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While increasing numbers of researchers are targeting ethnic minorities in order to address their health disparities, the unique health needs of Korean Americans are not well known to the mainstream community, and only relatively few systematic research studies have been conducted in this “hard-to reach” population. The purpose of this paper is to describe the barriers to recruiting participants for health promotion research and to identify facilitators in the community that can contribute to this effort. We have analyzed data pertaining to the 14 studies we have conducted since 1998, which included a total sample of about 2,400 Korean Americans. We describe in detail the unique recruitment challenges that we have faced in regard to the culture, language, sociodemographic characteristics of the participants, such as gender and age, and other community level barriers. Multiple strategies at different levels (individual and community) to address these issues are discussed.

African American men with hypertension (HTN) in low socioeconomic urban environments continue to achieve poor rates of HTN control.In a 5-year randomized clinical trial with 309 hypertensive urban African American men aged 21 to 54 years, the effectiveness of a more intensive educational/behavioral/pharmacologic intervention provided by a nurse practitioner/community health worker/physician team was compared to less intensive information and referral intervention. Changes in behavioral factors, health care utilization, blood pressure (BP) control, left ventricular hypertrophy (LVH), and renal insufficiency were evaluated.Follow-up rates exceeded 89% of available men. The ranges of mean annual systolic BP/diastolic BP change from the baseline to each year follow-up were -3.7 to -10.1/-4.9 to -12.3 mm Hg for the more intensive group and +3.4 to -3.0/-1.8 to -8.7 mm Hg for the less intensive group. The annual proportion of men with controlled BP (140/90 mm Hg) ranged from 17% to 44% in the more intensive group and 21% to 36% in the less intensive group. At 5 years the more intensive group had less LVH than the less intensive group and 17% of the men were deceased primarily due to narcotic or alcohol intoxication (36%) and cardiovascular causes (19%).An appropriate educational/behavioral intervention significantly improved BP control and reduced some sequelae of HTN in a young African American male population. Improvement in risk factors other than HTN was limited and sustained control of HTN was difficult to maintain during 5 years.

Although significant progress has been made in the reduction of overall cardiovascular risk factors in the United States during the last decade, controlling high blood pressure (HBP) remains a difficult task for many individuals. In particular, socially disadvantaged groups, such as new immigrants, and ethnic minority groups, such as Korean Americans, continue to struggle with this chronic disease and suffer unnecessary complications. We conducted a quasi-experimental study to test the efficacy of a self-help intervention program for HBP control in first-generation Korean American seniors with HBP. The intervention consisted of 3 concurrently administered components: (1) structured behavioral education on HBP management, (2) home blood pressure (BP) monitoring, and (3) monthly support groups facilitated by a bilingual nurse. Of the 49 Korean American seniors (> or =60 years old) who agreed to participate, 31 received the intervention and completed the follow-up interviews at 6 months. Final analysis of BP outcomes using repeated measures and postintervention data suggested that the self-help intervention was effective in significantly improving the proportion of individuals who achieved BP control (

1) To describe stressful life events as experienced by a sample of young Black men with high blood pressure (HBP) living in inner-city Baltimore, Maryland; and 2) to examine the effect of cumulative stressful life events on substance use, depression, and quality of life.Data were obtained over 48 months by interview from 210 men in an HBP management study.Stressors repeatedly occurring over time included death of family member or close friend (65.2%), having a new family member (32.9%), change in residence (31.4%), difficulty finding a job (24.3%), and fired or laid off from work (17.6%). Involvement with crime or legal matters was reported at least twice during the 48 months by 33.3% of men. When a cumulative stressful life events score was calculated by summing the number of events experienced at 6-month points over 48 months and tested for its relationship with the health outcomes, the findings of multivariate analyses revealed significant associations between cumulative life stressors and depression and quality of life. No significant relationship was found between stressful life events and substance use.The results suggest that cumulative stressful life events have a negative effect on mental health and quality of life in young Black men with HBP. Future study should focus on developing interventions to assist individuals in managing distress related to stressful events with necessary community resources.

To identify barriers to achieving optimal management of high blood pressure (HBP) among hypertensive Korean-American elderly (KAE).This study used data on a subsample of 146 hypertensive KAE from a total of 205 KAE in Maryland who participated in a cardiovascular health assessment study. The study group consisted of 56 males and 90 females with a mean age of 69.8 +/- 6.6 years. The PRECEDE-PROCEED model guided selection of study variables.Many KAE with HBP had no regular HBP care (66%) and did not achieve HBP control (92.5% of KAE with HBP and 77.6% of KAE on HBP medications). Lack of health insurance emerged as a strong barrier to receiving adequate HBP care. Other barriers to HBP care included not having a Korean doctor and not having a regular medical checkup. While 22.4% of KAE on HBP medication had controlled blood pressure (BP), those with more visits to traditional Asian medicine doctors were less likely to have achieved HBP control.The study unveils some of the multilevel barriers to care and control of HBP uniquely experienced by KAE and suggests the need for developing interventions to assist KAE in managing HBP.

Pancreatic cancer is one of the most fatal human cancers and continues to be a major unsolved health problem. The goal of this study was to estimate the independent effects and interactions between cigarette smoking and diabetes on the risk of pancreatic cancer in Korean male population. Cigarette smoking and the risk of incidence and death from pancreatic cancer were examined in a 10-year prospective cohort study of 446,407 Korean men aged 40 to 65 years who received health insurance from the National Health Insurance Corporation and who had a medical evaluation in 1992. Relative risks (RR) and 95% confidence intervals (CI) were calculated using a Cox proportional hazards model after adjusting for age, body mass index, exercise and alcohol use. Current smoking was associated with an increased risk of incidence (RR = 1.7, 95% CI = 1.6-1.9) and mortality (RR = 1.6, 95% CI = 1.4-1.7) from pancreatic cancer. The RR for pancreatic cancer increased with both duration and amount of smoking. Diabetes was also associated with an increased risk of both incidence (RR = 1.8, 95% CI = 1.5-2.2) and mortality (RR = 1.7, 95% CI = 1.4-2.1) from pancreatic cancer. There was no interaction between smoking and fasting serum glucose in terms of pancreatic cancer risk. Thus, our prospective study has demonstrated that cigarette smoking and elevated fasting serum glucose are independently associated with an increased risk of pancreatic cancer in a large cohort of Korean males.

Today's Korean American elderly are predominantly first-generation immigrants who face stern challenges of acculturation, which is often associated with depression. Social support has been identified as an effective personal resource for alleviating acculturative stress and achieving better mental health outcomes. The purposes of this study were to describe available sources of social support utilized by Korean elders and to examine the relationships among acculturative stress, social support, and depression. In particular, social support was operationalized as an integrative concept encompassing the size of the social network, satisfaction with the support received, and appraisals of the level of social support. This study was a secondary data analysis of an existing survey of 205 elderly Korean immigrants (>or=60 years) in a major metropolitan city on the East coast. Adult children were found to be the main source of support utilized by elders, even when the elder had a living spouse. Hierarchical multiple regression analysis revealed that higher acculturative stress and lower social support were associated with higher depression scores after demographics and health status were controlled for, whereas network size and satisfaction with support were not. Future interventions should address the cultural/social needs of these immigrants, not only by reinforcing their existing social network but also by providing additional support for their family members to prevent social isolation and depression in the population.

Background An in-depth assessment of coronary heart disease (CHD) risk factors in Koreans was conducted to develop effective risk reduction strategies for this population. Method Based on 2001 Korea National Health and Examination Survey, a cross-sectional survey, this paper presents the prevalence of major CHD risk factors and estimates future risk by applying the Framingham model and CHD risk factor guidelines of the National Cholesterol Education Program Adult Treatment Panel III (NCEP) to 4639 Koreans aged 20 to 79 years. Result Our findings indicate that CHD is a major health threat to Koreans. Among these factors, low high-density lipoprotein cholesterol (HDL-C) was seen in 35.1% of men and 17.8% of women; both had a low rate of controlled high blood pressure (men 13.7%, women 23.6%), and age-adjusted current smoking was especially high (61.6%) in men. The 10-year CHD risk averaged 11.1% in men and 5.5% in women based on Framingham model, and 7.4% and 1.4% based on NCEP guidelines. About 9.1% of men and 2.6% of women were "high-risk," (>20%) based on the Framingham model, and 4.7% and 0.7%, respectively, on the NCEP guideline. Diabetes was the most prevalent risk factor among high-risk individuals and total cholesterol in men and low HDL-C in women was fairly high regardless of prediction method. Conclusion These findings suggest that current coronary heart health of Koreans is nearly comparable to that of western developed countries. Developing and implementing effective population-based intervention strategies focusing on diabetes is warranted to lower the CHD risk for Koreans.

Prevention strategies for coronary artery disease among hypertensive patients require assessment of other modifiable risk factors in the target population. In this article, we describe the prevalence of other cardiovascular risk factors in military beneficiaries with high blood pressure (HBP). Baseline data from an ongoing randomized clinical trial designed to test effectiveness of a comprehensive HBP intervention are used in the analysis. A total of 147 beneficiaries from a military health system participated in this study. Findings indicate that the rate of HBP control in this sample was suboptimal (32%: blood pressure140/90). Other prevalent cardiovascular risk factors include high cholesterol, obesity, and diabetes. Many of these patients (31.3%) are also in the moderate-to-high danger level of developing coronary artery disease in the near future. These findings warrant a regular assessment of cardiovascular risk factors and rigorous behavioral interventions for all beneficiaries of the military health care system.

Background. Breast cancer is the most commonly diagnosed cancer among Korean American women (KAW). Many KAW are not aware of the importance of regular screening. This research estimates the rates of regular breast cancer screening and examines the predictors and barriers to obtaining regular mammograms. Methods. Face-to-face surveys were conducted with 459 KAW residing in Maryland. Study participants were recruited through Korean churches and senior housing. Results. About 33% had regular mammograms. In multiple logistic regression analyses, the strongest correlate of regular mammograms was knowledge of screening guidelines. Age, spoken English proficiency, and physician recommendations were associated with regular mammograms. Employment interacted with insurance: Employed women without insurance had lower rates of mammograms than those employed with insurance. The most frequent reason for not having regular mammograms was a woman's belief that she was at low risk for breast cancer. Conclusions. Results indicate that knowledge of screening guidelines and physician recommendations for screening are important in this minority population. Culturally relevant educational programs about breast cancer screening should be developed for less acculturated women and recent immigrants.

Although many epidemiological studies have suggested that increased serum uric acid levels are a risk factor for mortality, this relationship remains uncertain. This cohort study examined the effects of serum uric acid level on death from cancer, atherosclerotic cardiovascular disease (ASCVD) or all causes in men.A 9-year, prospective cohort study was carried out with 22698 Korean men, aged 30 to 77 years, who received health insurance from the National Health Insurance Corporation and who underwent biennial, secondary medical evaluations in 1992-1996. The main outcome measures were death from cancer, ASCVD or all causes, compared by quintiles of serum uric acid level. At baseline, the mean (SD) level of serum uric acid was 354.4 (98.1) micromol/l.During 199746 person-years of follow-up, there were 387 cancer deaths, 323 ASCVD (99 ischaemic heart disease, 192 stroke) deaths and 1625 all-cause deaths. In multivariate Cox proportional hazards models, having controlled for age, current smoking, diabetes, hypertension and hypercholesterolaemia, uric acid levels were not associated with mortality from cancer, ASCVD or all causes. However, for those with diabetes, uric acid levels were associated with mortality from all causes even after full adjustment of the covariates. When the interaction term was included in the multivariate model, there was significant interactive effect of uric acid with diabetes (RR=1.26, 95% confidence interval 1.02-1.55) on the risk of all cause of death, whereas the effects of uric acid itself did not attain significance.These findings indicate that uric acid level is not an independent risk factor for death from cancer, ASCVD or all causes.

This study examined the prevalence and correlated factors of cigarette smoking in a cross-sectional, epidemiological survey of Korean American men living in Maryland (n=333). In this sample, 26.1% were current smokers and 42.3% were former smokers. The older age group (> or = 40 years) was more likely to have quit smoking than the younger age group (< 40 years). In multiple logistic regression analysis, acculturation was associated with smoking status; those who stayed more than 20 years in the U.S. were less likely to be current smokers (OR=0.32, 95% CI 0.13-0.77) than those who stayed less than 10 years. Alcohol use was associated with smoking status; those who consumed alcohol were more likely to be current smokers (OR=5.24, 95% CI 2.33-11.79) or former smokers (OR=5.45, 95% CI=2.69-11.04) than those did not. Those with hypertension were more likely to have quit smoking (OR=3.11, 95% CI=1.33-7.24). The results suggest that the role of acculturation in smoking status among Korean American men deserves further attention by researchers as well as by health professionals who develop smoking prevention and cessation programs.

Relationships between depression, alcohol and illicit drug use, adherence behaviors, and blood pressure (BP) were examined in 190 urban hypertensive Black men enrolled in an ongoing hypertension control clinical trial. More than one fourth (27.4%) of the sample scored greater than 16 on the Center for Epidemiological Studies-Depression Scale (CES-D), indicating a high risk of clinical depression. Depression was significantly associated with an increased likelihood of meeting Diagnostic and Statistical Manual of Mental Disorders (4th ed.) criteria for alcohol abuse or dependence (odds ratio = 5.2; 95% confidence interval = 1.897-14.214). The level of depression was significantly correlated with poor medication (r =.301) and poor dietary compliance (r =.164). Both alcohol intake and illicit drug use were significantly correlated with poor dietary compliance (r =.195 and.185, respectively) and smoking (r =.190 and.269, respectively). Although no direct relationship between depression and the level of BP was substantiated by multivariate analysis, findings of descriptive analyses revealed statistically significant associations among depression, substance use, poor adherence, and poor BP outcomes. Given the harsh environment in which a large number of young urban Black men live, the high prevalence of substance abuse might be an attempt to fight off depression. Further in-depth investigation is needed to identify the role of depression and BP control in urban young Blacks in order to construct effective interventions that address their unique needs.

The purpose of this study was to estimate the prevalence and correlates of breast and cervical cancer screening tests among Korean American elderly women. This study examined the effects of individual socio-demographic background, acculturation level (e.g., proportion of life spent in the US, spoken English proficiency), health status and access to health care on uptake of mammography and Pap smear tests in the past 2 years. Subjects were 130 Korean American women aged 60 and older living in the Greater Metropolitan Baltimore Area. A cross-sectional face-to-face interview was conducted. The 2-year prevalence was only 35% for mammography and 29% for Pap smear tests. In multiple logistic regression analysis, educational attainment, government support, multiple chronic conditions, and routine checkups were associated with having mammography. Age, acculturation and insurance were associated with having a Pap test. Taking advantage of the positive influence of identified covariates may increase the effectiveness of cancer control interventions among Korean American elderly women.

Background. Cancer is the second leading cause of death among Korean Americans aged 65 and older. Colorectal cancer is the second most commonly diagnosed cancer among Korean American women and the third among men. The purpose of this study was to examine the rates of colorectal cancer (CRC) screening and the correlates of screening tests. Methods. The study employed cross-sectional face-to-face interviews with a sample of 205 Korean American elderly aged 60 and older. Results. About 18% of respondents had ever had a fecal occult blood test (FOBT) and 11%, sigmoidoscopy. A history of bloody stool was related to having FOBT. In multiple logistic regression analyses, government assistance, routine checkups, having insurance, and speaking fluent English were associated with having FOBT. Marital status, proportion of time spent in the U.S., and general health status were related to having sigmoidoscopy. Conclusions. The findings suggest a need for further research addressing barriers to cancer screening in Kor...

Inaccurate self-reporting is the primary threat to the validity and utility of self-report in the research on illicit drug use. The purpose of this study was to estimate the sensitivity and specificity of self-report of drug use, using urine toxicity screening as a criterion variable, and to explore the individual characteristics associated with false reporting in a sample of urban African American males. Baseline data from urine tests and a questionnaire about self-report of illicit drug use were obtained from 290 hypertensive African American males enrolled in an ongoing hypertension clinical trial. Sensitivity and specificity of self-report were estimated, and multivariate logistic regression analysis was conducted to examine factors associated with true or false reporting of drug use. Result: The sensitivity and specificity of self-report were 0.87±0.019 and 0.63±0.02, respectively. Members of the underreporting group were more likely to be older, more educated, employed, living with family, and having experience with jail. Jail experience (OR, 2.0) and living with friends or family (OR, 1.7) were the two strongest predictors of false reporting. This study further confirms that social desirability and fear of the consequences of drug use are major contributing factors in underreporting of drug use.

The objective of our study was to examine the effect of lifetime lactation on breast cancer risk among premenopausal women. The data were from a prospective cohort study with a follow-up period of 6 years in Korea (1995-2000). The cohort was composed of 110,604 premenopausal parous Korean women, aged 20 years and older, who received health insurance from the Korea Medical Insurance Corporation and who had medical evaluations in 1992 and 1994. Multivariate Cox proportional hazard models were tested, controlling for age, age at menarche, number of children, age at first pregnancy, oral contraceptive use, smoking, exercise and obesity. At baseline, 57,440 (51.9%) reported breastfeeding and 4,584 (4.1%) reported breastfeeding more than 24 months. From 1995-2000, 360 incident cases of breast cancer (61.8/100,000 person-years) occurred. Compared to parous women who had no history of lactation, a period of lactation of 13-24 months decreased the risk of breast cancer (RR, 0.7; 95% CI, 0.5-1.1), and this risk was decreased even further for those who breastfed for more than 24 months (RR, 0.6; 95% CI, 0.3-1.0). There was a clear trend of decreasing breast cancer risk with the duration of lactation (p for trend

Background Although the Personal Resource Questionnaire (PRQ 85-Part 2) has been widely used to measure perceived level of social support, results of psychometric evaluation of the measure with a Korean population are not currently available in the literature. Objective To assess the psychometric properties of the Korean language version of the PRQ 85. Method An empirical validation of the theoretical relationships among the construct, social support, as measured by the PRQ 85, and other related constructs was conducted. In addition, factor structure comparison with a cross-validation technique was utilized on a combined sample of 555 Korean adults from three independent studies. Results Construct validity for the Korean PRQ 85 was evidenced by statistically significant correlations of perceived social support with the theoretically relevant variables such as depression and psychosocial adjustment. Using principal axis factoring with an oblique rotation, the two-factor solution was found to be most satisfactory in the first random sample and was cross-validated in the second sample, accounting for 52% and 54.1% of the total variance, respectively. Inspecting the distribution of variables within the factors, however, only the first factor appeared to be a construct-related factor; the second factor, which was exclusively represented by negatively keyed items, was method-related. Conclusion The findings suggest that a one-factor solution can be used to accurately describe a substantive (or construct-related) factor pattern of the Korean version of the PRQ 85. Although researchers generally agree that negatively worded questions are important in order to minimize the "response bias," this approach appeared to be problematic for Koreans who used the translated PRQ 85. Further research is warranted to explicate this important methodological issue in cross-cultural instrumentation.

Objective: Research on diabetes mellitus (DM) indicates that people with a low body mass index (BMI) but a high waist-to-hip ratio (WHR) are in a particularly high-risk group. The purpose of this study was to investigate the prevalence of and the effect of smoking on this paradoxical relationship. Research Methods and Procedures: Our study sample consisted of 3450 men and 4250 women who had participated in the Korean Nationwide Health Examination Survey. We divided the study sample into tertiles (low, medium, and high), according to the level of WHR and of BMI, which yielded nine different combinations. Individuals exhibiting so-called paradox A had the highest WHR and the lowest BMI. Results: The prevalence of paradox A was 4.7% for men and 3.8% for women. The overall agreement of WHR and BMI groups was poor [for men: κ = 0.31 and 95% confidence interval (CI) = 0.29 to 0.34; for women: κ = 0.39 and 95% CI = 0.37 to 0.42 for women]. The odds ratios for subjects having paradox A were estimated using a logistic regression model after adjusting for age, age2, height, education, smoking, use of alcohol, and exercise. The risk for paradox A among current smokers was 2.1-fold (95% CI, 1.5 to 3.0) higher for men and 2.5-fold (95% CI, 1.6 to 3.9) higher for women than for nonsmokers, after adjusting for age and covariates. Discussion: Cigarette smoking may increase the risk of paradox A. The findings of this study should be crossvalidated to different populations.

To examine the effects of hypertension on lung cancer prospectively and to determine the interactive effect of hypertension and smoking on lung cancer risk.A prospective cohort study.The cohort comprised 452,645 Korean men, aged 35-64 years, who received health insurance from the Korea Medical Insurance Corporation and who had biennial medical evaluations in 1992 and 1994.Multivariate Cox proportional hazard models were tested, controlling for age, smoking status, exercise, body mass index, alcohol use, diabetes and serum cholesterol concentration.Deaths from lung cancer.At baseline, 261 080 persons (58.3%) were identified as current cigarette smokers. Between 1995 and 1999, 883 deaths from lung cancer (44.8/100,000 person-years) occurred. An initial finding indicated that hypertension increased the mortality risk of lung cancer [risk ratio (RR) 1.3, 95% confidence interval (CI) 1.1-1.5]. However, after stratification for smoking status, the risk ratio was increased only for current smokers (RR 1.4, 95% CI 1.2-1.6). When the interaction term was included in the multivariate model, there was a significant interactive effect of hypertension with current smoking (RR 1.8, 95% CI 1.0-3.1) on the risk of death from lung cancer, whereas the effect of hypertension itself did not attain significance.Hypertension was not an independent risk factor in lung cancer-related deaths, but it increased the modest risk of lung cancer death among current smokers.

OBJECTIVE: To examine patterns and factors associated with the utilization of health care services among Korean American elderlylpar;KAErpar;. DATA SOURCES/STUDY SETTING: Data collected from a survey of faceshy;toshy;face interviews with 205 KAE, aged 60 years and older, residing in the Greater Baltimore Metropolitan area in 1999. STUDY DESIGN: We employed a cross-sectional design, based on the behavioral model of health service utilization for vulnerable populations. Poisson regression was used to estimate parameters associated with physician visits, the utilization of Oriental medicine, and hospitalization. DATA COLLECTION: Data were collected using face-to-face interviews with 205 KAE. PRINCIPAL FINDINGS: About 60% of respondents reported that they could not get care when needed, and the majoritylpar;86%rpar; had experienced difficulty getting care. About 71% of respondents visited a physician, and 25% used Oriental medicine at least once during the previous 6 months. Only 8% visited an emergency room. Enabling factors such as public insurance and having a regular physician were important to the utilization of physician care and hospitalization, whereas perceived or evaluated needs were crucial to the utilization of Oriental medicine. The level of acculturation was not significant. CONCLUSIONS: Korean American elderly grossly underutilized ambulatory health facilities, a finding which suggests that this vulnerable population needs culturally effective interventions and policies. KEY WORDS: Korean American, Elderly, Health Service Utilization, Behavioral Model for Vulnerable Population

The contexts of adherence for African Americans with high blood pressure African American men between the ages of 18 and 49 years have the lowest rates of awareness, treatment and control of high blood pressure (HBP) of all age/race/gender groups in the United States. A qualitative study was done to gain an understanding of urban black males' experiences of living with HBP. In-depth semi-structured interviews were conducted with 19 black males. The interviews explored perceptions of health, health problems and priorities, and concerns of daily living that influenced appointment keeping and medication taking. The sample was a subset of 309 men participating in a 3-year clinical trial to improve HBP control in an inner city African-American population. Content analysis of transcribed interviews identified the following themes and related concerns: (a) personal contexts: meaning of health, high blood pressure and treatments; (b) social context: living as a young black male in an urban environment; and (c) cultural context of relating: patient-provider relationship can make a difference. Influencing participants' responses were: interpreting symptoms; adjusting medication taking; protecting personal privacy; allocating limited resources; dealing with addiction; and feeling cared for by a health care provider. Adherence appeared to be multifaceted and changing depending upon: the men's social, economic and personal circumstances; empathetic and non-judgemental assistance from providers; financial concerns and employment; and drug addiction. Findings are useful in refining high blood pressure interventions.

The Hill-Bone Compliance to High Blood Pressure Therapy Scale assesses patient behaviors for three important behavioral domains of high blood pressure treatment: 1) reduced sodium intake; 2) appointment keeping; and 3) medication taking. This scale is comprised of 14 items in three subscales. Each item is a four point Likert type scale. The content validity of the scale was assessed by a relevant literature review and an expert panel, which focused on cultural sensitivity and appropriateness of the instrument for low literacy. Internal consistency reliability and predictive validity of the scale were evaluated using two community based samples of hypertensive adults enrolled in clinical trials of high blood pressure care and control. The standardized alpha for the total scale were 0.74 and 0.84, and the average interitem correlations of the 14 items were 0.18 and 0.28, respectively. The construct and predictive validity of the scale was assessed by factor analysis and by testing of theoretically derived hypotheses regarding whether the scale demonstrated consistent and expected relationships with related variables. In this study, high compliance scale scores predicted significantly lower levels of blood pressure and blood pressure control. Moreover, high compliance scale scores at the baseline were significantly associated with blood pressure control at both baseline and at follow up in the two independent samples. This brief instrument provides a simple method for clinicians in various settings to use to assess patients' self reported compliance levels and to plan appropriate interventions.

Barriers to high blood pressure (HBP) care and control have been reported in the literature for > 30 years. Few reports on barriers, however, have focused on the young black man with HBP, the age/sex/race group with the highest rates of early severe and complicated HBP and the lowest rates of awareness, treatment, and control. In a randomized clinical trial of comprehensive care for hypertensive young urban black men, factors potentially associated with care and control were assessed at baseline for the 309 enrolled men. A majority of the men encountered a variety of barriers including economic, social, and lifestyle obstacles to adequate BP care and control, including no current HBP care (49%), risk of alcoholism (62%), use of illicit drugs (45%), social isolation (47%), unemployment (40%), and lack of health insurance (51%). Having health insurance (odds ratio = 7.20, P = .00) and a negative urine drug screen (odds ratio = .56, P = .04) were significant predictors of being in HBP care. Low alcoholism risk and employment were identified as significant predictors of compliance with HBP medication-taking behavior. Men currently using illicit drugs were 2.64 times less likely to have controlled BP compared with their counterparts who did not use illicit drugs, and men currently taking HBP medication were 63 times more likely have controlled BP compared with men not taking HBP medication. Comprehensive interventions are needed to address socioeconomic and lifestyle issues as well as other barriers to care and treatment, if HBP care is to be salient and effective in this high risk group.

This article does not intend to simplify the emotional world of KAs, nor to generate a stereotype of cultural knowledge about KAs. A practice based on stereotypical knowledge often does more harm than good (Brigham, 1971). Cultures are not indefinitely static systems. Cultural subgroups and the dominant culture in which they reside exchange influences, which results in changing cultural pattern (DHHS, 1993). Consequently, a wide range of individual differences exists in terms of educational status, language sufficiency, acculturation status, and personalities. Although clinicians should acknowledge and be sensitive to a client's cultural background, they need to base clinical decisions on awareness of individual differences. Nevertheless, an understanding of how cultural and social forces affect the vulnerability to depression should guide practitioners in designing and implementing culturally relevant treatment regimens for all clients (Weiss, 1988). Unfortunately, critical questions, such as what specific therapies are necessary for effective treatment of Korean-American clients, has not been found in current research. Systematic and accurate data-based information about KAs are lacking. Future research into the mental health needs of KAs should include assessments of needs in order to provide a basis for planning the prevention and intervention programs to adequately meet Korean Americans' mental health needs.

Korean Americans (KAs) with psychiatric service needs underutilizes the mainstream mental health services in United States (US). Barriers to mental health service access among KAs reflect their unique heritage and culture. More than two-thirds of KAs identify themselves as Christians, and Korean clergy have influential roles in daily lives of vast majority of KAs. By working with the Korean clergy, a small voluntary organization such as the Association of Korean American Psychiatrists could provide invaluable assistance in removing the barriers to mental health services for KAs.