of depression, which should be incorporated into a management system for multiple chronic conditions.

An in-depth cardiovascular risk factor assessment was carried out in a sample of 205 Korean American elderly in Maryland, consisting of 75 males and 130 females aged 60 to 89 years (mean age = 69.9± 6.5 years). Six risk factors were assessed in each participant: high blood pressure, current smoking, high blood cholesterol, overweight, sedentary lifestyle, and diabetes. The findings of this cross-sectional study suggested that high blood pressure was the leading cardiovascular disease risk factor among Korean American elderly (71%), followed by high blood cholesterol (53%), overweight (43%), sedentary life style (24%), diabetes (18%), and smoking (7%). Two thirds of the sample had multiple cardiovascular disease risk factors. The pattern of prevalence and risk factors that was observed was consistent with the distribution of multiple risk factors in that the combination of high blood pressure, high blood cholesterol, and overweight was most common in Korean American elderly (62%). These findings indicate that culturally relevant and salient strategies are needed to reduce multiple risk factors in this population.

BACKGROUND Adequate self-care is crucial for blood pressure control. A number of hypertension (HBP) self-care instruments are available, but existing tools do not capture all the critical domains of HBP self-care and have limited evidence of reliability and validity. OBJECTIVE The purpose of this study was to develop and validate a new tool--the HBP Self-Care Profile (HBP SCP)--in a sample of inner-city residents. METHODS The HBP SCP encompasses comprehensive domains of HBP self-care behaviors. Guided by 2 validated theoretical approaches--Orem's self-care model and Motivational Interviewing--the HBP SCP includes 3 scales that can be used together or independently: Behavior, Motivation, and Self-efficacy. The sample included 213 English-speaking inner-city residents with HBP (mean age, 68.6 years; 76.1% women; 81.7% African American). RESULTS Item-total correlations ranged from 0.20 to 0.63 for Behavior, 0.46 to 0.70 for Motivation, and 0.40 to 0.74 for Self-efficacy, meeting the cutoff set a priori at 0.15. Internal consistency reliability coefficients ranged from 0.83 to 0.93. Concurrent and construct validities of the HBP SCP were achieved by significant correlations between HBP SCP scales and theoretically selected instruments (P < .05 for all correlation coefficients). The HBP SCP-Behavior scale also successfully discriminated between those with or without blood pressure control (P < .05). CONCLUSIONS The reliability and validity of the HBP SCP were supported in this sample of inner-city residents with HBP. The high reliability estimates and strong evidence of validity should allow researchers to use the HBP SCP to assess and identify gaps in HBP self-care behavior, motivation, and self-efficacy. Future research is warranted to evaluate the HBP SCP in diverse ethnic and age samples of hypertensive patient populations.

Korean Americans (KA) comprise the fourth largest Asian-American subgroup, with a population estimated at nearly 1.7 million, and the vast majority (up to 85%) of KA elders attends ethnic churches. Despite the rapid increase of the KA elderly population, data on mental health service utilization among KA elders are scarce.Based on a cluster sampling method, the Memory and Aging Study among Koreans in Maryland (MASK-MD) recruited and assessed 630 KA elders (mean age: 70.9 ± 6.1 years; 68.9% female) in KA churches for depression, dementia, and level of mental health service utilization. The Korean versions of the Patient Health Questionnaire (PHQ-9K) and Mini-mental Status Examination (MMSE-KC) were administered by trained community health workers.Of the 630 participants, 23.2% and 7.3% had PHQ-9 scores of 5 ('mild depression') or above and 10 or above ('clinical depression'), respectively. In addition, 7.0% scored below the age- and education-specific cutoff values for probable dementia based on the MMSE-KC. Of the 92 participants with 'clinical depression' or having thoughts of death or self-injury, only 16 (17%) reported utilizing mental health services. Likewise, of 56 participants with probable dementia, only 3 (7.3%) sought treatment from a health care provider.The prevalence of depression and cognitive impairment are high in community-dwelling KA elders attending KA churches, but the rate of mental health service utilization among depressed or cognitively impaired Korean elders is low. Further research is warranted to identify barriers to and strategies for adequate mental health care for Korean immigrant elders.

Objectives Numerous studies have demonstrated that fasting serum glucose (FSG) levels and certain single-nucleotide polymorphisms (SNPs) are related to an increased risk of colorectal cancer (CRC); however, their combined effects are still unclear. Methods Of a total of 144,527 men and women free of cancer at baseline, 317 developed CRC during 5.3 years of follow-up. A case-cohort study (n=1,691) was used, consisting of participants with a DNA sample available. Three well-known SNPs (rs3802842, rs6983267, rs10795668) were genotyped. Hazard ratios (HR) and 95% confidence intervals (CI) of CRC, colon and rectal cancer were calculated, with the Cox proportional hazard models. Results The crude incidence rates per 100,000 person-years were 41.1 overall, 48.4 for men, and 29.3 for women. Among participants with dysglycemia, SNPs rs3802842 and rs6983267 were both associated with an increased risk of CRC (HR, 3.2; 95% CI, 1.9 to 5.5 and HR, 1.8; 95% CI, 1.1 to 3.1, respectively) and rectal cancer (HR, 3.4; 95% CI, 1.8 to 6.6 and HR, 3.3; 95% CI, 1.6 to 7.1, respectively). The interaction effect of dysglycemia and SNPs was positive, that is, resulted in an elevated risk of CRC, but was not statistically significant. Conclusions This study demonstrates that both high FSG and certain SNPs are major risk factors for CRC and rectal cancer but that they did not interact synergistically. The difference in effect size of the SNPs according to CRC subtype (i.e., colon or rectal cancer) and presence of dysglycemia merits further research.