Breast cancer prognosis and breast cancer molecular subtype vary by race/ethnicity. We determined whether the distribution of breast cancer subtypes varies among different Asian ethnic groups. Using immunohistochemical surrogates for the four molecularly defined breast cancer subtypes, we characterized breast cancer subtype for 346 Asian subjects treated at two New York City institutions. We found that Chinese and Japanese had a higher proportion of good-prognosis luminal A cancers (66.7 and 80.0%, respectively) compared to Filipinos and Koreans (48.5 and 47.1%) (P = 0.001). Filipinos had a higher proportion of HER-2/neu positive cancers (45.6%) compared to other ethnic groups (23.6%) (P = 0.002). Koreans had a higher proportion of triple negative cancers (23.5%) compared to other ethnic groups (7.5%) (P = 0.06). The results suggest that differences exist in breast cancer tumor biology among distinct Asian ethnic groups and have implications for cancer care and research. Future studies of breast cancer in Asian-Americans should distinguish among the different ethnic groups.
Asian ethnicity; Breast cancer; Her2/neu; Breast cancer subtypes
Migration status and the accompanying diversity in culture, foods and family norms, may be an important consideration for practitioners providing individualized care to treat and prevent complications among youth with diabetes. Approximately 20% of youth in the US have ≥ 1 foreign-born parent. However, the proportion and characteristics of youth with diabetes and ≥ 1 foreign-born parent have yet to be described. Study participants (n = 3,086) were from SEARCH for Diabetes in Youth, a prospective multi-center study in the US. Primary outcomes of interest included HbA1c, body mass index and barriers to care. Multivariable analyses were carried out using logistic regression and analysis of covariance. Approximately 17% of participants with type 1 diabetes (T1D) and 22% with type 2 diabetes (T2D) had ≥ 1 foreign-born parent. Youth with T1D and ≥ 1 foreign-born parent were less likely to have poor glycemic control [adjusted odds ratio (OR) (95% confidence interval): 0.70 (0.53, 0.94)]. Among youth with T2D, those with ≥ 1 foreign-born parent had lower odds of obesity [adjusted OR (95% CI): 0.35 (0.17, 0.70)]. This is the first study to estimate the proportion and characteristics of youth with diabetes exposed to migration in the US. Research into potential mechanisms underlying the observed protective effects is warranted.
diabetes; youth; migration; US
High rates of sex and drug risk behaviors have been documented among Latino migrant men in the U.S. Whether these behaviors were established in the migrants’ home countries or were adopted in the U.S. has not been described and has implications for prevention strategies. Quarterly surveys were conducted to gather information on selected sex and drug risk practices of Latino migrant men who arrived in New Orleans after Hurricane Katrina seeking work. Both kappa scores and McNemar’s tests were performed to determine if practice of these behaviors in home country was similar to practice post-emigration to the U.S. Female sex worker (FSW) patronage, same sex encounters (MSM), and crack cocaine use was more likely to occur post-rather than pre-emigration. Of those who ever engaged in these selected behaviors, most adopted the behavior in the U.S. (i.e. 75.8% of FSW patrons, 72.7% of MSM participants, and 85.7% of crack cocaine users), with the exception of binge drinking (26.8%). Men who were living with a family member were less likely to adopt FSW patronage OR=0.27, CI=0.10-0.76, whereas men who earned >$465 per week were more likely to adopt crack cocaine use OR=6.29 CI=1.29, 30.57. Interventions that facilitate the maintenance of family cohesion and provide strategies for financial management may be useful for reducing sex and drug risk among newly arrived migrants.
binge drinking; drugs; female sex worker; immigration; Latino migrant worker; MSM; New Orleans; new receiving community
Rising incidence of type 2 diabetes (DM) in Korean immigrants has highlighted the need for better prevention efforts. Health literacy is an important predictor in the utilization of preventative health measures, however little is known about health literacy in Korean immigrants. This study examined DM risk factors in a sample of 145 at-risk Korean immigrants, their level of health literacy, and associations between health literacy and DM risk factors. Findings indicated a high prevalence of DM risk factors and a low level of health literacy in the sample. Health literacy was correlated with English proficiency, acculturation, and lower waist to hip ratios among all participants, and with lower blood glucose levels among highly acculturated participants. Korean immigrants who are less acculturated may have lower health literacy than those who are more acculturated. Thus, linguistically and culturally sensitive health education should be incorporated into diabetes prevention efforts.
Health Literacy; Korean Americans; Type 2 diabetes risk prevention; Health behaviors
This study investigates a theorized link between Latino immigrants’ experience of acculturative stress during their two initial years in the United States (US) and declines in family cohesion from pre- to post-immigration contexts. This retrospective cohort study included 405 adult participants. Baseline assessment occurred during participants’ first 12 months in the US. Follow-up assessment occurred during participants’ second year in the US. General linear mixed models were used to estimate change in family cohesion and sociocultural correlates of this change. Inverse associations were determined between acculturative stress during initial years in the US and declines in family cohesion from pre-immigration to post-immigration contexts. Participants with undocumented immigration status, those with lower education levels, and those without family in the US generally indicated lower family cohesion. Participants who experienced more acculturative stress and those without family in the US evidenced a greater decline in family cohesion. Results are promising in terms of implications for health services for recent Latino immigrants.
Latino; Immigration; Acculturation; Acculturative stress; Family cohesion
Community health center providers and staff access to resources for their Latino and non-Latino patients with diabetes is unknown. We analyzed survey data from 577 community health center providers and staff who manage diabetes from 85 sites across 10 Midwestern states. Respondents were labeled as high proportion (HP) providers if >25 % of their site’s diabetes population was Latino. HP providers were more likely than non-HP providers to have access to physician’s assistants (71 vs. 58 %) and certified diabetes educators (61 vs. 51 %), but less access to endocrinologists (25 vs. 35 %) (p < 0.05). HP providers had greater access to Spanish-speaking providers (48 vs. 26 %), on-site interpreters (83 vs. 59 %), culturally tailored diabetes education programs (64 vs. 26 %), and community outreach programs (77 vs. 52 %) (p < 0.05). Providers at HP sites reported greater access to a range of personnel and culturally tailored programs. However, increased access to these services is needed across all sites.
Diabetes; Latino; Services; Community health centers
Cancer fatalism is believed to be a major barrier for cancer screening in Black males. Therefore, the purpose of this study was to compare perceptions of prostate cancer (CaP) fatalism and predictors of CaP screening with Prostate Specific Antigen (PSA) testing between U.S.-born and Caribbean-born Black males. The Powe Fatalism Inventory and the Personal Integrative Model of CaP Disparity Survey were used to collect the following data from males in South Florida. Multivariate logistic regression models were constructed to examine the statistically significant predictors of CaP screening. A total of 211 U.S.-born and Caribbean-born Black males between ages 39–75 were recruited. Nativity was not a significant predictor of CaP screening with PSA testing within the last year (Odds ratio [OR] = 0.80, 95 % confidence interval [CI] = 0.26, 2.48, p = 0.70). Overall, higher levels of CaP fatalism were not a significant predictor of CaP screening with PSA testing within the last year (OR = 1.37, 95 % CI = 0.48, 3.91, p = 0.56). The study results suggest that nativity did not influence CaP screening with PSA testing. However, further studies are needed to evaluate the association between CaP screening behavior and levels of CaP fatalism.
CaP; Nativity; Screening; Perception; Fatalism
Latino immigrants, particularly Mexican, have some health advantages over U.S.-born Mexicans and Whites. Because of their lower socioeconomic status, this phenomenon has been called the epidemiologic “Hispanic Paradox.” While cultural theories have dominated explanations for the Paradox, the role of selective migration has been inadequately addressed. This study is among the few to combine Mexican and U.S. data to examine health selectivity in activity limitation, self-rated health, and chronic conditions among Mexican immigrants, ages 18 and over. Drawing on theories of selective migration, this study tested the “healthy migrant” and “salmon-bias” hypotheses by comparing the health of Mexican immigrants in the U.S. to non-migrants in Mexico, and to return migrants in Mexico. Results suggest that there are both healthy migrant and salmon-bias effects in activity limitation, but not other health aspects. In fact, consistent with prior research, immigrants are negatively selected on self-rated health. Future research should consider the complexities of migrants’ health profiles and examine selection mechanisms alongside other factors such as acculturation.
Hispanic paradox; Limitation; Mexican; Self-rated health; Selection; Chronic conditions
The association between international and domestic migration and alcohol use among indigenous communities is poorly understood. We explored migration-related factors associated with alcohol use behaviors among an indigenous Mayan, binational population. From January to March 2012, 650 indigenous participants from the high-emigration town of Tunkás in the Mexican state of Yucatán (n = 650) residing in Mexico and California completed surveys. Multivariate logistic regression identified migration-related factors associated with alcohol use behaviors. US migration of shorter duration (<5 years) was independently associated with at-risk drinking (adjusted odds ratio (AOR) 2.34; 95 % confidence interval (CI) 1.09–5.03), as was longer-duration domestic migration (≥5 years) (AOR 2.34; 95 % CI 1.12–4.87). Ability to speak Maya (AOR 0.26; 95 % CI 0.13–0.48) was protective against at-risk drinking. Culturally appropriate alcohol use prevention interventions are needed for domestic and international indigenous Mexican migrants to address alcohol use behavior in the context of migration.
Alcohol use; Indigenous populations; International migration; Domestic migration; Mexico
Dominicans, one of the fastest growing Hispanic subgroups in New York City (NYC), have a high rate of diabetes. A qualitative study exploring Dominicans’ knowledge, perceptions, and experiences in managing their diabetes was conducted. There were a total of 40 participants who were Spanish speaking Dominicans, 40 to 74 years of age, diagnosed with diabetes and NYC residents. Four focus groups were conducted in Spanish, which were recorded and then transcribed into English. Content analysis was used to analyze the text of the focus groups. Different themes emerged from the data, with apparent gaps in diabetes knowledge and of awareness of risk for diabetes complications.
This paper reports pilot testing of “Familias En Nuestra Escuela”, an in-school interpersonal violence prevention intervention targeting Hispanic-American teens. The intervention, based on the hypothesis that the preservation and reinforcement of Hispanic cultural values can serve as a protective factor against violence, focused on the enhancement of ethnic pride. Researchers formed a partnership with a midwestern Hispanic community to test the feasibility, receptivity and preliminary impact of the intervention in a pre/post test, no control group design. Participants were low-income, predominantly first-generation Hispanic-American freshmen and sophomore students from one Hispanic-serving high school. Findings revealed a statistically significant increase in the intervention's mediator, ethic pride. Changes in the desired direction occurred on measures of perceptions of self-efficacy for self-control, couple violence, and gender attitudes. The incidence of physical fighting and dating violence behaviors decreased over the course of an academic school year. Results provide preliminary evidence for the use of interventions based on ethnic and cultural pride as a violence prevention strategy among Hispanic-American teens, especially those who are first generation Americans.
Participatory action research; Teen violence; Latino; Ethnic pride
Obesity at diagnosis of breast cancer is associated with higher all-cause mortality and treatment-associated toxicities. We evaluated the association between parity and obesity in the Ella study, a population of Mexican and Mexican–American breast cancer patients with high parity. Obesity outcomes included body mass index (BMI) ≥30 kg/m2, waist circumference (WC) ≥35 in (88 cm), and waist-to-hip-ratio (WHR) ≥0.85. Prevalence of obesity ([BMI] ≥30 kg/m2) was 38.9 %. For WC, the multivariate odds ratio (OR) (95 % confidence interval [CI]) for having WC ≥ 35 inches in women with ≥4 pregnancies relative to those with 1–2 pregnancies was 1.59 (1.01–2.47). Higher parity (≥4 pregnancies) was non-significantly associated with high BMI (OR = 1.10; 95 % CI 0.73–1.67). No positive association was observed for WHR. Our results suggest WC is independently associated with high parity in Hispanic women and may be an optimal target for post-partum weight loss interventions.
Parity; Obesity; Hispanic women; Body mass index; Waist circumference
The decrease in adolescent birth rates in the United States has been slower among Latinas than among other ethnic/racial groups. Limited research has explored how socioeconomic opportunities influence childbearing among Latina adolescents.
We conducted in-depth interviews with 65 pregnant foreign- and U.S.-born Latina women (31 adolescents; 34 adults) in two California counties. We assessed perceived socioeconomic opportunities and examined how family, immigration and acculturation affected the relationships between socioeconomic opportunities and adolescent childbearing.
Compared with women who delayed childbearing into adulthood, pregnant adolescents described having few resources for educational and career development and experiencing numerous socioeconomic and social barriers to achieving their goals. Socioeconomic instability and policies limiting access to education influenced childbearing for immigrant adolescents. In contrast, family disintegration tied to poverty figured prominently in U.S.-born adolescents’ childbearing.
Limited socioeconomic opportunities may play a large role in persistently high pregnancy rates among Latina adolescents.
Hispanic Americans; Pregnancy; Unplanned; Acculturation; Immigration; Socioeconomic Factors
Our goal was to explore the perceived determinants of obesity in Brazilian, Latin American and Haitian women. This is part of an ongoing community-based participatory intervention. Focus groups by immigrant group were conducted and themes extracted. Women expressed differences in beliefs, attitudes, and barriers regarding diet and physical activity in the US versus their home country. Participants thought food in the US is “less natural,” there is less time for preparation, and there is more variety. The weather is a barrier to physical activity in the US and work is more physically demanding. Job-related efforts were not considered physical activity. They reported higher levels of stress, less control of their time and less social support in the US. Providing immigrants with appropriate support and education early in the acculturation process has the potential to help prevent obesity.
Immigrants; Lifestyle changes; Obesity; Diet; Physical activity
No previous study has assessed the association between immigration status and awareness regarding a person's own CVD risk factors.
Using physical examination-based data and participants' self-report of prior diagnosis, we assessed immigration-based disparities in awareness of diabetes, hypertension, hypercholesterolemia, and overweight among 12,124 participants in the 2003-2008 National Health and Nutritional Survey.
Unawareness of CVD risk factors is high among all groups, but tends to be higher among foreign-born English and non-English speaking participants than among US-born participants. Adjusting for demographic factors and access to health care, foreign-born participants are more likely to be unaware of their hypertension and overweight than US-born participants.
Immigrants are more likely than those born in the US to be unaware of their CVD risk factors, and may therefore be less motivated to seek treatment and modify their behavior to prevent negative CVD outcomes.
Cardiovascular diseases; risk factors; epidemiology; hypertension; obesity
Information is limited on alcohol use among Arab Americans. The purpose of this study was to describe and analyze the alcohol use pattern among Arab Americans by reviewing existing surveys using an acculturation model. Secondary data analysis. Nationally, English-speaking immigrant Arab Americans reported lower rates of lifetime alcohol use (50.8%), past month use (26.4%) and binge drinking (10%) than the White majority group. In a state survey, self-identified English-speaking Arab Americans were less likely to report past month use (45.6%) than the White majority group but reported similar rate of binge drinking (17.0%). Locally, lifetime drinking was reported by 46.2% of the immigrants but only 13.4% of refugees fleeing war. Few databases are available to estimate alcohol use pattern among Arab Americans; the limited data suggest a drinking pattern consistent with acculturation. However, the potential influence of other factors is unknown and needs to be investigated.
Arab Americans; Alcohol; Refugees; Acculturation
English as a Second Language programs serve large foreign-born
populations in the US with elevated risks of tuberculosis (TB), yet little is
known about TB perceptions in these settings. Using a community-based
participatory research approach, we elicited perceptions about TB among
immigrant and refugee learners and staff at a diverse adult education center.
Community partners were trained in focus groups moderation. Ten focus groups
were conducted with 83 learners and staff. Multi-level, team-based qualitative
analysis was conducted to develop themes that informed a model of TB perceptions
among participants. Multiple challenges with TB control and prevention were
identified. There were a variety of mis-perceptions about transmission of TB,
and a lack of knowledge about latent TB. Feelings and perceptions related to TB
included secrecy, shame, fear, and isolation. Barriers to TB testing include low
awareness, lack of knowledge about latent TB, and the practical considerations
of transportation, cost, and work schedule conflicts. Barriers to medication use
include suspicion of generic medications and perceived side effects. We posit
adult education centers with large immigrant and refugee populations as
excellent venues for TB prevention, and propose several recommendations for
conducting these programs. Content should dispel the most compelling
misperceptions about TB transmission while clarifying the difference between
active and latent disease. Learners should be educated about TB in the US and
that it is curable. Finally, TB programs that include learners and staff in
their design and implementation provide greater opportunity for overcoming
previously unrecognized barriers.
Tuberculosis; Community-based participatory research; Focus groups; Adult education; Immigrants; Refugees
Smoking may be a coping mechanism for psychosocial stress caused by discrimination.
We conducted a cross-sectional survey of rural-to-urban migrant women working as restaurant/hotel workers (RHWs) and those working as sex workers (FSWs) in 10 Chinese cities to investigate whether perceived discrimination is associated with smoking. We interviewed RHWs at medical examination clinics and FSWs at entertainment venues. Modified Poisson regression was used to estimate prevalence ratios.
Of the 1696 RHWs and 532 FSWs enrolled, 155 (9.1%) and 63 (11.8%) reported perceived discrimination, respectively. Perceived discrimination was independently associated with ever tried smoking (prevalence ratio [PR], 1.71; 95% confidence interval [CI], 1.31–2.23) and current smoking (PR, 2.52; 95% CI, 1.32–4.79) among RHWs and ever tried smoking (PR, 1.36; 95% CI, 1.16–1.61) and current smoking (PR, 1.63; 95% CI, 1.28–2.06) among FSWs.
Perceived discrimination is associated with higher prevalence of smoking among rural-to-urban migrant women in China.
health disparities; migrant health; smoking; tobacco control; women’s health
This qualitative study examines help-seeking pathways to depression care of low-income Latinos with diabetes and major depression. A purposive sample (N = 19) of Spanish-speaking, immigrant, low-income Latinos was selected from a randomized clinical trial targeting Latinos with diabetes and major depression. Four focus groups followed by 10 in-depth qualitative interviews were conducted. Narratives were analyzed using the constant comparative method informed by grounded theory. Need for formal care was described in relation to acute somatic symptoms, functional impairment, and mood changes. Treatment initiation occurred through family members and primary care physicians who encouraged or inhibited help-seeking. Adherence to depression care focused on interpersonal aspects of care, evaluated symptom relief, and improved functioning. Help-seeking barriers included self-reliance, language barriers, stigma, competing health demands, and structural barriers. Findings from this study highlight potential points of intervention for developing culturally-appropriate collaborative care approaches for low-income Latinos with diabetes and major depression.
Diabetes; Latinos; Depression; Help-seeking
Although numerous studies have looked at cancer incidence and survival in Asian Indian-American (AIA) patients, there is a paucity of data regarding clinicopathologic presentation of cancer in this ethnically diverse population. After receiving IRB approval, AIA patients of Indian and Pakistani descent who presented with Stage 0, I, & II breast cancer to our facility were identified. Charts were extracted for clinical and pathologic variables in addition to outcomes data. Standard statistical analyses were performed using SAS (v 9.1). The population (n = 50) consisted of 86% Indian (n = 43) and 14% Pakistani (n = 7). The median age at diagnosis was 52 (range 25–79). Sixty-three percent of tumors were detected after discovery of a palpable mass while 36% had a mammographically detected mass. Stage 0, I & II distribution was 14, 42 and 44%, respectively. The median tumor size was 1.5 cm (range 0.2–4.5 cm). ER, PR, and HER2 were positive in 69, 67, and 24% of AIA patients, respectively; 21% were triple-negative. Treatment data shows that 60% underwent lumpectomy (n = 29), 39% underwent mastectomy (n = 19), 74% received hormonal therapy (n = 26) and 55% received chemotherapy (n = 30). To our knowledge, this is the first detailed report of the clinicopathologic presentation of Asian-Indian American women with breast cancer at a single institution. Of note, AIA women were more likely to present with palpable masses and at a younger age. This differs from Caucasian women and may indicate a social or cultural barrier to routine screening mammograms and possibly a biologically more aggressive tumor.
Asian-Indian American; Ethnic disparity; Early stage breast cancer; Radiation therapy (RT); Breast conserving therapy (BCT)
Disparities in incarceration rates and in prison-based TB/HIV testing may contribute to health disparities in the communities most affected by incarceration. We analyzed Bureau of Justice Statistics surveys of federal and state prison inmates to assess TB and HIV screening rates for US-born Hispanics, foreign-born Hispanics, non-Hispanic blacks, and non-Hispanic whites. Screening rates were high overall but foreign-born Hispanic inmates had significantly lower odds of being tested for TB in both state (AOR 0.55) and federal prisons (AOR 0.31) compared to white inmates. Foreign-born Hispanics also had lower odds of being tested for HIV in state prisons and Hispanics had lower odds of being tested for HIV in federal prisons compared to white inmates. Screening for infectious diseases in state and federal prisons is high but Hispanics have higher odds of going untested; this has important consequences for prevention of further transmission in the communities to which they return.
Incarceration; Prisons; Hispanics; Disparities; HIV; TB
Qualitative data was collected from Mexican-American (MA) and Puerto Rican (PR) breast cancer survivors to gain their perspectives on the relevant issues surrounding breast cancer survivorship and exercise. Six focus groups, a total of 31 participants were convened (three in Puerto Rico and three in Texas). Responses were analyzed and compared between the Mexican-American and Puerto Rican groups. Follow-up sessions were conducted at the sites to review the initial results and to validate a culturally adapted exercise intervention trial. A total of 900 responses were catalogued into 27 codes. Both groups had similar descriptions of exercise and barriers to exercise. Both groups expressed lack of information regarding their exercise capabilities. The groups differed in their responses to perceived safety in their community and how to deliver a culturally adapted exercise intervention in their community. We found important cultural differences and similarities in relevant factors of exercise and breast cancer survivorship.
Hispanic; breast cancer; cultural adaptation; exercise; survivorship