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Lor M, Li A, Brown R, Swedlund MP, Hawkins JG, Nolander ET, Chewning B. Improving pain communication between limited English-speaking Hmong patients, medical interpreters, and health care providers in primary care: A pilot study. Res Nurs Health 2024; 47:289-301. [PMID: 38175545 DOI: 10.1002/nur.22363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 11/13/2023] [Accepted: 12/03/2023] [Indexed: 01/05/2024]
Abstract
This pilot study assessed the feasibility of implementing a pain assessment information visualization (InfoViz) tool to address cultural and language barriers among limited English proficiency (LEP) Hmong patients in primary care. We used a static group comparison design to collect data from 20 patient, interpreter, and provider triads under usual care (i.e., interpreter using verbal pain descriptions), followed by another 20 triads under the intervention (i.e., interpreter using verbal pain descriptions and the InfoViz tool). Feasibility outcomes included recruitment and retention rates, InfoViz tool completion, acceptability, and fidelity. We also assessed mutual understanding (MU) and pain electronic health record (EHR) documentation. Descriptive data were calculated and thematic analysis was conducted. Thirty-six LEP Hmong patients (n = 29 female, mean age = 59.03), 27 providers (n = 15 female), and four interpreters participated in this study. The patient recruitment rate was 18% while the retention rate was 81%. Interpreter recruitment rate was 80%, and 75% for retention rate. The intervention fidelity mean score was 83%. In the intervention condition, patient-provider MU of pain severity improved by 30%, coupled with a 28% increase in pain severity EHR documentation compared to usual care. While communication of pain quality did not improve, there was a higher mean number of pain descriptors (3.31 in the intervention vs. 1.79 in usual care) in EHR documentation. All participants had a positive experience with the tool, reporting it as valuable with 100% completeness of all tools. Findings revealed the tool was acceptable and feasible to use among LEP patients-interpreters-providers, providing support for an efficacy study.
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Affiliation(s)
- Maichou Lor
- School of Nursing, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Angie Li
- School of Nursing, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Roger Brown
- School of Nursing, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Matthew P Swedlund
- Department of Family Medicine and Community Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | | | - Evan T Nolander
- Department of Family Medicine and Community Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Access Community Health Centers, Madison, WI, USA
| | - Betty Chewning
- School of Pharmacy, University of Wisconsin-Madison, Madison, Wisconsin, USA
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Park L, Vang A, Yang B, Quanbeck A. Barriers to Type 2 Diabetes Mellitus Management for Older Hmong Patients with Minimal English Language Skills: Accounts from Caregivers, Case Managers, and Clinicians. J Racial Ethn Health Disparities 2023; 10:3062-3069. [PMID: 36512312 PMCID: PMC9746559 DOI: 10.1007/s40615-022-01480-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 11/22/2022] [Accepted: 11/23/2022] [Indexed: 12/14/2022]
Abstract
Type 2 diabetes mellitus prevalence rates for Hmong Americans in Wisconsin are more than double that of non-Hispanic Whites. The Hmong's history, lifestyle (dietary and behavioral patterns), and reliance on traditional medicine contribute to their increased risk of diabetes. This qualitative study aimed to better understand the barriers challenging older Hmong patients' ability to manage diabetes. Asian Americans have long been overlooked in health-related research, but recent disaggregated data of specific ethnic groups reveal significant health inequities. Among the different ethnic groups, there is a significant lack of research on the Hmong Americans. Three participant groups (Hmong American family caregivers, Hmong American case managers, and clinicians from different racial backgrounds who provide care for Hmong patients) were recruited from the community and interviewed to understand the barriers experienced by older Hmong patients with minimal English language skills in managing their diabetes. Directed content analysis of the data resulted in three major themes: adherence to culture, health inequity, and managing diabetes. Subthemes included Hmong herbs and shamans, lack of trust in Western medicine, the significance of rice, language barriers, lack of cultural sensitivity, health literacy, monitoring glucose, medicine compliance, and nutrition. Minimal English language skills and low literacy rates (health and education) contribute to their strong adherence to cultural practices which challenges Western medicine, creating difficulty for older Hmong patients to manage their diabetes. Recognizing cultural differences and barriers will enable healthcare providers to improve and cater the treatment options, bridging the gap between older Hmong patients and Western medicine.
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Affiliation(s)
- Linda Park
- Department of Family Medicine and Community Health, University of Wisconsin-Madison, Madison, WI, USA.
| | - Addison Vang
- University of Wisconsin-Madison, Madison, WI, USA
| | | | - Andrew Quanbeck
- Department of Family Medicine and Community Health, University of Wisconsin-Madison, Madison, WI, USA
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Brown KM, Silveira C, Xiong S, Lumpkin N, Carlin C, Pang CJ, Schafer KM. A Digital Diabetes Storytelling Intervention for the Hmong Community: A Pilot Study. Health Promot Pract 2023:15248399231208990. [PMID: 37933120 DOI: 10.1177/15248399231208990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
Hmong-Americans experience higher rates of diabetes and poorer diabetes-related health outcomes than their White peers. Traditional methods of diabetes education do not reach Hmong patients effectively due to known socioeconomic and literacy barriers. The purpose of this study is to examine the acceptability of a culturally informed diabetes self-management education video tool, using digital storytelling that was created using a community-engaged approach, administered in a single academic clinic that sees a large percentage of Hmong patients. The video tool was successful in the areas of acceptability, story transformation, and story identification; 96% of participants stated that the video felt like something from their community, 88% stated that they could identify with the story, 79% stated that they wanted to know what happened next, and 70% of participants reported that they were motivated to do something different after watching. New methods to improve diabetes education and improve health outcomes in Hmong communities are needed. Culturally informed digital storytelling is one tool, which may be used to improve diabetes health outcomes in this population.
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Affiliation(s)
- Kathryn M Brown
- University of Minnesota Medical School, Minneapolis, MN, USA
| | | | - Serena Xiong
- Washington University in St. Louis, St. Louis, MO, USA
| | - Nirmal Lumpkin
- University of Minnesota Medical School, Minneapolis, MN, USA
| | - Caroline Carlin
- University of Minnesota Medical School, Minneapolis, MN, USA
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Hussein HM, Kashyap B, O'Keefe L, Droegemueller C, Othman SI, Yang MK, Hanson LR. Stroke Characteristics in a Cohort of Hmong American Patients. J Am Heart Assoc 2023; 12:e026763. [PMID: 37466390 PMCID: PMC10492969 DOI: 10.1161/jaha.122.026763] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 05/18/2023] [Indexed: 07/20/2023]
Abstract
Background Prior studies have indicated high rates of vascular risk factors, but little is known about stroke in Hmong. Methods and Results The institutional Get With The Guidelines (GWTG) database was used to identify patients discharged with acute ischemic stroke, intracerebral hemorrhage, or subarachnoid hemorrhage between 2010 and 2019. Hmong patients were identified using clan names and primary language. Univariate analysis was used to compare Hmong and White patients. A subarachnoid hemorrhage comparison was not conducted because of the small sample size. We identified 128 Hmong patients and 3084 White patients. Hmong patients had more prevalent hemorrhagic stroke (31% versus 15%; P<0.0016). In the acute ischemic stroke cohort, compared with White patients, Hmong patients were younger (60±13 versus 71±15 years; P<0.0001), presented to the emergency department almost 4 hours later; and had a lower thrombolysis usage rate (6% versus 14%; P=0.03496), worse lipid profile, higher hemoglobin A1C, similar stroke severity, and less frequent discharge to rehabilitation facilities. The most common ischemic stroke mechanism for Hmong patients was small-vessel disease. In the intracerebral hemorrhage cohort, Hmong patients were younger (55±13 versus 70±15 years; P<0.0001), had higher blood pressure, and had a lower rate of independent ambulation on discharge (9% versus 30%; P=0.0041). Conclusions Hmong patients with stroke were younger and had poorer risk factor control compared with White patients. There was a significant delay in emergency department arrival and low use of acute therapies among the Hmong acute ischemic stroke cohort. Larger studies are needed to confirm these observations, but action is urgently needed to close gaps in primary care and stroke health literacy.
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Affiliation(s)
- Haitham M. Hussein
- Department of NeurologyUniversity of MinnesotaMinneapolisMNUSA
- Neuroscience Research, HealthPartners Neuroscience CenterBloomingtonMNUSA
- Regions Hospital Comprehensive Stroke CenterSaint PaulMNUSA
| | - Bhavani Kashyap
- Neuroscience Research, HealthPartners Neuroscience CenterBloomingtonMNUSA
- HealthPartners InstituteSaint PaulMNUSA
| | | | | | - Sally I. Othman
- Neuroscience Research, HealthPartners Neuroscience CenterBloomingtonMNUSA
| | - Mai Kau Yang
- Department of NeurologyUniversity of MinnesotaMinneapolisMNUSA
| | - Leah R. Hanson
- Neuroscience Research, HealthPartners Neuroscience CenterBloomingtonMNUSA
- HealthPartners InstituteSaint PaulMNUSA
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Lee HY, Xiong S, Sur A, Khang T, Vue B, Culhane-Pera KA, Pergament S, Torres MB, Koopmeiners JS, Desai J. Evaluating Human Papillomavirus eHealth in Hmong Adolescents to Promote Vaccinations: Pilot Feasibility Study. JMIR Form Res 2023; 7:e38388. [PMID: 37338961 PMCID: PMC10337404 DOI: 10.2196/38388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 12/13/2022] [Accepted: 12/13/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Human papillomavirus (HPV) is a common sexually transmitted infection, causing multiple cancers, including cervical, penile, and anal. Infection and subsequent health risks caused by HPV can be diminished by HPV vaccination. Unfortunately, vaccination rates among Hmong Americans are substantially lower than those among other racial and ethnic groups, despite having higher cervical cancer rates than non-Hispanic White women. Such disparities and sparse literature highlight the need for innovative and culturally appropriate educational interventions to improve HPV vaccine rates in Hmong Americans. OBJECTIVE We aimed to develop and evaluate the effectiveness and usability of an innovative web-based eHealth educational website, the Hmong Promoting Vaccines website (HmongHPV website), for Hmong-American parents and adolescents to improve their knowledge, self-efficacy, and decision-making capacities to obtain HPV vaccinations. METHODS Through social cognitive theory and community-based participatory action research process, we created a theory-driven and culturally and linguistically appropriate website for Hmong parents and adolescents. We conducted a pre-post intervention pilot study to assess the website's effectiveness and usability. Overall, 30 Hmong-American parent and adolescent dyads responded to questions about HPV and HPV vaccine knowledge, self-efficacy, and decision-making at preintervention, 1 week after intervention, and at the 5-week follow-up. Participants responded to survey questions about website content and processes at 1 and 5 weeks, and a subset of 20 dyad participants participated in telephone interviews 6 weeks later. We used paired t tests (2-tailed) to measure the change in knowledge, self-efficacy, and decision-making processes, and used template analysis to identify a priori themes for website usability. RESULTS Participants' HPV and HPV vaccine knowledge improved significantly from pre- to postintervention stage and follow-up. Knowledge scores increased from preintervention to 1 week after intervention for both parents (HPV knowledge, P=.01; vaccine knowledge, P=.01) and children (HPV knowledge, P=.01; vaccine knowledge, P<.001), which were sustained at the 5-week follow-up. Parents' average self-efficacy score increased from 21.6 at baseline to 23.9 (P=.007) at post intervention and 23.5 (P=.054) at follow-up. Similar improvements were observed in the teenagers' self-efficacy scores (from 30.3 at baseline to 35.6, P=.009, at post intervention and 35.9, P=.006, at follow-up). Collaborative decision-making between parents and adolescents improved immediately after using the website (P=.002) and at follow-up (P=.02). The interview data also revealed that the website's content was informative and engaging; in particular, participants enjoyed the web-based quizzes and vaccine reminders. CONCLUSIONS This theory-driven, community-based participatory action research-designed and culturally and linguistically appropriate educational website was well received. It improved Hmong parents' and adolescents' knowledge, self-efficacy, and decision-making processes regarding HPV vaccination. Future studies should examine the website's impact on HPV vaccine uptake and its potential for broader use across various settings (eg, clinics and schools).
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Affiliation(s)
- Hee Yun Lee
- School of Social Work, The University of Alabama, Tuscaloosa, AL, United States
| | - Serena Xiong
- School of Medicine, Washington University in St Louis, St Louis, MO, United States
| | - Aparajita Sur
- School of Public Health, University of Minnesota, Twin Cities, MN, United States
| | - Tounhia Khang
- SoLaHmo Partnership for Health & Wellness, Community University Health Care Center, Minneapolis, MN, United States
| | - Bai Vue
- SoLaHmo Partnership for Health & Wellness, Community University Health Care Center, Minneapolis, MN, United States
| | - Kathleen A Culhane-Pera
- SoLaHmo Partnership for Health & Wellness, Community University Health Care Center, Minneapolis, MN, United States
| | - Shannon Pergament
- SoLaHmo Partnership for Health & Wellness, Community University Health Care Center, Minneapolis, MN, United States
| | - M Beatriz Torres
- Department of Public Health, Mercyhurst University, Erie, PA, United States
| | - Joseph S Koopmeiners
- School of Public Health, University of Minnesota, Twin Cities, MN, United States
| | - Jay Desai
- Minnesota Department of Health, Saint Paul, MN, United States
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Culhane-Pera KA, Vang KB, Ortega LM, Xiong T, Northuis CA, de la Parra P, Lakshminarayan K. Mobile health technology for hypertension management with Hmong and Latino adults: mixed-methods community-based participatory research. Ethn Health 2023; 28:413-430. [PMID: 35387531 PMCID: PMC9535036 DOI: 10.1080/13557858.2022.2059451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 03/23/2022] [Indexed: 05/05/2023]
Abstract
OBJECTIVE To identify Hmong and Latino adults' perspectives about a mHealth-based care model for hypertension (HTN) management involving blood pressure (BP) self-monitoring, electronic transmission of BP readings, and responsive HTN medication adjustment by a provider team. DESIGN We conducted a mixed-methods formative study with 25 Hmong and 25 Latino participants with HTN at an urban federally-qualified health center. We used a tool to assess HTN knowledge and conducted open-ended interviews to identify perspectives about mHealth-based care model. RESULTS While most participants agreed that lowering high blood pressure decreased the risk of strokes, heart attacks, and kidney failure, there were gaps in medical knowledge. Three major themes emerged about the mHealth-based care model: (1) Using mHealth technology could be useful, especially if assistance was available to patients with technological challenges; (2) Knowing blood pressures could be helpful, especially to patients who agreed with doctors' medical diagnosis and prescribed treatment; (3) Transmitting blood pressures to the clinic and their responsive actions could feel empowering, and the sense of increased surveillance could feel entrapping. Some people may feel empowered since it could increase patient-provider communication without burden of clinic visits and could increase involvement in BP control for those who agree with the medical model of HTN. However, some people may feel entrapped as it could breach patient privacy, interfere with patients' lifestyle choices, and curtail patient autonomy. CONCLUSIONS In general, Hmong and Latino adults responded positively to the empowering aspects of the mHealth-based care model, but expressed caution for those who had limited technological knowledge, who did not agree with the medical model and who may feel entrapped. In a shared decision-making approach with patients and possibly their family members, health care systems and clinicians should explore barriers and potential issues of empowerment and entrapment when offering a mHealth care model in practice.
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Affiliation(s)
| | | | | | - Txia Xiong
- SoLaHmo Partnership for Health and Wellness, Minnesota Community Care, St Paul, MN, USA
| | - Carin A Northuis
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Pilar de la Parra
- SoLaHmo Partnership for Health and Wellness, Minnesota Community Care, St Paul, MN, USA
| | - Kamakshi Lakshminarayan
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
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Sun B, Wen YF, Culhane-Pera KA, Lo M, Straka RJ. Pharmacogenomic variabilities in geo-ancestral subpopulations and their clinical implications: Results of collaborations with Hmong in the United States. Front Genet 2023; 13:1070236. [PMID: 36685861 PMCID: PMC9845584 DOI: 10.3389/fgene.2022.1070236] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 12/07/2022] [Indexed: 01/06/2023] Open
Abstract
Underrepresentation of subpopulations within geo-ancestral groups engaged in research can exacerbate health disparities and impair progress toward personalized medicine. This is particularly important when implementing pharmacogenomics which uses genomic-based sources of variability to guide medication selection and dosing. This mini-review focuses on pharmacogenomic findings with Hmong in the United States and their potential clinical implications. By actively engaging Hmong community in pharmacogenomic-based research, several clinically relevant differences in allele frequencies were observed within key pharmacogenes such as CYP2C9 and CYP2C19 in Hmong compared to those in either East Asians or Europeans. Additionally, using state-of-the-art genome sequencing approaches, Hmong appear to possess novel genetic variants within CYP2D6, a critical pharmacogene affecting pharmacokinetics of a broad range of medications. The allele frequency differences and novel alleles in Hmong have translational impact and real-world clinical consequences. For example, Hmong patients exhibited a lower warfarin stable dose requirement compared to East Asian patients. This was predicted based on Hmong's unique genetic and non-genetic factors and confirmed using real-world data from clinical practice settings. By presenting evidence of the genetic uniqueness and its translational impact within subpopulations, such as the Hmong, we hope to inspire greater inclusion of other geo-ancestrally underrepresented subpopulations in pharmacogenomic-based research.
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Affiliation(s)
- Boguang Sun
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN, United States
| | - Ya-Feng Wen
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN, United States
| | | | - Muaj Lo
- Minnesota Community Care, St. Paul, MN, United States
| | - Robert J. Straka
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN, United States,*Correspondence: Robert J. Straka,
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Xiong S, Kasouaher MY, Vue B, Culhane-Pera KA, Pergament SL, Desai J, Torres MB, Lee HY. "We will do whatever it takes": Understanding Socioecological Level Influences on Hmong-American Adolescents and Parents' Perceptions of the Human Papillomavirus Vaccine. J Cancer Educ 2022; 37:1893-1901. [PMID: 34164765 PMCID: PMC8221556 DOI: 10.1007/s13187-021-02057-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/15/2021] [Indexed: 05/05/2023]
Abstract
Human papillomavirus (HPV) vaccination completion rates in Asian-American populations are substantially lower than most White Americans. Our objective was to identify the knowledge, perceptions, and decision-making processes about HPV vaccinations in the Hmong population, an Asian-American group with increased risks of HPV-related cancers. We conducted eight focus groups with Hmong adolescents (n = 12) and parents (n = 13) to learn about barriers, facilitators, and decision-making processes regarding general vaccinations and the HPV vaccine. The focus group results were analyzed using thematic analysis, informed by the socioecological model and asset lens. Findings showed that at the individual level, Hmong adolescents and parents had low HPV and HPV vaccine awareness levels (barrier) and strong desires to learn about HPV and the HPV vaccine (facilitator). Community-level barriers included salient narratives about traumatic experiences with vaccines and vaccine research, while facilitators included strong community connections. At the institutional level, barriers included structural constraints in health care settings, while facilitators included ease of obtaining vaccines at school-based clinics and provider authoritative decision-making. Additionally, a range of decision-making processes between parents, adolescents, and providers were present, with parents expressing a strong appeal to engage in more shared decision-making with providers. A linguistically and culturally specific HPV educational program for Hmong adolescents and parents could address the barriers and build on facilitators and assets to promote HPV vaccine uptake in this growing Asian-American community.
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Affiliation(s)
- Serena Xiong
- School of Public Health, University of Minnesota, 1300 S 2nd Suite 300, Minneapolis, MN, 55454, USA.
- Somali, Latino, and Hmong Partnership for Health and Wellness (SoLaHmo), Community-University Health Care Center (CUHCC), 2001 Bloomington Ave, Minneapolis, MN, 55404, USA.
| | - Maiyia Y Kasouaher
- Somali, Latino, and Hmong Partnership for Health and Wellness (SoLaHmo), Community-University Health Care Center (CUHCC), 2001 Bloomington Ave, Minneapolis, MN, 55404, USA
| | - Bai Vue
- Somali, Latino, and Hmong Partnership for Health and Wellness (SoLaHmo), Community-University Health Care Center (CUHCC), 2001 Bloomington Ave, Minneapolis, MN, 55404, USA
| | | | - Shannon L Pergament
- Somali, Latino, and Hmong Partnership for Health and Wellness (SoLaHmo), Community-University Health Care Center (CUHCC), 2001 Bloomington Ave, Minneapolis, MN, 55404, USA
| | - Jay Desai
- Minnesota Department of Health, Health Promotion and Chronic Disease Division, P.O. Box 64975, St. Paul, MN, 55164, USA
- HealthPartners Institute, P.O. Box 1524, Bloomington, MN, 55440-1524, USA
| | - M Beatriz Torres
- Public Health Department, Mercyhurst University, 501 East 38th Street, Erie, PA, 16546, USA
| | - Hee Yun Lee
- School of Social Work, University of Alabama, 1022 Little Hall, Box 870314, Tuscaloosa, AL, 35487, USA
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Wen YF, Gaedigk A, Boone EC, Wang WY, Straka RJ. The Identification of Novel CYP2D6 Variants in US Hmong: Results From Genome Sequencing and Clinical Genotyping. Front Pharmacol 2022; 13:867331. [PMID: 35387332 PMCID: PMC8979107 DOI: 10.3389/fphar.2022.867331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 02/21/2022] [Indexed: 11/13/2022] Open
Abstract
Objective: Hmong individuals represent a unique East Asian subpopulation in whom limited information concerning pharmacogenetic variation exists. The objectives of this study were to comprehensively characterize the highly polymorphic CYP2D6 gene in Hmong, estimate allele and phenotype frequencies and to compare results between two testing platforms. Methods: DNA from 48 self-identified Hmong participants were sequenced using a targeted next-generation sequencing (NGS) panel. Star allele calls were made using Astrolabe, manual inspection of NGS variant calls and confirmatory Sanger sequencing. Structural variation was determined by long-range (XL)-PCR and digital droplet PCR (ddPCR). The consensus diplotypes were subsequently translated into phenotype utilizing the activity score system. Clinical grade pharmacogenetic testing was obtained for 12 of the 48 samples enabling an assessment of concordance between the consensus calls and those determined by clinical testing platforms. Results: A total of 13 CYP2D6 alleles were identified. The most common alleles were CYP2D6*10 and its structural arrangements (37.5%, 36/96) and the *5 gene deletion (13.5%, 13/96). Three novel suballeles (*10.007, *36.004, and *75.002) were also identified. Phenotype frequencies were as follows: ultrarapid metabolizers (4.2%, 2/48), normal metabolizers (41.7%, 20/48) and intermediate metabolizers (52.1%, 25/48); none of the 48 participants were predicted to be poor metabolizers. Concordance of diplotype and phenotype calls between the consensus and clinical testing were 66.7 and 50%, respectively. Conclusion: Our study to explore CYP2D6 genotypes in the Hmong population suggests that this subpopulation is unique regarding CYP2D6 allelic variants; also, a higher portion of Hmong participants (50%) are predicted to have an intermediate metabolizer phenotype for CYP2D6 compared to other East Asians which range between 27 and 44%. Results from different testing methods varied considerably. These preliminary findings underscore the importance of thoroughly interrogating unique subpopulations to accurately predict a patient's CYP2D6 metabolizer status.
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Affiliation(s)
- Ya Feng Wen
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Twin Cities, MN, United States
| | - Andrea Gaedigk
- Division of Clinical Pharmacology, Toxicology and Therapeutic Innovation, Children's Mercy Research Institute, Kansas City, MO, United States.,School of Medicine, University of Missouri-Kansas City, Kansas City, MO, United States
| | - Erin C Boone
- Division of Clinical Pharmacology, Toxicology and Therapeutic Innovation, Children's Mercy Research Institute, Kansas City, MO, United States
| | - Wendy Y Wang
- Division of Clinical Pharmacology, Toxicology and Therapeutic Innovation, Children's Mercy Research Institute, Kansas City, MO, United States
| | - Robert J Straka
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Twin Cities, MN, United States
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Abstract
INTRODUCTION Ineffective intercultural communication can occur due to inaccurate medical interpreting for limited English proficiency (LEP) patients. Research shows that Hmong patients experience poorer quality interpreter services than other LEP populations. This study's purpose is to understand Hmong medical interpreters' perceptions of the factors that affect their ability to make accurate medical interpretations during clinical encounters. METHOD A qualitative study was conducted with Hmong-speaking medical interpreters. The interviews were semistructured, audio recorded, and analyzed using conventional content analysis. RESULTS 13 interpreters aged 29 to 49 years participated in the study. Three factors affected the interpreters' ability to make accurate medical interpretations for Hmong-speaking patients: (a) matched gender between the interpreter and patient, (b) culturally taboo topics in communicating about reproductive body parts and sexual health/activity, and (c) culture and generational language differences between interpreters and Hmong patients. DISCUSSION Clinical encounters that match patient-interpreter ages, gender, and/or local culture may reduce communication barriers.
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Affiliation(s)
- Maichou Lor
- University of Wisconsin–Madison, Madison, WI, USA
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11
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Trofholz A, Richardson K, Mohamed N, Vang C, Berge JM. How a Racially/Ethnically Diverse and Immigrant Sample Qualitatively Describes the Role of Traditional and Non-traditional Foods in Feeding Their Children. J Immigr Minor Health 2020; 22:1155-62. [PMID: 32219660 DOI: 10.1007/s10903-020-00999-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Previous research suggests a deleterious impact on dietary quality when people immigrate to the United States and that children influence immigrant parent's decisions to serve traditional and/or non-traditional foods. Interviews (n = 75) were conducted with Hmong, Somali, and Latino parents of 5-7 year old children about the foods they serve to their children and how the child influences these food decisions. A racially/ethnically diverse team coded interviews using a mixed inductive/deductive approach. Most Latino and Somali parents reported serving mostly traditional foods at home. Regarding feeding decisions, parents reported: (1) allowing children non-traditional foods when requested; (2) "Americanizing" traditional foods; and (3) that children prefer traditional foods. Some Hmong parents reported serving their children non-traditional foods at meals while parents ate traditional foods. Results offer guidance to providers working with immigrant parents of young children regarding maintaining healthful diets when children request potentially unhealthy non-traditional foods.
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Kosasih M, Sendaydiego X, Bednarke K, Wong S, Chow Y, Fox A, Chen Z, Saeian K. Prevalence and Susceptibility to Hepatitis B virus and the Need for Community Health Education in Milwaukee's Hmong Community. J Racial Ethn Health Disparities 2021. [PMID: 34342867 DOI: 10.1007/s40615-021-01124-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/27/2021] [Accepted: 07/28/2021] [Indexed: 10/25/2022]
Abstract
BACKGROUND Chronic Hepatitis B virus infection, the leading cause of hepatocellular carcinoma worldwide, disproportionately affects Asian Pacific Islanders (APIs) within the USA. Among APIs, the Hmong have one of the highest rates of chronic HBV infection-up to 18% compared to 0.1% for non-Hispanic Caucasians. This study sought to estimate the prevalence of HBV infection and assess the need for community HBV education within Milwaukee County's Hmong. METHODS Between 3/2013 and 12/2019, 287 Hmong participants were screened for HBV and 271 were provided targeted HBV education to evaluate its impact on HBV knowledge. RESULTS Among participants screened, 178 (62%) were immune; 77 (27%) susceptible; 27 (9%) positive; and 5 (2%) in a "gray zone." Targeted health education showed statistically significant improvement in HBV knowledge. DISCUSSION With 38% lacking immunity to HBV and 9% with active infection, there remains a significant need for HBV screening, vaccination, and education in Milwaukee's Hmong community.
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Roman YM, Lor K, Xiong T, Culhane-Pera K, Straka RJ. Gout prevalence in the Hmong: a prime example of health disparity and the role of community-based genetic research. Per Med 2021; 18:311-327. [PMID: 33787318 DOI: 10.2217/pme-2020-0107] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Individuals of distinct Asian backgrounds are commonly aggregated as Asian, which could mask the differences in the etiology and prevalence of health conditions in the different Asian subgroups. The Hmong are a growing Asian subgroup in the United States with a higher prevalence of gout and gout-related comorbidities than non-Hmong. Genetic explorations in the Hmong suggest a higher prevalence of genetic polymorphisms associated with an increased risk of hyperuricemia and gout. History of immigration, acculturation, lifestyle factors, including dietary and social behavioral patterns, and the use of traditional medicines in the Hmong community may also increase the risk of developing gout and lead to poor gout management outcomes. Engaging minorities such as the Hmong population in biomedical research is a needed step to reduce the burden of health disparities within their respective communities, increase diversity in genomic studies, and accelerate the adoption of precision medicine to clinical practice.
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Affiliation(s)
- Youssef M Roman
- Assistant Professor, Virginia Commonwealth University, School of Pharmacy, Richmond, Virginia 23298, USA
| | - Kajua Lor
- Associate Professor & Chair, Medical College of Wisconsin, School of Pharmacy, 8701 W Watertown Plank Rd, Milwaukee, WI 53226, USA
| | - Txia Xiong
- Clinical Pharmacist, West Side Community Health Services, St. Paul, MN 55106, USA
| | | | - Robert J Straka
- Professor & Department Head, University of Minnesota College of Pharmacy, Minneapolis, Minnesota 55455, USA
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Khalil N, McMillan S, Benbadis SR, Robertson D. Fish soup for the falling sickness: Tracing epilepsy through Hmong and Western beliefs. Epilepsy Behav 2021; 115:107725. [PMID: 33434883 DOI: 10.1016/j.yebeh.2020.107725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 12/14/2020] [Accepted: 12/16/2020] [Indexed: 11/15/2022]
Abstract
Hmong communities originated in China but today are located across the globe. Salvation, health, and well-being in Hmong tradition are contingent upon pleasing spirits and ancestors. While most diseases are believed to reflect the displeasure of spirits and ancestors, epilepsy is unique in that it portends a heightened capacity for achieving an elevated level of spirituality, which has led it to be deemed honorable by Hmong society members. This stands in stark contrast to some contexts within which epilepsy has been historically understood in the West in which the disease was believed to originate from sin and evil. If and how societal response toward persons with epilepsy (PWE) in Hmong communities differ from that in other Western communities in a way that parallels these differences in beliefs regarding the etiology and significance of the seizures is unknown. Understanding this may have implications that guide efforts in combatting stigma affecting PWE.
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Affiliation(s)
- Nadia Khalil
- University of South Florida Morsani College of Medicine, Department of Neurology, Tampa, FL, USA.
| | | | - Selim R Benbadis
- University of South Florida Morsani College of Medicine, Department of Neurology, Tampa, FL, USA
| | - Derrick Robertson
- University of South Florida Morsani College of Medicine, Department of Neurology, Tampa, FL, USA
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Tran HL, Ta TAM, Nguyen NN, Pham TT, Hoang H, Ha Chu H. Population genetic data of 22 autosomal STR loci for the Mong people in Vietnam. Leg Med (Tokyo) 2021; 48:101825. [PMID: 33338949 DOI: 10.1016/j.legalmed.2020.101825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/10/2020] [Accepted: 12/04/2020] [Indexed: 11/22/2022]
Abstract
This study investigated 22 autosomal short tandem repeat (STR) loci in 156 unrelated individuals from the Mong ethnic minority in Ha Giang Province, Vietnam. Allele frequencies and forensic parameters were calculated, showing the combined Powers of Discrimination reaching 1.000000000000000000000000000000 and the combined Power of Exclusion greater than 0.999999986623. Phylogenetic analysis indicated that the Vietnamese Mong population has close genetic relationships with other Hmong-Mien populations.
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16
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Holzer K, Culhane-Pera KA, Straka RJ, Wen YF, Lo M, Lee K, Xiong T, Peng K, Bishop J, Thyagarajan B, Zierhut HA. Hmong participants' reactions to return of individual and community pharmacogenetic research results: "A positive light for our community". J Community Genet 2021; 12:53-65. [PMID: 32761465 DOI: 10.1007/s12687-020-00475-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 06/21/2020] [Indexed: 12/14/2022] Open
Abstract
Pharmacogenetic research has historically lacked racial and ethnic diversity, limiting the application of findings to minority populations. Recent studies, including the Hmong, have gauged communities' interest in participating in genomic research and receiving their individual results. This study was conducted to create a culturally and linguistically appropriate format to return pharmacogenomic results and identify Minnesota Hmong research participants' reactions to their personal and collective results. Using a community-based participatory research approach, researchers collaborated with Hmong community members to format the pharmacogenetic disclosure process. Three focus groups were completed with 24 Hmong participants and three major themes emerged using thematic analysis. Many Hmong focus group participants viewed the results positively, finding them useful for themselves and their community as a means to optimize responses to and avoid harms from medicines. However, some participants expressed concerns about harms that the pharmacogenetic information could bring, including anxiety, misunderstanding, discrimination, exploitation, and lack of a clinician involvement in interpreting and applying the result. Many participants interpreted their results through an experiential lens, trusting their experience of medicines more than trusting genetic information, and through a cultural lens, expressing the belief that environmental factors may influence how people's bodies respond to medicines by influencing their inherited flesh and blood (roj ntsha). Lastly, participants stressed the importance of disseminating the information while acknowledging the complex linguistic, educational, and cultural factors that limit understanding of the results. Researchers, genetic counselors, pharmacists, and healthcare providers should strive to return results in meaningful ways to all members of society.
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Wen YF, Culhane-Pera KA, Thyagarajan B, Bishop JR, Zierhut H, Lo M, Xiong T, Peng K, Holzer K, Lee K, Straka RJ. Potential Clinical Relevance of Differences in Allele Frequencies Found within Very Important Pharmacogenes between Hmong and East Asian Populations. Pharmacotherapy 2020; 40:142-152. [PMID: 31884695 DOI: 10.1002/phar.2360] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Implementing pharmacogenetics for very important pharmacogenes (VIPs) holds the promise of improving clinical outcomes through optimal medication selection and dosing. However, significant differences in the frequency of actionable variants in VIPs may exist within subpopulations of a given ancestral group. Furthermore, these differences can potentially impact drug selection and dosing. The purpose of this study was to ascertain allele frequencies for VIPs and to predict medication requirements using Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines in Hmong and compare with published data for East Asians. METHODS Using a community-based participatory action research approach, DNA collected from 194 Hmong adults living in the United States was analyzed for 22 genetic variants within eight VIPs (CYP2C9, CYP2C19, CYP4F2, DPYD, G6PD, SLCO1B1, TPMT, VKORC1). Allele frequencies for VIPs and predicted medication requirements using CPIC guidelines were compared between Hmong participants and East Asians. RESULTS Significant differences in allele frequencies between the Hmong and East Asians were found for 23% (5/22) of the CPIC-actionable variants tested. Allele frequencies for VIPs in Hmong versus East Asians were 16.6% versus 3.4% in CYP2C9*3A, 42.2% versus 29.0% for CYP2C19*2, 0.3% versus 8.3% in CYP2C19*3, 6.5% versus 22.1% in CYP4F2*3, and 3.6% versus 0.1% in SLCO1B1*5, respectively. These differences significantly influenced predicted medication usage recommendations in warfarin, simvastatin, and phenytoin between Hmong and East Asians. CONCLUSIONS Important differences in allele frequencies for key genetic variants influencing selection of medications and dosages were found between the Hmong and East Asians. The magnitude and nature of these differences can be expected to result in different medication recommendations for the Hmong relative to East Asians.
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Affiliation(s)
- Ya-Feng Wen
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota
| | | | - Bharat Thyagarajan
- Department of Laboratory Medicine and Pathology, School of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Jeffrey R Bishop
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota.,Department of Psychiatry, School of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Heather Zierhut
- Department of Genetics, Cell Biology and Development, College of Biological Science, University of Minnesota, Minneapolis, Minnesota
| | - Muaj Lo
- Minnesota Community Care, St. Paul, Minnesota
| | - Txia Xiong
- Minnesota Community Care, St. Paul, Minnesota
| | - Kerui Peng
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota
| | | | | | - Robert J Straka
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota
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Tepper CG, Dang JHT, Stewart SL, Fang DM, Wong KA, Liu SY, Davis RR, Dao DY, Gregg JP, Török NJ, Chen MS. High frequency of the PNPLA3 rs738409 [G] single-nucleotide polymorphism in Hmong individuals as a potential basis for a predisposition to chronic liver disease. Cancer 2019; 124 Suppl 7:1583-1589. [PMID: 29578593 DOI: 10.1002/cncr.31122] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 10/13/2017] [Accepted: 10/17/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND An exploratory study was performed to determine the prevalence of the patatin-like phospholipase domain-containing protein 3 (PNPLA3) rs78409 [G] allele among the Hmong as a risk factor for nonalcoholic fatty liver disease (NAFLD). NAFLD/nonalcoholic steatohepatitis is the world's most common chronic liver disease and is expected to replace viral hepatitis as the leading cause of cirrhosis and potential precursor to hepatocellular carcinoma (HCC). Of all populations in California, the Hmong experience the highest risk of death from HCC and the highest prevalence of metabolic syndrome risk factors among Asians that predispose them to NAFLD. Here a genetic explanation was sought for the high rates of chronic liver disease among the Hmong. The literature pointed to the PNPLA3 rs738409 [G] allele as a potential genetic culprit. METHODS Cell-free DNA was isolated from 26 serum samples previously collected in community settings. Quantitative polymerase chain reaction-based single-nucleotide polymorphism (SNP) genotyping was performed with a validated TaqMan SNP genotyping assay, and results were analyzed with TaqMan Genotyper software. RESULTS The PNPLA3 rs738409 [C>G] variant occurred at a frequency of 0.46 (12 of 26; 95% confidence interval, 0.27-0.67). This carrier rate would rank the Hmong as the third highest population in the 1000 Genomes Project. CONCLUSIONS Although this small sample size limits the generalizability, the high frequency rates of this allele along with the presence of metabolic syndrome risk factors warrant further studies into the etiology of NAFLD among the Hmong. Cancer 2018;124:1583-9. © 2018 American Cancer Society.
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Affiliation(s)
- Clifford G Tepper
- Department of Biochemistry and Molecular Medicine, University of California Davis, Sacramento, California
| | - Julie H T Dang
- Division of Hematology and Oncology, Department of Internal Medicine, University of California Davis, Sacramento, California
| | - Susan L Stewart
- Division of Biostatistics, Department of Public Health Sciences, University of California Davis, Sacramento, California
| | - Dao M Fang
- Hmong Cultural Center of Butte County, Oroville, California
| | - Kimberly A Wong
- Department of Internal Medicine, University of California Davis, Sacramento, California
| | - Stephenie Y Liu
- Department of Pathology and Laboratory Medicine, University of California Davis, Sacramento, California
| | - Ryan R Davis
- Department of Pathology and Laboratory Medicine, University of California Davis, Sacramento, California
| | - Doan Y Dao
- Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jeffrey P Gregg
- Department of Pathology and Laboratory Medicine, University of California Davis, Sacramento, California
| | - Natalie J Török
- Department of Internal Medicine, University of California Davis, Sacramento, California
| | - Moon S Chen
- Division of Hematology and Oncology, Department of Internal Medicine, University of California Davis, Sacramento, California
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Vasudevan V, Vang PD, Fernandez-Baca D. An exploration of healthy eating and physical activity habits of Hmong high-school students by disability status: A pilot study. Disabil Health J 2019; 12:694-698. [PMID: 31257033 DOI: 10.1016/j.dhjo.2019.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 06/17/2019] [Accepted: 06/21/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND Immigrants are at risk of being obese from obesogenic environments and face factors which limit physical activity and healthy eating. While Hmong immigrants acknowledge the importance of healthy eating and physical activity, to our knowledge no studies have looked at health promoting behaviors among Hmong adolescents with and without disabilities. OBJECTIVE In this paper, we seek to provide baseline data about physical activity and healthy eating among Hmong high school students with disabilities in Minnesota. METHODS We used data from the 2016 Minnesota Student Survey. The study included responses from 1,824 Hmong high school students. We compared physical activity and healthy eating of Hmong high school students by disability status. RESULTS Approximately 13% of Hmong had a disability (n = 239). A greater percentage of Hmong high school students with disabilities reported zero days of 60 min of physical activity (20.5% vs 14.8%, p < 0.10) and zero days participation in sports teams outside of school (69.0% vs. 64.3%, p < 0.10). Compared to Hmong students without disabilities, a significantly lower percentage of Hmong students with disabilities reported not receiving free/reduced lunch (66.5% vs 73.1%, p < 0.05) and significantly more likely to skip meals because their family did not have enough money (14.2% vs 9.7%, p < 0.05). CONCLUSION Adolescent Hmong with disabilities encounter both cultural and disability specific factors which could contribute to poorer health promoting behaviors. This study shines light on the need for social policy that promotes disability inclusive, culturally specific health promotion information and advocacy for immigrant youth with disabilities and their families in schools and communities.
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Affiliation(s)
- Vijay Vasudevan
- Autism Speaks, 1060 State Rd., 2nd Floor, Princeton, NJ, 08540, USA.
| | - Pa Der Vang
- St. Catherine University, Department of Social Work, 2004 Randolph Ave #F-15, St. Paul, MN, 55105, USA
| | - Daniel Fernandez-Baca
- Center for Health Statistics, Minnesota Department of Health, PO Box 64882, St. Paul, MN, 55164, USA
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Dubost JM, Phakeovilay C, Her C, Bochaton A, Elliott E, Deharo E, Xayvue M, Bouamanivong S, Bourdy G. Hmong herbal medicine and herbalists in Lao PDR: pharmacopeia and knowledge transmission. J Ethnobiol Ethnomed 2019; 15:27. [PMID: 31196205 PMCID: PMC6567612 DOI: 10.1186/s13002-019-0307-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 05/23/2019] [Indexed: 05/05/2023]
Abstract
BACKGROUND In Lao PDR, the Hmong ethnic group has extensive knowledge about the use of medicinal plants. However, despite the importance of the Hmong pharmacopeia as a primary health care resource, no study has been undertaken to thoroughly document medicinal plant knowledge and its transmission. Objectives of this study are (i) to describe and characterize Hmong pharmacopeia, and (ii) to understand how medicinal plant knowledge is transmitted and spread among Hmong in Lao PDR, in order to assess whether this knowledge base is under threat. METHODS In order to describe Hmong pharmacopeia, a total of 14 interlocutors were interviewed in three provinces (Bokeo, Xieng Khouang, and Vientiane), using "walk in the wood" methodology. To gain insight about knowledge transmission, semi-structured interviews were conducted with 28 people. Twenty of them were herbalists. Data analysis was performed using univariate analysis for the description of the pharmacopeia. Medicinal plant knowledge consistency was assessed through use and plant name overlapping. Answers to the semi-structured interview on knowledge transmission were analyzed qualitatively. RESULTS Three hundred thirty-three different medicinal species were collected. The majority of uses attributed to plants were gastrointestinal conditions (22% of total use reports), gynecological conditions and sexually transmitted disease (12%), skin affections (8%), kidney and bladder problems (5%), physical traumas (5%), and aphrodisiac (or male tonics; 5%). Use convergences are more marked in the gynecological sphere, but there is a strong heterogeneity in practices and knowledge. Medicinal plant knowledge transmission is oral, gained from direct experience since childhood, matrilineal, and kept strictly within the family lineage. Apparent limited consensus on uses might stem from the method of knowledge transmission and to the economic value given to medicinal plants. DISCUSSION Use pattern of species from the Hmong pharmacopeia does not appear to be strikingly different from the national Lao pharmacopeia. Differences may lie in the methods and reasons for knowledge transmission. It can be proposed that the economic value given to plants helps in keeping the knowledge alive, and encourages its transmission. CONCLUSION Hmong traditional medicine is constantly evolving in a dynamic process and aims to respond to health problems faced by the local population. Herbalists appear as health fully fledged actors and should be recognized and valued as such.
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Affiliation(s)
| | | | - Chithdavone Her
- Faculty of Pharmacy, Mahosot Road, PO. Box 7444, Vientiane, Lao People’s Democratic Republic
| | - Audrey Bochaton
- UMR 7533 Ladyss, Université Paris Nanterre, Department of Geography, Nanterre, France
| | - Elizabeth Elliott
- University College London-UCL, 14 Taviton St, Kings Cross, London, WC1H 0BW UK
| | - Eric Deharo
- UMR 152 Pharmadev, Université de Toulouse, IRD, UPS, Toulouse, 31400 France
| | - Mouachan Xayvue
- Institute of Traditional Medicine, Phonepapao village, Sisattanack district, Vientiane, Lao People’s Democratic Republic
| | - Somsanith Bouamanivong
- Biotechnology and Ecology Institute, Ministry of Science and Technology, Po Box 2279, Vientiane, Lao People’s Democratic Republic
| | - Geneviève Bourdy
- UMR 152 Pharmadev, Université de Toulouse, IRD, UPS, Toulouse, 31400 France
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Her-Xiong Y, Schroepfer T. Walking in Two Worlds: Hmong End of Life Beliefs & Rituals. J Soc Work End Life Palliat Care 2018; 14:291-314. [PMID: 30457447 PMCID: PMC6386587 DOI: 10.1080/15524256.2018.1522288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 08/07/2018] [Accepted: 08/10/2018] [Indexed: 06/09/2023]
Abstract
For over 40 years, the Hmong have sought refuge in the United States; however, many Hmong elders continue to honor healthcare and end-of-life beliefs and rituals that they practiced in their home country. With little knowledge by the general public and healthcare systems about these beliefs and rituals, healthcare professionals may struggle to provide the Hmong community with culturally-sensitive care. This study sought to address this gap by conducting in-depth face-to-face interviews with 12 Animist and 8Christian Hmong elders born in Southeast Asia, who now reside in the United States. Results provided insights regarding the heterogeneity among these Hmong elders concerning their end-of-life beliefs and rituals. Both Animist and Christian respondents believed family should provide care at end of life. Animist Hmong elders reported the importance of Shamanistic rituals such as soul calling or spiritual offering while Christian Hmong elders believed in the power of prayers. Healthcare providers need to assess Hmong elders' preferences for care at end of life, be open to the inclusion of traditional healers in their care and/or decision-making, and understand preferences of family and community members' involvement in care at the end of life.
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Affiliation(s)
- Youhung Her-Xiong
- a School of Social Work , University of Wisconsin-Madison , Madison , WI , USA
- b Center for Women's Health Research , University of Wisconsin-Madison , Madison , WI , USA
| | - Tracy Schroepfer
- a School of Social Work , University of Wisconsin-Madison , Madison , WI , USA
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22
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Lor M. Systematic Review: Health Promotion and Disease Prevention Among Hmong Adults in the USA. J Racial Ethn Health Disparities 2018; 5:638-661. [PMID: 28795343 PMCID: PMC5807234 DOI: 10.1007/s40615-017-0410-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 06/14/2017] [Accepted: 07/04/2017] [Indexed: 10/19/2022]
Abstract
Although disparities in the burden of disease and illness experienced across major racial and ethnic groups in the USA is well known, little is known about subgroups, including the Hmong population. This review sought to determine the current state of health disparities related to health promotion and disease prevention among Hmong adults from 1975 to 2015. Seventy-one descriptive (qualitative, mixed methods, and quantitative) studies were reviewed. Most focused on two areas: (1) health status (mainly breast and cervical cancers) and (2) health-related behaviors. This literature review confirms the existence of health disparities related to health promotion and disease prevention in the Hmong adult population. Effective intervention relies on identifying these disparities. A possible explanation for these disparities is the lack of health data collected on subgroup populations, which include the Hmong adult population. More research and more comprehensive health policies at the organizational level are needed to allow data to be collected on subgroup populations in order to better understand the social determinants that place the Hmong people at risk.
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Affiliation(s)
- Maichou Lor
- School of Nursing, Columbia University , Mailbox 6, 630 W 168th Street, New York City, New York, 10032, USA.
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23
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Tran MT, Jeong MB, Nguyen VV, Sharp MT, Yu EP, Yu F, Tong EK, Kagawa-Singer M, Cuaresma CF, Sy AU, Tsoh JY, Gildengorin GL, Stewart SL, Nguyen TT. Colorectal cancer beliefs, knowledge, and screening among Filipino, Hmong, and Korean Americans. Cancer 2018; 124 Suppl 7:1552-1559. [PMID: 29578600 PMCID: PMC5875724 DOI: 10.1002/cncr.31216] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 11/22/2017] [Accepted: 12/13/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND To the authors' knowledge, there are few studies to date regarding colorectal cancer (CRC) beliefs, knowledge, and screening among multiple Asian American populations, who are reported to have lower CRC screening rates compared with white individuals. The current study was performed to assess knowledge and beliefs regarding the causes of CRC, its prevention, and factors associated with CRC screening among 3 Asian American groups. METHODS The authors conducted an in-language survey with Filipino (Honolulu, Hawaii), Hmong (Sacramento, California), and Korean (Los Angeles, California) Americans aged 50 to 75 years who were sampled through social networks. Bivariate and multivariable analyses were conducted to assess factors associated with CRC screening. RESULTS The sample of 981 participants was 78.3% female and 73.8% reported limited proficiency in English. Few of the participants were aware that age (17.7%) or family history (36.3%) were risk factors for CRC; 6.2% believed fate caused CRC. Only 46.4% of participants knew that screening prevented CRC (74.3% of Filipino, 10.6% of Hmong, and 55.8% of Korean participants; P<.001). Approximately two-thirds of participants reported ever having undergone CRC screening (76.0% of Filipino, 72.0% of Hmong, and 51.4% of Korean participants; P<.001) and 48.6% were up to date for screening (62.2% of Filipino, 43.8% of Hmong, and 41.4% of Korean participants; P<.001). Factors found to be significantly associated with ever screening were being Korean (compared with Filipino), having a family history of CRC, having health insurance or a regular source of health care, and knowing that a fatty diet caused CRC. Believing that fate caused CRC and that praying prevented it were found to be negatively associated with ever screening. Factors associated with being up to date for CRC screening included being born in the United States, having a family history of CRC, and having access to health care. CONCLUSIONS Knowledge regarding the causes of CRC and its prevention among Filipino, Hmong, and Korean individuals is low. However, health care access, not knowledge or beliefs, was found to be a key determinant of CRC screening. Cancer 2018;124:1552-9. © 2018 American Cancer Society.
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Affiliation(s)
- Mi T Tran
- Division of General Internal Medicine, University of California at San Francisco, San Francisco, California
| | - Matthew B Jeong
- Division of General Internal Medicine, University of California at San Francisco, San Francisco, California
| | - Vickie V Nguyen
- Division of General Internal Medicine, University of California at San Francisco, San Francisco, California
| | - Michael T Sharp
- Division of General Internal Medicine, University of California at San Francisco, San Francisco, California
| | - Edgar P Yu
- Division of General Internal Medicine, University of California at San Francisco, San Francisco, California
| | - Filmer Yu
- Division of General Internal Medicine, University of California at San Francisco, San Francisco, California
| | - Elisa K Tong
- Department of General Internal Medicine, University of California at Davis, Davis, California
| | - Marjorie Kagawa-Singer
- Department of Community Health Sciences, Los Angeles Fielding School of Public Health, University of California at Los Angeles, Los Angeles, California
| | - Charlene F Cuaresma
- Department of Public Health, University of Hawai'i at Manoa, Honolulu, Hawaii
| | - Angela U Sy
- Department of Public Health, University of Hawai'i at Manoa, Honolulu, Hawaii
| | - Janice Y Tsoh
- Department of Psychiatry, University of California at San Francisco, San Francisco, California
| | - Ginny L Gildengorin
- Division of General Internal Medicine, University of California at San Francisco, San Francisco, California
| | - Susan L Stewart
- Department of Public Health Sciences, University of California at Davis, Davis, California
| | - Tung T Nguyen
- Division of General Internal Medicine, University of California at San Francisco, San Francisco, California
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Bart G. Ethnic differences in psychosocial factors in methadone maintenance: Hmong versus non-Hmong. J Ethn Subst Abuse 2017; 17:108-122. [PMID: 29120275 DOI: 10.1080/15332640.2017.1371656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Little is known about the characteristics of U.S.-based Asian populations undergoing methadone maintenance treatment for opioid use disorders. We evaluated psychosocial factors in 76 Hmong and 130 non-Hmong on methadone maintenance for at least two months in a single urban methadone maintenance clinic. Assessments included the Addiction Severity Index 5th Edition, the Symptom Checklist-90, and the Structured Clinical Interview for DSM-IV Axis I Disorders. The Hmong were older, predominately male, and on lower doses of methadone than the non-Hmong. Hmong had significantly lower ASI composite scores across all dimensions except employment and legal. While the SCL-90 Global Severity Index (GSI) score did not differ between groups, the Hmong had lower scores in the interpersonal sensitivity, depression, anxiety, hostility, and paranoid ideation dimensions. Sixty-seven percent of Hmong and 29% of non-Hmong were without Axis I diagnoses (p < .001). There was no difference between the groups in DSM-IV substance use diagnoses. The extent to which these psychosocial differences impact methadone dose requirements and treatment outcomes in Hmong and non-Hmong remains unknown.
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Affiliation(s)
- Gavin Bart
- a Hennepin County Medical Center , Minneapolis , Minnesota
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Trofholz AC, Thao MS, Donley M, Smith M, Isaac H, Berge JM. Family meals then and now: A qualitative investigation of intergenerational transmission of family meal practices in a racially/ethnically diverse and immigrant population. Appetite 2018; 121:163-72. [PMID: 29128396 DOI: 10.1016/j.appet.2017.11.084] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 10/16/2017] [Accepted: 11/06/2017] [Indexed: 11/23/2022]
Abstract
Having frequent family meals has consistently been associated with better health outcomes in children/adolescents. It is important to identify how intergenerational transmission of family meal practices occurs to help families benefit from the protective nature of family meals. Limited studies exist that explore the intergenerational transmission of family meal practices, particularly among racially/ethnically diverse and immigrant populations. This study explores how parents describe differences and similarities between meals "then" and "now", lessons they learned as children about family meals, lessons they passed onto their children, the challenges of carrying out family meals, and how families handle the barriers/challenges to intergenerational transmission of family meal practices. The study was conducted with a sample of African American, Native American, Latino, Hmong, Somali, and White families (25/category). Qualitative themes were explored with the overall sample, by race/ethnicity, immigrant status, and by time in the United States (US) as an immigrant. Parents overwhelmingly reported learning as children that family meals were important and conveying this message to their own children. Differences existed among racial/ethnic groups and time in the US as an immigrant. For example, Somali parents frequently endorsed having no challenges with intergenerational transmission of family meal practices. Immigrant parents in the US for a longer period of time were more likely to endorse learning/teaching about family meal importance, that the food eaten now is different than growing up, that a chaotic environment is a challenge to having family meals, and that they accommodate family member's schedules when planning family meals. Results demonstrate that exploring a parent's early family meal experiences may be important when intervening with parents from diverse racial/ethnic and immigrant populations when trying to improve or increase family meal practices.
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Lor M, Bowers BJ. Feasibility of Audio-Computer-Assisted Self-Interviewing With Color-Coding and Helper Assistance (ACASI-H) for Hmong Older Adults. Res Nurs Health 2017; 40:360-371. [PMID: 28431187 DOI: 10.1002/nur.21796] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2017] [Indexed: 11/07/2022]
Abstract
Many older adult immigrants in the US, including Hmong older adults, have limited English proficiency (LEP), and cannot read or have difficulty reading even in their first language (non-literate [NL]). Little has been done to identify feasible data collection approaches to enable inclusion of LEP or NL populations in research, limiting knowledge about their health. This study's purpose was to test the feasibility of culturally and linguistically adapted audio computer-assisted self-interviewing (ACASI) with color-labeled response categories and helper assistance (ACASI-H) for collection of health data with Hmong older adults. Thirty dyads (older adult and a helper) completed an ACASI-H survey with 13 health questions and a face-to-face debriefing interview. ACASI-H survey completion was video-recorded and reviewed with participants. Video review and debriefing interviews were audio-recorded and transcribed. Directed and conventional content analyses were used to analyze the interviews. All respondents reported that ACASI-H survey questions were consistent with their health experience. They lacked computer experience and found ACASI-H's interface user-friendly. All used the pre-recorded Hmong oral translation except for one, whose helper provided translation. Some Hmong older adults struggled with the color labeling at first, but helpers guided them to use the colors correctly. All dyads liked the color-labeled response categories and confirmed that a helper was necessary during the survey process. Findings support use of oral survey question administration with a technologically competent helper and color-labeled response categories when engaging LEP older adults in health-related data collection. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Maichou Lor
- University of Wisconsin-Madison School of Nursing, 701 Highland Ave., Madison, WI, 53705
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Culhane-Pera KA, Straka RJ, Moua M, Roman Y, Vue P, Xiaaj K, Lo MX, Lor M. Engaging Hmong adults in genomic and pharmacogenomic research: Toward reducing health disparities in genomic knowledge using a community-based participatory research approach. J Community Genet 2017; 8:117-125. [PMID: 28074382 DOI: 10.1007/s12687-017-0292-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 01/01/2017] [Indexed: 01/10/2023] Open
Abstract
Advancing precision medicine relies in part on examining populations that may exhibit unique genetic variants that impact clinical outcomes. Failure to include diverse populations in genomic-based research represents a health disparity. We implemented a community-based participatory research (CBPR) process with the Hmong community in Minnesota, who were refugees from Laos, in order to assess the feasibility of conducting genomic and pharmacogenomic-based research for genetic variants that are relevant to the Hmong community. Our Hmong Genomics Board, consisting of Hmong and non-Hmong professionals, used CBPR principles and built on previous formative research to create and implement culturally and linguistically appropriate informed consent processes for Hmong people at six community venues. The Board chose genetic variants for diabetes risk and warfarin response as relevant to the community. The Institutional Review Board approved aggregate but not individual return of results. Two hundred thirty-seven Hmong participants with mean (range) age of 30.2 (18-81) years and diverse levels of education (22% without and 75% with high-school education) provided saliva for genetic (DNA) analyses. Eighty-five percent of participants agreed to store DNA for future analyses, 82% agreed to share DNA with other researchers, and 78% agreed to be contacted for future studies. Twenty-five elders refused to participate because they wanted individual results. Aggregate results were shared with all participants. This CBPR approach proved highly successful to obtain informed consent and recruit a sample from the Hmong community for a genomic and pharmacogenomic study. Investment in the CBPR process may prove successful to address the gap of genomic information in under-represented communities.
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Affiliation(s)
| | - Robert J Straka
- Department of Experimental and Clinical Pharmacology, College of Pharmacy University of Minnesota, 7-115 Weaver-Densford Hall, 308 Harvard St SE, Minneapolis, MN, 55455, USA
| | - MaiKia Moua
- Benton County Health Services, 530 NW 27th St, Corvallis, OR, 97330, USA
| | - Youssef Roman
- Department of Experimental and Clinical Pharmacology, College of Pharmacy University of Minnesota, 7-115 Weaver-Densford Hall, 308 Harvard St SE, Minneapolis, MN, 55455, USA
| | - Pachia Vue
- University of Minnesota Medical Center-Fairview Campus, 2450 Riverside Ave, Minneapolis, MN, 55454, USA
| | - Kang Xiaaj
- West Side Community Health Services, 153 Cesar Chavez St, Saint Paul, MN, 55107, USA
| | - May Xia Lo
- Phalen Family Pharmacy, 1001 Johnson Parkway, St Paul, MN, 55106, USA
| | - Mai Lor
- Department of Experimental and Clinical Pharmacology, College of Pharmacy University of Minnesota, 7-115 Weaver-Densford Hall, 308 Harvard St SE, Minneapolis, MN, 55455, USA
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Tong EK, Nguyen TT, Lo P, Stewart SL, Gildengorin GL, Tsoh JY, Jo AM, Kagawa-Singer ML, Sy AU, Cuaresma C, Lam HT, Wong C, Tran MT, Chen MS. Lay health educators increase colorectal cancer screening among Hmong Americans: A cluster randomized controlled trial. Cancer 2016; 123:98-106. [PMID: 27564924 DOI: 10.1002/cncr.30265] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 07/05/2016] [Accepted: 07/27/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Asian Americans have lower colorectal cancer (CRC) screening rates than non-Hispanic white individuals. Hmong Americans have limited socioeconomic resources and literacy. The current randomized controlled trial was conducted to determine whether bilingual/bicultural lay health educator (LHE) education could increase CRC screening among Hmong Americans. METHODS A cluster randomized controlled trial was conducted among Hmong Americans in Sacramento, California. LHEs and recruited participants were randomized to intervention or control groups. The intervention group received CRC education over 3 months delivered by an LHE. The control group received education regarding nutrition and physical activity delivered by a health educator. The outcomes were changes in self-reported ever-screening and up-to-date CRC screening after 6 months. RESULTS All 329 participants were foreign-born with mostly no formal education, limited English proficiency, and no employment. The majority of the participants were insured and had a regular source of health care. The intervention group experienced greater changes after the intervention than the control group for ever-screening (P = .068) and being up-to-date with screening (P<.0001). In multivariable regression analyses, the intervention group demonstrated a greater increase than the control group in reporting ever-screening (adjusted odds ratio, 1.73; 95% confidence interval, 1.07-2.79) and being up-to-date with screening (adjusted odds ratio, 1.71; 95% confidence interval, 1.26-2.32). Individuals who had health insurance were found to have >4 times the odds of receiving screening, both ever-screening and up-to-date screening. A higher CRC knowledge score mediated the intervention effect for both screening outcomes. CONCLUSIONS A culturally and linguistically appropriate educational intervention delivered by trained LHEs was found to increase CRC screening in an immigrant population with low levels of education, employment, English proficiency, and literacy. Cancer 2017;98-106. © 2016 American Cancer Society.
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Affiliation(s)
- Elisa K Tong
- Department of Internal Medicine, University of California at Davis, Sacramento, California
| | - Tung T Nguyen
- Department of Internal Medicine, University of California at San Francisco, San Francisco, California
| | - Penny Lo
- Hmong Women's Heritage Association, Sacramento, California
| | - Susan L Stewart
- Department of Public Health Sciences, University of California at Davis, Sacramento, California
| | - Ginny L Gildengorin
- Department of Internal Medicine, University of California at San Francisco, San Francisco, California
| | - Janice Y Tsoh
- Department of Psychiatry, University of California at San Francisco, San Francisco, California
| | - Angela M Jo
- University of New Mexico at Albuquerque, Albuquerque, New Mexico
| | - Marjorie L Kagawa-Singer
- Fielding School of Public Health and Asian American Studies Center, University of California at Los Angeles, Los Angeles, California
| | - Angela U Sy
- University of Hawai'i at Manoa, Manoa, Hawaii
| | | | - Hy T Lam
- Department of Internal Medicine, University of California at San Francisco, San Francisco, California
| | - Ching Wong
- Department of Internal Medicine, University of California at San Francisco, San Francisco, California
| | - Mi T Tran
- Department of Internal Medicine, University of California at San Francisco, San Francisco, California
| | - Moon S Chen
- Department of Internal Medicine, University of California at Davis, Sacramento, California
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Abstract
AIM Hyperuricemia commonly causes gout. Minnesota Hmong exhibit a two- to fivefold higher prevalence of gout versus non-Hmong. To elucidate a possible genomic contribution to this disparity, prevalence of risk alleles for hyperuricemia in Hmong was compared with European (CEU) and Han-Chinese (CHB). METHODS In total, 235 Hmong were genotyped for eight SNPs representing five candidate genes (SLC22A12, SLC2A9, ABCG2, SLC17A1 and PDZK1). RESULTS The frequency of seven out of eight risk alleles in the Hmong was significantly different than CEU; six higher and one with lower prevalence. The frequency of three out of eight risk alleles in the Hmong was significantly different than CHB; two higher and one with lower prevalence. CONCLUSION Hyperuricemia risk alleles are more prevalent in the Hmong than CEU and HB.
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Affiliation(s)
- Youssef M Roman
- Department of Experimental & Clinical Pharmacology, University of Minnesota College of Pharmacy, MN 55455, USA
| | | | - Jeremiah Menk
- Center of Translational Science Institute, Biostatistical Design & Analysis Center, University of Minnesota, MN 55455, USA
| | - Robert J Straka
- Department of Experimental & Clinical Pharmacology, University of Minnesota College of Pharmacy, MN 55455, USA
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Abstract
Research has documented the influence of cultural values, beliefs, and traditional health practices on immigrants' health care utilization in their host countries. We describe our findings of how Hmong immigrants to the United States make decisions about whether and when to use traditional and/or Western health services. We conducted semi-structured interviews with 11 Hmong adults. We found their decisions depended on whether they classified the illness as spiritual or not and how they evaluated the effectiveness of different treatment options for their illness. Hmong participants' expectations for effective treatment in traditional or Western health care encounters combined with physical evidence of an illness influenced their decisions and often led them to shift from one type of care to the other. Understanding cultural differences in perceptions of the causes of illnesses and the link between perceived cause and treatment is important to improving care for the Hmong population.
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Affiliation(s)
- Maichou Lor
- 1 University of Wisconsin-Madison, Madison, WI, USA
| | | | - Linda Park
- 1 University of Wisconsin-Madison, Madison, WI, USA
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Abstract
BACKGROUND Over 25 million people in the USA have limited English proficiency (LEP). Interpreters are often used to facilitate communication with health care providers. Little is currently known about interpreter quality. OBJECTIVE To explore the quality of telephone interpretation during medication consultations between Hmong clients and their pharmacists. METHODS This descriptive study analyzed transcripts from videos of consultations between six triads of Hmong patients, pharmacy students and interpreters. Analysis was divided into two segments: (1) pharmacy: communication from student pharmacist the interpreter to patient and (2) patient: communication from patient to interpreter to student pharmacist. Researchers coded transcripts separately then compared codes. KEY FINDINGS The six encounters yielded 496 communications with 275 discrepancies including omissions, additions, and word substitutions. Pharmacy to patient communications included, 45% (118/262) of omissions, 27.5% (72/262) of substitutions, and 15.6% (41/262) of additions. The patient to provider communications included, 8.1% (19/234) of omissions, 6.0% (14/234) of substitutions, and 4.2% (10/234) of word additions. Some omissions, additions, and substitutions in the pharmacy to patient communications were classified as potentially clinically relevant. Significantly, substantial discrepancies between the student pharmacists' comments and the interpretation to patients had potential for hindering relationship building between patients and their providers. CONCLUSIONS Pharmacists may assume that the presence of an interpreter ensures accurate communication from pharmacist to patient and from patient to pharmacist. This study confirms that those assumptions may not be valid. These findings highlight the need to improve pharmacy education and interventions to improve pharmacist communication with LEP patients.
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Affiliation(s)
- Maichou Lor
- School of Nursing, University of Wisconsin-Madison, Madison, WI, USA
| | - Betty Chewning
- School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA
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Lor M, Xiong P, Schwei RJ, Bowers BJ, Jacobs EA. Limited English proficient Hmong- and Spanish-speaking patients' perceptions of the quality of interpreter services. Int J Nurs Stud 2016; 54:75-83. [PMID: 25865517 PMCID: PMC4592691 DOI: 10.1016/j.ijnurstu.2015.03.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 03/23/2015] [Accepted: 03/27/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Language barriers are a large and growing problem for patients in the US and around the world. Interpreter services are a standard solution for addressing language barriers and most research has focused on utilization of interpreter services and their effect on health outcomes for patients who do not speak the same language as their healthcare providers including nurses. However, there is limited research on patients' perceptions of these interpreter services. OBJECTIVE To examine Hmong- and Spanish-speaking patients' perceptions of interpreter service quality in the context of receiving cancer preventive services. METHODS Twenty limited English proficient Hmong (n=10) and Spanish-speaking participants (n=10) ranging in age from 33 to 75 years were interviewed by two bilingual researchers in a Midwestern state. Interviews were audio taped, transcribed verbatim, and translated into English. Analysis was done using conventional content analysis. RESULTS The two groups shared perceptions about the quality of interpreter services as variable along three dimensions. Specifically, both groups evaluated quality of interpreters based on the interpreters' ability to provide: (a) literal interpretation, (b) cultural interpretation, and (c) emotional interpretation during the health care encounter. The groups differed, however, on how they described the consequences of poor interpretation quality. Hmong participants described how poor quality interpretation could lead to: (a) poor interpersonal relationships among patients, providers, and interpreters, (b) inability of patients to follow through with treatment plans, and (c) emotional distress for patients. CONCLUSIONS Our study highlights the fact that patients are discerning consumers of interpreter services; and could be effective partners in efforts to reform and enhance interpreter services.
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Affiliation(s)
- Maichou Lor
- University of Wisconsin School of Nursing, Madison, USA.
| | - Phia Xiong
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, USA
| | - Rebecca J Schwei
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, USA
| | | | - Elizabeth A Jacobs
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, USA
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Kue J, Thorburn S, Szalacha LA. Perceptions of Risk for Hepatitis B Infection among the Hmong. Hmong Stud J 2016; 17:http://hmongstudies.org/KueThorburnSzalachaHSJ17.pdf. [PMID: 28154502 PMCID: PMC5283865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The Hmong in the U.S. who emigrated from Southeast Asia, an area where hepatitis B is endemic, experience high rates of hepatitis B infection and liver cancer compared to non-Hispanic whites. This exploratory study examined the Hmong's perceptions of risk of hepatitis B infection. We interviewed 83 Hmong women and men living in Oregon. In bivariate statistical analysis, greater perceived susceptibility, lower perceived barriers, and having a healthcare provider recommendation were each significantly related to having ever been screened for hepatitis B. Logistic regression models indicated that having a recommendation by a doctor or healthcare provider was the strongest predictor of having been screened for hepatitis B, followed by education and insurance. Future interventions with the Hmong population should focus on the important role of health care providers play in raising awareness about hepatitis B infection and increasing screening uptake.
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Affiliation(s)
- Jennifer Kue
- College of Nursing, The Ohio State University, 1585 Neil Avenue, Columbus, OH 43210, , ,
| | - Sheryl Thorburn
- School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, 401 Waldo Hall, Corvallis, OR 97331-6406
| | - Laura A Szalacha
- College of Nursing, University of Arizona, 1305 N. Martin Avenue, Tucson, AZ 85721
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Xiong S, Degroote N, Byington H, Harder J, Kaminski K, Haglund K. Engaging in Culturally Informed Nursing Care With Hmong Children and Their Families. J Pediatr Nurs 2016; 31:102-6. [PMID: 26413994 DOI: 10.1016/j.pedn.2015.08.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 04/29/2015] [Accepted: 08/27/2015] [Indexed: 11/21/2022]
Abstract
The Hmong are an ethnic hill tribe group originally from Southern China with concentrated populations throughout Southeast Asia, especially the mountains of northern Laos. Following the Vietnam War, the Hmong started immigrating to the United States in waves to escape prosecution for fighting communism alongside the United States. Today, the Hmong population in the United States is growing rapidly, with a median age of 20.4 years. As the Hmong move and redistribute themselves across the country to be with family or pursue new opportunities, it is more and more likely that nurses everywhere will interact with Hmong children and their families. Historically medically underserved, the Hmong community continues to face barriers to healthcare as a result of culture, language, and lack of access. Nurses who are informed about cultural values and norms of the Hmong and their family and social structures, as well as their spiritual and traditional practices, will be able to establish trust with their pediatric patients and their caregivers. Utilizing strategies including interpretive services, asking detailed social and physical histories, providing extra appointment time, asking open ended questions, and employing teach back methods can help improve communication as well as provide higher quality care that addresses the specific needs of this population.
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Bart G, Lenz S, Straka RJ, Brundage RC. Ethnic and genetic factors in methadone pharmacokinetics: a population pharmacokinetic study. Drug Alcohol Depend 2014; 145:185-93. [PMID: 25456329 PMCID: PMC4254688 DOI: 10.1016/j.drugalcdep.2014.10.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 10/16/2014] [Accepted: 10/16/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Treatment of opiate use disorders with methadone is complicated by wide interindividual variability in pharmacokinetics. To identify potentially contributing covariates in methadone pharmacokinetics, we used population pharmacokinetic modeling to estimate clearance (CL/F) and volume of distribution (V/F) for each methadone enantiomer in an ethnically diverse methadone maintained population. METHODS Plasma levels of the opiate-active R-methadone and opiate-inactive S-methadone were measured in 206 methadone maintained subjects approximately two and twenty-three hours after a daily oral dose of rac-methadone. A linear one-compartment population pharmacokinetic model with first-order conditional estimation with interaction (FOCE-I) was used to evaluate methadone CL/F and V/F. The influence of covariates on parameter estimates was evaluated using stepwise covariate modeling. Covariates included ethnicity, gender, weight, BMI, age, methadone dose, and 21 single nucleotide polymorphisms in genes implicated in methadone pharmacokinetics. RESULTS In the final model, for each enantiomer, Hmong ethnicity reduced CL/F by approximately 30% and the rs2032582 (ABCB1 2677G>T/A) GG genotype was associated with a 20% reduction in CL/F. The presence of the rs3745274 minor allele (CYP2B6 515G>T) reduced CL/F by up to 20% for S-methadone only. A smaller effect of age was noted on CL/F for R-methadone. CONCLUSION This is the first report showing the influence of the rs2032582 and rs3745274 variants on methadone pharmacokinetics rather than simply dose requirements or plasma levels. Population pharmacokinetics is a valuable method for identifying the influences on methadone pharmacokinetic variability.
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Affiliation(s)
- Gavin Bart
- Department of Medicine, Hennepin County Medical Center, 701 Park Avenue, Minneapolis, MN 55415, USA.
| | - Scott Lenz
- Minneapolis Medical Research Foundation, 914 S 8th St., Minneapolis, MN 55404, USA
| | - Robert J. Straka
- Department of Experimental and Clinical Pharmacology, University of Minnesota College of Pharmacy, 5-130 Weaver-Densford Hall, 308 Harvard Street SE, Minneapolis, MN 55455, USA
| | - Richard C. Brundage
- Department of Experimental and Clinical Pharmacology, University of Minnesota College of Pharmacy, 5-130 Weaver-Densford Hall, 308 Harvard Street SE, Minneapolis, MN 55455, USA
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Woldehanna S, Zimicki S. An expanded One Health model: integrating social science and One Health to inform study of the human-animal interface. Soc Sci Med 2014; 129:87-95. [PMID: 25464873 PMCID: PMC7115783 DOI: 10.1016/j.socscimed.2014.10.059] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 10/16/2014] [Accepted: 10/31/2014] [Indexed: 11/28/2022]
Abstract
Zoonotic disease emergence is not a purely biological process mediated only by ecologic factors; opportunities for transmission of zoonoses from animals to humans also depend on how people interact with animals. While exposure is conditioned by the type of animal and the location in which interactions occur, these in turn are influenced by human activity. The activities people engage in are determined by social as well as contextual factors including gender, age, socio-economic status, occupation, social norms, settlement patterns and livelihood systems, family and community dynamics, as well as national and global influences. This paper proposes an expanded “One Health” conceptual model for human-animal exposure that accounts for social as well as epidemiologic factors. The expanded model informed a new study approach to document the extent of human exposure to animals and explore the interplay of social and environmental factors that influence risk of transmission at the individual and community level. The approach includes a formative phase using qualitative and participatory methods, and a representative, random sample survey to quantify exposure to animals in a variety of settings. The paper discusses the different factors that were considered in developing the approach, including the range of animals asked about and the parameters of exposure that are included, as well as factors to be considered in local adaptation of the generic instruments. Illustrative results from research using this approach in Lao PDR are presented to demonstrate the effect of social factors on how people interact with animals. We believe that the expanded model can be similarly operationalized to explore the interactions of other social and policy-level determinants that may influence transmission of zoonoses. Zoonotic disease emergence is not a purely biological process. Animal-to-human transmission of disease depends on how people interact with animals. An expanded One Health model for human-animal exposure accounts for social factors. The expanded model was the conceptual basis for a human-animal exposure study. Illustrative results from Lao PDR demonstrate how social factors can affect exposure.
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Affiliation(s)
| | - Susan Zimicki
- FHI 360, 1825 Connecticut Ave NW, Washington DC 20009, USA
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Abstract
Comparisons between Asian American and Pacific Islander (AAPI) and, when possible, similar populations from their ancestral land of origin may allow for unique insights into the development of substance use disorders. Drawn from research conducted within the Hmong residing in the United States and from ongoing collaborative work between the United States and Vietnam, this paper presents a few examples of the types of addiction research that may be possible in Asian populations, both in the United States and in Asia, with a focus on developing South East Asian countries and their AAPI counterparts in the United States. Approaches to research may include epidemiological surveys, evaluation of treatment need and outcome, and genetic contributors to the risk for substance use disorders (SUDs) as well as response to SUD treatment.
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Affiliation(s)
- Gavin Bart
- Division of Addiction Medicine, Hennepin County Medical Center, University of Minnesota Medical School, Minneapolis, MN, USA
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Abstract
BACKGROUND Hmong women are reported to have very low rates of breast and cervical cancer screening compared to other Asian and White women in the USA. Reasons for low cancer screening rates among this population are not well understood. METHODS This qualitative study (n=83) explored Hmong women and men's perceptions of breast and cervical cancer and cancer screening, women's experiences with breast and cervical cancer screening, and health care system barriers to screening. RESULTS Hmong women and men perceived breast cancer to be more severe than other types of cancers. Participants believed that breast cancer is curable if detected early. Cervical cancer was not well understood and was of greater concern than breast cancer because of its location within the body and its consequences for reproduction. In general, few participants had personal experiences with breast and/or cervical cancer. Overall, women and men had positive things to say about screenings for breast and cervical cancer, expressing that screenings offered a 'proof of illness.' The majority of women did not report any concerns with the exams themselves, although some discussed embarrassment, pain, and discomfort. Barriers to screening included lack of health insurance, making co-payments, language, and issues related to scheduling appointments. Barriers differed for younger and older women. CONCLUSION Results of this study provide new insight into perceptions, experiences, and barriers to breast and cervical cancer screening among Hmong women and men. These findings have implications for developing culturally appropriate interventions to increase breast and cervical cancer screening in this population.
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Affiliation(s)
- Jennifer Kue
- College of Nursing, The Ohio State University, 1585 Neil Ave., Columbus, OH 43210
| | - Ann Zukoski
- Rainbow Research, 621 West Lake St., Ste. 300, Minneapolis, MN 55408
| | - Karen Levy Keon
- Formerly with the College of Public Health and Human Sciences, Oregon State University, 401 Waldo Hall, Corvallis, OR 97331
| | - Sheryl Thorburn
- College of Public Health and Human Sciences, Oregon State University, 401 Waldo Hall, Corvallis, OR 97331
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Chen Q, Goto K, Wolff C, Bianco-Simeral S, Gruneisen K, Gray K. Cooking up diversity. Impact of a multicomponent, multicultural, experiential intervention on food and cooking behaviors among elementary-school students from low-income ethnically diverse families. Appetite 2014; 80:114-22. [PMID: 24845782 DOI: 10.1016/j.appet.2014.05.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 04/19/2014] [Accepted: 05/12/2014] [Indexed: 11/26/2022]
Abstract
This study evaluated the impact of a pilot intervention promoting ethnic produce through classroom food demonstrations, tastings and home cooking activities among ethnically diverse elementary-school children ages 5-8 years old and their family members in Northern California. A total of 604 intervention students from four schools participated in classroom food demonstrations and tasting activities using seven food recipes. The control group included 600 students from two additional schools. Each recipe featured one vegetable from Latino, Hmong, or mainstream American cultures. Intervention students also received food kits containing ingredients to take home for each recipe. Mixed methods of quantitative student and parent pre-post surveys, parent feedback surveys, and qualitative focus groups were used to evaluate the intervention. Generalized estimating equations were used for survey data analysis. Qualitative data from parent focus groups were analyzed based on the principles of grounded theory. Both quantitative and qualitative results revealed that intervention students increased familiarity, preferences, and consumption of the featured vegetables and significantly increased their involvement in food preparation at home. Qualitative results showed that children were actively involved in food preparation at home. In addition, the intervention helped parents increase their appreciation for new foods and recipes. The results suggest that promoting locally grown ethnic produce to children is effective in increasing their consumption of a variety of vegetables and their involvement in food preparation at home.
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Affiliation(s)
- Qiong Chen
- Department of Nutrition and Food Sciences, California State University, Chico, CA, USA
| | - Keiko Goto
- Department of Nutrition and Food Sciences, California State University, Chico, CA, USA; Center for Nutrition and Activity Promotion, California State University, Chico, CA, USA.
| | - Cindy Wolff
- Department of Nutrition and Food Sciences, California State University, Chico, CA, USA; Center for Nutrition and Activity Promotion, California State University, Chico, CA, USA
| | - Stephanie Bianco-Simeral
- Department of Nutrition and Food Sciences, California State University, Chico, CA, USA; Center for Nutrition and Activity Promotion, California State University, Chico, CA, USA
| | - Kristin Gruneisen
- Center for Nutrition and Activity Promotion, California State University, Chico, CA, USA
| | - Katharine Gray
- Department of Mathematics and Statistics, California State University, Chico, CA, USA
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Roy M, Benedict K, Deak E, Kirby MA, McNiel JT, Sickler CJ, Eckardt E, Marx RK, Heffernan RT, Meece JK, Klein BS, Archer JR, Theurer J, Davis JP, Park BJ. A large community outbreak of blastomycosis in Wisconsin with geographic and ethnic clustering. Clin Infect Dis 2013; 57:655-62. [PMID: 23735332 DOI: 10.1093/cid/cit366] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Blastomycosis is a potentially life-threatening infection caused by the soil-based dimorphic fungus Blastomyces dermatitidis, which is endemic throughout much of the Midwestern United States. We investigated an increase in reported cases of blastomycosis that occurred during 2009-2010 in Marathon County, Wisconsin. METHODS Case detection was conducted using the Wisconsin Electronic Disease Surveillance System (WEDSS). WEDSS data were used to compare demographic, clinical, and exposure characteristics between outbreak-related and historical case patients, and to calculate blastomycosis incidence rates. Because initial mapping of outbreak case patients' homes and recreational sites demonstrated unusual neighborhood and household case clustering, we conducted a 1:3 matched case-control study to identify factors associated with being in a geographic cluster. RESULTS Among the 55 patients with outbreak-related cases, 33 (70%) were hospitalized, 2 (5%) died, 30 (55%) had cluster-related cases, and 20 (45%) were Hmong. The overall incidence increased significantly since 2005 (average 11% increase per year, P < .001), and incidence during 2005-2010 was significantly higher among Asians than non-Asians (2010 incidence: 168 vs 13 per 100 000 population). Thirty of the outbreak cases grouped into 5 residential clusters. Outdoor activities were not risk factors for blastomycosis among cluster case patients or when comparing outbreak cases to historical cases. CONCLUSIONS This outbreak of blastomycosis, the largest ever reported, was characterized by unique household and neighborhood clustering likely related to multifocal environmental sources. The reasons for the large number of Hmong affected are unclear, but may involve genetic predisposition.
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Affiliation(s)
- Monika Roy
- Epidemic Intelligence Service, Scientific Education and Professional Development Program Office, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS C-09, Atlanta, GA 30307, USA.
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Lor M, Khang PY, Xiong P, Moua KF, Lauver D. Understanding Hmong women's beliefs, feelings, norms, and external conditions about breast and cervical cancer screening. Public Health Nurs 2013; 30:420-8. [PMID: 24000914 DOI: 10.1111/phn.12043] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To describe the beliefs, feelings, norms, and external conditions regarding breast and cervical cancer screening in a sample of Hmong women. DESIGN AND SAMPLE In a descriptive design, female Hmong researchers recruited 16 Hmong women (ages 24-73) at a community center. Guided by the Theory of Care Seeking Behavior (TCSB), researchers asked participants semi-structured questions about their beliefs, feelings, norms, and external conditions in a group setting. Researchers documented responses in writing and audio recordings. Guided by theory, we used directed content analysis to categorize responses. RESULTS Participants' beliefs' about screening included uncertainty about causes of breast and cervical cancer, uncertainty about Western forms of treatments, and terminal illness as outcomes of such cancer. Many felt embarrassed about breast and cervical cancer screening. Their cultural norms about undressing for an exam and listening to authority figures were different from Western norms. External conditions that influenced participants' for screenings included difficulties in communicating with interpreters and clinicians. CONCLUSIONS Consistent with the TCSB, Hmong women's beliefs, affect, cultural norms and external conditions helped to understand their use of breast and cervical screening. Findings could guide nursing and public health interventions to improve culturally sensitive, cancer screening for Hmong women.
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Affiliation(s)
- Maichou Lor
- University of Wisconsin-Madison, Clinical Science Center, School of Nursing, Madison, Wisconsin 53792, USA.
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Sheikh MY, Atla PR, Ameer A, Sadiq H, Sadler PC. Seroprevalence of Hepatitis B and C Infections among Healthy Volunteer Blood Donors in the Central California Valley. Gut Liver 2012; 7:66-73. [PMID: 23423771 PMCID: PMC3572322 DOI: 10.5009/gnl.2013.7.1.66] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Revised: 05/17/2012] [Accepted: 06/10/2012] [Indexed: 12/29/2022] Open
Abstract
Background/Aims The Central California Valley has a diverse population with significant proportions of Hispanics and Asians. This cross-sectional study was conducted to evaluate the prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) in healthy blood donors in the Valley. Methods A total of 217,738 voluntary blood donors were identified between 2006 and 2010 (36,795 first-time donors; 180,943 repeat donors). Results Among the first-time donors, the HBV and HCV prevalence was 0.28% and 0.52%, respectively. Higher HBV prevalence seen in Asians (3%) followed by Caucasians (0.05%), African Americans (0.15%), and Hispanics (0.05%). Hmong had a HBV prevalence of 7.63% with a peak prevalence of 8.76% among the 16- to 35-year-old age group. Highest HCV prevalence in Native Americans (2.8) followed by Caucasians (0.59%), Hispanics (0.45%), African Americans (0.38%), and Asians (0.2%). Conclusions Ethnic disparities persist with regard to the prevalence of HBV and HCV in the Central California Valley. The reported prevalence may be an underestimate because our study enrolled healthy volunteer blood donors only. The development of aggressive public health measures to evaluate the true prevalence of HBV and HCV and to identify those in need of HBV and HCV prevention measures and therapy is critically important.
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Affiliation(s)
- Muhammad Y Sheikh
- Division of Gastroenterology & Hepatology, University of California San Francisco Fresno Medical Education Program, Fresno, CA, USA. ; Department of Medicine, Community Regional Medical Center, University of California San Francisco Fresno Medical Education Program, Fresno, CA, USA
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Abstract
A critical examination of Richard Miller's position in his recent Children, Ethics, and Modern Medicine on how to handle pediatric interventions in cases of cross-cultural conflict between parents and doctors with respect to treating young children. Particular emphasis is placed on Miller's interpretation of and arguments about a Hmong case extensively researched by Anne Fadiman in her The Spirit Catches You and You Fall Down. The conclusion drawn is that Miller's position requires further nuance and development, and some recommendations are made toward that end.
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Numrich C, Plotnikoff G, Yang D, Wu CY, Xiong P. Enhanced listening skills: gifts from the Hmong. J Clin Ethics 2003; 13:337-43. [PMID: 12793327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
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Trotter G. Medicine's response to ethnic differences. Health Care Ethics USA 2001; 7:6-7. [PMID: 11660713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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Wells R, Sheldon M. Making room for alternatives. Hastings Cent Rep 2000; 30:26-8. [PMID: 10862367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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Culhane-Pera KA, Vawter DE. A study of healthcare professionals' perspectives about a cross-cultural ethical conflict involving a Hmong patient and her family. J Clin Ethics 1998; 9:179-90. [PMID: 9750991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Vawter DE, Babbitt B. Hospice care for terminally ill Hmong patients. A good cultural fit? Minn Med 1997; 80:42-4. [PMID: 9385811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- D E Vawter
- Minnesota Center for Health Care Ethics, Minneapolis, USA
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