Preparing the "Ground War" against tobacco among Chinese Americans in New York City: baseline data.

OBJECTIVES: The objective of this paper is to report on data on the perceptions regarding smoking and environmental tobacco smoke as well as the health communication patterns of a representative sample of 715 adult Chinese families with children under age 18 who had not banned smoking in the home. METHODS: We selected a representative sample of Chinese American families residing in New York's five boroughs: Brooklyn, Bronx, Manhattan, Queens, and Staten Island based on Chinese family surnames and interviewed them by telephone between December 2000-March 2001. All except 4% of the interviews were conducted in English; most respondents chose to speak Cantonese and lesser numbers chose Mandarin. FINDINGS: For the most part, respondents believed in the hazards of smoking, especially as it harms children living at home. To address smoking, respondents believed the physicians is the most trustworthy source of health information and the sources of health information consulted would be overwhelmingly the Chinese language newspaper, followed by Chinese language radio and television. CONCLUSIONS: This study represents the first systematic assessment of Chinese Americans in New York with regard to selected tobacco control issues. The findings provide the empirical base for developing potential messages using the source considered most trustworthy (the physician) and the vehicle most consulted (Chinese language media).

Tobacco use characteristics among rural Ohio Appalachians.

Appalachians remain at high risk for cancer, heart and lung disease, in part because of their high prevalence of tobacco use; yet, information about their tobacco consumption patterns is limited. The purpose of this study was to describe tobacco consumption variables among rural adult Appalachian tobacco users. Subjects, aged 18 and older (N = 249), participated in a face-to-face interview about tobacco consumption variables and knowledge regarding the health effects of tobacco at fairs in two rural Ohio Appalachian counties. The majority of participants were categorized as precontemplators, although 21 percent were classified in preparation stage of change. Mean age of initiation was 16.6 years and number of cigarettes smoked per day (cpd) was significantly higher for men, as compared to women. One-third of males reported the use of smokeless tobacco. The majority had not tried to quit for more than a year and the average number of previous quit attempts was low. One-half of the sample had been advised in the past to quit by their physician. Few had used nicotine replacement with past quit attempts but greater than half would consider this approach with future attempts. Knowledge about the health effects of smoking indicated that most were aware of the relationship between smoking and cancer but less than one-half recognized its association with heart disease. Those with less education were less informed about the health effects to self and non-smokers. While a sizeable portion expressed interest in quitting, knowledge about the health effects of smoking is lacking, especially with regard to heart disease and among those with less education.

China's "market economics in command": footwear workers' health in jeopardy.

This study of occupational safety and health (OSH) problems in the footwear industry in China, the world's largest shoemaker, is based on four years of research in China supplemented by research in Taiwan, Australia, and the United States. With the advent of the economic reforms of the early 1980s, the Chinese state is being driven by an economic imperative under which the profit motive overrides other concerns, causing a deterioration in OSH conditions. Footwear workers are being exposed to high levels of benzene, toluene, and other toxic solvents contained in the adhesives used in the shoe-making process. Many workers have been afflicted with aplastic anemia, leukemia, and other health problems. Most of China's current permissible exposure limits to toxins are either outdated or underenforced. As a result, the Chinese state's protection of footwear workers' health is inadequate. The article aims to draw the attention of the international OSH community to the importance of setting specific exposure standards for the footwear industry worldwide.

Informal care and the empowerment of minority communities: comparisons between the USA and the UK.

This paper examines informal care and the empowerment of minority communities with respect to health care and health promotion in the USA and the UK based upon work prepared for the workshop, 'Involving Black and Minority Ethnic Users in Delivery of Services and Empowering Communities' presented during the bi-national 1997 USA, UK. Conference, 'Health Gain for Black and Minority Ethnic Communities' and the information gained from that Conference. 'Informal care' is operationally defined as 'the practice of alleviating distressful physiological and psychological dysfunctions through all others (e.g. traditional healers, family members, self, etc.) using measures that do not require a physician's prescription or intervention (e.g. lifestyle modifications) typically outside of formal, institutionally based care mechanisms (e.g. homes and communities). Informal care is a significant force in health maintenance, health promotion, and disease prevention. In the USA, at least one-third of the population is estimated to engage in unconventional medical practices, and perhaps, one-half of racial/ethnic populations use informal care. An enormous potential exists to better utilize informal care because informal care is culturally more compatible, relatively low cost, and flexible. The policy of the Indian Health Service in accepting the use of traditional medicine was cited. The US Congress recognized the potential of alternative medicine by establishing such an Office within the National Institutes of Health. 'Empowerment of racial/ethnic minority communities is the right for minority populations to determine their own destinies. In the USA, racial/ethnic minority populations are Blacks, Hispanics, Asians or Pacific Islanders, and American Indian/Alaska Native. These classifications are based upon self-report; in the UK, the black and minority classifications are based upon countries of birth rather than self-reported racial/ethnic identities. Empowerment of these communities is important both demographically and historically. In demographic terms, racial/ethnic minority populations are increasing at higher rates than the majority population in the USA and hence, the health status of minorities will become the health status of the nation in the next half century. Historically, racial/ethnic minorities have not been empowered. As a consequence of the 1985 Secretary's Task Force Report on Black and Minority Health Federal measures to address disparities in the health status of minorities were initiated. In March 1994, the UK Government initiated the Ethnic Health Unit within the National Health Service. These measures are not mature enough to evaluate their impact. However, progress in implementing measures to empower minorities in the UK have begun and are illustrated by the work reported by Dr Pui-Ling Li, the UK counterpart to the workshop, 'Involving Black and Minority Ethnic Users in Delivery of Services and Empowering Communities'. Recommendations are made to increase use of informal care and the empowerment for racial/ethnic minority communities and to build upon the works in progress in both the USA and the UK.

Health care reform in Croatia: the consumers' perspective.

AIM: Assessment of the Croatian health care system (under the reform) from the perspective of the users of health care services. We analyzed the consumers' satisfaction with health care system, health care expenses and access, and described the consumers' attitudes toward health reform, examining the differences among sociodemographic groups. METHODS: The study is based on a data set collected in 1994 through the interviews with randomly selected adults in two major cities of Croatia: Zagreb and Split. RESULTS: A great proportion of respondents were dissatisfied with the current health care services, quality of health care facilities and equipment, and encountered difficulties in access. The elderly, women, and those with lower socioeconomic status were more likely to be dissatisfied and to consider out-of-pocket payments for health services as a problem. A great number of the respondents believed that the reform would either fail or would not achieve significant results. Compared to the younger and higher socio-economic group, the older and lower socioeconomic groups were more likely to evaluate the health care reform negatively. CONCLUSION: Croatian government decided to rationalize the health care system without taking much account of the impact of health reform on the consumers. Revealed dissatisfaction with the health care services might be linked with the expressed doubts in health care reform and concern that changes could worsen the consumers' position as patients.

Health care reform in Croatia: for better or for worse?

Along with the rest of Central and Eastern Europe, Croatia has begun to dismantle its long-standing socialist health care system and to replace it with a market-based approach. Marketization's advocates maintain that the market will bring efficiency and quality to the Croatian health care system. Nevertheless, data from consumer surveys and official statistics reflect the reform's hidden costs: limited access to care, heightened costs, growing inequality, and the deemphasis of preventive and proactive care in favor of costly therapeutic medicine.

Industrial workers' health and environmental pollution under the new international division of labor: the Taiwan experience.

Using Taiwan as an example, this paper conducts a historical analysis of the relationship between economic development in the new international division of labor and environmental pollution and industrial workers' health. Three industries-asbestos, plastic, and dye-were chosen for case studies. We trace the emergence of each industry in Taiwan and study each industry's protection of workers' health and environmental quality. Under the new international division of labor, the state's prioritization of economic development leads to lenient regulation. Under such state policies, employers have few incentives to invest in the protection of their workers' health and in the control of environmental pollution. Workers and the public are constrained in their efforts to protect their own health and prevent environmental pollution. This situation is exemplified by the deplorable working conditions and inadequate environmental pollution controls in the asbestos, plastic, and dye industries. Workers' health and the public's health are greatly compromised by economic development in the new international division of labor.

Multivariate profile of smoking in Southeast Asian men: a biochemically verified analysis.

BACKGROUND: Cigarette smoking prevalence rates among Southeast Asian males are among the highest reported in comparison with other ethnic male groups in the United States. The objective of this study is to profile current smokers, former smokers, and never smokers among Southeast Asian males, based on subject characteristics. METHODS: Southeast Asian (Cambodian, Laotian, and Vietnamese) males residing in the Greater Columbus, Ohio, area were surveyed, utilizing culturally sensitive instruments and interviewers, with respect to demographic and acculturation variables. All subjects were biochemically verified by collecting a saliva sample at the time of the interviews. RESULTS: Those Southeast Asian males who quit smoking tended to be older, employed, more assimilated into the U.S. culture, and of Cambodian ethnicity. The current smokers, relative to never smokers, tended to be older, not in the labor force, traditionally oriented to their native culture, less educated, and of Laotian or Vietnamese ethnicity. CONCLUSIONS: Specific strategies for smoking cessation programs would indicate more intense, and possibly different, efforts be directed at Southeast Asian males of Laotian and Vietnamese ethnicity who are younger, unemployed and less assimilated into the U.S. culture. On the other hand, smoking prevention programs would target those individuals who are at highest risk of smoking.

Misclassification of smoking status among Southeast Asian adult immigrants.

A total of 1,403 Southeast Asian adult immigrant males (n = 783) and females (n = 620) from Cambodia, Laos, and Vietnam who currently resided in Central Ohio were interviewed to determine the self-reported smoking prevalence among them, and underwent biochemical confirmation of their smoking status. Variables having to do with the subjects' sociodemography, acculturation, and smoking history that were related to the misclassification of smoking status were also investigated. Self-reported current smoking rates were 40.9% and 5.6% for males and females, respectively. After verification of the subjects' smoking status by saliva cotinine assay (smoker status > or = 14 ng/ml), the rates of smoking were found to be greater, at 43.7% for males and 14.8% for females. Years of education, self-reported smoking status, country of origin, and method of healthcare payment were significant predictors of misclassification. These findings suggest that the prevalence of smoking is higher among Southeast Asian adult females than has been previously reported. Variables that predict misclassification with regard to smoking status are presented, and their implications for clinicians and researchers are discussed.

A debunking of the myth of healthy Asian Americans and Pacific Islanders.

PURPOSE: To present evidence that the model of healthy Asian Americans and Pacific Islanders (AAPIs) stereotype is a myth. SEARCH METHOD: The authors retrieved literature from the National Library of Medicine's compact disk databases (Cancerlit, CINAHL, Health, and MEDLINE), and examined pertinent federal government publications supplemented by the authors' knowledge of other published materials. IMPORTANT FINDINGS: This review paper presents three reasons why AAPIs are underserved: (1) the population growth rate has been unusually rapid and recent; (2) data regarding the health status of AAPIs are inadequate; and (3) the myth that AAPIs are model minority populations in terms of their health status was promulgated. MAJOR CONCLUSIONS: The conclusions are as follows: (1) AAPIs are heterogenous with respect to demographic factors and health risk factors; (2) because the current databases on the health status of AAPIs include small sample sizes, both the quantity and quality of these data need to be improved with respect to appropriate gender and ethnic group representation; (3) Risk factor and mortality data for AAPIs suggest that the burden of certain preventable diseases, namely, tuberculosis, hepatitis-B, liver cancer, and lung cancer may be higher than those of any other racial and ethnic population. The model healthy AAPI stereotype is a myth.

An acculturation scale for Southeast Asians.

This article reports the development of an acculturation scale for Southeast Asian immigrants. From factor analyses of responses on 13 items obtained from samples of three different Southeast Asian ethnic groups, i.e., Cambodians, Laotians, and Vietnamese, two subscales were derived: (1) proficiency in languages (land of origin versus English), and (2) language, social and food (LSF) preferences. Inter-item reliability of the scales was demonstrated for each of the three ethnic groups, with Cronbach alpha coefficients of 0.76 or above. Construct validity was also established within each of the three ethnic groups by demonstrating expected associations of the subscales with current age, years in the USA, total years of education, percentage of lifetime in the USA, and age on entering the USA. Multivariate analyses within each of the ethnic groups revealed that, once controlling for years of education, percentage of lifetime in the USA, and type of health care coverage, although not significant for the Cambodians (P = 0.08) males tended to show higher scores for the proficiency in language subscale in comparison to females. Similar multivariate analyses for the LSF preference subscale showed that although slightly higher for the males, the differences between the genders was not significant for the Cambodians (P = 0.78); both the Laotian (P = 0.23) and Vietnamese (P = 0.01) females showed higher scores in comparison to males although only just reaching significance for the Vietnamese.

Prognostic assessment of tumor regression after external irradiation for cervical cancer.

From February 1980 to December 1986, 428 cases of cervical cancer in Stage I through IVA were given curative radiation therapy at Chang Gung Memorial Hospital, Taipei. All of them received external irradiation and intracavitary brachytherapy. The degree of tumor regression was assessed immediately before the first intracavitary brachytherapy treatment. Patients were classified at this time as having (a) no gross residual tumor, or (b) gross residual tumor. Factors found to be associated with tumor regression by logistic regression analysis were stage, age and hemoglobin level. Patients with advanced cancer (Stage III, IVA), young age (less than 40 years), and low hemoglobin level (less than 10 g/dl) had a low incidence of no gross residual tumor. Five-year survival rate was 77% in patients with no gross residual tumor and 31% in patients with gross residual tumor (p less than 0.001). This significant difference held true even when one compared these two groups stage for stage; the difference was 77% versus 41% (p less than 0.001) in Stage II and 72% versus 28% (p less than 0.001) in Stage III. The local relapse rate was 59% in the gross residual tumor groups, significantly greater (p less than 0.001) than the 12% found in the no gross residual tumor group. It was concluded that patients whose tumors did not regress after external pelvic irradiation tended to recur after intracavitary brachytherapy, most often locally. This would justify a more aggressive treatment to improve local tumor control in this subset of high risk patients.

An epilogue to evaluating the impact of P.L. 99-252 on decreasing smokeless tobacco use.

In a previous paper, "Evaluating the Impact of P.L. 99-252 on Decreasing Smokeless Tobacco Use," the context of this law and the theoretical framework for an evaluation plan for measuring its impact were described. In this paper, the methodology and selected findings from this project as well as their implications are discussed. This discussion includes the identification of the six indicators considered to be the most relevant, valid, reliable, accessible, and practical for measuring the impact of this law on decreasing smokeless tobacco use, as well as a report on the feasibility analysis of three of these indicators. Pilot data on two indicators--pounds of smokeless tobacco sold and incidence rates of tobacco-induced leukoplakia--are presented and analyzed.

Evaluating the impact of P.L. 99-252 on decreasing smokeless tobacco use.

Literally, Public Law 99-252 (otherwise known as the Comprehensive Smokeless Tobacco Health Education Act of 1986) includes provisions that are informational in nature. Implicitly, however, this law is considered part of the federal effort in disease prevention and health promotion. This paper reviews the societal and legislative context of that act and presents a plan to evaluate the impact of this law on decreasing smokeless tobacco use. The uniqueness of this plan is its incorporation of nine disciplinary perspectives in the derivation of indicators to measure process, impact, and outcome measures for decreasing smokeless tobacco use. A basic prevention strategy is suggested by this interdisciplinary approach. In addition, specific lessons could be applied from the history of successes in public health to decreasing smokeless tobacco use.

Organizational resources for worksite health promotion: a selective national directory.

This article identifies 19 organizations (two federal government, nine not-for-profit and voluntary health agencies, and eight for profit) that offer resources on a national basis for employers and health professionals who desire to initiate worksite health promotion programs. These resources are divided into one of four categories: publications, consultive services, programmatic services, and audiovisuals. The variety represented by these organizational offerings suggests that it is unnecessary to "re-invent the wheel" in order to initiate a worksite health promotion program.

Children's preventive dental behavior in relation to their mothers' socioeconomic status, health beliefs and dental behaviors.

This study examined the relationships between the preventive dental behaviors (PDBs) of children from 495 American families, their mothers' socioeconomic status (SES), health beliefs, and dental behaviors. Mothers' PDBs were the cofactors most strongly correlated with children's PDBs.