Hsing Fang Hsieh

Stages of mammography adoption in Asian American women

Asian American women have the lowest mammography screening rate and are often diagnosed at later stages of breast cancer compared with other ethnic groups. This study applied the Transtheoretical Model and examined the relationships between stages of mammography adoption and mammography-related beliefs while controlling for socio-demographic factors. The study consisted of a convenience sample of 315 participants from four populous Asian ethnic groups in Michigan (109 Asian Indians, 51 Chinese, 36 Koreans and 119 Filipinos). In this relatively small sample, Koreans appeared to be more likely to be at the pre-contemplation stage and less likely to be at the maintenance stage. Perceived barriers and decisional balance scores differed by stage, with pre-contemplators reporting highest barriers and lowest scores in decisional balance. In terms of specific barrier items, pre-contemplators also displayed significantly greater agreement for most of the barrier items. Participants in the action stage have less favorable decisional balance than those in two earlier stages (i.e. contemplation and relapse). Common barriers for this sample of Asian participants included the items related to access and modesty issues. Overall, the study supports the notion that assessing differences in mammography-related beliefs by stage of screening behavior may facilitate the development of stage-matched interventions for Asian ethnic groups.

Demographics and Perceptions of Barriers Toward Breast Cancer Screening Among Asian-American Women

ABSTRACT Objective: The purpose of this study was to identify and compare the differences in perceived barriers for mammography screening among four ethnic groups of Asian-American women. Methods: Self-administered questionnaires were completed by 315 women in these four groups. Results: The results from the multivariate analyses indicated that even after taking into account insurance coverage and demographic variables, specific barriers still prevent Asian-American women from seeking mammography. Discussion: Recognizing similarities and differences in the barriers among demographic variables such as ethnicity, age, and length of U.S. residency among Asian subgroups can assist health professionals to address their needs when promoting adherence to mammography guidelines.

Ethnicity and Cardiovascular Risk Factors Among Asian Americans Residing in Michigan

Asian Americans are at least 4% of the US population, but there are very few studies about the prevalence of cardiovascular risk factors among this group. Cardiovascular disease (CVD) is the leading cause of death among Asian Americans in the United States. Limited research that studied cardiovascular risks among Asian Americans were available, therefore, more information is urgently needed. Cross-sectional surveys and blood tests were conducted at community-based health fairs in southeastern Michigan. A total of 388 Asian participants provided data for this analysis. The results showed that four Asian groups differ in the level of specific risk factors; in particular, the most urgent hypertension and cholesterol problems were found among Chinese and Filipino participants, while the risk of diabetes may be highest among the Hmong participants. The results from the multivariate analysis showed that after controlling for demographic and medical care-related factors in the model, ethnicity is still a significant predictor that contributed to the differences in CVD risks. The results show that cardiovascular and diabetes risks are high in the Asian American populations studied. Attention needs to be paid to the extent and nature of ethnic-specific health problems because each culture’s health-related habits and beliefs affect their entry into preventive care so that strategies can be designed and implemented to effectively reduce and ultimately eliminate health disparities.

Stress, active coping, and problem behaviors among Chinese adolescents

Little is known about the stress and coping mechanisms on problem behaviors among Chinese adolescents, which might be quite different from their counterparts in Western cultures. We examined risk process of stress for internalizing outcomes (i.e., psychological distress, self-acceptance) and externalizing outcomes (i.e., substance use, delinquency, violent behavior) among Chinese adolescents. We also examined John Henryism Active Coping as a protective factor in a test of resilience from the negative effects of stress. A cross-sectional survey using self-reported questionnaires was conducted in 2 urban cities in China: Beijing and Xian. Participants included 1,356 students in Grades 7 to 12 (48% male, 52% female). Structural equation modeling analyses were conducted to test the conceptual model. The modifying (protective) effects of John Henryism were tested in multiple-group analysis. After controlling for demographics, we found that stress was associated with decreased self-acceptance and increased psychological distress among adolescents. Higher degree of psychological distress was then associated with increased delinquent behaviors and substance use. The results also indicated that individuals who scored higher in John Henryism reported more substance use as a result of psychological distress. Overall, our results support previous research with Western samples. Although John Henryism did not serve as a protective factor between stress and its negative outcomes, the findings underscore the relevance of addressing stress and possible coping strategies among Chinese adolescents. Further research that refines the active coping tailored for Chinese adolescents is necessary to more precisely test its protective effects.

Family Functioning and Parent Support Trajectories and Substance Use and Misuse among Minority Urban Adolescents: A Latent Class Growth Analysis

We sought to examine latent classes of family functioning and parent support trajectories during high school and whether these trajectories are associated with an increased risk of substance use and misuse among urban youth. A total of 850 adolescents (Mage = 15.1 years) were included in this study, assessed at baseline, 12-, 24-, and 36-months postbaseline, and completed self-report measures on past 30-day alcohol and marijuana use, binge drinking, and measures of family functioning and parent support. Latent class growth analysis revealed that trajectories of high family functioning and parent support are associated with a decreased risk of marijuana use. Findings may be helpful to inform family-based preventive interventions.

Perceived Peer Behavior and Parental Support as Correlates of Marijuana Use: The Role of Age and Gender

ABSTRACT Introduction: Parental support and perceptions of peer behavior on substance use are well-studied, but precisely how their associations vary as a function of age, and how those age-specific patterns vary by gender, remain unknown components of the developmental process underlying substance use. Methods: Using data from an 18-year longitudinal study of predominantly African-American students at high-risk for high school dropout in Flint, Michigan (baseline average age = 14.8 years), we examined longitudinal associations between past 30-day marijuana use and three self-reported variables: perceived friend drug use, perceived friend aggression, parental support. We used varying-coefficient regression models to semiparametrically estimate how covariate effects on past 30-day marijuana use vary smoothly as a function of age; gender differences in these age-specific coefficient trajectories were also tested. Results: In the unadjusted tests, the risk-enhancing effect of perceived friend drug use decreased with age in both genders, but the effect of perceived friend aggression varied only in females; in both cases, gender differences were not significant. In males, parental support had protective effects that decreased with age. The effect of both parental support differed in females, with less protective baseline effects and no evidence of age-variation. Adjusted models simultaneously including both friend and parental variables produced qualitatively similar results. Conclusions: Prevention strategies focusing on social exposures may be more effective if they are age- and gender-specific. In particular, interventions focusing on perceived peer behaviors may be more appropriate during adolescence, and those involving parental relationships may be more appropriate for males.

Compliance with point-of-sale tobacco control policies and student tobacco use in Mumbai, India

Background We measured how student tobacco use and psychological risk factors (intention to use and perceived ease of access to tobacco products) were associated with tobacco vendor compliance with India’s Cigarettes and Other Tobacco Products Act provisions regulating the point-of-sale (POS) environment. Methods We conducted a population-based cross-sectional survey of high school students (n=1373) and tobacco vendors (n=436) in school-adjacent communities (n=26) in Mumbai, India. We used in-class self-administered questionnaires of high school students, face-to-face interviews with tobacco vendors and compliance checks of tobacco POS environments. Logistic regression models with adjustments for clustering were used to measure associations between student tobacco use, psychological risk factors and tobacco POS compliance. Results Compliance with POS laws was low overall and was associated with lower risk of student current tobacco use (OR 0.48, 95% CI 0.26 to 0.91) and current smokeless tobacco use (OR 0.40, 95% CI 0.21 to 0.77), when controlling for student-level and community-level tobacco use risk factors. Compliance was not associated with student intention to use tobacco (OR 0.50; 95% CI 0.21 to 1.18) and perceived ease of access to tobacco (OR 0.73; 95% CI 0.53 to 1.00). Conclusions Improving vendor compliance with tobacco POS laws may reduce student tobacco use. Future studies should test strategies to improve compliance with tobacco POS laws, particularly in low-income and middle-income country settings like urban India.

Are trajectories of a syndemic index in adolescence linked to HIV vulnerability in emerging and young adulthood

Objectives: To examine trajectories of adolescent psychosocial risk – drug use, depressive and anxiety symptoms, and violence victimization and observation – and the longitudinal relationship between psychosocial risk trajectories during adolescence and HIV risk behaviors in adulthood. Methods: The 18-year longitudinal study was conducted from September 1994 through May 2013, in Michigan. Eight hundred and fifty predominantly (80%) African-American adolescents completed demographics and measures of drug use, depressive and anxiety symptoms, violence victimization and observation at Times 1–4, sexual risk behaviors at Times 5 and 6, and social conditions (i.e. family, peer, and community-level factors) between 14.9 and 32.0 years of age. Results: Growth mixture modeling revealed two trajectories of psychosocial risk factors which can be characterized as a syndemic index: high-frequency and low-frequency. The high-frequency class was more likely to report HIV risk behaviors, including condomless sex at last sexual intercourse with their primary and secondary partner, sexual intercourse with someone they just met, at least four sexual partners, and licit and illicit drug use prior to sexual intercourse at Time 5 (mean age 23.1). At Time 6 (mean age 32.0), the high-frequency class was more likely to report sexual intercourse with someone they just met and at least four sexual partners, relative to the low-frequency class. In addition, the high-frequency class was linked to peer and family-level indicators of social conditions. Conclusion: A syndemic index comprised of co-occurring psychosocial risk factors in adolescence seem to have lasting effects on the vulnerability to engage in HIV risk behaviors in emerging adulthood, some of which extend into young adulthood.

Violence Victimization, Social Support, and Papanicolaou Smear Outcomes: A Longitudinal Study from Adolescence to Young Adulthood

BACKGROUND African American youth are among those at greatest risk for experiencing violence victimization. Notably, the mortality rate of cervical cancer for African American women is also twice that of white women. To date, we know of no literature using longitudinal data to examine how violence victimization relates to Papanicolaou (Pap) smear results or cervical cancer in this population. Our study examines how violence victimization during adolescence (age 15 to 18) influences psychological distress, perceived social support, heavy substance abuse, and sexual risk behaviors during emerging adulthood (age 20 to 23), and subsequent Pap smear outcomes during young adulthood (age 29 to 32). METHOD This study is based on 12 waves of data collected in a longitudinal study of 360 African American women from mid-adolescence (ninth grade, mean age = 14.8 years) to young adulthood (mean age = 32.0 years). We used structural equation modeling analysis to examine the hypothesized model. RESULT Violence victimization during adolescence had a direct effect on decreased social support, increased psychological distress, and increased heavy cigarette use during emerging adulthood. Better social support was also associated with fewer sexual partners during emerging adulthood and lower odds of abnormal Pap smear results during young adulthood. The effect of violence victimization on abnormal Pap smear was mediated by social support. CONCLUSION Our results show that violence victimization during adolescence has long-term negative effects through multiple pathways that persist into adulthood. Our findings also suggest that social support may help to compensate against other risk factors. Interventions designed to address the perceived support may help victims cope with their experience.

The Protective Effects of Social Support and Engagement Coping Strategy on the Relationship between Perceived Discrimination and Psychological Distress among Chinese Migrant Children.

This study was aimed to figure out whether perceived stress mediates the relationship between perceived discrimination and psychological distress among Chinese migrant children and whether social support and engagement coping moderate the detrimental effects of perceived discrimination on psychological distress. The sample comprised 813 middle-school students (482 migrant children, 331 non-migrant children) from three schools in Southwest China. The results indicate that migrant children’s perceived discrimination and perceived stress are associated with psychological distress, and perceived stress does not mediate the relationship between perceived discrimination and psychological distress. Both social support and engagement coping are inversely related to psychological distress and compensate the deleterious influences of perceived discrimination and stress on psychological distress. These findings highlight the need to consider providing social support and cultivating engagement coping when designing mental health interventions to reduce the negative influence of perceived discrimination on Chinese migrant children’s mental health.