Journal of Immigrant and Minority Health

Cho, Young; Johnson, Timothy; Barrett, Richard; Campbell, Richard; Dolecek, Therese; Warnecke, Richard

doi: 10.1007/s10903-010-9339-3pmid: 20232147

Immigrant women are at greater risk for late stage breast cancer diagnosis. The rapid increase in the US foreign-born population and new immigration patterns lead us to investigate the association between changes in immigrant population and the likelihood of distant metastasis stage at diagnosis of breast cancer among women in Cook County, Illinois. Analyses employed Illinois State Cancer Registry data for 42,714 breast cancer cases diagnosed between 1994 and 2003 in conjunction with 1990 and 2000 Census tract data. We find that concentration of and increases in immigrant populations within neighborhoods contributed to the risk of late stage breast cancer diagnosis. These findings suggest that, although some health indicators for immigrant populations have improved in recent years, important health disparities in breast cancer diagnosis still remain at the neighborhood level. They further suggest that cancer screening and follow-up resources should be directed to areas experiencing rapid increases in immigrant populations.

McDermott, Sarah; DesMeules, Marie; Lewis, Roxanne; Gold, Jenny; Payne, Jennifer; Lafrance, Bryan; Vissandjée, Bilkis; Kliewer, Erich; Mao, Yang

doi: 10.1007/s10903-010-9347-3pmid: 20490685

Canadian immigrants have lower overall cancer risk than the Canadian-born population. Less is known about risks for immigrant subgroups and site-specific cancers. Linked administrative data sets were used to compare cancer incidence between subgroups of immigrants to Canada and the general Canadian population. The study involved 128,962 refugees and 241,010 non-refugees. Standardized incidence ratios (SIRs) were calculated for all-site and site-specific cancers by immigration categories and regions of birth. Relative to the general Canadian population, incidence of all-site cancer was lower among immigrants overall, by sex and refugee status (non-refugee SIRs 0.25: men, 0.24: women; refugee SIRs 0.31: both). Significantly higher SIRs resulted for liver, nasopharyngeal and cervical cancers, including liver cancer among South-East Asian and North-East Asian immigrants, and nasopharyngeal cancer among North-East Asian non-refugees. Hypothesized explanations for variation in cancer incidence include earlier viral infection in the country of origin.

Elson, Joshua; Beebe-Dimmer, Jennifer; Morgenstern, Hal; Chilkuri, Mahdavi; Blanchard, John; Lentsch, Alex

doi: 10.1007/s10903-010-9330-zpmid: 20596779

As an evolutionary response to prevent malaria infection, most Africans do not express the Duffy Antigen/Receptor for Chemokines (DARC) on their red blood cells. Results from experimental studies suggest that DARC expression inhibits prostate-tumor growth. We tested the hypothesis that men of African descent who lack DARC expression are at increased risk of prostate cancer. A case–control study involving 81 age-matched pairs was conducted in Jamaica. Participants were interviewed to collect data, and they donated blood for determination of DARC expression. Logistic regression was used to estimate associations with prostate cancer and aggressive disease. Little or no association was observed between erythrocyte DARC expression and prostate cancer or between DARC expression and aggressive disease. These associations changed little when adjusting for other potential confounders. Our results do not support an effect of erythrocyte DARC expression on the risk or progression of prostate cancer in men of African descent.

Rao, Malay; Khan, Atif; Moran, Meena; Hirshfield, Kim; Ganesan, Shridar; Haffty, Bruce; Goyal, Sharad

doi: 10.1007/s10903-010-9359-zpmid: 20563645

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.

Ho, Ivy; Dinh, Khanh

doi: 10.1007/s10903-010-9358-0pmid: 20571898

The incidence of cervical cancer is high among Southeast Asian American women, but their participation in preventive cervical cancer screening is alarmingly low. This paper reviews the literature on factors associated with participation in cervical cancer screening among women of Vietnamese, Cambodian and Hmong descent in the United States. These factors include acculturation, age, marital status, knowledge about cervical cancer, apprehension about cervical cancer screening, financial concerns, access to health care, and physician characteristics and recommendation. Suggestions for future research include the need to investigate the role of physicians treating Southeast Asian American women, the need for more extensive up-to-date studies on the current generation of young Southeast Asian American women, and the use of more advanced assessments of acculturation. Overall, much more work is needed in order to deepen our understanding of the various ways to improve the rate of cervical cancer screening among Southeast Asian American women.

Gor, Beverly; Chilton, Janice; Camingue, Pamela; Hajek, Richard

doi: 10.1007/s10903-010-9343-7pmid: 20414727

Cervical cancer is a major health disparity among Asian Americans, with cervical cancer rates of Vietnamese women being significantly higher than for the general US female population and low screening rates reported for Asian American females. Focus groups and interviews were conducted with young Vietnamese, Filipino, and Korean adults (ages 18–29) to collect information on knowledge, perceptions and sources of information regarding cervical cancer, Pap tests and the human papillomavirus. 16 Korean, 18 Vietnamese, and 18 Filipino (50% female) adults participated in the study. Many participants had never heard of HPV, cervical cancer and Pap testing. Cervical cancer screening rates were low for Korean and Vietnamese females and were influenced by moral beliefs and lack of awareness. Culturally relevant education materials that consider specific Asian ethnicity and language are needed to increase awareness of cervical cancer, Pap testing, and HPV among Asian American young adults

Sheikh, Mohamud; Wang, Shu; Pal, Abhijit; MacIntyre, C.; Wood, Nicholas; Gunesekera, Hasantha

doi: 10.1007/s10903-010-9325-9pmid: 20198433

Vitamin D deficiency is common in newly resettled refugee children and is associated with significant morbidity including rickets. To determine risk factors and burden of vitamin D deficiency in newly resettled refugee children in Australia. A descriptive epidemiological study and survey on refugee children attending an outpatient general health clinic at the Children’s Hospital Westmead, Sydney. 215 patients were examined (age range 0–17 years), (76%) majority were from Africa. Mean serum 25OHD level was 46 nmol/L (SD = 24) (sufficiency range 50–150 nmol/L). 40% had mild deficiency (26–50 nmol/L), 19% moderate deficiency (13–25 nmol/L) and 2% were severely deficient (<13 nmol/L). Deficiency was most common in East African (72%) and Middle Eastern (66%) refugees, children in early puberty (89%) and those living in Australia >6 months (71%). Deficient children were more likely to have had movement restrictions and longer time in hiding in their country of refuge (OR 3:1[CI 0.9–9.7], P = .062).

Montoya, Jared; Salinas, Jennifer; Barroso, Cristina; Mitchell-Bennett, Lisa; Reininger, Belinda

doi: 10.1007/s10903-010-9342-8pmid: 20401536

The purpose of this study is to determine the relationship between nativity and nutritional behaviors and beliefs in the Mexican American population living in the South Texas border region. Mexican Americans living the border region of South Texas were sampled to assess their nutrition behaviors and beliefs. Nativity was measured as whether subjects were born in the United States or Mexico. Nutritional behaviors were measured using the SPAN and indexes were used to measure barriers to good nutrition, dietary self-efficacy, and dietary importance. OLS regression analysis was used and adjustments were made for sociodemographic factors. Differences between US-born Mexican Americans and Mexico-born Mexican Americans existed in nutritional beliefs, but not in behaviors. Mexico-born Mexican Americans reported their dietary choices as more important and reported greater food self-efficacy than their US-born Mexican American counterparts. Socioeconomic status influenced US-born Mexican Americans nutritional beliefs only and the same effect was not observed for Mexico-born Mexican Americans. Despite low levels of overall acculturation in the border region dietary beliefs still exist between immigrants and US-born Mexican Americans in dietary beliefs, but, not behaviors in US-born Mexican Americans.

Lora, Karina; Lewis, Nancy; Eskridge, Kent; Stanek-Krogstrand, Kaye; Travnicek, Daryl

doi: 10.1007/s10903-009-9314-zpmid: 20094794

Background Low socioeconomic status (SES) and acculturation of Latino immigrants in the U.S. are linked to a decrease in diet quality. Methods Interviews were conducted with 162 firstgeneration Latinas to examine the association of SES and acculturation with intake of omega-3 (n − 3) fatty acids. Each participant provided dietary intake by use of a validated n − 3 food frequency questionnaire administered twice, 4 weeks apart, three 24-h recalls, sociodemographic information and completed the 5-item Short Acculturation Scale. Results Mean intakes of Total n − 3, α-linolenic acid (ALA), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) (g/d) were 1.2 ± 0.7, 1.1 ± 0.6, and 0.1 ± 0.1, respectively. After adjusting for energy intake, education was significantly correlated with EPA + DHA intakes, and acculturation was significantly correlated with Total n − 3, ALA and EPA + DHA intakes. Foods sources of EPA + DHA eaten by at least 50% of participants were chicken, shrimp, tuna and eggs. Discussion Given the beneficial cardiovascular effects of n − 3 fatty acids, it is important to understand sociocultural factors affecting adequate intake towards an improvement in diet quality in minorities.

Ton, Thanh; Steinman, Lesley; Yip, Mei-Po; Ly, Kiet; Sin, Mo-Kyung; Fitzpatrick, Annette; Tu, Shin-Ping

doi: 10.1007/s10903-010-9340-xpmid: 20306224

Cardiovascular disease (CVD) is the leading cause of death among Asian Americans, the majority of whom are foreign-born. However, CVD and risk factor data is sparse for specific Asian immigrant populations. To assess knowledge and understanding of CVD and risk factors within Chinese, Korean and Vietnamese immigrant populations, we conducted eight focus groups of 77 participants between 36 and 84 years old. Participants correctly identified signs and symptoms for heart attacks while knowledge about stroke was incomplete. While poor diet, lack of exercise, older age, and high cholesterol were frequently discussed as risk factors, mechanisms perceived as contributing to heart disease were influenced primarily by non-Western paradigms. Non-Western remedies were discussed in detail among Chinese and Vietnamese participants. All participants desired more information, and identified barriers to effective communication with healthcare providers. A deeper understanding of beliefs and barriers faced by Asian immigrants can help guide health promotion efforts.