Fung Kuen Koo

Culture and sun exposure in immigrant East Asian women living in Australia

In this qualitative study, researchers examined cultural and attitudinal factors that might be related to sun-exposure behaviors among East Asian women living in Australia. Researchers asked Chinese (n = 20) and Korean (n = 16) immigrant women who participated in a larger cross-sectional quantitative study of vitamin D blood levels to volunteer to participate in an in-depth interview in 2010. These women reported a number of cultural factors related to their attitudes and behaviors with regard to sun exposure. They expressed preference for fair skin, a tradition of covering skin when outdoors, and no sunbathing culture. They believed that fair skin was more beautiful than tanned skin. They reported that beauty was the reason for active avoidance of sunlight exposure. Although they reported knowledge of the need for sun avoidance due to skin cancer risk, few reported knowledge about the benefits of sun exposure for adequate vitamin D levels. These findings may provide some reasons for vitamin D deficiency previously reported in these populations. Thus, researchers recommend that these attitudes of excessive sun protection and limiting sun exposure be further investigated as they may have implications for planning and delivery of health promotion programs to this growing population of immigrants in Australia.

Qualitative exploration of HIV-related sexual behaviours and multiple partnerships among Chinese men who have sex with men living in a rural area of Yunnan Province, China

BACKGROUND The HIV epidemic has been spreading rapidly among men who have sex with men (MSM) in China. The present study explored the pattern of HIV-related high-risk sexual practices among MSM in a rural Chinese setting. METHODS Data were collected by semistructured in-depth interviews conducted among 15 MSM in Yuxi Prefecture, Yunnan Province, China. Fifteen respondents were recruited through a local non-governmental organisation via purposive sampling. Thematic analysis was used. RESULTS Technological changes, risk behaviours, social stigma and high migration rates have played a significant role in the spread of HIV among MSM in rural China. The Internet has become the primary channel for soliciting casual sex partners in the MSM community. Bisexuality and having concurrent and multiple sexual partners were common among rural MSM. A large number of sexual partners and low condom use in all MSM partnership types were noted. Due to Chinese cultural traditions and social stigma, Chinese rural MSM were reluctant to disclose their homosexuality. Rural-to-urban migrant MSM were often engaged in the commercial sex trade. CONCLUSIONS Rural MSM is a distinctive and complex population with multiple identities in China. Concurrent multiple sexual partnerships, high mobility and low disclosure rate are the major challenges for HIV prevention and intervention programs in MSM.

Socio-cultural influences on the transmission of HIV among gay men in rural China

Bisexual behaviours are relatively common among men who have sex with men in China. This pilot study aims to reveal the complex processes through which such men manage their sexuality, family responsibilities and sexual behaviours in a rural Chinese setting. A total of 15 men who have sex with men were recruited by purposive sampling. Face-to-face in-depth interviews were conducted to explore participants’ views about their sexual experiences and practices. The Chinese traditional moral code, family values and gender roles that form the crucial components of Confucianism were reflected in the participants’ efforts to maintain familial and social harmony through a compromised form of sexual partnership. Most study participants demonstrated a mixed experience of social stigma, sexual naiveté and ignorance of HIV and sexually transmitted infections (STIs). Under cultural and family pressure, men who have sex with men entered heterosexual marriages with the intention of maintaining a balance between their collectivist (familial) obligations and their individualistic (same-sex sexual) desires. However, the opaque nature of their concurrent sexual relationships may endanger their personal health and accelerate HIV and STI transmission. Reducing the stigma and social prejudice associated with male same-sex sexual relations is essential for any culturally sensitive HIV-prevention programme to succeed in rural China.

Acculturation is associated with higher prevalence of cardiovascular disease risk-factors among Chinese immigrants in Australia: Evidence from a large population-based cohort

Background Acculturation is associated with increased prevalence of cardiovascular disease (CVD) risk-factors among immigrants in Western countries. Little is known about acculturation effects on CVD risks among Chinese immigrants, one of the fastest growing populations in Western countries. In this study, we aim to examine the association between acculturation and CVD risk-factors among Chinese immigrants, Australia’s third-largest foreign-born group. Methods We accessed a subsample of Chinese immigrants (n = 3220) within the 45-and-Up Study (2006–2009). Poisson regression model with a robust error variance examined the association between acculturation and CVD risk-factors, and prevalence ratios were reported, adjusted for socio-demographic characteristics. Indicators of acculturation included age at migration, length of Australian residence and language spoken at home. The outcomes were self-reported CVD diagnosis and six risk-factors (hypertension, diabetes, high cholesterol, smoking, overweight/obesity, physical inactivity). Results Mean age of Chinese participants was 58.9-years (SD = 10.7) and 55.5% were women. Chinese migrating to Australia aged <18 years were significantly more likely to report diabetes (prevalence ratio = 1.71; p < 0.01), overweight/obesity (prevalence ratio = 1.49; p < 0.001) and ≥ 3 CVD risk-factors (prevalence ratio = 1.47; p < 0.05) compared with those who migrated after 18-years-old. Chinese immigrants who lived in Australia for ≥ 30 years were significantly more likely to have diabetes (prevalence ratio = 1.84; p < 0.01) and ≥ 3 CVD risk-factors (prevalence ratio = 1.84; p < 0.01). There were no significant differences by language spoken at home. The association between indicators of acculturation and CVD risk-factors appeared to differ by sex. Conclusion Greater acculturation was associated with adverse CVD risk-factors among Chinese immigrants in Australia.

A Chinese Immigrant Paradox? Low Coronary Heart Disease Incidence but Higher Short‐Term Mortality in Western‐Dwelling Chinese Immigrants: A Systematic Review and Meta‐Analysis

Background Chinese form a large proportion of the immigrant population in Western countries. There is evidence that Chinese immigrants experience an increased risk of coronary heart disease (CHD) after immigration in part due to cultural habits and acculturation. This is the first systematic review and meta‐analysis that aims to examine the risk of CHD in people of Chinese ethnicity living in Western countries, in comparison with whites and another major immigrant group, South Asians. Methods and Results Literature on the incidence, mortality, and prognosis of CHD among Chinese living in Western countries was searched systematically in any language using 6 electronic databases up to December 2014. Based on the meta‐analysis, Chinese had lower incidence of CHD compared with whites (odds ratio 0.29; 95% CI: 0.24–0.34) and South Asians (odds ratio 0.37; 95% CI: 0.24–0.57) but higher short‐term mortality after first hospitalization for acute myocardial infarction compared with whites (odds ratio 1.34; 95% CI, 1.04–1.73) and South Asians (odds ratio 1.82; 95% 1.33–2.50). There was no significant difference between Chinese immigrants and whites in long‐term outcomes (mortality and recurrent events) after acute myocardial infarction. Conclusions These findings provide an important focus for resource planning to enhance early secondary prevention of CHD to improve short‐term survival outcomes among Western‐dwelling Chinese immigrants.

Vitamin D and Metabolic Syndrome in Immigrant East Asian Women Living in Sydney, Australia: A Pilot

Background: As epidemiological studies have linked vitamin D deficiency to risk of metabolic syndrome, we investigated vitamin D deficiency with metabolic syndrome prevalence in immigrant Asian women. Materials and Methods: In a cross-sectional pilot survey of older East Asian women (n=85 aged 60-95) we examined the association between vitamin D status (measured by serum 25-hydroxyvitamin D) with metabolicsyndrome risk factors. Results: The population mean for 25-hydroxyvitamin D concentration in serum was 56 ± 22 nmol/L with forty percent being vitamin D deficient (< 50 nmol/L). Ninety-eight percent of the population had at least one metabolic syndrome risk factor, 85% had two, 55% had three and 8% had four. Having four metabolic syndrome risk factors was associated with a three fold risk of vitamin D deficiency. Vitamin D deficiency was associated with high non-fasting blood glucose levels ≥7.7 mmol/L (OR=5.2, 95%CI=1.8-18) and non-significantly, with being overweight (OR=1.8, 95%CI =0.7-5). In contrast, vitamin D deficiency was not associated with either hypertension or central obesity. Environmental factors associated with vitamin D deficiency in these data were no vitamin tablet intake (calcium or vitamin D) (OR=7.2, 95%CI=1.8-29; OR=6.3, 95%CI=1.2-32, respectively); not being acculturated to an Australian lifestyle, (OR=2.6, 95%CI=0.9-8) or less sun exposure on the weekends (OR=3.6, 95%CI=1.0-13). After adjustment for these predictors, if these Asian immigrants were vitamin D deficient they were at an eight fold risk of having high blood glucose measurements (OR=7.6, 95%CI=1-53). Conclusion: Further larger prospective studies should be conducted to examine the association between vitamin D deficiency and risk of metabolic syndrome in similar immigrant populations.

Marked differences in cardiovascular risk profiles in middle-aged and older Chinese residents: Evidence from a large Australian cohort.

BACKGROUND Although Chinese form the largest non-English speaking group in Australia, cardiovascular disease (CVD) risk profiles among Chinese Australians have not been comprehensively examined, nor has the effect of mixed-Chinese ethnicity been adequately explored. This study is to investigate cardiovascular risk among Chinese, mixed-Chinese, and non-Chinese Australians. METHODS Using data from 266,696 Australian participants from the 45 and Up Study (2006-2009), this study investigated cardiovascular risk among Chinese (n=3454), mixed-Chinese (n=1062), and non-Chinese (n=262,180) participants. Poisson regression models with a robust error variance were used to estimate prevalence ratio (PR) and 95% confidence intervals (CI) for CVD (coronary heart disease (CHD) and stroke) and six major risk factors (hypertension, diabetes, high cholesterol, smoking, overweight/obesity, and physical inactivity) by ethnicity using non-Chinese participants as the reference group. Each outcome was adjusted for sociodemographic characteristics. RESULTS Compared with non-Chinese Australians, Chinese had lower prevalence of CHD (PR=0.67; 95% CI=0.59-0.75) and stroke (PR=0.67; 95% CI=0.51-0.88). Of the risk factors, Chinese had higher prevalence of diabetes (PR=1.25; 95% CI=1.12-1.39), smoking (PR=1.22; 95% CI=1.04-1.43) and physical inactivity (PR=1.48; 95% CI=1.41-1.55) but lower prevalence of hypertension (PR=0.90; 95% CI=0.86-0.95), high cholesterol (PR=0.87; 95% CI=0.79-0.95), and overweight/obesity (PR=0.46; 95% CI=0.43-0.48). Mixed-Chinese had higher prevalence of CVD and worse CVD risk profiles compared with Chinese. CONCLUSIONS There are marked differences in the prevalence of CVD and risk factors among three groups. The noticeable variations in CVD risk between Chinese and mixed-Chinese indicate that conventional classification of treating all Chinese as homogeneous could be misleading. More investigation into the health outcomes of mixed ancestry is warranted.

Participation in treatment decision-making among Chinese-Australian women with breast cancer

PurposeUsing Confucian philosophy as a conceptual framework, this article examines the extent to which cultural values and language affect the participation preferences and experiences of the breast cancer treatment decision-making (TDM) process among Chinese women with breast cancer in Australia.MethodsThree focus groups were conducted with 23 Chinese-Australian women diagnosed with breast cancer in their native language (Mandarin and Cantonese). Each interview was translated and transcribed. Content analysis was used to uncover the major themes.FindingsFour typologies emerged: the patient as an active decision maker, the patient as a passive decision maker, the patient as a reluctant decision maker and the patient as a reluctant passive decision maker. Language barriers, cultural expectation of doctor’s role and family role in Chinese culture appear as influential factors in TDM process among this group of women.ConclusionsIntervention to improve doctors’ cultural sensitivities in order to help them assess women’s role preferences in TDM and the ability of doctors to communicate in a culturally appropriate manner, may improve the process of breast cancer TDM among women from Chinese background.

Barriers and Potential Improvements for Needle and Syringe Exchange Programs (NSPs) in China: A Qualitative Study from Perspectives of Both Health and Public Security Sectors.

This study explores the acceptability, the barriers to the implementation of needle and syringe exchange programs (NSPs) and the potential improvement strategies in China from the perspectives of governmental health and public security officials. Purposive sampling was used for recruitment of participants who had been involved in NSPs implementation. Semi-Structured individual interviews were conducted in Mandarin to address three aspects of NSPs: (1) participants’ attitudes towards NSPs, (2) participants’ opinions on the effectiveness and barriers of NSPs, and (3) suggestions for improving the program. Content analysis was used to analyse the translated interview data. A total of 68 participants from 12 Hunan counties were interviewed (34 from each of the Bureau of Health and the Narcotic Division). Both groups recognised the importance and effectiveness of NSPs in HIV prevention, but public security officials regarded NSPs as a temporary intervention in place of punitive measures. Most health officials (32/34) regarded the main barriers to its implementation as administrative and structural, whereas participants from Narcotics Division (n=24) questioned the legitimacy of NSPs and concerned about the poor management of drug users’ risk behaviours. Close cooperation between the health and public security sectors, engagement of the drug user community and an enabling policy environment were reportedly to be critical for potential improvements of NSPs in China. Misconceptions about NSPs encourage drug users’ addictive behaviour, and an unclear leadership and insufficient support de-motivate the participants from the Bureau of Health and the Narcotics Division to actively support the program implementation.

Voices of dissent: unpacking Vietnamese international student experience

Purpose The purpose of this paper is to examine Vietnamese international students’ experiences with the campus learning environment by analysing differences in staff and student perceptions. Design/methodology/approach Two focus groups (n=12) and ten in-depth interviews were conducted with Vietnamese students and four in-depth interviews with the university staff (totalling 26). Findings The findings show a greater divergence of views between students and staff on teaching and learning than English language proficiency and student support services. These key differences were influenced by students’ prior expectations of their learning environment in Vietnam. Research limitations/implications This study is limited to one group of international students and to one Australian university. Practical implications The lecturers/administrators must have a good understanding of international students’ learning backgrounds and expectations to enhance their positive experience; appropriate teaching skills and practices are essential for teachers to meet the current needs of students. More effective training for international students to understand the multicultural nature of Australia is also essential. Originality/value This study contributes to the literature by identifying the experience of Vietnamese international students in a western university, which is, a relatively under-researched nationality compared to other Asian nationalities such as Chinese and Indian.