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

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.

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

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

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)

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

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.

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.

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

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

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

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.

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.

Timeline & Tasks Sept 2007 – Aug 2009 O 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

What have we learned?

Questions?