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Colorectal Cancer-Related Knowledge, Acculturation, and Healthy Lifestyle Behaviors Among Low-Income Vietnamese Americans in the Greater Philadelphia Metropolitan Area

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Abstract

Colorectal cancer (CRC) is the second and fourth most common cancer in Vietnamese American women and men, respectively. Recent research has highlighted the importance of modifiable lifestyle behaviors such as smoking, alcohol use, dietary behaviors, and physical activities in CRC prevention for the general population. However, it is not well understood how well Vietnamese Americans knew about CRC prevention and risk factors, and whether there were any disparities in knowledge within this vulnerable population. This study examined whether comprehensive measures of acculturation and knowledge of CRC risk are associated with different health behaviors, specifically physical activity, protective dietary behaviors, and risky dietary behaviors in Vietnamese Americans. We recruited 374 Vietnamese Americans aged 50 or above from community-based organizations in the Vietnamese American communities in the greater Philadelphia metropolitan area. Through a cross-sectional survey, we collected data on their knowledge of CRC prevention and risk factors, acculturation-related factors, and sociodemographic characteristics. We found limited knowledge of CRC prevention and risk factors, and suboptimal physical activity and healthy dietary behaviors in the Vietnamese Americans. We also found that higher levels of knowledge about CRC and risk factors were associated with less unhealthy diets but not with more protective diets or physical activity. Acculturation was not significantly associated with overall dietary behaviors in our study. Our findings addressed gaps in current literature concerning the impact of knowledge about CRC risk factors and acculturation on different dimensions of dietary behaviors as well as physical activity. Research and practical implications were discussed.

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References

  1. Howlader, N., Noone, A. M., Krapcho, M., Garshell, J., & Miller, D. (2013). SEER cancer statistics review, 1975–2011. SEER. https://seer.cancer.gov/archive/csr/1975_2011/index.html.

  2. Gomez, S. L., Noone, A.-M., Lichtensztajn, D. Y., Scoppa, S., Gibson, J. T., Liu, L., et al. (2013). Cancer incidence trends among Asian American populations in the United States, 1990–2008. Journal of the National Cancer Institute, 105(15), 1096–1110. https://doi.org/10.1093/jnci/djt157.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Edwards, B. K., Ward, E., Kohler, B. A., Eheman, C., Zauber, A. G., Anderson, R. N., et al. (2010). Annual report to the nation on the status of cancer, 1975–2006, featuring colorectal cancer trends and impact of interventions (risk factors, screening, and treatment) to reduce future rates. Cancer, 116(3), 544–573. https://doi.org/10.1002/cncr.24760.

    Article  PubMed  Google Scholar 

  4. American Cancer Society. (2015). Cancer prevention & early detection. American Cancer Society. https://www.cancer.org/research/cancer-facts-statistics/cancer-prevention-early-detection.html.

  5. Baena, R., & Salinas, P. (2015). Diet and colorectal cancer. Maturitas, 80(3), 258–264. https://doi.org/10.1016/j.maturitas.2014.12.017.

    Article  CAS  PubMed  Google Scholar 

  6. Afable-Munsuz, A., Ponce, N. A., Rodriguez, M., & Perez-Stable, E. J. (2010). Immigrant generation and physical activity among Mexican, Chinese & Filipino adults in the US. Social Science & Medicine (1982), 70(12), 1997–2005. https://doi.org/10.1016/j.socscimed.2010.02.026.

    Article  Google Scholar 

  7. Kandula, N. R., & Lauderdale, D. S. (2005). Leisure time, non-leisure time, and occupational physical activity in Asian Americans. Annals of Epidemiology, 15(4), 257–265. https://doi.org/10.1016/j.annepidem.2004.06.006.

    Article  PubMed  Google Scholar 

  8. Li, K., & Wen, M. (2013). Racial and ethnic disparities in leisure-time physical activity in California: Patterns and mechanisms. Race and Social Problems, 5(3), 147–156. https://doi.org/10.1007/s12552-013-9087-9.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Maxwell, A. E., Crespi, C. M., Alano, R. E., Sudan, M., & Bastani, R. (2012). Health risk behaviors among five Asian American subgroups in California: Identifying intervention priorities. Journal of Immigrant and Minority Health, 14(5), 890–894. https://doi.org/10.1007/s10903-011-9552-8.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Yi, S. S., Roberts, C., Lightstone, A. S., Shih, M., & Trinh-Shevrin, C. (2015). Disparities in meeting physical activity guidelines for Asian Americans in two metropolitan areas in the United States. Annals of Epidemiology, 25(9), 656–660.e2. https://doi.org/10.1016/j.annepidem.2015.05.002.

    Article  PubMed  PubMed Central  Google Scholar 

  11. The New York City Department of Health and Mental Hygiene. (2013). Physical activity & transit survey. https://www1.nyc.gov/site/doh/data/data-sets/physical-activity-and-transit-survey.page.

  12. Ngoan, L. T., Thu, N. T., Lua, N. T., Hang, L. T. M., Bich, N. N., Hieu, N. V., et al. (2009). Cooking temperature, heat-generated carcinogens, and the risk of stomach and colorectal cancers. Asian Pacific Journal of Cancer Prevention: APJCP, 10(1), 83–86.

    Google Scholar 

  13. McPhee, S. J., & Nguyen, T. T. (2000). Cancer, cancer risk factors, and community-based cancer control trials in Vietnamese Americans. Asian American and Pacific Islander Journal of Health, 8(1), 18–31.

    PubMed  PubMed Central  Google Scholar 

  14. Nguyen, T. T., Liao, Y., Gildengorin, G., Tsoh, J., Bui-Tong, N., & McPhee, S. J. (2009). Cardiovascular risk factors and knowledge of symptoms among Vietnamese Americans. Journal of General Internal Medicine, 24(2), 238–243. https://doi.org/10.1007/s11606-008-0889-1.

    Article  PubMed  Google Scholar 

  15. Rahman, M. M., Luong, N. T., Divan, H. A., Jesser, C., Golz, S. D., Thirumalai, K., et al. (2005). Prevalence and predictors of smoking behavior among Vietnamese men living in California. Nicotine & Tobacco Research: Official Journal of the Society for Research on Nicotine and Tobacco, 7(1), 103–109. https://doi.org/10.1080/14622200412331328487.

    Article  Google Scholar 

  16. Abraído-Lanza, A. F., Chao, M. T., & Flórez, K. R. (2005). Do healthy behaviors decline with greater acculturation? Implications for the Latino mortality paradox. Social Science & Medicine, 61(6), 1243–1255. https://doi.org/10.1016/j.socscimed.2005.01.016.

    Article  Google Scholar 

  17. Andreeva, V. A., Kesse-Guyot, E., Barberger-Gateau, P., Fezeu, L., Hercberg, S., & Galan, P. (2011). Cognitive function after supplementation with B vitamins and long-chain omega-3 fatty acids: Ancillary findings from the SU.FOL.OM3 randomized trial. The American Journal of Clinical Nutrition, 94(1), 278–286. https://doi.org/10.3945/ajcn.110.006320.

    Article  CAS  PubMed  Google Scholar 

  18. Ayala, Y. M., Zago, P., D’Ambrogio, A., Xu, Y.-F., Petrucelli, L., Buratti, E., et al. (2008). Structural determinants of the cellular localization and shuttling of TDP-43. Journal of Cell Science, 121(Pt 22), 3778–3785. https://doi.org/10.1242/jcs.038950.

    Article  CAS  PubMed  Google Scholar 

  19. Diez Roux Ana, V., Robert, D., Sharon, J., Jacobs, D. R., Schreiner, P. J., Steven, S., et al. (2005). Acculturation and socioeconomic position as predictors of coronary calcification in a multiethnic sample. Circulation, 112(11), 1557–1565. https://doi.org/10.1161/CIRCULATIONAHA.104.530147.

    Article  CAS  PubMed  Google Scholar 

  20. Gordon-Larsen, P., Harris, K. M., Ward, D. S., & Popkin, B. M. (2003). Acculturation and overweight-related behaviors among Hispanic immigrants to the US: The National Longitudinal Study of Adolescent Health. Social Science & Medicine, 57(11), 2023–2034. https://doi.org/10.1016/S0277-9536(03)00072-8.

    Article  Google Scholar 

  21. Kandula, N. R., Diez-Roux, A. V., Chan, C., Daviglus, M. L., Jackson, S. A., Ni, H., et al. (2008). Association of acculturation levels and prevalence of diabetes in the multi-ethnic study of atherosclerosis (MESA). Diabetes Care, 31(8), 1621–1628. https://doi.org/10.2337/dc07-2182.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Lutsey, P. L., Steffen, L. M., & June, S. (2008). Dietary intake and the development of the metabolic syndrome. Circulation, 117(6), 754–761. https://doi.org/10.1161/CIRCULATIONAHA.107.716159.

    Article  PubMed  Google Scholar 

  23. Moran, B. I., & Wildman, S. M. (2007). Race and wealth disparity: The role of law and the legal system (SSRN Scholarly Paper ID 1020321). Social Science Research Network. https://papers.ssrn.com/abstract=1020321.

  24. Ro, A. (2014). The longer you stay, the worse your health? A critical review of the negative acculturation theory among Asian immigrants. International Journal of Environmental Research and Public Health, 11(8), 8038–8057. https://doi.org/10.3390/ijerph110808038.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Désilets, M.-C., Rivard, M., Shatenstein, B., & Delisle, H. (2007). Dietary transition stages based on eating patterns and diet quality among Haitians of Montreal, Canada. Public Health Nutrition, 10(5), 454–463. https://doi.org/10.1017/S1368980007222931.

    Article  PubMed  Google Scholar 

  26. Lara, M., Gamboa, C., Kahramanian, M. I., Morales, L. S., & Bautista, D. E. H. (2005). Acculturation and Latino health in the United States: A review of the literature and its sociopolitical context. Annual Review of Public Health, 26, 367–397. https://doi.org/10.1146/annurev.publhealth.26.021304.144615.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Patil, C. L., Hadley, C., & Nahayo, P. D. (2009). Unpacking dietary acculturation among new Americans: Results from formative research with African refugees. Journal of Immigrant and Minority Health, 11(5), 342–358. https://doi.org/10.1007/s10903-008-9120-z.

    Article  PubMed  Google Scholar 

  28. Khan, S. A., Jackson, R. T., & Momen, B. (2016). The relationship between diet quality and acculturation of immigrated South Asian American adults and their association with metabolic syndrome. PLoS ONE, 11(6), e0156851. https://doi.org/10.1371/journal.pone.0156851.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Liu, A., Berhane, Z., & Tseng, M. (2010). Improved dietary variety and adequacy but lower dietary moderation with acculturation in Chinese women in the United States. Journal of the American Dietetic Association, 110(3), 457–462. https://doi.org/10.1016/j.jada.2009.11.016.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Kirshner, L., Yi, S. S., Wylie-Rosett, J., Matthan, N. R., & Beasley, J. M. (2019). Acculturation and diet among Chinese American immigrants in New York City. Current Developments in Nutrition, 4(1), nzz124. https://doi.org/10.1093/cdn/nzz124.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Lee, M., Zhu, L., Wang, M. Q., Wei, Z., Tan, Y., Nguyen, M. T., et al. (2017). Psychosocial predictors of HBV screening behavior among Vietnamese Americans. American Journal of Health Behavior, 41(5), 561–570. https://doi.org/10.5993/AJHB.41.5.5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Fang, C. Y., Lee, M., Feng, Z., Tan, Y., Levine, F., Nguyen, C., et al. (2019). Community-based cervical cancer education: Changes in knowledge and beliefs among Vietnamese American women. Journal of Community Health, 44(3), 525–533. https://doi.org/10.1007/s10900-019-00645-6.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Walsh, J. M. E., Kaplan, C. P., Nguyen, B., Gildengorin, G., McPhee, S. J., & Pérez-Stable, E. J. (2004). Barriers to colorectal cancer screening in Latino and Vietnamese Americans. Compared with non-Latino white Americans. Journal of General Internal Medicine, 19(2), 156–166. https://doi.org/10.1111/j.1525-1497.2004.30263.x.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Le, T. D., Carney, P. A., Lee-Lin, F., Mori, M., Chen, Z., Leung, H., et al. (2014). Differences in knowledge, attitudes, beliefs, and perceived risks regarding colorectal cancer screening among Chinese, Korean, and Vietnamese sub-groups. Journal of Community Health, 39(2), 248–265. https://doi.org/10.1007/s10900-013-9776-8.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Afable, A., Ursua, R., Wyatt, L. C., Aguilar, D., Kwon, S. C., Islam, N. S., et al. (2016). Duration of US residence is associated with overweight risk in Filipino immigrants living in NY metro area. Family & Community Health, 39(1), 13–23. https://doi.org/10.1097/FCH.0000000000000086.

    Article  Google Scholar 

  36. Bhattacharya Becerra, M., Herring, P., Marshak, H. H., & Banta, J. E. (2015). Social determinants of physical activity among adult Asian-Americans: Results from a population-based survey in California. Journal of Immigrant and Minority Health, 17(4), 1061–1069. https://doi.org/10.1007/s10903-014-0074-z.

    Article  PubMed  Google Scholar 

  37. Yi, S. S., Beasley, J. M., Kwon, S. C., Huang, K.-Y., Trinh-Shevrin, C., & Wylie-Rosett, J. (2016). Acculturation and activity behaviors in Chinese American immigrants in New York City. Preventive Medicine Reports, 4, 404–409. https://doi.org/10.1016/j.pmedr.2016.08.007.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Pérez-Escamilla, R., & Putnik, P. (2007). Role of acculturation in nutrition, lifestyle, and incidence of Type 2 diabetes among Latinos | | Oxford academic. The Journal of Nutrition, 137(4), 860–870. https://doi.org/10.1093/jn/137.4.860.

    Article  PubMed  Google Scholar 

  39. Ha, A. S., Macdonald, D., & Pang, B. O. H. (2020). Physical activity in the lives of Hong Kong Chinese children. Sport, Education and Society, 15(3), 331–346. https://doi.org/10.1080/13573322.2010.493313.

    Article  Google Scholar 

  40. Zhou, N., Cheah, C. S. L., Van Hook, J., Thompson, D. A., & Jones, S. S. (2015). A cultural understanding of Chinese immigrant mothers’ feeding practices: A qualitative study. Appetite, 87, 160–167. https://doi.org/10.1016/j.appet.2014.12.215.

    Article  PubMed  Google Scholar 

  41. Lv, N., & Cason, K. L. (2004). Dietary pattern change and acculturation of Chinese Americans in Pennsylvania. Journal of the American Dietetic Association, 104(5), 771–778. https://doi.org/10.1016/j.jada.2004.02.032.

    Article  PubMed  Google Scholar 

  42. Tseng, M., Wright, D. J., & Fang, C. Y. (2015). Acculturation and dietary change among Chinese immigrant women in the United States. Journal of Immigrant and Minority Health / Center for Minority Public Health, 17(2), 400–407. https://doi.org/10.1007/s10903-014-0118-4.

    Article  PubMed Central  Google Scholar 

  43. Dela Cruz, F. A., Lao, B. T., & Heinlein, C. (2013). Level of acculturation, food intake, dietary changes, and health status of first-generation Filipino Americans in Southern California. Journal of the American Association of Nurse Practitioners, 25(11), 619–630. https://doi.org/10.1111/1745-7599.12031.

    Article  PubMed  Google Scholar 

  44. Jasti, S., Lee, C. H., & Doak, C. (2011). Gender, acculturation, food patterns, and overweight in Korean immigrants. American Journal of Health Behavior, 35(6), 734–745.

    PubMed  Google Scholar 

  45. Ma, G. X., Shive, S. E., Fang, C. Y., Feng, Z., Parameswaran, L., Pham, A., et al. (2007). Knowledge, attitudes, and behaviors of hepatitis B screening and vaccination and liver cancer risks among Vietnamese Americans. Journal of Health Care for the Poor and Underserved, 18(1), 62–73. https://doi.org/10.1353/hpu.2007.0013.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Nguyen, T. T., Taylor, V., Chen, M. S., Bastani, R., Maxwell, A. E., & Mcphee, S. J. (2007). Hepatitis B awareness, knowledge, and screening among Asian Americans. Journal of Cancer Education, 22(4), 266. https://doi.org/10.1007/BF03174128.

    Article  PubMed  Google Scholar 

  47. Wu, C. A., Lin, S. Y., So, S. K., & Chang, E. T. (2007). Hepatitis B and liver cancer knowledge and preventive practices among Asian Americans in the San Francisco Bay Area, California. Asian Pacific Journal of Cancer Prevention: APJCP, 8(1), 127–134.

    PubMed  Google Scholar 

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Acknowledgements

This research project was supported by Grant U01MD010627 (PI: Grace X. Ma, PhD) from the National Institute on Minority Health and Health Disparities (NIMHD) of the National Institutes of Health (NIH) and in part by TUFCCC/HC Regional Comprehensive Cancer Health Disparity Partnership, Award Number U54 CA221704(5) from the National Cancer Institute of the National Institutes of Health (NCI/NIH). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of NIMHD or NCI/NIH.

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Authors and Affiliations

  1. Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, 19140, USA

    Grace X. Ma, Minsun Lee, Lin Zhu, Yin Tan, Phuong Do & Xinrui Ma

  2. Department of Clinical Sciences, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, 19140, USA

    Grace X. Ma

  3. Asian American Buddhist Association, Philadelphia, PA, 19147, USA

    Tam Tran

  4. Center For Cancer Health Disparities Research, Hunter College of the City University of New York, New York, NY, 10065, USA

    Cicely K. Johnson

  5. Fox Chase Cancer Center, Temple Health, Philadelphia, USA

    Grace X. Ma

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  1. Grace X. Ma
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Ma, G.X., Lee, M., Zhu, L. et al. Colorectal Cancer-Related Knowledge, Acculturation, and Healthy Lifestyle Behaviors Among Low-Income Vietnamese Americans in the Greater Philadelphia Metropolitan Area. J Community Health 45, 1178–1186 (2020). https://doi.org/10.1007/s10900-020-00931-8

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