Hee Soon Juon

Model minority at risk: expressed needs of mental health by Asian American young adults.

The objective of this study is to obtain and discuss in-depth information on mental health problems, including the status, barriers, and potential solutions in 1.5 and 2nd generation Asian American young adults. As a part of the Health Needs Assessment project, the researchers conducted two focus groups with 17 young adults (mainly 1.5 or 2nd generation) from eight Asian American communities (Asian Indian, Cambodian, Chinese, Indonesian, Korean, Taiwanese, Thai, and Vietnamese) in Montgomery County, Maryland. We developed a moderator’s guide with open-ended questions and used it to collect qualitative data. Using a software, we organized and identified emergent themes by major categories. Participants reported a several common sources of stress that affect the mental health of Asian American young adults including: pressure to meet parental expectations of high academic achievement and live up to the “model minority” stereotype; difficulty of balancing two different cultures and communicating with parents; family obligations based on the strong family values; and discrimination or isolation due to racial or cultural background. Young Asian Americans tend not to seek professional help for their mental health problems; instead they use personal support networks—close friends, significant others, and religious community. Participants suggested that Asian cultural norms that do not consider mental problems important, and associated stigma of seeking professional care might undermine their mental health help seeking behavior. Our findings support a need for delivering culturally appropriate programs to raise awareness of mental health and cultural training for health providers to deliver culturally appropriate care.

A longitudinal study of developmental trajectories to young adult cigarette smoking

This study examined smoking trajectories between adolescence and adulthood in an African American cohort followed prospectively from first grade to age 32. We classified non-smokers, former smokers, current smokers/late adopters (initiated after age 18), and current smokers/early adopters (initiated before age 17). Results show that almost half of the population were currently smoking. Multiple logistic regression analyses showed that non-smokers differed most from the three smoking groups on social integration. Non-smokers were less likely to have left home before the age of 18, to have had more drug use parental supervision as an adolescent, to have moved less, and to attend church more frequently as an adult. Those current smokers who initiated early differed from the non-smokers and also from the former smokers and the current smokers who adopted smoking after the age of 18; they were more likely to be rated as aggressive or both shy and aggressive by their first grade teachers and to have drug problems as adults. Current smokers were less likely to attend church as adults than the non-smokers and former smokers. Neither mothers smoking or lifetime depression was related to smoking. The findings elucidate the contribution of factors over the life course that have an impact on smoking initiation, continuation, and cessation. They highlight the importance of targeting African American children and adolescents for prevention despite the fact that African American youth have the lowest rates of smoking across all ethnic groups. Possible interventions could be aimed at early aggressive behavior, parental supervision and monitoring, and other social integration efforts.

Cardiovascular Disease Risk Factors in Korean American Elderly

An in-depth cardiovascular risk factor assessment was carried out in a sample of 205 Korean American elderly in Maryland, consisting of 75 males and 130 females aged 60 to 89 years (mean age = 69.9±6.5 years). Six risk factors were assessed in each participant: high blood pressure, current smoking, high blood cholesterol, overweight, sedentary lifestyle, and diabetes. The findings of this cross-sectional study suggested that high blood pressure was the leading cardiovascular disease risk factor among Korean American elderly (71%), followed by high blood cholesterol (53%), overweight (43%), sedentary life style (24%), diabetes (18%), and smoking (7%). Two thirds of the sample had multiple cardiovascular disease risk factors. The pattern of prevalence and risk factors that was observed was consistent with the distribution of multiple risk factors in that the combination of high blood pressure, high blood cholesterol, and overweight was most common in Korean American elderly (62%). These findings indicate that culturally relevant and salient strategies are needed to reduce multiple risk factors in this population.

Peer, parent and media influences on adolescent smoking by developmental stage

Previous studies of social influences on adolescent smoking have focused on peers and parents, using data collected prior the 1998 Master Settlement Agreement. This study used the 2004 wave of the National Youth Tobacco Survey to examine associations between peer smoking, smoking at home, tobacco-related media exposure, and smoking behavior during early and middle adolescence. Findings indicate that peer smoking and smoking at home remain strongly associated with current smoking among early and middle adolescents, controlling for gender, race/ethnicity and exposure to tobacco industry and anti-tobacco media. The magnitude of the association between peer smoking and current smoking decreases from early adolescence to middle adolescence while the association between smoking at home and current smoking is static across developmental stage. Exposure to tobacco-related media is associated with increased current and former smoking in both early and middle adolescence.

Effect of Acupressure on Nausea and Vomiting During Chemotherapy Cycle for Korean Postoperative Stomach Cancer Patients

Despite the development of effective antiemetic drugs, nausea and vomiting remain the main side effects associated with cancer chemotherapy. The purpose of this study was to examine the effect of acupressure on emesis control in postoperative gastric cancer patients undergoing chemotherapy. Forty postoperative gastric cancer patients receiving the first cycle of chemotherapy with cisplatin and 5-Fluorouracil were divided into control and intervention groups (n = 20 each). Both groups received regular antiemesis medication; however, the intervention group received acupressure training and was instructed to perform the finger acupressure maneuver for 5 minutes on P6 (Nei-Guan) point located at 3-finger widths up from the first palmar crease, between palmaris longus and flexor carpi radialis tendons point, at least 3 times a day before chemotherapy and mealtimes or based on their needs. Both groups received equally frequent nursing visits and consultations, and reported nausea and vomiting using Rhodes Index of Nausea, Vomiting and Retching. We found significant differences between intervention and control groups in the severity of nausea and vomiting, the duration of nausea, and frequency of vomiting. This study suggests that acupressure on P6 point appears to be an effective adjunct maneuver in the course of emesis control.

Predictors of Older Korean Americans' Participation in Colorectal Cancer Screening

BACKGROUND Cancer is the second leading cause of death among Korean Americans aged 65 and older. Colorectal cancer is the second most commonly diagnosed cancer among Korean American women and the third among men. The purpose of this study was to examine the rates of colorectal cancer (CRC) screening and the correlates of screening tests. METHODS The study employed cross-sectional face-to-face interviews with a sample of 205 Korean American elderly aged 60 and older. RESULTS About 18% of respondents had ever had a fecal occult blood test (FOBT) and 11%, sigmoidoscopy. A history of bloody stool was related to having FOBT. In multiple logistic regression analyses, government assistance, routine checkups, having insurance, and speaking fluent English were associated with having FOBT. Marital status, proportion of time spent in the U.S., and general health status were related to having sigmoidoscopy. CONCLUSIONS The findings suggest a need for further research addressing barriers to cancer screening in Korean Americans.

Risk factors for suicide in Caucasians and in African-Americans: a matched case-control study

Abstract It is known that suicide rates for Caucasians are higher than those for African-Americans. However, there has been little research examining whether risk factors associated with suicide differ by race, when the effects of age, gender, and educational-occupational status are taken into account. A matched case-control study was constructed from the 1986 National Mortality Followback Survey to address such concerns. Cases included all individuals aged between 25 and 64 years dying from suicide. Controls were those who died of natural causes, who were frequency matched to cases by age and gender. The study results for Caucasians indicate that those who had at least a high school education were more likely to commit suicide [odds ratio (OR) = 1.91; 95% confidence interval (CI) = 1.37–2.67] than those who had less than a high school education; those who were heavy drinkers were more likely to commit suicide (OR = 1.64; 95% CI = 1.16–2.33) than those who were light or moderate drinkers; those who lived alone were more likely to commit suicide (OR = 1.72; 95% CI = 1.28–2.30) than those who lived with others; those who had blue-collar occupations were more likely to commit suicide (OR = 1.79; 95% CI = 1.33–2.42) than those who had white-collar occupations; and those who had used mental health services were more likely to commit suicide (OR = 3.07; 95% CI = 2.34–4.01) than those who had not used them. For African-Americans, use of mental health services was the only factor significantly associated with suicide (OR = 4.56 95% CI = 1.69–12.29).

Correlates of non-medical prescription drug use among a cohort of injection drug users in Baltimore City

Despite reports of increasing non-medical prescription drug use, relatively few studies have systematically evaluated the prevalence and correlates of non-medical prescription drug use, particularly in populations that might be especially vulnerable (e.g., injection drug users [IDUs]). We examined factors associated with non-medical prescription drug use among a community-based cohort of current and former IDUs in Baltimore (The ALIVE Study). We conducted a cross-sectional analysis of data from cohort participants that responded to a survey that included questions on non-medical prescription drug use between 2005-06 (n=1320). Non-medical prescription drug use was considered to be use of any of the following: Opiates (Oxycontin, Percocet), Benzodiazepines or Clonidine, purchased on the street and taken orally within the last six months. Data on other covariates of interest (e.g., demographics, substance use, general health) was obtained through a standardized interview. The median age was 46 years; 66% were male, 85% were African-American. Twenty one percent reported any non-medical prescription drug use; 12% reported using more than one drug. Non-medical use of opiates was most common (17%). In multivariate analysis, non-medical prescription drug use was significantly associated with Caucasian race (prevalence ratio [PR]: 1.79), self-reported bodily pain (PR: 1.58), hazardous alcohol use (PR: 1.47), marijuana use (PR: 1.65), non-injection cocaine/heroin use (PR: 1.70), diverted use of buprenorphine (PR: 1.51) or methadone (PR: 2.51), and active injection drug use (PR: 3.50; p<0.05 for all). The association between bodily pain and non-medical prescription drug use was stronger among persons that were not using substances (marijuana, injecting drugs, snorting/smoking heroin, cocaine, using crack) as compared to those using these substances. The high prevalence of non-medical prescription drug use among this population warrants further research and action. Information on the risks of nonmedical prescription drug use especially overdose, should be incorporated into interventions targeted at IDUs.

Pathways to Adult Marijuana and Cocaine Use: A Prospective Study of African Americans from Age 6 to 42

This study examines pathways to adult marijuana and cocaine use in a cohort of African Americans from Woodlawn, an inner city community in Chicago. Assessments were conducted in first grade (age 6), adolescence (age 16), early adulthood (age 32), and in mid-adulthood (age 42). The “social adaptation life course” framework guided the focus on social adaptation, social bonds, and economic resources as predictors of adult drug use. Results indicate that more frequent substance use in adolescence and lower-income and less-frequent church attendance in early adulthood increase the risk of mid-life drug use. Shyness in first grade related inversely to later cocaine use and marijuana use (marginally significant). Indirect pathways to drug use also were identified. Gender differences were not significant. The findings show continuities in social maladaptation over time and the importance of social integration and economic resources in the early adult years.

Barriers to health care access in 13 Asian American communities

OBJECTIVE To obtain and discuss in-depth information on health care use in Asian Americans (AAs). METHODS Nineteen focus groups were conducted in 174 adults from 13 AA communities in Montgomery County, Maryland. MAX QDA software was used to analyze qualitative data. RESULTS Financial, physical, communication, and cultural attitudes were 4 major barriers to accessing health care. Underrepresented communities reported unique additional barriers, such as lack of screening opportunities and interpretation services due to lack of resources in the communities. CONCLUSIONS Future studies, public health policy, and funding resources should consider including underrepresented AA subgroups and reflect their needs.