1. The Role of Cultural Health Beliefs on Health Behaviors among Chinese, Korean & Mexican American Breast Cancer Survivors
PI’s: Drs. Patricia Gonzalez, Jung-Wong Lim & Ming Wang
Students: Ann Lee & Suirong Li
Advisor: Dr. Kimlin Ashing-Giwa
April 7, 2008

2. Introduction
Breast cancer is the most frequently diagnosed cancer in Asian American & Latina women.
Survival rates are increasing.
Differences in HRQOL outcomes are documented (Ashing-Giwa, 2004; 2007)
Differences in health behaviors and health beliefs may exist based on culture and ethnicity.

3. Overall Goal
Examine the relationships among health behaviors and cultural health beliefs among Chinese, Korean and Mexican BCS
Conduct secondary data analyses to examine doctor patient relationships

4. Methods – Phase I
Secondary data derived from Dr. Ashing-Giwa’s study examining QOL among a population-based, multi-ethnic and multi-lingual sample of BCS
Participants (N=237)
Chinese (N=85), Korean (N=29), and Mexican (N=123)
Data Analyses:
Factor analysis: Health beliefs
ANOVAs: differences by ethnicity & language on acculturation & doctor-patient relationships
Chi-Squares: treatment-related decisions & life style changes by ethnicity

5. Demographic and Medical Characteristics
Variables
CA (N=85)
KA (N=29)
MA (N=123)
Age (mean; SD)
54.04 (11.9)
52.76 (8.8)
52.90 (12.1)
Income: Under 25K
25K – 75K
Over 75K
19 (23.5)
40 (49.4)
22 (27.2)
14 (48.3)
12 (41.4)
3 (10.3)
59 (48.0)
48 (39.1)
16 (13.0)
Education: < high
≥high
15 (17.6)
70 (82.4)
2 (6.9)
27(93.1)
38 (31.1)
84 (68.9)
Health insurance (Yes)
83 (97.6)
20 (71.5)
111 (89.4)
Employment status:
Unemployed
Employed
21 (24.7)
64 (75.3)
19 (65.5)
10 (34.5)
85 (69.1)
38 (30.9)
Spoken language:
Own language
English
55 (64.7)
30 (35.3)
22 (75.9)
7 (24.1)
64 (52.0)
Years since diagnosis (M, SD)
3.29 (2.1)
2.62 (1.4)
2.88 (1.5)
# of Comorbidities
1.20 (1.2)
2.07 (1.9)
2.00 (1.5)
Age at diagnosis (M, SD)
51.85 (8.0)
49.97 (9.2)
50.08 (11.7)

6. Results I: Reasons Causing Breast Cancer by Ethnicity
Order F
Chinese
Korean
Mexican
Pollution 2
0.269
Hormone replacement tx 4 3
0.504
Foods I eat 5
0.738
Hereditary 1
1.114
First child after the age of 30 9 7
5.300**
Not having children 8 10
0.729
Not breastfeeding 6
2.716
Radiation
1.364
Injury or trauma to the breast
16.096***
A spouse fondling 11
0.977
Stressful life
8.977***
** P < 0.01; ***p<0.001

7. Reasons Causing Breast Cancer
Chinese & Mexican-Americans believed hereditary is the most reason causing breast cancer.
Korean-Americans believed stressful life to be the most important reason.
The reasons indicating significant differences in reasons causing breast cancer according to ethnicity:
- first child after the age of 30 (p=0.006)
- injury or trauma to the breast (p=0.000)
- stressful life (p=0.000)
The perceived reasons causing breast cancer needs to be explored further with more reliable methods for statistical interpretation.

8. Results II: Cultural Health Beliefs
Health Belief Items
1. When people get sick it is the will of God or a higher power.
2. Harboring a lot of anger can make a person vulnerable to illness.
3. I am in control of my health.
4. My family situation has a lot to do with my becoming sick or staying healthy.
5. Luck plays a big part in determining how soon I will recover from an illness.
6. Health professionals control my health.
7. My cultural background plays a big part in how I feel about my illness.
All three ethnic groups showed different factor loadings in health belief items.

9. Results III: Health Behavior Changes by Ethnicity
Variables
Chinese
Korean
Mexican X2
Life style change
(Yes/No)
60 (70.6%)
24 (82.8%)
71 (58.7%)
7.313*
Eating
49 (81.7%)
19 (79.2%)
68 (89.5%)
3.356
Exercise
47 (78.3%)
17 (70.8%)
41 (56.2%)
7.507*
Complementary/
alternative medicine
28 (46.7%)
7 (29.2%)
25(34.2%)
3.134
Reduce stress
40 (66.7%)
18 (75.0%)
36 (48.6%)
7.287*
* P < 0.05

10. Changes in Health Behaviors by Ethnicity
All three ethnic groups were more likely to change their eating patterns after their breast cancer diagnosis and treatment.
Chinese- and Korean-Americans showed different patterns in health behavior changes
⇒ Chinese-Americans: exercise, and
complementary /alternative medicine
⇒ Korean-Americans: stress management

11. Results IV: Acculturation & Patient-doctor Relationship by Ethnicity
Variables
Chinese
(N=85)
Korean
(N=29)
Mexican
(N=123) F
Acculturation
2.34 (0.78)
1.88 (0.64)
2.59 (0.85)
9.853***
Patient-doctor relationship
24.91 (3.76)
25.10 (4.39)
22.85 (4.39)
7.533**
** P < 0.01; ***p<0.001

12. Acculturation and Patient-doctor Relationship by Ethnicity
The lower acculturated level for Korean-Americans may be related to their short immigration history.
The score for patient-doctor relationship by Mexican- Americans needs further investigation for the possible contributory factors such as financial & language barriers.

13. Discussion
The perceived reasons causing breast cancer needs to be explored further with more reliable methods for statistical interpretation.
Significant differences in life style changes by ethnicity exist. ⇒ the importance of different health behavior intervention based on culture/ethnicity
Lower acculturation level and better patient-doctor relationship for Korean-Americans may be related to sample characteristics including immigration history, language, and SES.
Patient-doctor relationship for Mexican-Americans needs further investigation to explore the possible factors such as financial & language barriers.
Lower acculturation level and better patient-doctor relationship for Korean-Americans may be related to sample characteristics including immigration history, language, and SES.

14. Timeline & Tasks Sept 2007 – Aug 2009O N D J F M A
2008
2009 1 2 3 4 5 6 7 8 9 10 11 12
13-18
19-24
IRB Approval
1. Secondary Data Cleaning
2. Data Analysis
3. Report Findings
4. Manuscripts
5. Develop Interview
Protocol
6. Translation Protocol
7. Site Visits
8. Recruit Subjects
9. Conduct Focus Group
10. Verbatim Transcript
11. Translations
12. Data Analysis
13. Final Report
14. Manuscript
15. Future Grant
Target Schedule Completed In-process 17

15. What have we learned?

16. Questions?